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A Possible Epoch for Metabolic Syndrome

On the outside, the market for metabolic syndrome may not seem so sexy. Marketing products that deal with lowering blood pressure and reducing insulin resistance may not get the blood pumping. Sure, weight-loss campaigns can be attractive, but thats really only the after pictures.

Thats on first glance. However, delving deeper into the market for metabolic syndrome reveals differing views, consumer appeal and potential for a bright future. A bright future that can bring sales and isnt making money one of the sexist things out there?

Then again, some say the market for metabolic syndrome does not exist, at least not under that term. Deanne Dolnick, director of sales, Next Pharmaceuticals,  said: I decided to take a run to Whole Foods to look at whats on the shelf for metabolic syndrome. The answer is nothing. There is no section dedicated to metabolic syndrome. Suffice it to say that the store personnel said they never get asked about products that address metabolic syndrome. They asked me what it was.

Instead of addressing metabolic syndrome as a whole, Dolnick said, their products address certain aspects of the ailment. I think because the industry discusses metabolic syndrome and we do hear about in the news, there is an assumption that there are product labels stating they are for metabolic syndrome. This just isnt so, she said.

James Elliott Ph.D., FACN, director of nutritional science at DSM Nutritional Products Inc. agreed, I think most products are directed toward the individual risk factors like cholesterol and diabetes rather than metabolic syndrome, since consumers may not be familiar with this concept.

However, Matt Phillips, president, Cyvex Nutrition, said consumers are becoming more aware of the term metabolic syndrome. This particular market segment continues to increase in consumer awareness and demand, as well as in product launches, he said. About six to eight years ago, not even quite a decade, syndrome X or metabolic syndrome was just beginning to be discussed and it was not that easy to understand because for the first time, seemingly disparate conditions were unified in their roles and intimate relationships with one another. Theres still a lot of education to be done so that the majority of Americans understand this more easily. Phillips said he has seen numerous products that address metabolic syndrome, and not just in dietary supplements. Functional foods with cardio, weight management and glycemic control are exploding on the shelves, he said.

With consumer awareness increasing, its possible products for this condition are about to start selling like hotcakes. I think that we are just on the cutting edge of products being specifically marketed for metabolic syndrome, said Scott Steil, president, Nutra Bridge Corp. Right now people are getting more into using the term metabolic syndrome. This trend is really happening right now in a way that has some critical mass to it, whereas two years ago, I dont think it existed.

Understanding Metabolic Syndrome

Maybe the reason many consumers dont know about metabolic syndrome is because its a concept that may be difficult to grasp. First off, no definitive description exists for it, at least not one all can agree on. In 1988, Gerald M. Reaven, M.D. of Stanford University Medical center coined the term Syndrome X to describe how insulin resistance sets the stage for more serious diseases. Then, the American Heart Association (AHA) identified six components of metabolic syndrome: 1) abdominal obesity, 2) atherogenic dyslipidemia (raised triglycerides and low concentration of high-density lipoprotein (HDL) cholesterol), 3) raised blood pressure, 4) insulin resistance, a.k.a., glucose intolerance, 5) proinflammatory state (elevated C-reative protein (CRP)) and 6) prothrombotic state (increased plasma plasminogen activator inhibitor and fibrinogen). A diagnosis of metabolic syndrome can be made by evaluating a persons waist circumference, triglyceride levels, HDL cholesterol, blood pressure and fasting glucose levels. If three of those five criteria are too high or too low, a person can be said to have the syndrome. The AHA states the underlying risk factors for metabolic syndrome are obesity, physical inactivity and an unhealthy diet, while the major risk factors are smoking, hypertension, elevated low-density lipoprotein (LDL) cholesterol, low HDL cholesterol, family history of cardiovascular disease (CVD) and aging.

The World Health Organization (WHO) recognizes CVD at the primary outcome of metabolic syndrome, but says insulin resistance is required for a diagnosis and requires a higher blood pressure than the AHA. The American Association of Clinical Endocrinologists calls it insulin resistance syndrome, but gives no defined number or risk factors and leaves the diagnosis to clinical judgment.

