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No Sugar-Coating It

Careful conversations can have a huge impact on an epidemic of high blood sugar. Supplements support the lifestyle efforts retailers have to put at the forefront of customers’ minds.

Areport from the Centers for Disease Control and Prevention (CDC) revealed that the number of new diabetes cases diagnosed each year between 1980 and 1990 showed little change; however, in the next two decades (1990-2000 and 2000-2010), the annual number of new cases of diabetes almost tripled.

The National Diabetes Fact Sheet of 2011 showed there were 25.8 million people, including children, suffering from diabetes. “In recent times, the perception of diabetes as an adult onset disease has changed, with children also getting diagnosed,” said Anurag Pande, PhD, vice president of scientific affairs with New Jersey-based Sabinsa Corp., makers of America’s Finest, Inc. supplements. “It is estimated that one in every 400 children has diabetes.”

Further, the CDC estimates that there were as many as 79 million pre-diabetics in 2011, and that number is on the rise as well, with the largest increase in the disease observed in those aged 40- 65 years, according to Mark Schumacher, president Tennesseebased Pharma Defense LLC, the worldwide distributor of Diabetes Defense, and the president of Enerex USA, Pharma Defense’s U.S. distribution arm. “Nearly 50 percent of those over 65 are pre-diabetic. In 2011, when an estimated 105,000 were either diabetic or prediabetic, that meant about 35 percent of the population was affected.”

Since weight gain in most cases is tied to glucose metabolism and the insulin secretion signaling fat storage, Schumacher estimated that those with blood sugar concerns are more in the 50 percent range of the population. “If accurate, one out of every two people that walk into a store should have an interest [in blood sugar] education,” he added.

Natural retailers offer the preventative tools customers are actively seeking. Sabinsa’s Pande noted that the blood sugar management category of dietary supplements is a fast-growing segment— in 2012, it was estimated to be $126 million, and is forecasted to double year by year by 2019—showing that more people are moving toward the preventive health care system.

“The growth of this market has not been overnight, but in fact is rising in consonance with the increasing incidence of diabetes and related health conditions such as obesity,” said Pande. “Obesity has become a major cause of concern, with 80 to 90 percent of people who are diagnosed as diabetic also being obese, providing a strong link between the two diseases.

“Early detection helps people to make changes in lifestyle and dietary patterns,” he added, “and also prompts people to look for preventive care system, which can often help in management of healthy blood sugar levels.”

Causes

The modern American lifestyle is having an indelible effect on blood sugar balance, and Jolie Root, nutritionist and educator with Carlson Laboratories in Illinois, expressed that stress is a core cause. “When stress occurs, the body prepares to handle the perceived threat via the ‘fight or flight’ response, which readies the individual by making energy available to fuel the muscles. Glucose levels rise, glycogen stores are released from the liver, to fuel the flight from danger,” she explained. “But this design was intended for short-term situational stress. Long-term stress such as dealing with a difficult health issue, relationship or financial challenge can cause long-term elevated blood sugar levels, wreaking havoc with glucose control.”

And when people are stressed, most of them eat, and what they eat isn’t ideal. Root cited the increase of intake of high fructose corn syrup and added sugars as another factor. “Flooding the body with these refined carbohydrates challenges the metabolism, and makes blood sugar control very difficult to manage,” she said.

Pharma Defense’s Schumacher concurred, explaining that as blood sugar spikes after digestion of simple carbs or sugary beverages, insulin is released to shuttle the glucose out of the blood stream and into the cells where it can be metabolized. “When the cells begin to become insulin resistant due to coatings of fats, or too much insulin bombarding it, we end up with insulin resistance. If blood sugar stays elevated for more than two hours at levels of 140 mg/dl, beta cell death begins to occur,” he said, adding that at some point after several years, when enough beta cells are destroyed, one can no longer produce enough insulin to manage blood sugar and may require insulin injections. “Most people are unaware that damage is occurring to their capillaries at levels over 110 mg/dl for just a two-hour period. So long before they are diagnosed as a diabetic, they already have some level of damage.”

