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Code and Title of the Paper: F11FN Functional Foods and Nutraceuticals
Code and Title of the Module: F11FN31 Functional Foods and Nutraceuticals in Management of Diabetes
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Name of the Content Writer: Dr. Kalpagam Polasa
Role Name Affiliation

Principal Investigator Dr. S. Kowsalya Avinashilingam Institute for Home Science
and Higher Education for Women,
Coimbatore.
Co-Principal Investigators Dr. Sheela Ramachandran Avinashilingam Institute for Home Science
Dr.M.Sylvia Subapriya and Higher Education for Women,
Dr.G. Bagyalakshmi Coimbatore.
Mrs.E.Indira
Paper Coordinator Dr. S. Thilakavathy Avinashilingam Institute for Home Science
and Higher Education for Women,
Coimbatore.
Content Writer Dr. Kalpagam Polasa National Institute of Nutrition
Telangana, Hyderabad.
Content Reviewer Dr. K. Bhaskarachary National Institute of Nutrition
Language Editor Dr. Kalpagam Polasa National Institute of Nutrition
Item Description of module

Subject name Food and Nutrition
Paper name Functional Foods and Nutraceuticals
Module name F11FN 31
Module ID Functional foods & Nutraceuticals in management of Diabetes Mellitus
Pre requisites Diabetes is a metabolic disorder which is managed by drugs and diet.
Special diabetic functions foods are available in the market. Many
supplements are meant for use by diabetics.
Objectives · Complications associated with diabetes mellitus
· Role of diet in the prevention and management
· Functional foods that can be of benefit to those suffering from
DM
Key words Diet and diabetes, Diabetic complications, Hypoglycemia. Glycemic
foods, Glycemic index.
Key words Functional foods, Nutraceuticals, phytosterols, dietary fiber, Novel
foods.
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Objectives
To learn about
Complications associated with diabetes mellitus
Role of diet in the prevention and management
Functional foods that can be of benefit to those suffering from DM
Introduction
The prevalence of diabetes is increasing day by day as a major health problem. Uncontrolled
disease state and long duration of the disease results in micro and macrovascular complications.
Since it is a chronic and progressive illness good medical care and patient self-management is
required to prevent not only the acute complications but also reduce the risk of long-term
complications including cardiovascular disease, retinopathy, neuropathy and nephropathy. In
spite of the availability of a number of hypoglycemicagents to treat diabetes,they are not helpful
to prevent the long term complications. Evidence suggests that inflammation is the underlying
cause of the long term complications which is due to poor control of the disease.A diet high in
antioxidant rich foods can help counter inflammation.
Diabetes is known to common man as abnormal increase in blood sugar. Broadly DM may be
classified as type 1 or Type 2. Type 1 is also known as the juvenile diabetes occurring in young
people whereas the Type 2 afflicts a normal individual during his adulthood, hence also known
as adult onset diabetes. There is another type known as the Gestational Diabetes Mellitus which
affects pregnant woman and the woman generally becomes normal after the delivery.
The common symptoms are increased thirst (polydipsia), increased frequency of micturition
(polyuria), increased appetite (polyphagia), getting tired easily, and loss of weight.
Pre disposing factors
The Type 1 diabetes develops in childhood or adolescence is immune mediated and require
mostly insulin administration. The type 2 is associated with increased carbohydrates, obesity or
over weight, stress and lack of physical activity.
Objectives of management
Hyperglycemia or elevated sugar levelis the common problem in all DM individuals. Therefore
maintaining normal blood sugar level known as normal glycemic status is of paramount
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importance. Following are essential to avoid the long term complications: maintain ideal body
weight, maintain normal blood and urine sugar levels, maintain normal lipid profile(low
cholesterol, LDL and triglycerides), take proper foot care and diet control to avoid macular
andretinal changes in the eyes, good neurological status and micro and macrovascular
complications.
Diet and Diabetes
Diet is the corner stone in the management along with drug therapy. Diet will not reverse the
diabetic status but will have synergistic effect along with the drugs in preventing hyperglycemia
(increase in blood sugar level). The diabetic should eat a nutritious diet that should have
moderate amount of carbohydrates (CHO), preferably complex, adequate proteinand low in
simple sugar, fat and salt. The diet should have lot of vegetables including the green leafy
vegetables.
Glycemic index and load
The overall dietary components should be low in glycemic index (the capacity of a food to
increase blood sugar). Foods that increase the blood sugar high are known as high glycemic
index foods and that which do not elevate the blood sugar levels following consumption are
known as low glycemic index foods. Of course the quantity consumed is also important and that
is expressed as glycemic load. Ultimately the elevation in the blood sugar level after consuming
a meal is dependent on both the glycemic index and the portion size or the glycemic load.In this
context the choice of food for diabetics is important. The diet designed must also supply all the
vitamins and minerals that are required. The diabetic person should maintain proper lipid profile
