Palatinose

Palatinose (Isomaltulose): A Comprehensive Reference

1. Identity, Nomenclature, and Natural Sources

Chemical Identity

Isomaltulose (trade name Palatinose, chemical name 6-O-α-D-glucopyranosyl-D-fructose) is a disaccharide carbohydrate composed of glucose and fructose. It is a reducing disaccharide with the chemical name 6-O-α-D-glucopyranosyl-D-fructofuranose (CAS No. 13718-94-0); it is composed of glucose and fructose linked α-1,6 instead of α-1,2.

The prototype of sucrose isomers is provided by isomaltulose (marketed under the brand name Palatinose), which consists of a glucose–fructose dimer similar to sucrose. However, the two sugars are linked by an α1,2-glycosidic bond in sucrose and by an α1,6-glycosidic bond in isomaltulose. This single structural difference—the type of glycosidic bond—is ultimately responsible for isomaltulose's markedly different physiological properties.

Compared to sucrose, isomaltulose has high stability, is tooth-friendly, has slow digestibility, and 40–50% of the sweetening power of sucrose. It tastes similar to table sugar with half the sweetness. It has the same energy as table sugar, but is digested slower and thus leads to a lower blood glucose and insulin response.

Natural Occurrence

Isomaltulose (6-o-α-d-glucopyranoside-d-fructofuranose) occurs naturally in honey, beet, and sugar cane (<2% of sugars) and is manufactured by rearrangement of sucrose. Its natural presence in common foods means it is not a novel compound to human metabolism, a fact that has influenced its regulatory evaluation.

Commercial Forms and Preparations

This glucose-fructose disaccharide isomaltulose, discovered in Germany in 1957 and marketed under the brand Palatinose™, occurs naturally in small amounts in honey and sugar cane juice. Palatinose™ is made from sugar beet by strengthening the glucose-fructose linkage with the help of natural enzymes. Commercial isomaltulose (Palatinose®) is manufactured from food-grade sucrose by enzymatic rearrangement of the glycosidic linkage from a (1,2)-fructoside to a (1,6)-fructoside followed by crystallization.

Palatinose™ (isomaltulose) is purely based on sucrose from sugar beet. It is 100% vegan, kosher, halal, and non-GMO. It is generated through enzymatic rearrangement of the glycosidic bond between glucose and fructose from an α-1,2 linkage in sucrose to an α-1,6-glycosidic bond in Palatinose™. The final product is a pure, white, crystalline powder. On food labels and ingredient lists of retail products, the term Isomaltulose is used.

Industrially, multiple bacterial species are employed as biocatalysts. Industrial bioconversion of sucrose to isomaltulose happens through the enzymatic activity of sucrose isomerases from numerous microorganisms, including Protaminobacter rubrum, Erwinia rhapontici, Serratia plymuthica, and Enterobacter sp. FMB-1. The enzyme responsible for this conversion is a sucrose isomerase (SI; EC 5.4.99.11), which was first isolated from Protaminobacter rubrum by Weidenhagen and Lorenz in 1957. The current large-scale production of isomaltulose is still carried out using immobilized cells of this organism.

Isomaltulose is commercially available as a bulk crystalline ingredient used in a wide range of food and beverage applications, including sports drinks, functional beverages, breakfast cereals, dairy products, nutrition bars, and infant and follow-on formulas. Novel food forms, such as isomaltulose syrup (dried), consist of a mixture of mono- and disaccharides in powder form, mainly composed of isomaltulose (≥75%) and trehalulose (<13%).

2. Historical Discovery and Traditional Use

Discovery

Historically, isomaltulose was first mentioned in a 1952 article as a by-product of a fermenting micro-organism, Leuconostoc mesenteroides. In an article published in the Angewandte Chemie journal, Weidenhagen & Lorenz (1957) investigated sucrose metabolism in 45 bacterial strains isolated from the sugar manufacturing process; they reported that one of the strains, probably of the Enterobacteriaceae family, produced a reducing disaccharide, which was until then unknown. The authors reported that this disaccharide is produced from the isomerization of sucrose by enzymatic action using glucosyltransferases. The proposed name was Palatinose, due to the region where it was obtained; however, it could also be called isomaltulose on account of the nomenclature already mentioned by Stodola et al. in 1954 and 1956.

