Consumer interest in the use of dietary supplements to maintain healthy blood sugar levels has seen incremental growth. In fact, the 2009 HealthFocus Trends Study showed that the percentage of adults using supplements to manage their blood sugar levels was 6% versus 4% in 2008 (representing growth of 44%). Additionally, the percentage of consumers managing diseases naturally in 2009 found 17% of respondents maintaining blood sugar levels and an average of 13% managing type I and II diabetes. (The numbers were nearly the same in 2008.)

Nearly half of all consumers surveyed said they were aware of foods/supplements that could help them manage their blood sugar, according to HealthFocus International, St. Petersburg, FL. Also, according to SPINS, a market research and consulting firm for the natural products industry, category sales in the natural channel hit $22 million, which is up nearly 2% over last year’s sales (SPINScan Natural, 52 weeks ending September 4, 2010).

The same HealthFocus report offers encouraging news about a broader trend developing in this category. With the mainstreaming of ingredients like inulin, resistant starch and stevia for blood sugar regulation, new data reveal these ingredients also have the lowest impact on the glycemic index (GI), which measures how a carbohydrate-containing food raises blood glucose in the body. In essence, foods with a low GI don’t raise blood sugar levels as much as foods with a high GI. And it appears consumers want to know how blood sugar management supplements will affect their GI. The HealthFocus Report asked consumers the question, “When shopping, how much do the following labels, seals or marks influence your choice?” In response, 28% of respondents said glycemic index is a strong or moderate influence; this is up from 21% in 2006.

In the quest to provide solutions, industry companies are reviewing how best, if at all, to widen the discussion about foods and supplements supporting healthy blood sugar levels for sustained energy, weight control and reducing the risk of developing diabetes.
 
Scientific Proof

Before suppliers begin redesigning labels, there are some legal hurdles to overcome. One of the main barriers to adding low GI claims to blood sugar management products is the shortfall of scientific evidence on low GI. Some industry members are calling for definitive proof of the relevance for citing glycemic index. “Scientific research is divided in terms of the usefulness of the glycemic index as a parameter for choosing foods that lead to weight loss. Paying attention to the glycemic index can be helpful in reducing the consumption of processed and junk food. However, studies have summarized that lowering the glycemic load and glycemic index of weight reduction diets does not provide any added benefit in promoting weight loss,” said Bio-Botanica’s (Hauppauge, NY) professional herbalist/nutritionist, Ellen Kamhi, PhD, RN.
 
Ecuadorian Rainforest’s (Belleville, NJ) marketing representative, Valery Lavigne, also found some issues with defining GI, in addition to the time and expense of conducting human clinical trials. “The GI is not an easy term to define,” not to mention, “There [are] a limited number of nutrition research groups certified to provide accurate measures [and] there are often conflicting numbers in findings of the groups.” She pointed to an article by Nutrition Data, an online source for nutrition information, which noted that one certification group measured the GI of Russet baked potatoes to be 56, while another set it at 111.

On the other hand, Shoreview, MN-based NutraBridge believes in the existing science and is confident low GI will be a concept consumers will come to understand and embrace. “Consumer awareness toward the concept of glycemic index has grown nicely with the publication of a number of positive clinical trials showing the benefits of eating slowly-digestible carbohydrates, such as those contained in whole grains or legumes,” said Scott Steil, NutraBridge’s president.

Mr. Steil recalled a 2008 study published in the Journal of the American Medical Association (JAMA), showing a low-GI diet helped type II diabetics reduce their glycated hemoglobin level, as well as increase their good cholesterol compared to a high-cereal-fiber diet. This news received mainstream media coverage in Time magazine as well as Canadian national television networks and newspapers like The Globe & Mail in late 2008.
 
While some suppliers are concerned about the quantity of scientific proof available to support GI supplement claims, other industry pundits like Andrew Shao, PhD, senior vice president, Scientific & Regulatory Affairs, Council for Responsible Nutrition (CRN), Washington, D.C., believe the problems lie with the U.S. regulatory environment and whether or not products claiming low GI are actually healthful.
 
“Claims with the term ‘diabetes’ or ‘diabetic’ tend to be interpreted by FDA as disease or drug claims; same for ‘lowers blood sugar.’ While it may be difficult to come up with language that would not provoke FDA, since structure-function claims are not reviewed by FDA, some companies have chosen to take the risk and include these terms in their claims,” Dr. Shao said, adding, “But even if some of these claims fly under FDA’s radar, there is also the [Federal Trade Commission] and the [National Advertising Division] to consider. While these latter two don’t focus so much on whether a claim on a dietary supplement is a disease claim, they do take a close look at the substantiation.”

The second issue is that lower GI may not necessarily mean more healthful. “Some foods may have a low GI, but are also calorie dense. When it comes to weight loss, there have been few studies on the effectiveness of low GI foods, and whether low GI or simply low calorie is more important,” Dr. Shao explained.
 
