Unfortunately, diabetes is rather pervasive in our society. According to the Center for Disease Control’s (CDC) “National Diabetes Statistics Report, 2017,” 30.3 million Americans had diabetes in 2015, amounting to 9.4% of the population (1). Of these more than 30 million people, 7.2 million or 23.8% of those suffering from diabetes, are undiagnosed. This is scary because millions of people are not getting the help they need, which will further exacerbate their diabetes as well as lead to other complications.

“Diabetes is responsible for the number one preventable cause of vision loss — diabetic retinopathy,” explains Cheryl Myers, chief of education and scientific affairs at EuroPharma, Inc., Green Bay, WI. “It is the number one cause of kidney damage, kidney failure, and the need for kidney transplant. It contributes to atherosclerosis and heart disease. Nerve damage in the legs and feet is called diabetic neuropathy. The physical toll taken by diabetes is substantial.”

People may also be unaware of the substantial impact diabetes has on the cognitive health of affected individuals. “Elevated blood sugar levels and diabetes can make a person more prone to cognitive decline or Alzheimer’s disease,” Myers explains further. “Considering the delicate nature of blood vessels in the brain and how easily they can be damaged by inflammation, it’s easy to see a relationship between blood sugar levels and the processes that could be responsible for cognitive disabilities.”

Not only that but the potential for developing diabetes is huge. According to the CDC’s report, 33.9% of American adults aged 18 or older, or 84.1 million people, were prediabetic. “People with high blood sugar levels are five times more likely to develop diabetes,” says Jay Levy, director of sales, Wakunaga of America Co., Ltd., Mission Viejo, CA. “If you have either high blood sugar, metabolic syndrome, or diabetes, you have twice the risk of heart disease and heart attack. You also have a 55% higher risk of developing kidney stones, a 75% increased risk of colorectal cancer, and are 20% more likely to experience memory problems.”

Understanding the DiseaseObviously, your job as a retailer is not to diagnose people or treat their diseases but to give them the tools to make healthy decisions and fortify their diets effectively. However, understanding the risk factors and the path an unhealthy lifestyle may lead is important to properly educate clientele and hopefully light a fire under their behinds.

When it comes to diabetes, one term that people may be familiar with is blood sugar. Blood sugar refers to glucose, which is the main source of energy for the body and insulin is the hormone that helps the cells in our body use glucose (2). Insulin is produced in the pancreas and released when the amount of glucose in the blood rises, generally after a meal, preventing blood glucose levels from remaining too high. Insulin resistance is when muscle, fat, and liver cells do not respond properly to insulin and are unable to effectively absorb glucose from the bloodstream. This causes the body to need more insulin and forces beta cells in the pancreas to produce more insulin in order to meet its demand. Over time this ramped up production will no longer be sustainable and as the pancreas fails to produce enough insulin, glucose will build up causing a person to have prediabetes or even type 2 diabetes.

Individuals can suffer from either low blood sugar (hypoglycemia) or high blood sugar (hyperglycemia), which Dallas Clouatre, Ph.D., consultant for R&D, Jarrow Formulas, Inc., Los Angeles, CA says are both related to the issue of insulin resistance. “Two common symptoms are energy and mood swings reflecting the ‘roller coaster’ effects of high blood sugar after meals, poor uptake into lean tissue followed by an overshoot of regulation leading to low blood sugar,” he explains. “Mood effects can include anger and depression as blood sugar troughs before the next meal leading to a blood sugar spike. Snacking and binge eating also are linked to poor blood sugar regulation.”

In between meals when blood glucose dips, another hormone brings it back up. “The hormone glucagon causes the liver to release stored glucose from the cells into the blood stream,” explains Virginie Codran, product manager, Frutarom USA, Inc. based in North Bergen, NJ. “Thus, in healthy individuals fasting blood glucose levels remain stable between 4 and 5.5 mmol/l. However, unhealthy lifestyles often upset this balance leading to slightly increased glucose concentrations.”

More specifically, excess glucose is stored in the liver and muscles as glycogen, which glucagon breaks down into glucose when levels drop too low in a process called gluconeogenesis (3). However, hypoglycemia is more typical of those already with diabetes taking drug treatments designed to lower blood sugar.