Isomaltulose was first identified and documented by researchers Weidenhagen and colleagues at a SUEDZUCKER sugar production facility in Germany's Palatinate region. The brand name Palatinose™, under which it is commercially available today, reflects this origin. Following its discovery, SUEDZUCKER explored the unique properties of isomaltulose, recognizing its potential as a "slow-release" sugar alternative offering a more gentle energy supply compared to regular sugar.

Early Commercial Use

Isomaltulose has been used as food in Japan since 1985. The taste and appearance of isomaltulose are similar to sucrose, while its sweetening power is about half of that of sucrose. Commercial isomaltulose is produced from sucrose by enzymatic rearrangement and has been used as a sugar in Japan since 1985. Japan remains one of the longest-standing markets where isomaltulose has been accepted and consumed. Unlike many botanical dietary supplements, isomaltulose has no documented pre-modern or traditional ethnomedical history; it is an ingredient whose properties were identified through 20th-century food chemistry.

3. Key Constituents and Mechanisms of Action

Molecular Structure and Digestion

Ingested isomaltulose is metabolised by the sucrase–isomaltase complex in the intestinal mucosa. Equal parts of glucose and fructose are produced and absorbed, contributing 4 kcal/g, as does sucrose. The key difference between the metabolism of sucrose and isomaltulose is that the hydrolysis of isomaltulose proceeds at a much slower rate than that of sucrose.

After ingestion, the enzymatic digestion of sucrose and isomaltulose occur on the same sucrase-isomaltase enzyme complex, which is located in the small intestine. Several studies show that this complex breaks down isomaltulose more slowly than sucrose. The maximum rate at which isomaltase can process isomaltulose (V_max) is 4.5 times lower than that of sucrase for sucrose.

While the same sucrase-isomaltase complex enzyme system used to hydrolyse other carbohydrates is also used to hydrolyse isomaltulose, enzyme kinetic studies show that in the small intestine, the presence of the stronger α-1,6 glycosidic bond causes the rate of isomaltulose hydrolysis to be 20–25% slower than sucrose.

Glycemic and Incretin Effects

As a result of its slow digestion, isomaltulose travels further through the human small intestine than sucrose does, as evidenced by the difference in incretin responses they elicit. Compared to sucrose, isomaltulose leads to lower secretion of the incretin hormone GIP (glucose-dependent insulinotropic polypeptide), which is released from the upper (proximal) part of the small intestine.

One plausible explanation for the acute effects of isomaltulose on glycemic variability is the increased secretion of glucagon-like peptide-1 (GLP-1) and the decreased secretion of glucose-induced insulinotropic peptide (GIP). The main impact of the slower hydrolysis rate of isomaltulose is that the resulting glycaemic and insulin responses of healthy subjects and those with type II (non-insulin dependent) diabetes are attenuated.

Oral Microbiota and Dental Effects

In comparison with sucrose and most other carbohydrates, isomaltulose is not a significant substrate for oral bacteria. This property is central to its non-cariogenic classification and is elaborated under the dental health section below.

4. Scientific Evidence by Area of Use

4.1 Glycemic and Insulinemic Response

Clinical Evidence

The most extensively studied attribute of isomaltulose is its effect on postprandial blood glucose and insulin. A systematic review and meta-analysis (PRISMA guidelines) searched PubMed, Cochrane Library, and ClinicalTrials.gov for randomized controlled trials or crossover studies comparing isomaltulose and sucrose. Ten studies were included, involving 367 participants. The meta-analysis showed that isomaltulose significantly reduced plasma glucose level at 60 min post-meal compared to sucrose (MD: −7.99, 95% CI: −8.58, −7.39, p < 0.00001). The authors noted, however, that only studies involving diabetic or glucose-sensitive participants were included in the primary pooled meta-analysis, while studies focusing exclusively on healthy individuals were evaluated narratively or through subgroup analysis.

Notable variability in study results was observed, which may be attributed to multiple factors such as participant demographics and meal composition. The findings from the analysis are supportive for the use of isomaltulose as a beneficial dietary alternative to sucrose for managing postprandial glycemic levels in diabetic patients.

An earlier, larger systematic review and meta-analysis published in Advances in Nutrition (2022) examined RCTs from four countries (Japan, Brazil, Germany, and the Netherlands). The trials were conducted in participants with various health conditions. Moderate evidence suggested that oral isomaltulose caused an attenuated glycemic response compared with sucrose at 30 min. Evidence regarding the effect of isomaltulose on glycemic and insulinemic responses is still conflicting, which limits isomaltulose's application in glycemic management.