These different criteria can not only confuse consumers, but it can be difficult to evaluate clinical data. Initially, the WHO introduced definitions and later, several alternative definitions surfaced (EGIR, IDF, NCEP, ATPIII), said Frank Schonlau, Ph.D., director of scientific communications, Horphag Research and Natural Health Science. This makes it particularly problematic for scientists to compare one clinical study on metabolic syndrome to another. A population-based study in Sweden this year with 4,232 participants compared the different definitions. While 45 percent of men and 30 percent of women met the criteria for metabolic syndrome with one of the classifications, only 17 percent of men and 9 percent of women were identified by all three definitions.

All three organizations agree metabolic syndrome increases the risk of CVD and diabetes and that it affects millions of Americans. According to the American Diabetes Association, 50 million Americans in the United States had metabolic syndrome in 2007, and the Centers for Disease Control and Prevention (CDC) said 57 million U.S. adults had pre-diabetes that same year. The World Diabetes Foundation says diabetes affects 24 million Americans and 230 million people worldwide.

If you look at where we were ten years ago and where we are today with diabetics, with pre-diabetics, with people who are overweight and with people who are clinically classified as obese, the numbers are scary how quickly theyve gone up, Steil said. As a pool of consumers for our industry to focus on, the market is fantastic. Its not great as a country, but were trying to help people resolve their issues.

The unmet need is there, Steil continued. I dont see the product growth any where near the rise in the number of consumers that are suffering from metabolic syndrome, which means there is a huge upside and market opportunity for suppliers, like our company, if we can come out with products that produce results and if we can somehow get that message to the consumer.

Dolnick agreed. We certainly have enough consumers who desperately need products that deal with high cholesterol, high blood pressure, high blood sugar, weight loss and inflammation, she said. Its just whether or not they will choose to take the supplements to improve their lives or whether theyll just take a pharmaceutical and not make the necessary changes to lead a healthier life.

But, it looks like consumers may be starting to understand their health works as a symbiotic system. The market has grown dramatically stemming from increased mass media coverage about what metabolic syndrome is, tying together weight, blood fat/cardiovascular status and insulin response, said Ulrik Carlsson, president, Sprunk-Jansen. More consumers now understand that each individual health condition is intimately interrelated and by improving one, the others may also be positively impacted. This is very important: the body is a wholly functioning unit comprised of numerous systems, organs and cells that impact one another. Therefore, steering the consumers minds into thinking about whole body impact rather than the staid and limited one-system-only focus will be greatly beneficial.

While the term may seem like a curse because it is so broad and confusing, Steil said its a blessing for the natural products industry. As a dietary supplement manufacturer and marketer, you can talk about metabolic syndrome, he said. Its very tough to talk about diabetes and CVD because they are defined as diseases and supplements are not sold to treat diseases. It is good for marketing because ethical companies are not going say their product will treat diabetes, even though it may. Metabolic syndrome is a different story. You can define it, and then talk about products and why they address metabolic syndrome issues.

And, a diagnosis of metabolic syndrome may not be as daunting for the consumer as a diagnosis of CVD or diabetes. It could bring hope instead of dread. For those with metabolic syndrome, a diagnosis does not mean they are destined for diabetes or heart disease, said Steve Holtby, president and CEO, Soft Gel Technologies Inc. Rather, it is an opportunity for patients to intervene to delay the onset of diabetes, which will also lower the risk for other complications, such as coronary artery disease or stroke.

Addressing the Issue

Regular exercise and a healthy high-fiber diet low in saturated and trans fat can help reduce the severity of metabolic syndrome. One suffering from the condition should eat low-glycemic foods and reduce the amount of sugars, calories, alcohol and salt.

Nutritional ingredients can also help reduce the negative effects of metabolic syndrome; but, when formulating products, make sure those ingredients have scientific backing. Regulatory agencies and consumers require it. The market has changed in the respect that more and more regulatory focus is coming on the market and more science and validation of claims are being demanded by regulatory authorities, said R.V. Venkatesh, managing director of Gencor.

Catherine Lecareux, marketing manager of Bio Serae Laboratories, added, Consumers are in need for strong proof that would make them trust the products and the industry. Consumers are indeed more and more demanding about the origin and the quality of the products they consume and they now pay a great attention to what the industry offer them.

In addition to having scientific validation, the perfect ingredient for including in products addressing metabolic syndrome would do many things. Elliott noted, The popular ingredients for treating metabolic syndrome would be those which are effective in (1) reducing total cholesterol, reducing LDL cholesterol and raising HDL cholesterol, (2) reducing blood pressure, (3) reducing plasma glucose and insulin resistance , (4) reducing weight, (5) reducing triglycerides, (6) reducing inflammation and (7) reducing obesity.

