Although onset of type 2 diabetes typically develops in adulthood, it has been occurring with alarming frequency in children. Proper diet, weight management, and exercise can control type 2 diabetes, however.
According to the “2014 National Diabetes Statistics Report,” published by the Centers for Disease Control and Prevention (CDC), diabetes affects nearly 30 million Americans—almost 10% of the population. While this number includes the 21 million people who have been correctly diagnosed, it also includes 8.1 million who remain undiagnosed.
The CDC also believes that, as of 2014, an estimated one out of three American adults aged 20 or older—nearly 90 million people—could be considered pre-diabetic. Pre-diabetes, a.k.a., metabolic syndrome, is a condition in which individuals have blood glucose or hemoglobin A1c (HbA1c) levels higher than normal but not high enough to be classified as diabetic. HbA1c is the portion of a red blood cell that has been exposed to glucose and, since the 1990s, have been used as the common measure of blood glucose.
Low Glycemic Carbohydrates
Slow carbs (with a low GI) are released more slowly into the body, ensuring more balanced blood sugar levels.
The latest scientific research carried out by Professor Dr. Andreas F.H. Pfeiffer and his team at the German Institute of Human Nutrition, Potsdam-Rehbrücke, Germany, shows that the type of sugar used makes a significant difference to the blood glucose management of people with type 2 diabetes. It becomes clear that not all sugars are alike in their metabolic profile. Consequently it is physiology and hormone response that matter more than carbohydrate chemistry.
The reason for the significantly different incretin response of Palatinose™ compared to sucrose is explained by its unique molecular bond and related slow release properties. As a result of its slower digestion, Palatinose™ bypasses the K-cells in the upper intestine (which produce GIP) and reaches GLP-1 producing L-cells in the lower intestine. These incretin hormones play an important role in blood glucose regulation, insulin release and related long-term effects in development of insulin resistance and type 2 diabetes.
Learn more about low glycemic carbohydrates.
Sugarless products were the primary “diabetic foods” for decades. Typically, they made heavy use of artificial sweeteners and were poor substitutes for the foods they were meant to replace. Such products have come a long way since the 1980s’ limited selection of sugar-free hard candies, canned shakes, and sugarless chewing gums.
While sucrose is the gold standard of comparison for sweeteners, an increasing number of alternative sweeteners provide manufacturers with not only varying sweetness power, but also varying caloric values. As a carbohydrate, sugar weighs in at 4kcal/g. On the flip side, high-intensity sweeteners, such as aspartame, acesulfame-K, and sucralose, are considered non-caloric. Aspartame and acesulfame-K are about 200 times sweeter than sugar, while sucralose is 600 times sweeter.
Although aspartame, an esterified dipeptide of the amino acids aspartate and phenylalanine, is one of the most heavily tested sweeteners made, it also has garnered accusations regarding various health concerns, from diabetes to cancer. Yet there is ample evidence of its safety.
In spite of such scientific vindication, continued negative consumer perception has made using aspartame somewhat of a liability. Some companies are moving away from its use. PepsiCo announced last year that it would shift to using sucralose from aspartame in its diet beverages.
Polyols (sugar alcohols), such as xylitol, maltitol, and sorbitol, are about 95%, 90%, and 60% as sweet, respectively. They have a long history of usage in sugar-free formulations designed for persons with diabetes. They were widely used from the 1970s through 2000, when saccharine, the popular high-intensity/zero-calorie sweetener, was declared carcinogenic by the FDA. By the time the designation was withdrawn in 2000, the other sweeteners, especially polyols, had taken firm hold.
The caloric values of polyols range from a low of 2.1kcal/g for maltitol, to a high of 2.6kcal/g for sorbitol, with xylitol in the middle at 2.4kcal/g. However, excess consumption of sorbitol can have a laxative effect, and xylitol can provide a cooling sensation in the mouth—so its applications and use levels are somewhat limited.
Xylitol, from birch trees, has the highest digestive tolerance of all sugar alcohols and ranks a “7” on the glycemic index (GI), as compared to sugar, which has a value of 100. While sugar replacers, such as erythritol and allulose, are only about 60-70% as sweet as sugar, they have 90% fewer calories at only 0.2kcal/g and 0.4kcal/g, respectively.
