When Life Gives You Lemons – Addressing and Managing Prediabetes, by Rob Brewster, President of Ingredients by Nature
Under the Radar
Being prediabetic is often overshadowed by other health concerns, often until it is too late. As a precursor to type 2 diabetes, prediabetes affects one in three adults in the U.S.1, and, unfortunately, many of those that are affected don’t even know what it is or that they can properly manage it. Prediabetes is recognized by unhealthy changes in a combination of interdependent health concerns that indicate a decline in the body’s ability to maintain blood glucose levels within a healthy range. Prediabetes has no apparent signs or symptoms and, without a visit to a doctor, can easily fly under the radar causing many prediabetic individuals to realize there is an issue after it is too late. The American Diabetes Association (ADA) estimates that about 70 percent of prediabetic adults will eventually progress to type 2 diabetes2, putting affected individuals at higher risk of additional health concerns and complications over time.
There is more research and education than ever before on the importance of incorporating exercise and a nutritious diet as part of a healthy lifestyle, but a majority of individuals are not meeting standards. According to the CDC, only about 23 percent of adults aged 18 and over are attaining a sufficient amount of exercise3 and poor diet quality has become a leading risk factor for a number of serious and chronic diseases4. Combining little to no exercise together with a regularly unhealthy diet quietly pushes the body into a prediabetic state and beyond. Poor lifestyles sometimes lead to excessive abdominal fat, which is another very common risk factor as about 71.6 percent of adults aged 20 and over are overweight or obese5.
Each factor—sedentary lifestyles, poor eating habits, and increased abdominal fat—may directly influence an increase in fasting blood sugar levels beyond a normal range, resulting in a debilitating cycle of heightened oxidative stress, increased inflammation and further elevation in blood sugar levels6. Fortunately, prediabetes can be addressed, and both prevention or recovery are possible by taking proper steps.
The Lemon Lifestyle
Small and simple lifestyle changes are vital when going up against a prediabetic condition. The ADA continues to encourage the adoption of a nutrient-rich diet and incorporating regular exercise7. Both approaches are necessary to incorporate together in order to address prediabetes. In addition to the implementation of exercise and a proper diet, supplementation can yield a range of benefits that work to further enhance effort towards ending the cycle. But, because prediabetes is not a single condition, delaying progression of prediabetes—and even reversing it to normal blood glucose levels—requires addressing each inter-related aspect of it. One supplement category in particular that provides a holistic approach is flavonoids, especially those found in lemons.
Flavonoids were first discovered in citrus and their health benefits have been studied for almost 90 years. Over that time, research has shown that flavonoids serve as powerful antioxidants and anti-inflammatories8, both of which serve to help manage a prediabetic condition. Furthermore, research into a particular blend of lemon flavonoids called Eriomin™ has shown it to be one of the most effective therapeutic strategies by addressing the many physiological systems that interact to improve insulin resistance and glucose uptake, thereby managing prediabetes in an effective manner9.
An Insulin Breakdown
The ability to properly manage blood glucose levels and the entry of glucose into cells and organs is directly related to the body’s insulin response. But, as the body’s ability to properly respond to insulin diminishes, prediabetes occurs and breaks down the interactive relationship of blood glucose and insulin further. This happens as the hormone GLP-1, which increases insulin secretion and improves glucose uptake, degrades via the enzyme DPP-4, which inhibits insulin secretion. As a result, insulin resistance begins to develop, driving a hypersecretion of insulin to compensate. Blood glucose levels then continue to increase as, over time, the functionality of insulin-producing beta cells fades, causing the situation to worsen and the prediabetic individual to be at greater risk of type 2 diabetes.
Lemon flavonoids are able to inhibit the activities of the DPP-4 enzyme, which then prevents the hydrolysis of GLP-1, and thereby improve insulin secretion and glucose uptake10. One study on the Eriomin blend of multiple lemon flavonoids—which includes eriocitrin, hesperidin, and naringin—showed that the combination of flavonoids helped to influence an improvement in blood glucose levels from an increase in GLP-1 levels and decreased insulin resistance9.
