Did you know that more than 29 million Americans have diabetes (1)? That’s more than 9% of the total population. The numbers climb every year with approximately 1.4 million Americans diagnosed with diabetes every year (1). With numbers like these, it’s no wonder why many consumers want to support healthy blood sugar levels throughout life. Some individuals can keep their numbers in the normal range with just good food choices and plenty of regular exercise. Others—through no fault of their own—need some extra support, including from dietary supplements.

No matter how excited you or your shoppers are about dietary supplement research (or even a personal experience) remember to emphasize that supplements are not intended to cure, treat or prevent diabetes. Any addition of a supplement to one’s routine should be discussed with a healthcare professional.

The Basics Though your sales staff won’t be diagnosing shoppers with blood sugar problems, it’s good to have some baseline knowledge of how they develop.

First, let’s talk about insulin, a term that is ubiquitous with diabetes. Neil E. Levin, CCN, DANLA, nutrition education manager at NOW Foods, Bloomingdale, IL, explains that this hormone is made by the pancreas and helps glucose that is circulating in the bloodstream to be used by cells for energy. “Insulin also encourages the storage of surplus glucose into glycogen in the liver and muscles, while discouraging the production of glucose in the liver,” he states.

Now, how does this relate to diabetes?

Type-1 diabetes is often (but not always) diagnosed during childhood. While the exact cause isn’t known, current wisdom is that it’s actually an autoimmune disease. Something—a virus, perhaps—triggers the immune system to attack cells that release insulin. With insulin production severely hampered or destroyed entirely, cells cannot absorb glucose from the bloodstream. These individuals often require insulin injections to avoid dangerously high or low glucose levels; there is no cure for the disease.

Type-2 diabetes often occurs in adults, but its prevalence is rising in children. In this more common form of the disease, individuals make insulin, but their bodies aren’t using it appropriately. Why does the body shut off its ability to respond to insulin?

The answer is more complicated than you might think. Though genetics and socioeconomics play a role, there is a lifestyle component. Overconsumption of sugar and refined carbs may contribute to the onset of the disease. That’s because eating such foods results in increased insulin production. This overstimulation makes cells less responsive to insulin in the long run by expressing fewer and fewer insulin receptors on their surface. States Jocelyn Bérubé, M.Sc., executive and scientific director of health and nutrition at innoVactiv Inc., Rimouski, Canada, “This is the start of a vicious cycle where insulin resistance triggers high blood sugar levels, triggering higher insulin levels and more resistance.”

Chris D. Meletis, N.D., naturopathic physician, director of science and research at Trace Minerals Research, Ogden, UT, puts the situation in perspective with this analogy: “If you live in an apartment complex and your neighbors have lots of visitors, all the knocking on doors can be very overwhelming. So, in order to maintain your sanity, you have to tune out all the noise. The same thing happens when there is an overabundance of blood sugar-inducing foods—there is a lot of insulin knocking, stimulating the cells to let the sugar in. The body basically becomes resistant to this constant barrage (insulin resistance).”

According to Luke Blotsky, managing partner and CEO of Mineral Biosciences, Goodyear, AZ, continual over-consumption of carbohydrates not only causes elevated blood glucose levels, but it also creates advanced glycation end-products (AGEs). AGEs cause inflammation in the body and increase one’s risk of developing insulin resistance (2).

Laura Coti Garrett, R.D., certified diabetes educator and owner of Realtime Nutrition, Morristown, NJ, offers an analogy to explain why. Think of receptor sites on cells as docking points for insulin boats. In the case of insulin resistance, the boat can’t dock because the port isn’t working properly. In the case of inflammation, “the boat [i.e., insulin] faces stormy seas to get to the destination and can’t get to port as well,” she explains.

With inflammation impairing insulin’s ability to get to the right place, cells become starved for energy, according to Cheryl Myers, chief of education and scientific affairs at EuroPharma, Inc., Green Bay, WI. “If cells start to ignore insulin—that is, when ‘insulin resistance’ begins—they do not respond to insulin’s signals to accept sugar into the cell for energy production. Starved too long, cells start to die. Ironically, type-2 diabetes, often associated with excess body weight, is a disease of cellular starvation.”

