Consumers say they regularly use low-calorie, sugar-free foods and beverages to stay in better overall health or simply because they taste good. Many of these products contain ingredients called "sugar alcohols," frequently referred to as "polyols." Sugar alcohols or polyols are not sugars and they are not alcohols. They are a group of low-digestible carbohydrates derived from the hydrogenation of their sugar or syrup source (e.g., lactitol from lactose). These unique sweeteners taste like sugar but have special advantages.
ADVANTAGES OF POLYOLS
Many low-calorie, sugar-free foods are sweetened with polyols
Polyols taste like sugar.
Polyols have fewer calories than sugar
Polyols do not promote tooth decay
The U.S. Food and Drug Administration has approved a "does not promote tooth decay" health claim for sugar-free foods and beverages sweetened with polyols
The American Dental Association has issued an official statement saying sugar-free foods do not promote dental caries
Polyols elicit a low glycemic response beneficial to all consumers, including those with diabetes.
Polyols serve as useful alternatives to sugars in a wide range of products, including chewing gums, candies, ice cream, baked goods and fruit spreads. In addition, they function well in fillings and frostings, canned fruits, beverages, yogurt and tabletop sweeteners. They are also used in toothpastes, mouthwashes and pharmaceutical products such as cough syrups and throat lozenges.
There are several polyols used as ingredients in sugar-free foods: erythritol, hydrogenated starch hydrolysates (including maltitol syrups), isomalt, lactitol, maltitol, mannitol, sorbitol and xylitol. The Nutrition Facts Panel on food labels may list them as sugar alcohols or by their specific name.
In addition to their clean sweet taste and unique functional properties, polyols offer important health benefits. For example, they are reduced in calories and do not cause sudden increases in blood sugar levels. Importantly, polyols are not readily converted to acids by bacteria in the mouth and, therefore, do not promote tooth decay.
Since most polyols are not as sweet as sugar they are often used in combination with approved low-calorie sweeteners such as acesulfame potassium, aspartame, neotame, saccharin or sucralose. Scientific research supports the fact that these low-calorie sweeteners, like polyols, do not promote tooth decay.
In some people, over consumption of polyol-containing foods may cause gastrointestinal symptoms, including laxative effects, similar to reactions to beans, cabbage and certain high-fiber foods. Such symptoms are dependent upon an individual's sensitivity and the other foods eaten along with the polyol-containing product. Any gastrointestinal symptoms (such as a feeling of fullness) from consuming foods with polyols, if they occur at all, are usually mild and temporary. Most people will adapt to polyols after a few days, the same way they do to high fiber foods. Food manufacturers are advised to inform consumers of these possible effects through product labeling.
DO NOT PROMOTE TOOTH DECAY
The U.S. Food and Drug Administration (FDA) has authorized the use of the "does not promote tooth decay" health claim for sugar-free food products sweetened with polyols. The regulation provides that "when fermentable carbohydrates are present in the sugar alcohol-containing food, the food shall not lower plaque pH below 5.7 by bacterial fermentation either during consumption or up to 30 minutes after consumption, as measured by the indwelling plaque test found in 'Identification of Low Caries Risk Dietary Components,' T.N. Imfeld, Volume 11, Monographs in Oral Science (1983)."
FDA regulations prohibit the expansion of the health claim beyond the parameters set by FDA and the health claim may not attribute any degree or state an amount of risk reduction with the use of polyol-containing foods. Also, the claim may not imply that consuming polyol-containing foods is the only recognized means of achieving a reduced risk of dental caries.
In October 1998, the American Dental Association's House of Delegates approved a position statement acknowledging the "Role of Sugar-Free Foods and Medications in Maintaining Good Oral Health." ADA recognizes that "it is neither advisable nor appropriate to eliminate from the American diet sugar-containing foods that provide necessary energy value for optimal nutrition." To maintain good health it is very important to satisfy the body's basic nutritional needs. Without a balanced diet the body cannot function efficiently. A balanced diet includes eating a variety of foods every day. Foods from each of the five major food groups -- milk, yogurt and cheese; meat, poultry, fish and alternatives; fruits; vegetables; and bread, cereals and other grain products should be chosen. The Association recommends, however, "that major efforts be made to promote the use of sugar-free foods or chewing substances in place of sugar-containing foods that involve a frequent intake or repeated oral use . . . use of these sugar-free products will contribute to improved oral health."
