Medical Edge Newspaper Column

Diabetic's Diet: Balanced, But Not Necessarily Sugar-Free

May 7, 2006
DEAR MAYO CLINIC:
Is it true that a person with type 2 diabetes should not eat any product containing ingredients that end with "ose" (like lactose) or "ol" (such as sorbitol)? If a product is labeled "sugar-free," is it safe for the patient? -- Chicago

ANSWER:
On your first question, the short answer is no! A person with diabetes doesn't have to shun all "oses" and "ols" or, for that matter, virtually any other food component.

On the second question: Yes, it is safe to eat sugar-free products. But it's safe to eat sugar-containing foods, too. "Safe" does not mean "unlimited," however. The key factors in consuming all such ingredients are moderation, selectivity and balance.

"Oses" are naturally occurring sugars -- fructose, for example, is the sugar found in fruits -- and "ols" (sugar alcohols) are often derived from oses. For instance, lactitol is made from lactose (the principal sugar in milk).

The reason sugar, sugar-derived compounds and carbohydrates are an issue for people with type 2 diabetes is that the body can have difficulty processing them. During digestion, a healthy person's body converts carbohydrates from food into various sugar molecules. These sugars are further converted into mainly glucose, the primary fuel of the body. With the aid of insulin (a hormone produced by the pancreas), the glucose enters cells to provide the body with energy. But in type 2 diabetes, either the pancreas doesn't make enough insulin or the muscles and other tissue have become resistant to insulin, or both. As a result, sugar accumulates in the bloodstream, causing various adverse events.

A traditional assumption about diabetics' diets was that the direct consumption of sugar was to be avoided. But since the 1990s, studies have shown that what really matters is overall management of carbohydrates. The modern attitude about a diabetic's diet is that there is a carbohydrate "budget" and it should be spent at regular intervals throughout the day -- not in one lump sum. An occasional donut, for example, is likely acceptable as long as it is offset by specific reductions elsewhere in the meal.

The operative word here is "occasional" -- it's best not to make a habit of such indulgences, because they tend to displace healthier choices. For example, one 8-ounce cup of milk has the same amount of carbohydrate as 4 ounces of sugar-sweetened soda pop. But milk offers many more nutrients (such as calcium and vitamin D for strong bones) than the pop. Routinely substituting nutrient-poor sweets for nutrient-rich fruits, vegetables, whole grains and low-fat dairy products makes for an unhealthy diet. Likewise, routinely eating sweets in addition to these foods results in many unwanted calories and excess body weight.

What about those "ols"? Sugar alcohols are lower in calories than regular sugar and the body absorbs them slowly, resulting in a slower rise in blood sugar. Although this sounds good, foods containing sugar alcohols also contain other ingredients that contribute calories (which also add to blood sugar levels), and sugar alcohols can have a laxative effect. When "ols" are eaten outside of the bounds of moderation, these two characteristics can be a problem for some people.

Given the diversity of individuals and the frequently complex nature of diabetes, there is no one diabetic diet. But a diabetes educator -- typically, a registered dietitian -- can teach you how to build a diet that fits your health goals, food preferences and lifestyle.

Having diabetes doesn't mean you must eat only bland, boring foods. Instead, it means you'll eat more foods that are high in nutrition and low in fat and calories -- and fewer animal products. You can have occasional sweets (containing "oses" or "ols") and still have good control of your blood sugar and weight. Actually, this is the same eating plan that all people should follow.

-- Jennifer K. Nelson, Clinical Dietetics, Mayo Clinic, Rochester, Minn.