POLYOLS IN SUGAR-FREE AND REDUCED-CALORIE FOODS AND BEVERAGES INFO - - PowerPoint PPT Presentation

▶
polyols in sugar free and reduced calorie foods and
SMART_READER_LITE
LIVE PREVIEW

POLYOLS IN SUGAR-FREE AND REDUCED-CALORIE FOODS AND BEVERAGES INFO - - PowerPoint PPT Presentation

May 07, 2023 294 likes •588 views

POLYOLS IN SUGAR-FREE AND REDUCED-CALORIE FOODS AND BEVERAGES INFO RM A TIO N FO R NUTRITIO NISTS WHAT ARE POLYOLS? L o w-dig e stib le c a rb o hydra te swe e te ne rs, a lso kno wn a s sug a r a lc o ho ls, tho ug h the y a re ne ithe

slide-1
SLIDE 1

INFO RM A TIO N FO R NUTRITIO NISTS

POLYOLS IN SUGAR-FREE AND REDUCED-CALORIE FOODS AND BEVERAGES

slide-2
SLIDE 2

WHAT ARE POLYOLS?

  • L
  • w-dig e stib le c a rb o hydra te swe e te ne rs, a lso

kno wn a s sug a r a lc o ho ls, tho ug h the y a re ne ithe r sug a rs no r a lc o ho ls

  • Hydro g e na te d fo rms o r mo no -, di- o r

po lysa c c ha ride s, me a ning the hydro xyl g ro up re pla c e s the a lde hyde o r ke to ne g ro up 1

  • Hydro g e na te d mo no sa c c ha ride s inc lude : D-ta g a to se ,

e rythrito l, ma nnito l, so rb ito l, xylito l

  • Hydro g e na te d disa c c ha ride s inc lude : iso ma lt, iso ma ltulo se ,

ma ltito l, tre ha lo se

  • Hydro g e na te d po lysa c c ha ride s inc lude : hydro g e na te d

sta rc h hydro lysa te s (HSH), po lyg lyc ito ls (e .g ., ma ltito l a nd so rb ito l syrups)

slide-3
SLIDE 3

POLYOLS AS SUGAR REPLACERS

  • Ac c o rding to a 2010 c o nsume r surve y b y the

Ca lo rie Co ntro l Co unc il, 78% o f Ame ric a ns who a re trying to lo se we ig ht use lo w-sug a r, sug a r-fre e a nd re duc e d-c a lo rie fo o ds a nd b e ve ra g e s2

slide-4
SLIDE 4

MOST POLYOLS ARE NUTRITIVE

  • Po lyo ls a re no t c a lo rie -fre e a s the re is so me de g re e
  • f dig e stio n a nd a b so rptio n o f the c a rb o hydra te
  • As po lyo ls c a n b e use d to re duc e the le ve l o f sug a r

in fo o ds a nd b e ve ra g e s, the y a re c o mmo nly kno wn a s:

  • Sug a r sub stitute s
  • Sug a r re pla c e rs
  • Alte rna tive swe e te ne rs
  • L
  • w-c a lo rie swe e te ne rs3
slide-5
SLIDE 5

CALORIC VALUE OF POLYOLS

  • Po lyo ls pro vide fe we r c a lo rie s pe r g ra m tha n sug a r,

whic h pro vide s 4 c a lo rie s/ g ra m

Polyol Calor ic Value *

E rythrito l 0.0 c a lo rie s/ g ra m Ma nnito l 1.6 c a lo rie s/ g ra m I so ma lt 2.0 c a lo rie s/ g ra m L a c tito l 2.0 c a lo rie s/ g ra m Ma ltito l 2.1 c a lo rie s/ g ra m Xylito l 2.4 c a lo rie s/ g ra m So rb ito l 2.6 c a lo rie s/ g ra m Hydro g e na te d Sta rc h Hydro lysa te s 3.0 c a lo rie s/ g ra m *Ca lo ric va lue pe r the F DA fina l rule o n nutritio n la b e ling 4

slide-6
SLIDE 6

FUNCTIONALITY IN FOODS AND BEVERAGES

  • F
  • r the mo st pa rt, po lyo ls re ta in the c he mic a l

struc ture o f sug a rs, me a ning the y ha ve ma ny o f the pro pe rtie s o f sug a r in fo o ds1

