The number of consumers impacted by diabetes is growing at an alarming pace. The World Health Organization estimated that approximately 350 million people are currently living with diabetes, with 90% suffering from type 2 diabetes—a chronic but preventable condition that affects the way the body metabolizes sugar. WHO predicted diabetes will become the seventh leading cause of death by 2030 and total deaths from diabetes could rise by more than 50% in the next decade.

The International Diabetes Federation’s “Diabetes Atlas Sixth Edition” (2013), reported that worldwide diabetes cases may grow by 55% looking ahead to 2035, reaching a staggering 592 million people.

Meanwhile, in the U.S. it’s estimated that two out of five Americans will develop type 2 diabetes in their lifetime, according to new research published in The Lancet Diabetes and Endocrinology (August, 2014).

With diabetes rates climbing, natural product solutions that can help manage blood sugar from a preventive perspective offer substantial promise.

“Chronic high blood sugar levels lead to diabetes,” warned Shaheen Majeed, marketing director, Sabinsa Corporation, East Windsor, NJ. “It is known as a silent killer because it can literally go unnoticed in people until they are extremely ill.” Mr. Majeed cited data from the American Diabetes Association, which reported that 29.1 million people suffer from diabetes in the U.S., while an additional 8.1 million people have undiagnosed diabetes. “Proper management of blood sugar levels in people suffering from both diabetes and pre-diabetes is important. While pharmaceuticals are prescribed for people with diabetes, dietary supplements can provide a good selection of products, which can help people manage their blood sugar levels,” he said.

However, the issue of blood sugar management impacts health in a variety of ways, and encompasses much more than the avoidance or management of diabetes, which according to Sid Hulse, director of new product development, PLT Health Solutions, Morristown, NJ, “nutraceutical producers cannot really talk about” without getting into questionable territory with structure/function claims. The market for blood sugar management also encompasses up-and-coming nutraceutical trends such as “energy management, the issue of blood sugar spikes (think kids), sports nutrition, weight management and the overall desire to live healthier and feel better,” which PLT Health Solutions is keenly interested in exploring.

Maintaining Balance
While elevated blood sugar levels lead to health issues, blood sugar itself at regulated concentrations is a critical component of a healthy, functioning body.

“Blood sugar is cellular fuel. Cells need it and like it to produce energy needed for simple and complex biological functions,” stated Mitch Skop, senior director of new product development, Pharmachem Laboratories Inc., Kearny, NJ.

However, an imbalance in this delicate system leads to health problems. “Our bodies depend on stable blood sugar levels to function properly,” explained Sebastien Bornet, director of global marketing at Switzerland-based Horphag Research, “and when we eat sugar or carbohydrates, the body converts them into glucose.” He noted that the hormones insulin and glucagon help the body maintain blood sugar levels, which in turn helps the body “store nutrients after you eat by lowering glucose, amino acids and fatty acids that circulate in your blood.”

Insulin, which is produced by beta cells in the pancreas, is essential for the transport of sugars in the bloodstream. The more sugar present, the more insulin is needed to escort it to cells in the body. “When there is a surplus of blood sugar, it is delivered to the liver and muscles where it is stored as glycogen. When the body needs more glucose, the glycogen is roused from its stores, converted to glucose and sent to cells,” explained Mr. Skop.

An imbalance in blood sugar regulation can negatively impact health in multiple ways. With type 1 diabetes, the body does not produce enough insulin to support the transfer of glucose to the cells, so external insulin supplementation is required. With type 2 diabetes, the body’s insulin response is damaged by continually high blood glucose levels, and the pancreas struggles to keep up with insulin production.

