Guida ai polioli in chetogenica

Quando si parla di dieta chetogenica dobbiamo fare molta attenzione ai carboidrati: e quando entra in gioco il concetto di polioli - carboidrati solo parzialmente disponibili - è necessario approfondire le caratteristiche di ogni singolo alcool zuccherino.

Con questo approfondimento cerchiamo di fare chiarezza relativamente alla quantità di carboidrati generati dall'ingestione di ogni singolo tipo di polialcol, valutare l'impatto su glicemia e insulina e determinare l'apporto calorico in maniera più precisa.

 

Cosa sono i polioli

I polioli sono una sottoclasse di carboidrati. Il nome è un’abbreviazione del termine “polialcoli” detti anche "alcoli polivalenti", ma sono chiamati anche “carboidrati idrogenati” o “alcoli zuccherini”.

La caratteristica distintiva è la presenza di un gruppo alcolico (>CH-OH) al posto del gruppo carbonilico (>C=O) nelle porzioni aldose e chetose di mono-, di-, oligo- e polisaccaridi; quindi i polioli non sono zuccheri e generalmente portano il suffisso "-itolo" al posto del suffisso "-oso" secondo la moderna nomenclatura dei carboidrati di McNaught.

Che differenza c’è tra polioli e zuccheri?

Gli zuccheri sono legalmente definiti solo ai fini dell'etichettatura nutrizionale come mono e disaccaridi. Al contrario, i polioli possono essere mono-, di- idrogenati, ma anche oligo- e polisaccaridi.

I polioli non sono cariogeni, hanno un basso indice glicemico e insulinemico e un basso consumo energetico e queste caratteristiche sono legate alla proprietà comune dei polioli di essere difficili da digerire o lenti da metabolizzare ma relativamente facili alla fermentazione nel colon.

Qual è l’Indice Glicemico e e l’indice insulinemico dei Polioli?

Interessante è l'indice glicemico (IG) dei polioli per quanto riguarda le implicazioni sulla salute. La letteratura sulla glicemia e l'insulinemia dopo ingestione di polioli è stata analizzata ed ha prodotto i seguenti valori:

POLIOLI	I.G.	I.I.
Eritritolo	0	2
Xylitolo	13	11
Sorbitolo	9	11
Mannitolo	0	0
Isomalto	9	6
Lattitolo	6	4
Maltitolo	35	27
Regular maltitol syrup	52	44
Intermediate maltitol syrup	53	41
High maltitol syrup	48	35
Sciroppo di maltitolo (High Polymer maltitol syrup)	36	31
Poliglicitolo	39	23

Questi valori sono tutti molto inferiori al saccarosio (65), o al glucosio, che viene preso come misura di riferimento (100).

Queste proprietà dei polioli derivano dalla difficoltà alla digestione e all'assorbimento da parte del gruppo alcolico che sostituisce il gruppo carbonile e dalla presenza di legami saccaridici diversi da α1–4 e α1–6 presenti negli amidi e nel saccarosio. Pertanto, una bassa digeribilità e/o un lento rilascio epatico di glucosio è il determinante delle loro proprietà di bassa risposta glicemica e insulinemica.

 

Come vengono digeriti i polioli

All’interno della bocca i polioli resistono alla fermentazione e all'acidogenesi da parte dei microrganismi della placca dentale e non vengono assorbiti in misura significativa attraverso lo stomaco. L'assorbimento avviene per diffusione passiva del poliolo monosaccaride lungo un gradiente di concentrazione. I disaccaridi e i polioli superiori sono troppo grandi per diffondersi dall'intestino nella circolazione in quantità superiori al 2% dell'assunzione orale. Alcuni polioli di-, oligo- e polisaccaridi possono liberare glucosio, ma poiché la loro digestione è lenta e incompleta, ciò non provoca un aumento sostanziale della glicemia.

Una volta assorbiti, i polioli monosaccaridi vengono escreti attraverso i reni, ossidati direttamente o convertiti in glicogeno o glucosio nel fegato. La via del metabolismo e dell'escrezione dipende dalla loro struttura. I carboidrati non assorbiti dai polioli sono generalmente fermentati completamente dalla microflora del colon.

