Paula Deen brought diabetes management into the headlines in January 2012 when she revealed she had been suffering from type 2 diabetes for three years. With 2 million Americans diagnosed each year with the insulin-resistance disease, it was not the diagnosis that got the public talking. The cook is known for her high-fat, carb-loving comfort foods. The fact that she had the disease for years while still promoting unhealthy food options would have caused alarm on its own, but things got worse for healthy living advocates when she revealed she was a spokesperson for Novo Nordisk, makers of the diabetes drug Victoza.

Perhaps if Deen had eaten better or had paid more attention to her health, she would not need to take prescription drugs, critics argued. Indeed, nutrition plays a big part in both types of diabetes, but type 2 diabetes is much better managed through diet and lifestyle. In fact, six weeks after the news broke, Deen said she would start offering healthier versions of her foods in upcoming episodes of her Food Network show.

While it's most certain nutrition affects type 2 diabetes, dietary supplements are not allowed to claim they cure, treat, prevent or mitigate diseases in the United States. However, under structure/function claims allowed by FDA, product manufacturers can address how products help maintain healthy levels of blood sugar and insulin, a hormone produced by the pancreas to control blood sugar. The type of wording may even help open a wider range of consumers for these products, as maintaining healthy blood glucose and insulin levels will reduce cardiovascular disease (CVD) and diabetes risk for those who do not already suffer from the disease. Even if a person doesn't have diabetes, it's wise to manage blood sugar levels and metabolism to avoid onset of diabetes or other health conditions, such as heart disease or obesity.

Healthy blood sugar levels can be maintained by reducing sugar intake, exercising to stimulate insulin production, and adding natural ingredients to the diet that can affect glucose production or absorption. These ingredients are now available in capsules, tablets, powers and functional foods, and they each have a different mechanism of action. Thankfully, research has not only shown these ingredients work, but how they can help manage blood sugar levels.

Chromium

Chromium, an essential trace mineral, can boost insulin activity in the body by enabling the hormone to bind to its receptor and enhancing insulin-dependent function, according to a review of chromium research from 1959 to 1980.¹ It's found in whole grains and eggs, but may be better absorbed by the body when taken in the supplement forms chromium picolinate, chromium polynicotinate and chromium aspartate.² Research has shown consuming diets high in simple sugars stimulates serum chromium losses; this, coupled with a low intake of dietary chromium, may lead to chromium deficiency, which is associated with impaired glucose and lipid metabolism.³

Chromium's role in insulin management is thought to be behind its positive effects on diabetes management. Supplementing with chromium picolinate at levels higher than the upper limit of the Estimated Safe and Adequate Daily Dietary Intake (100 mcg and 500 mcg) had significant beneficial effects on glycosylated haemoglobin (HbA1c, a lab test that shows average blood sugar levels over three months), glucose, insulin and cholesterol in subjects with type 2 diabetes.⁴ A 2002 study from India found chromium supplementation improved glycemic control in type 2 diabetic patients, and it appears to be due to an increase in insulin action rather than stimulation of insulin secretion.⁵

A 2006 study from the Czech Republic found type 2 diabetics who supplemented with 400 mcg chromium-enriched yeast experienced improvements in blood glucose and oxidative stress compared to placebo.⁶ Also in 2006, Taiwanese researchers reported supplementation with 400 mcg/d of chromium-containing milk powder for 16 weeks resulted in lower fasting plasma glucose levels, fasting insulin levels and improvement of metabolic control in male patients with type 2 diabetes.⁷

Zychrome, an enhanced chromium ingredient from InterHealth Nutraceuticals, affected insulin levels and function more than chromium picolinate by 1.4-fold and 2.0-fold, respectively, in a study presented at the 52nd American College of Nutrition Meeting in November 2011.

Botanicals

Gymnema is a well-known natural blood sugar management ingredient. Gymnema sylvestre, a woody climbing shrub native to India and Africa, has a long history of use in Ayurvedic medicine. In London, researchers noted an alcoholic extract of Gymnema sylvestre stimulated insulin release in pancreatic beta-cell lines in vitro.⁸ A 2003 Indian study found oral administration of 200 mg/kg/body weight of an alcoholic extract of the Gymnema montanum leaf for three weeks reduced blood glucose,increased plasma insulin and decreased free radical formation in plasma of diabetic rats.⁹