to avoid cardiovascular disease. That means the type of fat consumed is also very important.
Saturated fats should be avoided and monounsaturated and polyunsaturated are to be preferred.
Nutrients and Non-nutrients in diet
Diet is a source of nutrients and non-nutrients. All the foods contain macro, micronutrients,
vitamins, minerals, fiber, electrolytes as well as several hundred naturally occurring substances
in plant foods called phytochemicals. The naturally occurring antioxidants in whole unprocessed
foods such as fruits, vegetables, beans, legumes, nuts, seeds, whole grains, herbs and spices exert
better protective effect than the antioxidant supplements.
Role of functional foods and nutraceuticals
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The functional Foods are foods or dietary components that may provide a health benefit beyond
basic nutritional properties that it possesses. A diversified diet can be a rich source of all the
necessary bioactive substances including the nutrients and non-nutrients.
According to the European Commission Concerted Action on Functional Food Science in
Europe (FUFOSE) a food is regarded as functional if it is proven to exert a beneficial effect. It
should not only be able to result in improved state of health and well-being, but also reduce
disease risk, besides its nutritional effects. These effects must occur even if functional foods are
consumed at levels that are normally consumed as diet.
The difference between the functional food and thenutraceutical is that while the functional
foods are consumed as part of diet the nutraceuticalsare ingested as pharmacological preparation
in the form of powder, pill, capsules etc. Since these preparations are the active principles
present in the food that are extracted, purified and made into pharmacological preparations, their
intakes may exceed the concentrations that are normally consumed through diet.
Types of functional foods
Although there are many typesof “functional foods”, they are broadly classified as either
conventional or modified foods. The conventional foods are those in which the beneficial health
promoting phytochemicals are naturally present like the whole grains, nuts, soybean, tomatoes
etc. The foods are modified by deleting or adding a new phytonutrient or adding an already
present nutrient or non-nutrient at higher concentrations by using processing technology.Milk to
which vitamin D or extra calcium is added is an example of modified food. All the fortified
foods available in the market fall under this category.
Whole grains
Whole grains may be considered as one of the conventional functional food. Brown rice, wheat,
minor millets like bajra, soghum, and others are now considered as functional foods and their
consumption by people is increasing. However by refining there is a loss of functionality of the
cereals. During the processing of cereals the outer part known commonly as bran is removed.
Bran is rich in fibers, all B vitamins, phytonutrients (flavonoids, indoles), antioxidants, minerals
and some amount of proteins.The middle part known as central stratum is the endosperm. This
partis rich in starch and proteins but poor in micronutrients.The inner part is the embryo or germ.
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It contains a high amount of lipids and proteins, minerals (Fe, Zn), vitamins B group,
phytosterols, antioxidants and vitamin E.
Effect of processing
The cereals are crushed and bran and the germ are removed to produce the so-called “refined
grain flour” by processing. If the bran and germ components are retained, the flour is known as
“whole grain flour.” The refining process results in loss of many nutrients and phytochemicals
such as fibers, oligosaccharides, vitamins, minerals, phytosterols, phytoestrogens, and
polyphenols. The fiber content of the refined grain flours is about 78% less total fiber and the
mineral and vitamins levels 50% less. By refining the concentrations of total polyphenols are
also reduced.
Role of dietary fiber
The absorption of fats and oils is inhibited by dietary fiber. The absorption of carbohydrates is
also mitigated by fiber. Since it is antagonistic to absorption of both fat and carbohydrates it has
beneficial effect both on lipid and glucose status. Dietary fiber reduces insulin resistance. It
decreases intestinal transit time and facilitates intestinal movement. Some categories of fiber
support the growth of beneficial colonic bacteria. These bacteria carry out fermentation in colon
and produce responsibleshort-chain fatty acids (SCFAs) namely; acetate, propionate and
butyrate.These molecules have the property of inhibiting chronic inflammation of colonic
mucosa. Fiber content of the diet gives satiety and restricts food intake. The restricted food
intake as well as lowered absorption of fats and carbohydrates helps in prevention of overweight
and obesity which are risk factors for T2DM and CVD.
Probiotics
The probiotics or the friendly bacteria and the prebiotics which support the growth of probiotics
are considered as functional foods. A mixture of both pre and probiotics is known as synbiotics
is also available asfunctional food. The prebiotic is a component of food like dietary fiber and
encourages the growth of bacteria which produces secondary metabolites, vitamins and
beneficial chemical compounds by fermentation.Most of the probiotics belong to the Lactic acid
bacterial family. The probiotic, prebiotic and synbiotics are usually added to dairy products like
milk, yoghurt and cheeses.
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Daily consumption of prebiotics facilitates the selective growth of Lactobacilli and

