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Fructose in type 1 and type 2 diabetes

, medical expert
Last reviewed: 25.02.2021
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Common dietary sugar is made up of two saccharides: glucose and fructose. In a free state, it is found in all sweet fruits, honey. It used to be thought that fructose is a sugar substitute for diabetes because insulin is not needed for its penetration into cells, unlike glucose. The lack of a carrier protein activated by insulin, or the insensitivity of cells to it, leads to the accumulation of sugar in the blood, which is dangerous for all body systems, and for the pancreas it is generally fatal. So what is the substitute for sugar for diabetics? [1]

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

Fructose instead of sugar in diabetes

What made you look at fructose differently? Modern research has shown that humans lack enzymes that can process it. Because of this, it enters the liver, where glucose and bad cholesterol are formed from it, 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 sugary foods and increases appetite. How to give up sweets in diabetes? First of all, you need to give up sugar in its pure form, and use sweeteners or sweet fruits in small quantities as sweet (with the exception of grapes, bananas). At least their fiber slows down the absorption of carbohydrates. Fans of flour desserts first need to limit themselves in portions, and then gradually learn how to cook them themselves or buy them in grocery stores in special departments. [3]

Can fructose be used for type 1 and type 2 diabetes?

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

Fructose in pregnancy diabetes

Changes in hormonal levels in pregnant women sometimes lead to the development of diabetes, which is called "gestational". His main treatment is diet therapy. It involves a decrease in the daily energy value of the diet by an average of one third, mainly due to a decrease in the total amount of carbohydrate intake. Fast foods should be removed from the diet altogether and replaced with complex ones, rich in dietary fiber. Any sugar substitutes, including fructose, are contraindicated for pregnant women, because can negatively affect embryonic development. [5] It has been shown that dietary fructose or low protein intake during pregnancy can exacerbate already impaired glucose homeostasis, causing gestational diabetes and fatty liver. [6]

Benefits

Here are the most common judgments about the benefits and harms of fructose in diabetes. The following facts are considered as arguments for it:

  • it raises 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;
  • it does not cause caries, so it is used in chewing gums and toothpastes;
  • hypoallergenic.

Harm to fructose

Speaking about the harm, they cite data on its ability to cause obesity, a negative effect on the liver, the emergence of dependence on it, and high calorie content. The latter casts doubt on the statement that fructose should be used for weight loss, moreover, 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 contributing factor to the rise in obesity worldwide. Fructose stimulates insulin secretion less than glucose and glucose-containing carbohydrates. Because insulin increases the release of leptin, low levels of circulating insulin and leptin after fructose intake can suppress appetite less than other carbohydrate intake and lead to increased energy intake. However, there is no conclusive 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 an adverse effect on postprandial serum triglycerides, so high fructose supplementation in the diet is undesirable. Glucose can be a suitable sugar substitute. Fructose, which is naturally found in fruits and vegetables, provides only a small amount of dietary fructose and should not be a cause for concern. [11], [12]

Fructose-based foods for diabetes

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

  • jam with fructose for diabetes mellitus - it is easy to make yourself, using various fruits, berries with a low glycemic index with added fructose in the summer season. Due to the fact that it is sweeter than sugar, it is needed less (500-600g per kilogram of fruit), and such a dessert turns out to be very fragrant. It is not worth boiling 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 confectionery lovers to refuse them, even knowing about the dangers of such products. Baking with the addition of fructose will come to the rescue, in which you need to use rye, oatmeal or buckwheat flour without adding eggs and butter. The baking time should be minimal. A large assortment of such products and in the trade network;
  • candies on fructose for diabetes - made without the use of granulated sugar. Depending on the manufacturer and type, they have a different taste, but a low glycemic index. To satisfy the body's daily norm in fructose, 40 mg is enough, in terms of candy, this is on average 3 pieces;
  • halva on fructose in type 2 diabetes - the composition of such halva differs from the usual one. It does not include any dyes or preservatives. The best raw materials for it are sunflower seeds, nuts, licorice root, milk whey powder. 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 in people who are allergic to it. Its excessive consumption contributes to obesity, the  [13]development of metabolic syndrome, and  [14] can cause cardiovascular pathologies. [15]

Sorbitol or fructose, which is better for diabetes?

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

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