Diabetes: Diabetes Care

With increasing evidence of risk associated with certain pharmaceuticals, natural products suppliers are urging consumers to talk to their physicians about incorporating dietary supplements in their daily regimen. Recently, U.S. health officials raised a red flag over use of the diabetes drug rosiglitazone (Avandia) as new research highlights a link between usage and increased risk of heart attacks. Avandia, according to its maker GlaxoSmithKline, makes the use of insulin more effective in patients with type 2 diabetes.

This isn’t the first time safety questions have arisen over Avandia. In 2007, an analysis from a Cleveland Clinic cardiologist showed that Avandia patients had a 43% increased risk of heart attacks and a 64% increase in risk of death from
cardiovascular causes.

“The news is fraught with examples of the potential dangers associated with clinical drugs for treating diabetes,” says Valery Lavigne, marketing representative at Ecuadorian Rainforest LLC (Belleville, NJ). “Consumers must be educated not only on the dangers of the disease itself, but also the risks associated with its treatment.”

According to the National Institutes of Health, the basic tools for managing type 2 diabetes are healthy eating, physical activity, and blood glucose monitoring. “Some people with diabetes choose to incorporate complementary and alternative therapies, including dietary supplements, to help manage symptoms, improve blood glucose control, and lessen the risk of developing serious complications,” explains NP Nutra’s (Rancho Dominguez, CA) marketing manager, Marina Linsley.

Christian Artaria, Indena S.p.A.’s (Milan) marketing director and head of functional food development, agrees, adding, “Choosing an effective supplement is one way individuals are seeking help with diabetes.”

He adds, “An individual should receive professional advice from a medical doctor on how best to manage the disease.”

Avandia’s troubles translate into increased opportunities to bring new formulations backed by solid science to market, targeted at a wider base of consumers looking to incorporate natural products in their lifestyle.

Making a Case for Development
Nearly two million Americans are diagnosed with some form of diabetes each year, according to the American Diabetes Association’s (ADA) 2007 National Diabetes Fact Sheet. By 2050, one out of every three U.S. adults may suffer from type 2 diabetes, according to a new Centers for Disease Control and Prevention report. Currently, 10% of U.S. adults suffer from diabetes, and 25% percent of those with diabetes remain undiagnosed. Additionally, some 23.6 million Americans have been diagnosed as diabetic, and of that, nearly one in five people have an issue with blood-sugar management, ADA reports. In short, there are a lot of people out there who need to make changes to incorporate a healthier lifestyle.

“Frequent consultations with a healthcare provider and appropriate medications, along with necessary lifestyle changes, may be required for disease prevention and/or control,” says Kaori Dadgostar, PhD, a technical specialist for Jarrow Formulas (Los Angeles).

The downside of ignoring a health practitioner’s advice: “Diabetes is a starting point for many other life-threatening diseases,” such as cardiovascular, obesity, neural, kidney, and eye-health problems, as well as problems with the feet and teeth, explains R.V. Venkatesh, managing director of Gencor Pacific (Anaheim, CA).

“Many people fail to acknowledge the serious threat that diabetes poses to individuals, families, and communities,” says Kemin Health’s (Des Moines, IA) technical services manager, Diane Alexander, PhD.

“A lot of people don’t know what to look for in this disease, and minor symptoms that people ignore on a daily basis sometimes make a big difference,” says David Romeo, managing director, Nutraceuticals International (Elmwood Park, NJ).

“For governments, it is a call to implement effective strategies and policies for the prevention and management of diabetes. For healthcare professionals, it is a call to improve knowledge so that evidence-based recommendations are put into practice. For the general public, it is a call to understand the serious impact of diabetes and know, where possible, how to avoid or delay diabetes and its complications,” Alexander adds.

“Diabetes has been covered extensively by media and will likely continue to be, given the wide-reaching effects of the disease,” explains Cargill Health and Nutrition’s (Minneapolis) global marketing programs and communications manager, Pam Stauffer.

Chromium
One of the most widely studied ingredients to help manage insulin resistance, which is associated with keeping blood sugar levels under control in people with type 2 diabetes, is the mineral chromium. Albion Human Nutrition (Clearfield, UT) is a manufacturer of the TRAACS line of amino acid chelates and organic acid mineral compounds, including chromium chelate, a highly bioavailable, well-tolerated, safe form of chromium.

Similarly, Kemin Health recently launched Cr-Pro chromium propionate, another alternative, safe source of chromium. Cr-Pro is backed by the established benefits of facilitating blood sugar uptake by cells, says the company.

Similarly, Soft Gel Technologies (Los Angeles) offers a 200-µg chromium picolinate soft gel. Nine out of 15 randomized controlled trials investigating chromium’s ability to enhance insulin sensitivity and improve blood sugar control in diabetics showed significant benefit, says Soft Gel.

NOW Foods’ (Bloomingdale, IL) Tri-Chromium supplement combines three forms of chromium-chromium picolinate with chromium chelavite (chromium amino acid chelate) and InterHealth Nutraceuticals’ ChromeMate (chromium polynicotinate)-in a base of cinnamon.

“It’s a positive development, that more people address health conditions when they first have indications of a growing problem. This may be partly because of high healthcare costs, but many people are also motivated to improve their health for its own sake,” explains NOW’s nutrition education manager, Neil Levin, CCN, DANLA.

Botanicals
A plant little known in the United States, but widely accepted in other parts of the world, has been developed into a nutraceutical to help maintain healthy blood sugar levels. Marketed as Madeglucyl by Italy’s Indena S.p.A., seeds from the Eugenia jambolana plant have been used for centuries in Europe, India, and Southeast Asia in folk medicine and for their antihyperglycemic properties. Madeglucyl has been designed specifically for this pathology, and several polyphenol-rich extracts have been shown to be supportive.

