Alan Richman04.01.09
If you don't believe that diabetes is today's most pressing health issue, you haven't been paying attention. Just look at the thickening middles of Middle Americans, not to mention those on both coasts. The standard American diet has failed.
The American Diabetes Association (ADA) estimates that more than 23 million U.S. residents already suffer from the disease, and another 57 million are at risk of developing it. Of all cases, 90-95% are attributable to type 2 diabetes, which results when the body does not produce enough insulin and/or is unable to properly use the insulin it makes. Many of those who have not yet been diagnosed with diabetes are symptomatic of a pre-diabetes condition variously called "Metabolic Syndrome" or, more ominously, "Syndrome X." Frightening as it may seem, says ADA, of those living with these ticking time bombs, fully one-third or more-several million people-are unaware that they have the disease or conditions that predispose them to developing it.
Diabetes unchecked can be deadly. That's no secret. What is less recognized-at least by lay people-is that this is one ailment that can be stabilized with proper care. Key elements of any successful regimen would have to include diet, exercise and healthy weight maintenance.
The goal of these lifestyle choices is to manage blood glucose levels and keep them within a safe range, ideally between 80 and 100 mg/dL, and certainly no more than 120 mg/dL. This is where many natural food and supplement ingredients may play a useful role.
There are many approaches that show promise, including low-carb products, complex carbohydrates, fiber, sensible sweeteners, chromium, cinnamon extract, inulin, resistant starch, items with low glycemic index scores and more.
Low-carb foods, which soared and then crashed around 2004, have pretty much had their day-although there have been some valuable "residual effects," according to Steven Light, business development manager for City of Industry, CA-based Amax NutraSource, Inc., which produces lou han guo, a natural sweetener with a low-glycemic index of 20-22.
Because low-carb foods were once popular, says Mr. Light, "today's consumer has more choices," numerous manufacturers have systematically decreased the carb count in their products, and retailers are more aware of the products they select to stock their shelves.
It is probably safe to say, however, that most suppliers would rather not go through the same fad-driven, gut-wrenching, capital-draining scenario to establish their entries in the marketplace. For example, Erin Silva, MS, RD, registered dietitian and technical marketing manager, Vitamer Labs, Irvine, CA, says, "Manufacturers need to keep current with the trends-but at the same time, invest only in science-based products. These products will outlast any fads and minimize a company's risk."
Vitamer, she says, offers biotin, alpha lipoic acid, whole psyllium husk and chromium. According to Ms. Silva, research shows that biotin "promotes glucose uptake in muscle tissue, potentiates the glucose supporting properties of chromium picolinate and aids in metabolism."
"Our Show Me The Whey protein powder is probably the most ideal form for those with blood sugar issues, as it contains a high quality, non-rBGH (non-bovine growth hormone) source of whey protein, with only one to three grams of total carbohydrates per serving (depending on the flavor)," she added. "We offer it in Chocolate, Strawberry and Vanilla."
Vladimir Badmaev, MD, PhD, Sabinsa's vice president of medical and scientific affairs, seconds the notion that "sticking with science" is the way to avoid fads. His company, which is headquartered in Piscataway, NJ, is steeped in Ayurvedic tradition and produces no fewer than 10 products with potential for management of either blood glucose levels or body weight.
Three of the most noteworthy are FenuFibers, LactoWise and Saberry. "FenuFibers is a dietary fiber product obtained from seeds of fenugreek," he said. "Its content features 53% total fiber, including 19% gel fiber and 32.5% neutral detergent fiber." Because it has low levels of acetate and succinate, he explains, soluble sugars from the fiber are unavailable to support fermentation, in turn leading to less bloating and gas than is common with other fiber products.
LactoWise, Dr. Badmaev noted, is a probiotic and prebiotic composition consisting of beneficial human intestinal microorganisms and water-soluble dietary fiber for promoting gastrointestinal health and growth of beneficial bacteria. A process of proprietary hydrolysis using fenugreek seed fibers yields fenumannans, a class of polysaccharides. In turn, the fenumannans reduce the rate of glucose absorption and may delay gastric emptying, he says.
Saberry, derived from the herb amla, also known as Indian gooseberry, is a powerful antioxidant with a combined ORAC (Oxygen Radical Absorbance Capacity) value of 358,600 umolTE/100 gm. According to Dr. Badmaev, it exerts a "sparing effect on the internal, or body-made, antioxidants such as catalase, superoxide dismutase (SOD) and glutathione peroxidase." The Sabinsa executive believes this may make the ingredient "particularly useful in prevention of diabetic nephropathy, which is the leading cause of kidney failure in the U.S."
Antioxidants are also popular with RFI Ingredients, Blauvelt, NY. Company president Jeff Wuagneux discussed the widely held belief that elevated blood glucose levels lead to an increase in free radicals, and that many people with diabetes have depleted levels of antioxidants in their bodies. "These free radicals produce additional oxidative stress and possibly cause various forms of diabetes-related tissue damage, such as atherosclerosis, cataracts and neuropathy," he commented.
The OxyPhyte line from RFI Ingredients includes green tea, grape skin (10% resveratrol), apple extract, grape seed extract and green coffee extract. "All are made with GRAS (Generally Recognized As Safe) herbs or fruits/veggies, so these products can be used in any product delivery system from beverages and bars to supplements," he said.
Herbs remain the major ingredient source espoused by Ecuadorian Rainforest for blood sugar management. Steve Siegel, vice president of the Belleville, NJ-based firm, lists bilberry leaf extract, garlic, ginkgo biloba and ginseng as herbs that "may assist in the maintenance of already healthy blood sugar levels." He cites both animal pre-clinical research and human clinical trials pointing to the efficacy of these botanicals.
