For persons with diabetes, diet is prescribed as a cornerstone of ther apy. Unease over just what is safe and prudent to eat is an important con cern, and health professionals who work with persons who have diabetes must strive to keep abreast of current nutritional research. One area of con troversy is the role of sweeteners in the diet. Rather than removing most sweeteners from the diet, a more feasible approach may be intensive patient education so that the person with diabetes can make more knowl edgeable decisions as to which types of sweeteners to include in the diet and how to calculate the food values in relation to insulin supply. Five sub stitute sweeteners (saccharin, fructose, sorbitol, xylitol, and aspartame) are considered from the standpoint of taste, availability and costs, metabolic activity, carcinogenic risks, and cur rent American Diabetes Association recommendations.
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References
1.
American Diabetes Association.Principles of nutrition and dietary recommendations for individuals with diabetes mellitus. Diabetes Care, 1979, 2, 520-523.
2.
Nuttall, F.Q.Diet and the diabetic patient. Diabetes Care, 1983, 6, 197-207.
3.
Brunzell, J.D.Use of fructose, sorbitol, or xylitol as a sweetener in diabetes mellitus. Journal of the American Dietetic Association , 1978, 73, 499-506.
4.
Moscowitz, H.The psychology of sweetness: Historical trends and current research. In J.H. Shaw & G.G. Roussos, (Eds.), Sweeteners and dental caries (Special Supplement to Feeding, weight, & obesity abstracts) . Washington D.C.: Information Retrieval , 1978, 41-74.
5.
Beidler, L.M.The biological and cultural role of sweeteners . In J.H. Shaw & G.G. Roussos (Eds.), Sweeteners and dental caries (Special Supplement to Feeding, weight, & obesity abstracts). Washington D.C.: Information Retrieval, 1978, 33-39.
6.
Beck, K.M.The practical requirements for the use of synthetic sweeteners. In B.K. Dwivedi (Ed.), Low calorie and special dietary foods, 1978. West Palm Beach: CRC Press.
7.
Zienty, F.B.Present status and uncertainties concerning saccharin. In J.H. Shaw & G.G. Roussos (Eds.), Sweeteners and dental caries (Special Supplement to Feeding, weight, & obesity abstracts). Washington D.C.: Information Retrieval, 1978, 253-261.
8.
Ronk, R.L.Regulatory constraints on sweetener use. In J.H. Shaw & G.G. Roussos (Eds.), Sweeteners and dental caries (Special Supplement to Feeding, weight, & obesity abstracts). Washington D.C.: Information Retrieval, 1978, 131-139.
9.
Bonar, J.R.Diabetes. A clinical guide (2nd ed.). Garden City, New York: Medical Examination Publishing Co., Inc., 1980.
10.
Arnold, D.L. , Krewski, D., & Munro, I.C.Saccharin: A toxicological and historical perspective. Toxicology, 1983, 27, 179-256.
11.
Moller-Jensen, O., Knudsen, J.B., Sorensen, B.L., & Clemmesen , J.Artificial sweeteners and absence of bladder cancer risk in Copenhagen. International Journal of Cancer, 1983, 32, 577-582.
12.
Tanzer, J.M. , & Slee, A.M.Saccharin inhibits tooth decay in laboratory models. Journal of American Dental Association, 1983, 106, 331-333.
13.
American Diabetes Association.Policy statement: Saccharin. Diabetes Care, 1979, 2, 380.
14.
Kulkarni, K.Sweeteners: Past, present, and future. The Diabetes Educator, 1984, 10(1), 52.
15.
Olefsky, J.M. , & Crapo, P.Fructose, xylitol, and sorbitol. Diabetes Care, 1980, 3, 390-393.
16.
Osberger, T.F., & Linn, H.R.Pure fructose and its applications in reduced calorie-foods. In B.K. Dwivedi (Ed.), Low calorie and special dietary foods, 1978. West Palm Beach: CRC Press.
17.
Ganong, W.F.Review of medical physiology. Los Altos, CA: Lange Medical Publications, 1975, 211.
18.
Crapo, P.A. , Kolterman, O.G., & Olefsky , J.M.Effects of oral fructose in normal, diabetic, and impaired glucose tolerance subjects. Diabetes Care, 1980, 3, 575-581.
Akgun, S., & Ertel, N.H.A comparison of carbohydrate metabolism after sucrose, sorbitol, and fructose meals in normal and diabetic subjects. Diabetes Care, 1980, 3, 582-585.
21.
Jain, N.K., Ulahannan, M.J., Rosenberg, D.B., & Pitchumoni, C.S.Sorbitol intolerance (SI) in adults and its implication in diabetics. [Abstract]. Diabetes, 1984, 33(Suppl.1), 94A.
22.
Medical Letter Inc., The. Aspartame and other sweeteners. The Medical Letter onDrugs and Therapeutics, 1982, 24(600), 1-2.
23.
Karam, J.H.Diabetes mellitus, hypoglycemia, & lipoprotein disorders. In M.A. Krupp & M.J. Chatton (Eds.), Current medical diagnosis & treatment. Los Altos, CA: Lange Medical Publications, 1984, 759-789.
24.
Crapo, P.The nutritional therapy of noninsulin dependent (Type II) diabetes. The Diabetes Educator, 1983, 9(3), 13-18.
25.
G.D. Searle & Co. Nutritional information included on package labeling of Equal , 1982.
26.
Bost, R.G., & Ripper, A.Aspartame: A commercially feasible aspartic acid based sweetener. In J.H. Shaw & G.G. Roussos (Eds.), Sweeteners and dental caries (Special Supplement to Feeding, weight, & obesity abstracts). Washington D.C.: Information Retrieval, 1978, 269-281.
27.
Eisenberg, J. & Pardridge, W.Phenylalanine transport through the human blood brain barrier (BBB): Implications for diabetic diets. [Abstract]. Diabetes, 1984, 33(Suppl.1), 50A.
28.
Stegink, L.D. , Brummel, M.C., McMartin, K., Martin-Amat, G., Filer, L.J., Jr., Baker, G.L., & Tephly , T.R.Blood methanol concentrations in normal adult subjects administered abuse doses of aspartame. Journal of Toxicology and Environmental Health, 1982, 7, 281-290.
29.
Walter, B.J.Sweetener economics: Analysis and forecasts. In J.H. Shaw & G.G. Roussos (Eds.), Sweeteners and dental caries (Special Supplement to Feeding, weight, & obesity abstracts). Washington D.C.: Information Retrieval, 1978, 93-109.
