The numbers are staggering: More than 100 million Americans have diabetes or prediabetes. More than 30 million—9.4 percent of the population—are diabetic, with another 84.1 million battling prediabetes, a condition that can lead to Type 2 diabetes if not treated, according to the most recent report from the Centers for Disease Control and Prevention (CDC) (1).
While the report confirms that the rate of new cases holds steady, diabetes continues to represent a growing health problem: It was the 7th leading cause of death in the U.S. in 2015.
The findings reveal progress in diabetes management and prevention, but “there are still too many Americans with diabetes and prediabetes,” CDC director Brenda Fitzgerald, M.D., said. “More than a third of U.S. adults have prediabetes, and the majority don’t know it. Now, more than ever, we must step up our efforts to reduce the burden of this serious disease.”
Other key findings from the CDC report include:
- Nearly 1 in 4 four adults living with diabetes – 7.2 million Americans – didn’t know they had the condition. Only 11.6% of adults with prediabetes knew they had it.
- Rates of diagnosed diabetes increased with age. Among adults 18-44, 4% had diabetes. Among those ages 45-64 years, 17% had diabetes. And among those ages 65 years and older, it’s 25%.
- Prevalence varied by education. Among U.S. adults with less than a high school education, 12.6% had diabetes. Among those with a high school education, 9.5% had diabetes; and among those with more than a high school education, it fell to 7.2%.
- More men (36.6%) had prediabetes than women (29.3%). Rates were similar among women and men across racial/ethnic groups or educational levels.
The CDC report also includes county-level data for the first time, and some areas of the country bear a heavier diabetes burden than others. Among the reasons for this is food insecurity, or areas in the country where access to healthy foods is limited, as well as the higher cost of purchasing fresh, unprocessed foods. The southern and Appalachian areas of the United States had the highest rates of diagnosed diabetes and of new diabetes cases.
Adding to the urgency: Studies are showing a link between blood sugar concerns and Alzheimer’s disease. Researchers at the Mayo Clinic recently explored whether some cases of Alzheimer’s disease are triggered by a form of diabetes in the brain, which is being referred to as Type 3 Diabetes (2).
The Bitter Truth on Sugar
Spoiler Alert: After reading this you may never be able to fully enjoy a caramel frappuccino again.
Chances are good that many of your customers are trying to quit sugar. Chances are also good that their vow to quit ends with their first cup of coffee—and that teaspoon, or two, they end up putting into it. But quitting this ingredient is more important now than ever, as the list of potential health effects of sugar overconsumption continue to grow; the sweet stuff has been linked to everything from obesity to heart disease to Alzheimer’s.
The Department of Health and Human Services (HHS) suggests that less than 10% of one’s daily calories should come from added sugars (7). And the American Heart Association recommends that women limit their added sugar intake to no more than 24 grams a day. That’s six teaspoons per day, or 100 calories a day. Men should have no more than 36 grams of sugar a day—that’s 9 teaspoons, or 150 calories a day. There are four calories in one gram, so if a product has 15 grams of sugar per serving, that’s 60 calories just from the sugar alone, not counting the other ingredients.
Most people today eat much more than that. Case in point: a typical 8 ounce can of soda has 8 teaspoons of sugar. For women, that’s the extent of their sugar intake for the day. For men, it’s very close to their suggested intake.
To help consumers be more aware of how much sugar is in their food, the FDA updated parts of its consumer nutrition facts label involving the definition of added sugars last year. As reported in WholeFoods, the new labels have a new space on the label for added sugars (8). While the old label lists total grams of sugars, it doesn’t distinguish between sugars that are naturally occurring in foods like fruits and vegetables, and sugars that meet the definition of added sugars. The new label now includes added sugars in grams and as percent Daily Value. “Added sugars” are sugars and syrups that are added to foods or beverages when they are processed or prepared, and are regarded as worse than sugars occurring naturally.
One surprising outcome of the new labels was discovering the number of foods that had so much added sugar. They include:
Low Fat Yogurt: Many have sugar added to them to enhance flavor. A single cup can contain up to 47 grams of sugar, which is 12 teaspoons.
Ketchup: A single tablespoon can contain 1 teaspoon of sugar.
Fruit Juice: Despite seeming like a healthy choice, it can come with a large dose of sugar and very little fiber.
Spaghetti sauce: All sauces contain some natural sugar, but many have extra sugar added.