An herb also is central to the work being done in this area by Terry Laboratories, of Melbourne, FL. David Nelson, international sales manager, says the company's branded ingredient Glysync is derived from purified juice of the cactus Indica ficus, also known as Nopal. Patrick Anderson, western regional sales manager, says Nopal contains 18 amino acids, vitamins A, E, C, B1, B2, B3 and B12, and 10 essential minerals, which, along with other properties found in the cactus, "help to maintain proper glucose balance as well as stimulate the immune system."
Yet another company pursuing plant-based pathways to blood sugar management is Nutraceuticals International, Elmwood Park, NJ, which, along with its affiliate, Amruta Herbals Pvt. Ltd., of Indore, India, promotes all of the following in the U.S.: Gymnema sylvestre extract containing gymnemic acid 25%-75%; bitter gourd extract with charantin 1%-5%; white kidney bean extract which has phaseolamin 1%; and banaba extract 1%.
Fenugreek, blueberry leaf, cayenne, cinnamon extract, green tea, Gymnema sylvestre, guggul lipids, stevia and bitters such as goldenseal and gentian root are featured ingredients from Bio-Botanica, Hauppauge, NY, reports Ellen Kamhi, PhD, RN, the company's professional herbalist/nutritionist and author of Weight Loss: The Alternative Medicine Guide.
Newcomers to the blood sugar management category include acai berry, chia seed and Slimaluma. According to Dr. Kamhi, chia seeds provide both soluble and insoluble fiber, which help to increase feelings of "fullness" and offer the added benefit of omega 3 fatty acids, while Slimulama is a proprietary standardized extract of Caralluma fimbriata, an edible cactus plant used for centuries in India as a famine food and appetite suppressant.
GlucoFit, from Los Angeles, CA-based Soft Gel Technologies, Inc. (SGTI) and its sister company OptiPure Brand Chemco Industries, is a patented and clinically tested banaba leaf extract. According to Steve Holtby, SGTI's president and CEO, the leaves of banaba or crepe myrtle (Lagerstroemia speciosa L.), contain significant amounts of corosolic acid, which, he says, has been shown to possess anti-diabetic properties.
Mr. Holtby went on to cite a 1998 Japanese placebo-controlled, crossover clinical study demonstrating that corosolic acid safely and effectively lowers blood glucose levels. "Corosolic acid also contains significant amounts of tannins, which were identified and shown to act as activators of glucose transport in fat cells," he said. "In addition, corosolic acid possesses strong antioxidant activity to scavenge free radicals and to prevent cell membrane lipid peroxidation. It helps maintain low blood pressure and normal kidney function by controlling blood sugar, and thus preventing damage to blood vessels and kidneys."
Nevertheless, SGTI doesn't close out its concerns about blood glucose with GlucoFit alone. Other of its ingredients that take on this problem include CoQSol, chromium picolinate, cinnamon, Gymnema sylvestre, bitter melon, fenugreek and American ginseng.
Cinnamon, already mentioned twice in this article, almost certainly deserves closer attention. This seemingly innocuous table spice is not only for sprinkling on cookies and cappuccino, but also may be the source of one of the more powerful blood glucose control agents. In fact, if you Google the words "cinnamon" and "blood sugar" at the same time, you get more than 370,000 hits in just six-tenths of a second, including thousands that report on research showing that cinnamon can reduce blood sugar levels, increase natural production of insulin and lower blood cholesterol.
No wonder Logan, UT-based A.M. Todd Botanical Therapeutics has made it the centerpiece of its efforts to help consumers attain healthy blood glucose levels. A.M. Todd is the North American distributor of CinSulin, a U.S.-patented water extract of cinnamon manufactured by Tang-An Medical, Ltd., a Chinese company with offices in Palo Alto, CA.
Salba, a grain farmed along the desert coast of Peru and sold under trademark in the U.S. by Core Naturals, Winter Springs, FL, is said by the company to be the "richest whole food source of omega 3 fatty acids and fiber found in nature." Core Naturals claims that "every serving of Salba provides over 2400 mg of omega 3s and over 4500 mg of dietary fiber," while delivering fewer than 0.5 net carbohydrates per serving.
Sherrill Sellman, ND, is an independent researcher, educator, lecturer and author of The Return of the Ancient Seed, who has on occasion worked with Core Naturals, lecturing and educating store personnel. She describes Salba as "a nutrient-dense, low-glycemic functional food, which helps to promote blood sugar balance with its high-fiber, low-glycemic, low-carbohydrate, mineral-rich profile."
Meanwhile, helpful as they are, herbs are not the only instruments that can be brought to bear against rising blood sugar. Minerals also are important, and none more so than the trace mineral chromium. When you Google "chromium" and "blood sugar," you get more than 440,000 hits, about 19% more than for cinnamon.
Nutrition 21, headquartered in Purchase, NY, is one company that understands this connection. Anne La Russo, the firm's director of marketing, cites an ADA study showing that chromium improved glucose control in subjects who had a chromium deficiency. "Supplementing with chromium picolinate plus biotin significantly lowered A1c levels and improved glycemic control in patients with poorly controlled blood sugar levels," she said.
But chromium isn't the only weapon in Nutrition 21's arsenal. Ms. La Russo also notes research by the American Heart Association (AHA) suggesting that use of dietary magnesium may lower the chances of a person getting high blood pressure, diabetes and high levels of fats and cholesterol in the blood. And, she offered, "There is evidence that diabetes is characterized by taurine deficiency, which has been linked to diabetic retinopathy, neuropathy and nephropathy, according to a study published in Diabetes Care, the official journal of the ADA."
