Something’s Got to Give
A natural look at American’s trudging battle against diabetes
by Alissa Marrapodi
“The Edge ... there is no honest way to explain it because the only people who really know where it is, are the ones who have gone over.”— Hunter S. Thompson
Americans are living voraciously edgy lifestyles as they wear their true “nutritious” colors on their sleeve by placing a higher value on television and quick, nutrient-void food instead of physical activities and a healthy body. Skyrocketing rates of obesity and diabetes reveal Americans’ obsession with the edge as they precariously teeter self-indulgence and self-control. And with that balance lacking, they are sadly choosing to deleteriously chip away at their health.
“Dietary habits have shifted away from healthy foods (such as fruits, vegetables and whole grains) to a much greater reliance on fast food, processed snack foods and sugary drinks,” said Frederic J. Vagnini M.D., FACS, the medical director of the Heart, Diabetes and Weight Loss Centers of New York. “Nearly one-third of U.S. children aged 4 to 19 eat fast food every day, resulting in approximately six extra pounds per year, per child. Since 1970, fast-food consumption has increased fivefold among children.”(1)
Dietary problem number one? Portion size. How much larger can our food get? “Look at the youth who are diagnosed with type 2 diabetes: obese, inactive and high-fat, high-carb, nutritionally devoid diets,” said Sharon Howard, R.D., M.S., C.D.E., F.A.D.A., member of the Healthcare Advisory Board of Diabetescare.net. “Let's not ‘blame’ this on one food ingredient or lack of a single nutrient. It’s broader as a societal issue. Everything is BIG. It's even difficult to find medium-size eggs in a store!”
This is not a revolutionary concept. Six years ago a documentary, “Supersize Me,” focused on many aspects of the fast-food industry—from fat, sodium and calorie content to a McDonald’s-only diet’s effect on mood, liver function, energy levels and many other factors of general health—but more notably, portion control; hence, the title.
With diets swinging back and forth between large portions and nutrient-sparse food, it is no wonder diabetes is a household condition. According to the American Diabetes Association, 23.6 million children and adults in the United States, or 7.8 percent of the population, have diabetes. While an estimated 17.9 million have been diagnosed with diabetes, unfortunately, 5.7 million people (or nearly one quarter) are unaware that they have the disease. A Canadian review noted, “In the United States in the next 50 years, it is projected that the percentage of adults with type 2 diabetes will exceed 30 percent, with the vast majority older than 65 years. It is therefore important to determine the best possible dietary and lifestyle modifications to prevent and control this disease and its associated complications.”(2)
Childproof
An obtuse approach to one’s own diet may seem acceptable, but an obtuse and flippant approach to children’s diet is an entirely different story. A blatant disregard toward a child’s diet and their immobile lifestyles is causing diseases such as type 2 diabetes—what used to be known as “adult-onset diabetes”—to show up in young children; even worse, the onset of type 2 diabetes is showing up as early as pregnancy. “In a culture that has encouraged a child's diet and lifestyle to include excessive amounts of sugar and refined carbohydrate consumption, inactivity and exposure to environmental toxins that can impair blood sugar regulation, the inevitable result is obesity and type 2 diabetes,” said Sherrill Sellman, N.D., an educator, women’s natural health expert, psychotherapist and journalist.
The National Institutes of Health (NIH) reported an estimated 92 percent of all children with type 2 diabetes are substantially overweight, and about 40 percent are clinically obese. What happened to sewer tag and neighborhood hide-and-go-seek? Instead, afterschool playtime consists of movies and videogames.
“The most damning statistic of our American lifestyle is there has been a 10- to 30-fold increase in American children with type 2 diabetes in the past 10 to 15 years alone,” said Cheryl Myers, chief of scientific affairs and education, EuroPharma Inc. “Most of these children are from ethnic groups at high risk for type 2 diabetes, i.e., African, Hispanic and Asian descent. According to the Canadian Diabetes Association (CDA), it’s anticipated the global incidence of type 2 diabetes in children will increase by up to 50 percent in the next 15 years. What a sad nutritional legacy to leave to our children.”