But diabetes is more than insulin and the pancreas; there’s also the liver to consider. The liver synthesizes glucose from proteins and fats. In diabetics, this process tends to happen more readily, “so carbohydrate intake alone may not determine blood sugar levels,” states Levin. For instance, those with a fatty liver (i.e., non-alcoholic fatty liver disease [NAFLD]) may have excess production of glucose and triglycerides, he says.

Moreover, the disease has a connection to an enzyme called AMPK (adenosine monophosphate protein-activated kinase), which is activated during youth and tapers off with age. “This enzyme works through several signaling pathways to control energy production. As we age, AMPK activity naturally decreases. Combine this with a diet high in carbohydrates, and the stage is set for insulin resistance,” states Michael Smith, M.D., senior health scientist for Life Extension, Fort Lauderdale, FL.

Therefore, train staff that the causes of insulin resistance are not simple; indeed, the condition may well encompass insulin resistance across several tissues in the human body. States Jay Levy, director of sales at Wakunaga of America Co., Ltd./Kyolic, Mission Viejo, CA, “More precisely, muscle, fat and liver cells do not respond properly to insulin and thus cannot easily absorb glucose from the bloodstream.”

Warning Signs Many times, an early sign that trouble is brewing is elevated fasting blood sugar levels. “A fasting blood sugar reflects not so much what you eat, but how your body copes with overnight blood glucose (blood sugar),” states Coti Garrett.

During long periods of fasting—say four hours or more—the liver dumps glucose into the bloodstream. The amount, says Coti Garrett, is regulated like a thermostat. “Once it gets too high, it stops,” she states. “People with type-2 diabetes do not seem to have that thermostat control and the liver continues to put out sugar.” Therefore, they may make less insulin and more glucose than their bodies need during periods of fasting.
Type-2 diabetes, often associated with excess body weight, is a disease of [cellular] starvation.

— Cheryl Myers, EuroPharma, Inc.
Fasting numbers are the hardest to control with diet since, as Coti Garrett notes, levels are more related to organ function than anything else. Some diabetics even experience the dawn phenomenon, a surge in hormones that often happens between 2 and 8 a.m. Nonetheless, some individuals find that concentrating on high-protein, lower carb foods in the evening helps keep numbers in the normal range, while others may need help from a pharmaceutical.

Some individuals who monitor blood sugar levels may see an uptick in levels following meals (postprandial), often one to two hours after the start of a meal. Still others may have physicians who are monitoring their A1c numbers. Blotsky explains that the A1c blood test “provides the average levels of glycated hemoglobin in the blood over the past two to three months. It is an indication of how much glycation is occurring, which can result in cellular damage from AGEs.”

Glycation is the amount of “sugar coating” that has developed on hemoglobin within red blood cells. These cells have a lifespan of 90–120 days, so the test can help physicians understand the damage to cells from blood sugars.

Coti Garrett explains that red blood cells are normally smooth, but constantly elevated blood glucose levels cause the edges to be rough. “The A1c is a very important lab value in that it not only encompasses fasting blood glucose, but also blood glucose control after meals,” she states.

The test breaks “normal” levels at below 5.7%, according to the Mayo Clinic. “The higher the level of A1c the poorer your blood sugar control, leading to higher risk of health problems,” says Richard Staack, Ph.D., MBA, vice president of research and commercial development for Prinova USA, Carol Stream, IL. Scores of 5.7–6.4% might suggest prediabetes, and higher values may point to the need for dietary and/or medical intervention, depending on the person and the physician analyzing the results.

Myers says that A1c tests show long-term trends in blood sugar and don’t change quickly. Still, she states, “Even a small change in A1c—and by small, I mean a one point decrease—can mean huge improvements in health. You reduce your risk of cataracts by 19%, heart failure by 16%, and risk of amputation or death from peripheral vascular disease by 43%.”