With the bulk of the issue stemming from the standard American diet (SAD), this also causes the body to be deficient in essential nutrients that may cause the body to not metabolize sugar properly or produce the insulin it needs, Schumacher added.

Diet & Lifestyle

Most customers come to Choice Health, a single store serving the Westfield, MA area for 25 years, looking for assistance— recognizing they have problem, but with no idea how to fix it, according to Suellen Duga, guest relations specialist. “Pre-diabetics come in and know they want to avoid medication, but they don’t know where to go from there. So we make suggestions of supplements for blood sugar control, but we absolutely start with weight control.”

Duga has a very personal tie to the blood sugar category, having been diagnosed more than 20 years ago with a blood sugar disorder called hyperinsulinemia, a condition in which there are excess levels of insulin circulating in the blood than expected relative to the level of glucose when carbohydrates are taken in. She was told she would eventually become diabetic, but through managing her diet, taking nutritional supplements and improving her lifestyle, her condition has not worsened, so she presents a positive, but frank, counsel for customers.

“Some want to think that diabetes just happens to them regardless of their habits. The real challenge is getting them to change their minds, and we’ve had a lot of customers resistant to that—they want to monitor their blood sugar themselves, but they don’t want to change their habits,” she added. “We have to help them see: if you do what you’ve always done, you’ll keep getting the same results, which is what brought you to this point. They need to make lasting changes for their health, and that’s where we start with our customers.”

Jain Makepeace, assistant manager and chief associate at Choice Health, noted that because blood sugar is such a comprehensive systemic issue, there is a product in just about every section of the store that pertains to blood sugar issues—amino acids, vitamins, minerals, herbs, blood sugar supplements, fibers, foods, teas and even topicals for diabetic neuropathy. But looking at products specifically designed to affect blood sugar, she estimates 15 to 25 products, or 10 to 25 percent of the vitamin offering, in one way or another, impacts blood sugar and the body’s ability to process insulin.

At Choice Health, a consultation begins with a conversation, so they can learn exactly what a customer is dealing with and what they’re looking to accomplish. Typically when dealing with blood sugar issues, the conversation will turn to lifestyle and weight loss. Two products Choice Health turns to regularly are Garden of Life’s Raw Fit and Natural Factors’ PGX.

“These products are great for kickstarting a diet/weight loss regimen,” said Makepeace. “On top of that, we have culled from years of being exposed to products and diets that people must have 35 g of fiber a day to lose weight and balance the blood sugar. It doesn’t matter the diet, all encompass 35 g fiber a day and balancing one’s blood sugar.”

Similarly, John Turner, nutritional consultant with Rainbow Blossom Natural Food Markets, a five-store chain based in Louisville, KY, said while the store carries 17 SKUs in one location that are for blood sugar control, the consultation conversation begins with diet.

“Some of our customers know what they want, but a great many others need help, and that’s where we come in,” said Turner, who is always challenging himself to learn more. “I’m currently reading a book on diabetes called Sweet Fire, but after reading Wheat Belly by Dr. William Davis, I understand the havoc gluten can wreak on our bodies. Gluten spikes our blood sugar, but it also fits in the opiate receptors in our brains, which makes us crave it. I’ll often tell customers to abstain from gluten as a start, and then we’ll discuss the nutrients that can assist them with their blood sugar receptors, such as EFAs, chromium, fiber, bitter melon, cinnamon and gymnema.”

Don Verhulst, MD, chief science officer at Michigan-based InBalance Health Corp., a company that launched its functional food and supplement line specifically formulated for diabetics at Expo East 2012, noted it is in fact possible to prevent or delay type II diabetes in those at high risk for developing the disease. “Clinical trials have shown that losing five to seven percent of body weight—that’s 10 to 14 pounds for a 200-pound person—and getting at least 150 minutes of moderate physical activity each week reduces the risk of type 2 diabetes by nearly 60 percent in those at high risk for developing the disease,” he said. “That means products that help people to get to and maintain ideal weight, build muscle and have enough energy to exercise are going to be in great demand. Weight-loss supplements, especially those that address healthy fat metabolism, could slow the progression of pre-diabetes to full blown type 2 diabetes.”

