Volume 29 Issue 1 Article 1
2021
Suitability of Sugar Alcohols as Antidiabetic Supplements: A Review
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Recommended Citation Msomi, Nontokozo Z.; Erukainure, Ochuko L.; and Islam, Md. Shahidul (2021) "Suitability of Sugar Alcohols as Antidiabetic Supplements: A Review," Journal of Food and Drug Analysis: Vol. 29 : Iss. 1 , Article 1. Available at: https://doi.org/10.38212/2224-6614.3107
This Review Article is brought to you for free and open access by Journal of Food and Drug Analysis. It has been accepted for inclusion in Journal of Food and Drug Analysis by an authorized editor of Journal of Food and Drug Analysis. Suitability of Sugar Alcohols as Antidiabetic Supplements: A Review
Cover Page Footnote The authors would like to acknowledge the Research Office, University of KwaZulu-Natal and the National Research Foundation (NRF), Pretoria, South Africa (Grant number 1124300) for support.
This review article is available in Journal of Food and Drug Analysis: https://www.jfda-online.com/journal/vol29/iss1/ 1 Suitability of sugar alcohols as antidiabetic
supplements: A review REVIEW ARTICLE
Nontokozo Z. Msomi a, Ochuko L. Erukainure b, Md. Shahidul Islam a,* a Department of Biochemistry, School of Life Sciences, University of KwaZulu-Natal, (Westville Campus), Durban 4000, South Africa b Department of Pharmacology, School of Clinical Medicine, Faculty of Health Sciences, University of the Free State, Bloemfontein 9300, South Africa
Abstract
The major goals in the management of diabetes are to maintain optimum control of high blood glucose level or hyperglycemia. Dietary modification is one of the most recommended treatment modalities for diabetic patients. The use of foods sweetened with sugar alcohols (also known as polyols) such as xylitol, sorbitol, mannitol, maltitol, lactitol, isomalt and erythritol has brought an escalating interest in the recent years since some sugar alcohols do not rise plasma glucose, as they are partially digested and metabolised. Diet composition and adequacy may be altered by replacing carbohydrates with sugar alcohols. It has been established that these polyols are appropriate sugar substitutes for a healthy lifestyle and diabetic foods. The present review focuses on the evidence supporting the use of sugar alcohols in the management of diabetes, by evaluating their physical and chemical properties, metabolism, absorption, glycemic and insulinemic responses. Although documentation on the glycaemic and insulinemic response of polyols is evident that these compounds have beneficial effects on the better management of hyperglycemia, the possible side effects associated with their normal or higher dosages warned their use according to the relevant Food & Drug Administration guidelines. For the same reason, future studies should also focus on the possible toxicity and side effects associated with the consumption of sugar alcohols in order to define their safety.
Keywords: Diabetes, Glycemic index, Insulinemic index, Sugar alcohols, Sweeteners
1. Introduction to reduce the consumption of added sugars but also to reduce the daily energy intake from refined sugar fi fi he global prevalence of diabetes is [5]. This has led to the identi cation of modi able increasing progressively, with an estimated diets and lifestyle factors for the prevention and T better management of diabetes [6,7]. A growing in- 463 million people living with diabetes and a terest in products sweetened with sugar alcohols in projection of 700 million by 2045, the vast majority the market has transpired, targeted towards people of whom have type 2 diabetes (T2D) [1]. Epidemic with diabetes [8,9]. Studies have suggested that of diabetes has astounding healthcare expendi- sugar alcohols have the ability to alter the nutri- ture and significant impacts in the quality of life tional adequacy of a diet since they have lower en- [2]. In 2019, the global diabetes-related healthcare ergy values due to the way they are metabolized expenditure reached an estimated 760 billion [10]. Therefore, these sugar substitutes are useful in USD, with a 14.5% increase from 2017 [1]. the maintenance of a nutritionally balanced diet for diabetic individuals [11]. Considering all above, the Diabetes is a multifactorial disease and one of its present review was designed to analyse the benefi- most prominent association is the consumption of cial effects, mechanisms of actions and possible side excess refined sugar or sugar containing foods and effects of different widely used sugar alcohols for food products [3,4]. Therefore, the World Health the better and safer management of hyperglycemia Organization issued nutritional guidelines not only and diabetes.