Nutrition 21 has gathered its blood glucose control products in a line called Diabetes Essentials. Products in the line include Blood Sugar Health, "powered by" Diachrome, the company's trademarked combination of chromium picolinate and the B vitamin biotin, and a multivitamin formula available in a natural citrus-flavored Nutrition To Go drink packet.
A relatively new supplement on the glucose management scene comes from the ocean in the form of InSea2, a demineralized blend of polyphenols coming from brown seaweeds. According to Jocelyn Bérubé, scientific director, Health & Nutrition, innoVactiv, Rimouski, Quebec, Canada, InSea2 acts by "inhibiting both alpha-amylase and alpha-glucosidase, two enzymes that are involved in the degradation of complex starches and more simple oligosaccharides."
Noting that InSea2 is suitable for use in capsules, tablets, drinks or flour products, Ms. Bérubé added, "The ingredient's dual action may reduce the rate of digestion of a wider range of carbohydrates ranging from starches to table sugar, hence limiting the negative impact on blood insulin levels created by high glycemic index foods. By doing so, it also prevents blood glucose from falling below normal levels shortly after a meal, a condition that leads to sleepiness, lack of concentration or cravings. The transient nature of the inhibitory effect helps reduce the peak insulin secretion and prolongs the absorption of glucose over a longer period of time."
Bloomingdale, IL-based Healthco International, the bulk sales and private label division of NOW Health Group, a major manufacturer of finished products, offers a variety of nutrients for blood glucose management. Among these is Phase 2, an all-natural white bean extract that may help reduce the breakdown and absorption of complex carbohydrates by limiting the action of alpha-amylase enzymes.
In addition, says Neil Levin, CCN, DANLA, the firm's education manager, Healthco distributes Ultra Omega 3 fish oil (or flax oil for vegetarians), alpha lipoic acid and Tri-Chromium, which are designed to improve the insulin response that moves sugar out of the blood and into cells for fuel, instead of turning it into fat. And, to help maintain sugar and cortisol (stress hormone) levels within the normal range, the company offers Glucose Metabolic Support, corosolic acid (GlucoFit), Super Cortisol Support and AlphaSorb-C. "In fact," Mr. Levin notes, "antioxidants of all kinds are very protective for people with blood sugar issues."
The NOW Foods executive also shared some thoughts about sweeteners, including: cane sugar, which is well-known for its ability to raise blood sugar and trigger an insulin response; beet sugar, which NOW offers as an alternative; fructose, which raises blood sugar only about 20% as much as white sugar; stevia, an herb that could only be sold as a supplement until late in 2008, when FDA finally allowed it to be called a sweetener (very little stevia-1/32 teaspoon per cup of beverage-goes a long way, and it is heat-stable, making it suitable for cooking and baking); honey, best in Mr. Levin's view when it is used raw or unfiltered; erythritol, a sugar alcohol used in some low-carb foods (because it is absorbed but later released virtually intact through the urine, erythritol is believed to cause less GI distress than some other sugar alcohols); xylitol, another sugar alcohol that has a low glycemic index score, has 40% fewer calories than white sugar, and will not promote tooth decay; and such traditional natural food sweeteners as molasses, barley malt powder and liquid rice bran syrup, date sugar made from pure dried fruit, dextrose, lactose, maple syrup, Sucanat (dried cane juice with the molasses still in it) and turbinado sugar.
Sweeteners also are much on the mind of the folks at Cargill Health & Nutrition, Wayzata, MN. Deb Schulz, product manager, describes the company's Xtend sucromalt and Oliggo-Fiber inulin as, respectively, a low glycemic index sweetener and a bulking agent to replace high GI ingredients such as sugars and starches.
Sucromalt, she says, replaces traditional liquid sweeteners such as corn syrup with a functional ingredient that is 70% as sweet as sucrose but with a low GI.
In addition, Cargill is one of the companies at the forefront in bringing stevia into the mainstream. On December 18, 2008, The Wall Street Journal published an article announcing that Coca-Cola Co., PepsiCo Inc. and other large-scale food processors had committed to introductions of stevia-sweetened products. Cargill is Coke's supplier, calling its entry in the field Truvia.
Pepsi's version, called PureVia, is being supplied by Malaysia-based Pure Circle under a marketing agreement linking both PepsiCo and Chicago, IL-based Merisant Co.'s Whole Earth Sweetener unit (which also is responsible for Equal's ubiquitous blue packets).
Resistant starch, simply defined, is the portion of starch that reaches the large intestine. Literally resisting digestion in the small intestine, it can prove useful in the management of blood sugar levels, according to Rhonda Witwer, senior business development manager for nutrition at National Starch Food Innovation, Bridgewater, NJ.
Ms. Witwer says her company's Hi-maize 260 resistant starch delivers 60% insoluble dietary fiber (dry basis) and is derived from a proprietary strain of traditionally bred, high amylose corn. She cites 32 clinical studies demonstrating a variety of glycemic benefits, as well as the following additional benefits: weight management, digestive health and anti-inflammation. She also reports that animal studies have suggested that Hi-maize resistant starch may improve immune support and bone health, while increasing mineral bioavailability and heart health.
One of the more intriguing approaches to blood sugar management is use of the glycemic index (GI). Conceived in the early 1980s by David Jenkins, a scientist at the University of Toronto, the GI is a system for ranking different types of carbohydrates, such as pasta, rice or cereal, according to their effect on blood sugar levels.