  • While func tio na lity va rie s b e twe e n po lyo ls a nd

spe c ific a pplic a tio ns, po lyo ls c a n impa rt the fo llo wing pro pe rtie s whic h impa c t func tio na lity:

  • Swe e tne ss
  • Bulking , whic h influe nc e s vo lume a nd mo uthfe e l
  • Mo isture re te ntio n
  • Wa te r a c tivity inhib itio n
  • Sug a r c rysta lliza tio n inhib itio n
  • Visc o sity
  • F

la vo r re te ntio n a t hig h te mpe ra ture s1,5-7

slide-7
SLIDE 7

WHERE CAN POLYOLS BE FOUND?

  • Po lyo ls a re prima rily fo und in sug a r-fre e , re duc e d-

sug a r, re duc e d-c a lo rie a nd no sug a r a dde d fo o ds a nd b e ve ra g e s

  • Co nfe c tio na rie s, b a ke d g o o ds, fro ze n de sse rts, syrups,

b e ve ra g e s

  • Che wing g um, b re a th mints
  • Po lyo ls c a n a lso b e fo und in o ra l he a lth pro duc ts,

inc luding to o thpa ste a nd mo uthwa sh, a s we ll a s me dic a tio ns, suc h a s c o ug h me dic ine s

  • Po lyo ls a re no t so ld a s fo o d ing re die nts fo r ho me

use

slide-8
SLIDE 8

REGULATION OF POLYOLS IN THE US

  • I

n the US, the F

  • o d a nd Drug Administra tio n (F

DA) re c o g nize s po lyo ls a s e ithe r a ppro ve d fo o d a dditive s o r a s Ge ne ra lly Re c o g nize d a s Sa fe (GRAS)5

  • Appro ve d fo o d a dditive s: ma nnito l, xylito l (fo r spe c ia l

die ta ry use s)

  • GRAS: e rythrito l, iso ma lt, la c tito l, ma ltito l, hydro g e na te d

sta rc h hydro lysa te s/ po lyg lyc ito ls

slide-9
SLIDE 9

FOOD ADDITIVE APPROVAL VS. GRAS

  • F
  • r the fo o d a dditive a ppro va l pro c e ss,

ma nufa c ture rs pro vide sa fe ty da ta to the F DA in the fo rm o f a F

  • o d Additive Pe titio n, whic h is

re vie we d b y the Ag e nc y a nd a ppro ve d o r de nie d 8

  • F
  • r tho se ing re die nts whic h me e t the de finitio n o f a

fo o d a dditive b ut a re “g e ne ra lly re c o g nize d a s sa fe ,” ma nufa c ture rs c a n file a GRAS no tific a tio n with the F DA a nd c a n re c e ive a n a ffirma tive re spo nse (“le tte r o f no o b je c tio n”) o r a re je c tio n8

  • I

ng re die nts a re c o nside re d to b e GRAS b y e xpe rts fo r the inte nde d use in the no tific a tio n

slide-10
SLIDE 10

DIGESTION AND ABSORPTION OF POLYOLS

  • Mo no sa c c ha ride po lyo ls a re a b so rb e d mo re slo wly

tha n g luc o se 1,6,7,9

  • Di- a nd po lysa c c ha ride po lyo ls a re pa rtia lly o r

inc o mple te ly dig e ste d a nd a b so rb e d in the sma ll inte stine a nd fe rme nte d in the la rg e inte stine 1,6,7,9

  • Sinc e po lyo ls a re no t c o mple te ly dig e ste d,

a b so rb e d a nd me ta b o lize d fo r e ne rg y, the y pro vide fe we r c a lo rie s pe r g ra m tha n sug a r