In humans, another Indian study from 1990 found 400 mg/d of an Gymnema sylvestre leaf extract given to type 2 diabetic patients reduced blood glucose, HbA1c and glycosylated plasma proteins (an index of long-term blood glucose levels) enough that conventional drug dosage could be decreased.¹⁰ Also, in subjects with insulin-dependent diabetes, 400 mg/d of a water-soluble extract of the leaves of Gymnema sylvestre reduced fasting blood glucose and HbA1c and glycosylated plasma protein levels in yet another Indian study.¹¹

Another tree-derived ingredient, French maritime pine bark, is also known for its blood-glucose controlling properties. A 2006 German study on the branded extract Pycnogenol (from Horphag Health Sciences) found it may offer a new treatment of diabetic ulcers;¹² diabetes can lead to lower limb ulcers that are very slow to heal. In this study, Pycnogenol taken both orally and topically produced 89-percent complete healing at six weeks versus 61 percent healing in the group that received prescription drugs. A 2006 Italian study found 50-mg capsules tid of Pycnogenol for four weeks decreased skin flux at rest in the foot (indicating a reduction of ulcers), decreased capillary filtration and improved venoarteriolar response in patients with diabetic ulcers compared to controls.¹³

Beyond diabetic ulcers, research has shown combining 100 mg/d Pycnogenol and conventional diabetes treatment lowered glucose levels and improved endothelial function in patients with type 2 diabetes after 12 weeks.¹⁴ In 2007, German researchers explored Pycnogenol's anti-diabetic effects, even though an increased insulin secretion was not observed after administration of the extract to patients.¹⁵ They analyzed the inhibitory activity of Pycnogenol, green tea extract and acarbose (as Glucobay® from Bayer Vital, a synthetic inhibitor of the carbohydrate alpha-glucosidase) , and found Pycnogenol exhibited the most potent inhibition of alpha-glucosidase compared to the two other compounds. Pycnogenol also lowered fasting blood glucose levels dose dependently (until 200 mg/d) without affecting insulin levels in a separate study.¹⁶

Pterostilbene, a compound found in small red berries, has been used for millennia in Ayurvedic medicine as a blood sugar management tool. Pterostilbene is also found in the Indian kino tree (Pterocarpus marsupium), and this tree was studied in a 1978 trial that reported 5 g/d tid of its extract reduced blood sugar levels after three weeks compared to baseline.17 In a 1997 study, Pterocarpus marsupium and pterostilbene significantly lowered the blood glucose level of hyperglycemic rats, and the effect was comparable to that of metformin, a prescription drug used to treat type 2 diabetes.¹⁸

Silbinol® (from Sabinsa Corp.), a standardized extract of P. marsupium, has been the subject of two unpublished clinical trials. The Indian Council of Medical Research found P. marsupium helped control both fasting and postprandial blood glucose in 67 of 93 newly diagnosed non-insulin dependent diabetes patients between 35 and 60 years old. And another study on 20 patients with maturity onset diabetes reported P. marsupium at 5 g tid after meals reduced fasting and postprandial blood sugar levels comparable with the conventional drug therapies.

More recent research on isolated pterostilbene found it decreased glucose levels in diabetic rats and also increased insulin production.¹⁹ Pterostilbene also acted as a protective antioxidant in type 2 diabetic rats by increasing the activity of superoxide dismutase (SOD) and glutathione, and normalizing lipid peroxidation in livers and kidneys.²⁰

Lagerstroemia speciosa L., commonly known as banaba or crepe myrtle, contains corosolic acid, a key component that has shown anti-diabetic properties. A 2004 Japanese study found corosolic acid reduced blood glucose levels in KK-Ay mice (an animal model of type 2 diabetes) four hours after single oral administration compared with the control group, and it also increased muscle facilitative glucose transporter isoform 4 (GLUT4), signifying it helps facilitate the transfer of glucose from the blood to muscles.²¹ Banaba also contains the ellagitannin lagerstroemin, which was shown to cause insulin-like actions in rat adipocytes, including increasing the rate of glucose uptake.²²

A study from SIBR Research Inc., Bradenton, FL, found a banaba leaf extract, standardized to 1-percent corosolic acid in a softgel capsule formulation (as GlucoFit, from Soft Gel Technologies Inc.) showed a 30-percent decrease in blood glucose levels compared to a 20-percent drop seen with dry-powder filled hard gelatin capsule formulation, suggesting the soft gel formulation has a better bioavailability.²³

Another extract from banaba leaves, standardized to 18-percent corosolic acid, has been the subject of two unpublished clinical trials. In the first study, one softgel of GlucoHelp (from Soft Gel Technologies Inc.) per day, providing 10 mg of corosolic acid, for one week reduced fasting blood glucose, as well as postprandial blood glucose 30, 60 and 120 minutes after eating a starchy meal. While none of the subjects in the trial had diabetes, those with pre-diabetes (fasting blood glucose levels of 110 mg/dL or above) saw the greatest decreases in blood glucose15 percent after one week and 21 percent after two weeks. In the second study, a randomized, placebo-controlled clinical trial found one daily soft gel of GlucoHelp for 30 days reduced fasting and two-hour postprandial blood glucose levels compared to control.