Healthy Range Goals When a shopper and his or her healthcare provider decide that it’s time to make a concerted effort to keep glucose numbers in the normal range, research suggests that some dietary supplement may help. No, they won’t cure, treat or prevent the disease. But for many people, they can be a tool for maintaining healthy blood sugar numbers, along with proper diet, exercise and any suggestions offered by their physicians.

One mineral on the hit list may be magnesium. According to Carolyn Dean, M.D., N.D., advisory board member for the Nutritional Magnesium Association, magnesium deficiency may be linked to type-2 diabetes. This mineral is part of the chemical reactions that shuttle glucose across cellular membranes so cells can use it for energy. “If there is not enough magnesium to do this job, both insulin and glucose become elevated outside the cells in the blood,” Dean states. “The excess glucose gets stored as fat and contributes to obesity. Having excess insulin puts you on the road toward diabetes and tissue damage.”

She believes that magnesium deficiency is an underlying cause of several metabolic disorders like hypertension, high cholesterol and even obesity. According to Dean, magnesium actually helps the body “digest, absorb and utilize proteins, fats and carbohydrates.” Moreover, Dean says that magnesium may help stop obesity genes from expressing themselves.

Also put this second mineral on your list for blood sugar support: chromium. Levin calls chromium the “most prominent blood sugar support nutrient.” The reason why is that absorbed dietary chromium is used to make glucose tolerance factor, which binds to insulin and increases its activity by about threefold (3). Levin adds that chromium also helps restrict glucose production in the liver, thus keeping blood sugar within the normal range. These benefits of chromium are supported by “a mountain of research,” says Meletis.

In one study of insulin-resistant animals, researchers found that chromium supplementation “potentiates the actions of insulin, augments the insulin signaling pathway, blunts the negative-regulators of insulin signaling, enhances AMPK activity, up-regulating cellular glucose uptake and attenuates oxidative stress” (12).

As for which form shoppers may want to take, Levy puts in a vote for chromium picolinate bound to niacin for optimum absorption. In addition to helping control appetite, Levy states, “A review of research found that, among type-2 diabetics, chromium picolinate reduced fasting glucose levels up to 15.3% and fasting insulin levels up to 29.8%.”

Paul Dijkstra, president and CEO of InterHealth Nutraceuticals, Benicia, CA, speaks of a branded chromium, niacin and l-cysteine combination ingredient from his company (Zychrome). New research on the ingredient soon to be published in Food & Nutrition Research focused on its effect on vascular inflammation, insulin levels and resistance and oxidative stress compared to placebo in 43 metformin users. States Dijkstra, “Zychrome significantly reduced fasting blood glucose levels compared to baseline. Average fasting glucose values declined toward a healthier range of 119.7 mg/dL. There was no such decrease in the placebo group.”

Another aspect of the chromium ingredient is that it reduced pro-inflammatory agents like cytokine TNF-α and lowered markers of oxidative stress more than the placebo. “The ability of Zychrome to reduce both TNF-α and oxidative stress levels is a key finding as increases in pro-inflammatory responses and oxidative stress levels are believed to be linked with the onset of heart and blood sugar related issues,” states Dijkstra.

Herbs and mushrooms also form a good part of the market for natural blood sugar support. Mark J. Kaylor, founder and director of the Radiant Health Project and consultant to Mushroom Wisdom of East Rutherford, NJ, believes that retailers should fully understand how they work. “While there are a number of botanicals that lower blood sugar levels, many of them do this by raising insulin levels,” he explains, warning, “While this may yield the short-term benefit of lowering one’s blood sugar, it may also contribute to the longer-term issue of insulin resistance.”

Indeed, as noted earlier, cells that are constantly bombarded by tons of insulin become less responsive to it over time, which creates a demand for more and more insulin production. States Kaylor, “We need to keep in mind that it is not just about blood sugar; rather, a healthy balance is supported by blood sugar and insulin levels kept at appropriate levels.”

Therefore, he believes in SX-Fraction from the maitake mushroom, which is clinically supported for improving cellular insulin sensitivity. Studies suggest it supports both blood sugar and insulin levels in the normal range and “evidence that it is improving insulin sensitivity is seen in its cardiovascular benefits of lowering total cholesterol, LDL cholesterol, triglycerides, and blood pressure,” Kaylor states. “In fact, one study found that Maitake’s actions were comparable to, and possibly even better, than a leading pharmaceutical drug.”

