“The increasing incidence of diabetes, as well as complications correlating to poor blood sugar is likely due to an increase in the associated risk factors in individuals, such as being overweight or obese,” said James Komorowski, chief science officer, Nutrition 21, Purchase NY.
Diets bereft of nutritional substance are a significant contributing factor, he suggested. “As of late, people are consuming a higher number of calories as well as overindulging on highly processed foods, which contain an abundance of refined sugars, flours, and fats. This all contributes to an increased incidence of obesity, which tends to go hand in hand with unhealthy blood sugar issues.”
Guy Woodman, general manager, Euromed USA, Bridgeville, PA, also pointed to insufficient intake of fruits and vegetables, and a rise in consumption of processed food, as risk factors contributing to high blood glucose. As an example, he cited a U.S. dietary survey (published in JAMA in 2016), which revealed that approximately 92% of the population might have a deficient intake of abscisic acid (ABA)—a nutrient that assists with the uptake of blood glucose into cells—due to their less than adequate intake of fruits and vegetables.
What consumers are eating plenty of, however, is sugar. “The average American consumes 66 pounds of added sugar in foods and beverages annually,” said Mr. Woodman. “The consumption of highly processed convenience and fast foods and insufficient exercise levels contribute to the growing incidence of type 1 and 2 diabetes in the U.S. The Centers for Disease Control (CDC) stated that 84 million Americans have prediabetes and should take preventative action against progressing to type 2 diabetes.”
Mr. Komorowski noted that elevated blood glucose levels over time can lead to serious negative consequences for health, such as heart disease, and damage to nerves and blood vessels.
Rhonda Witwer, vice president of marketing and business development, International Agriculture Group (IAG), Mooresville, NC, stressed the importance of recognizing insulin resistance as a problem, “as insulin controls the absorption of blood glucose.” She explained, “When the body’s tissues develop resistance to insulin, the movement of glucose from the bloodstream to the tissues where it is utilized and/or stored is delayed and glucose levels rise in the bloodstream. Thus, high blood glucose is the result of insulin resistance.”
Generally, she said, insulin resistance is the precursor to high blood glucose levels. “It is important to note that high blood glucose is typically the last symptom to occur. Insulin resistance may be present for five to 10 years or more before the body loses control of blood glucose levels and blood glucose levels start to rise.”
At the core of this issue is the importance of a healthy diet rich in essential nutrients supporting healthy blood sugar levels. In fact, up to 70% of type 2 diabetes cases can reportedly be prevented or delayed by adopting healthier lifestyles, noted Anke Sentko, vice president of regulatory affairs and nutrition communication, BENEO, Parsippany, NJ.
Mallory Junggren, senior director of marketing, Nutrition 21, pointed to a recent report from Frost & Sullivan that argued “specific nutritional supplements could not only help increase the prevention of specific diseases, such as diabetes, but could also potentially provide significant individual and societal healthcare savings.” The report, “Smart Prevention: Health Care Cost Savings Resulting from the Targeted Use of Dietary Supplements,” found that “a cumulative 649,944 events from 2013 to 2020 could potentially be avoided if all U.S. diabetics over the age of 55 diagnosed with CHD were to use chromium picolinate dietary supplements at preventive intake levels.”
Diet and nutrition play a huge role in healthy blood sugar management, and “more consumers are looking to proactively maintain their healthy blood sugar now, before it ever becomes an issue,” said Mr. Komorowski. In concert with living a healthy, active lifestyle, he suggested consumers are utilizing nutraceutical formulas to help them stave off these dangerous health issues.
Concern & Opportunity
According to HealthFocus International’s 2018 Global Trend Study USA Report, “Shoppers’ Journey Towards Living & Eating Healthier,” just 7% of survey respondents reported being personally affected by high blood glucose levels, with another 7% saying they were impacted by diabetes. Those dealing with these issues were predominantly male, with 14% reporting high blood glucose, and 10% diabetes, compared to 5% and 5%, respectively, in women. Those over 40 years of age were most impacted by these issues.
Yet, when participants in the HealthFocus study were asked about how concerned they were with these issues, 20% said they were extremely or very concerned about high blood glucose levels, and 20% were extremely/very concerned about diabetes.
“While the percent of participants in the HealthFocus 2018 Global Trend Study personally dealing with and concerned about high blood glucose and diabetes is moderate relative to many other more mainstream daily health issues such as tiredness, lack of sleep, back or neck pain, etc., this does not suggest lack of opportunity for marketers,” said HealthFocus International President Steven Walton.
