As natural products retailers you are not in the business of treating diseases, but enabling healthy lifestyles in your customers. However, we can’t deny the importance of understanding how poor health can lead to disease and your role in educating your customers of this. Diabetes (specifically Type II) is very much the result of poor lifestyle choices — as well as hereditary risk factors — and the potential is great that someone in your store has diabetes or is at risk of diabetes. According to the Center for Disease Control’s (CDC) “National Diabetes Statistics Report, 2017,” 30.3 million Americans had diabetes in 2015, amounting to 9.4% of the population (1). Of these more than 30 million people, 7.2 million or 23.8% of those suffering from diabetes, are undiagnosed. Another 33.9% of American adults aged 18 or older, or 84.1 million people, were prediabetic. Here are the tools you can give them to improve their lives.
What is Diabetes?
You may be familiar with blood sugar. Blood sugar refers to glucose, the main source of energy for the body and insulin is the hormone that helps the cells in our body use glucose (2). The pancreas produces insulin and releases it when the amount of glucose in the blood rises, generally after a meal, preventing blood glucose levels from remaining too high. Insulin resistance occurs when muscle, fat, and liver cells do not respond properly to insulin and cannot effectively absorb glucose from the bloodstream causing the body to require more insulin and forcing beta cells in the pancreas to produce more insulin in order to meet its demand. This ramped up production is not sustainable and as the pancreas fails to produce enough insulin, glucose will build up causing a person to have prediabetes or even type II diabetes.
While type II diabetes is heavily influenced by lifestyle, type I diabetes is an autoimmune disease in which the immune system attacks the cells in the pancreas that produce insulin creating a deficit in the hormone (2). Type I diabetics are the individuals who frequently monitor their blood sugar and administer insulin. This is irreversible, however in type II diabetics and more likely prediabetics, a drastic positive change in lifestyle over the long term can reverse the course of the disease.
Approaches and Ingredients
There are a couple of ways that dietary supplements are designed to support healthy blood sugar. “The first major mechanism is controlling the digestion of carbohydrates that we ingest and using the amount of glucose that is liberated in the small intestine resulting in lower levels of glucose in the blood,” explains Manos Apostolidis, associate professor at Framingham State University, director of the advisory board of Kunpoong Bio, developer of Kitomax, a branded ingredient supplied by CK Nutraceuticals, based in Oakville, Ontario, Canada. “The other class of ingredients that can be used are ingredients that assist in the glucose uptake into muscle cells predominantly and fat cells. These ingredients are actually designed to increase insulin sensitivity.”
The advantage of the first mechanism is that there are no concerns about bioavailability. This is because the active components do not have to pass through the small intestine, but are excreted within the small intestine where they can act as inhibitors, explains Apostolidis. Kitomax, a chitosan oligosaccharide, fits into this category. “[Kitomax] comes from chitosan, a polymer present in crabs…and we have developed a proprietary method that we enzymatically control the digestion of chitosan to develop a specific molecular weight that has a heightened effect for blood glucose management and the effect that we have observed is the inhibition of carbohydrate hydrolyzing enzymes,” he explains. “So the major mechanism of our ingredient is to control the amount of glucose that is liberated into the small intestine from the digestion of carbohydrates.”
One randomized, double blind, placebo controlled study, for example, gave prediabetics either the chitosan oligosaccharide or placebo for 12 weeks and assessed serum glucose and insulin levels after a 75 gram oral glucose intolerance test (OGTT) (3). Results showed that the treatment group experience significantly decreased in serum glucose levels at 30 minutes and 60 minutes following OGTT.
Another ingredient, Salacia chinensis (brand name OmniLean, from OmniActive Health Technologies, based in Morristown, NJ) works in a similar fashion, reducing the intestinal absorption of carbohydrates during digestion. In a randomized, double-blind, crossover OGTT study of 35 healthy individuals, dubbed the B.I.G. (Blood, Insulin and Glucose) Study, researchers studied the effects of blood glucose and insulin following a high sugar (table sugar, sucrose) load after subjects were given three different doses (200 mg, 300 mg or 500 mg) of Salacia chinensis. “OmniLean helped reduce the early rise in blood glucose and insulin following a high-sucrose load,” says Becky Wright, marketing manager for OmniActive.
