The American Diabetes Association (ADA) reports that an estimated 14.6 million people in the U.S. have been diagnosed with diabetes, a number likely to grow as Baby Boomers swell through advanced age. Diabetes requires careful dietary management to control blood sugar, because the body does not produce or properly use insulin, a hormone needed to convert food into energy for daily living.

“Eating a healthy breakfast is essential for maintaining blood sugar control,” says Lorena Drago, MS, RD, CDE, a registered dietitian and certified diabetes educator. “For many people, breakfast consists of whatever they can grab and eat on their way out the door in the morning, but it takes a lot more planning for people living with diabetes,” says chef and cookbook author Robyn Webb, MS, LN.

Slowing Digestion

Responding to this need, Abbott Nutrition featured Glucerna® brand Cereal at the ADA 2007 Food & Nutrition Conference & Expo (FNCE) in Philadelphia. A uniquely designed, traditional breakfast food formulated from wheat bran, whole-wheat flour, sucromalt, fructose and corn bran, it is made specifically for people with diabetes to manage morning blood sugar response and has been clinically shown to help minimize blood sugar spikes. It also contains chromium picolinate, an important mineral that helps the body’s own insulin work more efficiently.

In a study published in the Archives of Internal Medicine1, researchers conclude that fiber may help with the body's ability to handle blood sugar; research published in the Journal of the American College of Nutrition2 recommends that people with diabetes should eat 25-50g of fiber daily. High fiber intake has beneficial effects on insulin sensitivity and improved glycemic control--the manner in which various types of foods affect blood sugar.

Glucerna cereal also provides an excellent source of fiber, includes 5g of whole grains and 3g of protein per ¾ cup serving and has 0g of saturated and trans fat. The product “allows people with diabetes to enjoy this traditional breakfast food, while helping to reduce their blood sugar response," says Drago.

Intended for use under medical supervision as part of a diabetes management plan, Glucerna products are available in the pharmacy section of retail stores and include an improved line of shakes and snack bars enhanced by unique blends of slowly digested carbohydrate ingredients designed to help minimize a high rise in blood sugar, thereby promoting stability. Each 200-calorie shake contains a digestion-resistant maltodextrin, sucromalt, glycerine, fructose and chromium picolinate to help reduce postprandial (after a meal or snack) blood sugar response. The 200-calorie size contains 5g of fiber. The product is also available in a 140-calorie snack size with 3g of fiber. Glucerna’s Mini-Snack Bars with 70-80 calories and Meal Bars--calorie-controlled meal replacements to help manage blood sugar daily or for diabetic weight-loss plans--contain a uniquely designed carbohydrate blend consisting of maltodextrin, fructose, maltitol and/or lactitol, glycerine and fiber.

Because blood sugar control and insulin stability are key to healthy living with diabetes, the makers of Bios Life™, a natural formulation fiber and nutrient drink mix, also exhibited at ADA FNCE. The company claims the drink mix is clinically proven to help improve glycemic control and decrease hyperinsulinemia--excess insulin in the blood--in patients with type 2 diabetes. This helps to effectively augment therapeutic management of their condition by helping to keep blood sugar in better balance and decrease triglycerides.

Bios Life claims to delay gastric emptying, lowering post-meal blood sugar to protect from damage that can result when glucose or sugar in the blood and insulin spike. Taken shortly before a meal, it creates a gel fiber matrix in the stomach that traps food for short periods of time as it moves through the intestines, promoting a more gradual digestive process by slowing the rate of absorption so that blood sugar levels remain lower throughout the day; this healthfully stabilizes both blood sugar and insulin. The product proved effective in a clinical trial conducted by Independent Certified Diabetes Educators, working with www.diabetesincontrol.com, that was presented at the 2001 American Association of Certified Diabetes Educators (AADE) conference. (For more information about the study and Bios Life, please see “Website Resources.”)

