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Controlling blood sugar is a newer tactic for weight management.
Of all the neologisms that shape and mirror our age-locavore, crowdsource, twerking-none may resonate more profoundly, or regrettably, than diabesity. It’s a term that pediatric endocrinologist and researcher Francine R. Kaufman, MD, applied to the conflation of type 2 diabetes and obesity. Alas, the word all too aptly describes the collection of ills that characterize both epidemics: excess abdominal fat, high blood sugar, generalized inflammation, etc.
These truly are epidemics. The American Diabetes Association says that close to 10% of the U.S. population is diabetic, a diagnosis given to those with fasting blood glucose levels topping 126 mg/dL in at least two tests. The toll on our economy associated with diagnosed cases, to say nothing of undiagnosed cases, amounts to fully $245 billion annually.
Meanwhile, nearly 35% of adult Americans meet the Centers for Disease Control and Prevention’s definition of obesity-an adult with a body mass index of 30 or above-with repercussions ranging from conditions like heart disease, stroke, and some forms of cancer to-not coincidentally-type 2 diabetes.
The hybrid nature of diabesity underscores a fundamental link between the two conditions it describes-a link that not only reflects similarities in their causes, but suggests novel interventions for mitigating them. The more we learn about the relationship between the disordered glucose metabolism at the heart of diabetes and the weight gain that leads to obesity, the more it appears that supplements designed to control the former may help control the latter, as well.
Of course, researchers and clinicians have long known that obesity, overweight, and physical inactivity are risk factors for type 2 diabetes, which accounts for almost 95% of the nation’s cases, including in children, as more young people edge over into overweight territory. These associations notwithstanding, it’s worth noting that not all overweight or obese people are diabetic-nor are all diabetics, type 2 or otherwise, overweight or obese. But about 80% of type 2 diabetics are overweight or obese, which raises the question: What is it about excess weight and diabetes that bind the two in a sort of chicken-and-egg interdependence?
Researchers are still sorting out all the puzzle pieces, but we have some ideas as to where and how they fit. To bring that picture into better resolution, it helps to understand a bit about energy, its metabolism, and the hormones that make energy.
A healthy body harvests the energy it needs from the foods and drinks it eats. More specifically, the body breaks down fats, proteins, carbohydrates, and even alcohol to the simple sugar glucose, which is an easily convertible “energy currency” for the cells. The body does this with the help of the hormone insulin, which the pancreas continually secretes but really starts pumping out once glucose levels in the blood rise, such as after a meal or snack.
Because simple sugars and starches break down easily into glucose-that is, they have a high glycemic index-the more sugary or starchy the meal or snack, the more rapidly glucose floods the bloodstream in a state known as postprandial hyperglycemia. When we’re in that state, says Mitch Skop, senior director, new product development, Pharmachem Laboratories Inc. (Kearny, NJ), “the pancreas releases more insulin to escort glucose into the cells” where the glucose supplies immediate energy or goes into storage as fat in the liver. Given glucose’s ability to trigger this response, those of us fond of sweetened beverages and an abundance of starchy and sugary foods run the risk of drowning our cells in glucose-and insulin-every time we eat. And, sure enough, cells that have bathed too long in insulin soon grow desensitized to the hormone’s signals.
This desensitization more properly goes by the name insulin resistance. It means that much of that glucose in the blood winds up stuck outside the cells’ doors “with essentially nowhere else to go,” Skop says. This deprives the cells of valuable energy while causing a host of other problems down the line. “So it stands to reason,” he continues, “that a poor diet high in starch and sugar calories will, over time, cause insulin resistance, which itself may lead to diabetes.”
So, to recap: Excess sugar in the blood leads to insulin resistance, which leads to diabetes. And excess dietary energy (calories)-these days, that often means sugar-leads to overweight and obesity. Overweight and obesity themselves promote diabetes by making it harder for cells to pay attention to insulin’s glucose-management cues. And now we’re learning that simply having diabetes can make it harder for diabetics to manage their weight, as the insulin they take to treat the disease allows more glucose to enter the cells where-absent sufficient energy demand-it’s stored as fat.
This complicated relationship doesn’t surprise Mohammad Rafi, president of Bioactive American Corp. (Highland Park, NJ), who points out that “healthy blood sugar can help maintain normal body weight in healthy adults, and diabetic patients will often lose or gain weight based upon the antidiabetic drugs they’re taking.”
Further, he notes that both diabetes and obesity share an oxidative and inflammatory component in the sense that high blood sugar can promote inflammation. “There is a direct correlation to inflammation and issues that cause weight gain, such as blood sugar,” he says. In the words of a recent study in The Lancet1, all these elements are part of an “overlapping pathophysiology” that underlies both excess weight and poor glucose control.