An early landmark human study reported by Kawai et al. (1985) demonstrated that after administration of 50 g of isomaltulose or sucrose to healthy volunteers, the maximum increase in glucose concentration after 60 min was 110.9 mg/dL vs. 143.3 mg/dL, respectively.

Metabolic Syndrome Population

A study investigated the postprandial metabolic response at rest and during physical activity following low glycemic carbohydrate isomaltulose (Palatinose™) intake compared with a conventional carbohydrate (glucose syrup/sucrose) with a higher glycemic index. Twenty overweight or obese men (32–64 years old) with the metabolic syndrome and insulin resistance were enrolled in this double-blinded, randomized, cross-over study. In the morning, a breakfast consisting of a 250-mL drink and 140 g of cookies containing a total of 50 g of Palatinose™ or glucose syrup/sucrose was consumed.

A more recent double-blind, randomized, placebo-controlled crossover study examined the "second meal effect." The study recruited 15 adults with metabolic syndrome, who consumed either 50 grams of isomaltulose or a matching dose of sucrose. Compared to a sucrose control, Palatinose resulted in a lower glucose response compared to sucrose, including a significantly lower blood glucose peak; the supplement also significantly increased GLP-1 and PYY by comparison. This resulted in a slower and lower blood glucose response to lunch, which is known as a "second meal effect," suggesting that Palatinose supports metabolic stability across meals. This prolonged hormone response can stabilize blood glucose levels and improve insulin release, potentially increasing insulin sensitivity.

Type 2 Diabetes

In one 2012 study, replacement of sucrose with isomaltulose for 12 weeks in individuals with type 2 diabetes resulted in lower blood triglyceride levels but not lower HbA1c levels. This finding illustrates that while acute postprandial effects are well-established, longer-term glycated hemoglobin benefits remain less certain.

Glycemic Index Value

Isomaltulose has a low glycemic index (GI = 32–37) and low insulinemic response, so it might be more suitable for diabetics than sucrose. The replacement of conventional higher glycaemic carbohydrates (glycaemic index >70) such as maltodextrins by isomaltulose (Palatinose™, glycaemic index = 32) can lead to a follow-on formula with a lower glycaemic and insulinaemic response.

Strength of Evidence

The evidence that isomaltulose produces a lower and more sustained postprandial blood glucose response than sucrose is strong and consistent across multiple controlled crossover trials and meta-analyses. The evidence for meaningful long-term reductions in HbA1c or other chronic glycemic markers is more limited and preliminary, requiring further investigation.

4.2 Sports Performance and Fat Oxidation

Clinical Evidence

Several RCTs have investigated isomaltulose as a pre-exercise carbohydrate with a hypothesized glycogen-sparing effect via enhanced fat oxidation. The hypothesis was that isomaltulose ingestion before exercise would favor fat oxidation during the initial endurance exercise, leading to glycogen sparing in the muscle and liver. The spared glycogen would then be available for improved performance during a subsequent time trial.

In a randomized, double-blind, controlled trial published in Nutrients (2016), twenty male athletes participated (age 29 ± 3 years, VO₂max 61.3 ± 1 mL/kg/min). Subjects were eligible if they were healthy experienced endurance cyclists (VO₂max >55 mL/kg/min). In comparison to maltodextrin, fat oxidation was higher (88%–99% likelihood; p = 0.005) and carbohydrate oxidation was lower following isomaltulose (Palatinose).

A 2007 study at the University of Birmingham examined exogenous carbohydrate oxidation during moderate-intensity exercise. Peak exogenous carbohydrate oxidation rates were higher during the sucrose trial (0.92 ± 0.03 g/min) than during the isomaltulose trial (0.54 ± 0.05 g/min). Total endogenous carbohydrate oxidation over the final 90 min of exercise was lower in the sucrose trial than in the water and isomaltulose trials. Oxidation of ingested isomaltulose was significantly less than that of sucrose, most likely due to the lower rate of digestion of isomaltulose. A lower carbohydrate delivery and a small difference in plasma insulin may have resulted in higher endogenous carbohydrate use and higher fat oxidation during the isomaltulose trial than during the sucrose trial.

A 2021 double-blind, randomized, crossover trial published in the Journal of the International Society of Sports Nutrition investigated the effects of isomaltulose compared to glucose and maltodextrin in endurance runners. Twenty-one male recreational endurance runners performed a 70-min constant load trial at 70% maximal running speed (V_max), followed by a time to exhaustion (TTE) test at 85% V_max after ingesting either 50 g isomaltulose, maltodextrin, or glucose. In conclusion, 50 g isomaltulose ingestion seems to have a more advantageous effect on blood glucose, insulin and GIP response compared to maltodextrin and glucose, as was shown by reduced postprandial absolute concentrations and a lower rate of fluctuation during treadmill running exercise. However, glucose availability, as well as fat and carbohydrate oxidation rates, remained unaffected.