6,7,10,11

  • T
  • the e xte nt tha t po lyo ls a re me ta b o lize d, typic a lly

little to no insulin pro duc tio n is re q uire d 6,7,10,11

slide-11
SLIDE 11

POSSIBLE GI EFFECTS

  • Whe n c o nsume d in e xc e ssive a mo unts b y se nsitive

individua ls, po lyo ls c a n le a d to g a stro inte stina l (GI ) e ffe c ts, suc h a s g a s, b lo a ting , a b do mina l disc o mfo rt a nd inc re a se d la xa tio n (inc luding dia rrhe a )1,5,9,12

  • F

DA ha s de fine d “e xc e ssive c o nsumptio n” fo r so rb ito l (mo re tha n 50 g ra ms/ da y) a nd ma nnito l (mo re tha n 20 g ra ms/ da y)3,6,7,11

  • F
  • o ds whic h mig ht le a d to inta ke c lo se to the se le ve ls a re

re q uire d to inc lude a n a dviso ry sta te me nt o n the la b e l

slide-12
SLIDE 12

VARIABILITY IN GI EFFECTS

  • GI

e ffe c ts o f po lyo ls c a n va ry a mo ng individua ls a nd b e influe nc e d b y a numb e r o f fa c to rs

  • Amo unt c o nsume d 1,7,9
  • E

xc e ssive c o nsumptio n in o ne sitting c a n le a d to GI e ffe c ts

  • F

re q ue nc y o f c o nsumptio n/ a da pta tio n1,6,7,9

  • Po lyo ls a re b e tte r to le ra te d if c o nsume d in sma lle r po rtio ns

thro ug ho ut the da y

  • F
  • o d fo rm/ o the r fo o ds a nd nutrie nts c o nsume d 1,9,10
  • Po lyo ls ma y b e b e tte r to le ra te d in so lid ra the r tha n liq uid fo rm a s

so lid fo o ds mo ve thro ug h the GI tra c t mo re slo wly, a llo wing fo r mo re tra nsit time a nd inc re a se d dig e stio n/ a b so rptio n

  • I

ndividua l c ha ra c te ristic s a nd c o nditio ns9

  • Ce rta in he a lth c o nditio ns impa c ting the GI

c o uld le a d to inc re a se d GI e ffe c ts (e .g ., irrita b le b o we l syndro me (I BS))

slide-13
SLIDE 13

TOLERANCE IN CHILDREN

  • Due to the ir sma lle r b o dy size , c hildre n mig ht b e

mo re se nsitive to po te ntia l GI e ffe c ts9

  • T

he re fo re , c a re sho uld b e ta ke n to e nsure tha t c hildre n a re c o nsuming po lyo ls in sma lle r a mo unts5

slide-14
SLIDE 14

PROVIDING GUIDANCE ON GI CONCERNS

  • I

f a c lie nt is c o mpla ining a b o ut GI issue s, c o nsumptio n o f fo o ds a nd b e ve ra g e s swe e te ne d with po lyo ls sho uld b e a sse sse d a lo ng side o the r die ta ry, life style a nd he a lth fa c to rs

  • I

f a c lie nt ha s re c e ntly inc re a se d inta ke o f po lyo ls, sha re info rma tio n a b o ut po lyo ls, suc h a s the fo llo wing :

  • Po lyo ls a re b e tte r to le ra te d in so lid ve rsus liq uid fo rms
  • L

a rg e r inta ke s ma y b e a c c e pte d if g ra dua lly inc re a se d

  • ve r da ys o r we e ks a nd divide d into po rtio ns thro ug ho ut

the da y

  • E

xc e ss c o nsumptio n o f po lyo ls ma y sig na l a n a ssumptio n tha t o the r fo o ds c a n b e c o nsume d witho ut limit; the re fo re , a n e xpla na tio n o f to ta l c a lo rie s, no t just sug a r c o nte nt, sho uld b e g ive n

slide-15
SLIDE 15

GLYCEMIC RESPONSE

  • Co nsumptio n o f fo o ds a nd b e ve ra g e s with po lyo ls

pro duc e s a lo we r g lyc e mic re spo nse tha t simila r pro duc ts ma de with fully fe rme nta b le c a rb o hydra te s13