Of course, symptoms related to high blood sugar and early signs of insulin resistance are not uncommon to anyone. “Hyperglycemia has a number of warning signs, including headaches, blurred vision, increased thirst and urination, and fatigue,” explains Nichole Carver, marketing director, RidgeCrest Herbals, Salt Lake City, UT.

“Since many of these symptoms can be attributed to other conditions or even just a busy lifestyle, many people don’t make the connection to unhealthy blood sugar levels unless they are tested by their health care provider,” says Clouatre.

Insulin resistance and diabetes can also be wrapped up with a variety of other conditions, which means a person may have metabolic syndrome. “These components include insulin resistance and type 2 diabetes; over-weight and obesity; cardiovascular disorders like hypertension; and dyslipidemias such as high triglycerides and low high-density lipoprotein (HDL) cholesterol levels,” Clouatre explains. “We often think that such problems reflect advancing years. However, there is mounting evidence that the problem is diet and lifestyle, not age.”

These factors can make symptoms of blood sugar dysregulation difficult to pin down, further exacerbating the problem. Those with a family history of diabetes and with certain risk factors such as obesity, high blood pressure, poor diet and a sedentary lifestyle should be vigilant about their potential for diabetes.

One’s lifestyle is a major factor in developing type 2 diabetes while type 1 diabetes is an autoimmune disease heavily influenced by genetics. As Codran explains, “Type 1 diabetes is caused by the immune system destroying the cells in the pancreas that make insulin. This causes diabetes by leaving the body without enough insulin to function normally.” Carver says that while most people may believe diabetes means having to take insulin and closely monitor blood sugar on a regular basis, this is not the case for most. Type 1 will likely require the use of insulin but with the case of type 2, Carver says, “Good diet and regular exercise can reverse diabetes for many people.”

LifestyleAs mentioned earlier, a variety of factors can put a person at risk of developing diabetes, but a common denominator for many of these factors, such as obesity and poor nutrition, is the food we eat. Particularly, in America, our high sugar diet has a major impact.

“For most of human history, sugar intake was essentially zero,” explains Jacob Teitelbaum, MD, a spokesperson for EuroPharma, Inc., “[Now] the average 140 pounds of sugar added to each American’s diet in food processing yearly is a major trigger for insulin resistance and diabetes. That means that 18% of our calories have virtually no vitamins and minerals, so we’re seeing people be both malnourished and obese at the same time.”

Indeed, the most recent Dietary Guideline for Americans: 2015-2020, advises that people limit their sugar consumption to 10% of their calories per day (4). However, old habits die hard and as Teitelbaum puts it, more than just overconsumption, a major issue is sugar addiction. While this may seem like a radical claim, it is grounded in research. For example, one study in Current Opinion in Clinical Nutrition and Metabolic Care states, “Although this evidence is limited by the inherent difficulty of comparing different types of rewards and psychological experiences in humans, it is nevertheless supported by recent experimental research on sugar and sweet reward in laboratory rats. Overall, this research has revealed that sugar and sweet reward can not only substitute to addictive drugs, like cocaine, but can even be more rewarding and attractive”(5).

Although one would hesitate to compare addiction to sugar to that of cocaine or other controlled substances, at a physiological level, it operates in a similar fashion and may explain why people have difficulty controlling their consumption of high sugar foods. That is not to say someone cannot enjoy sweets every so often but consistently consuming sugary foods and beverages may be the sign of a more serious problem. “There are four main types of sugar addiction, and these are caused by fatigue, low blood sugars from adrenal fatigue, candida overgrowth, and anxiety or depression associated with perimenopause,” explains Teitelbaum.

The first two are perhaps the most relatable to your customers. Turning to sugary beverages such as soda or heavily sweetened coffees for energy is not uncommon and low blood sugar from adrenal fatigue which Teitelbaum nicknames, “feed me now or I will kill you moments” is more typically referred to as being “hangry.”