Ingestion of low-glycemic index isomaltulose not only suppresses subsequent carbohydrate oxidation but also inversely retains more carbohydrate after prolonged endurance exercise. Therefore, isomaltulose intake may affect anaerobic power output after prolonged endurance exercise.

Strength of Evidence

Evidence on fat oxidation during exercise is moderately consistent, with several well-controlled studies showing increased fat oxidation with isomaltulose versus sucrose or maltodextrin. Evidence for direct endurance performance improvement is mixed; some trials show modest benefit while others show no difference. The 2021 trial noted that evidence concerning performance benefits and physiological responses has produced varying results. Overall, metabolic effects (lower blood glucose and insulin, lower GIP) are more reliably demonstrated than performance outcomes.

4.3 Dental Health (Non-Cariogenicity)

Clinical Evidence and Regulatory Status

The dental properties of isomaltulose have been acknowledged by relevant authorities and established in corresponding claims regulations: in the US, isomaltulose is included in the list of non-cariogenic carbohydrate sweeteners for which dental health claims have been approved by the US FDA as laid down in the Code of Federal Regulations (US FDA 2008). In the EU, a dental claim has been approved for isomaltulose and laid down in the Annex of Regulation (EU) 432/2012, following a positive opinion from the European Food Safety Authority (EFSA 2011).

In comparison with sucrose and most other carbohydrates, isomaltulose is not a significant substrate for oral bacteria. This non-cariogenicity arises because oral streptococcal species that drive caries formation do not readily ferment isomaltulose's α-1,6 linkage, meaning they generate little to no acidic by-products that could demineralize enamel.

Strength of Evidence

The non-cariogenic property of isomaltulose is among the best established of its attributes, supported by in vitro, animal, and human plaque pH studies, and recognized by both US FDA and EFSA through formal regulatory approvals.

4.4 Cognitive Performance and Brain Glucose Supply

Clinical Evidence

The rationale for investigating isomaltulose and cognition stems from its sustained glucose release, which might theoretically provide a more stable fuel supply to the brain. To examine the effect of modulating glycemic response using isomaltulose on cognitive function, 24 healthy male adult participants consumed energy and macronutrient-matched milk-based drinks containing 50 g isomaltulose, 50 g sucrose, or a water control in a counterbalanced within-subject design. Neither administration of the sucrose nor isomaltulose drinks produced consistent effects on verbal or working memory, or psychomotor performance.

A large randomized crossover trial in 70 healthy adults published in Nutrients (2019) assigned participants to isomaltulose and sucralose (low-GI) beverage or a high-GI sucrose beverage. In summary, cognitive performance was unaffected by different glycaemic responses to beverages during the postprandial period of 140 min.

However, a separate randomized, double-blind, placebo-controlled crossover study in 64 healthy Japanese adults examined attention specifically, finding that palatinose intake was found to maintain attention better than glucose in healthy adults. This effect of palatinose on attention was caused by increased cerebral blood flow.

In children, a study on the glycaemic properties of isomaltulose at breakfast concluded that although isomaltulose produced a lower blood glucose profile than sucrose, there were no differences in memory or psychomotor performance.

A 2026 study in adults using an energy drink format reported that "non-inferiority between sucrose and isomaltulose was shown for all assessed cognitive domains except for composite memory, verbal memory, and visual memory."

Strength of Evidence

Evidence for cognitive benefits of isomaltulose over sucrose is weak and inconsistent. Most well-designed trials show no significant differences in memory or psychomotor performance between isomaltulose and sucrose. One study demonstrated a positive effect on attention via cerebral blood flow, but this requires independent replication. At present, cognitive benefits cannot be considered established.

4.5 Gut Microbiota and Gastrointestinal Health

Clinical Evidence

Meals with isomaltulose-sweetened drinks compared to meals with sucrose-sweetened drinks induced lower postprandial glycemia. Moreover, glucose oscillations over 24 hours were lower on isomaltulose when compared to sucrose test days. Responder analysis revealed that 72% of participants benefited from the sugar replacement with isomaltulose and that their gut microbiota differed from the low responders. Taken together, the incorporation of isomaltulose into the habitual diet was shown to be an effective strategy to improve glucose control and beneficially modulate gut microbiota.