The ADA statement in its entirety is as follows:
Research and clinical experience have shown that abundant and frequent exposures to dietary fermentable substances enhance the ability of cariogenic bacteria to implant, colonize and increase acid production, which facilitates the carious process. Initial implantation and colonization of mutans streptococci is made possible even if the amounts of sucrose, a sugar commonly used in food manufacture, are very low. Thus, colonization is mainly influenced by interaction of specific biochemical properties of the cariogenic bacterial strains with dietary substrates and the oral ecological environment.
Once cariogenic bacteria are established in dental plaque, their metabolic activity is stimulated by increases in the intake of fermentable carbohydrates but modulated by:
the type of food containing sugars or starches consumed;
the frequency of intake of such foods;
oral hygiene status;
availability of fluoride;
salivary gland function;
saliva composition; and
other host factors.
Considering the ubiquity of cariogenic bacteria in most population groups, frequent consumption of sugar-containing foods, medications and chewing substances are recognized as having a strong potential to increase the risk of dental caries, although the severity and magnitude of the caries challenge produced by these foods varies between individuals and population groups.
In light of current laboratory and epidemiological research findings, the Association recognizes that it is neither advisable nor appropriate to eliminate from the American diet sugar-containing foods that provide necessary energy value for optimal nutrition. However, it strongly recommends that major efforts be made to eliminate sugars from oral suspensions, chewable tablets, pastilles and troches and to promote the use of sugar-free foods or chewing substances in place of sugar-containing foods that involve a frequent intake or repeated oral use. In these circumstances, use of these sugar-free foods will contribute to improved oral health without any deleterious nutritional consequences.
REDUCED CALORIC VALUES
Because polyols have lower caloric values than sugars, they may help people achieve their weight goals. Polyols are metabolized differently than sugars as well as among themselves. They are generally incompletely absorbed. Absorbed portions are either metabolized (generally by insulin-independent mechanisms) or excreted via urine. A significant amount of the unabsorbed portion is metabolized to short chain fatty acids and gases by bacteria in the large intestine.
Due to their different metabolic fate, sugar alcohols provide significantly less than the traditional four calories per gram assigned to carbohydrates in general. While the numbers vary for each member of the class, there is broad consensus that polyols have a reduced caloric value compared to sugars. The FDA allows the use of the following caloric values for the polyols: 0.2 calories per gram for erythritol; 1.6 for mannitol; 2.0 for isomalt and lactitol; 2.1 for maltitol; 2.4 for xylitol; 2.6 for sorbitol; and 3.0 for hydrogenated starch hydrolysates - compared to sugars with four calories per gram.
LOW GLYCEMIC INDEX (GI)
The chemical nature of carbohydrates is not a reliable indicator of physiological effect. Glycemic Index (GI) was established some 20 years ago as a means of classifying foods based on their potential to increase blood glucose. During the last 20 years, clinical studies and scientific research have shown that the concept can be applied to single foods, mixed meals and whole diets, and people with or without diabetes and that the methods used are reproducible and consistent. Glycemic Index Tables have been published ranking over 1000 foods by GI, including pure carbohydrates and commercial products.
Health problems related to being overweight are becoming the major health concern of the industrialized world. The World Health Organization and Food and Agriculture Organization of the United Nations (WHO/FAO) have stated that, globally, overweight is a bigger problem than undernourishment and recommended that people in industrialized countries should base their diets on low GI foods to prevent most common diseases of affluence.
The clinical significance of GI remains the subject of intense debate. However, it is clear that the rate of carbohydrate absorption after a meal, as quantified by GI, has significant effects on postprandial hormonal and metabolic responses. High GI meals may promote excessive food intake, beta cell dysfunction, dyslipidemia and endothelial dysfunction. Thus, the habitual consumption of high GI foods may increase risk for obesity, type-2 diabetes, and heart disease. Conversely, a reduction in the overall glycemic load of the diet could help to reduce that risk.