Supplemental Assistance

With obesity and type II diabetes rising at unprecedented levels, so is the demand for natural solutions. “There is such an enormous interest in avoiding the traditional pharmaceutical approach to health issues whenever possible,” said Verhulst. “Informed consumers are looking for natural alternatives that really work—addressing the cause and not just covering the symptoms.”

In addition to its InBars, healthy and delicious options for people with weight-loss or glucose-management goals, InBalance also offers supplements formulated for pre-diabetics and type 2 diabetics. First is the doctor-formulated InSupport Multi, which provides optimum levels of B vitamins, chromium, vanadium, vitamin C, zinc and magnesium to combat the added stress of blood sugar imbalance. It also includes alpha lipoic acid, which protects against free radical damage and supports healthy nerve and insulin function; carnitine, which helps the body convert stored fat into energy; and Gymnema sylvestre, which supports insulin production by the pancreas to promote healthy glucose management.

The second product is InBalance Glucose Management, which supplies key nutrients to support the body’s ability to stabilize blood sugar after eating. “By slowing the breakdown of carbohydrates in the intestine, sugars are absorbed into the bloodstream more slowly, avoiding a sharp rise in blood sugar,” said Verhulst.

MoruCel, a patent-pending mulberry leaf extract, is at the heart of InBalance Glucose Management. MoruCel is a rich source of 1-deoxynojirimycin (DNJ), which inhibits alpha glucosidase, the enzyme that breaks down carbohydrates into simple sugars. It also includes bitter melon, the compounds of which have been shown to activate AMPK, the protein that regulates glucose uptake, a process impaired in diabetics, according to Verhulst. “Bitter melon also contains a lectin, which has insulin-like activity due to its nonprotein- specific linking to insulin receptors,” he said.

Sabinsa’s Pande offered that the current trend in blood sugar management is not just maintaining healthy blood sugar levels, but also reducing risk factors such as high cholesterol levels, management of health body weight and lifestyle changes.

“America’s Finest has a strong product profile of blood sugar management products, which have been used in traditional ayurvedic systems as well as new innovative products pioneered by science-based ingredient supplier, Sabinsa. One such multi-ingredient product Gymnema and Alpha Lipoic Complex, which contains blend of traditional ayurvedic herbs and their extracts, essential micronutrients and alpha lipoic acid for management of healthy blood sugar levels.”

The Gymnema and Alpha Lipoic Complex is a proprietary blend of herbmineral ingredients, including:

• Bitter melon fruit extract (standardized to 2.5 percent bitter principles)

• Gymnema extract (standardized to 25 percent gymnemic acids)

• Magnesium in the form of citrate

• Zinc as zinc monomethionine

• Chromium as chromium polynicotinate

• Vanadium as Bis glycinato oxo vanadium. “Vanadium is an insulin-mimicking compound and by using the more bioavailable form of vanadium, its dosage requirements is in microgram levels only,” said Pande.

Further, Gymnema Alpha Lipoic Complex also contains BioPerine, which is a bioavailability enhancer that helps in better absorption of the other ingredients, improving their bioavailability and efficacy.

“One of the key aspects of the ingredients used in America’s Finest supplements is standardization,” Pande explained. “By using proper biomarkers, we are able to bring the truly standardized products in the market, which can provide therapeutic benefits.”

Because type 2 diabetes is a major public health concern, researchers at the Human Nutrition Research Center of the U.S. Department of Agriculture screened extracts of a number of commonly consumed plants to see how well they could mimic the effects of insulin, the hormone that is responsible for regulating our blood sugar levels. According to Carlson’s Root, from a selection of 49 culinary and medicinal plants, they found in laboratory tests that cinnamon was far more effective than any other plant in fulfilling insulin’s appointed role.1

Carlson introduced its carefully formulated Ceylon Cinnamon product earlier this year. “Many of the products in the market are cassia cinnamon, which naturally contains a compound called coumarin. At high levels, coumarin can damage the liver. Coumarin can also have a ‘blood-thinning’ effect, so cassia cinnamon supplements shouldn’t be taken with prescription anti-clotting medication, such as Coumadin (warfarin), or by people with bleeding disorders,” said Root.