An Open Door
Granted, there’s nothing inevitable about being overweight or diabetic, as both conditions are largely preventable-even reversible-through sensible diet and exercise. Pharmaceuticals have also stepped in to combat the diseases’ progression, but we’ve already seen the unintended consequence insulin has on weight gain. Diabetes medications may present other drawbacks, as well, including their cost: the American Diabetes Association estimates that 18% of diabetes’ $245 billion price tag goes toward prescriptions to treat its complications. As for pharmaceutical attempts at addressing obesity, they have an even poorer track record, with the safety-driven withdrawals of fenfluramine/phentermine (better known as fen-phen), sibutramine, and others still fresh in mind.
Does this open a door for supplementary interventions? Rafi thinks it may. “The supplement industry needs to be proactive, advocating for healthy lifestyles that include a good diet, exercise, and stress reduction,” he says. But also “there is data that certain ingredients can prevent excess absorption of carbohydrates from foods to curb obesity, diabetes, and other chronic disorders.”
Indeed, Skop says, “Action has been taken for quite some time in the research and formulation of products for healthy blood sugar support”-products that could also encourage healthy weight loss. And though blood sugar management would be a new weight-control angle for the industry, it may be one whose time has come.
“Thermogenic fat burners, satiety enhancers, and metabolism boosters have all worked to a certain extent in weight loss or weight management and have been accepted by consumers,” says Xiaoming “Sandy” Chien, PhD, vice president, innovative products, HORN Nutraceuticals (La Mirada, CA). Blood sugar management may be “a less direct approach,” she says, but “it addresses the bottom line of weight management: excess glucose being stored as fat.”
Among the ingredients recognized for managing blood sugar are the South Asian botanical Gymnema sylvestre, banaba leaf extract (popular in the Philippines), bitter melon extract, cinnamon extract, and others. “Many of these products, such as the cinnamon extracts currently on the market, work with the beta cells in the pancreas to increase insulin production, and therefore help clear out blood glucose,” Chien says. “Some of the products can also increase insulin sensitivity, which helps cells take up blood glucose.”
Some of the ingredients attracting the most attention, both for their blood glucose and weight management potential, fall within the category of starch or carb blockers. Historically made from proteinaceous extracts of the white bean, Phaseolus vulgaris, they suppress the enzymes that break down starches and other polysaccharides into the simpler sugars that cells use for energy or store as fat.
More specifically, they target the enzymes alpha-amylase, which turns starches into oligosaccharides, and alpha-glucosidase, which breaks oligosaccharides further into monosaccharides like glucose. The theory is that by inhibiting the enzymatic release of these simple sugars, starch blockers make it harder to transform calories into pounds.
But there’s more to it than just that.
“Technically,” Chien says, “products that block starches actually delay their digestion and absorption, which allows the body fully to process the resulting glucose in a more sustained way, leaving little excess to be stored as fat.” Even better, she adds, starch blockers “will have some effect on postprandial glycemia, depending on how efficacious they are.” In fact, Skop says, “a wonderful side effect” of blocking carbohydrate absorption is that it puts “less stress on the pancreas, insulin, and blood sugar systems.”
In the 1990s, Skop’s company, Pharmachem, developed the first standardized starch blocker extracted from the white kidney bean-Phase 2 Carb Controller (known as StarchLite in the functional foods market). He says studies show significantly more “weight, fat, and inches lost” following Phase 2 intake.
A study recently published in Obesity2 reported that after 12 weeks of taking the extract, subjects lost 7 lb more on average-including significantly more body fat and waist circumference-than those taking a placebo. After 24 weeks, almost three-quarters of subjects in the weight-management phase of the trial had maintained their body weight.
While white beans provide the starting material for many starch blockers, it’s not the only source. According to Rafi, Salacia oblonga “is a safe, nontoxic herbal extract that has been used for thousands of years in ayurvedic medicine for the oral treatment of diabetes by helping naturally regulate blood sugar and insulin.” His company produces a branded S. oblonga extract, Salsulin, that inhibits alpha-glucosidase, preventing the enzyme’s hydrolysis of starch into glucose.
Rafi points to human clinical studies that indicate S. oblonga is a safe and effective blood sugar regulator. In one randomized, double-blind crossover study3, 61 patients with type 2 diabetes consumed one of three high-carbohydrate meals: a standard control meal, the control meal plus 240 mg S. oblonga extract, or a control meal plus 480 mg S. oblonga. Serum glucose and insulin samples taken at baseline and up to three hours postprandially showed that both doses of S. oblonga extract significantly lowered the postprandial positive area under the glucose curve-a measure that indicates reduced postprandial glycemia-Rafi says. Plus, he adds, both doses of S. oblonga extract lowered “the adjusted peak glucose response compared to the control meal, with the higher dose performing even better.”