Received 26 July 2020; revised 2 November 2020; accepted 12 January 2021. Available online 15 March 2021
* Corresponding author at: Department of Biochemistry, University of KwaZulu-Natal, Westville Campus, Durban 4000, South Africa. E-mail address: [email protected] (Md.S. Islam). https://doi.org/10.38212/2224-6614.3107 2224-6614/© 2021 Taiwan Food and Drug Administration. This is an open access article under the CC-BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). 2 JOURNAL OF FOOD AND DRUG ANALYSIS 2021;29:1e14 EIWARTICLE REVIEW
2. Sugar alcohols 2.1.2. Sorbitol Sorbitol is a six-carbon alditol also known as D- Sugar alcohols (polyols) are chemically defined as glucitol. It is naturally present in fruits (peaches, saccharide derivatives in which a ketone or alde- apples, cherries, apricots, nectarines and pears) and hyde group is replaced by a hydroxyl group [9,12]. some vegetables [23,24]. It is produced from glucose They are mostly known as caloric/nutritive sweet- by catalytic hydrogenation with hydrogen gas and eners that are white and water-soluble solids which nickel catalyst at high temperatures [25,26]. In are naturally present in small amounts in some alkaline conditions it is produced by electrochemical fruits and vegetables and are commercially pro- reduction of dextrose [23]. Sorbitol has sweetness of duced by hydrogenation reaction [8,13,14]. Sugar about 60% of sucrose, with fewer calories [9,27]. It alcohols are extensively used in sugar-free foods also characterizes with a 20-fold higher solubility in and food products such as gum, fruit spread, candy, water than mannitol [28,29]. Sorbitol has non-cari- baked goods and ice cream [15]. They are used as ogenic properties therefore it is used for nutritional sugar substitutes in diabetic food formulations to purposes in products designated for diabetic people reduce water activity in ‘intermediate moisture [30]. foods’; improvement of dehydrated foods; as soft- eners; and as crystallization inhibitors [16]. Some 2.1.3. Mannitol sugar alcohols are also widely used in oral and Mannitol is six-carbon polyol, an optical isomer of dental care products due to their proven and rele- sorbitol which is used as a reserve carbohydrate by vant beneficial effects [17,18]. some fungi, bacteria and seaweeds [31,32]. It is also naturally found in high amounts in olives, carrots, 2.1. Classification of sugar alcohols figs, pineapples, sweet potatoes and larches [29,33e35]. Industrial production of mannitol is Sugar alcohols (Fig. 1) are classified into three based on the catalytic hydrogenation of glucose/ groups according to the number of saccharide units fructose derived from invert starch or sugar at high present in the molecule as follows: (i) Mono- temperatures and pressure [33,36]. It has a caloric saccharide-derived sugar alcohols: for example- value of 1.6 kcal/g which is 50% sweet as compared xylitol, sorbitol and mannitol. These mono- to table sugar, with a desirable cooling effect that is saccharides are derived from xylose, glucose and efficient in masking bitter tastes [37]. This sugar mannose respectively; (ii) Disaccharide-derived alcohol is non-hygroscopic [35], which is used as a sugar alcohols: this includes lactitol and maltitol bulking agent in sugar free coatings and a dusting which are derived by the hydrogenation of lactose powder for chewing gum [9]. Mannitol is not and maltose, respectively. (iii) Polysaccharide- metabolized by humans therefore it doesn't induce derived sugar alcohols mixture: this includes Iso- hyperglycemia with no insulinemic and glycemic malt which is a 1:1 mixture of alpha-D-glucopyr- indexes [38]. anosyl-[1-6]-D-sorbitol (GPS) and alpha-D- glucopyranosyl-[1-6]-D-mannitol (GPM) [8,9,15]. 