Curbing the intake of food and beverages with a great deal of added sugars, which Teitelbaum refers to as “energy loan sharks,” and relying on natural sources of energy such as fruits and vegetables, eating smaller meals at more frequent intervals and increasing protein intake can be effective ways to reduce one’s reliance on sugar (6). He also suggests switching from white flour to whole grains.
Since many of these symptoms can be attributed to other conditions, many people don’t make the connection to unhealthy blood sugar levels. — Dallas Clouatre, Ph.D., Jarrow Formulas, Inc.
“Many don’t realize that other refined carbohydrates that impact blood sugar can be found in breads, pasta, rice, potatoes, and other high-glycemic foods, which can also cause a rapid rise in blood sugar,” explains Levy. “That, in turn, provokes a higher insulin secretion than eating foods low on the glycemic index.”

Many have been wrongly turning to artificial non-caloric sweeteners as well. “As recently reported, a greater metabolic response to sweet-tasting, lower-calorie drinks could explain the link between artificial sweeteners and diabetes,” says Clouatre. “According to Dana Small of Yale University, the assumption that more calories trigger a greater metabolic and brain response is wrong as calories are only half of the equation with sweet taste perception being the other half” (7).

Important NutrientsIn her book “Fortify Your Life,” Tieraona Low Dog, M.D. says that thiamine, or vitamin B1, plays an important role in the body’s production of energy. “It is a coenzyme, or helper nutrient — for enzymes that are responsible for converting food to energy, particularly the metabolism of carbohydrates, glucose, and alcohol,” she writes (8). Because the average diet is so typically laden with sugar, a constant supply of thiamine is necessary, particularly for those at risk of or with diabetes. “Studies show that it can help prevent or slow the development of diabetes-related diseases,” says Low Dog.

Food sources of thiamine include pork, trout, macadamia nuts, sunflower seeds, green peas, asparagus, oatmeal, beans, flax seed, brown rice and yeast (8). Cereal grains in the U.S. are also fortified with thiamine providing anywhere from 25 to 100% of one’s daily value. Of course, getting all the nutrients one needs from food is often easier said than done. Therefore, Low Dog says that a multivitamin providing between 1.5 to 3 mg per day of thiamine is adequate, though those with diabetes or taking thiamine-depleting drugs should aim to get 10-30 mg daily (8).

B vitamins are generally best taken in a complex and thiamine in particular is highly dependent on magnesium, so it’s crucial to get adequate amounts of both. This makes sense because magnesium is another nutrient important for proper blood sugar regulation. “Decreased magnesium intake caused by food processing is a major contributor [of high blood sugar],” says Teitelbaum. “Decreased vitamins C and K also play a role.”

Chromium is another nutrient consistently cited by our experts as important for managing blood sugar. “Chromium is a trace mineral—meaning we need it in small quantities—that is necessary for the efficient metabolism of carbohydrates and fats, and stable levels of blood sugar,” explains Levy. “It also helps cells respond as they should to insulin.”

This is backed up in “Fortify Your Life” where Low Dog writes, “Chromium enhances the action of insulin, increasing insulin sensitivity and the uptake of blood sugar by our cells.” A deficiency in chromium, she adds, may increase the risk of insulin resistance, predisposing a person to obesity and type 2 diabetes. Brewer’s yeast (dried Saccharomyces cerevisiae) is the richest source of biologically active chromium at around 60 mcg per tablespoon, but it is also present in meat, whole grains, broccoli, green beans, tomatoes, nuts and eggs. Processing of food lowers the level of chromium present in food and it also depends on the chromium content of the soil food was grown in, which is often depleted.

According to Levy, chromium picolinate, the form typically found in supplements, is bound in niacin to increase absorption and Low Dog says that vitamin C and certain B vitamins are also needed to absorb chromium into the gut. She also cites a study which found that when 600 mcg per day of chromium picolinate is combined with 2 mg of biotin, type 2 diabetics experienced improved blood glucose and cholesterol (8). Taking brewer’s yeast as a source of chromium is also possible and Low Dog’s preferred source. She just suggests that one check the label for the presence of chromium GTF.