The difficulty for processors with the above sweeteners also has been a matter of taste. Flavor-wise, except for some specific formulations, these ingredients do not always stack up to consumer expectations, which tended to favor sucrose. While each had, and still has, its advantages—for example, xylitol’s natural cooling effect makes it an outstanding enhancer of mint for items such as chewing gum—in a product such as a cookie, the flavor factor just could not compete as well as good old sugar.
Other low-/zero-calorie sweeteners used as sucrose replacers hit the sugarless scene about a decade ago. These include stevia (Rebaudioside-A or Reb-A), derived from the Stevia Rebaudiana plant, and lo han guo, an extract derived from monkfruit. Both stevia and monkfruit extract are about 200-300 times as sweet as sucrose. Used in such minute amounts, both are considered non-caloric.
Stevia’s taste has a slower onset and longer duration than that of sugar, and some of its extracts have become well-known for leaving a bitter or licorice-like aftertaste at high concentrations. The taste of stevia varies depending on the supplier, due to manufacturing processes, but there are several high-purity stevia products available with a clean flavor profile a product.
Both stevia and monkfruit extracts are heat-stable and can be used in cooking and baking. However, with baking, replacing all of the sugar in a recipe can be difficult. These natural and artificial sugar replacers do not melt like sugar and cannot replace sugar’s bulk properties. They can leave finished products, such as cakes, dense and relatively dry. Therefore, a reduced-sugar and lower calorie version is a better option for improved texture.
A relative newcomer that recently received GRAS status is allulose. Allulose contains 90% fewer calories compared to sugar. Several studies found allulose has no impact on blood glucose and actually suppresses glycemic response of other glycemic carbohydrates, when tested with carbohydrates or within a meal.
In one study that tested allulose as a single ingredient, 10 healthy adults were administered a tolerance test of either 25g allulose or 25g glucose, measuring blood glucose after two hours. Allulose was shown to be non-glycemic. Allulose can be used in a variety of food applications. In beverages, it provides a good mouthfeel and sweetness profile. In baked goods, it enables browning and caramelization; adds bulk and texture; and disperses evenly in the batter and dough. In frozen desserts, allulose adds a creamy mouthfeel and a smooth texture to products.
A versatile ingredient that can build solids, improve mouthfeel, and add sweetness is inulin. Inulin is considered a functional fiber, as well as a low-calorie sweetener, providing 1.3kcal/g. Inulin industrially is most often extracted from chicory root and belongs to a class of dietary fibers known as fructans or fructooliggosaccharides.
Inulin can yield different properties in food products, depending on its chain length. The degree of polymerization (DP) of standard inulin ranges from 2-60 monosaccharide units. After removing fractions with a DP of less than 10 units during the manufacturing process, the remaining product is composed of longer polymer chain lengths and is called as “high-performance” inulin.
Inulin fractions with a DP below 10 are classed as oliggofructose or short-chain fructooligosaccharides (sc-FOS), and have a sweetness level between 30-50% that of sucrose. Inulin has a clean taste; is highly water soluble; and can be used in a variety of sugarless beverages, to build solids and improve mouthfeel.
High-performance inulin also can function well in dairy-based beverages and desserts, such as whipped toppings and ice creams, as it acts as a viscosifier and as a fat replacer.
Fiber is a Natural
Inulin has value beyond its use as a bulker and an assisting sweetener for formulations tailored diabetics. It is a well-established prebiotic carbohydrate classed with fiber. Prebiotic fibers, instead of being digested in the stomach or upper gastrointestinal (g.i.) tract, are fermented in the lower g.i. They include arabinogalactan, resistant starch, pectin, beta-glucans, polydextrose, and other oligosaccharides, such as mannan-oligosaccharide and galactooliggosaccharide.
Prebiotic fibers perform several functions that make them valuable for formulators of foods and beverages to control diabetes. By functioning as bulking fiber, they at once increase satiety and digestive transit time, thus better modulating appetite, as well as the uptake and absorption of glucose. They also help modulate the uptake and absorption of fat and fat components, such as cholesterol.
