The New Diabetes Formulation Paradigm

The recent trend of developing diabetes-specific products that are mainstream and safe enough for regular consumption could transcend all healthy food and beverage categories.

By Kantha Shelke, Ph.D.

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Processors are seeing the old model of manufacturing special foods for persons with diabetes give way to several approaches. Actively, processors seek to include ingredients in formulations to tailor a food toward having a reduced glycemic impact. Fiber, fiberlike starch fractions and bioactive nutraceuticals are all being employed to this effect.

From the other direction, portion control is the chosen path. Since nearly 90 percent of the 15 million or so Americans with type 2 diabetes are overweight - most simply because they eat too much - this uncomplicated approach is popular. It also has the added benefit of being more inclusive.

Even persons without diabetes, but facing weight management or blood pressure problems, benefit from foods re-packaged to help with portion control. Since the formulation itself need not be changed, processors benefit from the wider appeal and marketability. Value-packed miniaturization is proving to be especially appealing to consumers, especially with premium and indulgent foods.

Sugar by Any Other Name is Still as Sweet

Sugar – the amount, the timing, the type and (when necessary) avoidance of intake – often challenges individuals managing blood glucose levels. The old paradigm of formulating for diabetes was mostly a matter of simply substituting sugar with a noncaloric sweetener. This approach is still viable, and the 21st-century substitutes are far more sophisticated.

Sugar ranks next to fat and calories in the information consumers seek on food packages. Consumers with diabetes are concerned about sugar and particularly about its replacement – the artificial sweeteners. Focus on satiety does not bode well for sugar-free formulations, however. Numerous studies suggest sugar-free products do not satiate a person's appetite, actually making the products a liability to some persons managing caloric intake.

Diabetes cover story: healthy beverage photo, courtesy of Palatinit
Sweeteners that are low in calories, glycemic index and insulin response are a boon to sugar-free beverage manufacturers. Photo courtesy of Palatinit Food Ingredients.

Removing sugar can be complicated, especially when it comes to baked goods and dairy products such as yogurt. These foods often rely on sucrose and other simple sugars for taste and texture. Makers of baked goods, confectionery, dairy products and beverages have responded by collaborating with sweetener companies to create treats that specifically address consumer demand for perfection in sugar-modified foods.

Palatinit Food Ingredients, Morris Plains, N.J., offers two popular examples of nutritive sweeteners for such applications. Palatinose is a caloric sweetener yet is very low-glycemic and low-insulinemic. It acts as a functional carbohydrate sweetener, and Isomalt is a low-calorie, very low-glycemic bulk sugar replacer.

Some research suggests sugar avoidance may even increase the threshold for satiety. For this reason, processors are focusing on every stage of formulation, from reducing the amount of sugar, replacing a portion of the sugar with a non-nutritive sweetener (so-called "fractional" products) to making products that are completely sugar-free.

Nutritive sweeteners, regardless of type, break down in the body into simple sugars to be used for energy. Non-nutritive sweeteners created specifically for their lack of calories and nonglycemic attributes are hard to market due to some consumers' negative perceptions. For example, according to Linda Gilbert of HealthFocus International, Atlanta, one in five parents actively seeks out no-sugar-added children's products. A majority of parents tend to shy away from artificial sweeteners in children's foods altogether.

Future Sweet

Two nonglycemic sweeteners currently labeled by FDA as dietary supplements (as opposed to food additives) are available in consumer retail markets but may not be used by U.S. food processors. Both are very stable under high temperatures and are being used to sweeten processed foods and beverages in other countries.

Stevia is a natural sweetener that comprises 40 percent of the sweetener market in Japan. Mesa, Ariz.-based Wisdom Natural Brands claims stevia and other natural sweeteners are healthier than artificial sweeteners for individuals with diabetes. The company cites scientific research demonstrating stevia to be effective in helping the body reduce fat in addition to achieving and maintaining proper glucose balance.

Stevia is available in the U.S. market as ground leaves and as stevioside, a highly refined white powder for use without restriction by consumers in foods, beverages, cooking and baking. The Coca-Cola Co., Atlanta, incorporates stevia in its Diet Coke products in Canada and Japan.

Lo han kuo is another natural nonnutritive sweetener. Derived from a sweet gourd and about 200-250 times as sweet as table sugar, lo han kuo has been used in Asia for generations. At one calorie per gram, it provides a natural and ultra-low calorie sweetness in foods and is very stable under high temperature, thus suitable for cooking and baking. It is commonly mixed with xylitol. Xylitol itself is a flavorless nonnutritive sweetener ideal for foods and beverages. It is a polyol occurring naturally in many fruits and vegetables and is commercially produced by Danisco Sweeteners, Ardsley, N.Y.