Vagnini commented, “When diabetes strikes during childhood, it is routinely assumed to be type 1, or juvenile-onset diabetes; however, in the last two decades, type 2 diabetes has been increasing among children and adolescents. The lack of physical activity by today’s children is a major risk factor. An average child in the United States regularly watches between two to three hours of television a day. Statistically, children who watch the most hours of television have the highest incidence of obesity. Not only does this time in front of the television use little energy (calories), it also encourages snacking. The situation at school isn’t any better—only 8 percent of elementary school children in the United States have daily physical education.”
However, there are efforts underway to encourage change. “There are a lot of programs out there today; for instance, the NFL Play 60 campaign, which encourages children to participate in in-school, afterschool and team-based programs,” said Dennis Torkko, president of Santal Solutions LLC. “The goal with this campaign is to get children to participate in 60 minutes of activity per day. I think that is attainable and could help enormously.”
And just as the size of children’s waistlines is increasing, so is the number of children diagnosed with diabetes. The Centers for Disease Control and Prevention (CDC) estimates one in every three American children born in 2000 could develop diabetes in his or her lifetime. Something has to change.
Lifestyle Control
Warding off this disease is possible; cutting off its resources, i.e., high-glycemic meals, sugary foods, etc., is a step in the right direction. “Blood sugar levels can be kept within the normal range by eating smaller frequent meals with a low glycemic index,” said Kaori Shimazaki, Ph.D., technical specialist for Jarrow Formulas. “In addition, some commercially available dietary supplements can assist in the maintenance of healthy blood sugar and cholesterol levels, appetite and vascular function. However, lifestyle changes often involve strong self-control and careful attention to daily habits. As we all know, this may be challenging for optimal glycemic control. Thus, frequent monitoring of blood sugar levels and consultations with a qualified health-care professional are beneficial while you make appropriate changes in lifestyle.”
So what is diabetes? Diabetes is a disease in which the body does not produce or properly use insulin. Insulin is a hormone that is needed to convert sugar, starches and other food into energy needed for daily life. In a non-diabetic person, glucose (sugar) is absorbed in the bloodstream and insulin from the pancreas transports the glucose into the cells which in turn, provides energy; any excess glucose is then stored in the liver. In diabetics, the glucose enters the bloodstream and insulin leaves the pancreas to transport the glucose into the cells. Unfortunately, one of two things happens next: either the pancreas doesn’t produce enough insulin to transport the glucose (type 1 diabetes and type 2 diabetes) or the cells become resistant to the insulin (type 2 diabetes) stifling the normal process leaving energy levels low, among other things. Type 2 diabetes increases the risk for heart disease, blindness, nerve damage and kidney damage.
Carb Control
Diabetes requires a reduction of dietary carbohydrates overall. Regulation of carbs is necessary due to the body’s resistance to or lack of insulin. However, certain carbohydrates are more acceptable than others. Those low on the glycemic index (GI) digest slower, so they don’t create a spike in glucose levels. The GI measures how a carbohydrate-containing food raises blood glucose and is comprised of low, medium and high measurements. It is prudent for everyone to eat low-glycemic foods such as 100-percent, stone-ground whole wheat or pumpernickel bread; oatmeal (rolled or steel-cut); oat bran; muesli; sweet potatoes; peas; and legumes. Foods such as these keep glucose levels steady.
A study in 2008 confirmed the benefits of a low-carb diet for improving and reversing type 2 diabetes.(3) During a 24-week period, 84 community volunteers with obesity and type 2 diabetes were randomized to either a low-carb, ketogenic diet (less than 20 g/d of carbohydrate; LCKD) or a low-glycemic, reduced-calorie diet (500 kcal/d deficit from weight maintenance diet; LGID). The diet lower in carbohydrates led to greater improvements in glycemic control, and more frequent medication reduction/elimination than the low GI diet.