When asked about the studies conducted on the product, Root offered one2 that recruited 60 patients with type 2 diabetes—30 men and 30 women, average age 52, who were randomized into two groups: one for placebo and one for treatment with cinnamon, in daily amounts of 1, 3 or 6 g. The duration of treatment was 40 days.

“All three cinnamon doses had a strong impact on blood glucose levels— and on blood lipid levels as well. Total cholesterol dropped 12-26 percent; LDL-cholesterol was reduced by 7-27 percent; HDL-cholesterol was unchanged; and triglycerides (fats) were reduced by 23-30 percent,” said Root, adding that all three doses of cinnamon showed remarkably sustained activity at the 60-day point (20 days after the treatment had stopped).

Meanwhile, Diabetes Defense from Pharma Defense offers 100 mg of a single ingredient, Isohumulones (manufactured via a patented extraction process of the hops flower), which was chosen due to the extensive research and safety exhibited in over 20 years of study. It has GRAS (generally recognized as safe) status with the FDA (U.S. Food and Drug Association) and has been been clinically proven in double-blind, placebo studies for both pre-diabetics and type 2 diabetics.

“Isohumulones have been clinically proven to help the body improve insulin resistance, reduce triglycerides, lower blood pressure, reduce visceral fat and clear the liver of fatty acids and toxins in a one-a-day 100 mg veggie capsule,” said Schumacher. “Diabetes Defense is a botanical nutrient for individuals who want to have a healthy glucose level and protect themselves against the damage of hyperglycemia (high blood sugar).”

Challenges

A difficult obstacle for retailers is properly advising their customers while staying in line with DSHEA (Dietary Supplement Health and Education Act), since diabetes is a disease and often communication is laden with medical facts on diabetes rather than on benefits of preventive care for management of healthy blood sugar levels.

But Choice Health has its bases covered: “When a customer comes in, we tell them we are not medical professionals, we have no medical training; we can’t diagnose or prescribe,” said Makepeace. “If they’re looking to go off a medication, we tell them that should be done under a doctor’s supervision. We can’t advise them to go off a script or to replace a medication with a supplement. They need to make decisions with the knowledge and monitor of their doctor.”

“In fulfilling our mission to minister to the community, they come to us with their issues and we convey our personal experiences and make our resources available to them,” added Duga, noting that the store offers the Healthnotes (Aisle7) database. “In that way, we’re sure we’re compliant with FDA regulations.” It’s a similar concern at Rainbow Blossom, according to Turner, who said he is always carrying books around the store.

“I try to provide our customers with citations—refer them to a reputable doctor or some piece of science that they can take to the bank,” he said. “At one of our last store meetings, a supplement buyer gave us a one-onone consultation on DSHEA and prohibitive language that was very helpful. We couch our answers and are careful about self-censoring.”

The regulatory environment is something manufacturers are acutely aware, and want to assist retailers to the best of their abilities.

“Educating customers is important since diabetes is a silent disease and may go unnoticed if periodic checks up are not carried out before it is too late. Dietary habits need to be improved for people suffering from diabetes or who are prone to diabetes,” said Sabinsa’s Pande. “America’s Finest is trying to improve the end user’s understanding on the benefits of preventive health care system, including dietary intervention and healthy lifestyle changes. [It] supports customers with wellresearched and standardized products that include well-documented and studied ingredients.”

References:

1 Broadhurst CL, Polansky MM, Anderson RA. Insulinlike biological activity of culinary and medicinal plant aqueous extracts in vitro. J Agric Food Chem. 2000 Mar;48(3):849-52.

2 Khan,A Safdar, M et al. Cinnamon improves glucose and lipids of people with type 2 diabetes. Diabetes Care. 2003 Dec;26(12):3215-8.

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