 

I SINGOLI POLIOLI: APPROFONDIMENTO

Andiamo ad approfondire le caratteristiche di ogni singolo poliolo, cercando di distinguere bene tra il concetto di carboidrati assorbiti dalla percentuale calorica rispetto al saccarosio: spesso i due concetti vengono confusi e la differenza risiede nel fatto che solo una percentuale di polioli viene assorbita, mentre la restante parte contribuisce alla fermentazione, per cui il calcolo calorico, quando non determinato da calorimetria indiretta, è stimato attraverso la seguente formula:

Kcal polioli=calore di combustione x (carboidrati disponibili + 0.5 x carboidrati fermentabili)

 

Eritritolo

L’eritritolo è una piccola molecola (a quattro atomi di carbonio, tetritolo) assorbita al 90% per diffusione, con il 10% che raggiunge l'intestino crasso nell'uomo.

L'eritritolo assorbito si distribuisce ampiamente attraverso i tessuti ma il suo metabolismo è minimo ed essendo scarsamente riassorbito attraverso i reni viene essenzialmente escreto nelle urine. Questo spiega perché è il poliolo maggiormente tollerato a livello intestinale con la minore influenza sui livelli glicemici.

L’eritritolo si presenta in forma di microgranuli cristallizzati, di colore bianco e produce un fresco retrogusto a contatto col palato ed è identificato dalla sigla E968.

Il suo indice glicemico è pari a zero, mentre l’indice insulinemico è stimato a 2. Sviluppa solo 0,2 Kcal/gr ma il decreto 1169/11 relativo alle etichettature consente valori nulli. La conversione in carboidrati è irrilevante.

 

Xilitolo

Identificato con la sigla E967, lo xylitolo è un poliolo estratto da betulle, da frutti come le fragole, i lamponi o le prugne ma a volte anche dal grano. Si presenta in forma cristallina di colore bianco ed ha un sapore molto simile al saccarosio.

L'assorbimento dello xilitolo dall'intestino tenue avviene meno facilmente rispetto alla molecola più piccola eritritolo, provocando una maggiore fermentazione nell'intestino crasso. Le stime dell'entità della fermentazione si aggirano attorno al 50 % mentre sulla base dei valori energetici proposto da diversi esperti, si stabilisce un assorbimento del 50 % con escrezioni urinarie inferiori al 2%, per cui si stima un apporto di carboidrati disponibili attorno al 48%

Il fegato sequestra prontamente lo xilitolo assorbito dove viene deidrogenato da una deidrogenasi citoplasmatica dipendente dalla NAD. Lo xilulosio così prodotto viene fosforilato tramite una xilulochinasi specifica a xilulosio-5-fosfato, un intermedio della via del pentoso-fosfato prima della conversione in glucosio, che viene rilasciato solo lentamente nel flusso sanguigno o immagazzinato come glicogeno.

L’indice glicemico e insulinemico dello xylitolo è pari a 13 e 11 rispettivamente.

Le Calorie stimate attraverso la formula citata sono pari a 3Kcal/gr.  Se calcolate per calorimetria indiretta lo xyilitolo è invece stimato a 2Kcal/gr.

 

Sorbitolo

Detto anche glucitolo, è un alditolo estratto generalmente da frutti, come pere, mele, bacche, ciliegie e dalle sorbe, da cui prende il nome. Come l’eritritolo, il sorbitolo rilascia una sensazione di freschezza quando ingerito e si presenta come una polvere bianca facilmente solubile. Viene identificato anche dalla sigla E420.

Le stime dell'assorbimento da soluzioni orali si aggirano al 25% della dose ingerita. Il sorbitolo assorbito viene metabolizzato quasi completamente poiché vengono escrete solo alcune tracce, per cui si stima una conversione in carboidrati del 25%. La deidrogenazione nel fegato avviene tramite la deidrogenasi citoplasmatica dipendente dalla NAD, come per lo xilitolo, con la produzione di fruttosio, quindi glicogeno o glucosio che possono essere lentamente rilasciati nel flusso sanguigno. Il sorbitolo non assorbito è ampiamente fermentato in acidi grassi a catena corta e gas a catena corta, con una notevole resa di acido butirrico in vitro.