Mr. Jenkins found that some foods traditionally defined as complex carbohydrates-potatoes for example-actually led to a rapid rise in blood sugar. Meanwhile, some foods high in simple carbohydrates appeared to digest more slowly, leading to a gradual elevation in blood sugar.
Following up these findings, researchers began to measure and classify foods by checking the amount of change in blood sugar that occurs at specified time intervals after one eats a food high in carbohydrates. The number assigned is an inherent property of the carbohydrate-containing food and therefore always is the same irrespective of how much of that carbohydrate is consumed. For purposes of the glycemic index, sugar (sucrose) is placed at 100-and in this case, it does not imply perfection.
Along the way, the concept of glycemic load (GL) was added to the equation. According to Katherine Corbett, director of business development for Toronto, Canada-based Glycemic Index Laboratories, a clinical research facility, "Glycemic load refers specifically to the mathematical product of the type of carbohydrate (as reflected by its GI) times the amount consumed."
Generally speaking, the following GI and GL values denote whether a food is high or low GI or GL: High GI = 70 and greater, High GL= 21 and greater; Moderate GI = 56-69, Moderate GL = 11-20; and Low GI = 55 or below, Low GL = 10 or below.
Today, both concepts-glycemic index and glycemic load-have become well-accepted. Books and articles have been written, lectures have been delivered, products have been created, and millions of people have turned to GI-related solutions for weight loss, disease prevention and maintenance of sustained energy, as well as for management of blood sugar.
Saul Katz, president and CEO of Solo GI Nutrition Inc., a food manufacturer headquartered in Edmonton, Alberta, Canada, is convinced that the "root cause" of the pervasive lack of energy, which is a foremost concern of consumers across all demographics, is the same metabolic process that has given rise to the interlinked epidemics that comprise "diabesity." His preferred solution is to employ a proprietary Controlled Glycemic Response Technology, based upon the underlying principles of glycemic index.
Mr. Katz's company markets a line of SoLo Gi Low Glycemic (Low GI) products, including a nutrition bar that has a clinically validated GI of 22-28 and has been acclaimed as one of the "Top 10 Best Choice snacks in the U.S."-the selection was made from among 750 snack products rated by the Nationwide Children's Hospital Snackwise Program.
Various experts agree that those individuals already diagnosed with diabetes generally have a strong understanding of the need to manage their blood sugar levels-most are already on insulin and all must monitor their blood sugar levels several times a day.
Unfortunately, so many millions of people are still walking around with undiagnosed illness that it would be unconscionable for anyone in either the medical community or the natural products industry to proclaim "Mission accomplished!"
So what can be done to improve communication of this life-saving message? Label claims for supplements and functional foods probably would help, but there are major restrictions on what the authorities will allow.
Barbara Davis, PhD, RD, vice president of scientific strategy for HealthFocus International, a research firm headquartered in St. Petersburg, FL, suggests that consumers actually are less interested in the blood sugar management process than they are in the end results of that process. Using IBC, a study methodology which stands for "ingredients-benefits-claims," her company found that more consumers are seeking improved energy than are looking for a metabolism/weight management benefit.
So, defining the most appealing target may play a role in whether a product succeeds or fails to catch public attention.
Ms. Corbett of Glycemic Index Laboratories believes the glycemic index has a good chance to break through into consumer consciousness because "everyone intuitively knows, through direct personal experience, what it feels like to have a 'sugar rush' and a subsequent 'sugar crash.' So the concept of slow-release versus quick-release carbohydrates resonates quite well. The benefit of a more sustained energy release makes sense."
Meanwhile, some argue that GI is not simple enough to ever become truly mainstream. Moreover, Nichole DeBlock, director of marketing and product developmentfor Nutraceuticals International, said, "Diabetes cannot be controlled only by reducing intake of glucose; it is very much essential to improve all body mechanisms that regulate glucose metabolism in our body such as activity, lifestyle and stress."
As with so many other conditions and so many other product categories, says Mr. Siegel of Ecuadorian Rainforest, education holds the key. "The efforts to disseminate information must be consistent," he said. "As a raw material supplier, we strive to provide top quality botanicals and the information to help our customers and their customers along the way."
When making product claims for natural ingredients aimed at blood sugar management, any mention of diabetes is out. It may be the 10,000-lb. elephant in the room, but it is not polite-or legal-to mention it.
According to Nancy Cheng, MD, PhD, founder and president of Tang-An Medical, Ltd., "Whatever is said must be in the context that the condition being managed is 'already within the normal range' and observes the rules of the standard disclaimer. So put together, the claim 'An aid to healthy blood sugar management already in the normal range,' would be acceptable today."
Terry Laboratories' Mr. Anderson added, "The prospect for health label benefit claims on blood sugar management rests solely on the nutraceutical industry and its willingness to do more clinical trials." He reports that his company currently is conducting such a trial on behalf of its Nopal product.
Getting more specific, how do claims of "low-glycemic" shape up? Marc Ullman, partner in the New York City law firm of Ullman, Shapiro & Ullman, LLP, explained, "To date, FDA has not objected to 'low-glycemic' claims or to claims referencing the glycemic index. There is no reason to expect that these claims would become an issue. Any company making a 'low-glycemic' claim would have to have substantiation supporting that claim, but this is true of any claim made on behalf of a dietary supplement."
Nonetheless, Glycemic Index Laboratories' Ms. Corbett points out that "glycemic index" and "glycemic load" are "specifically and clearly defined," whereas "low-glycemic" is "notoriously ambiguous and undefined." She therefore recommends that responsible marketers drop mentions of "low glycemic" in favor of "low glycemic load."
