The type 2 diabetes epidemic—evil offspring of the obesity epidemic—is a global scourge that is a leading cause of kidney disease, heart disease, stroke, blindness and amputation. According to the “2011 National Diabetes Fact Sheet,” published by the Centers for Disease Control (CDC), diabetes affects nearly one in 10 (26 million) Americans.
The CDC believes that, as of 2010, almost 80 million American adults aged 20 or older could be considered as pre-diabetic. And, in a CDC report released just six weeks ago, only 11% of the Americans who are at risk for diabetes are aware they are at risk. Still, the National Institutes of Health’s recommended basic regimen for managing type 2 diabetes is not pharmaceutical. It involves watching calorie and carbohydrate intake; increasing dietary fiber; and coupling healthy eating with physical activity to control weight and blood glucose.
With the continued emphasis on foods and beverages as pathways for diabetic control, a number of ingredients have become increasingly available to formulators to make great-tasting products that appeal organoleptically before all else. Another factor that puts the focus on flavor and texture concerns is the fact that nearly every American family has someone who needs to control their blood sugar, due to the prevalence of diabetes. This means foods for diabetics must appeal to the whole family, because time-stressed moms and dads are not in a position to prepare separate meals. It took a few decades, but formulators of foods for diabetics finally recognized that if an item does not taste top-notch, it won’t do anyone good.
The latest generation of ingredients for blood sugar management have in common a duality of purpose. Inulin or fructooligosaccharides (FOS) comprise versatile forms of fiber that make an excellent example: They provide biological, as well as textural functionality. Inulin can be used in a variety of applications, such as beverages, yogurts, nutrition bars, bakery fillings and chocolate. It has a high water solubility; is odorless and tasteless; and adds a good mouthfeel to reduced-fat products.

Dual Action

Oligosaccharides also have been shown to moderate bloodsugar levels, making them quality sugar substitutes in some low-glycemic foods. They can add bulk to products sweetened with zero-calorie, high-impact sweeteners (such as aspartame, stevia or sucralose), especially in beverage formulations. Oligosaccharides also can be used to mask the aftertastes produced by some of these intense sweeteners.
Oligosaccharides prolong shelflife by retaining moisture, without significantly increasing water-activity levels. In beverages, the high molecular weights of some oligosaccharides provide increased viscosity, which leads to improved body and mouthfeel.
While the standard inulin types are more directed towards texturizing and mouthfeel enhancement, a highly soluble inulin also combines well with non-nutritive sweeteners to replace sugar solids. Inulin can be used to add fiber, without a large impact on functionality or appearance of a food product. It also can be used to improve taste and texture of low-calorie products by serving as a fat mimetic and sugar substitute. As does FOS, inulin can mask off-flavors and/or off-notes associated with the high-intensity sweeteners, such as stevia. It also provides a well-rounded mouthfeel and can enhance fruity flavors.
Inulin can also be used to make a gel. It is used in low-calorie sauces and dressings to add creamy mouthfeel and replace fat; it works with gums to stabilize emulsions. It can be used in fillings to reduce sugar and calories, and can be used to improve texture and mouthfeel of low-fat dairy products.

Corn Advantages

Corn-derived fiber is a functional and versatile fiber that can be listed by several names on a nutrition label, such as soluble corn fiber, resistant maltodextrin or digestion-resistant maltodextrin. It can be used in formulating reduced-sugar or sugar-free products. Corn fiber can be used to achieve a good source of dietary fiber when formulated at 2.5g of fiber per serving, if all other conditions for making a fiber claim are met. A number of clinical studies have found that these ingredients can lower the glycemic response to carbohydrate-based foods.
Resistant starch, such as from hi-maize varieties of corn, have been rapidly filling the fiber gap, while showing remarkable benefits for regulating blood sugar. Resistant starch demonstrates an ability to do this both through its slowing down absorption, as well as boosting satiety through fiber-like bulking and biochemical response secondary to prebiotic actions in the GI tract.
In baked formulations, resistant starch can replace up to 25% or more of flour and actually provide, for some products, a slight increase in volume. The satiety effects are long-lasting and, while acting in the GI tract as a fiber does, resistant starch has been shown to be well-tolerated, with few, if any, of the undesired after-effects of fiber at levels of up to 35-45g or more per day.
What also makes resistant starches ideal for the food and beverage industry is that they typically are colorless, odorless, highly soluble and can function as dietary fiber; thus, they can benefit diabetics and assist in modulating blood sugar control. Resistant maltodextrin can be used effectively in beverages (either powdered mixes or ready-to-drink) and functions well across the pH spectrum. It also can be used in baked products, sweets and even in frozen desserts.