NP Nutra offers a range of botanicals, also unfamiliar to many in the United States, used in formulas to support diabetes healthcare such as banaba and Gymnema sylvestre, among others. Banaba (Lagerstroemia speciosa) has long been used in the Philippines as an aid for managing blood sugar. Interestingly, scientists have now found that banaba leaves are in fact high in corosolic acid, which is sometimes referred to as “plant insulin.”

“This acid, along with several other constituents of banaba, encourages the use of glucose as fuel and produces insulin-like effects. Therefore, banaba may be very helpful for maintaining healthy blood sugar levels,” explains Linsley.

The gymnemic acids contained in Gymnema sylvestre, used in Ayurvedic medicine for thousands of years, are similar in shape to glucose, which means they can fill cell receptors in the intestines, preventing uptake of sugars and keeping blood glucose at balanced levels. Researchers have found that persons treated with an extract of Gymnema sylvestre experienced a significant reduction of blood glucose levels and an increase in plasma insulin.

Among ingredient offerings from Ecuadorian Rainforest are chanca piedra and anamu, which are highlighted in their ability to effectively manage blood sugar levels and support overall function of the immune system. Chanca piedra (Phyllanthrus niruri) is a small herb native to tropical regions, such as the Amazon, that has been used for centuries by indigenous peoples to manage diabetes. Chanca piedra helps the body in lowering both blood sugar and cholesterol levels. It also detoxifies and protects the liver, which can become fatty in diabetics.

Cinnamon
Nutraceuticals International has a range of natural ingredients reported to help in primary blood control, including cinnamon. A number of published studies reveal antidiabetic properties of cinnamon. The spice has been shown to have beneficial effects through different mechanisms of action.

USDA’s Agricultural Research Service (ARS) is studying common spices like cinnamon. In one Ohio study, researchers tracked 22 volunteers with metabolic syndrome, a condition that increases the chances of developing diabetes. Volunteers were randomly assigned to supplement their diets with either water-soluble cinnamon extracts or a placebo for 12 weeks. According to ARS, volunteers who took the cinnamon extract showed significant decreases in fasting blood glucose and small increases in lean muscle mass compared with the placebo group.

Along those same lines, a Scandinavian study revealed that consumption of 3 g of cinnamon per day may improve control of blood glucose levels. Published last year in the American Journal of Clinical Nutrition, researchers found that ingesting the spice led to reductions in blood insulin, the hormone responsible for controlling blood sugar levels. This study of 15 people also revealed increased levels of a peptide believed to work by delaying the emptying of the stomach, known as gastric emptying, which, if unaddressed, can challenge blood glucose control. In 2007, in the same journal, these researchers reported that consumption of 300 g of rice pudding plus 6 g of cinnamon led to a decreased rate of gastric emptying.¹

Even with a growing body of evidence in support of cinnamon extract for diabetes management, a recent meta-analysis questioned the potential benefits of cinnamon for type 2 diabetes. Industry groups criticized the study for only considering five randomized placebo-controlled trials involving 282 subjects. The meta-analysis found no significant benefits of cinnamon supplement on glycated haemoglobin (A1C), fasting blood glucose, or other lipid parameters.

Fiber
Certain other nutraceutical fibers also work through the gastric tract to help with diabetes management. Sabinsa (East Windsor, NJ) offers a range of healthful multifunctional fiber ingredients, such as fenugreek fiber that slows gastric transit (with benefits in blood sugar support and glycemic index). Fenugreek offers satiety, digestive, antioxidant, and cardiovascular support as well.

“It is important that fibers and oligosaccharides do not produce flatulence or gastrointestinal distress, due to break down by intestinal bacteria. In an in vitro study at the University of Georgia,
Fenufibers from Sabinsa was found to be only minimally broken down by intestinal flora,” explained Sabinsa’s Lakshmi Prakash, PhD, vice president of innovation and business development.

Jarrow Formulas’ Glycemic Balance is a low-glycemic meal supplement designed to minimize glycemic fluctuations in the body. It contains fenugreek and glucomannan, which have been shown, in human studies, to support blood sugar balance and weight management, says the brand.

Sugar Management and Beyond
Sugar is one of the most damaging food items for people with diabetes, requiring people with the disease to manage their blood sugar levels. Cargill offers a range of alternative sweeteners including Truvia rebiana. Clinical studies have shown that daily consumption of 1000 mg of rebiana, equivalent to drinking eight 8-oz servings of rebiana-sweetened beverage every day for 16 weeks, did not affect blood sugar control and was well tolerated in people with type 2 diabetes. Truvia natural sweetener is said to have no effect on the glycemic index.

Lo han guo (Siraitia grosvenori) is a natural sweetener that contains no calories and does not elevate insulin levels, raise cholesterol, or stimulate fat storage. According to NP Nutra’s Linsley, emerging research indicates that lo han guo may also be helpful for maintaining normal levels of cholesterol and blood sugar, as well as supporting kidney and pancreatic health.

Could it soon be that a handful of cashews could help with blood sugar management? New results from lab tests highlighted a link between cashew seed extract and glucose uptake. Specifically, results from in vitro tests performed by Canadian researchers using mouse and rat liver cells found that the stimulatory effect of glucose uptake only occurred when high doses of cashew seed extract were used. Other parts of the cashew plant-including leaves, barks, and apples-were also tested, but were not found to have an effect on glucose uptake. The researchers are from the University of Montreal, Canada, and the Université de Yaoundé, Cameroun. ² The findings could establish cashew seed extract as a nutraceutical compound with potential antidiabetic properties.