Pharmachem Laboratories’ (Kearny, NJ) senior director, New Product Development, Mitch Skop, said he, too, believes the U.S. regulatory system is slow to embrace a GI claim. “This could be seen as a paradox given the increasing epidemic of obesity, diabetes and other lifestyle-related diseases in the U.S.,” he said. “Reasons cited include lack of definitive proof; the dangers of diabetics changing from traditional carbohydrate exchange routines; and questions as to how dietitians might recommend the concept to their clients.”
 
Calling for more investigation of the matter was BENEO, Inc.’s (West Morris Plains, NJ) executive vice president of sales and marketing, Joseph O’Neill. “Given the fact that [low glycemic] has been explicitly mentioned in the World Health Organization’s recommendations of the carbohydrate expert consultation in 1998, we believe that national regulations need to have a closer look into the matter,” he said.
 
In the U.K. and Australia, for example, labels featuring the glycemic index are already popular and soon will be in the U.S. as well, Mr. O’Neill added.
 
Product Possibilities

Several ingredients are available that can be positioned to help manage blood sugar levels. Albion’s (Clearfield, UT) director, Human Products Division, Max Motyka, said there is an important role for glycinate chelates like magnesium, zinc, chromium and vanadium—all mineral ingredients that are of great value to supplements aimed at increasing the efficiency of blood sugar management through their critical roles in helping insulin to function effectively.
 
A major focus for Premium Ingredients International (PII), Carol Stream, IL, this year is its high intensity sweeteners. PII recently signed a distribution agreement with PureCircle USA for natural, high purity stevia products (stevia and Reb-A). “These sweeteners, along with Ace K, aspartame, erythritol and xylitol, all coordinate with the end user’s attempts of blood sugar management due to their low calorie and low glycemic index. High intensity sweeteners reduce sugar levels in consumer products and therefore are finding their way into more functional products,” said PII’s global product manager, Brent Laffey.
 
Fiber and oligosaccharides also play a role in blood sugar management. Sabinsa, East Windsor, NJ, offers a range of healthful, multifunctional fiber ingredients, such as fenugreek and amla (Emblica officinalis) fiber that slow gastric transit (with benefits in blood sugar support), glycemic index, satiety and digestive support. It is important that fibers and oligosaccharides do not produce flatulence or gastrointestinal distress due to the breakdown 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.

One of the most potent ingredients Ecuadorian Rainforest offers for blood sugar management is the yacon herb, a relative of the dandelion that grows throughout the Andes region. Researchers at the National University of Tucuman of Argentina found that a tea made from only 10% yacon extract taken over a course of 30 days significantly lowered blood glucose levels, while improving key functions in insulin production. The yacon plant also contains one of the highest concentrations of fructooligosaccharides in nature, which resists absorption into the human body. Thus, yacon does not intensify a hyperglycemic condition and can successfully be used as a low-calorie sweetening substitute for blood sugar management.
 
From Bio-Botanica comes cinnamon, one of the most widely known ingredients for supporting blood sugar regulation, which also happens to be low on the GI. According to SPINS, sales of vitamins/supplements containing cinnamon reached nearly $36,000—an increase of more than 2% over last year (SPINSscan Natural, 52 weeks ending September 4, 2010). This spice has been used since ancient times for its flavor, aroma and medicinal actions, but scientific studies today are mounting, offering compelling support for its role in blood sugar management.
 
As recent as this summer, nutrition researchers from USDA’s Agricultural Research Service (ARS) released the results of a study on cinnamon extract and its beneficial effects on insulin levels and related functions. The study focused on 22 volunteers with metabolic syndrome, which 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. At the conclusion of the study, participants taking the cinnamon extract showed significant decreases in fasting blood glucose, among other health benefits.

Bio-Botanica’s Ms. Kahmi also highlighted fenugreek seeds. With sales in the natural channel inching upward 2% to reach nearly $26,000 for the 52 weeks ending early September over the year before, fenugreek seeds are noted for helping to lower blood sugar due to their high fiber content, which slows down carbohydrate digestion and absorption. Fenugreek may also stimulate insulin production and improve blood sugar balance.
 
Pharmachem has two ingredients that offer the benefits of helping manage blood glucose and insulin while helping people to lose weight: Phase 2 Carb Controller reduces the postprandial glucose and insulin spike after eating dietary starches, while Phase 3 Sugar Controller reduces the glucose and insulin reactions to simple table sugar.

Natural Health Sciences’ (Hoboken, NJ) Pycnogenol was also shown in a clinical study to dose-dependently lower blood sugar levels in 30 type II diabetes patients not requiring medication. The results indicated a daily dosage of 50 mg Pycnogenol lowered both fasting and postprandial blood glucose significantly, as compared to baseline. Higher dosages of 100 and 200 mg Pycnogenol were more effective. It also appears to facilitate blood sugar uptake by previously insulin-unresponsive body cells.
 
