Specialist diabetic foods are plentiful, but are they necessary or even useful? Charities for people with diabetes are negative, recommending instead a balanced diet with low fat, alcohol and salt as well as sugar. Yet still the diabetic foods market booms. Hugh Westbrook investigates an area shrouded in confusion.

Certain pre-conceptions about food are hard to shift. It has been received wisdom for years that diabetics have to cut out all sugar from their diets, and must eat sugar-free and specialist ‘diabetic’ foods accordingly. This view is particularly prevalent among non-diabetics. However, advice from diabetes charities around the world contradicts this idea. So what should diabetics eat, are there still specific diabetic products on the market and how should education about diabetes proceed?

Advice given to sufferers from diabetes now mirrors the tips given to people generally, namely that they should eat a balanced, healthy diet, coupled with increased exercise and activity. Increases in diabetes are more and more often being linked with rises in obesity.

People with diabetes suffer from an unhealthy rise in their blood glucose levels. In the past this led to the standard advice of cutting out sugar. However, it has now been realised that a range of foods leads to a rise in glucose levels, therefore the range of what is eaten has to be monitored. The development of the Glycaemic Index, which rates carbohydrates according to how quickly they raise glucose levels, is also important for diabetes sufferers, as foods with a lower GI rating lift blood sugar levels more slowly and are therefore more suitable.

Diabetes UK warns sufferers off specialist foods

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Diabetes UK’s advice for sufferers is similar to that now found everywhere. It recommends eating regular meals to ensure that blood glucose levels rise slowly, looking in particular for foods with a low GI rating. It advises cutting down on fat, salt, alcohol and sugar, though sugar is just one thing that has to be monitored and is not the only culprit, as discussed.

Importantly, it advises consumers to avoid ‘Diabetic foods’, saying they “often cost a lot more, and tend to be just as high in fat and calories as ordinary products. They usually contain a bulk sweetener, such as fructose or sorbitol, which can have a laxative effect and make blood glucose levels rise. Diabetic foods are unnecessary and offer no special benefit to people with diabetes.” The organisation and the Food Standards Agency issued a position statement in July 2002 counselling against the manufacture of foods marked as ‘diabetic’.

Diabetes Care Adviser Emma Bunn told just-food.com that there is still an awareness problem among the general public about ‘Diabetic’ foods, especially among those who are not sufferers themselves. People looking to buy gifts for sufferers will often look to buy a specialist diabetic product, she said.

Chocolate manufacturer Thorntons has created a range of products to address this need. The company told just-food.com that there is a demand from customers for a diabetic chocolate range, especially as it is packaged as a gift proposition which relatives like to come in and buy. They added that they think it is better to have the products rather than not as it gives their customers peace of mind.

Better education needed

There is clearly an education issue here. Bunn said that while the organisation worked with healthcare providers, the FSA and manufacturers to help get the message across, people are not getting enough information. She said that improved labelling would help consumers make informed choices.

UK supermarkets are taking on a helpful educational role. Sainsbury’s has an excellent section on its website replicating the advice from Diabetes UK and providing an interactive section to allow consumers to analyse separate sections of the shop to make decisions about what to buy. This kind of facility can only improve the information which is available. Other stores offer similar services.

One interesting development in Australia could set a template for marketing foods for sufferers on a wider scale. Developed by the International Diabetes Institute, the Shop for Gold programme allows foods to carry a special gold logo if they meet all of the Institute’s healthy food choice criteria. The Institute told just-food.com that foods must have: “suitable levels of fat, fibre, sodium, sugar and glycaemic index (GI), where relevant”. There is also a silver logo and products are eligible if they meet all but one of the institute’s criteria, though fat levels must always be met.

Meeting the Gold Standard

While obviously gold-approved products would be suitable for anybody looking for healthy foods, as a labelling idea for diabetics this clearly has potential – such labelling acts as a guarantee to sufferers that these foods can fit the kind of balanced diet they are encouraged to eat. Also, these are not foods being specifically developed for the specific diabetic market, rather they are existing foods being labelled because they fit certain criteria.

It is, however, possible to remain confused. The American Diabetes Association carries dietary advice similar to that found in other countries. It says that sugar can be eaten but has to be worked into an overall meal plan.

The charity is associated with Hershey’s sugar-free chocolate range, which was launched last year to meet demand among US consumers. The sugar-free chocolate is a legitimate product for diabetics to eat, but the label ‘sugar-free’ does not tell the whole story.

The automatic assumption is that because there is a sugar-replacement ingredient, lactitol, then the product can automatically be eaten. Hershey’s stresses that because lactitol is metabolised slowly, it raises blood sugar levels slowly and is therefore better for diabetics.

However, it also benefits sufferers because it has fewer calories than regular Hershey’s chocolate. This means that the ‘carbohydrate exchange value’ allows two units of sugar-free Hershey’s to one unit of regular. Nevertheless, the company points out that it cannot be consumed at will and still contains fat comparable to the regular product. The products also contain sucralose, a low-calorie sweetener used to ‘round out the sweetness’.

‘Sugar-free’ label not always helpful

The American Diabetes Association concedes that in many ways the ‘sugar-free’ label does not tell the real story. A spokeswoman told just-food.com that the existence of such products gives consumers a choice about where their calories and carbohydrates come from, rather than stressing the lack of normal sugar.

She said that with sugar-free chocolate, “some of the carbohydrates have been replaced with sugar alcohols. Sugar alcohols have about half the number of carbohydrates as sugar and are digested more slowly. However these products still contain calories and fat. The ADA believes that the total amount of carbohydrate in meals or snacks is more important than the source or type. Therefore if someone chooses a sugar-free product this might give them more options for other carbohydrate choices throughout the day.”

While this therefore confirms that products such as Hershey’s sugar-free chocolate do provide a valuable option for diabetics, it is interesting that the ‘sugar-free’ labelling attracts them even though the nutritional reasons why they can eat the product are a great deal more complicated than simply the absence of sugar.

It is clear that that understanding what diabetics should or should not eat is complicated. Health professionals would probably be happier if sufferers simply ate natural foods and a balanced diet. However, with people still looking for sugar-free and ‘diabetic’ ranges, there is a need for more education, and such products will remain on the market.

Useful links:

Diabetes UK
Sainsbury’s diabetes section
American Diabetes Association
International Diabetes Institute
Hershey’s sugar-free products