Also said to support insulin sensitivity is bitter melon, which helps the body use carbohydrates more effectively. Anthony Thomas, Ph.D., from the technical support and scientific affairs team at Jarrow Formulas, Los Angeles, CA, believes this extract reduces oxidative stress and inflammation, which supports insulin sensitivity.

Adds Levy, “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.” He says some studies even suggest that the herb functioned better than a diabetes drug (Avandia), though not as well as another (Metformin).

Cinnamon is also well known to support blood sugar health. According to Trisha Sugarek MacDonald, B.S., M.S., senior director of research and development, Bluebonnet Nutrition Corporation, Sugar Land, TX, a variety of studies—both in vitro and in vivo—suggest certain cinnamon compounds stimulate insulin receptors and inhibit an enzyme that inactivates the receptor. This increases cells’ ability to use glucose.

Staack speaks of a branded form (Cinnulin PF), which is said to support healthy fasting blood sugar levels, systolic blood pressure, oxidative stress markers, percent body fat and body composition.

Some studies suggest cinnamon can improve insulin action, insulin resistance and glucose metabolism, though no one knows exactly why. Some water-soluble cinnamon extracts contain polyphenol A, which may be responsible for some of the benefits because it inhibits an enzyme that deactivates some insulin receptors on cells (4).
Levin says that “cinnamon polyphenols mimic insulin-like activity,” which might actually reduce A1c numbers as well as blood pressure. In one study, various dosages (1,000, 3,000 or 6,000 mg per day) of cinnamon were studied in type-2 diabetics for 40 days, and the herb was found to be “significantly more effective than a placebo at reducing mean fasting blood glucose levels; lowering them by 18–29%, depending on the amount taken (5),” Levin points out.

There’s also salacia to consider. This ayurvedic herb is said to help stabilize blood sugar levels after high-carb meals, and Levy explains why. “[Compounds in the plant] work in the small intestine by inhibiting the enzymes used to digest some types of sugars. As a result, some of the sugar or starch eaten in a meal is eliminated as waste rather than being absorbed into the bloodstream,” he states.

In one study, 66 diabetics fasted and then consumed one of three meals: a control meal, a control meal plus 240 mg of salacia or a control meal plus 480 mg of salacia. Both salacia groups had lowered post-meal glucose levels, and better insulin response was noted with the larger dosage (6).

States Levy, “Some studies have even found that salacia can decrease insulin and blood glucose levels by up to 29 and 23%, respectively.”

Myers believes the bark of Hintonia latiflora is a good choice for blood sugar support because it has 60 years of research backing with some impressive benefits. “Almost from the beginning, early research showed that Hintonia latiflora could help people avoid the need to go on medication, or reduce medication in individuals unable to control their blood sugar by diet alone (7),” she states.

More recently, researchers have found that this extract has effects on blood glucose control. In one study of 41 diabetics, fasting glucose numbers, post-meal glucose values and A1c numbers all declined after taking the herb for six months (8).

In another study of 178 diabetics, Hintonia latiflora improved A1c levels by approximately 10.4%, fasting glucose by an average of 23.3% and postprandial glucose by an average of 24.9% (9), says Myers. She points out, “At the beginning of the study, 114 participants were taking some kind of medication—by the study’s end, 45 participants (39%) reduced their dosage and 10 participants no longer needed it.”

But, what’s the mechanism of action? “The reason that Hintonia works is related to a compound in the bark, coutareagenin, which helps stabilize blood sugar levels,” states Myers. “According to research, this compound appears to inhibit alpha-glucosidase, an enzyme that releases sugar from carbohydrates.”

The benefits of berberine (derived from goldenseal root, barberry bark, Oregon grape root, and coptis root) may apply to many aspects of metabolic health, including blood sugar support. According to Michael T. Murray, N.D., director of product science and innovation for Natural Factors, Monroe, WA, berberine has “an impressive amount of clinical research” backing it.