Bios Life, given twice daily before meals to patients with diabetes for three months, resulted in:

• Average reduction in postprandial blood sugar of 17.2%.
  
• Average reduction of fasting blood sugar of 17%.
  
• Average reduction of HbA1c of 15.2% in the first three months of usage. (HbA1c is an indicator of average blood sugar levels.)
  
• Average drop in body weight of 4% (8lbs).
  
• Average drop in triglycerides of 42%.

Controlling Weight

Weight control, or loss if overweight, is also a key factor in diabetes management. Health Care Products’ DiabetiTrim™, also exhibited at ADA FNCE, is positioned as a nutritionally balanced, weight management drink for people with diabetes. DiabetiTrim combines controlled or limited calories with a high proportion of protein to break down fat cells, while protecting muscle tissue.

The company said that in a study conducted by the Johns Hopkins University Bloomberg School of Public Health, researchers found that the vast majority of patients (91% of males and 72% of females) lost more than 40lbs with the formula made for DiabetiTrim. Currently, the Diabeti-Trim formula for people with diabetes is part of a study to evaluate the efficiency of the products, as compared to a standard ADA weight loss treatment program using whole foods.

Preventing a “spike and crash” in blood sugar is helpful for weight management, while providing sustained energy. SoLo Gi® Low Glycemic Nutrition Bars, also shown at ADA FNCE, are formulated with a unique combination of slow-release carbohydrates, high protein, dietary fat and a good source of fiber and are especially designed to release sugars from carbohydrates more slowly into the bloodstream. The Glycemic Index (GI) measures the physiological impact of a carbohydrate-containing food on blood sugar, compared to glucose (ranked at 100), replacing the current notion of simple or complex carbohydrates. For weight management, sustained energy and chronic disease prevention, the slower and lower the impact the better. Diets with a high Glycemic Load (GL)--a similar measured value that applies the GI to servings of food--result in a higher postprandial insulin response that can lead to food cravings, overeating and increased fat storage.

Low-glycemic diets--which stabilize blood sugar after eating--are more effective than low-fat diets in people who secrete large amounts of insulin, reports a new study in the May 16, 2007, Journal of the American Medical Association3. Saul Katz, president and CEO of Solo Gi Nutrition Inc., said, “Until recently, adoption of a low-GI/GL diet has been limited…due to the scientific nature of the GI--the complexity to calculate the GI and GL of a mixed meal, snack or food.” SoLo Gi Nutrition, a low-glycemic diet company, was established to offer low-GI/GL food solutions to help address the growing epidemics that comprise “diabesity”--diabetes caused by excess weight. SoLo Gi Bars are clinically validated as very low-GI and involved in five major independent clinical trials, including new studies at the Children’s Hospital Boston (with Harvard Medical School) and Children’s Hospital Oakland Research Institute. Studies are investigating the effect of a low-glycemic diet in relation to type 1 and type 2 diabetes among youth and the prevention of gestational diabetes, a type of diabetes triggered by pregnancy that may continue after the mother gives birth.

There have been many botanically based ingredients used in folk medicine and as dietary supplements throughout the world for their anti-hyperglycemic effects. One of the most common is Jambol fruit seeds (Eugenia jambolana).4 One supplier provides a proprietary extract that it obtains from the seed of the fruit, from a tree native to eastern India, through a natural alcohol extraction that is then standardized and spray-dried to form an easy-to-use powder. The Jambol fruit seeds contain the chemical constituents gallic acid, oxalic acid, antioxidants, sterols and ellagic acid.

The vendor reports that the Jambol extract has been shown to increase the activity of enzymes that utilize blood sugar and to have hypoglycemic or lowering effects on blood sugar levels. The supplier also says additional studies have been done that compare the efficacy of Jambol extract to a standard diabetic medication (glibenclamide) and that the Jambol administered as a dietary supplement performed reasonably close to glibenclamide in reducing fasting blood sugar levels.