  • Slo we r a nd inc o mple te a b so rptio n le a ds to sma lle r

a mo unts a nd/ o r a mo re slo wly a va ila b le supply o f g luc o se 10

  • Po lyo ls pro duc e a sig nific a ntly lo we r po st-pra ndia l

b lo o d g luc o se re spo nse c o mpa re d to fruc to se , g luc o se a nd suc ro se 13,14

  • Po lyo ls e ffe c t b lo o d g luc o se to so me e xte nt in

individua ls with a nd witho ut dia b e te s15

slide-16
SLIDE 16

WEIGHT MANAGEMENT

  • Po lyo ls c a n b e use d in the c o nte xt o f the o ve ra ll

e a ting pa tte rn a s o ne wa y to a ssist with we ig ht ma na g e me nt7,14,15

  • Due to the ir inc o mple te me ta b o lism, po lyo ls

pro vide a ppro xima te ly ha lf the e ne rg y o f o the r c a rb o hydra te s, so re pla c ing fo o ds a nd b e ve ra g e s ma de with po lyo ls fo r hig he r-sug a r ve rsio ns mig ht he lp re duc e c a lo rie c o nsumptio n1,3

slide-17
SLIDE 17

DENTAL CARIES

  • Po lyo ls, a nd pa rtic ula rly xylito l, do no t pro mo te

to o th de c a y a nd c o uld a ssist in pre ve ntio n o f de nta l c a rie s

  • Po lyo ls, unlike sug a rs, a re a po o r so urc e o f e ne rg y fo r

mic ro o rg a nisms in the mo nth a nd the re fo re , a re me ta b o lize d slo wly o r no t a t a ll b y pla q ue -synthe sizing b a c te ria 5,10,16

  • Xylito l ma y b e b e ne fic ia l in pro mo ting to o th

re mine ra liza tio n10,16

slide-18
SLIDE 18

POLYOLS IN CHEWING GUM

  • Che wing g um swe e te ne d with po lyo ls, whe n use d

to sub stitute sug a r-swe e te ne d g um, c a n re duc e e xpo sure o f b a c te ria in the mo uth

  • Che wing g um c a n inc re a se sa liva ry flo w, whic h c a n

re mo ve fo o d fro m the o ra l c a vity a nd ne utra lize pH in the mo uth16,17

slide-19
SLIDE 19

POLYOLS ON LABELS: INGREDIENT LIST

  • Spe c ific po lyo ls must b e liste d b y the ir na me in the

ing re die nt list o n fo o d a nd b e ve ra g e pro duc t la b e ls6,7,11

  • One tip fo r c o nsume rs is tha t mo st po lyo ls e nd in –o l,

so the y c a n lo o k o ut fo r the se in the ing re die nt list

slide-20
SLIDE 20

POLYOLS AND ADDED SUGARS

  • With the fina l rule fro m the F

DA in 2016 o n nutritio n la b e ling , o ne o f the ma jo r c ha ng e s is the ne w ma nda te to list the a mo unt o f a dde d sug a rs o n the la b e l

4

  • T

he a mo unt o f “Adde d Sug a rs” will a ppe a r unde r “T

  • ta l

Sug a rs” o n the Nutritio n F a c ts la b e l, whic h a ppe a rs unde r the “T

  • ta l Ca rb o hydra te s” line
  • I

n the fina l rule , F DA sta te d tha t po lyo ls a re no t c o nside re d a dde d sug a rs, so a re the re fo re no t sub je c t to inc lusio n o n the ne w ma nda te 4

slide-21
SLIDE 21

NUTRITION FACTS LABEL AND POLYOLS

  • T

he c a lo ric va lue o f spe c ific po lyo ls must b e use d in the la b e ling o f the c a lo ric va lue fo r T