He says in a meta-analysis of 27 trials studying berberine on type-2 diabetics, the alkaloid had benefits akin to that of drugs, “but side effects with berberine occurred at much lower rates and were milder than prescription drugs.”

Murray also likes mulberry leaf extract, which he believes benefits healthy blood sugar levels.

Select Blood Sugar Support Offerings

Bluebonnet Nutrition Corp.: Bluebonnet’s GTF Chromium 200 mcg Vegetable Capsules, Bluebonnet’s Cinnulin PF Cinnamon Bark Extract Vegetable Capsules, and Bluebonnet’s Alpha Lipoic Acid Vegetable Capsules in 100, 200, 300 and 600 mg potencies.

EuroPharma, Inc.: Sucontral D. For additional support if needed: Healthy Feet & Nerves, Clinical OPC Extra Strength (with French Grape Seed VX1 extract), CuraMed, and BioActive Vitamin B.

innoVactiv inc.: InSea2.

InterHealth Nutraceuticals: Zychrome and ChromeMate.

Jarrow Formulas: Glucose Optimizer, Glycostat Wild Bitter Melon Extract, Whey Proteins (Grass Fed Whey Protein, Virgin Whey Protein Isolate, The Slim Whey), Chromium GTF (Glucose Tolerance Factor), Inositol, Nicotinamide Riboside, SAM-e (200, 400), Liver Optimizer, Vision Optimizer, α-Lipoic Acid (R-α-Lipoic Acid, Sustained Release), Antioxidant Optimizer, BroccoMax, N-Acetylcysteine (NAC), Yaeyama Chlorella, Green Tea Extract, Curcumin (Curcumin 95, Cucumin Phytosome), Milk Thistle, Taurine, Grape Seed Extract (OPC + 95), Probiotics (e.g., Jarro-Dophilus Enhanced Probiotic System/EPS), Omega-3 Fatty Acids (e.g., EPActive, Max DHA, EPA-DHA Balance, Ahiflower Oil, Borage Oil), Proteins (e.g., Greek Yogurtein, Organic Hemp, Iso-Rich Soy, Optimal Plant, Brown Rice), Apple Cider Vinegar, HCActive Garcinia Cambogia, Sleep Optimizer, Melatonin. Various vitamin and mineral support formulations: B-Right Optimized B-Complex, Selenium Synergy, Vitamin C + Citrus Bioflavanoids, Vitamin D3, Famil-E (Vitamin E Forms), MK-7 (Vitamin K2), Magnesium Optimizer, etc.

Life Extension: Tri Sugar Shield, Cinsulin, Optimized Chromium, Super R-lipoic Acid, Vanadyl Sulfate, Coffee Genic Green Coffee Extract, Natural Glucose Control.

Mineral BioSciences: GlyDe D (contains Ioniplex and vitamin D3).

Mushroom Wisdom, Inc.: SX-Fraction.

Natreon: Crominex3 (prepared by complexing USP grade chromium chloride, Capros Phyllanthus emblica and PrimaVie Purified Shilajit).

Natural Factors: PGX, WellBetX Berberine.

Natural Vitality: Natural Calm magnesium citrate powders in several flavors and Natural Calm Plus Calcium blend. Both come in 8-oz, 16-oz and individual to-go packs.

NOW Foods: Numerous blood sugar management formulas including ChromeMate, Chromium Picolinate, Tri-Chromium 500 mcg with Cinnamon, GlucoFit, fiber (such as Organic Acacia Fiber, Apple Fiber, Glucomannan, Psyllium Husk and Fiber-3) and Alpha Lipoic Acid.

Pharmachem Laboratories: Phase 2 Carb Controller.

Prinova USA: Cinnulin PF.

Trace Minerals Research: Complete Cleansing Fiber, Liquid Ionic Chromium, Liquid Magnesium, Liquid Ionic Magnesium, Magnesium Tablets, Mega-Mag.

Wakunaga of America/Kyolic: Kyolic Blood Sugar Balance.