On the Sweet Side

While many consumers watching their blood sugar levels still crave sweet products, they might not be able to enjoy them as they used to. The good news is that today, there are several high-intensity alternatives to sugar available to formulators, with some classified as having organic and/or all-natural status. These sweet alternatives not only have less impact on insulin demand, they help lower total calories, since they are more potent than sugar.
Creating a balanced sweetness profile for any product is essential for consumer appeal. Stevia is a high-intensity, all-natural sweetener extracted from the leaves of the Stevia rebaudiana plant. Stevia has been used for centuries in South America and Asia for its sweetening capabilities in both food and drinks. The dried extract yields a compound which is low in bitterness, called Rebaudioside-A or Reb-A. Reb-A has 200-400 times the sweetness of sugar and is available at levels of up to 99% pure. Furthermore, it is non-caloric and does not affect the glycemic index during digestion.
Another zero-calorie sweetener from Asia that is growing in popularity is derived from luo han guo, or monk fruit. While Buddhist monks first cultivated monk fruit nearly 800 years ago, today the sweetener finds utility in a wide range of food and beverage applications. Monk fruit’s sweetness comes from unique natural antioxidants called mogrosides. Powdered monk fruit extract also is all-natural, heat-stable and GRAS. Like stevia, it is about 300 times sweeter than sugar. An added benefit of monk fruit extract is that it does not have the bitter or licorice aftertaste found in some stevia products, and manufacturers can formulate their products to higher levels of sweetness.
These zero-calorie sweeteners are ideal for beverage applications, such as teas, smoothies and dairy-based beverages, where the function of sugar as a bulking agent is not required. Typically, more water is added to a beverage product to make up for the lost volume when the sugar source is removed. Erythritol is commonly used with stevia as a sweetener to achieve a higher sweetness level than is possible with stevia alone, but this isn’t required when working with monk fruit extract. Additionally, if a decrease in mouthfeel is detected in a beverage, various ingredients, such as pectin or guar gum, can be added in small amounts to increase the viscosity.

Point of Sweetness

The recent popularity of agave syrup use has been, ironically, as a reaction to high-fructose corn syrup (HFCS). HFCS actually is nearly identical to sucrose chemically, at about 55-58% fructose vs. sucrose’s 50-50 ratio. Yet agave, from the same cactus fermented to produce tequila, is typically 60-90% fructose. But, this is good news for persons with diabetes. Fructose has long been used as a viable substitute for sucrose in foods and beverages designed for lower blood-sugar responses. Fructose also is sweeter than sucrose, so less is needed to achieve the same level of sweetness.
Agave nectar is purified when it is heated. Depending upon the levels of heating, two types are available: light and amber (dark). Light agave nectar offers a pure sweetness that will not add any flavor when sweetening beverages or recipes. The amber agave nectar gives a more caramel-like flavor to foods, which is perfect for sweetening breakfast foods, such as pancakes, oatmeal or cereal.
Since agave nectar is a naturally sweet product and ranks as having a low glycemic index, it makes for a versatile and ideal sweetener for blood sugar management. It is ideal for sweetening a variety of beverages and can be used in dressings and sauces, as well as baked goods. The properties of agave nectar are different from granulated sucrose, so some baked items may brown more quickly. It is recommended to reduce the oven temperature by 25°F and increase baking time by a few minutes. It also is important to note that cookie recipes using agave nectar will not bake as crisply as with sugar, but will have a cake-like texture. Low-glycemic index foods are an important part of healthy diets, as they help to keep energy levels balanced.
For food and beverage applications where a sustained energy or blunt glucose response is desired, there is a full-calorie, low-glycemic sweetener available that is a compound of sucrose and maltose. This sweetener has a lower glycemic response than sucrose or glucose and is 70% as sweet as sugar. It is fully digestible and can be used in dairy products, baked goods and beverages, having attained FDA GRAS status in 2009.
The compound can be used in multiple applications, such as beverages, bars, bakery, snacks, yogurts, ice cream, jams and jellies. In some applications, it has been found to have enough sweetness by itself. Moreover, when replacing other sweeteners, the reduced-sweetness level was found to be acceptable and even preferred by some consumers. There has been a great deal of interest in formulating beverages with the ingredient, for both the diabetic and energy beverage markets. It also can be used to reduce sugar in popular, child-friendly products, such as chocolate milk.