There have been a large number of in vivo studies on the ability of cinnamon spice and its phenolic extracts to display insulin-potentiating activity. Although not all study results have been positive, many have been. For example, a 2003 study in Diabetes Care reported that intakes of 1, 3 or 6g of cinnamon per day reduces serum glucose, triglyceride, LDL cholesterol and total cholesterol in people with type 2 diabetes.5 The conclusion from a more recent study is that “cinnamon spice supplementation may be important to in vivo glycemic control and insulin sensitivity in humans, and not only are its effects immediate, they also appear to be sustained for 12h.”6

Good lifestyle habits, such as regular exercise and a carefully controlled diet, remain the foundation for good health for those with diabetes or metabolic syndrome. The products mentioned here have the potential to assist in the quest for good health.

References:

1 Krishnan, S., et al. 2007. Glycemic index, glycemic load, and cereal fiber intake and risk of type 2 diabetes in U.S. black women. Arch Intern Med. 167:2304-2309.
2 Anderson, JW, et al. 2004. Carbohydrate and fiber recommendations for individuals with diabetes: a quantitative assessment and meta-analysis of the evidence. J Am Coll Nutr. 23:5-17.
3 Ebbeling, CB, et al. 2007. Effects of a low–glycemic load vs. low-fat diet in obese young adults: a randomized trial. JAMA. 297:2092-2102.
4 Helmstädter A, 2007. Antidiabetic drugs used in Europe prior to the discovery of insulin. Pharmazie. 62:717-20.
5 Kahn, A. et al., 2003. Cinnamon improves glucose and lipids of people with type 2 diabetes. Diabetes Care. 26:3215-8.
6 Solomon, TP and Blannin, AK. 2007. Effects of short-term cinnamon ingestion on in vivo glucose tolerance. Diabetes Obes Metab. 9:895-901.

Omega-3s and Insulin Resistance

Omega-3 fatty acids have been investigated for their benefits in a great number of health conditions, and diabetes and related insulin resistance, or “metabolic syndrome,” are no exceptions. For example, one study (Cancelas, J., et al. 2007. Horm Metab Res. 39:823-5) found that rats deficient in long-chain omega-3 fatty acids exhibited greater glucose intolerance associated to insulin resistance and increased insulin secretion compared to a control group. Other studies show mixed results. Hartweg, J., et al. (2008. Cochrane Database Syst Rev. 23:CD003205) looked at the effects of omega-3 PUFA supplementation on cardiovascular outcomes, cholesterol levels and glycemic control in people with type 2 diabetes mellitus. Omega-3 supplementation in this group lowered triglycerides and VLDL cholesterol, but had no statistically significant effect on glycemic control or fasting insulin. Omega-3 consumption is often simply recommended for these at-risk populations as part of a healthy diet. For example, in a study “Diagnostic criteria patterns of U.S. children with Metabolic Syndrome: NHANES 1999-2002,” Kranz, S., et al. (2007. Nutr J. 6:38.) notes the high number of children with metabolic syndrome risk factors and made the dietary recommendation that they “consume diets moderately low in fat with emphasis on polyunsaturated and monounsaturated fats within recommended ratios of omega-6 and omega-3 fatty acids.”

Some diabetic products do contain omega-3s. Mintel’s GNPD notes that in November 2006, Pathmark introduced a Diabetic Nutritional Shake “said to contain beta-carotene and omega-3 DHA and fiber [that] has no added sugar [and] is claimed to help maintain blood glucose levels.” The ingredients mimic those of a comparable Glucerna product.
--Claudia D. O’Donnell, Chief Editor

Links

• More information about Abbott Nutrition Glucerna products
• Visit this site to see a copy of the clinical trial conducted by Independent Certified Diabetes Educators working with Diabetes in Control.com
• More information about Bios Life
• Information about Health Care Products DiabetiTrim
• Information on the low-GI/GL study and SoLo Gi Bars