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However, low-carb is not always an option; fortunately, there are solutions. For example, Oceanova’s InSea2™ is a blend of purified polyphenols from two species of brown seaweeds that slows the digestion of carbohydrates by inhibiting pancreatic alpha-amylase and intestinal alpha-glucosidase enzymes. In fact, results from an unpublished suggest InSea may reduce the rate of glucose absorption by selectively blocking two enzymes that help convert alimentary carbs into single monomers. Additionally, a separate unpublished study showed a 90-percent reduction in normal elevation in blood glucose levels 30 minutes after animals were given InSea with a test meal; and a 40-percent reduction in peak insulin secretion was also observed. Comparatively, the control group, in which glucose absorption occurred over a shorter time period and control animals suffered from after-meal hypoglycemia approximately two hours after the test meal.
PharmaChem also tested its proprietary, standardized extract of a white kidney bean (Phaseolus Vulgaris), Phase 2 Carb Controller®, on its ability to lower the GI of white bread. In an unpublished, open-label, six-arm crossover study conducted by Medicus Research including 13 randomized subjects, the GI of Wonder Brand White Bread was significantly reduced by the addition of 3,000 mg of the Phase 2 in powder form. In a study published in the Alternative Medicine Review, participants receiving 1,500 mg of Phase 2 for eight weeks versus those receiving an identical placebo twice daily, lost an average of 3.79 lbs compared to 1.65 lbs, respectively.(4) Triglyceride levels in the Phase 2 group were reduced to an average of 26.3 mg/dL, more than three times greater a reduction than observed in the placebo group.
“What happens to a dream deferred? … Does it stink like rotten meat? Or crust and sugar over—like a syrupy sweet?” – Langston Hughes,Dream Deferred
Sugar Control
Sugar is the devil’s only friend, right? Wrong. It’s time to debunk the myth that sugar is bad for diabetics. Sugar is only one type of carbohydrate—starch, fiber, sugar and sugar alcohols all account for carbohydrates’ profile. As stated above, a low-carb diet approach is encouraged, leaning on the principle that it’s the amount of carbohydrates that matters, not necessarily sugar intake. This does not mean diabetics should overindulge in sugary treats such as key lime pie for breakfast and molasses cookies for lunch; but, occasionally swapping out carbs from pasta or bread for sugar-filled carbs does allow for some variation. With that in mind, there is a better way to approach the “devil’s only friend”—sucrose (table sugar) and other processed sugars— since they are not recommended for diabetics due to their high GI, which sends the body on high sugar-spikes. The better approach? Low-glycemic sugars that don’t send glucose levels on a roller coaster.
“As a preventive measure, the American populace, first and foremost, needs to reduce the amount of sugar in their diet,” said Fredrick Schilling, co-CEO/partner of Big Tree Farms. “Yet, humans like and need sugar, so use a sweetener that is rich in nutrients and will have a slow absorption rate into the bloodstream.”
Stevia has been the hottest trend to hit the sweeteners aisle in the last couple years. It was sold as a dietary supplement until 2008, when FDA approved it as a sweetener allowing companies such as Wisdom Natural Brands to promote the health benefits of stevia. Companies such as PureCircle and Cargill publicized standardized extracts of a single stevioside, marketed as Reb A, which paved the way for other companies. Wisdom’s SweetLeaf™ delivers whole stevia versus purified rebaudiosides.
But beyond the stevia leaf are other sweet options, such as organic coconut palm nectar. “Coconut palm nectar is the traditional sweetener of Southeast Asia and has been used in various ways, both to sweeten their foods, but also in traditional medicine,” Schilling said. “Recent studies have indicated it’s one of the lowest glycemic commercially available sweeteners (compared to real sugars, not stevia or processed extractive sweeteners) and also one of the most nutrient-rich sweeteners.” Schilling noted its contents are 70 to 80 percent sucrose, but the levels of amino acids and micro- and macronutrients slow the absorption rate down.
Fiber Control
Fiber is a necessary addition to any diet. It is a carbohydrate, but it is mandatory for digestion and helps regulate blood glucose levels in addition to its benefits on cholesterol and overall health. Fiber is found whole grains, as well as certain types of fruits and vegetables.