Once in the lower g.i., prebiotic fibers ferment and feed the beneficial probiotic bacteria (gut microbiome) that perform multiple functions that maintain and improve health. Hundreds of studies in the past couple of decades have yielded impressive results regarding a healthy digestive system, revealing its key role in immunity and metabolic balance.
In a survey published in the journal Diabetes and Metabolic Syndrome earlier this spring, Mohsen Mazidi, PhD, and colleagues, noted that “gut microbiota [have] a profound effect on human metabolism, potentially contributing to several features of the metabolic syndrome.”
Mazidi’s team also focused on the syndrome’s associated “central adiposity with visceral fat accumulation, dyslipidemia, insulin resistance, dysglycemia, and non-optimal blood pressure levels.”
Describing the benefits of a healthy microbiome to help counter these conditions and subconditions, the researchers concluded: “Existing evidence from studies, both in animals and humans, support a link between gut microbiome and various components of metabolic syndrome.”
Mazidi, et alia, determined the mechanisms of action by the microbiome to include “involvement with energy homeostasis and metabolic processes, modulation of inflammatory signaling pathways, interferences with the immune system, and interference with the renin-angiotensin system,” concluding that “modification of gut microbiota via prebiotics, probiotics or other dietary interventions has provided evidence to support a possible beneficial effect of interventions targeting gut microbiota modulation to treat components or complications of metabolic syndrome.”
These natural or synthetic sugar replacers are ideal in all types of beverage products, such as juice drinks, vitamin waters, teas, smoothies, and dairy-based beverages. Both stevia and monkfruit extract are stable across a wide pH range, making them ideal even in acidified, low-pH beverages.
Erythritol commonly is used with stevia as a sweetener, as they are synergistic together, and a higher sweetness level can be achieved. If a texture modifier is needed to improve mouthfeel in beverages, either inulin or different hydrocolloids, such as guar, xanthan gum, or pectin, also can be added.
Cookies are a baked product once commonly avoided by diabetics. However, over the past two decades, sweet baked snacks like cookies became an attractive challenge to formulators and received significant technical attention. New ingredients and technologies have allowed developers to meet the challenge more adeptly than ever.
Koochicoo LLC has a line of sugar- free cookies that are a perfect example of formulation endeavors that target diabetes concerns. The cookies are made using non-GMO ingredients and alternative sweeteners.
“Our cookies are sweetened with monkfruit extract,” says Sally Cox, company CEO. “Other sweeteners include erythritol, stevia, and agave inulin.” Cox notes that she chose erythritol as a very low-calorie (0.2 kcal/g) sweetener, because “It has no aftertaste and a low GI, making it suitable for diabetics. Our cookies also contain organic agave inulin, which delivers an excellent source of dietary fiber, at 5g per serving.”
On the savory side, company research chefs and R&D experts have been striving to create a new generation of better-for-you snacks packed with fiber and low in carbohydrates and saturated fat. LesserEvil LLC uses a variety of ingredients, such as white and black bean powders, brown rice, quinoa flour, lentil flour, chia powder, and chia seeds, to achieve this feat. The company’s Chia Pop product delivers 5g of fiber per serving and is made using non-GMO popcorn and chia powder. Another of its products, the Wasabi Buddah Bowl, utilizes raw virgin avocado oil, which is high in vitamin E, monounsaturated fats, lutein, and beta-sitosterol, a plant sterol known to help lower blood cholesterol levels.
As a high-fat, high-sugar and high-calorie food, peanut butter often has necessitated caution for some with diabetes. However, there are a number of companies making versions of sugarless nut butters, some enriched with such nutraceuticals as added protein, plant sterols, and omega oils.
Go Nuts Co.’s GoNuts! line is one such example. The company’s nut butters are lower in carbohydrates and saturated fats than standard peanut butters; have no added salt or added vegetable oil; and do have added omega oils and higher protein. They are sweetened slightly with xylitol, as well. The company markets six different flavors, including maple, chocolate mint, pumpkin spice, and espresso.
Krush Nutrition also launched a line of cereal bar flavors that include baked apple pie and contain whey protein isolate along with milk protein isolate. The bars are sweetened with a combination of agave inulin, erythritol, and sucralose.