  • ta l

Ca rb o hydra te s

  • T

he a mo unt o f po lyo ls in a pro duc t c a n b e liste d a s a c o mpo ne nt o f the T

  • ta l Ca rb o hydra te s1,4,6,7,15,18
  • T

he a mo unt c a n b e vo lunta rily ide ntifie d unde r T

  • ta l

Ca rb o hydra te s a s “Sug a r Alc o ho ls”

  • Ho we ve r, if a c la im is ma de a b o ut po lyo ls o r sug a rs (e .g .,

“sug a r fre e ”) o n the la b e l, the listing o f the a mo unt o f “Sug a r Alc o ho ls” is ma nda to ry

slide-22
SLIDE 22

SUGAR CLAIMS ON PRODUCT LABELS

  • A va rie ty o f c la ims a re use d o n pro duc ts re la te d to

sug a r c o nte nt in fo o ds a nd b e ve ra g e s whic h c o nta in po lyo ls, inc luding the fo llo wing :

  • Sug a r fre e
  • No sug a r a dde d
  • No a dde d sug a rs
  • I

t is impo rta nt tha t c o nsume rs unde rsta nd tha t fo r pro duc ts whic h inc lude the se c la ims, it do e s no t indic a te the pro duc t is c a lo rie - o r c a rb o hydra te - fre e

  • F
  • r tho se c o unting c a rb o hydra te s, the Nutritio n

F a c ts ta b le will pro vide the ne c e ssa ry info rma tio n

slide-23
SLIDE 23

USE OF POLYOLS IN DIABETIC MEAL PLANNING

  • Ma na g e me nt o f b lo o d g luc o se is o f prima ry

c o nc e rn to tho se with dia b e te s, a nd sinc e po lyo ls pro vide fe we r c a lo rie s a nd pro vide le ss g luc o se tha n o the r c a rb o hydra te s, the y c a n b e b e ne fic ia l fo r tho se with dia b e te s

  • Ho we ve r, tho se with dia b e te s sho uld no t a ssume

tha t pro duc ts ma de with po lyo ls a re “fre e fo o ds”

  • T

ho se with dia b e te s sho uld pa y a tte ntio n to the Ca lo rie s a nd T

  • ta l Ca rb o hydra te s line s a nd c o nside r pro duc ts ma de

with po lyo ls in te rms o f the o ve ra ll e a ting pla n a nd nutritio n g o a ls

slide-24
SLIDE 24

CALCULATING CARBOHYDRATES

  • As po lyo ls a re minima lly dig e ste d, it is e stima te d

tha t o nly ha lf o f the po lyo ls in a pro duc t sho uld b e c o unte d to wa rds the c a rb o hydra te inta ke 14,18

  • F
  • r e xa mple , if a pro duc t ha d o nly c a rb o hydra te s fro m

po lyo ls a nd the re we re 10 g ra ms o f po lyo ls, 10 g ra ms o f c a rb o hydra te wo uld b e c o unte d a s o nly 5 g ra ms

  • “F

re e fo o ds” 14,18

  • I

f a fo o d pro vide s 5 g ra ms o f c a rb o hydra te s o r le ss o r 20 c a lo rie s o r le ss

  • I

f a pro duc t c o nta ins le ss tha n 10 g ra ms o f to ta l c a rb o hydra te s with a ll fro m po lyo ls

slide-25
SLIDE 25

CALCULATING CARBOHYDRATES: EXAMPLE

  • I

f a pro duc t lists “Sug a r Alc o ho ls” in the Nutritio n F a c ts la b e l, c o unt o nly ha lf o f the po lyo l g ra ms whe n c a lc ula ting c a rb o hydra te s

  • E

xa mple :

