Fighting Metabolic Syndrome, Naturally

by Erika Camardella

Metabolic syndrome, also known as “Cardio-Metabolic Syndrome” or “Syndrome X”, is a cluster of conditions. There is some disagreement in the medical communities as to whether it is a condition unto itself or rather a list of previously identified risk factors relating to cardiovascular disease (CVD) and type 2 diabetes. Thus, research into the complex underlying process linking this group of conditions is ongoing. There is also some debate as to whether it is obesity or insulin resistance that causes metabolic syndrome, or if the syndrome is a result of a greater metabolic cause.

As the name suggests, metabolic syndrome is tied to the body’s metabolism, possibly to a condition called insulin resistance. This collection of cardiovascular disease (CVD) risk factors—including hypertension and dyslipidemia—and type 2 diabetes, and its association with insulin resistance led investigators to propose the existence of a distinct entity called “the metabolic syndrome,”¹ which has been defined by reputable organizations and assigned its own code in the World Health Organization’s (WHO) ICD-9.

Risk factors include age, race, obesity and family history of diabetes. The prevalence of metabolic syndrome increases with age, affecting less than 10 percent of people in their 20s and 40 percent of people in their 60s. People with the metabolic syndrome are at increased risk for developing diabetes and cardiovascular disease as well as increased mortality from CVD and all causes.

Limited information is available about the prevalence of the metabolic syndrome in the United States, but since the Centers for Disease Control (CDC) and Prevention/National Center for Health Statistics (NCHS) conducted the National Health and Nutrition Examination Survey (NHANES III) from 1988 to 1994, an estimated 47 million U.S. residents are reported to have the metabolic syndrome.² The age-adjusted prevalence of the metabolic syndrome for adults is 23.7 percent and ranges from 6.7 percent among people ages 20 to 29 to 43.5 percent for ages 60 to 69 and 42.0 percent for those aged 70 and older.³ The age-adjusted prevalence is similar for men (24.0 percent) and women (23.0 percent), but Mexican Americans have the highest age-adjusted prevalence of the metabolic syndrome at 31.9 percent.⁴ The lowest prevalence is among whites (23.8 percent), African Americans (21.6 percent) and people reporting an “other” race or ethnicity (20.3 percent).⁵

One of the possible outcomes of metabolic syndrome is development of type 2 diabetes, incidence of which is on the rise. The cost of caring for U.S. adults with diabetes rose sharply between 1996 and 2003, a period in which the number of patients soared from 9.9 million to 13.7 million and the average annual inflation-adjusted treatment costs rose from $1,299 to $1,714, according to the Agency for Healthcare Research and Quality (www.AHRQ.gov). The rising costs of prescription drugs accounted for much of the cost increase. Overall care for patients with diabetes—including treatment in all settings and for other illnesses such as congestive heart failure—averaged more than $10,000 annually. This is a high price to pay, particularly when lifestyle changes and nutritional support are far less costly.

“Lifestyle created the problem, and only significant lifestyle change can completely address it,” said Matt Warnok, president of RidgeCrest Herbals. While heredity and ethnicity may increase one’s risk for these conditions, the role lifestyle plays cannot be overstated. These conditions are often precipitated and exacerbated by poor habits such as overeating, an unhealthy diet and a sedentary lifestyle. Lifestyle changes are critical to success in managing metabolic syndrome. Exercise and nutrition modification are of primary importance to yield beneficial results. “The general societal lack of exercise and balanced nutrition is a key factor as to why metabolic syndrome is increasing at such an alarming rate,” said Tim Romero, executive vice president, Integrity Nutraceuticals. “These factors must be addressed first and foremost; dietary supplements are an adjunct to lifestyle modification.”

Along with exercise, a healthy diet should be a part of the lifestyle in naturally managing metabolic syndrome; the good news is people with diabetes or metabolic syndrome do not need special foods. “They are the same foods that are good for everyone in your family,” said Kathy Martino, manager, sales and customer service for Hero Nutritionals. “Eating foods that are low in fat, salt, and sugar and high in fiber such as beans, fruits vegetables and grains helps.”