The American Diabetes Association (ADA) estimates that more than 23 million U.S. residents already suffer from the disease, and another 57 million are at risk of developing it. Of all cases, 90-95% are attributable to type 2 diabetes, which results when the body does not produce enough insulin and/or is unable to properly use the insulin it makes. Many of those who have not yet been diagnosed with diabetes are symptomatic of a pre-diabetes condition variously called "Metabolic Syndrome" or, more ominously, "Syndrome X." Frightening as it may seem, says ADA, of those living with these ticking time bombs, fully one-third or more-several million people-are unaware that they have the disease or conditions that predispose them to developing it.
Diabetes unchecked can be deadly. That's no secret. What is less recognized-at least by lay people-is that this is one ailment that can be stabilized with proper care. Key elements of any successful regimen would have to include diet, exercise and healthy weight maintenance.
The goal of these lifestyle choices is to manage blood glucose levels and keep them within a safe range, ideally between 80 and 100 mg/dL, and certainly no more than 120 mg/dL. This is where many natural food and supplement ingredients may play a useful role.
Fads No More
There are many approaches that show promise, including low-carb products, complex carbohydrates, fiber, sensible sweeteners, chromium, cinnamon extract, inulin, resistant starch, items with low glycemic index scores and more.
Low-carb foods, which soared and then crashed around 2004, have pretty much had their day-although there have been some valuable "residual effects," according to Steven Light, business development manager for City of Industry, CA-based Amax NutraSource, Inc., which produces lou han guo, a natural sweetener with a low-glycemic index of 20-22.
Because low-carb foods were once popular, says Mr. Light, "today's consumer has more choices," numerous manufacturers have systematically decreased the carb count in their products, and retailers are more aware of the products they select to stock their shelves.
It is probably safe to say, however, that most suppliers would rather not go through the same fad-driven, gut-wrenching, capital-draining scenario to establish their entries in the marketplace. For example, Erin Silva, MS, RD, registered dietitian and technical marketing manager, Vitamer Labs, Irvine, CA, says, "Manufacturers need to keep current with the trends-but at the same time, invest only in science-based products. These products will outlast any fads and minimize a company's risk."
Vitamer, she says, offers biotin, alpha lipoic acid, whole psyllium husk and chromium. According to Ms. Silva, research shows that biotin "promotes glucose uptake in muscle tissue, potentiates the glucose supporting properties of chromium picolinate and aids in metabolism."
"Our Show Me The Whey protein powder is probably the most ideal form for those with blood sugar issues, as it contains a high quality, non-rBGH (non-bovine growth hormone) source of whey protein, with only one to three grams of total carbohydrates per serving (depending on the flavor)," she added. "We offer it in Chocolate, Strawberry and Vanilla."
From Field to Full
Vladimir Badmaev, MD, PhD, Sabinsa's vice president of medical and scientific affairs, seconds the notion that "sticking with science" is the way to avoid fads. His company, which is headquartered in Piscataway, NJ, is steeped in Ayurvedic tradition and produces no fewer than 10 products with potential for management of either blood glucose levels or body weight.
Three of the most noteworthy are FenuFibers, LactoWise and Saberry. "FenuFibers is a dietary fiber product obtained from seeds of fenugreek," he said. "Its content features 53% total fiber, including 19% gel fiber and 32.5% neutral detergent fiber." Because it has low levels of acetate and succinate, he explains, soluble sugars from the fiber are unavailable to support fermentation, in turn leading to less bloating and gas than is common with other fiber products.
LactoWise, Dr. Badmaev noted, is a probiotic and prebiotic composition consisting of beneficial human intestinal microorganisms and water-soluble dietary fiber for promoting gastrointestinal health and growth of beneficial bacteria. A process of proprietary hydrolysis using fenugreek seed fibers yields fenumannans, a class of polysaccharides. In turn, the fenumannans reduce the rate of glucose absorption and may delay gastric emptying, he says.
Saberry, derived from the herb amla, also known as Indian gooseberry, is a powerful antioxidant with a combined ORAC (Oxygen Radical Absorbance Capacity) value of 358,600 umolTE/100 gm. According to Dr. Badmaev, it exerts a "sparing effect on the internal, or body-made, antioxidants such as catalase, superoxide dismutase (SOD) and glutathione peroxidase." The Sabinsa executive believes this may make the ingredient "particularly useful in prevention of diabetic nephropathy, which is the leading cause of kidney failure in the U.S."
Antioxidants are also popular with RFI Ingredients, Blauvelt, NY. Company president Jeff Wuagneux discussed the widely held belief that elevated blood glucose levels lead to an increase in free radicals, and that many people with diabetes have depleted levels of antioxidants in their bodies. "These free radicals produce additional oxidative stress and possibly cause various forms of diabetes-related tissue damage, such as atherosclerosis, cataracts and neuropathy," he commented.
The OxyPhyte line from RFI Ingredients includes green tea, grape skin (10% resveratrol), apple extract, grape seed extract and green coffee extract. "All are made with GRAS (Generally Recognized As Safe) herbs or fruits/veggies, so these products can be used in any product delivery system from beverages and bars to supplements," he said.
Herbs remain the major ingredient source espoused by Ecuadorian Rainforest for blood sugar management. Steve Siegel, vice president of the Belleville, NJ-based firm, lists bilberry leaf extract, garlic, ginkgo biloba and ginseng as herbs that "may assist in the maintenance of already healthy blood sugar levels." He cites both animal pre-clinical research and human clinical trials pointing to the efficacy of these botanicals.