Antioxidant Power

It is known that elevated insulin and blood sugar can lead to oxidative stress in humans. Studies suggest that higher consumption of antioxidants in the diet might decrease diabetes risk in healthy adults and diabetic patients. In one study, “Dietary Antioxidant Capacity is Inversely Associated with Diabetes Biomarkers,” published in Nutrition, Metabolism & Cardiovascular Diseases, results indicated that higher total dietary antioxidant intake is correlated with lower levels of diabetes biomarkers—glucose, insulin and insulin resistance—in healthy individuals, as well as in pre-diabetic and diabetic ones.
Recent studies also suggest a relation between oxidative stress and diabetes via increased cellular free-radical production. Scientists have reported that high dietary antioxidant capacity has been found to decrease markers of inflammation, suggesting that inflammation and oxidative stress are interrelated.
Antioxidants derived from fruits, especially concentrated extracts and powders, can be easily incorporated into a variety of beverages because of their high water solubility. Pomegranate extracts standardized to a minimum of 40% punicosides (bioactive phytochemical components) contain high levels of antioxidants and natural compounds that reduce the cell damage typically created by free radicals during the natural biological process of oxidation.
Other antioxidant formulations are composed of a special blend of fruit extracts and concentrates and have already been clinically proven. These fruit extracts are composed of a wide spectrum of natural flavonoids and polyphenols that provide a diverse antioxidant profile and broad biological activity for consumers. Moreover, they can also have a high oxygen radical absorbance capacity (ORAC) of greater than 9,000.
Antioxidants also can come in the form of standardized powdered extract composed from several varieties of berries. Besides supplying health benefits, such an extract supplies several important anthocyanins, such as malvidin, cyanidin, delphinidin and petunidin. The suggested daily dosage of anthocyanins is 60mg. Anthocyanin powders will not add calories or sugar to the end-products, making them attractive to manufacturers and consumer alike. They typically retain strong colors and, in fact, often are used as natural colorants in foods and beverages. In these cases, it should be noted that some vitamin compounds, such as riboflavin, can destabilize anthocyanin pigments.
Antioxidants from green tea have been getting lots of press these days, both as natural energy boosters and as viable ingredients for beverages aiding in diabetes management. Modern research and scientific data have demonstrated that the beneficial effects of green tea are largely due to its main catechin, epigallocatechin gallate (EGCG). Recent research indicates there could be positive effects of EGCG in the field of disease risk-reduction regarding cancer, cardiovascular disease and to support healthy glucose metabolism. Moreover, for those who are caffeine-sensitive, the good news is that EGCG is a purified catechin extracted from green tea leaves and, thus, does not contain caffeine.

Emerging Ingredients

While omega-3 polyunsaturated fatty acids have been touted as being beneficial for cardiovascular health, recent epidemiological research and meta-analysis suggest this class of fatty acids—plant-based sources in particular (i.e., alpha-linolenic acid, ALA)—are associated with modestly lower risk of developing type 2 diabetes. The beneficial effects of these omegas appear to be through their ability to reduce insulin resistance, allowing the body’s cells to better utilize glucose.
There are a number of omega-rich oils available for formulators to use in food and beverage products, and each has its own characteristic flavor. Among these oils are borage, coconut, black currant, flax, rice bran and sunflower. Several of these oils are available as either liquids or spray-dried powders.
Two other ingredients gaining in popularity for the management of healthy blood glucose levels are cinnamon and chromium—think of them as the diabetic dynamic duo. Cinnamon has two active portions, a water-soluble portion and an oil-soluble portion, and the water-soluble extract contains the polyphenolic compounds responsible for the health benefits of cinnamon. However, the oil-soluble portion has components, such as cinnamaldehyde and coumarin, that are known to be toxic over long periods of consumption.
However, not all cinnamons are created equal. While Cinnamomum aromaticum (typically called cassia) is cultivated all over the world, it contains higher levels of these two potentially toxic fat-soluble compounds. A patented, water-soluble extract of Korintje cinnamon derived from the Cinnamomum burmannii species, primarily found in Indonesia, has been developed and contains the active components known as the type-A polyphenols, often times labeled at trimeric and tetrameric type-A polymers. Only 500mg of the water-soluble extract is equivalent to approximately 10g of whole cinnamon powder (i.e., 20:1 extract), and is standardized to contain at least 1.0% of the doubly-linked type-A polymers. These polyphenolic compounds target the insulin receptor, which is the gateway to getting glucose out of the blood and into the cells. People with insulin resistance essentially have poor receptor sensitivity, and that is where these type-A polymers would come into play.
A clinical study in pre-diabetic men and women showed that daily consumption of capsules containing 500mg of the powdered, water-soluble extract of cinnamon for 12 weeks led to significant improvements in several features of the metabolic syndrome associated with pre-diabetes (i.e., lowered fasting blood sugar and systolic blood pressure, and improved body composition—as measured by increase in lean mass and reduction in body fat). One drawback to formulation versatility is the fact that the active components of cinnamon are highly heat-sensitive.
Chromium is an important trace mineral that appears to be directly involved in carbohydrate, fat and protein metabolism. The trivalent (chromium 3+) form is the most biologically active and also the form found in foods. The Adequate Intake (AI) for adult men and women is 35mcg and 25mcg daily, respectively. Chromium is widely distributed in the food supply, but most foods provide only small amounts (less than 2mcg per serving). Meat and whole-grain products, as well as some fruits, vegetables and spices, are relatively good sources.
There are a handful of chromium supplement products in the market, and they are typically chelated or bound to a vitamin (i.e., niacin) and/or an amino acid to enhance bioavailability and absorption. While chromium polynicotinate (chromium bound to niacin) has been touted for weight loss, another newer form of chromium, chromium dinicocysteinate, has emerged for the management of healthy blood glucose. It is a chromium complex consisting of chromium, niacin and L-cysteine. Several studies, both in vitro and in vivo, have already demonstrated that chromium dinicocysteinate is more efficacious than other forms of chromium in decreasing fasting glucose levels, glycated hemoglobin levels (HbA1c), insulin levels and reducing oxidative stress.
There are a variety of nutritional and nutraceutical ingredients available that not only deliver added value to products, but also have minimal taste impact. The growing problems of obesity and diabetes around the world offer manufacturers opportunities to formulate food and beverage products that can help reduce these conditions and, thus, improve human health.