Download - 19-Psyllium Fiber VALORAR
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8/12/2019 19-Psyllium Fiber VALORAR
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A m J C in N u tr 19 91 ;53 :143 1-5 . P rin ted in U S A . 199 1 A m erican S oc ie ty fo r C lin ica l N u tr ition I431
Psyl l ium fib e r reduces ris e in pos tp rand ia l g lu cose
and in su lin concen tra tions in pa tien ts w ith
non in su lin d ependen t d iabe tes 3
J o y ce G re e n P a sto rs P e ter W B la isd ell T im o th y K B a lm C h ris to p h er M A sp lin a n d S te p h en L P o h I
A B S T R A C T T h e ab ility o f psy lliu m fibe r to red uce post-
prand ia l se ru m glucose an d insu lin co ncen tra tion s w as stud ied
in 1 8 non- in su lin -d ep en den t d iabe tic pa tien ts in a c rossov er de-
s ign . Psy lliu m fiber o r p lacebo w as adm in is te red tw ice d uring
each 1 5 -h crossov er ph ase , im m edia te ly befo re breakfast and
d in ner. N o p sy llium fiber o r p lacebo w as g iven a t lu nch , w hich
a llow ed m easurem en t o f residu al o r secon d-m ea l e ffects . F or
m ea ls eaten im m ediate ly a fte r psy lliu m ing estion , m ax im um
po stp rand ia l g lu co se e lev a tio n w as redu ced b y 14 % at b reak fas t
and 20% at d in ne r re lativ e to p lacebo . P o stp rand ia l se ru m insu lin
con cen tra tions m easured afte r b reak fast w ere reduced by 12%
re la tive to p laceb o . Second -m eal e ffec ts a fte r lunch show ed a
3 1% reduc tion in pos tp rand ia l g lucose eleva tion re la tive to p la -
cebo . N o sign if ican t d iffe ren ces in e ffec ts w ere no ted be tw een
pa tien ts w ho se d iabe tes w as
con tro lled b y d ie t a lon e and th ose
w hose d iab ete s w as con tro lled b y ora l hyp og ly cem ic d ru gs. R e -
su lts ind ica te tha t psy lliu m as a m ea l sup p lem en t red uces prox -
im a te an d seco nd-m ea l postp rand ial g lu co se and in su lin co n-
cen tra tion s in no n-in su lin -d ep en den t d iabe tics .
A m J C lin
ut r l991;53:l431-5.
K E Y W O R D S P sy llium , d ieta ry f ibe r, p ostp rand ia l g lucose ,
pos tp rand ia l insu lin , non -in su lin -d ep en den t d iabe tes, secon d-
m ea l e ffec ts
In troduct ion
S tu d ies in d ica te tha t p lan t f ib ers can m od erate pos tp rand ia l
g lucose and insu lin concen tra tions in n on-insu lin -depend en t
d iabe tic pa tien ts ifadm in iste red w ith m ea ls (1 -4 ). In particu la r,
w a te r-so lub le fibe rs inc lud ing gu ar , soy , psy llium , and pec tin
w ere rep orted to be m o re e ffec tive than inso lub le f ibe rs su ch as
w h ea t b ran (5 ). Som e researchers , how ever, failed to d e tec t s ig -
n if ican t p ostp ran d ial g lu co se b lun ting w hen soy (6 ) o r p sy llium
f ibe r (7 ) w as adm in iste red to non -in su lin -depend en t d iabe tic
p a tien ts o r w hen p ec tin w as adm in is te red to non d iabe tic pa tien ts
(8 ). T hese d isc rep an t f in d ings m ay be d ue in part to the type of
tes t m eal g iven w ith the fib er. In tw o tria ls w h ere no effec t w as
observed , the f ibe r w as adm in iste red w ith a liqu id te st m eal (6 ,
7 ). H o w ever, w hen the fibe r w as g iv en as a sup p lem en t to , o r as
a c o m po ne n t of, a conv en tio na l so lid -fo od m ea l, benefic ia l e ffec ts
w ere foun d (2 -4 ).