An Inflammatory Cycle
Increased insulin resistance and blood glucose levels are not the only signs of prediabetes. The next part of the prediabetic cycle is recognized by the presence of low-grade systemic inflammation. As blood sugar levels increase, so do pro-inflammatory cytokines. A decrease of adiponectin—a fatty tissue hormone associated with insulin sensitivity—occurs and interleukin 6 (IL-6), tumor necrosis factor alpha (TNF-α) and C-reactive protein (CRP) are released into the bloodstream11. Upon reaching the liver and pancreas, the pro-inflammatory cytokines cause hepatic fatty infiltration and beta-pancreatic cells dysfunction, in turn resulting in an imbalance in glycemia and insulin resistance. Thus, as insulin resistance is further developed it cycles into further cytokine production and inflammation and back again, contributing to long-term complications12.
To normalize glycemia and insulin response associated with prediabetes, addressing inflammation is a necessary step. Research has shown that even short-term intervention with lemon flavonoids can significantly reduce pro-inflammatory cytokine. The flavonoids are able to help activate PPARg expression and inhibit NFkB. As NFkB is controlled, the secretion of inflammatory cytokines is significantly inhibited13, 14. By playing a role in the reduction of inflammatory cytokines, Eriomin is able to support a proper inflammation response. Additionally, the flavonoids eriocitrin, hesperidin and naringin assist in the normalization and improvement of glucose regulation by increasing adiponectin levels9.
A Need for Antioxidants
Everything comes full circle when the heightened levels of blood glucose and inflammation cause an acceleration of reactive oxygen species (ROS) production. As ROS numbers rise, so do the levels of oxidative stress. Without taking proper measures, the growth of free radicals outpaces antioxidant production, leaving the body lacking a sufficient antioxidant defense. Without enough antioxidant activity to balance out the excessive levels of ROS, proteins, carbohydrates and lipids become damaged and lose their efficacy, putting health at greater risk of multiple serious conditions. Then the cycle begins once again as the oxidative stress, left unchecked, is able to further influence an increase in glucose intolerance and insulin resistance.15
The prevalence of education regarding vitamin C has placed citrus in the limelight as a powerful source of antioxidants. What many people do not realize is that citrus flavonoids are potent antioxidants themselves and studies into naringenin, hesperidin and eriocitrin have additional shown more holistic benefit package that synergistically work with each other—and vitamin C—for optimal support. Therefore, citrus flavonoids create balance by helping to prevent the formulation of ROS by neutralizing them and the free radicals they produce with an increase of antioxidant support. Lemon flavonoids, such as those in Eriomin, are able to accomplish this by enhancing the body’s antioxidant defense system with increased levels of previously depleted antioxidants, such as glutathione, vitamin C and vitamin E. With a boosted antioxidant defense system, the body is able to better suppress excessive ROS production9, 16, 17 and thereby not only helps in the prevention of oxidative damage but is a major factor in providing aid against the damaging cycle of prediabetes.
Supplement with Lemon-Aid
When beginning to implement lifestyle changes to either prevent or manage a prediabetic condition, improving diet and exercise habits should always be the first approach. Fortunately, those efforts can be augmented by regularly consuming a blend of citrus flavonoids for triple-pronged functionality. Eriomin’s combined influence helped an average of 24 percent of supplemented subjects to completely return to normal fasting glycemia9. Supplementing with clinically-validated “lemon-aid” takes a focused and integrated approach to successfully address the cyclical interaction of blood glucose levels with insulin sensitivity, inflammation levels and oxidative stress.
As a third-generation ingredient manufacturer for the natural products industry, Rob Brewster is proud to be part of the health and wellness world. He has followed in his grandfather’s and father’s footsteps, helping their company Brewster Foods grow since he joined in the 1990’s and then partnering with Syntech to form Ingredients by Nature, the world leader of citrus bioflavonoids and extracts. As President of Ingredients by Nature, Rob takes pride in citrus science and continues to invest heavily in citrus flavonoid science for condition specific applications and holistic wellness. Ingredients by Nature recently launched its latest branded lemon flavonoid blend, Eriomin Glucose for prediabetes management and Eriomin Esport for a healthy gaming lifestyle. Rob holds degrees in Business Administration and Biology from California State University, Northridge.
To read full published article, see Spring issue, Nutraceuticals now 2020.