The potential prebiotic role of isomaltulose has been proposed because its slower transit through the small intestine delivers glucose and fructose to more distal intestinal regions, which may alter the fermentation environment. The low glycaemic potential of isomaltulose has fuelled many recent in-vitro, animal and human studies including randomised-controlled trials and cohorts. Researchers have discussed the chemical and physiological properties of isomaltulose in relation to its potential health effects, with a focus on its prebiotic properties. However, unlike classical prebiotics (e.g., inulin, fructooligosaccharides), isomaltulose is fully digested in the small intestine and does not reach the colon intact, meaning its microbiota-modulating effects, if real, operate through indirect mechanisms such as changes in luminal glucose and altered incretin secretion rather than direct bacterial fermentation.

Strength of Evidence

Gut microbiota findings are preliminary and largely based on retrospective analyses or small studies. The mechanistic basis for direct prebiotic activity is limited since isomaltulose is fully absorbed before the colon. This area requires further prospective RCT data.

4.6 Cardiovascular and Metabolic Risk Markers

Clinical Evidence

Isomaltulose, D-tagatose, and trehalose are naturally occurring, low glycemic sugars widely used in food industries. Various studies have shown that these carbohydrates can regulate glucose metabolism and provide support in maintaining glucose homeostasis in patients with diabetes, but also can improve insulin response, subsequently leading to better control of hyperglycemia.

A consequence of slower hydrolysis of the isomaltulose molecule is a reduced glycemic and insulin reaction in healthy individuals and those with T2DM (not insulin-dependent), with a steady, low, and sustained growth in blood glucose levels. Reduced postprandial glucose excursions and lower insulin spikes over time are theoretically relevant to cardiometabolic risk, though direct cardiovascular endpoint trials with isomaltulose in humans are limited.

The increase in mean amplitude of glycemic excursions (MAGE) evoked by physical inactivity was significantly prevented by the consumption of low-GI beverages with isomaltulose. Reduced glycemic variability is recognized as an independent risk marker in metabolic disease, and isomaltulose's reduction of this metric represents a clinically meaningful finding.

Strength of Evidence

Evidence is supportive that isomaltulose favorably modifies postprandial metabolic parameters (glucose, insulin, GIP, glycemic variability). Long-term data on hard cardiovascular outcomes or atherosclerosis progression are absent. Current evidence is best characterized as promising but preliminary in this domain.

4.7 Infant and Pediatric Nutrition

Clinical Evidence

Isomaltulose has been studied in infant formula. Both isomaltulose-containing and control formulae were well accepted without differences in time of crying, flatulence, stool characteristics, and the occurrence of adverse events. The expected lower postprandial plasma insulin and blood glucose level due to replacement of high glycaemic maltodextrin by low glycaemic isomaltulose were not observed in the single time-point blood analysis. In infants aged 4 to 8 completed months fed a liquid formula, peak blood glucose might be reached earlier than 60 min after start of feeding. This suggests that the single-time-point measurement design may have missed the relevant window for metabolic differences in infants.

5. Body Systems and Health Areas Associated with Palatinose

• Endocrine/Metabolic system: Attenuates postprandial blood glucose and insulin response; reduces GIP secretion; increases GLP-1 and PYY secretion; may improve insulin sensitivity with longer-term use.
• Gastrointestinal system: Slow hydrolysis by the small intestinal sucrase-isomaltase complex; complete absorption without significant colonic fermentation; may influence incretin pattern and satiety hormones.
• Oral/Dental system: Non-cariogenic; not significantly metabolized by cariogenic oral bacteria.
• Musculoskeletal/Exercise physiology: Promotes fat oxidation during aerobic exercise; may contribute to glycogen sparing.
• Neurological/Cognitive system: Theoretical sustained brain glucose supply; one study showed improvement in attention via cerebral blood flow; most memory and psychomotor outcomes show no difference from sucrose.
• Cardiovascular system: Indirect evidence through reduction of glycemic variability and postprandial insulinemia; no direct cardiovascular endpoint trials.