Bifidobacteria. Since the prebiotics are mostly fiber they increase the stool volume and helps in
relieving constipation.They also help in absorption of some minerals like Ca, Mg, Zn, and Fe
produce B complex vitamins.
Oats
Oat has high levels of β-glucan which is a highly viscous soluble fiber. Itreduceselevation of
postprandial glucose due to consumption of food. Therefore it has beneficial effects on glucose
metabolism. Soluble fibers increases satiety and slow the gastric emptying time. It slows
absorption of glucose and hence has beneficial to the diabetics. The beneficial effect is due to the
viscosity. There are many cereal products which are fortified with dietary fiber and they are
helpful in controlling the increases in plasma glucose levels.
Beta glucan
β-glucan or other viscous fiber are added to food products using extrusion technology. Excess
intake of fiber can cause flatulence and render the food unpalatable. Therefore food
manufacturers cannot fortify foods with high amounts of fiber
Management of CVD risk in diabetics
Diabetics are at higher risk of developing cardiovascular diseases. The risk is 2-4 times higher
than non-diabetic. In diseases of metabolic syndrome usually more than one organ are affected.
The diabetics also have a condition known as dyslipidemia or abnormal lipid status. The
cholesterol levels, LDL cholesterol and triglycerides are elevated and these parameters are strong
risk factors for development of cardiovascular disease.Therefore, the management of diabetes
also involves management of lipid profile. Most of the diabetics are prescribed cholesterol
lowering drugs and anti-inflammatory drugs like mild doses of aspirin which inhibits platelet
aggregation in order to lower the CVD risk.
Cholesterol lowering by food components
There are many phytochemicals present in foods that can have positive effect on the circulating
levels of cholesterol. As per the recommendation of WHO and the National Cholesterol
Education Program Expert Panel(NCEP)it is better to limit the intakes of saturated fat and
cholesterol containing foods and eat more amount of fiber containing diet. Fiber prevents the
absorption of fats, particularly the soluble fiber present in cereals and legumes. Phytosterols
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present in soy foods and nuts compete with the cholesterol binding sites in the intestine and act
as competitive inhibitor. Some phytochemicals inhibit the cholesterol synthesis in the body.In
view of different metabolic pathways involved in lowering the cholesterol levels it is prudent to
consume a variety of foods. Soy proteins inhibit the HMG COA reductase which is the rate
limiting enzyme in cholesterol biosynthesis.
Other functional food ingredients thatcan be used indiabetes
Alliums
AlliumSativum (garlic): Garlic has many biological properties like anti-microbial, anti-
inflammatory, hypoglycemic and hypochlolesterolemic. In experimental diabetic animal models
using mice, rats and rabbits, it garlic administrationdecreased the serum glucose levels. Garlic
has many Sulphur containing phytochemicals which have strong antioxidant properties.
InStreptozotacin (STZ)-induceddiabetic rats garlic oil and diallyltrisulfidecould show
improvement in glycemic control. The antioxidant effect of S-allylcysteine sulfoxide another
sulphur containing chemical present in garlic has also beneficial effect indiabetes. Whole garlic
and the other Sulphur compounds present in garlic may have beneficial effect in diabetic
condition. The mechanism of action may be byincreasing the secretion of insulin by pancreas / β
cells or release of bound insulin or both.