And that caramel Frappuccino mentioned earlier? It has a whopping 66 grams of sugar. That’s nearly 16 teaspoons.
The best way to help consumers avoid hidden sugars in their meals is to direct them to your food aisle to fill up on fresh ingredients so they can make home-cooked meals at home, which will allow them to know exactly what’s in the food on their plate. For prepackaged food, encourage them to check the label to identify any hidden added sugars, especially when buying foods from this list.
What can you suggest to do to replace the cravings? Enjoy fruit for dessert most days and limit traditional desserts to special occasions; stir cinnamon into the coffee instead (as a bonus, the spice helps balance blood sugar!); buy 100% juice with no added sugars; enhance the flavor of foods with spices – try turmeric, nutmeg or ginger; drink sparkling water, unsweetened tea or sugar-free beverages.
So, what can retailers do to help reverse this growing problem? It starts with encouraging a healthy lifestyle, including cutting sugar and filling up on fresh whole foods. As WholeFoods columnist Jonny Bowden explains in his Nutrition Mythbuster column, “Insulin is the hormone that rises precipitously in the presence of high blood sugar. Its job is to get that sugar out of the bloodstream and deposit into cells. But when you eat too much sugar, the system breaks down. When blood sugar and insulin are constantly being driven to high levels—as they are with the standard American diet—insulin’s ability to regulate things starts to diminish. You develop a condition called insulin resistance, which we now know plays a role not only in diabetes and obesity, but in heart disease and Alzheimer’s” (3).
In terms of balancing blood sugar, Bowden points to low-carb diets, particularly keto diets, which count decreased insulin resistance as one of their primary benefits (3). For more on the role of diet in helping to ward off blood sugar concerns and disease, read Bowden’s column “Why Do Low-Carbers and Keto Dieters Like Intermittent Fasting So Much?”
Supplements should generally be for relatively healthy people who want to prolong good health, particularly those at risk for conditions such as diabetes, says Trisha Sugarek MacDonald, BS, MS, sr. director of research & development for Bluebonnet Nutrition. And people with diabetes can consult with their physicians and turn to supplements as a complementary therapy.
“Nearly 31% of diabetics use complementary medicine, including supplements, to manage their condition,” says Sébastien Bornet, VP global sales & marketing for Horphag Research. “Of the over 30 million Americans with diabetes, one in five are Baby Boomers. But research shows that Gen Xers are actually significantly more likely to develop diabetes. There is more focus from these populations as individuals become interested in natural supplements that can aid in diabetes care.”
To help meet this need, says Bornet, “Our flagship ingredient, Pycnogenol, is a super antioxidant shown in numerous studies to support healthy blood sugar levels. Pycnogenol may help normalize blood sugar levels by slowing the absorption of carbohydrates, which results in reduced glucose in the bloodstream. It is shown to significantly delay the uptake of complex sugars and inhibit the digestive enzyme a-glucosidase to help normalize blood sugar after a meal.” Bornet points to benefits seen in recent studies: A 2013 study found Pycnogenol to reduce metabolic syndrome factors, including waistline obesity, high cholesterol high blood pressure and high blood sugar; a 2015 study in the Journal of International Angiology found Pycnogenol naturally improves circulatory and endothelial function while improving fasting glucose levels in individuals with borderline high glucose; Pycnogenol has been found to reduce cardiovascular risk factors in diabetics, including high blood sugar, LDL cholesterol and blood pressure; Pycnogenol naturally supports kidney function in patients with metabolic syndrome, including benefits for managing blood pressure, reducing blood sugar and lowering body mass index.
Food is Medicine
Sticking to the right diet requires time and effort, and many people have turned to food delivery services to help them stay on track. Natural products retailers have long been in step with this trend, offering meal kits for everyone from vegans to paleo and keto followers. The number of food delivery plans for people with diabetes has also grown; with companies like Hello Fresh and Sun Basket churning out meals endorsed by the American Diabetes Association. We spoke to Adam Zbar, CEO of Sun Basket, which launched a Diabetes-Friendly meal plan in 2018. In addition to working with consumers, the company works with health organizations. “We are working on trials with some of the largest health insurers in the country, working with them to help their employer and patient populations learn that Food Is Medicine,” says Zbar. “The number one disease state we are targeting in these early trials is Type 2 Diabetes since it’s been shown that it is most receptive to a healthy diet.”
WF: What meals and particular ingredients are in your diabetes package and why?