An analysis of the leaves of Eriobotrya japonica, otherwise known as loquat, shows it too contains corosolic acid along with tormentic acid, which also possesses antidiabetic actions.²⁴ A 2010 study from Taiwan found loquat reversed insulin resistance and reduced hyperglycemia caused by a high-fat diet in mice.²⁵ And a 2008 study reported Eriobotrya japonica seeds lowered serum insulin and blood glucose levels in type 2 diabetic rats and mice compared to controls.²⁶

Coccinia indica (also known as Coccinia cordifolia), an herb growing abundantly in India, has been used in traditional treatment of diabetes, but it's also been the subject of clinical trials. In 2008, a double blind, placebo-controlled, randomized trial found 1 g/d of an alcoholic extract of the herb for 90 days decreased the fasting, postprandial blood glucose and A1C levels in patients with mild diabetes.²⁷ In 2011, a rat study found petroleum-ether, ethyl acetate and chloroform fractions isolated from ethanolic extract of the leaves of Coccinia cordifolia Linn. (150 mg/kg body weight) reduced blood glucose levels in normoglycemic rats.²⁸

The seeds of the jambol tree (Syzygium cumini), native to eastern India, contain the chemical constituents gallic acid, oxalic acid, antioxidants, sterols and ellagic acid; the combination may be the right mix to create a antihyperglycemic effect. A proprietary extract of the jambol tree (as JamboLean®, from Roxlor International) was found to act at the gene level to block glucose absorption, provide phytochemicals believed to have a role in diabetic control, and reduce inflammation and obesity in an in vitro, unpublished study sponsored by Roxlor.

Plant-Based Carb Blockers

Some ingredients are known to slow or inhibit the absorption of carbohydrates, which reduces the need for insulin in the body. With carb inhibitors, digestive enzymes allow an individual to eat a reasonable amount of carbohydrate, but lessen or at least slow the absorption of refined carbohydrates into the bloodstream. Carb blockers may also reduce the amount of calories absorbed.

White bean (Phaseolus vulgaris) extract can help diabetes sufferers navigate the world of white bread and refined grains as it can inhibit absorption of the carbohydrate amylase and a 5-carbon sugar (L-arabinose) to inhibit sucrose development. In a 2000 Norwegian randomized, placebo-controlled, double blind study, obese patients who ingested white bean extract experienced significant weight and fat loss.²⁹ Seven years later, an Italian randomized, double blind, placebo-controlled study found after 30 days, subjects receiving a standardized white kidney bean extract (445 mg) with a carbohydrate-rich, 2,000- to 2,200-calorie diet had significantly greater reduction of body weight, body mass index (BMI), fat mass, adipose tissue thickness, and waist/hip/thigh circumferences while maintaining lean body mass compared to subjects receiving placebo.³⁰

A proprietary, standardized extract of the white kidney bean (as Phase 2 Starch Neutralizer® from Pharmachem Laboratories) has been the subject of numerous studies conducted by Jay Udani, M.D., at Medicus Research LLC. In 2004, he and a team of researchers at the University of California, Los Angeles, reported clinical trends for weight loss and a decrease in triglycerides after obese subjects took 1,500 mg/d Phase 2, although statistical significance was not reached.³¹ In 2007, Udani conducted another study and found subjects who consumed 1,000 mg/d of Phase 2 and followed a multi-component weight-loss program, including diet, exercise and behavioral intervention, significantly reduced their weight and waist size in four weeks.³²

InSea2®, a carb blocker made from a blend of brown seaweed (Ascophyllum nodosum and Fucus vesiculosus) from innoVactiv Inc., inhibited alpha-amylase and alpha-glucosidase, reduced the normal increase in postprandial blood glucose in Wistar rats 30 minutes after a meal by 90 percent and reduced peak insulin secretion by 40 percent.³³ And a double blind, randomized, placebo-controlled crossover Canadian study reported consumption of two 250-mg capsules of InSea2 30 minutes before eating 50 g of carbs from bread was associated with a 12.1-percent reduction in the insulin incremental area under the curve and a 7.9-percent increase in the Cederholm index of insulin sensitivity.³⁴