Grace Ormstein, M.D., medical advisor and scientific director at Himalaya Herbals, agreed: “The plate should be a colorful palette. Vibrant vegetables and fruits contain essential vitamins, minerals, fiber, and phytochemicals the body needs to promote good health. "And for those with a sweet tooth, sugar can be replaced with safe substitutes such as stevia, xylitol or maltitol." Patients’ family histories help doctors monitor symptoms. To make it easier to compile a family health history, the Office of the Surgeon General has created a free, Web-based tool that organizes family health information into a printout that people can take to health care professionals to help determine whether they are at higher risk for disease (https://familyhistory.hhs.gov). “Gathering your family health history really is the first step towards personalized medicine,” said Francis S. Collins, M.D., Ph.D., director of the National Human Genome Research Institute (NHGRI), part of the National Institutes of Health (NIH).

“The market is expanding as quickly as our waistlines and, like our waistlines, is driven by our ever-deteriorating Western diet,” Warnok said. “In addition, research seems to show that high-fructose corn syrups and solids have exacerbated our glucosecontrol issues and may be significantly responsible for the epidemic spread of diabetic and pre-diabetic conditions in America today.”

Martino said there is growing awareness of the challenges of metabolic syndrome and its effect on society. “Many companies are developing products that can aid in that ailment,” she said. This complements the move by consumers to be more amenable to other options instead of turning to prescription medicine as the only option for managing symptoms. “In my opinion, the number of those [people] concerned about their health enough to educate themselves about alternative choices for care, especially in regards to blood sugar regulation, is increasing tremendously,” said Ormstein.

According to Kerrin Rourke, natural products expert, and Sonia Caltvedt, marketing and communications, with the market research firm SPINS, “Product sales (including vitamins, supplements, herbs and medicinal teas) related to the diabetes health concern have increased 13 percent in the natural channel and a whopping 45-percent in the conventional channel over the past year, for an average of 30-percent growth across channels.” Baby boomers are continuing to drive population trends and, according to Paul Dijkstra, executive vice president, InterHealth Nutraceuticals Inc., “Metabolic syndrome, diabetes and other blood sugar problems have a strong correlation to age, so it follows that we’re seeing a strong uptick in incidence as the boomers reach mid-life and beyond.”

Nature offers a garden of choices in managing one or more of the various elements in metabolic syndrome or diabetes. Diabetics who take dietary supplements as part of a healthy lifestyle program tend to have a better view of their personal health than those who do not supplement their diet, according to a recent study conducted by The Lewin Group.⁶ In the study, commissioned by the Dietary Supplement Education Alliance (DSEA), researchers reviewed existing data and found people who used dietary supplements reported to be in better health than the year before. Approximately onethird of diabetics take dietary supplements; users are more likely to be older, more highly educated, white, have a higher income and more likely to be insured. Diabetics who take supplements generally scored higher on the U.S. Healthy Eating Index and were less likely to be heavy drinkers of alcohol. Among the popular dietary supplements taken by diabetics were chromium, calcium, folate and omega-3s.

One of the first steps to manage metabolic syndrome is changing the diet. A high-carbohydrate, high-fiber diet can improve blood glucose and glycated hemoglobin (A1C) levels, which indicate long-term blood glucose control—and ultimately affect a person’s susceptibility to diabetes, according to a study published in the Journal of the American College of Nutrition.⁷ Based on 25 years of studies and recommendations, researchers said such a diet can also improve lipid (fat) levels in the blood and made the recommendation that people should eat 25 to 50 g/d of fiber. And, the National Public Health Institute of Helsinki, Finland, concluded that higher intake of whole grain and cereal fiber significantly reduced the risk of type 2 diabetes development in a 10-year study of more than 4,200 adults.⁸ In another study corroborating fiber’s benefit to blood glucose levels, researchers concluded that a higher intake of cereal fiber significantly reduced the risk of type 2 diabetes development.⁹ The eight-year study, conducted at the Harvard School of Public Health, found glycemic index was significantly associated with an increased risk of diabetes.

