Joint statement on 'diabetic foods' from the Food Standards Agency and Diabetes UK

Like the rest of the population, people with diabetes are encouraged to maintain a healthy weight and to eat a diet low in fat (particularly saturated fat), added sugar and salt. They are encouraged to eat plenty of fruit and vegetables, and meals based on starchy carbohydrate foods such as bread, chapatti, rice, pasta and yams – choosing wholegrain varieties where possible.

There is no single food that people with diabetes must not eat and the “sugar-free diet” is no longer necessary. However, like everybody, people with diabetes are recommended to eat only small amounts of foods that are high in added sugar and/or high in fat (especially saturated fat) as these can unbalance the diet, increase the risk of heart disease and stroke, and lead to weight gain.

The European Commission is considering how foods intended specifically for people with diabetes can be controlled.

In the UK at the moment the question of whether a manufacturer can label a food 'diabetic' or 'suitable for diabetics' could be referred to the local trading standards officer, who might then ask Diabetes UK for an opinion. The Food Standards Agency advises manufacturers that the use of 'diabetic' claims is not necessary.

The use of nutrition claims such as 'sugar free' is controlled by recent European Union (EU) legislation (EU Regulation 1924/2006). Such claims may only be used if substantiated and on a list of authorised claims. In the medium term further controls will be applied depending on the nutrient profile of the food intended to carry the claim. For more details see the Food Standards Agency website.

The Food Standards Agency is also pressing for changes to the EU requirements for labelling of nutrition information. At the moment, food manufacturers are not required to give nutrition information unless they are making a nutrition claim (such as 'sugar free'). The new EU Regulation on nutrition and health claims made on food will extend this to apply also when health claims are made. The Agency has made a commitment to seek mandatory nutrition labelling on all prepacked foods when the European Commission reviews these rules later this year.

Diabetes UK will continue to work in conjunction with the Food Standards Agency on these and other issues, to improve labelling information so that people with diabetes are given the information they need to choose a healthy diet.

In recent decades, diabetes care has focused on giving personalised advice about healthier food choices. This has replaced the concept of special 'diabetic' foods or a 'diabetic' diet.

'Diabetic' foods became popular in the 1960s when diabetes care focused on eating a sugar-free, low-carbohydrate diet.

By the 1980s, the UK and many other countries had issued national guidelines about diet for people with diabetes, recommending that the main objectives should be to restrict the amount of fat and energy (calories) eaten. This advice was based on scientific studies showing that restricting the amount of carbohydrates eaten, particularly complex carbohydrates, did not help to control diabetes. Restricting the intake of complex carbohydrates can have the undesirable effects of encouraging the selection of more energy dense foods (e.g. cakes, crisps and biscuits) which can be high in sugar and/or fat (especially saturated and trans fat) which are likely to make the long-term complications of diabetes worse, particularly heart disease.

In 1984, UK legislation was introduced to give criteria for the composition of 'diabetic' foods. Products labelled 'diabetic' were no longer permitted to contain more fat and energy than comparable foods. And any product that did not offer a 50 per cent reduction in energy content had to carry a warning saying 'not suitable for the overweight'.

On 1 March 1995, the rules on the composition of 'diabetic' foods were removed because by that time healthy eating advice for people with diabetes was the same as for other people. Diabetes UK was instrumental in removing these rules.

Polyols are nutritive sweeteners and include, for example, sorbitol, maltitol, xylitol, isomalt and mannitol. Some food manufacturers tend to use polyols instead of sucrose to make “diabetic” cakes, biscuits and confectionery. Some products such as chocolate and biscuits that contain polyols can be high in saturated fat and calories and so intake should be limited. Although polyols have fewer calories and less of an effect on blood glucose levels than sucrose, by using it as a replacement in a product you will only be making a limited calorie saving (a maximum of 40 calories from 20g of sweetener).

Polyols are also used in many sugar free confectionary and chewing gum and are better for dental health than sucrose but other potential long term health benefits (e.g. gut health) still need to be established. Despite some benefits of polyols the amounts likely to be consumed in the diet may not be sufficient to benefit people with diabetes in terms of blood glucose control or weight. Further research is needed.

Products containing polyols are safe to consume but should be eaten in moderation. Excessive consumption can cause diarrhoea, flatulence, and a laxative effect especially in young children because of their low body weight. Individuals vary in their tolerance of polyols – check packaging for advice on excessive consumption.
Important note: If polyols are consumed, people who take insulin and count carbohydrate may need less insulin as not all the carbohydrate from polyols is absorbed.