Chien points to her company’s patented extract of Cinnamomum zeylanicum, or Ceylon cinnamon. A product of HORN’s partnership with French-based biotechnology company Dialpha, the cinnamon extract, branded MealShape, inhibits alpha-amylase when taken 20 to 30 minutes before a starchy meal to delay the digestion and absorption of carbohydrates. This “reduces the post-meal glucose spike to allow for a slower and more controlled rise in blood sugar,” she says. “Body fat storage is also reduced as the rate of glucose entering the body drops.” Chien cites a 2013 randomized, crossover, double-blind, placebo-controlled clinical trial, still in peer review, involving 18 healthy subjects. The study validated the extract’s ability to lower blood sugar by more than 20% after a standard meal. “Plasma glucose and insulin levels were checked at regular intervals, demonstrating reduced postrandial glycemia via area-under-the-curve calculations,” she says. “This innovative approach to postprandial glycemia reduction offers potential global health benefits for diabetes, cardiovascular health, and weight management.”
But inhibition of digestive enzymes-the bailiwick of classic starch blockers-isn’t the only game in town. Skop notes that another product in the Pharmachem arsenal combines the starch blocker L-arabinose (a simple sugar extracted from corn that inhibits the digestive enzyme sucrase) and chromium picolinate ingredient Chromax.
Chromium has long been known to aid insulin regulation and improve blood sugar balance, and many glucose-management supplements-including the Pharmachem one Skop speaks of, called Prenulin-include it. A 2011 study published in Nutrition Journal4, found that, compared to a placebo, the Pharmachem product significantly lowered both circulating glucose and insulin levels following consumption of a 70-g sucrose challenge.
Chromium polynicotinate appears in InterHealth Nutraceuticals’ (Benicia, CA) product ChromeMate, which, company CEO Paul Dijkstra, says “has been shown to support healthy weight in clinical studies.” The supplement works, he explains, “by supporting balanced blood sugar levels, increasing fat loss, and maintaining lean body mass.”
And combining ChromeMate with InterHealth’s Garcinia cambogia extract Super CitriMax-a patented double salt bound to calcium and potassium for enhanced bioavailability-appears to have “a greater effect on weight loss than just Super CitriMax” or the chromium supplement alone, Dijkstra says, citing several published studies, including one published in 2004 in Diabetes, Obesity & Metabolism5.
Garcinica Cambogia...and Enzymes
How does Garcinia cambogia help with carbohydrate metabolism? As Melony Fuller, director of marketing for National Enzyme Co. (NEC; Forsyth, MO), explains, “One of the most notable active ingredients in Garcinia cambogia is hydroxycitric acid (HCA). HCA competitively inhibits the enzyme ATP citrate lyase by competing with citrate. This slows the conversion of sugars to fatty acids, and fewer fatty acids results in less excess energy being stored as fat in adipose tissue.” NEC’s H3XG weight-management ingredient includes 400 mg of HCA from G. cambogia.
The company also offers its Enzymolic CarbBlocker Support, whose primary active ingredient is the enzyme transglucosidase. Unlike an enzyme like alpha-amylase that promotes conversion of starch to simple sugars, transglucosidase “converts easy-to-digest starches, such as white rice or white potatoes, to complex polysaccharides that are actually more difficult to digest,” Fuller says.
Using enzymes for healthy starch metabolism is a relatively new interest area, “within the last decade,” she adds. “Until transglucosidase came along, most enzymes actually sped up the transition from starch to sugar during digestion.”
Aiming for a Twofer
Products that can both aid weight loss and even out blood sugar pose an opportunity for what Skop calls “twofer solutions.” Namely, he suggests, “Formulate a healthy weight-loss product and a healthy blood sugar–management product and shrink-wrap them with a well-written booklet explaining why the conditions are so intimately intertwined.”
He may not be far off the mark. Metabolic disorders are much in the news these days, as is the fact that obesity is straining the fabric of our nation’s healthcare system. Now may be the best time to capture consumers’ attention with products that can move them to a better place metabolically.
Education, Dijkstra says, is key. “It’s important to educate consumers so they recognize that even if they don’t have any form of diabetes, it’s still critical to manage blood sugar levels to help interfere with metabolic pathways that may lead to excess body weight or cardiovascular problems,” he says. “Being physically active, making healthy food choices, and reaching and maintaining a healthy weight can help decrease insulin resistance and maintain a healthy blood sugar level.”
“As consumers become more informed on how the body uses glucose and its effect on weight management, increased focus on how to aid in this process will make its way into mainstream channels, elevating awareness,” says NEC’s Fuller.
Photo © iStockphoto.com/Stacey Newman