“A high-fiber diet is beneficial for many things, one being blood sugar balance. Fiber helps to slow the transit of sugars into the bloodstream,” said Julie Tomlinson, sales/marketing manager of ALL ONE/Nutritech. ALL ONE offers a fiber complex—ALL ONE Totally Fiber—that uses a nutrient-dense, slow-burning carbohydrate powder called Aktivated Barley®. “Not only is this an appropriate carbohydrate option for diabetics, it also contains high amounts of beneficial beta-glucans,” she added. “We incorporated this powder as one of the ingredients of our ALL ONE Weight Loss proprietary blend. The Aktivated Barley is combined with chomate chromium, L-carnitine, banaba and whey protein, with additional vitamins and minerals, to offer a complete and balanced meal replacement free of any sugar or sweeteners that is safe for diabetics.”
And research backs up fiber’s claim on good glucose levels. In 2009, researchers out of California investigated the effect of five breakfast cereal test meals containing wheat and/or barley with varying amounts of soluble fiber and beta-glucan on glucose and insulin responses in 17 normoglycemic, obese women at increased risk for insulin resistance.(5) Consumption of 10 g of beta-glucan was able to induce physiologically beneficial effects on after-meal insulin responses in obese women at risk for insulin resistance.
Salba is commonly found in whole grains and is also a weapon against high glucose levels. Sprunk-Jansen uses salba seeds in its Greek-Arabic herbal medicine-based, three-pronged approach for the prevention of diabetes, the precursor to metabolic syndrome. “WeighLevel™, Glucose Level™ and Cholesterol Level™ have demonstrated through human clinical trials to successfully reduce all the major risk factors for metabolic syndrome,” Sellman said. “Some of the herbal ingredients in these formulas include lady's mantle, olive leaf, salt bush, nettle and walnut leaves.”
In a 2010 study at St. Michael's Hospital, Toronto, researchers stated the decrease in postprandial glycemia provided a potential explanation for improvements in blood pressure, coagulation and inflammatory markers previously observed after 12 weeks of salba supplementation in type 2 diabetes. (6)
As Iron Sharpens Iron
Essential trace elements such as chromium, manganese and zinc are often altered in diabetics. A study published in January 2009 compared the status of essential trace elements, chromium, manganese and zinc in biological samples of insulin dependent diabetic mothers and their newly born infants.(7) The mean values of chromium, manganese and zinc in scalp hair and blood samples of diabetic mothers and their infants were significantly lower as compared to the referent mothers-infants pairs, while urinary excretion of all these elements were high in diabetic mother-infant pair samples. Researchers concluded, “The deficiencies of essential trace elements, chromium, manganese and zinc in biological samples of diabetic women may play role in the pathogenesis of diabetes mellitus and impacts on their neonates.”
Many mineral-based products geared toward diabetics use a comprehensive approach by combining trace elements with other blood-sugar management ingredients. EuroPharma USA offers Blood Sugar Assist™ to support blood sugar metabolism, which includes five ingredients: chromium, vanadium, mulberry leaf, purslane and apple extract.
“Chromium has been shown in clinical studies to improve how the body handles blood sugar and insulin,” Myers said. “If your blood levels of vanadium are too low, you are likely to have more problems with high blood sugars. Mulberry leaf contains substances that inhibit an enzyme (alpha glucosidase) responsible for breaking down carbohydrates into sugars, which means absorbing these sugars is reduced and delayed, which lessens the stress on the insulin system. Purslane is an ancient herb that works in three ways to target diabetes: It helps the cell respond to insulin more favorably, it reduces sugar absorption from the intestine into the blood stream, and it helps move the sugars out of the blood and into the cells where they can be burned for fuel. Sour green cider apples have a rare plant compound called phloridzin that has been shown to help lower blood sugars safely by impacting how carbohydrates are absorbed, lessening stress on the insulin system, and helping the body to better metabolize carbohydrates that have been converted to sugars.”