SB: The Diabetes-Friendly meal plan includes high-quality carbs from foods like whole grains, beans, and lentils. Each meal contains at least 5 grams of fiber and 15 grams of protein or more per serving. Sun Basket menus change weekly to ensure fresh ingredients and delicious recipes; an example of a Diabetes-Friendly meal that Sun Basket offers is orange-glazed chicken with broccoli rabe, carrots and dates. There is a health epidemic going on in this country that is the result of Americans eating way too much processed food and refined sugars. These processed carbohydrates and refined sugars have really high glycemic loads, which have been shown to cause obesity, diabetes, and heart issues. We want to show that people can fundamentally change their diets, eating meals that consist largely of plants, some lean meats, and other high nutrient items, without giving up great flavor or convenience – which is critical to making change possible.
WF: Who is your customer?
SB: There are over 100 million people in the U.S. that are part of food tribes (Low Carb, Paleo, Vegan, Vegetarian, Mediterranean) and another 100 million Americans who are at risk due to poor nutrition (Diabetes, Obesity, Heart Disease) where healthy food can be medicine. Sun Basket is focused on both audiences by making healthy eating easy, delicious, and personalized. Our Diabetes-Friendly customers specifically range from millennials to empty nesters.
WF: Do the majority of your Diabetes-Friendly plan customers have diabetes, prediabetes, or simply looking to prevent it?
SB: Our Diabetes-Friendly Plan follows ADA guidelines, which are designed to help the 100 million people who are at risk for diabetes or already have diabetes improve their eating choices by eating a low glycemic diet.
Several herbs also can help maintain healthy blood sugar, says Sugarek MacDonald. She points to sustainably harvested or wildcrafted herbal/botanical extracts including bitter melon fruit extract, gymnema leaf extract and cinnamon bark extract (patented, branded Cinnulin PF). Chelated chromium and alpha lipoic acid are also ingredients that can help promote healthy blood sugar levels and insulin balance, as well as protect the nerves, which are often affected by diabetes, she adds. Bluebonnet Targeted Choice Blood Sugar Support features these complementary ingredients, which Sugarek MacDonald says are substantiated by science to:
- improve insulin activity and synthesis (beta cell site)
- increase cellular sensitivity to insulin
- delay glucose absorption in the blood break down fats and carbohydrates to make energy for other organs in the body
- protect cells from oxidative stress that may contribute to cellular resistance or insensitivity to insulin
- manage nerve-related complications associated with diabetes
Also beneficial: Abscisic acid (ABA), an extract from fig fruit, Ficus carica L., is gaining recognition for its impact on blood sugar control. Euromed USA was selected for inclusion at the 78th Annual American Diabetes Association meeting to discuss research on ABA, the active ingredient in the company’s ABAlife supplement. “Dietary intervention such as ABAlife supplementation in potentially reducing the risk of chronic diseases warrants further scientific examination,” says Guy Woodman, Euromed USA general manager. The company presented on a human study evaluating the efficacy of ABAlife on glucose metabolism blood parameters, particularly the Glycemic Index (GI) and the Insulinemic Index (II). The GI indicates how fast and efficiently the body can metabolize a carbohydrate meal, while the II shows how much insulin the body releases in response to a meal. The study looked at the effects of two different strengths of ABA in ABAlife standardized extracts (100 mg and 200 mg) on post-prandial glucose and insulin responses in healthy subjects. The higher dosage lowered overall levels and peaks in blood glucose and insulin between 30 and 120 minutes post-dose, and significantly improved glycemic index (GI) compared to a reference glucose solution alone. The lower dosage was also effective on GI but did not reach statistical significance. Both dosages, however, were able to lower significantly the post-prandial II, with the highest dosage indicating more significant values.
Another option to help with blood sugar balance: berberine, says Tommy Carello, digital marketing associate at Enzymedica. Berberine is an alkaloid found in many plants, most notably goldenseal, barberry, Oregon grape and goldthread. These plants have a long history of use in supporting health, Carello says. He adds that berberine appeals to a range of people with diabetes—those who have a history of diabetes in their family, are concerned with blood sugar levels, or are prediabetic and looking for support to naturally complement a diet and lifestyle change.