2.1.4. Maltitol Maltitol is a disaccharide polyol (4-O-a-D-gluco- 2.1.1. Xylitol pyranosyl-D-glucitol), formed from the hydrogena- Xylitol is a five-carbon crystalline substance tion of maltose to produce an a-1,4 glucose-sorbitol occurring naturally in small amounts in many linked polyol [9,39,40]. It is a crystalline powder that plants, micro-organisms and animal tissues [19,20]. acts as a bulking agent, a stabilizer, an emulsifier, It is produced in humans as part of the hepatic thickener and sweetener [9]. Maltitol properties metabolism of carbohydrates at levels of approxi- such as sweetness and taste resemble that of sucrose mately 5e15 g per day [21]. It is also commercially [34]. Maltitol is a non-cariogenic agent with appli- produced by the hydrogenation of xylose using a cations in many sugar-free foods, as well as nickel-catalyzed reaction process [22]. The molecule numerous reduced-calorie and reduce-fat foods contains a tridentate ligand (HeCeOH) which re- 3 [26,40]. acts with numerous polyvalent cations and oxyacids [13]. Xylitol is roughly as sweet as sucrose but with 2.1.5. Lactitol moderately lower caloric value of (2.4 kcal/g) Lactitol is disaccharide sugar alcohol obtained compared to sucrose (4 kcal/g), hence it is widely from the hydrogenation of lactose using nickel as a used in foods and pharmaceutical products [20]. catalyst. Its production is composed of galactose and JOURNAL OF FOOD AND DRUG ANALYSIS 2021;29:1e14 3
sorbitol [41e43]. Lactitol is an odourless white Sorbitol) and gluco-mannitol (a-D-gluco-pyranosyl- crystalline powder with a sweetness that is 30e40% 1-6-mannitol) [25]. It is produced from sucrose in a of sucrose [15,41]. It has an anhydrous form which is two-step process, which makes isomalt chemically applicable in case of moisture-sensitive products. It and enzymatically more stable than sucrose [44,45]. is used as an emulsifier, thickener and sweetener Isomalt on average has 45e65% of the sweetness of REVIEW ARTICLE [9]. sucrose. It has synergistic effects when combined with other sugar alcohols or with high-intensity 2.1.6. Isomalt sweeteners, it is also anti-cariogenic and does not Isomalt is a mixture of two isomeric disaccharide increase blood glucose or insulin levels [9,30]. This alcohols: gluco-sorbitol (a-D-gluco-pyranosyl-1-6-
Fig. 1. Chemical structure of commonly used sugar alcohols. 4 JOURNAL OF FOOD AND DRUG ANALYSIS 2021;29:1e14 EIWARTICLE REVIEW
polyol is partially digested in the intestines, only effects, i.e., breath mints, cough drops and loz- supplying half the caloric value of sucrose [39,45]. enges [13,40,49]. Solubility: The solubility of sugars and polyols 2.1.7. Erythritol in water is greatly affected by the extent of Erythritol is a four-carbon polyol, that occurs temperature. The solubility of the compounds naturally and widely distributed in nature. It occurs increases with temperature. Some polyols such as a storage or metabolite compound in fungi and as xylitol are highly soluble in water. Others like seaweeds, and as a constituent of numerous fruits mannitol are slightly but it does not confine their such as pears, melons and grapes [12,46]. It is also use in food applications [16]. commercially produced using fermentation in pro- Hygroscopicity: Hygroscopicity is the tendency cessed vegetables, fermented foods and drinks [12]. for materials to take up moisture from their It is a symmetrical molecule, therefore existing in surroundings or atmosphere. The hygroscopicity one form, the meso form [13]. It forms anhydrous of food products has very serious significance crystals with approximately 60e80% sweetness that during the production