Diabetes is a devastating condition most people strive to avoid, yet today's lifestyle beckons its onset. On the most basic level, individuals must ensure core nutrients—vitamins, minerals, probiotics, digestive enzymes and fiber—are being delivered on a daily basis. Just as learning to manage diabetes nutritionally can help put health back into balance, becoming proactive could prevent the disease altogether.

Diabetes develops when there is too much glucose (sugar) in the blood. Glucose is the major source of energy for the body's cells. Insulin, a hormone made in the pancreas, controls the amount of sugar in the blood by moving it into the cells, allowing the body to use it for energy. Without insulin, the cells cannot use, or control, glucose. When the body does not have enough insulin, or cannot use it efficiently, the level of glucose in the blood rises and the result is hyperglycemia. Too much insulin and the blood sugar level drops, resulting in hypoglycemia.

There are three elemental types of diabetes: type 1 diabetes (formerly called insulin-dependent or juvenile diabetes), type 2 diabetes (formerly called non-insulin-dependent diabetes mellitus or adult-onset diabetes), and gestational diabetes, which affects pregnant women. Type 2 diabetes is largely associated with older age, obesity, family history, physical inactivity, and race/ethnicity. It accounts for 90 percent to 95 percent of all diabetes cases.

Metabolic syndrome (also known as Syndrome X) is an important risk factor for diabetes. The syndrome, characterized by a clustering of independent risk factors, is a frequent finding in type 1 diabetes and puts a person at risk for type 2 diabetes. Impaired glucose regulation, central obesity, high levels of cholesterol and triglycerides, high blood pressure, insulin resistance and chronic inflammation are key elements that define the syndrome.

The body uses insulin to convert sugar, starch and other foods into energy; eating carbohydrates raises insulin, which then lowers blood sugar. This causes a craving for more food and, in many cases, carbohydrates. In fact, some people advocate severely reducing carbohydrate intake to reduce the insulin response and cravings.

People with diabetes or any pre-diabetic condition—metabolic syndrome, impaired fasting glucose, impaired glucose tolerance or polycystic ovarian syndrome—have difficulty maintaining normal blood glucose levels before and after meals. To combat this, Johanna Burani, Certified Diabetic Educator, suggested: "Try to incorporate slowly digested carbohydrates that are low on the glycemic index (GI). This type of carbohydrate will allow for a slow release of glucose into the bloodstream."

Others note choosing carbohydrate-containing foods with a lower GI will not only lower insulin response but will also curb the appetite. Saul Katz, president, Solo GI Nutrition, said carbs are the body's fuel of choice. "The body needs carbohydrates all day long to provide energy for the minute-to-minute activities that fill our days," he said. "This is where slowly digested carbohydrates serve the body so well." He also suggested minimally processed whole grains, fruits, vegetables, low fat dairy products, natural sugars (fructose, lactose) and soluble fibers, like inulin, offer more beneficial carbs. 

Also in favor of healthy carb consumption, the American Heart Association (AHA) suggests "a diet low in carbohydrates is likely to lack sufficient amounts of essential nutrients found in plant foods that promote good health." Douglas MacKay, N.D., research advisor for Nordic Naturals, agreed a certain amount of carbohydrate consumption is essential for balancing a normal blood glucose level.

Specialty Ingredients vs. Diabetes

Diabetes is far from preclusive, but the scores of diabetes-focused supplements and vitamins on the market can be overwhelming to the average consumer. There are many important core nutrients that may help support the body's response to insulin and mitigate risk factors associated with type 2 diabetes.

One type of novel fiber, Salba (Salvia hisponica, L), was studied by a team at St. Michael's Hospital, Toronto, to determine whether the addition of Salba and minerals to conventional treatment for type 2 diabetes was associated with improved cardiovascular risk factors.' In this study, subjects received either Salba or wheat bran while continuing conventional therapies. The study concluded long-term supplementation with Sallea decreased systolic blood pressure and other emerging factors safely beyond conventional type 2 diabetes therapies while maintaining good glycemic and lipid control.

Chromium, a popular and universally recognized trace mineral, works with insulin at the cellular level supporting healthy blood glucose levels and maintaining them within a normal range. The most active areas of chromium research are its use in supplement form to treat diabetes, lower blood lipid levels, promote weight loss, and improve body composition.

This mineral is a critical component of glucose tolerance factor (GTF), a compound that helps insulin transport glucose from the blood to the cells. Without chromium, blood sugar levels stay elevated because the action of insulin is blocked so that glucose is not transported into the cells. "Without chromium, the reaction does not take place, and the outcome is insulin resistance," MacKay said.

Researchers at Creighton University Medical Center studied long-term safety of oxygen-coordinated, niacin-bound chromium (NBC, as ChromeMate, from InterHealth Nutraceuticals) in SpragueDawley rats. At 6, 9 and 12 months of treatment, body weight gain of the ChromeMate -treated groups was significantly reduced by 7.7 percent, 8.1 percent, and 14.9 percent in male rats, and 5.5 percent, 11.4 percent, and 9.6 percent in female rats, respectively.