Men were slightly more worried than women (24% of men were extremely concerned with high blood glucose levels, and 23% diabetes; compared to 19% of women concerned about blood glucose and 18% diabetes). Adults 50+ were the most concerned demographic overall.
The report indicated the blood sugar management category was a “niche opportunity,” rife with potential. Mr. Walton noted that niche markets can be “highly profitable and successful if the core prospects are well identified and the solutions are properly delivered (e.g., right time, right place, right price, right product, and right communication). This category will follow the fast-moving consumer goods (FMCG) market pattern of 20% of your users will deliver on average 80% of your volume and generally higher profit.”
He added that while this target audience is limited, they are highly motivated, given their health is on the line. “The health implications for both type 2 diabetes and high blood glucose are more severe…including issues such as blood supply to vital organs, risk of heart disease, kidney problems, and eye sight.” Mr. Walton suggested that nutritional approaches to blood sugar support offer a simple proposition to concerned consumers looking to protect their health. “While there are broadly available prescription solutions, these medical products carry the extra baggage of being effective but not always safe, while foods and beverages are seen as very safe.”
Understanding Glycemic Index
While there is opportunity in the blood sugar management space, some consumers are failing to fully grasp the issue and the medical language related to it. “There is a lot of confusion,” said Ms. Witwer of IAG. “Common language has not yet evolved to talk about ‘good carbohydrates’ with regard to blood sugar impact.”
A 2017 HealthFocus report found 35% of survey respondents had heard of the term glycemic index, but didn’t know what it was. Only 16% said they were very clear on what glycemic index meant. While 23% had never even heard of glycemic index, another 26% reported they knew “glycemic index of foods is something I should pay attention to.”
The term “glycemic index” was initially created as a research technique to quantify the amount of glycemic carbohydrates in a food, however, Ms. Witwer explained the technique has “some inherent flaws that have prevented its widespread adoption.”
She said glycemic index, “compares the glycemic response (rise and fall of blood sugar) of 50 grams of ‘available’ or ‘glycemic’ carbohydrates to the glycemic response of 50 grams of glycemic carbohydrates from white bread or glucose. The glycemic response of glucose is assigned a value of 100, and the glycemic response of white bread is typically around 70. Foods with higher than 70 are described as ‘high glycemic,’ while foods lower are described as ‘medium’ or ‘low’ glycemic.”
The flaw in this technique, she suggested, is that the quantity of foods used for the test changes. “The glycemic index of a high fiber bread compares five slices of high fiber bread to four slices of white bread because both contain 50 grams of ‘available’ or ‘glycemic’ carbohydrates; the fiber is not ‘available’ or ‘glycemic.’ Under these test conditions, the glycemic index of high fiber bread is likely no different than the glycemic index of white bread.”
People simply do not eat this way, she said. Rather, they eat “based upon quantity of food, not quantity of ‘glycemic’ food, which is perhaps why this measurement tool hasn’t made much traction with consumers.”
While she said people should consume foods that have a lesser impact on glycemic response, Ms. Witwer suggested the broader “glycemic response” would gain better consumer acceptance “as long as foods of similar quantity are compared, leading to greater acceptance of the test results.”
Shaheen Majeed, president worldwide, Sabinsa, East Windsor, NJ, observed adoption of low glycemic index formulations among functional food and beverage creators as well as ingredient manufacturers. “Strategies such as low glycemic index diets are useful in weight control, and to reduce insulin levels and insulin resistance,” he said. “While a brand cannot use drug language for marketing dietary supplement products, manufacturers can discuss their products’ low glycemic index to customers.”
BENEO’s Ms. Sentko believes that consumers are responding to terms like “low-glycemic,” as well as the promotion of ingredients that are natural and non-GMO. “The proliferation of media attention and the medical community’s interest in promoting an overall wellness message has resonated with consumers—and will continue to do so,” she stated.
Principal researcher, Mitsutaka Kohno PhD, for the Research Institute for Creating the Future, Fuji Oil Holdings Inc., Japan, suggested physicians are becoming more vocal about the issue of glycemic index with patients, thus helping spread the message. “Consumers are more aware of low glycemic products because doctors have talked a lot about glycemic index and it’s promoted by various weight loss plans. Some consumers also know that low glycemic means suppression of blood glucose level rising after a meal.”
Ingredients for Support
The nutraceuticals industry is tapping into the vast consumer need for products that promote blood sugar control, or provide sugar reduction solutions.
