DIABETES: An Unfolding Epidemic

Prepared Foods, March, 2001 by Marie Spano

Supplements and food ingredients availing the diabetic and Syndrome X populations are poised for growth.

Epidemic levels...Overwhelming health care costs...Blindness, heart and nerve disease, and kidney failure." Such alarming should bites filled the media about a month or two ago when the Centers for Disease Control and Prevention (CDC), atlanta, released statistics on the increasing incidence of diabetes. For marketers looking for new demographic niches, this unhappily promises to be a large one.

Diabetes mellitus is a chronic disease that results from impairment in the body's production and/or use of the hormone insulin. Insulin is produced by the pancreas and helps transport glucose (sugar) into the cells of most organs where it is used for energy. Insulin also lends a hand in protein synthesis and fat storage. When diabetes is not under control, glucose and fat remain in the bloodstream, contributing to both organ and blood vessel damage over time. [1,2]

Diabetes effects more than 16 million Americans, approximately one-third of which are undiagnosed. [4] It is also on the rise. "From 1990 to 1998, the frequency of diabetes, especially Type 2 diabetes in adults, increased by about 33%. This increase was mainly due to new cases, and was closely associated with increasing weight and physical inactivity in this country," notes Frank Vinicori, Ph.D., director of the Division of Diabetes Translation, CDC. (See diabetes types, page 30.)

There is also growing awareness, particularly in the natural products industry, of a metabolic disorder called Syndrome X that is genetic in nature and starts with insulin resistance.

Terry Kristen Strom, co-author of SYNDROME X Overcoming the Silent Killer That Can Give You A Heart Attack and director of marketing for Shaman Pharmaceuticals, provides a description of the condition as follows. Insulin functions to escort glucose into cells. With insulin resistance, insulin does not work as well as it should. People with Syndrome X pump out higher levels of insulin. (As the body's insulin resistance increases, the pancreas produces additional insulin to maintain normal glucose levels.) Essentially, that insulin takes glucose and rams it [into] the cell by the sheer force of extra insulin in the bloodstream. The high insulin level may lead to potential complications, including polycystic ovarian syndrome, hypertension, dyslipemia, arteriosclerosis, Type 2 diabetes, heart disease, and possibly certain forms of cancer. This syndrome also is blamed, in part, on an American lifestyle of low physical activity and high fat and calorie diets. [5]

Management Through Diet

Diabetes treatment tends to focus on normalizing blood glucose levels. Type 1 diabetes treatment typically includes dietary management, exercise, insulin injections or the use of an insulin pump, and regular blood glucose monitoring. Type 2 diabetes treatment is similar, but also includes weight loss if needed and possibly oral medication and/or insulin. [3] The obesity in Type 2 diabetes tends to be self-perpetuating in that high insulin levels, or hyperinsulinemia, interferes with lipolysis (the breakdown of fat) and thus weight loss. [5]

Numerous theories exist on the proper macronutrient composition of a diabetic's diet. Dr. Gerald Reaven, endocrinologist, professor of medicine at Stanford University, and co-author of SYNDROME X, believes an optimal diet is composed of 45% of calories from carbohydrates, 40% fat, and 15% protein. Conversely, experts at the Pritikin Longevity Center in Santa Monica, Calif., promote a diet high in complex carbohydrates and very low in fat (less than 10% of total caloric intake).

Many individuals rely on the American Diabetic Association's Exchange System. (See photo and caption.) Some diabetics use a food's glycemic index to help guide diet! This is a measure of how rapidly a food will raise blood sugar. Foods that are digested rapidly (simple carbohydrates) produce a greater increase in blood sugar and have a higher glycemic index than more slowly digested foods (e.g., complex carbohydrates). The index's usefulness is controversial since it's impacted by many factors. [4]

Alternative Treatments

Several dietary supplements and functional foods are marketed to diabetics. As is often the case, the supporting science for the specific ingredients both varies in strength and continues to emerge. Here are a few.

* Bran and dietary fiber. Bran is simply dietary fiber from the course outer hull of the grain of wheat. Past studies of individuals who consume a high fiber diet (50 g or more per day) indicate that these individuals have a decreased risk for many diseases, including diabetes. [8]

* Fenugreek seeds. This product consists of the dried ripe seeds of a European herb. [9] Studies indicate that fenugreek has a favorable effect on postprandial glucose levels [11], fasting blood sugar, and lipid profiles. [12] It is a fibrous herb and therefore decreases the rate of digestion and subsequently slows down the typical rise in blood sugar that accompanies a meal while helping to increase satiety.