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The Evolving Evidence for Healthy Blood Sugar:

Moving Beyond Glycemic Reduction to Glycemic Health



Rhonda Witwer, MBA
Senior Business Development Manager of Nutrition

Christine Pelkman, Ph.D.
Senior Scientist and Clinical Research Manager

Outline
Introduction to glycemic health
Definitions and public health importance
Consumer perspective
Key role of insulin resistance
Reversing insulin resistance
Key findings from population studies
Research findings on glycemic effects of HI-MAIZE

resistant starch
Conclusions
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Glycemic Health = Maintaining Blood Sugar
Health
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Definition: Healthy
levels of blood sugar
(and insulin)
The Problem: 11.3%
of Americans (aged
20+ years) have
diabetes

35% have
prediabetes = 79
million adults


Obesity (BMI 30 kg/m
2
)
Diabetes
1994
1994
2000
2000
2007
2007
No Data <4.5% 4.5-5.9% 6.0-7.4% 7.5-8.9% >9.0%
CDCs Division of Diabetes Translation. National Diabetes Surveillance System available at
http://www.cdc.gov/diabetes/statistics
No Data <14.0% 14.0-17.9% 18.0-21.9% 22.0-25.9% >26.0%
The Rising Incidence of Obesity is Closely
Followed by a Rising Incidence of Type 2
Diabetes
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The Role of Insulin in Glycemic Health
Insulin is produced by beta cells in the pancreas

It helps move glucose from the blood into muscles and cells

In healthy individuals, insulin levels always rise right after eating
Higher levels of insulin prevent fat from being burned

Excess weight and inflammation cause the tissue to resist the action of
insulin
Higher levels of insulin needed to manage blood glucose

Loss of insulin sensitivity (i.e., insulin resistance) is the
beginning of the loss of glycemic health

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American Consumers Are Concerned About
Diabetes and Blood Sugar
42% of shoppers are extremely or
very concerned about diabetes; 38%
are for high blood sugar

31% of shoppers always or usually
maintain a high-protein and low-
carbohydrate diet

25% of shoppers had decreased their
use of carbohydrates in the past two
years

7
43%
42%
40%
38%
2008 2010
Diabetes High Blood Sugar
(Extremely/very concerned)
Consumers Want Healthy Blood Sugar
8
Extremely
Important / Very
Important Label
Claim
All
Shoppers
Education Household Income
Less
than
College
Some
College
Plus
Up to
$25K

$25-50K

$50-75K
Over
$75K
High fiber 51% 57% 48% 54% 53% 44% 51%
Helps to maintain
healthy cholesterol
levels
40% 46% 37% 44% 44% 34% 36%
Helps to maintain
healthy blood sugar
levels
36% 42% 34% 44% 43% 29% 30%
Bolded numbers are statistically different when compared to the total population numbers.
Copyright 2011 HealthFocus International/Ingredion Incorporated proprietary information
36% View Healthy Blood Sugar as an
Extremely or Very Important Label Claim
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Younger, health active shoppers
Shoppers monitoring carbohydrates for
weight
Older, diabetic, retired shoppers
Copyright 2011 HealthFocus International/Ingredion Incorporated proprietary information
Christine Pelkman, Ph.D.
Senior Scientist and Clinical Research Manager
Diabesity Concurrent Epidemics
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Diagnosed diabetes in the U.S.
Steep rise in diabetes
coincides with steep
rise in obesity
Key Role of Insulin Resistance
12
Metabolic staging of Type 2 diabetes
Saltiel: J Clin Invest, Volume 106(2).July 2000.163-164
What Is Insulin Sensitivity?
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A measure of how well
insulin functions in various
tissues
Fat
Liver
Muscle

A key player in the control of
blood glucose and
triglycerides

Basics of Carbohydrate Metabolism
14
Effects of Diet
In population studies
Higher intake of whole grains and fiber is
associated with lower risk for diabetes