L’indice glicemico del sorbitolo è pari a 9, mentre l’indice insulinemico è stimato a 11. Le Calorie stimate sono pari a 2,5 Kcal/gr.

 

Mannitolo

Il mannitolo è un alditolo il cui nome presente in molti vegetali, come conifere, funghi o alghe. Detto anche mannite, viene estratto dalla manna, ovvero dalla linfa del frassino e si presenta generalmente in polvere di colore bianco e a volte viene indicato in etichettatura con la sigla E421.

Diversi studi indicano che il mannitolo viene assorbito approssimativamente al 25% per poi venire escreto nelle urine nella stessa quantità perché è virtualmente non metabolizzabile nei tessuti. Il mannitolo residuo viene fermentato lentamente. L’indice glicemico ed insulinemico del mannitolo è pari a zero.

Le Calorie sviluppate sono 1,5 Kcal/gr. L’etichettatura USA impone di dichiarare 1,6 Kcal per grammo, mentre in EU tutti i polioli (tranne l’eritritolo) vengono dichiarati a 2,4Kcal/gr.

 

Isomalto

L’isomalto è un poliolo disaccaridico misto (alditolo) ricavato dalle barbabietole attraverso un processo chimico e si presenta come una sostanza cristallina, bianca e inodore. La sua sigla è E953.
I prodotti dell'idrolisi sono il glucosio, il sorbitolo e il mannitolo. Sulla base dei valori energetici dell'isomalto suggeriti da varie autorità ed esperti si ritiene che circa il 90% venga fermentato nel colon, con una stechiometria in vivo e in vitro che indica relativamente poca produzione di gas H2. Quindi solo un 10% viene assorbito, con escrezioni urinarie inferiori al 2%, per cui si stima una disponibilità di carboidrati pari all’8%.

Anche l’indice glicemico e insulinemico sono estrememente bassi: 9 e 6 rispettivamente. Le Calorie sviluppate sono pari a 2,2/gr, che si avvicinano estremamente alle 2Kcal calcolate con calorimetria indiretta.

Anche secondo l’etichettatura USA le Kcal sono 2 per ogni grammo.

 

Lattitolo

Il lattitolo (la cui sigla è E966) è un poliolo che si ottiene per idrogenazione del lattosio. La sua formula chimica è C12H24O11 e si presenta in forma di polvere cristallina.

Questo poliolo disaccaride viene assorbito pochissimo, forse il 2% come lattitolo e suoi prodotti di idrolisi, galattosio e sorbitolo. Ciò è dovuto a un'attività molto bassa della beta-galattosidasi nell'intestino umano. Il fegato utilizza prontamente il galattosio e il sorbitolo assorbiti sia nell'accumulo di glicogeno epatico che nella produzione di glucosio epatico. Il lattitolo non assorbito viene completamente fermentato con una stechiometria che fornisce una generosa resa di gas H2 in vivo e in vitro e acido butirrico in vitro.

Le Kcal stimate dalla formula matematica sono 1,9 per ogni grammo mentre per calorimetria indiretta sono pari a 2Kcal/gr. L’indice glicemico (pari a 6) e insulinemico (pari a 4) sono estremamente bassi e giustificati dalla bassissima conversione in carboidrati.

 

Maltitolo

Si tratta di un poliolo disaccaride, identificato con la sigla E965, per il quale è necessaria l'idrolisi prima dell'assorbimento. I prodotti dell'idrolisi sono il glucosio e il sorbitolo.

Per stabilire la percentuale di assorbimento è necessario tenere conto di tre approcci di studio non invasivi su soggetti umani.