A 1996 Japanese study on the monosaccharide L-arabinose reported the naturally occurring, but poorly absorbed, sugar suppressed the glycemic response after sucrose ingestion by inhibition of sucrase activity.³⁵ In 2001, a separate team of Japanese researchers found L-arabinose inhibited intestinal sucrase activity, thereby reducing sucrose utilization, and consequently decreasing fat production in rats.³⁶

Two studies on a patented combination of chromium and L-arabinose (as Phase 3 Sugar Controller, from Pharmachem Laboratories) showed the powder significantly lowered both circulating glucose and insulin levels after consumption of a 70-g sucrose challenge compared to placebo. In the first of the two studies, 20 healthy, non-diabetic subjects showed taking Phase 3 Sugar Controller led to an average reduction in glucose of 31 percent, and an average reduction in insulin levels of 32 percent when presented with a 70-g sucrose challenge.³⁷ In the two-phase clinical trial of 50 healthy non-diabetic adults, subjects taking Phase 3 Sugar Controller had an average reduction in glucose of 24.3 percent, and an average reduction in insulin of 28.2 percent when faced with the same sucrose challenge.

Many nutritionists encourage increased fiber consumption, but this adage is especially true for diabetes patients because it can slow or even block the absorption of carbs into the blood. A Georgetown University, Washington, study found adding oat bran to the diet can ameliorate sucrose-induced blood pressure elevations in spontaneously hypertensive rats.³⁸ According to a prospective, randomized, placebo-controlled, double blind, parallel group trial, 6 g/d of barley beta-glucan (as Barliv, from Cargill) consumed in a beverage over 12 weeks improved insulin sensitivity among individuals at risk for type 2 diabetes.³⁹

Unlike carb blockers, resistant starches escape enzymatic digestion and pass through the gastrointestinal (GI) tract undigested. Resistant starches pass into the colon where they may be fermented into short chain fatty acids and other health-promoting compounds.

Hi-Maize resistant starch (from Corn Products International) contains a mixture of rapidly digested and slowly digested starch (digested within the small intestine) and resistant starch (which reaches the large intestine and is fermented by the resident bacteria). A 2005 study with a four-week supplementation period of 30 g/d of Hi-Maize improved insulin sensitivity compared to placebo.⁴⁰ A few years earlier, the same team of researchers found adding 60 g of Hi-Maize to the diet led to next-day lower plasma glucose and insulin levels with a higher insulin sensitivity compared to diets without supplementation.⁴¹

A different set of researchers in China found four weeks of 30 g/d of Hi-Maize increased insulin sensitivity, and decreased fasting blood glucose, post meal blood glucose and body mass index (BMI) compared to controls.⁴² In 2008, Swedish researchers reported adding wheat bread enriched with a mixture of barley fiber and Hi-Maize improved glucose tolerance at the subsequent breakfast compared with unfortified white bread. ⁴³ The resistant-starch functional bread also lowered inflammatory markers and increased satiety.

In an animal model,  Hi-maize increased glucagon-like peptide-1 (GLP-1), another hormone that regulates insulin sensitivity, gastric emptying and inhibition of food intake.44 That study also found resistance starch increased peptide YY , a hormone that contributes to gastric emptying and appetite regulation.

The most recent study on Hi-Maize, published in February 2012, found consumption of 15 to 30 g/d of the ingredient increased the insulin sensitivity in men in four weeks; however, it did not affect insulin sensitivity in women.⁴⁵

Natural Sweeteners

Natural sweeteners that impart no or fewer calories than sugar can also be an effective way for those with diabetes to keep insulin numbers in check.