Natrol also uses chromium to battle glucose levels by combining it with cinnamon and biotin, a B vitamin. “Natrol® Cinnamon Biotin Chromium is a triple-action supplement designed to support metabolic health by providing 1 g of cinnamon extract in combination with chromium and biotin, two essential nutrients for glucose metabolism,” said Amy Fitzpatrick, MS, RD, Natrol’s corporate dietitian. “Cinnamon, a staple in most kitchen cabinets, is considered one of America’s favorite spices. Scientists report this culinary favorite is brimming with some of nature’s most potent antioxidant compounds while offering the important benefit of promoting blood sugar health.” Similarly, Enzymatic Therapy offers a three-prong cinnamon, biotin and chromium supplement, alpha betic® Cinnamon Plus Chromium & Biotin, designed to support the hearts of diabetics.
Magnesium is another trace mineral vital to metabolic health. “Magnesium is an essential mineral that plays a critical role in diabetes,” said Val John Anderson, executive vice president, and director of sales and marketing, Mineral Resources International Inc. (MRI). “In his ground-breaking paper that was published more than 17 years ago, ‘The Ionic Hypothesis of Hypertension, Insulin Resistance, Vascular Disease, and Related Disorders,’ Larry Resnick reported in individuals with metabolic abnormalities, i.e., metabolic syndrome, the cells of the body exhibit a disturbance or altered homeostasis with the cellular calcium and magnesium ratios. These individuals have a high ratio of calcium and a low ratio of magnesium, which, in turn, affects the entire body showing up as vasoconstriction in the blood vessels, high blood pressure, insulin resistance, etc. When there is a magnesium deficiency and insulin resistance, the cellular mechanisms don’t work, and it becomes a vicious cycle.” Anderson also noted low levels of magnesium translate in the body to insulin resistance, which impairs cellular uptake of not only glucose but magnesium. In the same way, it also serves as an anti-hypertensive, it helps regulate glucose and displays cardio-protective activity. MRI offers Anderson’s Concentrated Mineral Drops™, an all-natural, ultra-concentrated ionic magnesium and trace element supplement sourced from the Great Salt Lake. “A few years ago, we worked with Mildred S. Seelig, the world’s foremost expert on magnesium,” Anderson added. “According to her and several other published studies, as many as half of diabetic patients are deficient in magnesium. Further, magnesium supplementation can improve both insulin secretion and insulin sensitivity in diabetics.” MRI also created an alternative to table salt— Fortisalt® Gourmet Mineral Supplement—that provides more than 10 essential and trace elements, including magnesium, chromium and zinc, to avoid an excess of sodium.
Max R. Motyka, M.S., RPh, director of sales and marketing, Albion Human Nutrition, echoed Anderson’s comments, stating: “Certainly, it has been seen that all of these factors: diet, exercise and doing things to ensure you get enough of the key minerals all help. How effective? We still are at our infancy in terms of our ability to estimate.” Motyka highlighted magnesium glycinate chelate, zinc glyicnate chelate, and chromium nicotinate glycinate chelate, as they are all known to have a positive influence on insulin performance by fighting against insulin resistance.
Botanical Benefits
Pycnogenol®, French maritime pine bark has also shown promise in helping slow the absorption of starchy foods. “Pycnogenol has been subject to many studies with type 2 diabetic subjects,” said Dr. Frank Schonlau, director of scientific communications for Horphag Research & Natural Health Science. “An immediate benefit for diabetic people is Pycnogenol’s ability to slow down dietary carbohydrate absorption, which helps to prevent sugars from rushing into the blood stream too fast.” In a double blind, placebo-controlled, randomized, multi-center study, 77 diabetes type 2 patients received 100 mg/d of Pycnogenol (from Horphag Research Ltd.) for 12 weeks, during which a standard anti-diabetic treatment was continued.(8) Pycnogenol significantly lowered plasma glucose levels as compared to placebo. And results from an Italian study indicated Pycnogenol may be also useful to prevent diabetic ulcerations by controlling the level of microangiopathy
A side effect not often addressed in diabetes is diabetic neuropathy. “A study published two months ago has shown diabetic subjects with early stages of retinopathy, characterized by fragile capillaries in the retina, can be effectively overcome by taking Pycnogenol,(9)” Schonlau added. “Supplementation for three months stopped capillary leakage and the swelling of the retina and visual acuity was restored.”