1. Un primo approccio indica un limite inferiore di assorbimento del 35 % per il maltitolo (10 g) in soluzione.
2. In secondo luogo, la glicemia e l'insulinemia indicano un limite inferiore all'assorbimento rispettivamente dal 35 al 27 % di formaltitolo (25–50 g) in soluzione.
3. Terzo, sulla base della calorimetria indiretta in seguito all'ingestione di uno sciroppo di maltitolo ad alto polimero contenente il 50% di maltitolo e il 50% di polimero e uno studio separato della frazione polimerica è possibile stimare il valore energetico del maltitolo, che corrisponde a un assorbimento del maltitolo di circa il 32 % se consumato in tre pasti solidi misti intervallati da tre bevande al maltitolo (per un totale di 50 g di maltitolo in 50 g di polimero al giorno).

Sulla base dei valori energetici per il maltitolo proposti da diverse autorità, l'assorbimento è del 40%, con un’escrezione urinaria inferiore al 2% per cui si stima una conversione in carboidrati del 38-40% circa; l’indice glicemico del maltitolo (= a 35) è conforme alla sua conversione in CHO, mentre quello insulinemico è di 27. Le Kcal da formula e da calorimetria indiretta sono abbastanza simili: 2,7 e 2,6 rispettivamente, mentre la legislazione USA impone di calcolare 2,1Kcal/gr, a differenza dell’EU che vede tutti i polioli (con l’eccezione dell’eritritolo) calcolati a 2,4 Kcal/gr.

 

Sciroppo di maltitolo

Si tratta di un idrolizzato di amido idrogenato ed è costituito da una miscela di sorbitolo, maltitolo e oligo- e polisaccaridi idrogenati e si presenta come un liquido viscoso incolore. Sebbene sia identificato con la stessa sigla del maltitolo (E965) in realtà non solo possiede caratteristiche differenti, ma lo “sciroppo di maltitolo” identifica quattro prodotti nettamente diversi:

1. sciroppo di maltitolo normale
2.  sciroppo di maltitolo intermedio
3. sciroppo di maltitolo superiore
4. sciroppo di maltitolo ad alto polimero

 

La disponibilità dei carboidrati delle prime 3 tipologie è vicina al 50%, con un’escrezione urinaria del 2% circa, mentre il restante 50% viene fermentato, generando 3Kcal/gr (le stesse Kcal indicate dalla legislazione USA). L’indice glicemico di 1) 2) e 3) è rispettivamente pari a 52, 53 e 48.

L’ultimo tipo è stato introdotto recentemente: si tratta di uno sciroppo di maltitolo comprendente il 50 % di maltitolo e il 50 % di polimero idrogenato. La frazione ad alto polimero si ottiene riscaldando l'amido ad alta temperatura e bassa umidità in presenza di un catalizzatore acido, che cede dopo separazione un prodotto con un grado medio di polimerizzazione di circa 17, l'introduzione di 1–2 e 1–3 legami glucosidici e quindi una proporzione di legami ramificati. Sulla base dei dati di risposta glicemica e insulinemica, la disponibilità dei carboidrati dello sciroppo di maltitolo alto polimero è di circa il 40 % in base all'idrolisi con α-amilasi e amiloglucosidasi e al rilascio di sorbitolo e glucosio. Questo valore è coerente con la glicemia e l'insulinemia descritte nella presente rassegna.

Sciroppo di poliglicitolo 

Simile agli sciroppi di maltitolo, lo sciroppo di poliglicitolo è un idrolizzato di amido idrogenato, sebbene contenga più sorbitolo (< 20 v. < 8 %) e meno maltitolo (< 50 v. ≥ 50 %). L'assorbimento dei carboidrati dallo sciroppo di poliglicitolo è di entità incerta. Tuttavia, con un IG e un indice insulinemico simili a quelli del maltitolo in polvere (39 e 23 rispettivamente) ha probabilmente una digeribilità intorno al 40%. Viene indicato con la sigla E964.

Le Kcal stimate dalla formula sono pari a 2,8, cifra molto vicina a quella stabilita dalla legislazione USA, ovvero 3Kcal/gr. In EU viene sempre stimata a 2,4 Kcal/gr.

 

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