Stevia, a no-calorie sweetener from a South and Central American plant, gained GRAS (generally recognized as safe) status in 2008, allowing it to be formulated into foods and beverages. This was good news for those with diabetes who prefer this sweetener, as studies have shown stevioside treatment is associated with improved insulin signaling and antioxidant defense in both the adipose tissue and the vascular wall, leading to inhibition of atherosclerotic plaque development in insulin-resistant mice.⁴⁶ In 1986, Brazilian researchers reported 5 g Stevia rebaudiana extract administered to healthy volunteers at regular six-hour intervals for three days increased glucose tolerance, and decreased plasma glucose levels after consumption and after an overnight fast.⁴⁷ In 2004 Danish research, supplementation with stevioside in type 2 diabetic patients reduced postprandial blood glucose levels in type 2 diabetic patients compared to corn starch, indicating beneficial effects on glucose metabolism.⁴⁸

Sucromalt, derived from sucrose and maltose is considered GRAS, so it too can be used in low-sugar foods and beverages. A 2009 study reported a diet consisting of 47 energy percent energy from carbohydrate (mostly sucromalt), reduced blood glucose response, peak plasma glucose concentrations and plasma insulin responses in type 2 diabetes patients compared to a "standard diet" of 55 percent energy from carbohydrate.⁴⁹ A 2008 study found sucromalt elicited reduced glucose and insulin responses compared to high fructose corn syrup (HFCS), most likely related to differences in rate of digestion and absorption.⁵⁰

Research in 2011 on the sugar alcohol xylitol found it was more effective than sucrose at maintaining diabetes-related parameters, such as fasting blood glucose, in nondiabetic rats.⁵¹ And 2002 Russian research noted after patients with type 2 diabetes ingested 30 g erithritol dissolved in 300 ml of water, blood glucose did not show a marked increase compared with 30 g isomalt.⁵²

Fish Oil

Fish oil can also aid those with diabetes by reducing heart disease. A 2003 study from Circulation reported a higher consumption of fish and long-chain omega-3 fatty acids was associated with a lower coronary heart disease (CHD) incidence and total mortality among diabetic women.⁵³ A 2009 systematic review and meta-analysis confirmed omega-3 polyunsaturated fatty acids (PUFAs) supplementation decreased triglycerides by 7 percent and increased low-density lipoprotein (LDL) cholesterol by 3 percent in patients with type 2 diabetes compared to control, signifying a reduced risk of heart disease.⁵⁴ A separate meta-analysis conducted by the Mayo Clinic in 2000 reported fish oil supplementation in type 2 diabetes lowered triglycerides and raised LDL cholesterol, but had no statistically significant effect on glycemic control.⁵⁵

Aid for Nerve Damage

Nerve pain and damage (neuropathy) is a common symptom of diabetes and represents a major health problem, as it is responsible for substantial morbidity, increased mortality and impaired quality of life. Alpha lipoic acid, an antioxidant that is both water and fat soluble, given intravenously at a dosage of 600mg/d for three weeks, significantly reduced neuropathic pain, according to a 2010 review from The Netherlands.⁵⁶ A 1999 German review of 15 clinical trials reported a three-week pilot study of 1,800 mg/d given orally indicated a therapeutic effect, and oral treatment for four to seven months tended to reduce neuropathic deficits and improved cardiac autonomic neuropathy.⁵⁷ In a 2006 study, oral treatment with alpha lipoic acid for five weeks improved neuropathic symptoms and deficits in patients with distal symmetric polyneuropathy (DSP, when many nerves throughout the body malfunction simultaneously).⁵⁸

Ubiquinone, a reduced form of CoQ10, was shown to protect the kidneys by preserving mitochondrial function in an experimental model of type 2 diabetic nephropathy.⁵⁹ In a 2008 study, CoQ10 stopped the diabetes-induced shift toward nerve damage.⁶⁰ And CoQ10 and alpha-tocopherol, in combination and separately, decrease HbA1c levels and lipid peroxidation in the pancreases of diabetic rats in a 2008 Portuguese study.⁶¹

The eyes contain many nerves, and are thus at risk for damage in diabetes patients. Diabetic retinopathy, damage to the retina caused by leaky blood vessels, is a major cause of blindness in people with diabetes. Pycnogenol improved microcirculation, retinal edema and visual acuity in the early stages of diabetic retinopathy in a 2009 study.⁶²  An earlier study found Pycnogenol slowed the progression of diabetic retinopathy, while the retinopathy progressively worsened and the visual acuity significantly decreased in the placebo group.⁶³

From the eyes to the heart to the waistline, natural ingredients can help address complications associated with diabetes, offering the million of those who suffer with the disease and those at risk a way to help stabilize blood glucose levels.

Blood Sugar Health Market

Hear Luke R. Bucci, Ph.D., vice president of research, Schiff Nutrition Intl.; Douglas MacKay, N.D., vice president, scientific and regulatory affairs, Council for Responsible Nutrition (CRN); and Gregory J. Stephens, R.D., president, Windrose Partners, discuss what sells and to whom in the blood sugar health market at the SupplySide MarketPlace education session, "Expert Predictions for the Blood Sugar Health Market," Thursday, May 10 from 2 to 4 p.m. at the Javits Center in New York. InterHealth Nutraceuticals Is sponsoring the session.