AlliumCepaBulbus}:In traditional medical practices in Asia and Africa the bulbs ofAllium cepa
L. or common onion has beenused for the treatment of diabetes. Similar to garlic onion also has
antimicrobial, anti-inflammatory, hypoglycemic and hypocholesterolemic properties.Regular
consumption of onion can have beneficial effect on blood sugar and cholesterol levels.Due to
these effects, some of the secondary complications like nephropathy, retinopathy and other
neurological effects occurring in diabetics due to poor control of diabetes can be avoided.
Trigonellafoenum-graecum L. (Fenugreek)seeds are used as condiment in Indian culinary. In
human diabetics and experimental animal diabetic models it has been demonstrated that extracts
of fenugreekseeds, powder andleaves can lower the levels of blood glucose and cholesterol.The
active principle in fenugreek is trigonelline. Fenugreek also has saponin compounds namely
diasgenin and other alkaloids which have plasma glucose lowering property. It has soluble fiber
which may interfere with the glucose intake in the intestine. Fenugreek has been reported to have
anti-inflammatory properties.Fenugreek has also been associated withalterations in enzymes
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associated withcarbohydrate metabolism. Due to the soluble fiber content there is reduction in
the gastricemptying, glucose absorption and insulinresponse. There was improvement in other
clinicalsymptoms likepolydipsia (thirst) and polyuria (frequent urination) in a majority of
diabetic patients. An intake of around 25 g fenugreek seed daily can help in the management of
diabetes.
Curcuma longa (L.)(Turmeric)
Curcuma longa L., commonly known asturmeric is an Asian spice. It is used extensively in
Indian culinary practice for its aroma and color.It is also referred to as “poorman’s spice” or as
“salt of the Orient.” Turmeric is notonly known for its color, aroma and taste, buthas many
therapeutic benefits. Turmeric has antibacterial, antiviral, hypoglycemic, hypo lipidemic and
anti-inflammatory properties It can have beneficial health effects in diabetics. The active
principle of turmeric is the curcumin which has been reported to lower blood
glucose,glycosylated hemoglobin, free fatty acids, totalcholesterol, triglyceride and lipid
peroxidationlevels and increases plasma insulin andhepatic glycokinase activity levels in diabetic
animal models.
Cinnamomumzeylanicum
Cinnamon is another spice used in India and many parts of the world for its flavor. The active
principle present in cinnamon is the eugenol which has been shown to exert antidiabetic effects.
In vitro and invivo studies in experimental animals have shown that the chemicals present in
cinnamon has insulin like activity. It also improves the insulin sensitivity and has beneficial
effects on lipid levels.
Psidiumguajava L.
Guava fruits are rich in its content ofdietary fiber and other antioxidant compounds. The vitamin
C content of the fruit is very high. Besides the vitamin C guava also has carotenoids, vitamin
B1,B2, B6, and pectin. By virtue of its soluble fiber content guava can produce hyperglycemic
activityin diabetic patients. The anti-diabetic activity may also be attributed to its higher
concentration of Mg in theraw fruit peel.
Punicagranatum (Pomegranate)in traditional Chinese medical practice pomogranateis used
totreat diabetes mellitus.The fruit and the juice have been reported to haveantidiabetic activity.
The active principle I guava is ursolic acid.
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Momordicacharantia L. (bitter gourd) is acommonly consumed vegetable. In traditional