Nutrition bars can be of special value to persons with poorly controlled blood sugar levels. Every bit as important as keeping blood sugar low is keeping it from crashing too low. Bars made with complex carbohydrates and protein can be a convenient aid for these consumers. But until recently, the use of legumes as an ingredient to provide a near-perfect balance of complex carbohydrates and protein was rare in such products.
Kashi Co., a division of Kellogg Co., launched four new flavors of chewy bars made with legumes, as well as whole grains, nuts, and seeds. The flavors also trade on a number of current food trends and include Honey Pecan Baklava, Salted Dark Chocolate and Nuts, Dark Chocolate Cashew Chia, and Peanut Hemp Crunch. The company’s GOLEAN Plant Powered bars include a blend of crunchy nuts, seeds, pea crisps, and chewy whole grains, topped with a layer of nut butter or sunflower seed butter.
What goes around comes around. Centuries ago, the only interventions for blood sugar control were derived from herbs, spices, minerals, and fungi. As the epidemic of diabetes began to grow out of control, scientists plumbed these ancient remedies to add to the arsenal of blood sugar-management ingredients. Being natural and botanical, many of them can be suitable for inclusion in food and beverage products.
Herbal ingredients demonstrating beneficial health properties for maintaining healthy blood levels of glucose, insulin, and lipids number in the hundreds. Most also assist with treating pre-diabetes. Some of these, i.e., cinnamon, fenugreek, bitter melon, and Gymnema sylvestre (miracle fruit) have been used as folk medicine throughout Asia and South America. Even coffee has been associated with a significantly lower risk for the development of diabetes.
Cinnamon is an ancient spice derived from the bark of several species of trees. Chinese texts dating back 4,000 years mention it in conjunction with traditional medicine. It is known to be a rich source of polyphenolic compounds that act as free radical scavengers and have potent antioxidant activity. But not all cinnamons are equal. While the Cinnamomum aromaticum variety (typically called cassia) is cultivated around the world, and is less expensive due to its greater supply, it contains a potentially toxic compound called coumarin.
Coumarin actually is a natural blood-thinning and appetite-suppressing agent found in a number of common plants and herbs. For healthy persons, in the amounts received from consuming food, it is unlikely to cause any perceptible issues. But for those with compromised circulation (common in diabetes) or with a genetic sensitivity to coumarin (less than 10% of the population), there is the danger of increased risk of liver and kidney damage from coumarin ingestion. A level of 5mg coumarin per day is expected to cause no adverse effects, even in sensitive subgroups.
While cassia cinnamon has a median coumarin level ranging between around 3-9g/kg, Ceylon cinnamon (Cinnamomum zeylanicum a.k.a. Cinnamomom verum), also called “true cinnamon,” is a more expensive variety from Sri Lanka and has much lower coumarin levels. They range from non-detectable up to 190mg/kg.
There are now water-soluble cinnamon extracts available with markedly reduced levels of coumarin or other toxins present in whole cinnamon. One cinnamon extract of this type was tested in a 12-week, randomized, double-blind, placebo-controlled clinical trial with pre-diabetic men and women who also exhibited features of metabolic syndrome. At a dose of 500mg/day, the cinnamon extract demonstrated significant improvements in fasting blood sugar and systolic blood pressure. Subjects also experienced an increase in lean body mass and a reduction in body fat.
The hypoglycemic effects of banaba (Lagerstroemia speciosa) extract point to it as an emerging ingredient to counter the effects of diabetes and metabolic syndrome. This is due to its complement of the phytochemicals corosolic acid and ellagitannins. Several in vitro studies have been conducted, with both animal and human subjects using water-soluble banaba leaf extracts (100mg) and corosolic acid-standardized extracts (60mg containing 10mg corosolic acid).
In a 2012 study at the Suzuka University of Medical Science, Japan, researchers Toshihiro Miura, PhD, Satoshi Takagi, PhD, and Torao Ishida, PhD, concluded that banaba extract and corosolic acid could improve symptoms metabolic syndrome, as well as offer other health benefits. In fact, patients treated with pure corosolic acid (10mg/day for 30 days) had decreased blood sugar levels within one hour.