and storage of the food, of sucrose, with no caloric effect and good di- and it may affect how the ingredient itself is gestibility without impacting blood glucose and in- stored. Polyols that are highly water-soluble also sulin levels [47,48]. Its other general features include tend to be very hygroscopic. This behaviour may high stability in acidic and alkaline environments, assist in adding and retaining moisture in food and high stability against heat [46]. products [16,25]. Molecular weight: The molecular weight of 2.2. Physical and chemical properties polyols is important when replacing sugars with polyols, to ensure the colligative properties The probability of a sugar alcohol to be used as a remain unaffected. It can impact the texture, sweetener depends on its properties which include viscosity, osmotic pressure, freezing properties physical, chemical, processing and sensory (Table 1) and crystallization [40]. [16]. These compounds have numerous common Reducing power: Sugar alcohols have additional properties that are important in selecting the most hydrogen atoms which can be deposited on suitable polyol for a food application, these include: other metabolites to produce chemically reduced products and intermediates of metabolism [19]. Sweetness: Sweetness is an important property Reducing power of different sugar alcohols of any sugar alcohol or sugar alternative. The denote the level of their antioxidant activity sweetness of sugar alcohols is measured rela- [50,51]. tively to the sweetness of sucrose or table sugar. Hydrophilicity: Sugar alcohols have a great The sweetness of sugar alcohols varies from half number of hydroxyl groups making them readily as sweet to equal of that of sucrose (Table 2) soluble in saliva. Xylitol and erythritol are highly [9,39]. hydrophilic sugar alcohols which are able to Cooling Effect (Heat of solution): Each sugar compete with water molecules for the hydration alcohol is characterized by negative heat of so- layer of biomolecules [19]. lution which is the energy requiring process to Absence of a reducing carbonyl group: This dissolve the crystals. Some polyols such as iso- property makes the molecules less reactive malt have a noticeable high heat in solution chemically than the corresponding ketoses and followed by a cooling effect in the mouth. aldoses. Therefore, some polyols avoid these Cooling effect together with sweetness are midst chemical reactions that make many dietary the most important properties of polyols in their hexose-based sugars acidogenic and cariogenic use in pharmaceutical products with soothing in human dental plaque [52].
Table 1. Chemical and physical characteristics of Sugar Alcohols [Adapted from Refs. [9,37,49]. Sugar alcohol Molecular weight Melting point ( C) Heat of solution Viscosity at 25 C Hygroscopicity Xylitol 152.15 94 36 Very low Medium Sorbitol 182.17 97 26 Medium High Mannitol 182.172 165 29 Low Low Maltitol 344.313 150 19 Medium Medium Lactitol 344.313 94 14 Very low Very low Isomalt 688.62 167 9 High Low Erythritol 122.12 121 43 Very low Very low JOURNAL OF FOOD AND DRUG ANALYSIS 2021;29:1e14 5
Table 2. Relative sweetness of sugar alcohols compared to sucrose Table 3. Caloric values of sugar alcohols [Adapted from Refs. [35,47]]. [Adapted from Ref. [9]]. Sugar alcohols Caloric value (kcal/g) ¼ Sugar alcohol Sweetness (Sucrose 1) Europe Japan America Mean caloric value Xylitol 1.0
Xylitol 2.4 3 2.4 2.6 REVIEW ARTICLE Sorbitol 0.5e0.7 e Sorbitol 2.4 3 2.6 2.7 Mannitol 0.5 0.7 Mannitol 2.4 2 1.6 2 Maltitol 0.9 e Maltitol 2.4 2 2.1 2.1 Lactitol 0.3 0.4 Lactitol 2.4 2 2 2.1 Isomalt 0.45e0.65 e Isomalt 2.4 2 2 2.1 Erythritol 0.6 0.8 Erythritol 0 0 0 0 Sucrose 4 4 4 4