Berberine has been the subject of several trials; recently, a review of the 27 clinical studies with berberine provided insight into safety and efficacy, Carello says (4). Berberine has also been examined as a weight-loss aid in two double-blind clinical trials (5). In one, 37 men and women with metabolic syndrome were given 300 mg of berberine three times per day for three months. The body mass index (BMI) levels dropped from 31.5 to 27.4. In another study, 500 mg of berberine three times per day caused an average of 5 pounds of weight loss over 12 weeks (6). Due to the research on possible weight loss effects, Carello says, it resonates with customers who may be looking to drop a few pounds, begin a transformation, or optimize their wellness through a healthier body weight.
Sabinsa offers Curcumin C3 Complex. Shaheen Majeed, president worldwide, says it is reported that Curcuma longa provides a hypoglycemic effect. Sabinsa also offers a soluble fiber called Fennumannans that absorbs water and adds bulk to other material in the digestive tract. It is thought to slow the absorption of sugar by slowing food digestion.
Mushrooms are another studied option. Mushroom Wisdom offers a variety of products for healthy blood sugar support, including SX Fraction from Maitake Mushroom. Royal Agaricus, Chaga, Cordyceps, Lion’s Mane, Meshima, Poria, Reishi, and Tremella also have demonstrated activities that affect blood sugar.
Mujonso Botanicals offers herbal supplements that increase energy and help to maintain healthy blood sugar levels. Pioneer Paul Penders relates the story of how he accidentally discovered mujonso: He planted some bushes on his resort in Malaysia, which turned out to be not what he had thought, but mujonso. He learned that the herb was the subject of much medical research for its effect on blood sugar. With a family history of diabetes, and his own recent diagnosis, he became interested. He travelled to Africa for research and met many people who used mujonso in their daily diet to “help regulate sugar, settle digestive disorders and aid weight loss, and to cleanse the system.” His mission is a labor of love, he says – to bring Mujonso Botanicals to the wider world.
With a nutrient-rich diet and exercise, evidence shows it is possible to overcome blood sugar concerns and even reverse diabetes. And consumers can find the tools they need to do it right in your store. WF
- CDC, “New CDC report: More than 100 million Americans have diabetes or prediabetes,” CDC.gov. Published 7/18/17. Accessed 2/26/19. https://www.cdc.gov/media/releases/2017/p0718-diabetes-report.html
- Dennis Douda, “May Clinic Minute: Is Alzheimer’s Type 3 diabetes?” MayoClinic.org. Posted 11/7/17. Accessed 2/26/19. https://newsnetwork.mayoclinic.org/discussion/mayo-clinic-minute-is-alzheimers-type-3-diabetes/
- Jonny Bowden, “Why Do Low-Carbers and Keto Dieters Like Intermittent Fasting So Much?” WholeFoodsMagazine.com. Posted 2/13/19. Accessed 2/26/19. www.wholefoodsmagazine.com/columns/nutrition-mythbuster/why-do-low-carbers-and-keto-dieters-like-intermittent-fasting-so-much/
- Lan J, Zhao Y, Dong F, et al. “Meta-analysis of the effect and safety of berberine in the treatment of type 2 diabetes mellitus, hyperlipemia and hypertension.” J Ethnopharmacol. 2015 Feb 23;161:69-81 https://www.ncbi.nlm.nih.gov/pubmed/25498346
- Yang, J., Yin, J., et al. “Berberine improves insulin sensitivity by inhibiting fat store and adjusting adipokines profile in human preadipocytes and metabolic syndrome patients.” Evid. Based Complement. Altern. Med. 2012; 2012: 363845 https://www.ncbi.nlm.nih.gov/pubmed/22474499
- Perez-Rubio, K.G., Gonzalez-Ortiz, M., et al. “Effect of berberine administration on metabolic syndrome, insulin sensitivity, and insulin secretion.” Metab. Syndr. Relat. Disord. 2013; 11: 366–369 https://www.ncbi.nlm.nih.gov/pubmed/23808999
- President’s Council on Sports, Fitness & Nutrition, “Dietary Guidelines for Americans,” HHS.gov. Posted 1/26/17. Accessed 2/26/19. https://www.hhs.gov/fitness/eat-healthy/dietary-guidelines-for-americans/index.html
- WholeFoods Magazine Staff, “FDA Solidifies Deadlines, Added Sugar on Nutrition Facts Labels,” WholeFoodsMagazine.com. Posted 3/6/18. Accessed 2/26/19. www.wholefoodsmagazine.com/news/breaking-news/fda-solidifies-deadlines-added-sugar-nutrition-facts-labels/