The difficulty of replacing sucrose with a single substitute has prompted ingredient blenders such as Minneapolis-based Cargill Inc. to develop application-specific blends. Cargill's Eridex natural nonnutritive sweetener erythritol is blended with dextrins to yield a virtually calorie-free (0.2Kcal/g) bulk sweetener for formulations. The blend is used commercially in Hershey's Sugar Free Pot of Gold Truffles and reduced-calorie, all natural Light Smoothies from Stonyfield Farm, Londonderry, N.H.

To GI, or not to GI

The suddenly popular glycemic index (GI) was developed for persons with diabetes to recognize foods that release glucose slowly into the blood stream. The American Diabetes Assn., however, does not favor GI as a consumer tool. Still, controlling the impact of glucose-containing food is important to diabetes management (see "Glycemic Index: What's in a number?," Food Processing, March, 2006).

One way to reduce the glycemic impact of a flour-based formulation is to replace refined flour with a resistant starch such as Hi-Maize, from National Starch Food Innovation (www.foodinnovation.com), Bridgewater, N.J. The naturally occurring material delivers health benefits such as calorie reduction, glycemic moderation and increased insulin sensitivity, plus aids digestive health.

NUMBERS UP

The diabetic-friendly, sugar-free food and beverage market is poised to grow 32 percent between 2005 and 2009, according to Chanda Rowan, public relations manager of Mintel International, Chicago. The affected population, which includes all age groups and ethnicities, is growing in number and is forecasted to continue to do so. Increasing consumer desire to revise the diet for weight reduction and improved health is incentive enough for food processors to invest in suitable foods and beverages.

"Resistant starch, although chemically not a fiber, acts like a functional dietary fiber in the gastrointestinal tracts and allows for the advantages of fiber to a food without changing taste, texture or convenience," explains Rhonda Witwer, business development manager of nutrition for National Starch.

Another resistant starch is C*Actistar, developed from tapioca by Cerestar, a division of Cargill. C*Actistar is flavorless and non-GMO. Approximately 53 percent of the compound is resistant to digestion. It also reduces intestinal pH and increases calcium and magnesium absorption. C*Actistar may be labeled on food products as starch.

Labeling resistant starch and including dietary fiber under carbohydrates is a big issue for processors. Standard FDA labeling does not allow it to be labeled as "resistant to digestion" or designated as a prebiotic fiber good for gut health.

Alginate, a widely used hydrocolloid carbohydrate compound derived from seaweed, is now appealing to formulators as a great source of fiber and an ingredient to lower the glycemic impact of a food. Almost any food may be fortified with this seaweed extract because it is versatile and transparent.

Previously, alginates had been considered expensive and use required special expertise. Saatwic Foods Inc. (www.saatwic.com), Brentwood, Tenn., has developed a patented process to use alginate to cost-effectively reduce the glycemic impact of pasta without deteriorating taste or texture. "Clinical studies show our technology can help regulate starch digestion and give a 40 percent calorie reduction without any safety concerns or digestive abnormalities," claims Saatwic president Ajay Chawan.

Fiber Force

Dietary fiber enhancement is ideal for individuals with type 2 diabetes, the most common form of the disease. Fiber has multiple positive physiological effects. Adding fiber to formulations adds inert bulk that increases satiety and helps reduce caloric contribution and glycemic impact. Some dietary fibers are prebiotic, aiding gut health.

Sophisticated processing technologies have led to the development of a number of novel dietary fibers. Balantose, from Degussa Food Ingredients, Champaign, Ill., is a natural whole-grain ingredient derived from fermented wheat. It is low in simple sugars but high in soluble and insoluble fibers. Balantose powder is currently used in beverages, dairy and dessert products in Europe.

Orafti Active Food Ingredients, Malvern, Pa., offers Raftilose and Raftiline, fructooligosaccharides (FOS) that can replace dietary fat without significantly affecting mouthfeel and are prebiotics to help improve gut health. They can also substitute for sucrose or glucose in sweet foods such as Stonyfield smoothies.

Inulin is a naturally occurring FOS from chicory roots and artichokes. It is not digested until it reaches the large intestine. Because of its textural capabilities, it can be used as a low-calorie replacement for fat in spreads, baked goods, fillings, dairy products, frozen desserts and dressings.

Dreamfields pasta, manufactured by Dakota Growers Pasta Co., Carrington, N.D., uses a proprietary patented technology to create a matrix of hydrocolloids and inulin that retard the digestive rate of carbohydrate. With clinical data to support its "very low glycemic" claim, the product is suitable for those watching their glucose metabolism as well as for health and fitness reasons.

Another dietary fiber for formulators serving individuals with diabetes is Fibersol-2, a readily dispersible, flavorless dietary fiber derived from corn by Matsutani America, Forsyth, Ill. It is marketed by ADM, Decatur, Ill., as an acid- and heat-stable prebiotic with low viscosity and very high solubility.