There are also a range of dietary ingredients and natural supplements useful in addressing the various general aspects that affect metabolic syndrome including blood sugar regulation, antioxidant support and blood pressure. One hot ingredient is cinnamon (Cinnamomum cassia); its history as a medicinal herb goes back centuries in India and other parts of Asia, but it is better known in the Western world as a culinary spice. Cinnamon has had GRAS (generally recognized as safe) status since 1964 and has been shown to be effective in regulating blood sugar. Studies also show it may reduce blood pressure, inhibit fat body mass and encourage lean body mass. Cinnamon in the form of CinnabeticII from Hero Nutritionals uses Integrity Nutraceuticals’ patented water extract of cinnamon (Cinnulin PF®). A study published in Diabetes Care magazine revealed individuals treated with cinnamon for a period of 40 days showed decreases in fasting glucose levels of 18 to 29 percent, cholesterol decreases of 12 to 26 percent, and decreases in triglycerides of 23 to 30 percent.¹⁰ In a more recent study, cinnamon extract had a moderate effect in reducing fasting plasma glucose concentrations in diabetic patients with poor glycemic control.¹¹ In a group of 65 diabetics, fasting blood glucose levels dropped 10-percent in those who used cinnamon.

Chromium also is necessary for proper insulin function and blood glucose regulation because it helps facilitate the uptake of glucose for energy production. And it increases the efficacy of insulin, reducing the amounts the body must produce. It can be found in various foods, including whole-grain cereals, prunes, nuts and seafood. It is common for diabetics to be deficient in this vital trace mineral, but there are a number of chromium forms available in the dietary supplement market; many studies have been conducted and are ongoing in the management of blood glucose. Chromium carnosinate is a watersoluble, bio-available and biologically safe dipeptide-nutrient compound. And chromium picolinate, another biologically active form of chromium, has been tested on animals and humans.

Chromium picolinate improves insulin sensitivity by enhancing insulin receptor signaling in muscle tissue, improving the ability of insulin to enhance chemical signals that promote blood sugar uptake.¹² It may also enhance intracellular signaling.¹³ This mineral is one of the best studied in the area of diabetes as it has been shown to control blood glucose levels; however, studies have indicated chromium’s effectiveness in controlling or preventing type 2 diabetes might be a factor of ethnicity and diet. According to a study in Diabetes & Metabolism, chromium picolinate helps insulin bind to cells and increases the number of insulin receptors and insulin sensitivity.¹⁴ The study suggests low chromium levels in one’s diet can increase the risk of cardiovascular diseases as well as type 1 and 2 diabetes.

A unique patented form of oxygencoordinated niacin-bound chromium (as ChromeMate®, InterHealth Nutraceuticals), was shown to lower mean fasting glucose levels and also promote healthy lipid profiles and glucose metabolism, as well as a modest drop in mean triglycerides and glycosylated hemoglobin (Hb1Ac), the biomarker for long-term glucose control.¹⁵

A study out of the University of Vermont evaluated 37 people with type 2 diabetes in a randomized, double blind fashion and found supplementation with chromium picolinate with sulfonyurea agents significantly improves glucose control and insulin sensitivity.¹⁶ In addition, the researchers found chromium supplementation helped reduce weight gain and visceral fat accumulation when compared to the placebo group. Bulgarian scientists also found chromium supplementation early in the therapy of type 2 diabetes can help reduce the degree of insulin resistance.¹⁷

In a study in India, researchers concluded chromium supplementation can improve the glycemic control of type 2 diabetics possibly due to an increase in insulin action rather than stimulation of insulin secretion.¹⁸ Researchers added chromium levels appeared to be higher in the general Indian population when compared to many Western countries.

The issue of ethnic differences and the effectiveness of chromium in type 2 diabetics was also seen in a recent Diabetes Care study.¹⁹ Unlike many of the Asian-based studies, which often point to a benefit of chromium in type 2 diabetes patients, this study found that there is no evidence that high-dose chromium treatment is effective in European type 2 diabetics. The difference, the authors said, could be that Western diets naturally contain more chromium or that the Asian counterparts are not as obese as the Western patients.