medical practice it is used to treat diabetes in many parts of the world. In experimental studies
using animalsand studies in humans havesuggested that bitter gourd can control
hyperglycemia.Feeding Momordicacharantia extract, fruit juice, seed powder can decrease
fasting blood glucose. It can also help in improving the glucose tolerance in normal anddiabetic
animals as well as in humans. Among the chemicals that are present in bitter gourd, a
polypeptidenamed ascharantinhas been reported to have anti-diabetic properties.
Murrayakoenigii L.Curry leaves are used as condiments in India and some South East Asian
countries. Consumption of matured curry leaves may be helpful in the management of diabetes
and inducing weight loss. These leaves are also used in Indian traditional medicine. The leaves
also have antioxidant properties. Due to its chlorophyll content it has antimutagenic and
anticancer properties.All parts of this tree is rich in phytochemicals namelycarbazolealkaloids,
which are the active principles responsiblefor the medicinal effect.Some identified alkaloids are
Koenimbine,Koenine, Koenigine, Koenidine, Mahanimbine and Mahanine.
Cocciniaindica
Cocciniaindica (ivy gourd),(Kovakai in Tamil, Dondakai in Telugue, Kunduru in Hindi and
Tindora in Gujarathi) is an extensively consumed vegetable in India. Regular consumption of
this vegeatable may be helpful to the diabetics. The active ingredients present in theextract of
Cocciniaindica are triterpenes.
Syzygiumaromaticum
Cloves (Syzygiumaromaticum flower buds) are used as spice in India and many parts of the
world. It has been shown to counteract elevation in blood glucose levels in experimental Type 2
diabetic model. The active principle present in clove is eugenol.
Nuts
The nuts contain principally fat (70–80%) which are unsaturated fatty acids mostly the
monounsaturated fatty acids. Regular consumption of nuts like almonds, walnuts may be
beneficial to the diabetics to regulate glucose and insulinhomeostasis. Experimental studies using
animals have shown that higher amount of monounsaturated andpolyunsaturated fat in
proportion to the saturatedfat improvesglucose homeostasis. Nuts also contain some amount of
magnesium and fiber which reduce insulin resistance. They are also good source of other
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antioxidant vitamins and proteins. Due to their content of antioxidant compounds they have anti-
oxidant and anti-inflammatory properties. Hence consuming nuts or functional foods containing
nuts can be useful to prevent of both micro- andmacro-vascular complications in type 2diabetes.
Conclusions
Diet is the corner stone in the management of diabetes and long term secondary complications
occurring in the diabetic individuals. A life style change of which diet is the most important has
to be made. There are many functional foods that are available in the market which are mostly
fiber based for use by individuals with type2diabetes. However these products have to be
evaluated for efficacy and safety before they are recommended for use. Every country has its
own procedure to assess the safety through risk assessment. Nations also have labelling
requirements and no country’s regulation allows false claims.

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Code and Title of the Paper: F11FN Functional Foods and Nutraceuticals

Role Name Affiliation

Item Description of module

Daily consumption of prebiotics facilitates the selective growth of Lactobacilli and

Momordicacharantia L. (bitter gourd) is acommonly consumed vegetable. In traditional

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