  • T
  • ta l Ca rb o hydra te s: 30 g ra ms
  • Sug a r Alc o ho ls: 28 g ra ms
  • Ca rb o hydra te s: 30 – (28/ 2) = 16 g ra ms
slide-26
SLIDE 26

TOTAL EATING PATTERN APPROACH

  • Co nsume rs sho uld re me mb e r tha t a fo o d is no t

a uto ma tic a lly lo w-c a rb o hydra te , lo w-c a lo rie a nd with a lo w g lyc e mic re spo nse just b e c a use it is ma de with po lyo ls

  • F
  • o ds a re a mixture o f c a rb o hydra te so urc e s, a lo ng with
  • the r ma c ro nutrie nts (e .g ., pro te in, fa t)
  • T

he ma c ro nutrie nt c o nte nt a ffe c ts the g lyc e mic lo a d, whic h mig ht b e mo re impo rta nt tha t the g lyc e mic inde x o f individua l fo o ds

  • Po lyo ls c a n b e use d in the c o nte xt o f a n o ve ra ll

he a lthy wa y o f e a ting , inc luding a wa y to e njo y swe e t fo o ds a nd b e ve ra g e s with fe we r c a lo rie s a nd le ss sug a r

slide-27
SLIDE 27

KEY HIGHLIGHTS

  • Po lyo ls use d in fo o ds a nd b e ve ra g e s to re pla c e sug a r

c a n re duc e c a lo rie s a nd c a rb o hydra te s

  • I

n a dditio n to re g ula r o ra l hyg ie ne , pro duc ts ma de with po lyo ls, e spe c ia lly c he wing g um, c a n he lp re duc e risk o f de nta l c a rie s

  • Co nsume rs sho uld c o nside r the to ta l e a ting pa tte rn a nd

he a lth g o a ls, e spe c ia lly tho se with dia b e te s a nd tho se trying to ma na g e the ir we ig ht

  • Po lyo ls a re sa fe a nd pro duc ts ma de with the m c a n b e

e njo ye d b y c o nsume rs

  • F
  • r se nsitive individua ls, e xc e ssive inta ke o f po lyo ls c a n

c a use GI e ffe c ts, b ut this c a n b e a ddre sse d thro ug h g ra dua l a dditio n o f po lyo ls to the die t

slide-28
SLIDE 28

REFERENCES

1. Gra b itske HA, Sla vin JL . L

  • w-dig e stib le c a rb o hydra te s in pra c tic e . J Am Die t Asso c , 2008;

108:1677-81. 2. Ca lo rie Co ntro l Co unc il. T re nds a nd Sta tistic s. 2010. Ava ila b le a t http:/ / www.c a lo rie c o ntro l.o rg / pre ss-ro o m/ tre nds-a nd-sta tistic s. Ac c e sse d April 26, 2017. 3. F itc h C, K e im K

  • S. Po sitio n o f the Ac a de my o f Nutritio n a nd Die te tic s: Use o f Nutritive a nd

No nnutritive Swe e te ne rs. J Ac ad Nutr Die t, 2012;112:739-58. 4. US F

  • o d a nd Drug Administra tio n. F
  • o d L

a b e ling : Re visio n o f the Nutritio n a nd Supple me nt F a c ts L a b e ls; Se rving Size s o f F

  • o ds T

ha t Ca n Re a so na b ly Be Co nsume d a t One E a ting Oc c a sio n; Dua l-Co lumn L a b e ling ; Upda ting , Mo difying , a nd E sta b lishing Ce rta in Re fe re nc e Amo unts Custo ma rily Co nsume d; Se rving Size fo r Bre a th Mints; a nd T e c hnic a l Ame ndme nts; F ina l Rule s. 21 C.F .R. Pa rt 101. 2016. Ava ila b le a t https:/ / www.g po .g o v/ fdsys/ pkg / F R-2016-05- 27/ pdf/ 2016-11865.pd f. 5. K ro g e r M, Me iste r K , K a va R. L

  • w-c a lo rie swe e te ne rs a nd o the r sug a r sub stitute s: a re vie w o f

the sa fe ty issue s. Co mp Re v F

  • o d Sc i F
  • o d Safe ty, 2006; 5:35-47.

