Ron Bailey10.01.03
Diabetes Prevention In Japan: An Update
Diabetes is still of much concern amongst the Japanese paving the way for nutraceuticals that can help control this disease.
By Ron Bailey
It has been over two years since the last review of the status of diabetes prevention in Japan in this column. Unfortunately, there is not much positive news to report, as the experience in Japan is similar to that of much of the world, with diabetes a growing problem for the population.
On a global scale, the World Health Organization (WHO) estimated in a recent report that there are over 175 million “people with diabetes” in the world, and that number is expected to grow to 370 million people globally by the year 2030. The same report indicated that the number of Japanese with diabetes was around 7 million in 2000, and is expected to grow to nearly 9 million by 2030. While this rate of growth is slower than the global rate, it is a serious concern in Japan where healthcare is already in near crisis mode.
The Japanese Ministry of Health, Labor, and Welfare (MHLW) indicated that in 2000 diabetes was the ninth leading cause of death in Japan, with more females than males dying from the disease. Although the mortality rate related to diabetes is much lower than for the top four leading causes of death in Japan—cancer, heart disease, stroke and pneumonia—it is clearly a growing problem.
In addition to the more than 7 million “probable” cases of diabetes in Japan, there are another nearly 9 million “suspect” cases of adult diabetes as well, according to a report from MHLW issued recently as part of its Diabetes Population Survey. The total of 16 million probable and suspect cases makes up over 12% of the total population.
The Japanese are relatively aware of the connection between obesity and diabetes, and are beginning to use western terms like “metabolic syndrome” and “Syndrome X” to describe pre-diabetic health conditions. The National Institute of Health and Nutrition (an MHLW institute) in its “National Nutrition Survey in Japan, 2000” defines “obesity” officially as having a Body Mass Index (BMI) of greater than 25. Using that definition, over 25% of males in the 30’s through the 60’s age groups are obese, and over 20% of women in the 40’s to 70’s age groups are also obese. The general trend toward obesity for males has been increasing since 1980 for all age groups, although for women the obesity data are much more mixed and of somewhat less cause for concern.
In any discussion of health in Japan it is important to keep in mind that the Japanese population is aging more rapidly than any other country in the world. The projections consistently show that over one-third of the Japanese population will be 65 years of age or older by the year 2050. Prevention of diabetes is just one of the major challenges that will need to be addressed as the population ages, but it is very important as the incidence of diabetes increases with increasing age.
Non-Drug Approaches to Diabetes Prevention in Japan
The MHLW has been formally supporting efforts by consumers to help prevent or control diabetes by allowing relevant on-label health claims to be made for FOSHU (Foods for Specified Health Uses) foods. As of the end of June of this year, over 40 of the more than 370 approved FOSHU products had received approval to make an on-label claim related to blood sugar, such as “…moderates the absorption of sugar; it is suitable for people beginning to be concerned about blood sugar levels.”
In a presentation at the Natural Products Expo Europe trade show in Amsterdam in June, the Japan Health Food and Nutrition Food Association (JHNFA) reported that 2001 retail sales in Japan of FOSHU foods “Good for those who have high blood glucose” were around $150 million U.S. dollars. This is up from sales of only $6 million U.S. dollars for the same category of FOSHU products as recently as 1997. Clearly there is increasing consumer interest in blood sugar control in Japan.
It is worth noting that one “functional ingredient” used in the many of the FOSHU products responsible for blood sugar control is indigestible dextrin from Matsutani Kagaku. This dietary fiber source was originally targeted toward gastrointestinal health claims, but new clinical data were generated to support the second claim for blood sugar control.
It is also worth noting that claims for weight loss are not health claims in Japan and are therefore not considered to be suitable for the FOSHU application process.
Non-FOSHU Food Applications
At the same time that the FOSHU products with demonstrated blood sugar control efficacy are growing in sales, there are additional commercial ingredients in Japan that are used in products that do not (yet) have FOSHU status. Although no on-label claims can be made for non-FOSHU products, there are many ingredients supported by at least small clinical efficacy studies that are targeted at prevention of diabetes, through blood sugar control and/or support for weight loss.
A review of three recent issues of the “Japanscan Food Industry Bulletin” in the “Ingredient News” sections reveals the following examples:
• Rice peptide for diabetes prevention
• Capsicum fermentation extract for “fat absorption suppression”
• L-carnitine for “body fat burning”
•Loquat leaf extract for diabetes prevention
• Stevioside for blood sugar control
• Banaba leaf extract for blood sugar control
• Defatted rice germ as a slimming aid
• Brewer’s yeast for obesity
Other useful sources of ingredient information related to diabetes prevention are the tradeshow guidebooks from relevant shows in Japan, using as examples only those abstracts that specifically linked an ingredient with a health-related condition.
Examples from the ifia 2003 (International Food Ingredients and Additives), Health Industries Show 2003 and Health Ingredients Japan 2002 trade shows, all held in Tokyo, Japan, within the past year, include:
• Pinitol for blood glucose control
• Maltitol for diabetes
• Mulberry and green tea extract combinations for blood glucose control
• L-arabinose for blood sugar control
• Agaricus blazei mushroom for diabetes
• Black sesame for obesity and weight loss
• Korean balloonflower for diabetes
• Tamogi mushroom for diabetes
• Korean red ginseng for diabetes
• Helianthus for diabetes
Other ingredients were exhibited at the shows demonstrating efficacy related to diabetes prevention, but from companies that chose not to make even implied health-related claims in the show guidebooks. Larger companies in general are more conservative in their guidebook abstract ingredient and product “claims,” similar to the U.S. Some of the better-known ingredients for diet/weight loss such as chitosan, Garcinia cambogia and Gymnema sylvestre, for example, do not require guidebook explanations of the ingredient benefits.
Expectations for the Future
Until the annual increase in the number of people with pre-diabetes and diabetes in Japan is stopped, there is no question that Japanese companies will continue to search for new non-drug ingredients, which may help to prevent the disease. The MHLW’s support for the growing number of FOSHU products targeted toward diabetes-related conditions is an indication that the Japanese government also sees the need for such foods to be consumed on a regular basis. Given the global nature of the diabetes problem, successful overseas measures to prevent or control the disease will generate considerable interest in Japan as well.NW
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Note: Important sources of information for this summary are various Ministry of Health, Labor and Welfare websites, the National Nutrition Survey in Japan 2000 report, the Japan Health Food and Nutrition Food Association, the Japanscan Food Industry Bulletin, and the tradeshow guidebooks from ifia 2003, Health Industries Show 2003 and Health Ingredients Japan 2002.