A different randomized, double-blind, placebo-controlled, three-way crossover study dubbed the CARBS Study (Carbohydrate Appetite Reduction and Blood Sugar) assessed glycemic indices following a meal in subjects taking either placebo, 300 mg or 500 mg of Salacia chinensis. “OmniLean, taken with a meal, resulted in an improved glycemic response and positive changes in gut hormones in healthy overweight/obese individuals, thereby reducing blood sugar/insulin spikes and impacting appetite and satiety,” says Wright.
Pharmachem Laboratories Inc., a division of Ashland, Kearny, NJ, produces Phase 2, a white kidney bean extract that also promotes satiety in users, offering a weight management component while supporting healthy blood sugar management as well. “The digestion of carbohydrates begins with amylase secreted by the salivary glands,” says Mitch Skop, senior director, Pharmachem. “The alpha-amylase inhibitor properties of Phase 2 white kidney bean extract have been heavily studied with positive results in delaying the digestion and absorption of carbohydrates, thereby lowering their glycemic impact.”
For tackling insulin resistance, there are a variety of vitamins, minerals and herbs that help maintain insulin sensitivity. Among the most prominent is chromium. This essential trace mineral is important for maintaining the insulin-signaling pathways that control the amount of sugar absorbed through the digestive system. “Lower blood levels of chromium have been correlated with insulin resistance and are commonly found in people with diabetes or blood sugar imbalances,” says Maggie Luther, naturopath, formulator and medical educator at New Chapter, based in Brattleboro, VT. “Depending on the type of chromium, between 200 mcg and 600 mcg, daily, is needed for blood sugar balance.”
While an important mineral, the form in which it is consumed is crucial because of poor bioavailability. “The issue of bioavailability can be overcome by combining it with other organic components,” explains Apostolidis. This is why most manufacturers use chromium pinolinate.
“Chromium picolinate, a form of the mineral often found in supplements, is bound with niacin for optimum absorption,” explains Jay Levy, director of sales, Wakunaga of America, Ltd., based in Mission Viejo, CA. “A review of research found that, among type 2 diabetics, chromium picolinate reduced fasting glucose levels up to 15.3% and fasting insulin levels up to 29.8%.”
Cheryl Myers, chief of scientific affairs and education at EuroPharma, Inc., based in Green Bay, WI, recommends the glycinate chelate form of chromium which also offers superior absorption in the small intestine compared to chromium without an organic compound attached. Luther however, emphasizes fermentation as an aid to bioavailability.
“Fermentation not only makes the vitamin and mineral more bioavailable, it provides your body with nutrients that are more akin to food,” says Luther. “For instance, when you look at the different forms of chromium, chromium enriched yeast is as effective as chromium picolinate in balancing blood sugar and normalizing Hba1c, but only about half the dose is needed. In studies that use chromium picolinate, a 600 mcg dose has been found effective, whereas with chromium enriched yeast, 200-400 mcg gets similar results.”
Another branded ingredient called Prenulin from Pharmachem combines L-arabinose and chromium picolinate. “In two human clinical studies, Prenulin was tested against a 70 g glucose challenge,” explains Skop. “In both studies, as compared to the control groups, the treatment groups had signiﬁcantly lower glycemic responses for all testing times, concluding that the consumption of Prenulin after a 70 gram glucose challenge was signiﬁcantly effective in safely lowering both circulating glucose (-28.95%) and insulin levels (-20.19%)” (4)
B vitamins like thiamine are in a similar boat when it comes to bioavailability. “Standard B vitamins, like cyanocobalamin (B12), pyridoxine (B6), and folic acid require conversion by the liver in order to be utilized by the body,” explains Myers. “That’s why having bioavailable B vitamins in a regimen can be so important. With methylcobalamin (B12), pyridoxal-5-phosphate, and methylfolate, conversion by the liver is not required.”
In her book “Fortify Your Life,” Tieraona Low Dog, M.D. says that thiamine, or vitamin B1, plays an important role in the body’s production of energy. “It is a coenzyme, or helper nutrient — for enzymes that are responsible for converting food to energy, particularly the metabolism of carbohydrates, glucose, and alcohol,” she writes. “Studies show that it can help prevent or slow the development of diabetes-related diseases.”
She recommends that people take a multivitamin providing between 1.5 to 3 mg per day to get adequate thiamine, but those with diabetes or taking thiamine-depleting drugs should aim to get 10-30 mg daily. Thiamine is also highly dependent on magnesium. “Magnesium is required for B1 (thiamine) to work in the nervous system, and to make ATP, cellular energy, from carbohydrates,” explains Luther. “Magnesium and vitamin B1 must both be present for the Kreb’s/citric acid cycle to move forward making energy, burning your food for fuel. When blood glucose is high, both magnesium and vitamin B1 will be excreted in the urine.”