Another well-investigated form of chromium is chromium picolinate. In a placebo-controlled study, the efficacy and safety of a combination of chromium picolinate (as Chromax ) and biotin were evaluated . Results suggest the chromium picolinate/biotin combination, administered as an adjuvant to current prescription anti-diabetic medication, can improve glycemic control in overweight to obese individuals with type 2 diabetes; especially those patients with poor glycemic control on oral therapy.

The connection between diabetes and magnesium deficiency is well known. Several clinical studies have examined the potential benefit of supplemental magnesium on metabolic control of type 2 diabetes. In one study, an analysis was conducted to examine the relationship between serum magnesium in 50 type 1 and type 2 diabetic patients, with or without complications, and 40 healthy persons.

Serum magnesium levels in the diabetic population showed significantly low in comparison to the control group. The National Institute of Environmental Medicine, Stockholm, Sweden, reported increased consumption of magnesium-rich foods such as whole grains, beans, nuts, and green leafy vegetables may reduce the risk of type 2 diabetes.

The human body uses the trace mineral vanadium for normal metabolic processes and for the healthy growth of bones and teeth. However, recent research suggests it may do much more than that by assisting with cholesterol reduction and stabilizing blood sugars in type 2 diabetics. Researchers at Hokkaido College of Pharmacy, Otaru, Japan, examined the effect of oral administration of vanadyl sulfate (a form of vanadium) in diabetic rats.6 Results showed an increase in blood glucose was significantly greater in the diabetic rats.

Coenzyme Q10 (CoQ10) facilitates the energy process in cells, but also works as an antioxidant. Therefore, it appears CoQ10 can aid in the body's response to a host of health problems, including diabetes. Researchers from Gujarat, India, studied the effect of CoQ10 on catalase activity and other antioxidant parameters in diabetic rats!

Treatment with CoQ10 produced a significant decrease in elevated levels of glucose, cholesterol, triglycerides, very-low-density lipoprotein (VLDL), low-density lipoprotein (LDL) and atherogenic index, and increased high-density lipoprotein (HDL) cholesterol levels in the diabetic rats. The mechanism of action appears to be its antioxidant effects.

Another potentially beneficial antioxidant is alpha-lipoic acid (ALA). At its most fundamental biological level, ALA breaks down glucose in every cell and converts it to energy. In type 2 diabetes, the body over-produces insulin in response to diets high in refined carbohydrates. In turn, alpha liipoic acid (ALA) acts as an antioxidant, neutralizing hazardous free radicals that lead to diabetic complications, such as diabetic neuropathy and cataracts.

Researchers from the Mayo Clinic Rochester, Rochester, Minn., assessed whether oral ALA could improve neuropathic symptoms in patients with diabetic polyneuropathy. Results showed oral ALA in doses of 600 mg, 1,200 mg, and 1,800 mg was effective in reducing neuropathic symptoms at five weeks.

Trigonella foenum-graecum (fenugreek) seeds are high in soluble fiber, and studies have found fenugreek may help lower blood sugar levels by slowing carbohydrate digestion and absorption, Researchers at the University of Ulster, Northern Ireland, found a soluble dietary fiber (SDF) fraction of fenugreek provides anti-diabetic effects mediated through inhibition of carbohydrate digestion and absorption, and enhancement of peripheral insulin action.

Scientists at Pt. B.D. Sharma Medical College, Rohtak, also studied the effects of fenugreek on induced diabetic rats. After administering oral dosages of fenugreek, both the normal and the diabetic rats showed a significant decrease in blood glucose. The hypoglycemic effect was dose related.

Known for its hypoglycemic effect, bitter melon has some 90 names around the world, including bitter gourd, balsam pear and karela. Researchers from University of Hong Kong report bitter melon, combined with a high fat diet, improves insulin resistance, lowers serum insulin and leptin, but raises serum free fatty acid concentration. The study reveals multiple influences on glucose and lipid metabolism that counteract the effects of a high fat diet.

Gymnema sylvestre is fast becoming a popular remedy in the diabetes category. It offers a wide range of benefits. One of particular interest is its ability to stabilize blood glucose levels, making it possible for the body to use glucose more efficiently. "As an added bonus, the herb, when chewed, has been shown to dull down sweetness sensations, in addition to reducing the craving for sweets," said Jayson Kroner, health and fitness editor for NOW Foods. "This is paramount in maintaining a healthy body weight, which ultimately leads to most effective glucose stature."

In a two-part study conducted at Kobe University School of Medicine in Japan, the effect of gymnema on glucose homeostasis was studied in rats. In the first part, administration of GS4 (an extract of G. sylvestre) in non-diabetic rats significantly reduced the serum glucose response to an oral administration of glucose. In the second set of experiments, the chronic effect of gymnema was studied in mildly-diabetic rats. Results showed gymnema reduced the serum glucose concentrations in the fed state and improved glucose tolerance. These results suggest gymnema is useful in the treatment of certain classes of non-insulin-dependent diabetes mellitus.

