This month, we've asked our Expert Panel members to comment on the use of Sugar Alcohols (polyols) in low carbohydrate specialty foods. It's important to remember that not all members of our Expert Panel will agree with one another. And that we (Low Carb Luxury) may not necessarily always agree with our panel members. But each of them bring some valuable insight to the table. And each has tried to share their viewpoints and reasons behind them.

First, an explanation of sugar alcohols...

Polyols are hydrogenated carbohydrates used as sugar replacers. Chemically, polyols are considered polyhydric alcohols or sugar alcohols because part of their structure resembles sugar and part is similar to alcohols. However, these sugar-free sweeteners are neither sugars nor alcohols, as these words are commonly used.

Sugar Alcohols deliver the close taste and texture of sugar with an average of about half the calories. They're used to replace sugar in many sugar-free and low-calorie foods. Polyols vary in sweetness from about half as sweet as sugar to equally as sweet. Many makers of low carb specialty products have begun using them in greater amounts because they've adopted the practice of deducting them totally from the "net carb" count on the package, and thus get a more "attractive" package to sell carb-wary consumers. This practice is now being hotly debated.

Sugar Alcohols are slowly and incompletely absorbed from the small intestine, which is why they provide fewer calories per gram than carbohydrates. Because they aren’t completely absorbed, consuming moderate to large amounts of polyols at one time can often cause gas and/or laxative effects.

Here's a quick list of common polyols, listed with their calories per gram, their Glycemic Index number, their Insulinaemic Index number (also called the Insulin Sensitivity Index), and their Laxation Threshold (grams per day that most individuals get a laxative effect — for some it takes far less.)

From Richard Feinman, Ph.D.
Professor of Biochemistry
State University of New York Downstate Medical Center

What is known scientifically about the physiologic effects of sugar alcohols is well summarized in the introduction. Unfortunately, there is little scientific information on their effects in weight reduction so I cannot offer an expert opinion.

The question also came up at the recent conference on Nutritional and Metabolic Aspects of Low Carbohydrate Diets where a panel of scientists agreed that there was insufficient data to make a judgment. Anecdotal evidence suggests that some people find it a very valuable aide, even a blessing, to dieting, substituting candy bars or other treats containing sugar alcohols for similar products with sugar. Others find that it slows or stops weight loss even in relatively small amounts.

It should be remembered that we do not fully understand the mechanism that makes low carbohydrate dieting effective: beyond the direct control of insulin by glucose, sweetness from any source, nutritive or not, may affect total eating behavior or specific cravings for carbohydrate. The rationale of controlled carbohydrates is that you can regulate your caloric intake and cravings naturally by elimination of sugar and starch. If adding sugar alcohols to the diet interferes with this effect, it is obvious that you should not continue to use them. People who use sugar alcohol products frequently say that they like them as treats the way candy bars are supposed to be used generally. Even the manufacturers do not recommend them as a staple. Popular diet books, at least in the initial phases emphasize hard and fast rules (which helps many new dieters) but in the long run, it seems like the desirable state of any diet is steady weight loss or maintenance, no cravings and no sense that every meal is a battle with your psyche ("I know I really shouldn't eat so much of this.") Particular foods, natural or otherwise, that fit into this can be useful.

The bottom line is that despite the information on glycemic index, net carbohydrate values, etc., scientific data have little to say about a role for sugar alcohols. Individual dieters have to carefully monitor the effect of sugar alcohols on their diet and, despite my role as expert, I think, like Lady Macbeth's doctor "therein the patient must minister to himself."

From Fred Pescatore, M.D.
The Centers For Integrative and Complementary Medicine
Author of The Hamptons Diet

In the good old days of low carb diets, when I first started working with Dr. Robert Atkins as Associate Medical Director of his New York based medical practice, he would often tell people that the reason they were not losing weight was because of the sugar alcohol in the sugarless gum they were chewing. Now, it seems as if sugar alcohols are in every low carb product and people are not losing weight. This is harmful for two reasons:

1. Overweight people don't get to change the negative behavior that made them overweight in the first place — like eating candy bars and ice cream; and
   
   
2. It does nothing to decrease America's sweet tooth which must happen if we are ever going to put a dent in this obesity epidemic

While the sugar alcohols may have a place in the maintenance program of a low carb dieter, they still add calories and are absorbed by the body and MUST count. I advise my patients to stay away from these foods and they are very successful in losing weight because of that advice.

From Pete Maletto
Chief Science Officer
DynaPure Nutrition

The great thing about food science is that you never stop learning. More than six years ago, when I began developing low carb food products, I came across many diabetic foods in the marketplace. I looked to these for ideas on formulation for new lower carb food alternatives. I always thought of it as creating “health food.” So I began to ask myself, "What was the deal with all these sugar alcohols?” I grew concerned the day would come when they'd become "the evil of the low carb industry." They made great, cheap fillers alright... and manufacturers would not count them as effective carbs. But I was aware that most polyols (especially lactitol) induced diarrhea, bloating and gas.

As the low carb industry took off, companies rushed to make low carb foods as quickly as possible. And many took the predictable, low cost, easy route: sugar alcohols. Rather than creatively trying to find alternatives, they simply whipped out the old diabetic formulas and marketed them as low carb. And there it was — foods developed with contents as high as 98% sugar alcohols. "Low carb" candy, chocolate, ice cream... oh the humanity!

The other wrench in the works is the ketosis issue. For most dieters, sugar alcohols cause stalls and prevent ketosis. On Lora's chart above, you'll see that certain sugar alcohols actually produce blood sugar spikes — most notably maltitol. They have the uncanny ability to hang out in the intestines for a long period of time, slowly producing small amounts of blood sugar. This in turn induces the secretion of small amounts of insulin over longer periods of time. So rather than one big insulin secretion followed by a drop in insulin levels (as you'd get from a scoop of low fat ice cream), maltitol nets you a "Chinese water torture" type blood sugar reaction. This trickle is just enough to prevent the burning of fatty acids and halting weight loss altogether. Unless a person is exercising enough to really speed metabolism, one could produce insulin for quite a few hours of the day — defeating low carb dietary efforts, because as we all know, circulating insulin prevents weight loss.

What do we do now? As low carb specialty food developers, we all must formulate products as truly healthy alternatives to high carb products. This means using healthy ingredients like colloids and fibers to make up the bulk of your product. Just look at the methods the good folks at Expert Foods have employed.

Secondly, we must educate the public about the issue. Most know only that "they're supposed to deduct them from the carb count." Consumers must learn to read nutrition and ingredient labels closely to avoid being baited with the "net effective carbs" blurb on the front of the package.