The Calorie Control Council thanks the American Dental Association (ADA) for permission to use the ADA statement on the "Role of Sugar-Free Foods and Medications in Maintaining Good Oral Health" in this brochure. For additional oral health information, please visit the ADA web site at www.ada.org.

To maintain good health it is very important to satisfy your body's basic nutritional needs. Without a balanced diet your body cannot function efficiently. A balanced diet includes eating a variety of foods every day. Be sure to choose foods from each of the five major food groups -- milk, yogurt and cheese; meat, poultry, fish and alternatives; fruits; vegetables; and bread, cereals and other grain products.

Of course, you may also want to enjoy an occasional sweet or between meal treat. When you do, consider choosing one that is "sugar-free." People often say they regularly use low or reduced-calorie sugar-free foods and beverages to stay in better overall health, or simply because they taste good. When you read the labels of these foods you will see that many contain ingredients called "sugar alcohols," commonly called polyols. But don't be confused or concerned! Sugar alcohols are completely different than sugar and alcohol that most people know. In fact, sugar alcohols are not sugars and they do not contain alcohol. They are a group of unique ingredients that can substitute for sugars, but that also have some special advantages.

It's easy to find products from which sugars have been removed and replaced with sugar-free ingredients. Simply look for "sugar-free" on the food label. If you look at the ingredient list you will find that many of these foods contain one or more of the following ingredients: erythritol, hydrogenated starch hydrolysate (sometimes listed as maltitol syrup, hydrogenated glucose syrup, or simply "HSH"), isomalt, lactitol, maltitol, mannitol, sorbitol and xylitol. These ingredients are all polyols. The term "sugar alcohols" or the name of the individual polyol will also appear in the ‘Nutrition Facts" box.

Polyols have been used for many years to replace sugars in a wide variety of products such as chewing gums, candies, ice cream, baked goods and fruit spreads. They have also been widely used in products such as toothpastes, mouthwashes, cough syrups, and cough drops. The safety and variety of polyols means more and more sugar-free foods are becoming available. And, they taste good.

In addition to their good clean taste, polyols provide some important health benefits. For example, polyols have fewer calories than sugars. Foods that are sweetened with polyols have been of interest to people with diabetes for many years since they do not cause sudden increases in blood sugar levels. Also, while many people believe that tooth decay is no longer a problem in the U.S., tooth decay actually continues to be a major oral health problem. Importantly, polyols do not promote tooth decay (cavities) because bacteria in the mouth cannot easily change polyols to acids that can damage teeth.

Reading the label of a sugar-free food can also help you determine what benefits it may offer. Look for statements such as "low calorie" or "reduced calorie" on the package if weight control is of interest to you. Information on calories and the total carbohydrate content of a serving is also provided in the "Nutrition Facts" box, and may be of particular interest to people with diabetes. If a healthy smile is important to you, look for the FDA approved health claim on the label. It will appear as a statement such as "does not promote tooth decay."

Since most polyols are not as sweet as sugar they are often used in combination with approved low-calorie sweeteners such as acesulfame potassium, aspartame, saccharin or sucralose. These low-calorie sweeteners, like polyols, do not promote tooth decay.

In some people, excessive consumption of polyol-containing foods may cause gastrointestinal symptoms, including laxative effects, similar to reactions to beans and certain high-fiber foods. Such symptoms are dependent upon an individual’s sensitivity and the other foods eaten along with the polyol-containing product. Any gastrointestinal symptoms (such as a feeling of fullness) from consuming foods with polyols, if they occur at all, are usually mild and temporary. Most people will adapt to polyols after a few days, the same way they do to high fiber foods.

More on Dental Health

The benefits of sugar-free foods have long been recognized in many countries. In the U.S., after extensive review of scientific data, the U.S. Food and Drug Administration approved a "does not promote tooth decay" health claim for sugar-free products sweetened with sugar alcohols. Only sugar-free products that meet FDA's strict requirements to assure that they are safe for the teeth are allowed to carry the health claim on their label.

The American Dental Association (ADA), representing well over 100,000 professionals and experts in the field of dentistry and dental health, also agrees that sugar-free foods do not promote tooth decay. The ADA has officially acknowledged this conclusion in their policy statement "Role of Sugar-Free Foods and Medications in Maintaining Good Oral Health."

The ADA emphasizes that many factors play a role in tooth decay. In addition to the presence of cavity-causing bacteria in the mouth, other important factors include: the type of food containing sugars or starches eaten; the frequency of eating sugar-containing foods; oral hygiene habits; the availability of fluoride; and the amount of saliva and its components. The ADA also recognizes the importance of overall good nutrition and states, "it is neither advisable nor appropriate to eliminate from the American diet sugar-containing foods that provide necessary energy value for optimal nutrition."

The ADA strongly recommends, however, "that major efforts be made to promote the use of sugar-free foods or chewing substances in place of sugar-containing foods that involve a frequent intake or repeated oral use . . . use of these sugar-free products will contribute to improved oral health."

As the interest in eating healthy, reduced-calorie, sugar-free foods continues to grow, many additional good-tasting sugar-free products using the "does not promote tooth decay" health claim are expected to become available. So, when looking for that special treat, consider choosing a sugar-free product that does not promote tooth decay. Not only will it taste good, it can help to prevent cavities.

REFERENCES

American Dental Association. Position Statement on the Role of Sugar-Free Foods and Medications in Maintaining Good Oral Health. Adopted October 1998.

McNutt, K., Sentko, A. Sugar Replacers: A Growing Group of Sweeteners in the United States. Nutrition Today, 31(6):255-261, November/December 1996.

Office of the Federal Register, General Services Administration, Code of Federal Regulations, Title 21, Section 101.9, Nutrition labeling for food. Washington, DC, U.S. Government Printing Office, 1998.

Office of the Federal Register, General Services Administration, Code of Federal Regulations, Title 21, Section 101.80, Health Claims: dietary sugar alcohols and dental caries. Washington, DC, U.S. Government Printing Office, 1998.

U.S Department of Agriculture/U.S. Department of Health and Human Services. Nutrition and Your Health: Dietary Guidelines for Americans. Fourth Edition, 1995.