An herb also is central to the work being done in this area by Terry Laboratories, of Melbourne, FL. David Nelson, international sales manager, says the company's branded ingredient Glysync is derived from purified juice of the cactus Indica ficus, also known as Nopal. Patrick Anderson, western regional sales manager, says Nopal contains 18 amino acids, vitamins A, E, C, B1, B2, B3 and B12, and 10 essential minerals, which, along with other properties found in the cactus, "help to maintain proper glucose balance as well as stimulate the immune system."
Yet another company pursuing plant-based pathways to blood sugar management is Nutraceuticals International, Elmwood Park, NJ, which, along with its affiliate, Amruta Herbals Pvt. Ltd., of Indore, India, promotes all of the following in the U.S.: Gymnema sylvestre extract containing gymnemic acid 25%-75%; bitter gourd extract with charantin 1%-5%; white kidney bean extract which has phaseolamin 1%; and banaba extract 1%.
Fenugreek, blueberry leaf, cayenne, cinnamon extract, green tea, Gymnema sylvestre, guggul lipids, stevia and bitters such as goldenseal and gentian root are featured ingredients from Bio-Botanica, Hauppauge, NY, reports Ellen Kamhi, PhD, RN, the company's professional herbalist/nutritionist and author of Weight Loss: The Alternative Medicine Guide.
Newcomers to the blood sugar management category include acai berry, chia seed and Slimaluma. According to Dr. Kamhi, chia seeds provide both soluble and insoluble fiber, which help to increase feelings of "fullness" and offer the added benefit of omega 3 fatty acids, while Slimulama is a proprietary standardized extract of Caralluma fimbriata, an edible cactus plant used for centuries in India as a famine food and appetite suppressant.
GlucoFit, from Los Angeles, CA-based Soft Gel Technologies, Inc. (SGTI) and its sister company OptiPure Brand Chemco Industries, is a patented and clinically tested banaba leaf extract. According to Steve Holtby, SGTI's president and CEO, the leaves of banaba or crepe myrtle (Lagerstroemia speciosa L.), contain significant amounts of corosolic acid, which, he says, has been shown to possess anti-diabetic properties.
Mr. Holtby went on to cite a 1998 Japanese placebo-controlled, crossover clinical study demonstrating that corosolic acid safely and effectively lowers blood glucose levels. "Corosolic acid also contains significant amounts of tannins, which were identified and shown to act as activators of glucose transport in fat cells," he said. "In addition, corosolic acid possesses strong antioxidant activity to scavenge free radicals and to prevent cell membrane lipid peroxidation. It helps maintain low blood pressure and normal kidney function by controlling blood sugar, and thus preventing damage to blood vessels and kidneys."
Nevertheless, SGTI doesn't close out its concerns about blood glucose with GlucoFit alone. Other of its ingredients that take on this problem include CoQSol, chromium picolinate, cinnamon, Gymnema sylvestre, bitter melon, fenugreek and American ginseng.
Cinnamon, already mentioned twice in this article, almost certainly deserves closer attention. This seemingly innocuous table spice is not only for sprinkling on cookies and cappuccino, but also may be the source of one of the more powerful blood glucose control agents. In fact, if you Google the words "cinnamon" and "blood sugar" at the same time, you get more than 370,000 hits in just six-tenths of a second, including thousands that report on research showing that cinnamon can reduce blood sugar levels, increase natural production of insulin and lower blood cholesterol.
No wonder Logan, UT-based A.M. Todd Botanical Therapeutics has made it the centerpiece of its efforts to help consumers attain healthy blood glucose levels. A.M. Todd is the North American distributor of CinSulin, a U.S.-patented water extract of cinnamon manufactured by Tang-An Medical, Ltd., a Chinese company with offices in Palo Alto, CA.
Salba, a grain farmed along the desert coast of Peru and sold under trademark in the U.S. by Core Naturals, Winter Springs, FL, is said by the company to be the "richest whole food source of omega 3 fatty acids and fiber found in nature." Core Naturals claims that "every serving of Salba provides over 2400 mg of omega 3s and over 4500 mg of dietary fiber," while delivering fewer than 0.5 net carbohydrates per serving.
Sherrill Sellman, ND, is an independent researcher, educator, lecturer and author of The Return of the Ancient Seed, who has on occasion worked with Core Naturals, lecturing and educating store personnel. She describes Salba as "a nutrient-dense, low-glycemic functional food, which helps to promote blood sugar balance with its high-fiber, low-glycemic, low-carbohydrate, mineral-rich profile."
Minerals Matter
Meanwhile, helpful as they are, herbs are not the only instruments that can be brought to bear against rising blood sugar. Minerals also are important, and none more so than the trace mineral chromium. When you Google "chromium" and "blood sugar," you get more than 440,000 hits, about 19% more than for cinnamon.
Nutrition 21, headquartered in Purchase, NY, is one company that understands this connection. Anne La Russo, the firm's director of marketing, cites an ADA study showing that chromium improved glucose control in subjects who had a chromium deficiency. "Supplementing with chromium picolinate plus biotin significantly lowered A1c levels and improved glycemic control in patients with poorly controlled blood sugar levels," she said.
But chromium isn't the only weapon in Nutrition 21's arsenal. Ms. La Russo also notes research by the American Heart Association (AHA) suggesting that use of dietary magnesium may lower the chances of a person getting high blood pressure, diabetes and high levels of fats and cholesterol in the blood. And, she offered, "There is evidence that diabetes is characterized by taurine deficiency, which has been linked to diabetic retinopathy, neuropathy and nephropathy, according to a study published in Diabetes Care, the official journal of the ADA."