6. Dosage Forms and Dosages Reported in Studies

Isomaltulose is used in food and supplement contexts as a bulk crystalline ingredient, most commonly incorporated into beverages, beverages mixes, bars, and encapsulated or powdered products. The following dosages were reported in clinical studies:

• 50 g per serving: The most frequently used dose across human studies. Studies used 50 g isomaltulose in a milk-based drink for cognitive assessments in 24 healthy male adults. 50 g isomaltulose was used in a running exercise trial in 21 male recreational endurance runners. 50 grams of isomaltulose were consumed in a crossover study in 15 adults with metabolic syndrome.
• 50 g pre-exercise: A breakfast consisting of a 250-mL drink and 140 g of cookies containing in total 50 g of Palatinose™ was consumed in a study of 20 overweight men with metabolic syndrome.
• 50 g bedtime dose: In a randomized, controlled, cross-over study, 20 healthy young men consumed a drink containing either 50 g of isomaltulose or glucose before bedtime.
• 12-week dietary replacement: In one 2012 study, replacement of sucrose with isomaltulose for 12 weeks in individuals with type 2 diabetes was used to assess longer-term metabolic outcomes.
• In formula for infants: Used to partially replace maltodextrin in follow-on formula to assess glycemic and insulinemic response in infants aged 4–8 months, as noted in a published RCT.

The caloric value of isomaltulose is the same as sucrose: equal parts of glucose and fructose are produced and absorbed, contributing 4 kcal/g.

7. Safety Considerations

Regulatory Status

Isomaltulose is classified as "generally recognized as safe" (GRAS) in the USA and has been approved following a premarket safety estimation as a dietary component following the Novel Food Regulation in the European Union (EU) in 2005. In the European Union, isomaltulose is considered a novel food—a food that was not used in considerable amounts in the EU before the year 1997.

The information provided on the manufacturing process, composition, and specifications of isomaltulose syrup (dried) is sufficient and does not raise safety concerns per the EFSA NDA Panel assessment (2024). No absorption, distribution, metabolism and excretion (ADME) or toxicological data specific to the novel food form were provided; instead, the safety was assessed based on literature data available on isomaltulose and mixtures of isomaltulose and trehalulose. The Panel considered that such data were sufficient to conclude that the novel food is as safe as sucrose.

Isomaltulose is an acrogenic sugar with a low glycemic index and has been licensed as a food or food additive since 2005.

Toxicological Profile

In several subchronic toxicity studies, the administration of large doses (up to 7.0 and 8.1 g/kg body weight/day in male and female rats, respectively) of isomaltulose did not result in adverse effects. Isomaltulose ingested by healthy individuals in amounts up to 50 g per serving have not caused any side effects.

Genotoxicity has been evaluated in the context of the enzyme preparation used in isomaltulose production: genotoxicity tests did not indicate a safety concern. The systemic toxicity was assessed by means of a repeated dose 90-day oral toxicity study in rats. The panel identified a no observed adverse effect level of 1,011 mg TOS/kg body weight per day, the highest dose tested.

In infant nutrition trials, both isomaltulose-containing and control formulae were well accepted without differences in time of crying, flatulence, stool characteristics, and the occurrence of adverse events.

Allergenicity

Similarity of the amino acid sequence of the enzyme (sucrose isomerase) to those of known allergens was searched and no match was found. The Panel considered that, under the intended conditions of use, the risk of allergic sensitisation and elicitation reactions by dietary exposure cannot be excluded, but the likelihood of such reactions to occur is considered to be low.

Gastrointestinal Tolerance

When isomaltulose is consumed during prolonged, high-intensity exercise, it may affect gastrointestinal tolerance. One study noted that ingesting isomaltulose versus fructose-maltodextrin during prolonged moderate-heavy exercise increases fat oxidation but impairs gastrointestinal comfort and cycling performance. This finding suggests that individual gastrointestinal tolerance during physical exertion merits consideration.

Specific Populations

Isomaltulose is digested by the sucrase-isomaltase enzyme complex. Individuals with congenital sucrase-isomaltase deficiency (CSID), a rare inherited disorder, may be unable to adequately digest isomaltulose, as sucrase-isomaltase is a bifunctional glucosidase located on the brush border of the small intestine responsible for its hydrolysis. This population would be expected to experience the same gastrointestinal consequences from isomaltulose as from sucrose or isomaltose.

No drug–nutrient interactions with isomaltulose have been identified in the clinical literature reviewed. Its lower glycemic and insulinemic profile compared to sucrose is potentially relevant for individuals on insulin or oral hypoglycemic agents, in whom the reduced postprandial glucose and insulin surge may affect dosing calculations if substituted for sucrose in standardized meal plans; however, this effect has not been systematically characterized in interaction studies.

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