Smith says mulberry leaf supports blood sugar in three ways: • It targets alpha-glucosidase, an enzyme that regulates the conversion of starch into glucose. • It supports glucose transporter GLUT4, which shuttles glucose out of the bloodstream and into muscle and liver cells. • It promotes insulin sensitivity.

Another herbal mainstay for blood sugar support is Gymnema sylvestre. One study involving the herb found that it reduced blood glucose, A1c numbers and glycation. While the number of participants was relatively small, about one-quarter of individuals were able to discontinue their use of drugs that help achieve blood glucose homeostasis.

Aparna Kalidindi, Pharm.D., BCPS, technical sales and marketing manager at Natreon, New Brunswick, NJ, combine Gymnema sylvestre with berberine and fenugreek, which she says improves blood glucose levels.

Kalidindi adds that Phyllanthus emblica (or Indian gooseberry, as Natreon’s Capros) “has also shown in several published clinical studies to significantly reduce HbA1c levels.”

Another interesting ingredient—phloridzin, derived from apples—supports healthy blood sugar levels in some important ways. First, it targets two proteins (SGLT1 and SGLT2), which help block the absorption of glucose into the bloodstream and support glucose elimination via urine, according to Smith.

Coti Garrett says A1c levels may be better supported with white kidney bean extract, which she says helps people by blocking the absorption of some carbs, and thus may support post-meal blood glucose levels in the normal range.

Similarly, shoppers may also need some education about brown seaweed extract, which Bérubé says inhibits both amylase and glucosidase enzymes. These enzymes break down carbs, so brown seaweed extract (as branded InSea2) “allows a superior control over post-meal blood glucose and insulin spikes following both starch and sugar ingestion. Lately, InSea2 was also shown to possess high antioxidant potential, making it a very promising ingredient to prevent damages from the high amount of carbohydrates and sugar in our foods.”

While several excellent herbal options have been presented for blood sugar support, Levin calls fiber the “number one blood sugar control nutrient.”

The reason why is that it supports satiety and “slows the digestion and subsequent uptake of sugars from the carbohydrate portion of the meal.”

Specific forms that may be helpful include wheat, oat, psyllium husk, flax or chia seed meals, glucomannan (from konjac root) and more.

Murray is partial to PGX, a water-soluble, plant-based fiber matrix that upon consumption, forms a gelatinous mass in the stomach, which results in slower digestion without spikes after meals. Murray adds that 20 clinical trials on PGX suggest the fiber “helps restore insulin sensitivity, promotes satiety, supports healthy blood sugar levels already within the normal range and promotes healthy weight loss.”

For retailers offering dosage advice to shoppers, Murray recommends 2.5–5 grams before meals. “Start with a dosage of 750–1,000 mg and work your way up to the full dosage over the course of a couple of weeks,” he suggests. “Be sure to drink 8-16 ounces of water for each 2.5-g dose.”
The tremendous increase in Alzheimer’s disease parallels the rise in type-2 diabetes. —Michael T. Murray, N.D., Natural Factors
According to Smith, another fiber to try is sorghum bran. He explains that this type of fiber helps maintain healthy blood sugar levels by balancing the rate of sugar manufacture in the liver (gluconeogenesis), promoting insulin sensitivity, regulating PPAR-gamma (a metabolic thermostat supporting glucose metabolism) and regulating the enzyme alpha-amylase, which in turn maintains the release of sugar found in starch.

As for timing each supplement, it’s best to check out the manufacturers’ instructions before making recommendations. Some are best taken slightly before or with meals (like fiber, EuroPharma’s Sucontral or Cinnulin PF from Prinova USA), but non-nutrient supplements may work best on an empty stomach, says Kaylor. He adds, “Key, though, since maintaining healthy blood sugar and insulin levels is all about balance throughout the day, it is essential that the supplement is taken multiple times a day in order to help maintain that balance 24/7. Often, these types of supplements are best taken 30 minutes or so prior to meals so as not to get ‘lost’ in the meal and to support the body in a healthy blood sugar response.”

Beyond Diabetes Brain. The effects of chronically high blood sugar levels are linked to problems beyond the pancreas, liver and other organs we normally think of as in the same realm as diabetes. “Over time, extensive cellular damage, diseases and health issues result. One of those diseases can be Alzheimer’s, among a host of others, including type-2 diabetes,” say Blotsky.