HerbsWhile nutrients are crucial to our health, herbal remedies have always been there to provide assistance. For example, “Great herbs that support healthy blood sugar levels already in a normal range are anamarrhena root, eleuthero root, chinese licorice root, cinnamon bark, and gymnema,” says Carver. Below are some other herbs of note:

Bitter Melon.Used historically in Traditional Chinese Medicine, bitter melon is said to help the body better absorb carbohydrates to produce energy. “Studies show that bitter melon improves the ability of cells to be sensitive—rather than resistant—to insulin,” says Levin. “Animal and human research also shows that bitter melon works somewhat like insulin, enhancing the delivery of blood sugar. And, compounds in the fruit activate a protein that regulates glucose metabolism in much the same way exercise does.”

Omar Cruz, VP Creative Innovation & Botanical Science, Himalaya Herbal Healthcare, Sugarland, TX, agrees, but also recommends the addition of Triphala. “Triphala and Bitter Melon improve digestive efficiency and increase insulin performance, respectively,” he explains. The addition of adaptogens such as Holy Basil and Ashwagandha, Cruz says, will lower cortisol and improve metabolic function.
Other refined carbohydrates that impact blood sugar can be found in breads, pasta, rice, potatoes, and other high-glycemic foods which can also cause a rapid rise in blood sugar. — Jay Levy, Wakunaga of America, Co., Ltd.
A proprietary wild bitter melon extract (Glycostat) from Jarrow Formulas, Inc., says Clouatre, has been independently tested in animal models both at Georgetown University Medical School and at St. Johns College of Pharmacy in India and found to be effective for blood sugar regulation. “A trial in India at a hospital with participating diagnosed diabetics found that this bitter melon preparation significantly lowered both fasting and post-prandial blood glucose in these patients,” he explains. “These benefits appeared within the first month and were still stable at six months” (9).

The study, which tested the extract alongside metformin, a common diabetes medication, on diabetic rats suggested the bitter melon can have comparable benefits. “Two extracts administered at 250 mg/kg decreased glucose levels to values comparable to metformin at 150 mg/kg,” write the authors. “At 4 hours, EX-1 and EX-4 significantly reduced blood glucose 67% and 63%, respectively, compared with metformin’s 54%.”

Hintonia latiflora.A plant from the deserts of Mexico and Central America used traditionally as a tonic and tea, Hintonia (brand name Sucontral D, sold by EuroPharma Inc.) has been studied clinically in Europe, specifically Germany, for the last 60 years and is frequently recommended there by doctors to control blood sugar. Scientists discovered that it is rich in polyphenols called coutareagenin, which impacts blood sugar regulation and insulin function, explains Myers (10).

One study Myers cites found that Hintonia, along with other nutrients, significantly lowered A1C levels (the average levels of blood sugar over time), fasting blood glucose (blood sugar prior to a meal) and postprandial blood sugar (post meal) (11). “Fasting and postprandial blood glucose numbers are important because they show how much sugar circulates through your system and how your body deals with it after meals,” Myers explains. “Factoring all of the diabetic symptoms, the scores improved from 4.8 points to 1.3 points at the end of the study. Participants also saw improvements in blood pressure, lipids, and liver values.”

In a similar open prospective study in which 41 dietetically stabilized subjects with type 2 diabetes were given Sucontral D, “The three crucial glycemic parameters, HbA1c, fasting and postprandial glucose, were statistically significantly and clinically reduced during intake of a dry concentrate from the bark of Hintonia latiflora,” write the authors (12). The supplement also contains “30 mg vitamin C, 5 mg vitamin E, 0.7 mg vitamin B1, 0.8 mg vitamin B2, 1 mg vitamin B6, 0.5 g vitamin B12, 100 g folic acid, 75 g biotin, 2.5 mg zinc and 25 g chromium,” for added support.

While you should always consult with a physician before taking dietary supplements, in these clinical studies patients were able to stay on their meds while using the herb. “In fact, in some cases, patients were often able to reduce their use of medication or stop taking the medication altogether,” says Myers, though, “these were supervised clinical trials, so you would never want to advise someone to simply give up their medications and only take a supplemental product, but I think that it speaks to the usefulness of hintonia that it can be a safe, adjunct herbal medicine.”

Aged Garlic Extract (AGE).Although better known for its benefits in supporting cardiovascular health, AGE can be a great asset if concerned about the potential for high blood sugar. Made from organically grown garlic that is aged for two years using a proprietary extraction process, AGE has been shown to affect blood sugar in a few ways.

