Polyols and sugar-free products
Products labelled "sugar-free" often contain polyols instead of sugar. Polyols are carbohydrates, and they are absorbed to different degrees. That means not everything sugar-free is the same for blood glucose and ketosis.
What are polyols?
Polyols, also called sugar alcohols, are used as sweeteners in sugar-free products. The most common are sorbitol, xylitol, maltitol, isomalt, lactitol, mannitol and erythritol. Even though the name contains "alcohol", these are carbohydrates, and they count towards the total carbohydrate intake.
"Sugar-free" does not mean carbohydrate-free
The term "sugar-free" means the product contains at most 0.5 grams of sugar per 100 grams. The product can still contain polyols, starch or other carbohydrates. Sugar-free sweets, chewing gum, drops, cordial, jam and ice cream often contain maltitol or sorbitol in addition to starch, and can therefore affect ketosis even when the packaging says sugar-free.
Polyols are absorbed to different degrees
Erythritol is largely not absorbed and is mostly excreted unchanged in the urine. Sorbitol, xylitol and maltitol, on the other hand, are broken down or fermented in the gut and can give a noticeable rise in blood glucose. Maltitol comes closest to regular sugar in effect. How an individual child responds varies and must be assessed individually – blood glucose and ketones are followed up as the treatment team has decided.
How to read the declaration
In Norwegian and EU labelling, polyols appear as a sub-line "of which polyols" under carbohydrate. That means they are already included in the total carbohydrate figure, and you should not subtract them yourself. Use the carbohydrate figure as it stands in the declaration. If you are considering sugar-free products, discuss it with the clinical dietitian first.