References listed on the next page.

References for "Keeping Blood Sugar Slow and Steady" by Sandy Almendarez

1.       Mertz W. " Chromium research from a distance: from 1959 to 1980."J Am Coll Nutr. 1998 Dec;17(6):544-7.

2.       Gaby, A. "Chromium: Nutrition for Clinicians." Integr Med. 2006 Aug/Sept;5(4):22-26

3.       Kozlovsky AS et al. " Effects of diets high in simple sugars on urinary chromium losses." Metabolism. 1986 Jun;35(6):515-8.

4.       Anderson RA et al. " Elevated intakes of supplemental chromium improve glucose and insulin variables in individuals with type 2 diabetes." Diabetes. 1997 Nov;46(11):1786-91.

5.       Ghosh D et al. "Role of chromium supplementation in Indians with type 2 diabetes mellitus."J Nutr Biochem. 2002 Nov;13(11):690-697.

6.       Racek J et al. " Influence of chromium-enriched yeast on blood glucose and insulin variables, blood lipids, and markers of oxidative stress in subjects with type 2 diabetes mellitus." Biol Trace Elem Res. 2006 Mar;109(3):215-30.

7.       Pei D et al. "The influence of chromium chloride-containing milk to glycemic control of patients with type 2 diabetes mellitus: a randomized, double-blind, placebo-controlled trial." Metabolism. 2006 Jul;55(7):923-7.

8.       Persaud SJ et al. "Gymnema sylvestre stimulates insulin release in vitro by increased membrane permeability." J Endocrinol. 1999 Nov;163(2):207-12.

9.       Ananthan R et al. " Antidiabetic effect of Gymnema montanum leaves: effect on lipid peroxidation induced oxidative stress in experimental diabetes. Pharmacol Res. 2003 Dec;48(6):551-6.

10.   Baskaran K et al. " Antidiabetic effect of a leaf extract from Gymnema sylvestre in non-insulin-dependent diabetes mellitus patients." J Ethnopharmacol. 1990 Oct;30(3):295-300.

11.   Shanmugasundaram ER et al. "Use of Gymnema sylvestre leaf extract in the control of blood glucose in insulin-dependent diabetes mellitus." J Ethnopharmacol. 1990 Oct;30(3):281-94.

12.   Belcaro G  et al. " Diabetic ulcers: microcirculatory improvement and faster healing with pycnogenol." Clin Appl Thromb Hemost. 2006 Jul;12(3):318-23.

13.   Cesarone MR et al. "Improvement of diabetic microangiopathy with pycnogenol: A prospective, controlled study." Angiology. 2006 Aug-Sep;57(4):431-6.

14.   Liu X et al. " Antidiabetic effect of Pycnogenol French maritime pine bark extract in patients with diabetes type II." Life Sci. 2004 Oct 8;75(21):2505-13.

15.   Schäfer A, Högger P. " Oligomeric procyanidins of French maritime pine bark extract (Pycnogenol) effectively inhibit alpha-glucosidase." Diabetes Res Clin Pract. 2007 Jul;77(1):41-6.

16.   Liu X, Zhou HJ, Rohdewald P. "French maritime pine bark extract Pycnogenol dose-dependently lowers glucose in type 2 diabetic patients." Diabetes Care. 2004 Mar;27(3):839.

17.   Ojha et al. "Hypoglycemic effect of Pterocarpus marsupium Rox." Jour. Res. Ind. Med. Yoga & Homoeo. 1978(13)4:12-16

18.   Manickam M et al." Antihyperglycemic activity of phenolics from Pterocarpus marsupium."  J Nat Prod. 1997 Jun;60(6):609-10.

19.   Pari L, Satheesh MA." Effect of pterostilbene on hepatic key enzymes of glucose metabolism in streptozotocin- and nicotinamide-induced diabetic rats." Life Sci. 2006 Jul 10;79(7):641-5.

20.   Amarnath Satheesh M, Pari L. "The antioxidant role of pterostilbene in streptozotocin-nicotinamide-induced type 2 diabetes mellitus in Wistar rats." J Pharm Pharmacol. 2006 Nov;58(11):1483-90.

21.   Miura T et al. " Corosolic acid induces GLUT4 translocation in genetically type 2 diabetic mice." Biol Pharm Bull. 2004 Jul;27(7):1103-5.