In experimental studies
Fibers, especially fermentable fibers, increase
insulin sensitivity
Large body of evidence for effects of resistant
starch
Natural high-amylose maize, type 2 RS
(HAM-RS2)

15
What is Resistant Starch?
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Starch that resists digestion in the small intestine
Reaches the large intestine
Form of fermentable fiber

Found in whole grains, beans, bananas
and cooked & cooled starchy foods
Americans consume 4.9 grams of resistant
starch/day on average*

* Murphy M. et. al.., Journal of the American Dietetic Association, Jan 2008
Eriko Sugita / Reuters
(Japan Goes Bananas for a New Diet
October 17, 2008 TIME Magazine,
WORLD edition)
High-Amylose Maize (HAM) - RS2
Natural form of starch from high-amylose maize (70% amylose)

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Extensive Database of Evidence
18
*through August 2012
Published studies utilizing Ingredions RS2
high-amylose corn resistant starch*
Clinical studies 66
Animal studies 124
In vitro studies 57
TOTAL: 247
HI-MAIZE 260 for Glycemic Health
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Increased insulin
sensitivity
(Healthy people,
type 2 diabetes &
metabolic syndrome)
Reduced glycemic
impact at the
subsequent meal
(human studies)
Reduced glycemic
response
(human studies)
Reduced insulin
response
(human studies)
Glycemic
Impact
Mechanisms
(incretins)
(animal studies)
Increased beta-
cell health
(people with
metabolic syndrome)
Post-Meal Glycemic Benefits of HI-MAIZE
260
When replacing flour in foods, it lowers the blood sugar (glycemic) and
insulin impact of that food.

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4
4.5
5
5.5
6
6.5
7
7.5
8
0 30 60 90 120
Time (min)
B
l
o
o
d

G
l
u
c
o
s
e

(

m
m
o
l
/
L
)

Control bread
HI-MAIZE bread
Insulin Sensitivity Key to Sustaining Glycemic
Health
Many foods lower postprandial glycemia
But, the effect is temporary
Lower Glycemic Index not a sufficient
biomarker

Glycemic health
Longer-term state
Healthy carbohydrate metabolism
Insulin sensitivity is a key biomarker
Measured in fasting state
Challenge with a standard meal, beverage or infusion
Result is not due to differences in the food

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HI-MAIZE 260 Improved Insulin Sensitivity in
Six Clinical Trials
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Subjects Healthy men and women
Dose 100 g HI-MAIZE 260
(one day)
Results 69% Insulin sensitivity
Breakfast Lunch Dinner
Meal Tolerance
Test
500 kcal
Morning
Standard meals on two occasions
Each 25 g HM260
or
10 g digestible
starch
Three Longer-Term Studies
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25 g HM:
15 g fiber + 10 g
digestible starch
2 per day
10 g
digestible
starch
2 per day
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Subjects Healthy men and women
Dose 50 g HM260 (4 weeks)
Results 14% Clamp
34% Meal tolerance test
End of Week 3
Meal Tolerance
Test
500 kcal End of Week 4
Insulin is maintained at a
steady state.

How much glucose can be
infused is an indicator of
insulin sensitivity.
Longer-term study 12 weeks
Two groups 60 g HM/day versus 20 g waxy starch/day
High fasting insulin (> 60 pmol/L) meets criteria for insulin
resistance
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Subjects Men and women with high
fasting insulin
Dose 60 g HM260 (12 weeks)
Results 19% Clamp
European Group for the Study of Insulin Resistance
Dose-response crossover study
4 weeks per treatment
Low-dose 26 g HM260/day
High-dose 50 g HM260/day
Control matched to low-dose 11.6 g glycemic starch

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27
Subjects Men and women with abdominal obesity
Dose 26 and 50 g HM260 (4 weeks)
Results 56.5% and 72.8% IVGTT (men only)
Frequently sampled
intravenous glucose
tolerance test (IVGTT)
2012 Two Mechanistic Studies in Insulin-
Resistant Adults
Clamp method used with tracers
to measure
Endogenous glucose
production
Glucose disposal rate (R
d
)
Fasting measures used for
insulin sensitivity
Glucose uptake in forearm
measured during MTT
Key findings
Changes in gene expression
in adipose tissue