Chromium is known to help control blood sugar and carbohydrate cravings, as well as assis in weight management. “The ingredient is an essential trace mineral that has been shown to have a positive effect on the actions of insulin within the blood, which contributes to the body’s ability to adequately manage blood sugar levels,” explained Mr. Komorowski of Nutrition 21. Regulated blood sugar levels also make managing weight and appetite more feasible, he added.
Nutrition 21’s patented chromium picolinate, known as Chromax, is supported by over 35 human clinical studies that have shown the ingredient is effective in supporting daily nutritional needs as they relate to heart and lipid health, appetite control, and weight management, as well as glucose metabolism and insulin resistance.
Sabinsa also offers a range of products to support healthy blood sugar levels. The company’s Silbinol, proprietary natural pterostilbene, is extracted from the dried heartwood of Pterocarpus marsupium standardized to contain 5% and 90% pterostilbene. “Commonly known as Vijaysar, it is used in the Ayurvedic tradition for the management of diabetes and hyperlipidemia,” noted Mr. Majeed. “It significantly lowered the blood glucose level of hyperglycemic rats, which was comparable to that of the drug Metformin (J Nat Prod, 1997).”
In addition, Sabinsa provides a standardized water-soluble extract from the heartwood of Pterocarpus marsupium that is standardized to contain a minimum of 5% C-glycosides (pterocarposide and samioside). Marketed as PteroSol, the ingredient was examined in a flexible-dose open trial in which patients were given doses of PteroSol at 2, 3, and 4 grams (four weeks each). The subjects in the trial all had non-insulin dependent diabetes mellitus (NIDDM). “It was observed that fasting and postprandial blood glucose levels were controlled in 12 weeks in type 2 diabetic subjects given the dried aqueous extract (Indian J Med Res, 1998),” said Mr. Majeed.
In addition, a flexible-dose clinical study carried out at three different diabetic centers on 172 subjects found 86% of subjects given Pterocarpus extract (2-4 grams/day) showed glycemic control and was comparable to the activity of Tolbutamide (0.75-1.5 grams/day) (Diabetologia Croatia, 2005).
Fenumannan is a branded, standardized extract from the seeds of Trigonella foenum-graecum (Fenugreek) from Sabinsa, which contains a minimum of 60% galactomannan. “Fenugreek was found to significantly improve mean fasting blood glucose levels (from 157 mg/dL to 116 mg/dL). The 24-hour urinary glucose excretion was statistically significant in comparison with the control (Nutr Res, 1990),” said Mr. Majeed.
IAG supplies NuBana RS65 Green Banana Flour, which the company claimed is particularly rich in type 2 resistant starch (and particularly low in glycemic starch). “Glycemic starch digests very quickly in the small intestine, causing a fast and high spike in blood glucose,” noted Ms. Witwer. “On the other hand, resistant starch resists digestion in the small intestine and feeds the bacteria in the large intestine—it is a prebiotic dietary fiber. This fermentation of resistant starch by the intestinal bacteria produces short-chain fatty acids, which change the expression of more than 200 genes in the large intestine.” Some of these genes have been found to control insulin sensitivity, she said. “Numerous clinical trials have shown that resistant starch improves insulin sensitivity, especially people that are insulin resistant or prediabetic. Improved insulin sensitivity has been demonstrated as fast as one day after the consumption of resistant starch.”
Resistant banana starch has been shown to improve insulin sensitivity in healthy people as well as in type 2 diabetics (Interciencia, 2012; International Journal of Environmental Research and Public Health, 2010; Journal of Functional Foods, 2016).
Ms. Witwer also discussed evidence linking type 2 resistant corn starch to improved insulin sensitivity. The ingredient received a qualified health claim for reducing the risk of type 2 diabetes by the U.S. FDA in December 2016, she noted.
San Francisco, CA-based Fuji Plant Protein Labs, providing marketing and sales support for Fuji Oil Holdings, offers the mung bean protein isolate Glucodia. A study published in the Journal of Nutritional Science in 2018 sought to confirm the effects of a Glucodia on glucose and lipid metabolism through two independent double-blind, placebo-controlled clinical studies. In the first preliminary dose decision trial study, supplementation with 3 grams of mung bean protein per day was shown to exert physiologically beneficial effects. In the second main clinical trial study, mung bean protein isolate did not lower plasma glucose levels, although the mean insulin level decreased with use. The homeostatic model assessment of insulin resistance (HOMA-IR) values significantly decreased with mung bean protein, as did the mean TAG level. A significant increase in serum adiponectin levels and improvement in liver function enzymes were observed.