Enzymatic Therapy took a different approach to diabetes with its multivitamin, alpha betic® Multivitamin. It’s once-a-day, sustained-release tablets are formulated with essential vitamins, minerals and antioxidant designed to support diabetes, as well as a combination of B vitamins to enhance energy levels.
Botanicals are a popular approach to managing diabetes. Companies such as Santal Solutions LLC have created dietary supplements that are botanical, herbal and plant based. OmSanA® is an Ayurvedic virgin isolate from the leaves of the Gymnema sylvestre plant, which helps normalize blood sugar. Another botanical approach to managing diabetes is SugarBal™ from Alive Naturals. It’s made of four botanicals—mulberry leaf extract (MoruCel), bitter melon, astragalus root and cactus—designed to help all aspects of diabetes, including cutting the source of glucose, promoting the secretion of insulin, improving sugar tolerance, and preventing/relieving diabetic complications. Glucose Optimizer® from Jarrow Formulas is a comprehensive combination of nutrients that improve glucose metabolism and antioxidant protection, which incorporates alpha lipoic acid (ALA), banaba, gymnema, bitter melon, fenugreek and eucalyptus, green tea extract and bilberry.
Aloe vera is also used to combat diabetes. Lily of the Desert introduced its aloe-based product, Gluc-aloe. “Our clinical study showed the ability of the panelist tested to reduce blood sugar,” said Jack Brown, vice president of sales and marketing, Lily of the Desert. “It also showed weight loss (12 percent of body weight after 90 days with more than 95 percent of the lost weight being fat, not water, muscle or tissue). The blood sugar benefit is derived from the GI, which treats a high-glycemic meal like a low-glycemic meal and causes reduced blood sugar. The major benefit of this product is that it is just aloe, which has no known toxic side effects.”
The Final Word
Retailers get the “final word” with consumers, as they are vessel in which the end product is delivered; therefore, they have a large pull and influence on consumers. Retailers can use this advantageous effect to educate consumers on the importance of supplementation and diet in the management of diabetes.
“Consumers affected by metabolic syndrome or type 2 diabetes need to be educated to understand which foods contain the components (refined sugars, saturated fats) they need to avoid,” Schonlau said. “There are attempts for labeling foods to indicate in red, yellow or green the contents of sugars and fats. This will be an over-simplification as it doesn’t distinguish between unsaturated and saturated fats, but which reach out to the larger public. Appropriate food labeling which assists the consumer who lacks a deeper understanding of food composition to make a better choice may help to make a change in the future.”
That labeling can be complemented by an informed retail staff. “You are so correct that retailers have the final word with what consumers are exposed to,” Shilling said. “Retailers cannot act outside what FDA allows, in regards to making claims on health attributes of sweeteners; yet, they can take a leadership role in creating a sub-section in their sweetener section that highlights low-glycemic or alternative sweeteners. This continues to be a growing category and based on the diabetes pandemic that is growing; not only in the United States, but globally, the alternative/healthy sweetener category will continue to grow both on the retail and industrial side.”
However, Howard differed in her suggestions to retailers. She said: “It is not the retailer’s job to educate consumers—leave that to the medical professionals. Many products are touted to ‘aid with a condition,’ putting false promise in a bottle to solve problems that really are lifestyle changes. Supplements must be evidenced-based to make claims; otherwise, they do a disservice to the consumer. That said, there are important roles that dietary supplements and functional foods can play in a person’s health. For example, long term use of Metformin (an anti-diabetic drug) can cause vitamin B12 subclinical deficiency. So, sublingual B12 tablets are useful in treating this as an alternative to B 12 shots.”
There are many factors that play into being a retailer in the natural products industry. From FDA regulation to food labeling implementation, there are many things to be mindful of; but retailers have a great opportunity to inform diabetics of the alternatives options available and dietary supplements that ease the negative effects of starchy foods.
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