Gameil Fouad, PhD, president, Biotron Laboratories, Inc., Centerville, UT, said that when consumers choose “a diet with a high glycemic load, the pancreas either has difficulty keeping up, or the constant barrage of insulin makes the body less responsive to the hormone.” He noted that while type 1 diabetes is associated with lack of insulin, type 2 “is typically associated with other factors such as obesity, lack of exercise and a diet with a high glycemic load.” Better dietary choices with a lower glycemic index can be helpful in managing blood sugar extremes, he added. “It’s almost always the same advice your physician will give you: exercise more, lose weight, plenty of lean proteins, fresh fruit and vegetables and whole grain. The trouble is many (if not most) of us find this difficult in practice, unappealing or both.”

Targeting Consumer Behavior
“Diet is the singular controllable factor to reduce or delay onset of diabetes type 2,” explained Mr. Skop of Pharmachem. “Blood sugar increase is a direct biological response to eating food/drinking beverages, so it makes sense that consuming too much high-sugar, high-carb foods (carbs are metabolized into glucose) on a continual basis is the penultimate factor in increasing risk of developing diabetes type 2.”

To prevent type 2 diabetes, medical institutions such as the Mayo Clinic recommend lifestyle interventions such as eating a healthy diet rich in fruits, vegetables and whole grains; consuming low-calorie and low-fat foods that are high in fiber; getting 30 minutes of moderate exercise daily; and managing a healthy weight.

While dietary factors are controllable, consumers often lack the desire or will power to make smart choices for their health. “In the area of blood sugar management, consumers don’t do what they should and this behavior isn’t likely to change anytime soon,” said PLT’s Mr. Hulse. “Consumer studies show that they will often choose a good tasting option over a healthy option. As a result, we at PLT are focusing on improving blood sugar management in everyday foods—realizing that consumers want to engage in ‘healthy indulgence’ and helping people make better food choices.”

Lacking the desire to commit to a healthy diet combined with more sedentary lifestyles is a large part of what contributes to rising obesity rates internationally. Worldwide obesity has reached epidemic proportions; a major analysis recently published in The Lancet reported that the number of overweight and obese people rose from 857 million in 1980 to 2.1 billion in 2013.

However, Mr. Hulse is hopeful that with “the amount of attention and emphasis that will be placed by the medical and nutrition communities on the obesity/diabetes/blood sugar health issues that are facing the United States, it is inevitable that consumers will become more attuned to the issue of blood sugar management in their everyday lives.”

He predicted that terms relating to blood sugar management like “glycemic index,” “glycemic load,” “insulin resistance/sensitivity” will become a part of the average person’s vocabulary—just like the terms “calories” and “cholesterol levels” are today. But will heightened awareness and interest in blood sugar management actually make an impact on consumer waistlines? “It’s hard to say, but it is a distinct possibility,” said Mr. Hulse.

Innovative Ingredients
Once awareness becomes more widespread, consumers will need reliable and safe tools to help them manage their blood sugar. With that in mind, companies have developed a wide range of functional ingredients and dietary supplements backed by sound research that offer solutions for glucose control, weight management, slow energy release, and sugar and carbohydrate metabolism.

“Studies show that diets high in soluble fibers are associated with increases in insulin sensitivity,” said Mathieu Dondain, director of marketing and communication at France-based Nexira, which offers its soluble dietary fiber Fibregum. “According to the European Food Safety Authority (EFSA), acacia gum, a source of soluble fiber, reduces the post-prandial glycemic and insulinemic responses when replacing sugars in food and drinks.”

In addition to its health benefits, Fibregum offers a natural response to growing demand for clean label requirements, according to Nexira.

A study on white bread conducted by Nexira at the University of Sydney in 2007 found that Fibregum provided a repeatable effect, lowering post-prandial glycemia and insulinemia, which may represent a beneficial health effect, especially for people at risk for insulin resistance.  “A strong reduction of insulinemia could also imply a reduction of sugars potentially metabolized as body fat. This has been observed in two studies conducted on rats fed a glucose solution with and without acacia gum (Nasir et al, 2010),” said Mr. Dondain.