Chromium picolinate may not do all that, but it is a common ingredient for reducing insulin resistance. Supplementation with chromium has been shown to reduce insulin resistance and to help reduce the risk of CVD and type 2 diabetes;1 however, at least one other study has shown it does not improve key features of the metabolic syndrome in obese non-diabetic patients.2

Chromium picolinate increases insulin sensitivity in a number of ways: by increasing the number of insulin receptors; increasing insulin binding; increasing insulin receptor phosphorylation; and by increasing GLUT4 translocation (a specific facilitative glucose transporter that helps shuttle glucose into the cell), said Holtby, noting Soft Gel offers a 200 mcg chromium picolinate soft gel.

Kemin Health offers Cr Pro 4% Chromium Propionate, designed to control blood glucose and metabolic efficiency and have favorable effects on fat metabolism.

Fiber, such as psyllium, oat bran and glucomannan, can also help improve blood glucose levels and weight management. Bio Sera Labs offers NeOpuntia, a patented lipophilic fiber made from Opuntia ficus-indica cactus leaves. In a study published by Advances in Therapy, NeOpuntia showed positive effects in balancing blood lipid levels and improved HDL cholesterol in females with a body mass index (BMI) between 25 and 40.3 At the end of the study, close to 40 percent of the 68 participants were no longer diagnosed with metabolic syndrome.

Omega-3 essential fatty acids have been shown to improve the cardiovascular health of subjects with metabolic syndrome, with positive effects on weight, systolic blood pressure, lipid profile and markers of inflammation and autoimmunity.4

Adding a bit of spice to the story, cinnamon has been studied for it its ability to reduce insulin resistance. Supplementing with cinnamon extract reduced fasting blood glucose and systolic blood pressure, and improved body composition in men and women with metabolic syndrome in one study;5 another found water-soluble cinnamon compounds in the diet could reduce risk factors associated with diabetes and CVD.6

Botanical extracts are also key players in the metabolic syndrome market. Next Pharmaceuticals offers a blend of them in its Flavoxine. Next Pharmaceuticals Flavoxine is  is a patented all-natural blend of botanical extracts that has been clinically shown to decrease weight by 5 percent in eight weeks in overweight subjects, Dolnick said. It also significantly decreased LDL cholesterol, blood pressure, blood glucose and CRP. It addresses five of the six conditions that make up metabolic syndrome.

OptiPure offers a Loquoro, a natural plant extract from the leaves of Eriobotrya japonica, otherwise known as loquat. Loquat leaves contain corosolic acida phytochemical known to activate facilitative blood glucose transporters, said Holtby. These carrier proteins help utilize glucose more efficiently without causing hypoglycemia. Loquoro stimulates glucose uptake without increasing adiposity.

GlucoFit (an exclusive Soft Gel branded supplement) is an extract from the leaves of Lagerstroemia speciosa L., which is commonly known as Banaba or Crepe Myrtle. The leaves contain significant amounts of corosolic acid, which has been shown to possess anti-diabetic properties, noted Holtby. Corosolic acid also contains significant amounts of tannins, which were identified and shown to act as activators of glucose transport in fat cells. In addition, corosolic acid possesses strong antioxidant activity to scavenge free radicals and to prevent cell membrane lipid peroxidation. It helps maintain low blood pressure and normal kidney function, by controlling blood sugar, and thus preventing damage to blood vessels and kidneys.

Studies on Pycnogenol, a natural plant extract from the bark of the maritime pine tree offered by Horphag Research, showing positive effects on body weight and waist circumference in metabolic syndrome are expected this year, according to Schonlau. He continued, Pycnogenol was shown to inhibit alpha-glucosidase, an enzyme in the colon required to digest starchy carbohydrates. In turn, Pycnogenol prevents the glucose from rushing to quickly into the blood stream and prolongs satiety. Several studies have been carried out with Pycnogenol demonstrating significant blood sugar lowering.

Chirositol from Cyvex Nutrition is extracted from carob pod juice and can be used in both dietary supplements and in functional foods. Chirositol contains more than 95 percent D-chiro-inositol, which is a member of a family of naturally occurring myo-inositols structurally similar to glucose, said Phillips. It mimics insulin activity, enabling it to control blood glucose levels.