Magnesium itself is also very important for healthy blood sugar management. “Insulin helps the body transport magnesium from the blood into cells. Once inside the cells, magnesium is key to regulating insulin activity with the cell,” explains Luther further. “When it comes to blood sugar imbalances, insulin resistance will create a situation where magnesium no longer gets inside the cells, and instead is released from the body, along with excess sugars, in the urine. This creates a perpetual cycle of increased insulin resistance and low magnesium levels.”
A huge part of supporting healthy blood sugar are antioxidants. “All the side effects [of diabetes] like retinopathy, neuropathy, netropathy, are a result of increased oxidation,” says Apostolidis.
For this reason, antioxidants such as vitamin C and vitamin E are an important component of certain formulas targeting blood sugar management. Both, particularly when they work in tandem, scavenge free radicals and reduce lipid oxidation to maintain the health of cell membranes. Being fat soluble, vitamin E is the primary antioxidant protecting cell membranes — which are lipid based — from free radicals, Luther explains.
“Vitamin E places itself in the cell membrane and traps free radicals that attempt to enter the cell,” she says. “However, vitamin E has limited capacity for holding onto these trapped free radicals. This is where vitamin C comes in and vitamin E transfers the free radicals to vitamin C, which neutralizes them. This simple act of vitamin C taking the free radicals, restores vitamin E to full scavenging ability.”
Nutrition is clearly important, but herbal support can be very beneficial for supporting healthy blood sugar. Formulations by dietary supplement manufacturers often incorporate herbs in addition to synergistic nutrients to give customers the most effective product possible. For example, Sugarland, TX-based Bluebonnet Nutrition Corp.’s Targeted Choice Blood Sugar Support formula incorporates a number of herbs and minerals. “Sustainably harvested or wildcrafted herbal/botanical extracts such as bitter melon fruit extract, gymnema leaf extract and patented, branded Cinnulin PF cinnamon bark extract along with chelated chromium, plus alpha lipoic acid are all key ingredients that can help promote healthy blood sugar levels and insulin balance, as well as protect the nerves, which are often affected by diabetes,” says Trisha Sugarek MacDonald, BS, MS, senior director of research & development for Bluebonnet.
Bitter melon, says Levy, is an herb long used in Traditional Chinese Medicine and is known to aid in the digestion of carbohydrates and support insulin sensitivity. He cites a recent randomized, placebo-controlled trial conducted in Tanzania that studied 52 prediabetic subjects given either bitter melon or placebo for eight weeks (5). Results showed that those taking the herb experienced a significant reduction in fasting blood glucose and while not everyone responded, those with a higher initial level of fasting blood glucose had the most pronounced effect.
“Animal and human research also shows that bitter melon works somewhat like insulin, enhancing the delivery of blood sugar,” says Levy. “And, compounds in the fruit activate a protein that regulates glucose metabolism in much the same way exercise does.”
Cinnamon is not only delicious, but can be an important addition to your supplement regimen. Research on the branded extract Cinnulin PF, for example, has wielded positive results. One randomized, double-blind, placebo-controlled clinical trial randomly assigned 22 subjects with prediabetes and the metabolic syndrome to receive either placebo or 500 mg/day of cinnamon extract for 12 weeks (6). Results showed that those taking the cinnamon extract experience a significant decrease in fasting blood glucose and systolic blood pressure, as well as body fat, leading the researchers to conclude, “this naturally-occurring spice can reduce risk factors associated with diabetes and cardiovascular diseases.”
Another useful ingredient is aged garlic extract (AGE), which studies show can improve the uptake of glucose and acts as a powerful antioxidant. Levy cites a randomized, double-blind, placebo-controlled, crossover trial in which 46 subjects with metabolic syndrome were given 1.2 grams/day of AGE for 24 weeks, resulting in higher levels of plasma adiponectin for those given garlic. “Adiponectin is a protein hormone produced and secreted by fat cells [that] regulates the metabolism of both lipids and glucose, and influences the body’s response to insulin,” Levy explains. “Low blood levels increase the risk for type 2 diabetes. The researchers noted that, among the subjects taking AGE, adiponectin also tamed inflammation and increased cellular glucose uptake.”