According to Pharmachem Laboratories, the company’s patent-pending natural glucose support complex, Prenulin, supports the body’s ability to absorb sugar, as well as metabolize sugar in a more healthful way. “Prenulin combines the powerful glucose absorption properties of a specially-made, U.S.-manufactured form of L-arabinose derived from corn, with the insulin control capability of Chromax, the most clinically studied form of chromium on the planet,” said Pharmachem’s Mr. Skop.

He added that studies have found 1 gram of Prenulin reduces the glucose and insulin impact of 70 grams of sugar by almost 30%. “Pharmachem sponsored a clinical trial conducted by a research team led by Dr. Gil Kaats and Dr. Harry Preuss [Nutrition Journal, 2011],” Mr. Skop said. “In two separate studies, consumption of Prenulin was shown to significantly lower both circulating glucose and insulin levels after consumption of a 70-gram sucrose challenge, compared to placebo.”

In June of this year, PLT Health Solutions introduced Benecarb Glycemic Balance Complex to the functional food and general food and beverage markets. Derived from sugar-cane molasses, Benecarb contains high levels of natural antioxidants and polyphenols and is rich in naturally available minerals known to play a role in sugar metabolism, according to the company. “Benecarb, based on molasses phytonutrients, can reduce the glycemic impact of a broad range of everyday foods and beverages—with particular advantages in carbohydrate-rich formulations,” said PLT’s Mr. Hulse. “It is the synergistic effect of these micronutrients and plant bioactives that is thought to be the source of Benecarb’s sugar controlling capabilities.”

A key benefit of using Benecarb from a manufacturing standpoint is that its inclusion can change the glycemic index (GI) classification of a finished product. “Used in formulated foods and beverages, Benecarb has been shown to lower the GI of food and beverage systems up to 20% based on the 100-point GI scale—and can change the GI classification of a food from high or medium to medium or low,” said Mr. Hulse. “This can support product-based claims of ‘Low GI’ or ‘Lower GI;’ health benefit-based claims such as ‘Supports healthy blood sugar,’ ‘Supports blood glucose management,’ ‘Helps improve insulin sensitivity’ and ‘Helps lower blood sugar spikes.’”

Pycnogenol, Horphag’s patented antioxidant extract from the bark of the French maritime pine tree, also offers significant support for the normalization of blood sugar levels, as demonstrated by clinical studies. Mr. Bornet described Pycnogenol’s mode of action as “slowing the absorption of carbohydrates, which in turn, reduces glucose load to the blood stream.”

Mr. Bornet cited a 2008 study published in Nutrition Research, which found that “Pycnogenol reduces blood sugar in type 2 diabetes patients, allowing people to lower their antihypertensive medication and improves cardiovascular disease (CVD) risk factors…including lower blood sugar levels, LDL (low-density lipoprotein) cholesterol and blood pressure.” 

An additional study (Panminerva Medica, 2010), found that Pycnogenol naturally improved kidney function in patients with metabolic syndrome. “This study found the antioxidant effective in controlling blood pressure, reduced blood sugar and lowered body mass index (BMI) due to weight loss,” said Mr. Bornet.

Gencinia, ActivAMP and Slimaluma are all-natural extracts with documented actions for blood sugar control from Gencor, Irvine, CA, according to Dr. Paul Clayton, chief scientific advisor.

The company’s Coccinia cordifolia (Indica) extract Gencinia is a vegetable that has long been part of the regional diet in India, with its method of action believed to be an enhancement of mitochondrial activity, said Dr. Clayton.

A 60-patient, randomized, double-blind, placebo-controlled clinical trial was conducted using Gencinia, in which subjects ages 35-60 were examined for 90 days while being supplemented with 1 gram of Gencinia or placebo. Results indicated that when taken along with physical activity and dietary guidance, Gencinia supplementation led to statistically significant support for fasting blood glucose levels and post-prandial blood glucose levels.