Nutrition 21 has gathered its blood glucose control products in a line called Diabetes Essentials. Products in the line include Blood Sugar Health, "powered by" Diachrome, the company's trademarked combination of chromium picolinate and the B vitamin biotin, and a multivitamin formula available in a natural citrus-flavored Nutrition To Go drink packet.
More Choices
A relatively new supplement on the glucose management scene comes from the ocean in the form of InSea2, a demineralized blend of polyphenols coming from brown seaweeds. According to Jocelyn Bérubé, scientific director, Health & Nutrition, innoVactiv, Rimouski, Quebec, Canada, InSea2 acts by "inhibiting both alpha-amylase and alpha-glucosidase, two enzymes that are involved in the degradation of complex starches and more simple oligosaccharides."
Noting that InSea2 is suitable for use in capsules, tablets, drinks or flour products, Ms. Bérubé added, "The ingredient's dual action may reduce the rate of digestion of a wider range of carbohydrates ranging from starches to table sugar, hence limiting the negative impact on blood insulin levels created by high glycemic index foods. By doing so, it also prevents blood glucose from falling below normal levels shortly after a meal, a condition that leads to sleepiness, lack of concentration or cravings. The transient nature of the inhibitory effect helps reduce the peak insulin secretion and prolongs the absorption of glucose over a longer period of time."
Bloomingdale, IL-based Healthco International, the bulk sales and private label division of NOW Health Group, a major manufacturer of finished products, offers a variety of nutrients for blood glucose management. Among these is Phase 2, an all-natural white bean extract that may help reduce the breakdown and absorption of complex carbohydrates by limiting the action of alpha-amylase enzymes.
In addition, says Neil Levin, CCN, DANLA, the firm's education manager, Healthco distributes Ultra Omega 3 fish oil (or flax oil for vegetarians), alpha lipoic acid and Tri-Chromium, which are designed to improve the insulin response that moves sugar out of the blood and into cells for fuel, instead of turning it into fat. And, to help maintain sugar and cortisol (stress hormone) levels within the normal range, the company offers Glucose Metabolic Support, corosolic acid (GlucoFit), Super Cortisol Support and AlphaSorb-C. "In fact," Mr. Levin notes, "antioxidants of all kinds are very protective for people with blood sugar issues."
Sweetness and Lite
The NOW Foods executive also shared some thoughts about sweeteners, including: cane sugar, which is well-known for its ability to raise blood sugar and trigger an insulin response; beet sugar, which NOW offers as an alternative; fructose, which raises blood sugar only about 20% as much as white sugar; stevia, an herb that could only be sold as a supplement until late in 2008, when FDA finally allowed it to be called a sweetener (very little stevia-1/32 teaspoon per cup of beverage-goes a long way, and it is heat-stable, making it suitable for cooking and baking); honey, best in Mr. Levin's view when it is used raw or unfiltered; erythritol, a sugar alcohol used in some low-carb foods (because it is absorbed but later released virtually intact through the urine, erythritol is believed to cause less GI distress than some other sugar alcohols); xylitol, another sugar alcohol that has a low glycemic index score, has 40% fewer calories than white sugar, and will not promote tooth decay; and such traditional natural food sweeteners as molasses, barley malt powder and liquid rice bran syrup, date sugar made from pure dried fruit, dextrose, lactose, maple syrup, Sucanat (dried cane juice with the molasses still in it) and turbinado sugar.
Sweeteners also are much on the mind of the folks at Cargill Health & Nutrition, Wayzata, MN. Deb Schulz, product manager, describes the company's Xtend sucromalt and Oliggo-Fiber inulin as, respectively, a low glycemic index sweetener and a bulking agent to replace high GI ingredients such as sugars and starches.
Sucromalt, she says, replaces traditional liquid sweeteners such as corn syrup with a functional ingredient that is 70% as sweet as sucrose but with a low GI.
In addition, Cargill is one of the companies at the forefront in bringing stevia into the mainstream. On December 18, 2008, The Wall Street Journal published an article announcing that Coca-Cola Co., PepsiCo Inc. and other large-scale food processors had committed to introductions of stevia-sweetened products. Cargill is Coke's supplier, calling its entry in the field Truvia.
Pepsi's version, called PureVia, is being supplied by Malaysia-based Pure Circle under a marketing agreement linking both PepsiCo and Chicago, IL-based Merisant Co.'s Whole Earth Sweetener unit (which also is responsible for Equal's ubiquitous blue packets).
They've Got a Lot of Starch
Resistant starch, simply defined, is the portion of starch that reaches the large intestine. Literally resisting digestion in the small intestine, it can prove useful in the management of blood sugar levels, according to Rhonda Witwer, senior business development manager for nutrition at National Starch Food Innovation, Bridgewater, NJ.
Ms. Witwer says her company's Hi-maize 260 resistant starch delivers 60% insoluble dietary fiber (dry basis) and is derived from a proprietary strain of traditionally bred, high amylose corn. She cites 32 clinical studies demonstrating a variety of glycemic benefits, as well as the following additional benefits: weight management, digestive health and anti-inflammation. She also reports that animal studies have suggested that Hi-maize resistant starch may improve immune support and bone health, while increasing mineral bioavailability and heart health.
How Low Can You Go?
One of the more intriguing approaches to blood sugar management is use of the glycemic index (GI). Conceived in the early 1980s by David Jenkins, a scientist at the University of Toronto, the GI is a system for ranking different types of carbohydrates, such as pasta, rice or cereal, according to their effect on blood sugar levels.
