Fructose in type 1 and type 2 diabetes mellitus

Regular table sugar consists of two saccharides: glucose and fructose. In a free state, it is found in all sweet fruits and honey. Previously, it was believed that fructose is a sugar substitute for diabetes, since insulin is not needed for its penetration into cells, unlike glucose. A lack of a carrier protein activated by insulin, or cell insensitivity to it, leads to the accumulation of sugar in the blood, which is dangerous for all body systems, and is generally destructive for the pancreas. So what can diabetics replace sugar with? [ 1 ]

Studies in both healthy and diabetic subjects have shown that fructose causes smaller postprandial increases in plasma glucose and serum insulin than other common carbohydrates.[ 2 ]

Fructose instead of sugar for diabetes

What made us look at fructose differently? Modern research has shown that humans lack enzymes capable of processing it. Because of this, it gets into the liver, where it forms glucose and bad cholesterol, and most often it turns into fat and contributes to the accumulation of its subcutaneous deposits. In addition, fructose is high in calories and although it is positioned as a diabetic product, in fact it increases cravings for sweet foods and increases appetite. How to give up sweets if you have diabetes? First of all, you need to give up sugar in its pure form, and use sweeteners or sweet fruits in small quantities (except grapes and bananas) as sweets. At least their fiber slows down the absorption of carbohydrates. Fans of flour desserts should first limit themselves in portions, and then gradually learn to cook them themselves or buy them in special sections at grocery stores. [ 3 ]

Is fructose allowed for type 1 and type 2 diabetes?

The attitude towards fructose is very controversial, scientific publications cite the results of numerous studies that exclude each other. However, its molecules are present in 90% of all products in the world, including those that are on the shelves of the diabetic sections. It is believed that diabetics can consume fructose if they strictly count and control the bread units entering the body, and with type 1 diabetes, it is possible to adjust the insulin dose. [ 4 ]

Fructose in gestational diabetes

Changes in hormonal levels in pregnant women sometimes lead to the development of diabetes, called "gestational". Its main treatment is diet therapy. It involves reducing the daily energy value of the diet by an average of a third, mainly by reducing the total amount of carbohydrate consumption. Fast carbohydrates should be completely eliminated from the diet and replaced with complex ones, rich in dietary fiber. Any sugar substitutes, including fructose, are contraindicated for pregnant women, as they can negatively affect embryonic development. [ 5 ] It has been proven that dietary fructose or low protein intake during pregnancy can worsen the already disturbed glucose homeostasis, causing gestational diabetes and fatty liver disease. [ 6 ]

Benefits

Let's look at the most common opinions about the benefits and harms of fructose in diabetes. The following facts are considered as arguments in favor of it:

• it increases blood sugar more slowly than sucrose, which means it makes it possible to avoid hyperglycemia; [ 7 ]
• has a low glycemic index (20 units), sugar has 70;
• fructose is almost 2 times sweeter than sugar, which allows you to consume less of it;
• It does not cause caries, so it is used in chewing gum and toothpaste;
• hypoallergenic.

The harm of fructose

Speaking about the harm, they cite data on its ability to cause obesity, negative impact on the liver, the development of dependence on it, high caloric content. The latter calls into question the assertion that fructose should be used for weight loss, in addition, it increases the feeling of hunger due to an increase in the hormone ghrelin, which stimulates it.

There is concern that fructose may be a factor in the increasing prevalence of obesity worldwide. Fructose stimulates insulin secretion less than glucose and glucose-containing carbohydrates. Because insulin increases leptin release, low circulating insulin and leptin levels after fructose ingestion may suppress appetite less than other carbohydrates and lead to increased energy intake. However, there is no convincing experimental evidence that dietary fructose actually increases energy intake. There is also no evidence that fructose accelerates protein glycation. High fructose intake has been associated with an increased risk of gout in men [ 8 ], [ 9 ] and an increased risk of kidney stones. [ 10 ] Dietary fructose appears to have adverse effects on postprandial serum triglycerides, so adding large amounts of fructose to the diet is undesirable. Glucose may be a suitable sugar substitute. Fructose, which is naturally found in fruits and vegetables, provides only a small amount of dietary fructose and is not a concern.[ 11 ],[ 12 ]

Fructose Products for Diabetes

Thoughtfulness of your menu, inclusion of products that do not cause a sharp jump in glucose, and keeping it at a normal level is the key to a stable condition of a diabetic. For this, there are products on fructose, here are some of them:

• jam with fructose for diabetes - easy to make yourself, using various fruits, berries with a low glycemic index with the addition of fructose in the summer season. Due to the fact that it is sweeter than sugar, you need less of it (500-600g per kilogram of fruit), and such a dessert turns out to be very aromatic. You should not boil the jam too much, because this increases the concentration of natural sugars, and use thickeners agar-agar or gelatin;
• fructose cookies for diabetes - it is often difficult for lovers of confectionery products to refuse them, even knowing about the harm of such products. Baked goods with added fructose will come to the rescue, in which you need to use rye, oat or buckwheat flour without adding eggs and butter. Its baking time should be minimal. There is a considerable assortment of such products in the retail network;
• fructose candies for diabetes - are produced without the use of granulated sugar. Depending on the manufacturer and type, they have different tastes, but a low glycemic index. To satisfy the body's daily norm of fructose, 40 mg is enough, in terms of candies this is on average 3 pieces;
• fructose halva for type 2 diabetes - the composition of such halva differs from the usual one. It does not contain any dyes or preservatives. The best raw materials for it are sunflower seeds, nuts, licorice root, dry whey. Despite this, halva is a high-calorie product, it contains fats, carbohydrates, and the amount of XE is close to critical (4.2), so you should not abuse it.

Contraindications

Fructose is contraindicated for people with allergies to it. Its excessive consumption contributes to obesity, [ 13 ] the development of metabolic syndrome, [ 14 ] and can cause cardiovascular pathologies. [ 15 ]

Sorbitol or fructose, which is better for diabetes?

What should a diabetic choose, fructose or sorbitol? There are different opinions on this matter. Fructose is sweeter, so less of it is needed. On the other hand, it stimulates appetite, participates in fat synthesis, and increases uric acid production. [ 16 ] Sorbitol cleanses the liver well, reduces intraocular pressure, relieves swelling, but often causes allergic reactions. An endocrinologist and your own experience of using it can help you choose a sugar substitute.