Gymnema sylvestre , an herb used in Ayurveda, improved glycemic control over those who received conventional treatment alone in a non-randomized controlled clinical.7 In another study, five of the 22 diabetic patients were able to discontinue their conventional drug and maintain their blood glucose homeostasis with gymnema sylvestre alone.8

Also from plants, resveratrol has been shown to reduce metabolic disturbances and lower blood pressure in obese Zucker rats after long-term supplmentation9 and in an unpublished study conducted by Chang Gung University, Tao-Yuan, Taiwan, Resveratrol Improves Insulin Resistance in High Cholesterol-Fructose Diet Induced Metabolic Syndrome administration of resveratrol significantly improved tissue glucose uptake activities and hepatic glycogen synthesis in rats fed high cholesterol-fructose diet.

Last, but not least, coenzyme Q10 (CoQ10) presents promising results for those who suffer from metabolic syndrome. An increasing number of scientific reports indicate that dramatic decreases in CoQ10 levels and increased oxidative stress are associated with the aging process and with many age-related diseases, including metabolic syndrome, Holtby said. In a study involving an animal model of metabolic syndrome, treatment with CoQ10 was found to reduce cardiovascular risk, significantly decrease oxidative and inflammatory stress markers, prevent the elevation in serum insulin levels, reduce blood pressure and improve blood vessel health.10

With the number of ingredients and issues to address with metabolic syndrome, coupled with the increasing population diagnosed and awareness, the future for natural products to address this condition looks good. The future of the market of ingredients addressing syndrome X seems to us still very promising, Lecareux said. Two main factors should influence this trend: the growing overweight and obesity that developed countries, and now developing countries as well, for instance South America, must face. People suffering from obesity will look for nutraceuticals solution to alleviate the related troubles, such as syndrome X and associated parameters; and more and more technical products, with serious scientific results are creating a kind of race for scientific evidence.


References on the next page...


References for "The Metabolic Syndrome Market"

1.       Hummel M, Standl E, Schnell O. Chromium in metabolic and cardiovascular disease. Horm Metab Res. 2007 Oct;39(10):743-51.

2.       Iqbal N. et al. Chromium picolinate does not improve key features of metabolic syndrome in obese nondiabetic adults. Metab Syndr Relat Disord. 2009 Summer;7(2):143-50.

3.       Linares E., Thimonier C., Degre M. The effect of NeOpuntia® on Blood Lipid Parameters - Risks factors for the Metabolic Syndrome (Syndrome X)  Advances in Therapy®, The International Journal of Drug, Devices & Diagnostic Research, 2007 September-October issue.

4.       Ebrahimi M. et al. Omega-3 fatty acid supplements improve the cardiovascular risk profile of subjects with metabolic syndrome, including markers of inflammation and auto-immunity. Acta Cardiol. 2009 Jun;64(3):321-7.

5.       Ziegenfuss TN et al. Effects of a water-soluble cinnamon extract on body composition and features of the metabolic syndrome in pre-diabetic men and women. J Int Soc Sports Nutr. 2006 Dec 28;3:45-53.

6.       Roussel, A, et al. Antioxidant Effects of a Cinnamon Extract in People with Impaired Fasting Glucose That Are Overweight or Obese J Am Coll Nutr. 2009 Vol. 28, No. 1, 1621

7.       Shanmugasundaram ERB et al. Use of Gymnema sylvestre leaf extract in the control of blood glucose in insulin-dependent diabetes mellitus.  J Ethnopharmacology. 1990;30:281-294.

8.       Baskaran K et al. Antidiabetic effect of a leaf extract from Gymnema sylvestre in non-insulin dependent diabetes mellitus patients. J Ethnopharmacology. 1990;30:295-305.

9.       Rivera L, et al. Long-term resveratrol administration reduces metabolic disturbances and lowers blood pressure in obese Zucker rats. Biochem Pharmacol. 2009 Mar 15;77(6):1053-63.

10.   Kunitomo M, et al. Beneficial effect of coenzyme Q10 on increased oxidative and nitrative stress and inflammation and individual metabolic components developing in a rat model of metabolic syndrome.  J Pharmacol Sci, 2008; 107(2): 128-37.


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