Among several metals, vanadium has emerged as an extremely potent agent with insulin-like properties. These insulinlike properties have been demonstrated in isolated cells, tissues, different animal models of type 1 and type 2 diabetes as well as a limited number of human subjects.²⁰

Canadian researchers said vanadium has been shown to enhance glucose transport, glycogen and lipid synthesis, and inhibits gluconeogenesis and lipolysis in isolated cells.²¹ On the molecular level, the metal’s effects have been shown to activate several key insulin-signaling pathways. A study out of the Albert Einstein College of Medicine compared oral vanadyl sulfate, which is a salt of vanadium, in type 2 diabetics and nondiabetics.²² They found oral supplementation did not have an effect on insulin sensitivity in the nondiabetic group; however, vanadyl sulfate did improve hepatic and skeletal muscle insulin sensitivity in the type 2 diabetics studied. The researchers said this means vanadyl sulfate could enhance insulin’s inhibitory effect on lipolysis, which is the breakdown of fat.

French maritime pine bark extract also has been shown to help control blood sugar levels in diabetics. As Pycnogenol®, from Natural Health Science, the extract contains oligomeric proanthocyanidins (OPCs) as well as several other bioflavonoids: catechin, epicatechin, phenolic fruit acids (such as ferulic acid and caffeic acid), and taxifolin. In a multicenter study in which 77 type 2 diabetics took 100 mg/d of pine bark extract (as Pycnogenol) for 12 weeks, Chinese researchers concluded that pine bark can help type 2 diabetics lower glucose levels and improve endothelial function.²³

Italian researchers also studied Pycnogenol and determined it might have a beneficial effect on diabetic nephropathy (progressive kidney disease) and other vascular retinal disorders.²⁴ After two months of receiving 50 g of Pycnogenol three times daily, patients had no retinal deterioration and significantly recovered visual acuity, compared to placebo.

Pycnogenol was also investigated for its possible benefits in treating diabetic foot ulcers.²⁵ Thirty patients were divided into four groups and given one of four ulcer treatments; after six weeks, patients taking a combined treatment Pycnogenol supplement plus a cream applied topically healed 89 percent of the ulcers, those applying only local treatment healed 84 percent, and 85-percent healed with the oral treatment.

Alpha-lipoic acid (ALA) is approved in Germany as a drug for the treatment of nerve diseases such as diabetic and alcoholic polyneuropathies, and liver disease. ALA is found widely in plant and animal sources, and research has found ALA stimulates the signaling of insulin, which increases glucose uptake in muscle and fat cells.²⁶ It can also protect the body from oxidative stress-induced insulin resistance.

Such factors make this a viable option for the treatment of insulin resistance. Russian researchers assessed the safety and efficacy ALA had in improving nerve function in diabetics.²⁷ After treatments with ALA, the group improved their neuropathic scores by an average of 5.7 points while the placebo improved by an average of 1.8 points. The findings led the researchers to conclude ALA could be a useful ancillary treatment for the symptoms of diabetic polyneuropathy. In another study, researchers concluded oxidative stress could have a large role in diabetic nephropathy and that the disease could be slowed with ALA.²⁸

Traditional Chinese Medicine (TCM) and other ancient traditions offer a holistic approach to metabolic syndrome. Remedies that build and support the body’s own metabolic functions can be of great value, and TCM offers several such formulas. “For example, the oldest known TCM remedy for diabetes was to nourish the pancreas by eating pork pancreas,” Warnock noted. ”We usually think of diabetes (hyperglycemia) and hypoglycemia as ‘opposite’ conditions. In one sense they are, but they are both symptoms of the same condition, the body’s inability to deal with dietary challenges.” Many chronic diabetics will have bouts of hypoglycemia, and vice-versa. “The challenge is to build the body’s ability to regulate blood sugar—not to bypass it,” he said.

Blood Sugar Balance decoction (RidgeCrest Herbals) offers a TCM formula to holistically approach the risks associated with metabolic syndrome. “The Chinese herbologists have a saying: ‘Never send a single soldier to do the work of a troop’,” said Warnock. “Therefore, most TCM remedies are synergistic combinations. In addition, TCM looks at the energy and function balance of the body, and tries to restore it, rather than just hammering on a single symptom (like high blood sugar).” Clinical trials have been conducted on many versions of Bai hu, which contains gypsum, polished rice, anamarrhena root and licorice root, with favorable results. Warnock added, “Several clinical trials have also been conducted on eleuthero, and though we have not tested our specific formula, the combination is one known (though rather unusual) in TCM literature and widely sold since 1994 with great results.”