6. Inte rna tio na l F

  • o d Info rma tio n Co unc il F
  • unda tio n. Sug a r Alc o ho ls F

a c t She e t. 2009. Ava ila b le a t: http:/ / www.fo o dinsig ht.o rg / Re so urc e s/ De ta il.a spx? to pic =Sug a r_Alc o ho ls_F a c t_She e t. Ac c e sse d April 26, 2017. 7. Wa rsha w HS. F AQs a b o ut po lyo ls. T

  • day’ s Die titian, 2004; 6:36-44.

8. Rulis AM, L e vitt JA. F DA’ s fo o d ing re die nts a ppro va l pro c e ss: sa fe ty a ssura nc e b a se d o n sc ie ntific a sse ssme nt. Re g ul T

  • xic o l Pharmac o l, 2009; 53(1): 20-31.
slide-29
SLIDE 29

REFERENCES

9. Gra b itske HA, Sla vin JL . Ga stro inte stina l e ffe c ts o f lo w-dig e stib le c a rb o hydra te s. Crit Re v F

  • o d

Sc i Nutr, 2009; 49:327-60. 10. L ive se y G. He a lth po te ntia l o f po lyo ls a s sug a r re pla c e rs, with e mpha sis o n lo w g lyc a e mic pro pe rtie s. Nutr Re s Re vie ws, 2003; 16: 163-91. 11. Sa ulo AA. Sug a rs a nd swe e te ne rs in fo o ds. Unive rsity o f Ha wa ii a t Ma no a , Co lle g e o f T ro pic a l Ag ric ulture a nd Huma n Re so urc e s Co o pe ra tive E xte nsio n Se rvic e . F

  • o d Safe ty and

T e c hno lo g y, 2005; F ST

  • 16.

12. Sto re y D, L e e A, Bo rne t F , Bro uns F . Ga stro inte stina l to le ra nc e o f e rythrito l a nd xylito l ing e ste d in a liq uid. E ur J Clin Nutr, 2007; 61: 36-44. 13. Whe e le r ML , Pi-Sunye r F

  • X. Ca rb o hydra te issue s: type a nd a mo unt. J Am Die t Asso c , 2008; 108:

S34-9. 14. Ame ric a n Dia b e te s Asso c ia tio n. Nutritio n re c o mme nda tio ns a nd inte rve ntio ns fo r dia b e te s: a po sitio n sta te me nt o f the Ame ric a n Dia b e te s Asso c ia tio n. Diab e te s Care , 2008; 31(suppl 1): S61-78. 15. F re e ma n J, Ha ye s C. L

  • w-c a rb o hydra te fo o d fa c ts a nd fa lla c ie s. Diab e te s Spe c trum, 2004;

17: 137-40. 16. Burt BA. T he use o f so rb ito l- a nd xylito l-swe e te ne d c he wing g um in c a rie s c o ntro l. J Am De nt Asso c , 2006; 137-190-6. 17. De sphpa nde A, Ja da d AR. T he impa c t o f po lyo l-c o nta ining c he wing g um o n de nta l c a rie s: a syste ma tic re vie w o f o rig ina l ra ndo mize d c o ntro lle d tria ls a nd o b se rva tio na l studie s. J Am De nt Asso c , 2008; 139: 1602-14. 18. Whe e le r ML , Da ly A, E ve rt A, F ra nz MJ, Ge il P, Ho lzme iste r L A, e t al. Cho o se Yo ur F

  • o ds:

E xc hang e L ists fo r Diab e te s, Sixth E ditio n, 2008: De sc riptio n a nd Guide line s fo r Use . J Am Die t Asso c , 2008; 108: 883-88.