Gencor’s proprietary extract of Gynostemma pentaphyllum, ActivAMP, activates an enzyme called AMP-activated protein kinase (AMPk). “AMPk is often called the ‘master metabolic regulator’ because it switches on the same fat burning and energy-producing metabolic processes that exercise does,” said Dr. Clayton. “By regulating metabolic activity in the liver, lipids, skeletal muscle and brain, AMPk influences glucose utilization, oxidation and appetite.”

Gencor also offers Slimaluma, a standardized extract of Caralluma fimbriata that suppresses appetite while simultaneously reducing fat storage, according to the company.

Belgium-based BENEO Inc., helps product manufacturers control the glycemic impact of foods with its ingredients Palatinose and ISOMALT. Joseph O’Neill, president and general manager, said there are two main ways to minimize a food’s glycemic impact. The first way, he said, is to reduce glucose concentration. “This can be achieved with sugar substitutes, for example BENEO’s ISOMALT, or BENEO’s dietary fibers, such as oligofructose or inulin.” The second approach is to “modify the glucose supply in such a way that the carbohydrate energy enters the body in a slow, low and sustained way.” In this instance, he recommended the use of BENEO’s Palatinose isomaltulose.

While its chemical structure is technically classified as a sugar, the unique physiological properties of Palatinose make it low glycemic, and thus a “good” sugar, according to Mr. O’Neill. “Palatinose is a disaccharide with a glucose and a fructose unit that are linked by an -1,6-glycosidic binding. Its uniqueness lies in the fact that it provides the body with the full amount of energy—but over a longer period of time. Because of the -1,6-glycosidic binding, Palatinose is hydrolyzed by the enzymes in the small intestine four to five times more slowly, which leads to a low glycemic response. Digestion and absorption is nevertheless essentially complete by the end of the small intestine, thus Palatinose is a fully available carbohydrate,” he explained.

Study results published in British Journal of Nutrition (Holub et al., 2010) found that Palatinose may have beneficial effects on long-term carbohydrate metabolism. An additional study (König et al. Nutrition, 2012) determined that the low glycemic characteristics of Palatinose have beneficial effects on fat utilization in overweight and obese people.

BENEO’s sugar replacer ISOMALT is a hydrogenated carbohydrate made from sugar that allows manufacturers to reduce the amount of carbohydrates in a formula or finished product. Mr. O’Neil said that contrary to Palatinose, ISOMALT is not fully digestible, which means that a certain part passes the small intestine and reaches the large intestine where it is fermented to short chain fatty acids. “Therefore it has a very low effect on blood sugar and does not trigger insulin release to any significant extent (the GI would be 2). However, the overall amount of energy it supplies the body with (2 kcal/g ) is fairly minimal as well.” ISOMALT functions as a bulk sweetener with a sugar-like taste, and it can replace sugar on a 1:1 ratio in various applications, including hard-boiled candies, chewing gum, baked goods and extruded products.

An extract from the popular spice cinnamon is perhaps the most commonly used ingredient for blood sugar management, noted Dr. Fouad of Biotron Laboratories.

“Cinnamon extract has been shown safe and effective to support healthy blood sugar metabolism in several large scale trials, following the discovery of this activity during in vitro studies from the early 1990s.”

The company’s primary interest, however, is in the mineral side of blood sugar management, with its main focus on chromium and magnesium. “Chromium in various forms has been known to affect carbohydrate metabolism since at least the 1950s, when animal studies demonstrated that supplemental chromium could improve insulin activity,” said Dr. Fouad. “Later, observations in malnourished children extended this finding to humans. In the decades since, chromium supplementation has taken a variety of forms—from simple salts such as chloride to organic acid forms.” Biotron focuses on organically bound chromium, he said, mainly as chromium yeast and amino acid complexes of the element, which he described as being highly-bioavailable and safe.