To Blotsky’s point, some people call Alzheimer’s disease “diabetes of the brain” or “type-3 diabetes.” And the statistics behind the diseases’ connection are alarming. Murray states, “Individuals with type-2 diabetes have a 1.5 to 4-fold risk for Alzheimer’s disease as well as dementia caused by damage to the blood vessels of the brain.”

Since inflammation can easily damage blood vessels in the brain, elevated blood sugar levels may be linked to age-related cognitive problems. “Because decreased blood flow is potentially fatal to neurons, researchers speculate that ‘normal’ declines in memory function may come from uncontrolled fluctuations in blood sugar,” Levy explains.

Specifically, Meletis states, “insulin-resistance contributes changes to the brain hippocampal neurons and alters insulin receptors and oxidative damage within the brain (10).”

The hippocampus is the part of the brain that is involved in emotions and also forms and stores memories, so anything that damages this area is concerning. In fact, Kalidindi says studies suggest that even newly diagnosed diabetics (within 10 years) had memory problems typically associated with the hippocampus. She states, “Using brain imaging techniques, they found that people with diabetes had smaller hippocampal sizes than people without diabetes. They also found that the decreases in hippocampal size were correlated to HbA1c levels, suggesting that HbA1c levels could be used to indicate the onset of memory loss.”

Moreover, Levy says MRI brain scans conducted at Columbia University Medical Center found high blood sugar levels are linked with memory deficits. He explains that the study involved 240 healthy senior citizens, 60 of which had diabetes and 74 had brain infarcts. “The MRIs showed that different parts of the hippocampus are affected by rising cholesterol levels, body weight and yes, blood sugar, all of which tend to occur as people age,” he says.

There’s also beta-amyloid proteins to think about, the accumulation of which has been linked to Alzheimer’s disease. Kalidindi says research published in the Journal of Alzheimer’s Disease suggests those with high blood sugar levels had a “dramatic increase in beta-amyloid protein.”

That’s not all. Levin says the release of inflammatory mediators on a chronic level and resulting increased inflammation may lead to the development of diabetic retinopathy and neuropathy.

For this reason, one tool your shoppers might be interested to learn about is alpha-lipoic acid (ALA), which Murray says is important because of its antioxidant connection. Remember, inflammation support from antioxidants may be very helpful for blood sugar support.

He calls ALA “nature’s perfect antioxidant” because it can “block the effects of either water- or fat-soluble free radicals both inside the cell and outside in the spaces between cells.” Murray adds, “ALA supplementation has been shown to lead to an improvement in blood sugar metabolism, blood flow to peripheral nerves and actually stimulating the  regeneration of nerve fibers.” It may also be helpful to those concerned about diabetic neuropathy.

In addition to antioxidant support, Dean believes that magnesium can play a role in supporting balanced inflammation. “Alzheimer’s is mostly an inflammatory condition, so is diabetes,” she states. “Numerous studies show that magnesium lowers the inflammatory signals CRP, TNFa and IL6.”

In one study of 74 overweight women, taking 250 mg of magnesium oxide lowered CRP levels and other markers of inflammation better than a placebo (though results were not significant) (11).

Skin. It’s interesting to note that while blood sugar levels affect many aspects of the body from the inside, the outside can also be affected.

“Glycation can affect any cell in the body. The skin has some of the most physical symptoms including loss of elasticity, accelerated aging and compromised barrier function,” states Blotsky.

The situation is fairly common, according to Sugarek MacDonald. “Up to one-third of people with diabetes will experience skin problems related to the disease,” she states. She says issues can range from acanthosis nigricans (i.e., dark patches of skin in the folds), dermopathy, skin spots and skin tags.

The issue may have to do with—again—damage to blood vessels due to chronically high sugar levels in the bloodstream. Myers says that inflamed blood vessels mean less circulation, and more difficulty to heal damaged skin.

Dean adds that high blood sugar may cause yeast overgrowth, which could lead to skin rashes.