“The study suggests that Glucodia could be useful in the prevention of insulin resistance and visceral fat accumulation, which are known to trigger metabolic syndrome, and in the prevention of liver function decline,” said Yoshi Shiraishi, president and CEO for Fuji Plant Protein Labs.
BENEO’s chicory root fibers, inulin and oligofructose, and functional carbohydrates (Palatinose and ISOMALT) provide a lower blood glucose response in food and drink products—a benefit that has been confirmed by the European Commission with respective EU health claims—noted Ms. Sentko. In addition, she said various scientific studies have shown that BENEO’s chicory root fibers and functional carbohydrates help to lower blood glucose response.
For example, the ingredient ISOMALT has been shown to elicit a “very low blood glucose response, which has been tested and verified in at least 10 human intervention studies with healthy individuals, as well as those with type 1 and type 2 diabetes.” In addition, Palatinose’s low blood glucose response “has been assessed and verified in more than 30 human interventions in various population groups.” Lastly, chicory root fibers offer a blood glucose lowering effect and offer options for sugar replacement, which has been “verified in nine human intervention trials.”
On the regulatory front, BENEO received positive opinions from the European Food Safety Authority (EFSA) for the blood glucose lowering properties of BENEO’s oligofructose and inulin, as well as for Palatinose (isomaltulose) and ISOMALT with corresponding health claim approvals in the Annex of the Regulation 432/2012.
Fruits and vegetables contain the phytochemical abscisic acid (ABA) along with naturally occurring carbohydrates. Euromed offers the ABA ingredient ABAlife, which assists with the uptake of blood glucose into cells. “ABAlife is a standardized extract of ABA derived from one of the richest natural sources known, Ficus carica L. or fig fruit,” explained
High blood glucose concentrations cause the beta cells of the pancreas to release ABA, which improves the efficiency of a glucose transporter (Glut 4) to enhance glucose uptake into cells and support insulin efficiency, according to Mr. Woodman. “Adequate dietary ABA intake promotes glycemic control and homeostasis. ABA consumed as a dietary supplement will be an aid in improving glucose tolerance in healthy individuals and those seeking to optimize their blood sugar control.”
Research presented at the 2018 annual meeting of the American Diabetic Association (ADA) found that a dosage of 200 mg of ABAlife fig fruit extract added to a glucose solution lowered overall levels and peaks in blood glucose and insulin after 30- and 120-minute time periods after consumption. “It also significantly improved glycemic index compared to a reference glucose solution without ABAlife.”
The Future: Apps & Personalized Nutrition
Cutting-edge technology could be the next step forward for the blood sugar management category. “Personalized nutrition, mobile apps, wearable devices, artificial intelligence, and the like are already empowering better nutritional decisions for improved health outcomes,” noted Mr. Majeed. “The present day combining of blood testing services with actionable diet recommendations to increase energy and metabolism are sure to mature in scope. The technology, its availability, and popularity will only continue to evolve, quite likely in ways we can’t yet imagine.”
Mr. Woodman envisioned the development of non-invasive, wearable medical devices enabling users to monitor the effect of types of foods on blood sugar levels. “If one could observe a rapid elevation in blood sugar levels after a food rich in processed sugar, they would be less likely to consume it,” he proposed. With such technology, the impact of dietary supplements could demonstrate “an immediate post-meal effect in lowering blood sugar levels,” further validating their efficacy.
Ms. Witwer pointed to the emerging trend of microbiome health as having a significant future impact on the market for products managing blood sugar. “Resistant starch improves insulin sensitivity by positively impacting the intestinal microbiome. As people become more aware of the importance of maintaining a healthy microbiome, they will also have a greater understanding of gut health for blood sugar management.”
Others predicted a more holistic, back-to-basics approach, grounded in consumer education and functional nutrition. “Although, historically, individuals with blood glucose issues were unaware or uneducated about the benefits of adding a nutraceutical into their daily regimen, more recently, this demographic has taken to proactively educating themselves on what to look for in specific nutritional supplements,” said Ms. Junggren of Nutrition 21. “Additionally, over time, there has been some turnover in the traditional medical community allowing for an upsurge of homeopathic or more naturally inclined physicians, who are open to exploring nutraceuticals as a recommended option for their patients.”