Going Bioactive

Bioactive plant components may be the most significant trend in dietary control of diabetes. Scientific inquiry reveals several phytochemicals to be potent blood-glucose regulators. In many cultures, diabetes has been traditionally stabilized via phytonutrients from such natural sources as bitter melon, cinnamon, fenugreek and green tea. Sophisticated processing is making these bioactive phytochemicals viable for processors. Best of all, many consumers are familiar with or curious about these ingredients.

Polyphenolic compounds called catechins and epicatechins in green tea, thought to protect against heart disease and certain cancers, also are believed to act as insulin sensitizers and perhaps even pancreatic protectants. (The pancreas is the organ responsible for producing insulin, the hormone that regulates glucose.) By delaying glucose absorption, green tea extracts can also mitigate the glycemic load of foods.

Diabetes cover story: Photo of blueberries
The U.S. Highbush Blueberry Council says recent studies suggest anthocyanins - which blueberries have in abundance - may help control blood sugar levels.

Polyphenols from cinnamon have long been believed to improve glucose and lipid status. More recent research indicates cinnamon compounds may prevent insulin resistance. However, the fat-soluble compounds in cinnamon can be harmful at high levels. Integrity Nutraceuticals International, Sarasota, Fla., has licensed and patented a method to extract only the beneficial fractions to create Cinnulin PF. Cinnulin PF may be used for formulating foods and beverages.

Fenugreek, an herb used in Eastern European, Middle Eastern and Indian cuisine, is an excellent source of bioactive phytochemicals for managing glucose. Fenugreek contains a free amino acid, 4-hydroxyisoleucine, which stimulates insulin secretion and limits the elevation of glucose in the blood. It also is rich in galactomannans, soluble fibers that can significantly reduce postprandial glucose levels.

The major issue with incorporating fenugreek in formulations is its strong aroma. Acatris Inc., Minneapolis, has developed a process for an odor-free fenugreek extract called Fenulife. In addition to helping regulate insulin, Fenulife includes the galactomannans that form a viscous gel. In the gastrointestinal tract, the gel can help slow the absorption of sugar.

According to the U.S. Highbush Blueberry Council, San Francisco, recent studies reveal that cells that normally produce insulin secreted more of the hormone in the presence of anthocyanins, the flavonoid pigments that provide the red, blue or purple color to foods such as blueberries, strawberries and cherries. The data suggest anthocyanins may help control blood sugar levels. Blueberries are particularly high in anthocyanins.

A plant that is less familiar to westerners but showing great promise in this area is the bitter melon. Popular in Asian cooking, the chartreuse squash possesses an active, blood sugar-lowering property in the form of an alkaloid called charantin. The plant also contains insulinlike peptides, such as polypeptide P. Several companies have developed extracts of the plant for food and beverage use.

Well Oiled

DSM Nutritional Products, Parsippany, N.J., engineered fractionates of palm and oat oil into Fabuless, an emulsion clinically proven to lower calorie metabolism by delaying digestion. It is also believed to help the body suppress hunger signals. In addition, Degussa Bioactives, Waukesha, Wis., has a novel alpha-lipoic acid (ALA) formulation for use in foods. ALA plays an important role in the body in maintaining healthy antioxidant levels but it recently attracted attention by demonstrating a positive effect on blood glucose levels. Improved insulin sensitivity has been reported with doses of 600mg/day in individuals with type 2 diabetes.

In the past, formulating foods with ALA was severely limited because of its low stability in shear and heat and its irritating effect on the throat. However, microencapsulation with alpha-cyclodextrin allows for foods to be fortified with alpha-lipoic acid while improving shelf life and flavor. BI Neutraceuticals, Long Beach, Calif., took a different approach to the stability problems with ALA. The result is K-RALA (potassium-R-lipoate), a heat-stable, nonhygroscopic, and nonpolymeric potassium salt of R-lipoic acid. ALA is now GRAS (generally recognized as safe).

While foods marketed to individuals with diabetes clearly offer the promise of higher margins, companies looking at mainstream rather than niche markets should bear in mind that consumers without a diagnosed medical problem are unlikely to pay a premium to manage their glucose metabolism. This is a great opportunity for food companies to step in with functional formulation solutions viable for the population at risk while appealing to the entire population as well.


Rising GI Levels

Although health experts disagree over the principle of marketing foods labeled as "low-glycemic index" to persons without diabetes, low-GI products are certainly on marketers' radar screens. Todd Hale, senior vice president of consumer and shopper insights for ACNielsen, Chicago, predicts "a continued rise in consumer demand for low-GI products in the coming year." He cautions, "Manufacturers need to be paying close attention to this segment."

In 2005, low-GI products were a strong category, growing by almost 50 percent over the prior year by those considered "health neglectors," as identified by ACNielsen data and Spectra segmentation. Hale prognosticates, "This year, expect a surge in food and beverages touting low-glycemic index claims."

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