Packed with nutrients from nature, herbs are another source of nutritional supply for starving pancreatic cells. Maitake, bitter melon and banaba are just a few of the many natural nutritional sources.

Maitake, a beautifully wavy and rippling form of mushroom, grows in clusters at the foot of oak trees, giving it an image of dancing butterflies; hence the name, maitake translated means “dancing mushroom” in Japanese. In a study conducted on rats, Japanese researchers found a diet with 20-percent maitake improved insulin concentration, organ weight, serum composition and islets of Langerhans (pancreas cells that produce insulin and glucagons).²⁹ Another Japanese rodent study found a certain glycoprotein fraction of maitake taken orally for eight weeks (as SX-Fraction, from Maitake Products) caused a reduction in blood glucose, insulin and triglyceride in comparison with a control group.³⁰ “We have clinical research showing that diabetes patients taking SX-Fraction for two months were able to lower blood sugar from 203 mg/d to 171 mg/d,” said Ken Babal, consultant to Maitake Products. “Long-term use of the product (five to seven months) caused blood sugar to drop from 196 to 137.”

A specific fraction of the maitake mushroom (in Maitake SX-Fraction), is also used to combat several aspects of Syndrome X. According to Babal, “Even before the term was coined, numerous studies with maitake mushroom showed that it was effective in reducing high blood sugar, blood pressure, body weight and lipids.”

Bitter melon, or bitter gourd, is the most commonly used Ayruvedic herb for high blood sugar. Despite its warty exterior and bitter taste, it is widely used in folk medicine in the West Indies and Central America. Bitter melon (Momordica charantia) has been shown in preliminary research to increase the cells’ sensitivity to insulin—key to maintaining healthy blood sugar levels. Scientists have isolated a hypoglycemic peptide called polypeptidep from its fruit, seeds and skin, and found it can support normal blood sugar levels.

Developed in 1995, bitter melon plus gymnema—in the form of GlucoCare®, from Himalaya Herbal Healthcare—was shown to support normal blood sugar levels as well as structure and function of the pancreatic cells.³¹ GlucoCare combines the powerful benefits of each individual herb. Studies have also shown that bitter melon supports normal cholesterol and triglyceride levels. Researchers in India found a diet with dried bitter gourd powder could reduce glomular filtration rates in diabetic rats and could partially prevent renal hypertrophy (disease of the kidneys).³² Bangladeshi scientists analyzed bitter melon’s effect on serum glucose levels during fasting or two hours after oral administration of 75 g glucose in moderate non-insulin dependent diabetics, and found supplementation with suspension of bitter melon pulp led to a significant reduction in 86-percent of the test subjects.³³

Preliminary human evidence suggests gymnema (Gymnema sylvestre) may be effective in the management of blood sugar levels in type 1 and type 2 diabetes, as an adjunct to conventional drug therapy, for up to 20 months. Gymnema appears to lower serum glucose and HbA1c levels following chronic use, but may not have significant acute effects. Several studies have shown different species of gymnema to benefit insulin function and glucose control. Gymnema montanum was shown in animal research to reduce blood glucose levels and increase plasma insulin levels.³⁴ The same gymnema species was shown in additional research to have antioxidant properties, as well as antihyperglycemia effects.³⁵Gymnema yunnanense was shown to lower fasting glucose and improve glucose tolerance in obese mice, as well as decrease fasting blood glucose levels in diabetic mice.³⁶

Fenugreek contains several compounds suggested to be beneficial in preventing diabetes. Fenugreek seeds contain a high amount of protein, including the free amino acid 4-hydroxyleucine (4- OH-Ile), as well as saponins and dietary fiber, including the soluble fiber galactomannan. Fenugreek, also known as Greek hay, is an herb that grows two to three feet tall with light green leaves and small white flowers. According to Judi Quilici-Timmcke, senior technical consultant, TSI Health Sciences, “Many people are not aware there is also a stand alone product, Promilin, a patent-pending proprietary extract of bioactive amino acids extracted from fenugreek seeds to assist in healthy blood sugar and insulin utilization.” In one study, Indian researchers found fenugreek leaf powder supplementation significantly lowered lipid peroxidation and significantly increased the antioxidant system in the diabetic rats.³⁷ In another rodent study, researchers in Bangladesh concluded that fenugreek can significantly reduce fasting blood glucose levels and improve diabetes mellitus.³⁸