Magnesium on the other hand, is a relative newcomer to the blood sugar support category, Dr. Fouad noted. “Data collected over a decade ago by Lopez-Ridaura et al. as part of the NHANES surveys showed an inverse correlation between magnesium intake and the risk of type 2 diabetes. It’s been hypothesized that the magnesium ion plays a role in the second messenger cascade that is triggered when insulin binds to its receptor. Too little magnesium may attenuate this signal.” This is an exciting area of research that the company is following closely, he added.

Additionally, Dr. Fouad cited a recent meta-analysis of the CHARGE consortium studies (Cohorts for Heart and Aging Research In Genomic Epidemiology), which explored whether genetic variation in magnesium metabolism pathways (as opposed to low magnesium intake itself) leads to the conclusion that low magnesium concentration is related to poor glucose management (Hruby et al., Journal of Nutrition, 2014).

“In fact, this hypothesis was disproved and the authors conclude that higher magnesium intake is associated with lower fasting glucose and insulin levels, and (with one or two rare exceptions) this finding is largely unrelated to genetic background,” he said. As a geneticist, he added, the key takeaway from these findings is that “the role of magnesium in glucose metabolism seems to be pretty basic and whatever the mechanism of magnesium in exerting these effects—it’s at the level of fundamental biological pathways which can’t tolerate too much genetic change over time. This strengthens the argument that this mineral is an essential nutrient for proper blood sugar response.”

Orisett from NutraGenesis LLC, Brattleboro, VT, is a naturally derived, patent-pending blood sugar management nutraceutical composed of low molecular weight chitosan oligosaccharide. Bruce Abedon, PhD, the company’s director of scientific affairs, explained that the ingredient “provides both fast-acting, short-term post-prandial blood sugar balance as well as long-term blood glucose support through multiple mechanisms of action. These mechanisms include inhibition of enzymes that digest carbohydrates as well as enhanced insulin sensitivity.”

Backed by two clinical trials, Orisett has demonstrated its efficacy in the battle for blood sugar control. In the first study, subjects took a one-time dose of Orisett (or placebo) and then underwent an Oral Sucrose Tolerance Test 20 minutes later. In the short-term crossover trial it was found that subjects taking Orisett had peak post-prandial blood glucose levels that were significantly reduced. Timing of peak post-prandial blood sugar was delayed by 40% compared to the placebo group. “This was due to Orisett’s ability to inhibit the sucrose-digesting enzyme, alpha-glucosidase. In vitro and in vivo testing have confirmed these clinical results,” said Dr. Abedon.

In a second double-blind, placebo-controlled human clinical trial, researchers found that 12 weeks of Orisett supplementation resulted in significantly improved insulin sensitivity as well as enhanced glucose uptake and utilization rates in the body based on results of an Oral Glucose Tolerance Test performed on subjects at the beginning and end of the trial. Dr. Abedon stated that Orisett also provided, “superior long-term blood glucose support by significantly lowering glycosylated hemoglobin (HbA1c) levels in subjects. HbA1c is a scientifically advanced test that measures long-term blood sugar levels over an entire 12-week period.”

Sabinsa offers numerous natural extracts for healthy blood sugar management that are scientifically backed for safety and efficacy. Silbinol may have insulin like effects because of the pterostilbene present in the Pterocarpus marsupium, an active herbal component of the formula. As a result, Silbinol may help suppress hepatic gluconeogenesis, stimulate glycolysis and inhibit glucose absorption from the intestine, said Mr. Majeed.

A newly introduced ingredient Pterosin “has C-glucosides, the newest types of anti-diabetic compounds now gaining popularity,” according to Mr. Majeed. “C-glycosides prevent re-absorption of glucose from the urine back into the blood.”

Sabinsa also offers Momordicin, derived from the bitter gourd momordica. Traditionally used in Ayurveda for its anti-diabetic potential, “actives in momordica can inhibit glucose uptake by the gut, stimulate glucose uptake by skeletal muscle cells and also preserve the islets beta cells and beta cell functions,” explained Mr. Majeed.