Bitter melon or bitter gourd (Momordica charantia) produces oblong-shaped fruits with a distinctive warty exterior. This species has been studied in vitro and in vivo for its potential anti-diabetic properties, with different parts of this plant (seeds, fruit pulp, leaves, and whole plant) and different doses (from 400mg to up to 6g/day) being studied.
While several animal studies and small-scale human studies have demonstrated a hypoglycemic effect of concentrated bitter melon extracts, some recent research has shown evidence that its effects can largely depend on how it is consumed.
A 2014 review article presented evidence that bitter melon, when consumed in raw or juice form, can be more efficacious in lowering blood glucose levels than tablets or capsules. However, more studies need to be performed in order to verify this effect.
Fenugreek seeds (Trigonella foenum-graecum) are used to enhance flavor, color, and texture of food, but also are used for medicinal purposes. They contain a high level of dietary fiber (>45%) in the forms of galactomannans, hemicellulose, pectin, cellulose, and lignins. Different epidemiological and laboratory studies have proven their medicinal properties.
Studies in humans demonstrate that fenugreek exerts hypoglycemic effects by stimulating glucose-dependent insulin secretion from pancreatic beta-cells, and by increasing the number of insulin receptors, as well as by inhibiting the activity of alpha-amylase and sucrase. Several studies identified different compounds responsible for these. Research has shown that the amino acid 4-hydroxyisoleucine is responsible for the increase in glucose-induced insulin release in humans, acting on pancreatic beta-cells.
Another potential active principle ingredient is trigonelline, the major alkaloid component of fenugreek. It demonstrates both hypoglycemic activity and affects beta-cell regeneration, insulin secretion, and enzyme activities related to glucose metabolism. It also displays antioxidant capacity.
The leaf of G. sylvestre is a reputed herb in both Ayurvedic and Western medicines. It shows positive effects on blood sugar homeostasis and also controls sugar cravings. It acts through the stimulation of insulin secretion from pancreatic beta-cells, and some active compounds have been cited such as gymnemic acids and gurmarin, a 35-amino-acid peptide.
The dried powder of the rhizome of Curcuma longa L., commonly known as turmeric, has been used for centuries as a medicinal agent and, specifically, as an anti-diabetic drug. Studies on diabetic retinopathy established that the therapeutic potential of curcumin for delaying this damage is exerted through its antioxidant and anti-inflammatory properties, as well as inhibition of vascular endothelial growth factor, stromal cell-derived factor 1, and the peroxisome proliferator-activated receptor (PPAR).
The curcuminoids have extensively been studied for their antioxidant and anti-inflammatory properties. Curcuminoids exert their antioxidant power by acting as superoxide radical scavengers and singlet oxygen quenchers. A primary metabolite of curcumin, tetrahydrocurcumin, is the most potent antioxidant among the naturally occurring curcuminoids. The anti-inflammatory properties of curcumin are due to its ability to inhibit the enzymes cyclooxygenase-2 and lipoxygenase.
Curcuminoids exhibit poor solubility in water, at both acidic and physiological pH ranges, and are poorly absorbed by the body. However, there has been active research into developing new methods of delivering curcumin, including the development of solid lipid nanoparticles, liposome, and micro-emulsion formulations that increase intestinal absorption and, thus, bioavailability of curcumin.
With the development of new botanical interventions for countering the effects of aberrant blood sugar levels at a metabolic level—coupled with new foods and beverages benefiting from technology in sweeteners, starches, proteins and lipids—the variety of products for consumers with pre-diabetes and diabetes will continue to expand. Food and beverage makers are not in the business of curing diabetes, but the new products that make use of these ingredients might ease many of the difficulties of living with the condition.
Originally appeared in the May, 2016 issue of Prepared Foods as Diabetes Developments.
Last year, high-amylose corn resistant starch type 2 (RS2) was submitted for a health claim petition to the FDA. The petition was based on solid scientific evidence going back more than a decade and including eight recent, controlled clinical trials that demonstrated a clear link between the consumption of the RS2 product and a reduced risk for the development of type 2 diabetes. The decision from the FDA is expected this year.