Mr. Jenkins found that some foods traditionally defined as complex carbohydrates-potatoes for example-actually led to a rapid rise in blood sugar. Meanwhile, some foods high in simple carbohydrates appeared to digest more slowly, leading to a gradual elevation in blood sugar.
Following up these findings, researchers began to measure and classify foods by checking the amount of change in blood sugar that occurs at specified time intervals after one eats a food high in carbohydrates. The number assigned is an inherent property of the carbohydrate-containing food and therefore always is the same irrespective of how much of that carbohydrate is consumed. For purposes of the glycemic index, sugar (sucrose) is placed at 100-and in this case, it does not imply perfection.
Along the way, the concept of glycemic load (GL) was added to the equation. According to Katherine Corbett, director of business development for Toronto, Canada-based Glycemic Index Laboratories, a clinical research facility, "Glycemic load refers specifically to the mathematical product of the type of carbohydrate (as reflected by its GI) times the amount consumed."
Generally speaking, the following GI and GL values denote whether a food is high or low GI or GL: High GI = 70 and greater, High GL= 21 and greater; Moderate GI = 56-69, Moderate GL = 11-20; and Low GI = 55 or below, Low GL = 10 or below.
Today, both concepts-glycemic index and glycemic load-have become well-accepted. Books and articles have been written, lectures have been delivered, products have been created, and millions of people have turned to GI-related solutions for weight loss, disease prevention and maintenance of sustained energy, as well as for management of blood sugar.
Saul Katz, president and CEO of Solo GI Nutrition Inc., a food manufacturer headquartered in Edmonton, Alberta, Canada, is convinced that the "root cause" of the pervasive lack of energy, which is a foremost concern of consumers across all demographics, is the same metabolic process that has given rise to the interlinked epidemics that comprise "diabesity." His preferred solution is to employ a proprietary Controlled Glycemic Response Technology, based upon the underlying principles of glycemic index.
Mr. Katz's company markets a line of SoLo Gi Low Glycemic (Low GI) products, including a nutrition bar that has a clinically validated GI of 22-28 and has been acclaimed as one of the "Top 10 Best Choice snacks in the U.S."-the selection was made from among 750 snack products rated by the Nationwide Children's Hospital Snackwise Program.
Building Awareness
Various experts agree that those individuals already diagnosed with diabetes generally have a strong understanding of the need to manage their blood sugar levels-most are already on insulin and all must monitor their blood sugar levels several times a day.
Unfortunately, so many millions of people are still walking around with undiagnosed illness that it would be unconscionable for anyone in either the medical community or the natural products industry to proclaim "Mission accomplished!"
So what can be done to improve communication of this life-saving message? Label claims for supplements and functional foods probably would help, but there are major restrictions on what the authorities will allow.
Barbara Davis, PhD, RD, vice president of scientific strategy for HealthFocus International, a research firm headquartered in St. Petersburg, FL, suggests that consumers actually are less interested in the blood sugar management process than they are in the end results of that process. Using IBC, a study methodology which stands for "ingredients-benefits-claims," her company found that more consumers are seeking improved energy than are looking for a metabolism/weight management benefit.
So, defining the most appealing target may play a role in whether a product succeeds or fails to catch public attention.
Ms. Corbett of Glycemic Index Laboratories believes the glycemic index has a good chance to break through into consumer consciousness because "everyone intuitively knows, through direct personal experience, what it feels like to have a 'sugar rush' and a subsequent 'sugar crash.' So the concept of slow-release versus quick-release carbohydrates resonates quite well. The benefit of a more sustained energy release makes sense."
Meanwhile, some argue that GI is not simple enough to ever become truly mainstream. Moreover, Nichole DeBlock, director of marketing and product developmentfor Nutraceuticals International, said, "Diabetes cannot be controlled only by reducing intake of glucose; it is very much essential to improve all body mechanisms that regulate glucose metabolism in our body such as activity, lifestyle and stress."
As with so many other conditions and so many other product categories, says Mr. Siegel of Ecuadorian Rainforest, education holds the key. "The efforts to disseminate information must be consistent," he said. "As a raw material supplier, we strive to provide top quality botanicals and the information to help our customers and their customers along the way."
What Can You Say-Legally?
When making product claims for natural ingredients aimed at blood sugar management, any mention of diabetes is out. It may be the 10,000-lb. elephant in the room, but it is not polite-or legal-to mention it.
According to Nancy Cheng, MD, PhD, founder and president of Tang-An Medical, Ltd., "Whatever is said must be in the context that the condition being managed is 'already within the normal range' and observes the rules of the standard disclaimer. So put together, the claim 'An aid to healthy blood sugar management already in the normal range,' would be acceptable today."
Terry Laboratories' Mr. Anderson added, "The prospect for health label benefit claims on blood sugar management rests solely on the nutraceutical industry and its willingness to do more clinical trials." He reports that his company currently is conducting such a trial on behalf of its Nopal product.
Getting more specific, how do claims of "low-glycemic" shape up? Marc Ullman, partner in the New York City law firm of Ullman, Shapiro & Ullman, LLP, explained, "To date, FDA has not objected to 'low-glycemic' claims or to claims referencing the glycemic index. There is no reason to expect that these claims would become an issue. Any company making a 'low-glycemic' claim would have to have substantiation supporting that claim, but this is true of any claim made on behalf of a dietary supplement."
Nonetheless, Glycemic Index Laboratories' Ms. Corbett points out that "glycemic index" and "glycemic load" are "specifically and clearly defined," whereas "low-glycemic" is "notoriously ambiguous and undefined." She therefore recommends that responsible marketers drop mentions of "low glycemic" in favor of "low glycemic load."