“Gymnema extract standardized to 25% and 75% gymnemic acids (GS4 PLUS) helps in lowering blood sugar levels by preventing the uptake of sugar,” said Mr. Majeed. “The gymnemic acids also interfere with the ability of taste buds to taste sweet and by inhibiting this ability they can limit the craving for sweets or sugar.”

FenuFibers is an extract obtained from fenugreek seeds standardized to 50% dietary fibers, which are traditionally used in Ayurveda for the management of blood sugar levels and also reducing oxidative stress. Sabinsa claims that the water retaining property of fenugreek seed fibers can help to reduce the rate of glucose absorption.

Additionally, Sabinsa’s popular Curcumin C3 Complex offers support for glycemic control, and has been studied for its beneficial action in combating  “diabesity.” Curcumin C3 Complex has been examined in a mouse model for management of healthy lipid levels in obese subjects, according to Mr. Majeed. “With the implication of inflammation as a major cause of diseases like diabetes and obesity, curcumin’s role in management of healthy blood sugar levels cannot be ignored. In fact, in a recent animal study, it was found that dietary curcumin can improve glycemic control in a type 2 diabetes model; it can also reduce the inflammatory and metabolic derangements associated with obesity. Thus curcumin can play an important role in maintaining healthy blood sugar levels in obese subjects and can also reduce the inflammation associated with obesity.”

Ingredion Incorporated, Westchester, IL, offers HI-MAIZE resistant starch for blood sugar management, which is backed by science to support the stabilization of blood sugar.

The company’s Patrick Luchsinger, marketing manager, said the science behind HI-MAIZE demonstrates that it helps to maintain healthy blood sugar levels in three primary ways: by reducing glycemic response; by increasing long-term insulin sensitivity; and by improving metabolism and facilitating healthy fat storage within the adipose tissue and pancreatic function. Evaluated in more than 60 published human studies, HI-MAIZE was most recently found to improve insulin sensitivity in test subjects with metabolic syndrome (Diabetic Medicine, 2010), overweight and obese men (Journal of Nutrition, 2012), and men and women with metabolic syndrome (Journal of Clinical Endocrinology & Metabolism, 2012).

Awareness & Prevention
With a plethora of functional active solutions to support blood sugar management and weight loss readily available, are consumers ready to commit to serious lifestyle changes to improve their health? Increasing obesity and type 2 diabetes rates would seem to suggest otherwise.

Horphag Research’s Mr. Bornet is hopeful that growing public health issues in the U.S will motivate more consumers to make healthier lifestyle choices. “With the dramatic increase of Americans diagnosed with pre-diabetes and diabetes, blood sugar management will play an integral role in new product development. Consumers are becoming much more health-conscious and educated on the ingredients that go into their products and supplements, and will turn to such products that are proven effective to help manage blood sugar levels.”

Mr. Dondain of Nexira suggested that more consumers are aware of the impact their diet can have on health, with the majority of them looking for active ways to improve their eating habits.

For example, he noted the 2013 “Food and Health Survey Report” from the International Food Information Council (IFIC) Foundation indicated that 58% of Americans are aware that whole grains and dietary fibers help promote healthy blood sugar. One-third of consumers would like more ingredients to help balance blood sugar, according to the Natural Marketing Institute’s 2012 Consumer Trends analysis. Additionally, in its 2013 Trends Predictive Model, Sloan Trends highlighted that long lasting energy and weight-management are the two trends mentioned around blood sugar control, beyond diabetes.

Pharmachem’s Mr. Skop warned that fad diets can be too restrictive, and thus short lived. While the concept of eating closer to nature, similar to what’s prescribed in the Paleo Diet can be a sensible approach, it takes serious commitment. Healthy eating in general can help drop pounds, restore blood sugar and insulin response, and promote overall wellness. Therefore, he promoted “sensible, healthy eating for the long-term, supported by a dietary supplement protocol that elevates the success of a nutritious diet.”