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Subjects Men and women with
high fasting insulin
Dose 67 g HM260 (8 weeks)
Results 21% R
d

10%

Insulin sensitivity
65% MTT
Twofold increase found for key
adipose tissue genes 3 lipases (LPL, ATGL, HSL)
adipokines: perilipin, adiponectin
2012 Improved Pancreatic Beta-Cell
Function
Used IVGTT method to
allow for study of beta cell
function
Not possible with clamp

Increased first-phase insulin
secretion, an important early
indicator of improved beta
cell function

29
Subjects Men and women with
high fasting insulin
Dose 67 g HM260 (4 weeks)
Results 36% First-phase I response

Rhonda Witwer
Senior Business Development Manager, Nutrition
31
Consumers Are Learning About Resistant
Starch from Leading Health Experts
Health magazine launched The CarbLovers
Diet in 2010 and The CarbLovers Diet Pocket
Guide in 2011
Health magazine has 1.4 million subscribers

Prevention magazine launched The Skinny
Carbs Diet in October 2010
Prevention magazine is the #1 consumer
health magazine, with 2.9 million subscribers
150 recipes with 125 recipes with food
sources and 25 recipes with HI-MAIZE

resistant starch

Featured on Dr. Oz, May 24, 2012
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HI-MAIZE Resistant Starch
White, insoluble starch from a natural hybrid of high-amylose corn
Mixture of:
40% slowly digestible starch
60% resistant starch
The resistant starch portion = insoluble fiber
Does not thicken
One tablespoon (~9.5 g) = ~5 g dietary fiber

In contrast with regular cornstarch --
White, insoluble starch
Quickly digested - 100% glycemic starch
Provides viscosity & thickens with heat
Not fiber
Formulating With HI-MAIZE Resistant Starch
Supplements
Insoluble powder
Disperses in smoothies &
shakes
Mix into foods, e.g., oatmeal,
yogurt, etc.
Substitute for flour in home
baking






Food Formulations
Replace up to 15-25% of
flour in formulation
Low water-holding capacity
Stable in baking and mild
extrusion
Excellent dough-handling
properties

33
Smoothies &
Shakes

Baked Goods & Bakery Mixes
Pizza Pasta Cereal
Snacks
Supplements
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Recommended HI-MAIZE Labeling Claim for Glycemic
Health:
Helps maintain healthy blood sugar levels
as part of a high-fiber diet
Applications and Claims
Available Online at www.KingArthurFlour.com
HI-MAIZE natural fiber
Replace up to one-quarter of the flour in almost any
recipe with an equal amount of HI-MAIZE resistant
starch
Gluten free

High fiber flour
King Arthur All-Purpose Flour blended with HI-
MAIZE resistant starch
Substitute 1:1 for all-purpose flour

Golden Vanilla Cake Mix
Good source of fiber with HI-MAIZE resistant starch
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Conclusion
Tremendous public health need to maintain
glycemic health
Consumers want healthy blood sugar
Insulin sensitivity is a critical biomarker
HI-MAIZE resistant starch improves insulin
sensitivity
Emerging evidence shows improvement in fat
metabolism and pancreatic function
HI-MAIZE resistant starch enables innovative
supplements and great-tasting carbohydrate-rich
foods with proven glycemic health benefits
36
Additional Information Available
Formulation information: www.foodinnovation.com/hi-maize

In-depth information on health benefits: www.ResistantStarch.com


Simple, consumer-friendly information: www.Hi-maize.com

Rhonda Witwer: rhonda.witwer@ingredion.com

Dr. Christine Pelkman: christine.pelkman@ingredion.com

Ingredion sales representative: salessupport@ingredion.com



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