GlucoHelp (an exclusive Soft Gel branded supplement) is an extract from Lagerstroemia speciosa L., commonly known as banaba leaves or Crepe Myrtle. This plant grows extensively in the tropical areas of the world. A 1998 Japanese placebo-controlled, crossover clinical study demonstrated 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. Further, a five-month crossover study involving type II diabetics demonstrated that GlucoFit—another banaba extract offering from Soft Gel—significantly reduced blood glucose levels and supported small, but significant weight loss. GlucoFit also showed a “memory effect” of blood glucose-lowering for a few days, even after the treatment was stopped.
 
Outlook for Low GI

For now, some suppliers are actively looking for ways to combine a low GI label with a blood sugar management claim. Others worry that the interest in low GI is simply a misunderstood fad, sure to fall by the wayside like the low-carb trend.

On the bright side, Ecuadorian Rainforest’s Ms. Lavigne said while the low-carb movement had its peak and descent, it left permanent change with manufacturers who continued to decrease the carbohydrate load in their products. “The market for low glycemic goods will likely go down the same path, resulting in an overall positive transformation in manufacturing practices,” she said.

At Beneo, Mr. O’Neill said, low glycemic is viewed as a steady baseline of new product developments, a movement very unlike low-carb. “The focus of low glycemic is more a question of the quality of carbohydrates we consume in our every day diet. Consumers and industry understand increasingly that carbs are a very important part in the human diet and are the ‘fuel’ for the body,” he said. “The question is what is a clever choice of carbs or are there new and smart carbs around that help me to make the most out of my food and that provide me the desired energy in a more gentle way for my metabolism.”

Whether or not low GI has staying power will depend on how well consumers digest terms like “low GI” and how low GI intersects blood sugar management. “I think it is important to note that about half of shoppers (53%) get the connection that low glycemic index foods are important for controlling their blood sugar levels,” said HealthFocus International’s Barbara Davis, PhD, RD, vice president of market research. “There seems to be more interest in foods that ‘help manage blood sugar levels’ (37% are extremely interested; 75% are at least somewhat interested). But, that’s not to say there isn’t interest in ‘low glycemic foods’—28% say they are very interested; 67% say they are at least somewhat interested.”

With at least one quarter of respondents interested in low glycemic index foods, NutraBridge, in partnership with innoVactiv, recently launched a new ingredient called InSea2, which reportedly will change the way consumers manage the impact of starch and carbohydrates on blood sugar and insulin response. InSea2 is said to significantly block both alpha amylase and alpha glucosidase enzymes, meaning it blocks the breakdown of both starch and table sugar.
 
While market reports highlight consumer interest in labels such as glycemic index and blood sugar management, experts argue that consumers remain confused about these terms. Bio-Botanica’s Ms. Kahmi called phrases like ‘glycemic index’ and ‘glycemic load,’ “Buzzwords in the weight loss industry.”
 
According to Ms. Kahmi, glycemic index is specifically determined by the amount of insulin released in response to consuming 100 grams of a specific food. The glycemic load takes water and fiber content into account of food consumption. “This (glycemic load) is usually a more realistic number in terms of how the body actually uses food that is consumed,” she explained. “Consumers also don’t understand that the effect of a given food will vary depending on factors other than the glycemic index. For example, watermelon has a high glycemic index, but a low glycemic load because a lot of watermelon would have to be eaten in order to get 100 grams, due to the high water and fiber content.

Lakshmi Prakash, PhD, Sabinsa’s vice president of innovation and business development, agreed, adding, “Complex carbohydrates are slowly broken down, so is amount or type important? Besides, factors such as ripeness of a fruit, storage and cooking methods of foods would affect carbohydrate type (complex to simple carbohydrates). The American Diabetes Association now acknowledges the value of GI knowledge in supporting normal blood sugar levels, but the use of GI is far from mainstream.”

Soft Gel’s Steve Holtby offered a similar perspective. “There is some controversy over how useful the glycemic index is for consumers. It seems like an ideal solution for people with type II diabetes, since it directly addresses the issue of blood sugar levels,” he said, adding, “However, according to the Mayo Clinic, the practical application of the principles of the low glycemic index diet is far more complicated than the average consumer is able to do on his or her own. This is because the glycemic index of foods can swing widely depending upon how the food is prepared and what other foods are eaten at the same time.”

Despite the long list of issues with GI, Lore Kolberg, regulatory and scientific affairs manager, Cargill Food Ingredients Systems, Minneapolis, MN, said a change in consumer understanding could be on the horizon. “The 2010 Dietary Guidelines for Americans will have greater emphasis on healthful dietary patterns and somewhat less emphasis on individual/specific food components. Overall, the 2010 Dietary Guidelines will likely be consistent with those of a low glycemic diet with respect to emphasis on consuming lean meats/poultry, fruits and vegetables and whole grains.”

Cargill Health & Nutrition is conducting consumer research to gain insights into the optimal way to speak to consumers about “low glycemic” carbohydrates that provide a steady source of energy. These insights will be shared later this year with customer partners to help ensure the success of new product launches with Cargill’s Xtend sucromalt.  
References furnished upon request.