Banaba tree is an ornamental plant grown in Southeast Asia, India and the Philippines, but it is not just for show; this plant gets to work controlling blood glucose levels. In a proprietary, randomized, double blind study, 12 type 2 diabetics were given a 1-percent corosolic acid concentration of banaba (as GlucoFit®, from OptiPure). Diabetics who took the banaba showed a significant drop in blood glucose levels at a 48 mg dose. Other herbs that may assist in the body's glucose balancing act include holy basil (ocimum sanctum), jambolan (Eugenia jambolana), aloe vera and asparagus (Asparagus racemosus). And one Himalaya herb, Pitasara (Pterocarpus marsupium), has been shown to be supportive of a normal blood sugar level. “There are specific flavanoids in pitasara that also assist in keeping the total cholesterol, LDL and triglycerides on normal level,” Ormstein added.

“All of these conditions (pre-diabetes, cardiovascular disease, type 2 diabetes, obesity, hyperinsulinemia) are interlinked, hence the metabolic syndrome,” Romero said. “Often, it is not just one of these elements that surfaces, it is many. The very general issue is that poor lifestyle choices coupled with a person’s genotype can lead to these conditions.”

According to Stephen Holt, M.D., of Nature’s Benefit, and Holt M.D. Labs: “Insulin excess and other metabolic disturbances in Syndrome X encourage depressed immunity, liver disease, polycystic ovary syndrome, Alzheimer’s disease ... to name a few conditions that are commonly associated with Syndrome X. Many other factors contribute, and modern medicine has recognized obesity as an inflammatory disorder associated with raised blood CRP levels.”

The diagnostic criteria in metabolic syndrome clearly establish the correlation between CVD, obesity and hyperinsulinemia. Individuals with metabolic syndrome are at risk for developing type 2 diabetes, coronary heart disease, heart attack or stroke.³⁹ Since cardiovascular (heart and blood vessel) disease is the leading cause of death for adults in developed countries, many medical studies focus on treating or preventing heart disease and stroke. The metabolic syndrome may identify persons at high risk for developing CVD. “The real initiative in the dietary supplement industry should focus more on the nutritional management of Syndrome X and pre-diabetic states which involve obesity management, with a global health initiative,” Holt said.

Obesity is one aspect of metabolic syndrome that needs to be addressed by many people—as rates continue to climb. Scientists from the Centers for Disease Control (CDC) predict that at present rate, 50 percent of Americans will soon be obese. “Since the conditions are oftentimes caused by these lifestyle choices it creates a domino effect,” Romero said. “The good news is it can often be reversed with the right nutrition, exercise and dietary supplements.”

As natural options continue to expand and research continues, public awareness is also growing. “The new trend conducted by companies that manufacture supplements and wish to produce high quality products for consumers is to subject their products to scientific research,” according to Ormstein. With numerous products on the shelves of health food stores, it can be difficult for consumers to know which is best. “More educated customers are requiring that the supplements they take be proven effective,” she said.

One of the best ways retailers can market a nutraceutical product responsibly is to be up-to-date on consumer concerns and ongoing scientific developments, and to be an information resource for their customers. “Providing thorough explanations and information, such as differentiating premium ingredients from lower-quality knock-offs, and explaining the difference between natural products and over-the-counter or prescription, is of great help to consumers,” Dijkstra said.

There is no question knowledge proves advantageous. “The best way to responsibly merchandise any product is knowledge,” said Martino. And as natural approaches become more known and researched, people will want to look for these products with minimal confusion. Ormstein said she suspects consumers will increasingly turn to preventive, natural approaches to metabolic syndrome and related conditions. Improving the visibility of natural products that target the support of metabolic balance is one way to facilitate the growing consumer demand.

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