Low glycemic index-Diabetic friendly

Something happened overseas that changed the way I think about raw ingredients.

I was overseas on a factory tour and I asked why 50 lb bags of table sugar were stacked to the ceiling.  The answer was that they were making children's cough syrup.  Turns out sugar was the number one ingredient.  They went on to explain that that was the only way they could make it palatable to children.  A bit shocked, my comment was that my son is  a Type 1 diabetic, so I questioned why sugar was used.   The counter argument was it wasn’t intended for kids with diabetes, yet no disclaimer was on the label.

The same argument was made for orange-flavored keto analogue blends that were available.  The company was rightfully proud of being able to hide the taste of the keto and amino acids because they smell and taste bad on their own.  A lot of time and effort went into making the taste acceptable. Lemon, vanilla, and chocolate were also being tested. 

However, just like the children’s cough syrup, the number one ingredient was a sweetener with a glycemic index higher than table sugar.  

Two main problems with this approach is that 45% to 60% (depending on source) of kidney patients are diabetic or prediabetic.  The amount of sugars/starches/flavorings needed to make this palatable was incredibly high compared to the amount of keto/amino acids in the flavored powder. In one packet or scoop of powder, the vast majority of the powder was basically sugar.  Keto and amino acid content was low in comparison. 

I made the same argument about sugar content, but the counter argument was the same. The product was not made for diabetics, despite being for kidney patients.   The fine print should read something like  “ For non diabetic kidney patients only” in real life.

Second, the problem is magnified because we are on a low-protein diet.  Carbohydrate intake at each meal normally increases as you limit protein intake.  Adding a high glycemic or high sugar supplement to a carbohydrate rich diet is a really bad idea.

Needless to say, we passed on this product/approach.  It made no sense  to go against all available research on this subject.

Studies like this one tell us we should limit high glycemic foods:

Added sugars drive chronic kidney disease and its consequences: A comprehensive review

“Data for animals and humans suggest that the consumption of added sugars leads to kidney damage and related metabolic derangements that increase cardiovascular risk.”

CKD guidelines should stress a reduction in the consumption of added sugars as a means to prevent and treat CKD as well as reduce CKD–related morbidity and mortality.”

Journal of Insulin Resistance 2016

Sugars/starches like table sugar and maltodextrin are of course considered safe by the FDA, but organizations like the National Kidney Foundation and the American Heart Association recommend limiting intake of these high glycemic sugars/starches to the absolute minimum, or eliminate them all together.  Sugar and maltodextrin consumption and related high glycemic sugars/starches are not recommended for anyone, whether they are diabeteic or not. Same for other sweeteners like high fructose corn syrup, which we know is bad for kidney patients. Other studies also suggest that reducing glycemic index may increase kidney function (GFR).

The top five highest glycemic sugars/starches are listed here.  Table sugar has a glycemic index of 100.  Above 100 is worse than table sugar and below 100 is better.

 Common name Glycemic index
Maltodextrin 105
Maltose 100
Dextrose 100
Glucose 100

High Fructose
Corn syrup


Look for these ingredients when you are reading labels.

Ingredients on the label are listed by amounts.  The first ingredient on the label is the one in the greatest amount in the product.  Every protein supplement will have some form of extra ingredients to aid in manufacturing or taste, but we want those extra ingredients to be at the bottom of the list of ingredients, not the top. Ideally, the keto and amino acids will be at the top of the list and the extra ingredients needed for manufacturing/processing will be at the bottom.

The evidence is so overwhelming on this data, I am not going to to list the organizations or studies because:

No organization or regulatory authority on earth recommends high glycemic index products for kidney patients.  Again, zero debate.

Learn to read the labels and look for hidden sugars and starches.  The amounts should be listed on the label. Again, you can always call or email companies to find out the amount of added sugars and starches.  For those of us on a low-protein diet, it likely matters much more than for healthy people on a regular diet. Most of us have enough health problems and dietary restrictions as it is,  we don’t need more bad things in our diet.