22.   Hattori K et al. " Activation of insulin receptors by lagerstroemin." J Pharmacol Sci. 2003 Sep;93(1):69-73.

23.   Judy WV et al. "Antidiabetic activity of a standardized extract (Glucosol) from Lagerstroemia speciosa leaves in Type II diabetics. A dose-dependence study." J Ethnopharmacol. 2003 Jul;87(1):115-7.

24.   Taniguchi S et al. " Production of bioactive triterpenes by Eriobotrya japonica calli." Phytochemistry. 2002 Feb;59(3):315-23.

25.   Shih CC, Lin CH, Wu JB. "Eriobotrya japonica improves hyperlipidemia and reverses insulin resistance in high-fat-fed mice." Phytother Res. 2010 Dec;24(12):1769-80. doi: 10.1002/ptr.3143.

26.   Tanaka K et al. " Hypoglycemic activity of Eriobotrya japonica seeds in type 2 diabetic rats and mice." Biosci Biotechnol Biochem. 2008 Mar;72(3):686-93.

27.   Kuriyan R et al. " Effect of supplementation of Coccinia cordifolia extract on newly detected diabetic patients." Diabetes Care. 2008 Feb;31(2):216-20. Epub 2007 Nov 13.

28.   Islam MA et al." Antidiabetic and hypolipidemic effects of different fractions of Coccinia cordifolia L. on normal and streptozotocin-induced diabetic rats." Pak J Pharm Sci. 2011 Jul;24(3):331-8.

29.   Thom E. "A randomized, double-blind, placebo-controlled trial of a new weight-reducing agent of natural origin." J Int Med Res. 2000 Sep-Oct;28(5):229-33.

30.   Celleno L et al. "A Dietary supplement containing influences body composition of overweight men and women. Int J Med Sci. 2007 Jan 24;4(1):45-52.

31.   Udani J, Hardy M, Madsen DC. "Blocking carbohydrate absorption and weight loss: a clinical trial using Phase 2 brand proprietary fractionated white bean extract." Altern Med Rev. 2004 Mar;9(1):63-9.

32.   Udani J, Singh BB. " Blocking carbohydrate absorption and weight loss: a clinical trial using a proprietary fractionated white bean extract." Altern Ther Health Med. 2007 Jul-Aug;13(4):32-7.

33.   Marie-Claude, R. et al. " Effect of a commercially-available algal phlorotannins extract on digestive enzymes and carbohydrate absorption in vivo." Food Research International 44 (2011) 30263029

34.   Paradis ME, Couture P, Lamarche B. "A randomised crossover placebo-controlled trial investigating the effect of brown seaweed (Ascophyllum nodosum and Fucus vesiculosus) on postchallenge plasma glucose and insulin levels in men and women." Appl Physiol Nutr Metab. 2011 Dec;36(6):913-9.

35.   Seri K et al. " L-arabinose selectively inhibits intestinal sucrase in an uncompetitive manner and suppresses glycemic response after sucrose ingestion in animals." Metabolism. 1996 Nov;45(11):1368-74.

36.   Osaki S et al. " L-arabinose feeding prevents increases due to dietary sucrose in lipogenic enzymes and triacylglycerol levels in rats." J Nutr. 2001 Mar;131(3):796-9.

37.   Kaats GR et al. "A combination of l-arabinose and chromium lowers circulating glucose and insulin levels after an acute oral sucrose challenge." Nutr J. 2011 May 6;10(1):42.

38.   el Zein M et al. "Influence of oat bran on sucrose-induced blood pressure elevations in SHR." Life Sci. 1990;47(13):1121-8.

39.   Bays H et al. " Reduced viscosity Barley β-Glucan versus placebo: a randomized controlled trial of the effects on insulin sensitivity for individuals at risk for diabetes mellitus." Nutr Metab (Lond). 2011 Aug 16;8:58.

40.   Robertson MD et al. "Insulin-sensitizing effects of dietary resistant starch and effects on skeletal muscle and adipose tissue metabolism." Am J Clin Nutr. 2005 Sep;82(3):559-67.

41.   Robertson MD et al. "Prior short-term consumption of resistant starch enhances postprandial insulin sensitivity in healthy subjects." Diabetologia. 2003 May;46(5):659-65. Epub 2003 Apr 24.