AGE’s antioxidant activity comes from a sulfur-containing component called S-allylcysteine (SAC). “During one preliminary study, SAC lowered blood sugar levels while raising plasma insulin, superoxide dismutase, catalase, and reduced glutathione levels,” says Levy. “Another study found that the anti-diabetic and antioxidant effects of SAC were comparable to the hypoglycemic drug Gliclazide” (7).
Banaba also has value for blood sugar management. “Banaba plants grow extensively in the tropical areas of the world,” says Steve Holtby, president & CEO, Soft Gel Technologies, Inc., based in Commerce, CA. “The leaves contain significant amounts of corosolic acid, which has been shown to possess anti-diabetic properties.”
GlucoHelp, a standardized extract of Banaba exclusively from Soft Gel Technologies, is standardized to 18% corosolic acid. “Corosolic acid also contains significant amounts of tannins which were identified and shown to act as activators of glucose transport in fat cells,” explains Holtby. “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.”
Bergamot, which like AGE is known to be an effective supplement for cardiovascular health, provides additional support to blood sugar regulation, making it ideal for those with metabolic syndrome which encompasses a large breadth of symptoms and conditions. “Because excess abdominal fat is a factor in metabolic syndrome, stimulating fat burning helps to lessen this symptom,” says Annie Eng, CEO, HP Ingredients, based in Bradenton, FL. “The flavonoids in Bergamonte stimulate AMP-activated protein kinase (AMPK) [which] plays a central role in regulating healthy glucose, lipid metabolism and energy production. AMPK activation can prevent abdominal fat accumulation, regulate glucose tolerance, normalize liver markers, and reduce oxidative stress and inflammation in the liver and heart.”
HP Ingredients’ proprietary bergamot extract, Bergamonte, is standardized to greater than 38% bergamot polyphenolic fraction consisting of naringin, neohesperidin, neoeriocitrin, melitidin, and brutieridin. “Bergamot flavonoids activate the glucose transporter GLUT1 in all cells and upregulation and translocation GLUT4 to the cell membrane in muscle cells,” says Eng. “In another study, it was found that naringin significantly increased AMP Kinase (AMPK) activity and glucose uptake in the muscle cells and liver.”
Mushrooms have been used medicinally for centuries in Traditional Chinese Medicine and when extracted or even eaten in culinary applications, can have valuable health benefits. When it comes to blood sugar management, maitake is the ideal mushroom. “Chief among its actions is its ability to make cells more sensitive to insulin with the end result being less insulin needed to do its job and lower blood sugar levels as cells are now more able to absorb the glucose,” explains Mark J. Kaylor, founder of the Radiant Health Project, representing Mushroom Wisdom, East Rutherford, NJ. In an animal study, for example, 48 type-1 diabetic rats were divided into four groups, one placebo and three groups which received diabetic medication or a maitake extract (8). Researchers found that “All treatments compared with control generally decreased circulating glucose levels, but only the maitake SX consistently enhanced measured insulin sensitivity.”
An alkaloid called berberine can be found in a variety of plants, including goldenseal, barberry, Oregon grape and goldthread, all of which have a long history of traditional use. Customers can get berberine from products sold as the herbs themselves or berberine extracted from the herbs. For example, Enzymedica, based in Venice, FL has released a berberine sourced from barberry seeds. In a pilot study, subjects with type II diabetes were randomly assigned to take either berberine or metformin for three months and the hypoglycemic effect of the alkaloid was shown to be similar to that of the diabetes medication, significantly lowering hemoglobin A1c, fasting blood glucose and postprandial blood glucose (9).
Abscisic acid, a naturally-occurring plant hormone in fruits and vegetables is important for maintaining glucose homeostasis and according to the latest U.S. dietary survey, because of inadequate consumption of fruits and vegetables 92% of Americans are deficient in abscisic acid (10). A new standardized extract of abscisic acid called ABAlife from Euromed, based in Spain, is sourced from fig fruit. In a recent study testing its efficacy, researchers recruited ten healthy subjects with normal weight to eat a reference food (50 g glucose solution) or two test foods: a glucose solution with 100 mg of extract or a glucose solution with 200 mg of extract. Fasting blood glucose was obtained prior to consumption to reference or test foods and then blood samples were taken at 15, 30, 45, 60, 90 and 120 minutes. Both test groups experienced lower peak and overall glycemic and insulinemic responses between 30-120 compared to reference food, with 25% and 24% reduction in glucose index and insulin index respectively for the 200 mg extract.