Sugar can also do a number on youthful skin. Thomas says, “collagen and elastin proteins, and hyaluronic acid (a glucosaminoglycan or amino sugar) are the main components of the skin dermis.” Elastin keeps skin taught while and hyaluronic acid keeps the skin hydrated. The collagen network provides the infrastructure for elastin and hyaluronic acid, Thomas states.

“Elevated blood sugar and oxidative stress can increase inappropriate protein glycation, resulting in the formation of AGEs that promote inflammation,” Thomas explains.

“Glycation of collagen leads to cross-linking and compromised integrity along with inflammation, which contributes to deterioration of the skin collagen network: enhanced collagen breakdown and reduced collagen, elastin and hyaluronic acid production (i.e., premature skin aging).”

According to Bérubé, “Any increment of 2.5 mmol/L adds one year to your perceived age.” Beyond healthy-looking skin, Murray sees a connection between blood sugar and acne, which he says some dermatologists decades ago called “skin diabetes.” “The reasons were very interesting,” he states. “Although results from oral glucose tolerance tests in acne patients showed no differences from controls in blood glucose measurements, when researchers looked at the levels of glucose within the skin through repetitive biopsies, it revealed that the acne patients’ skin glucose tolerance was significantly disturbed.”

Therefore, Murray believes acne may be affected by consumption of high-sugar drinks or meals as well as stress (cortisol). He believes that Brewer’s yeast (which contains chromium) may help, noting that in one double-blind study, more than 80% of the patients taking Brewer’s yeast saw their acne almost completely healed within five months. Only 26% of the placebo group saw this benefit.

Call for more research. Though there have been several links between high blood sugar and various health conditions like Alzheimer’s, readers should understand that a causal link is still being investigated. While studies suggest that the higher the blood sugar, the higher the risk of dementia, Sugarek MacDonald states, “This is just an association between these factors and this does not prove that high blood sugar causes dementia. But it does beg the question, why?”

Therefore, she believes more research is needed before any finite conclusions can be drawn. WF

References 1. American Diabetes Association, “Statistics About Diabetes,” www.diabetes.org/diabetes-basics/statistics, accessed Sept. 16, 2016. 2. L. Zanteson, “Advanced Glycation End Products,” Today’s Dietitian 16 (3), 10 (2014). 3. M.F. McCarty, “The therapeutic potential of glucose tolerance factor,” Med. Hypotheses. 6 (11), 1177–1189 (1980). 4. M. McCulloch, “Herbs and Spices: Cinnamon’s Link to Diabetes Control,” Today’s Dietitian, 17 (11), 12 (2015). 5. A. Khan, et al., “Cinnamon Improves Glucose and Lipids of People With Type 2 Diabetes,” Diabetes Care 2003 Dec; 26(12): 3215-3218. 6. J.A. Williams, “Extract of Salacia oblonga lowers acute glycemia in patients with type 2 diabetes,” Am J Clin Nutr. 2007 Jul;86(1):124-30. 7. Kuhr, R. Oral Diabetes Therapy with an Euphorbiacean Extract. Der Landarzt, 1953. 29(23):1-8. 8. Korecova M, Hladikova M. Treatment of mild and moderate type-2 diabetes: open prospective trial with Hintonia latiflora extract. Eur J Med Res. 2014 Mar 28;19:16. doi: 10.1186/2047-783X-19-16. 9. Schmidt M, Hladikova M. Hintonia concentrate - for the dietary treatment of increased blood sugar values: Results of a multicentric, prospective, non-interventional study with a defined dry concentrate of hintonia latiflora. Naturheilpraxis. Feb. 2014. (Translated article). 10. X. Li et al., “Link Between Type 2 Diabetes and Alzheimer’s Disease: From Epidemiology to Mechanism and Treatment,” Clin. Interv. Aging 10: 549–560 (2015). 11. N. Moslehi, “Effects of Oral Magnesium Supplementation on Inflammatory Markers in Middle-Aged Overweight Women,” J. Res. Med. Sci. http://jrms.mui.ac.ir/index.php/jrms/article/view/8502.

Published in WholeFoods Magazine November 2016