The Food and Nutrition Board of the Institute of Medicine of the U.S. National Academy of Sciences recently concluded:
There is a significant body of data suggesting that more slowly absorbed starchy foods which are less processed, or have been processed in traditional ways, may have health advantages over those which are rapidly digested and absorbed. These foods have been classified as having a low GI and reduce the glycemic load of the diet. Not all studies of low GI or low glycemic load diets have resulted in beneficial effects, however, none have shown negative effects. There are also theoretical reasons at a time when populations are increasingly obese, inactive and prone to insulin resistance that dietary interventions that reduce insulin demand may have advantages. In this section of the population, it is likely that more slowly absorbed carbohydrate foods and low glycemic load diets will have the greatest advantage. . . . However, the principle of slowing carbohydrate absorption, which may underpin the positive findings made in relation to GI, is a potentially important principle with respect to the beneficial health effects of carbohydrates. Further research in this area is needed.
All polyols have a low GI and can be used to completely or partially replace sucrose, glucose and high GI polysaccharides such as starch and maltodextrin in a wide range of processed foods such as dairy products, baked goods and confectionery. Polyols and associated specialty carbohydrates can have a useful role in reducing the overall glycemic load of the diet and in so doing help to reduce the risk of a variety of "lifestyle" related diseases.
SUMMARY
With current consumer demand for low-calorie, sugar-free products, as well as the increased availability of polyols and innovations in food technology, additional good tasting sugar-free and reduced-calorie products are expected to be available. These products may assist consumers in maintaining good oral health, maintaining or reducing weight and reducing glycemic load.
REFERENCES
American Dental Association. Position Statement on the Role of Sugar-Free Foods and Medications in Maintaining Good Oral Health. Adopted October 1998.
Federation of American Societies for Experimental Biology. The evaluation of the energy of certain polyols used as food ingredients. June 1994 (unpublished).
FNB (2002) Dietary Reference Intakes for Energy, Carbohydrates, Fiber, Fat, Protein and Amino Acids (Macronutrients).
http://www.nap.edu/books/0309085373/html/FAO (1998) Carbohydrates in Human Nutrition. A report of a joint FAO/WHO meeting. Rome 14-18 April, 1997. FAO Food and Nutrition Paper 66.
Foster-Powell, K., Holt, S.H.A. and Brand-Miller, J.C. (2002) International table of glycemic index and glycemic load values. Am J Clin Nutr 76:5-56.
Ludwig, D.S. (2002) The Glycemic Index. Physiological Mechanisms Relating to Obesity, Diabetes, and Cardiovascular Disease. JAMA 287(18):2414-2423.
McNutt, K., Sentko, A. Sugar Replacers: A Growing Group of Sweeteners in the United States. Nutrition Today, 31(6):255-261, November/December 1996.
Nabors, L.O. 1999. The Benefits of Sugar-Free Products in Oral Health. The Dental Assistant. September/October. pp. 38-39.
Office of the Federal Register, General Services Administration, Code of Federal Regulations, Title 21, Section 101.9, Nutrition labeling of food. Washington, DC, U.S. Government Printing Office, 2002.
Office of the Federal Register, General Services Administration, Code of Federal Regulations, Title 21, Section 101.80, Health Claims: dietary sugar alcohols and dental caries. Washington, DC, U.S. Government Printing Office, 2002.
U.S Department of Agriculture/U.S. Department of Health and Human Services. Nutrition and Your Health: Dietary Guidelines for Americans. Fourth Edition, 1995.
Warshaw, H.S., Powers, M.A. 1999. A Search for Answers About Foods With Polyols (Sugar Alcohols). Diabetes Educator. May/June. pp. 307-321.
Ziesenitz, S.D., Siebert, G. The Metabolism and Utilization of Polyols and Other Bulk Sweeteners Compared with Sugar. In Developments in Sweeteners - 3. T.H. Grenby, ed., Elsevier Science Publishing Co., Inc., New York, 1987, pp. 139-40.
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