Cinnamon has been studied for its use in treating elevated blood sugar levels. A study published in the Journal of the International Society of Sports Nutrition examined the effects of cinnamon supplementation on body composition and metabolic syndrome, Twenty-two subjects with pre-diabetes and metabolic syndrome, were randomly given either cinnamon (as Cinnulin PF, from Integrity Nutraceuticals) or placebo as supplements to their diet.

Those in the Cinnulin PF group showed significant decreases in fasting blood glucose, systolic blood pressure and an increase in lean mass compared to the placebo group. In addition, the Cinnulin PF group showed a significant decrease in body fat. These data suggest this naturally-occurring spice can reduce risk factors of diabetes, as well as other cardiovascular diseases.

A team from the University of Birmingham, England, also conducted a study to determine the effects of cinnamon spice and its phenolic extracts on glucose homeostasis in humans.16 Seven lean, healthy male volunteers underwent oral glucose tolerance tests supplemented with placebo, cinnamon or cinnamon taken 12 hours prior in a randomized crossover design. Results showed reduced total plasma glucose responses, as well as improving insulin sensitivity. Not only were its effects immediate, they also appeared to be sustained for 12 hours.

According to another study by the Institute of Food Science in Hanover, Germany, cinnamon extract seems to have only a moderate effect in reducing fasting plasma glucose concentrations in diabetic patients.

Maitake (Grifola, frondoso), an edible medicinal mushroom, grows in the northern hemisphere and is found in Japan, China, Europe and North America. As maitake grows, the content of crude protein rapidly decreases while the total carbohydrate weight rapidly increases. At harvest, fresh maitake contains 91-percent moisture, with beneficial proteins, carbohydrates and fiber, as well as vitamins B1, B2 and ergosterol (provitamin D).

A study from Nishikyushu University, Saga, Japan, investigated the effects of maitake on insulin concentration, organ weight, serum composition, and islets of Langerhans in induced diabetic rafs. The diabetes and control groups were given either diets containing 20 percent maitake (DM and CM groups) or control diets (D and C groups). During administration of the experimental diets, researchers measured body weight, food intake, amount of feces, and serum insulin concentration at glucose loading. The results showed maitake's bioactive substances can ameliorate diabetic.

Another study from Georgetown University Medical Center, Washington, D.C., examined benefits of a water-soluble extract of maitake on the glucose/insulin metabolism of insulin-resistant KK mice. The extract favorably influenced glucose/insulin metabolism.

Aloe vera has been used since prehistoric times for medicinal purposes such as soothing sun burns and healing wounds. But clinical studies show aloe gel taken internally may produce a mild reduction in mean glucose levels. In a study conducted at the University of Istanbul, Turkey, experiments were done on three groups of rats: non-diabetic, type 1 and type 2 diabetes.

Aloe vera leaf pulp and gel extracts were unsuccessful in lowering the blood sugar level in the non-diabetic rats; however, they showed hypoglycemic activity in both type 1 and type 2 diabetic rats compared to the anti-diabetic medication glibenclamide. In contrast, gel extract showed hyperglycemic activity in type 2 diabetic rats. Researchers concluded due to the differences in the part of the plant, the pulps of the leaves devoid of the gel may be of use in the treatment of non-insulin dependent diabetes mellitus (type 2 diabetes).

Scientists at the University of Madras, Chennai, India, evaluated the presence of hypoglycemic activity in an alcohol extract of aloe vera gel through oral administration in normal fasted rats, oral glucose-loaded rats and streptozotocin-induced diabetic rats." The aloe maintained the glucose homeostasis by controlling carbohydrate metabolizing enzymes.

The Educational Bullhorn

Before retailers can properly assist customers in locating the best dietary supplements for their metabolic/insulin sensitive needs, they should educate themselves about how the malady develops, key symptoms and commonly prescribed medications, and the most vital nutrients for dietary support. It's important for retailers to fully grasp the nature and seriousness of diabetes and metabolic syndrome. Knowledge will go a long way when working one on one with customers. "Do not be afraid to ask questions, and be patient with those you assist, as they might not completely understand either," Kroner said.

Katz added, "Just as consumers learned not all fats are bad, they need to be educated that good cards are digested and metabolized slowly and without causing spike in blood sugar or insulin levels. The emphasis should be on card management, not card elimination or reduction.

Management and prevention of type 2 diabetes and metabolic syndrome is behavior modification toward a positive lifestyle involving appropriate diet, good nutrition, exercise and avoidance of substance abuse. For those that have diabetes, it is not a death sentence. Retailers should offer no constraints on the provision of credible educational material to customers in their health food stores on the nutritional support. This is a big step in helping consumers put health back into balance.   

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