A relatively new herb on the American market, but used for decades in Germany, is called Hintonia latiflora. Native to the deserts of Mexico and Central America, this herb is rich in a polyphenol called coutareagenin, which impacts blood sugar regulation and insulin function (2). “This compound appears to inhibit alpha-glucosidase, an enzyme that releases sugar from carbohydrates,” says Myers. “It also plays a role in reducing insulin resistance and improving several parameters of diabetes.”
Myers cites a study in which 41 type II diabetics given Hintonia, along with other nutrients, experienced significantly lowered A1C levels (the average levels of blood sugar over time), fasting blood glucose and postprandial blood sugar (8). “Factoring all of the diabetic symptoms, the scores improved from 4.8 points to 1.3 points at the end of the study, an improvement of over 70%,” she explains. “Participants also saw improvements in blood pressure, lipids, and liver values.”
Far more than taking supplements, health is about having a good lifestyle. Diabetes results from a long string of bad health choices and once someone gets to the point of having the disease, changing course is much harder. As a natural products retailer, you are in a better position than most to facilitate change for your clientele, not only providing resources like supplements but also natural sugar-free products or low glycemic alternatives such as stevia, monk fruit or xylitol which are the first steps to healthy blood sugar management. Your shelves and expertise are an invitation to be better, it’s your job to convince people to accept that invitation. WF
- “National Diabetes Statistics Report, 2017,” http://www.diabetes.org/assets/pdfs/basics/cdc-statistics-report-2017.pdf
- S. Krawiec. “Mitigating the Risks of High Blood Sugar.” https://wholefoodsmagazine.com/supplements/features-supplements/mitigating-risks-high-blood-sugar/, Accessed 3/1/2018.
- H.J. Kim et al., “The effects of chitosan oligosaccharide (GO2KA1) supplementation on glucose control in subjects with prediabetes.” Food & Function. 5(10):2662-9. 2014.
- G.R. Kaats et al., “A Combination of L-Arabinose and Chromium Lowers Circulating Glucose and Insulin Levels After an Acute Oral Sucrose Challenge,” Nutrition Journal. 10:42. 2011.
- MB Krawinkel et al., “Bitter gourd reduces elevated fasting plasma glucose levels in an intervention study among prediabetics in Tanzania.” J Ethnopharmacol. 216:1-7. 2018.
- T.N. Ziegenfuss, et al., “Effects of a Water-Soluble Cinnamon Extract on Body Composition and Features of the Metabolic Syndrome in Pre-Diabetic Men and Women.” J Int Soc Sports Nutr. 3(2): 45–53. 2006.
- G. Saravanan et al., “Beneficial effect of S-allylcysteine (SAC) on blood glucose and pancreatic antioxidant system in streptozotocin diabetic rats.” Plant Foods Hum Nutr. 65(4):374-8. 2010.
- H.G. Preuss, et al. “Fraction SX of maitake mushroom favorably influences blood glucose levels and blood pressure in streptozotocin-induced diabetic rats.” J Med Food. 15(10): 901-8. 2012.
- J. Yin, et al. “Efficacy of Berberine in Patients with Type 2 Diabetes.” Metabolism. 57(5): 712–717. 2008.
- E. Zocchi, et al. “Abscisic Acid: A Novel Nutraceutical for Glycemic Control.” Front Nutr. 4: 24. 2017.
- M. Korecova et al., “Treatment of mild and moderate type-2 diabetes: open prospective trial with Hintonia latiflora extract.” Eur J Med Res. 28;19:16. 2014.
UPDATED 3/27/2018 AT 1:00 PM: In the Abscisic acid section above, the author mistakenly wrote the dosage from research as grams instead of milligrams. The corrected text reads: “In a recent study testing its efficacy, researchers recruited ten healthy subjects with normal weight to eat a reference food (50 g glucose solution) or two test foods: a glucose solution with 100 mg of extract or a glucose solution with 200 mg of extract. Fasting blood glucose was obtained prior to consumption to reference or test foods and then blood samples were taken at 15, 30, 45, 60, 90 and 120 minutes. Both test groups experienced lower peak and overall glycemic and insulinemic responses between 30-120 compared to reference food, with 25% and 24% reduction in glucose index and insulin index respectively for the 200 mg extract.”
Published in WholeFoods Magazine April 2018