One double-blind, placebo-controlled, randomized, crossover study of 43 subjects with metabolic syndrome taking 1.2 g of AGE for 12 weeks found that compared to placebo, those taking AGE experienced a significant increase in their adiponectin levels (13). “Adiponectin is a protein hormone produced and secreted by fat cells,” explains Levy. “It regulates the metabolism of both lipids and glucose, and influences the body’s response to insulin. Low blood levels increase the risk for type 2 diabetes. The researchers noted that, among the subjects taking AGE, adiponectin also tamed inflammation and increased cellular glucose uptake.”

AGE’s antioxidant properties are also an important component to consider, reducing oxidative stress, due to its sulfur-containing compound called S-allyl cysteine (SAC). “During one preliminary study, SAC lowered blood sugar levels while raising plasma insulin, superoxide dismutase, catalase, and reduced glutathione levels,” says Levy. “Another study found that the anti-diabetic and antioxidant effects of SAC were comparable to the hypoglycemic drug Glycalazide.”

Increased glycation is another factor of chronically high blood sugar, says Levy. This is the process in which sugar bonds with proteins to form advanced glycation end products. “Advanced glycation is one of the major pathways involved in the development and progression of different diabetic complications including nephropathy, retinopathy and neuropathy,” states an article published in the Korean Journal of Physiological Pharmocology (14). “The intermolecular collagen cross-linking caused by [Advanced Glycation Endpoints] leads to diminished arterial and myocardial compliance, increased vascular stiffness, increase in diastolic dysfunction and systolic hypertension.”

Studies show that AGE has the potential to inhibit glycation. For example, an in vitro study found that “Both aged garlic extract and S-allyl cysteine inhibited formation of glucose and methylglyoxal-derived advanced glycation endproducts” (15).

Purslane.One unique proprietary extract (Portusana by Frutarom) utilizes a nutritious garden weed called purslane, or Portulaca oleracea. This weed is known to have seven times the beta-carotene of carrots, six times the vitamin E of spinach and is very rich in omega-3 fatty acids (16). “[Purslane] is treasured for its anti-diabetic properties in Near Eastern folk medicine,” explains Codran. “Today, the beneficial effects of purslane on glucose homeostasis have also been confirmed in preclinical and clinical studies. Diabetic subjects consuming purslane seeds, for instance, displayed significant reductions in fasting and postprandial glucose, insulin body weight, together with a normalization of the lipid profile.”

Mushrooms.Perhaps better known for its immune health benefits, certain mushrooms can be particularly helpful for controlling blood sugar. “Many of the leading medicinal mushrooms we are familiar with for a range of other activities, like Royal Agaricus, Chaga, Cordyceps, Lion’s Mane, Meshima, Poria, Reishi, and Tremella have demonstrated activities that affect blood sugar and insulin levels,” says Mark J. Kaylor, founder of the Radiant Health Project, representing Mushroom Wisdom, East Rutherford, NJ. “Even many of the edible mushrooms have also demonstrated benefits in this area, including the common button, oyster, and shiitake.”

However, one mushroom in particular stands out — maitake. According to Kaylor, a proprietary extract (SX-fraction by Mushroom Wisdom) of maitake’s proteoglycans has been found in clinical studies to effectively lower both serum blood glucose and insulin levels. “Chief among its actions is its ability to make cells more sensitive to insulin with the end result being less insulin needed to do its job and lower blood sugar levels as cells are now more able to absorb the glucose,” he explains. “Evidence that it is actually improving insulin sensitivity is found in the cardiovascular benefits which are a sign of improvement in this area. This activity includes lowering total cholesterol and LDL cholesterol, as well as improvements in triglyceride levels and blood pressure.”

There is no magic bullet of course. It all starts with making better choices and improving one's lifestyle. As a natural product retailer, you not only provide the resources to make good decisions but with your expertise, make the process less intimidating.WF

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  14. Varun Parkash Singh, et al. "Advanced Glycation End Products and Diabetic Complications." Korean J Physiol Pharmacol. Feb; 18(1): 1–14. 2014 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3951818/
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Published in WholeFoods Magazine November 2017