42.   Zhang WQ et al. "[Effects of resistant starch on insulin resistance of type 2 diabetes mellitus patients]." Zhonghua Yu Fang Yi Xue Za Zhi. 2007 Mar;41(2):101-4.

43.   Nilsson AC et al. " Including indigestible carbohydrates in the evening meal of healthy subjects improves glucose tolerance, lowers inflammatory markers, and increases satiety after a subsequent standardized breakfast." J Nutr. 2008 Apr;138(4):732-9.

44.   Zhou J et al. " Dietary resistant starch upregulates total GLP-1 and PYY in a sustained day-long manner through fermentation in rodents." Am J Physiol Endocrinol Metab. 2008 Nov;295(5):E1160-6.

45.   Maki KC et al. " Resistant Starch from High-Amylose Maize Increases Insulin Sensitivity in Overweight and Obese Men." J Nutr. 2012 Feb 22.

46.   Geeraert B et al. " Stevioside inhibits atherosclerosis by improving insulin signaling and antioxidant defense in obese insulin-resistant mice. "Int J Obes (Lond). 2010 Mar;34(3):569-77. Epub 2009 Dec 15.

47.   Curi R et al. "Effect of Stevia rebaudiana on glucose tolerance in normal adult humans." Back in Braz J Med Biol Res. 1986;19(6):771-4.

48.   Gregersen S et al. "Antihyperglycemic effects of stevioside in type 2 diabetic subjects." Metabolism. 2004 Jan;53(1):73-6.

49.   Vanschoonbeek K et al. 'Slowly digestible carbohydrate sources can be used to attenuate the postprandial glycemic response to the ingestion of diabetes-specific enteral formulas." Diabetes Educ. 2009 Jul-Aug;35(4):631-40.

50.   Grysman A, Carlson T, Wolever TM. "Effects of sucromalt on postprandial responses in human subjects." Eur J Clin Nutr. 2008 Dec;62(12):1364-71.

51.   Islam MS. "Effects of xylitol as a sugar substitute on diabetes-related parameters in nondiabetic rats." J Med Food. 2011 May;14(5):505-11.

52.   Sharafetdinov KhKh et al. "[Use of a new sugar substitute, erithritol, in the diet therapy of type 2 diabetes patients]." Vopr Pitan. 2002;71(3):19-23.

53.   Hu FB et al. Fish and long-chain omega-3 fatty acid intake and risk of coronary heart disease and total mortality in diabetic women." Circulation. 2003 Apr 15;107(14):1852-7.

54.   Hartweg J et al. "Potential impact of omega-3 treatment on cardiovascular disease in type 2 diabetes." Curr Opin Lipidol. 2009 Feb;20(1):30-8.

55.   Montori VM et al." Fish oil supplementation in type 2 diabetes: a quantitative systematic review." Diabetes Care. 2000 Sep;23(9):1407-15.

56.   Mijnhout GS et al. " Alpha lipoic acid: a new treatment for neuropathic pain in patients with diabetes?" Neth J Med. 2010 Apr;68(4):158-62.

57.   Ziegler D et al." Alpha-lipoic acid in the treatment of diabetic polyneuropathy in Germany: current evidence from clinical trials." Exp Clin Endocrinol Diabetes. 1999;107(7):421-30.

58.   Ziegler D et al. Oral treatment with alpha-lipoic acid improves symptomatic diabetic polyneuropathy: the SYDNEY 2 trial." Diabetes Care. 2006 Nov;29(11):2365-70.

59.   Sourris KC et al. Ubiquinone (coenzyme Q10) prevents renal mitochondrial dysfunction in an experimental model of type 2 diabetes." Free Radic Biol Med. 2012 Feb 1;52(3):716-23.

60.   Ayaz M et al. " Coenzyme Q(10) and alpha-lipoic acid supplementation in diabetic rats: conduction velocity distributions." CoQ10 to Methods Find Exp Clin Pharmacol. 2008 Jun;30(5):367-74.

61.   Sena CM et al. " Supplementation of coenzyme Q10 and alpha-tocopherol lowers glycated hemoglobin level and lipid peroxidation in pancreas of diabetic rats." Nutr Res. 2008 Feb;28(2):113-21.

62.   Steigerwalt R et al. " Pycnogenol improves microcirculation, retinal edema, and visual acuity in early diabetic retinopathy." J Ocul Pharmacol Ther. 2009 Dec;25(6):537-40.

63.   Spadea L, Balestrazzi E. "Treatment of vascular retinopathies with Pycnogenol." Phytother Res. 2001 May;15(3):219-23.