In add ition to red uc ing acu te rises in se rum glucose and insu lin
concen tra tio ns w hen adm in iste red w ith a m ea l, so lub le fibe rs
m ay have residua l o r second -m eal e ffec ts tha t b lun t th e p ost-
p ran d ial g lucose rise a fte r m ea ls ea ten severa l hou rs a fte r the
f ibe r ing es tion (9 ) . S eve ral s tud ie s in no nd iab etic sub jec ts dem -
on stra ted such effec ts w ith bo th so lub le -fibe r supp lem en ts an d
h igh -fibe r foo ds (9 -I 1 ). L ittle ev id en ce o fso lub le f ib er s second -
m ea l e ffec t ex ists to da te in d iabe tic pa tien ts .
T o reso lve so m e o fth e am b ig u itie s o fthese find in gs, w e s tud ied
the ab ility o fp sy llium to reduce p ostp ran d ial se rum glucose an d
insu lin concen tra tions in non-insu lin -depend en t d iabe tic pa-
tien ts. T o de te rm ine w hether psy llium s ab ility to alte r po st-
p ran d ial g lu cose con cen tra tions d ep ends on the m od e of d iabe tic
the rapy , pos tp rand ia l e ffec ts w ere inv es tiga ted sep arate ly in pa-
tien ts con tro lled by d ie t a lo ne or in pa tien ts con tro lled by ora l
hyp og lycem ic agen ts.
S ub jec ts an d m e tho ds
rotocol
In th is p lacebo-co n tro lled , c rossov er tr ia l, 1 8 non- in su lin -d e-
penden t d iabe tic pa tien ts w ere random ly assign ed to rece ive ei-
the r p sy llium or p lacebo as the ir firs t trea tm en t. T o ensure an
overn ig h t fast, p atien ts w ere ad m itted to the G enera l C lin ica l
R esearch C en te r, U n iversity o f V irg in ia, the prev iou s even ing .
T h e fo llo w ing m o rn in g , a sam plin g cath ete r w as p laced in a
periphera l ve in and pa tency w as m ain ta in ed w ith a sa line drip .
T hree b lo od sam p les w ere d raw n a t 15-m m in te rva ls (-30 , -15 ,
and 0 m m before p sy llium or p lacebo w ere ad m in is te red ) and
assay
re su lts w ere ave rag ed to ob ta in a fa stin g g lucose va lue .
Patien ts then took th e psy llium or p lacebo fo llow ed im m edia te ly
(w ith in 2 m m ) by a s tan dard ized b reakfast. P a tien ts w ere in -
struc ted to consum e th is en tire m ea l w ith in 1 5 m m . S e rum g lu -
cose co ncen tra tion s w ere de te rm in ed du rin g the nex t 5 h fro m
sam ple s d raw n a t 1 5 -m m in terva ls b etw een 30 m m an d 2 h ,
I
F rom th e D iabe tes C en ter and th e D iv is ion of E n do crin o lo gy , U ni-
versity o f V irg in ia , C harlo tte sv ille ; the D iv is ion o f H ea lth and Persona l
C a re, P rocter & G am ble C om pa ny , C in cin na ti; and D iabe tes A sso cia tes ,
In c , L ex in g ton , K Y .
2 S up ported by T h e P roc te r &
G am ble C om pan y , C in cin na ti.
3 A d d r e s s rep rin t requ es ts to JG Pas to rs, U n iv ersity o fV irg in ia D iabe tes
C en te r, U n iv ersity o f V irg in ia , B o x 4 48 , Jo rd an H all, C h arlo tte sv ille ,
V A 229 08 .
R ec ei ve dJ un e 1 1, 1 99 0.
A ccep ted fo r pu b lica tion S ep tem ber 1 9 , 1 990 .
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1 4 3 2
PA S T O R S E T A L
T A B L E I
Fo o d co m po sitio n o f m eals
F o o d
A m o u n t
g
B rea k fa s t
E gg , s c r a mb l e d
5 0
C o rn f lak es 2 1
Ora n g e ju ice
24 9
M ilk , 2 fat
24 4
M arg arin e , co rn o il
5
B re ad, w hite
24
L u n c h
T u n a, w ate r p ack ed 9 2
M ay o n n aise 1 4
W h ite b read
48
T o m ato s o u p 1 2 2
A p ples au ce , u nsw e ete ne d
12 2
G rah am crack ers 2 1
Din n er
B ak ed ch ick en b reast 8 6
Po tato , b o iled w ith o u t sk in 1 5 0
M arg arin e , co rn o il 1 5
R o ll, d in n er 2 8
G reen bean s, can ned
75
Pineapple
rin gs, ju ice p ack ed
83
th en at 2 .5 , 3 , 4 , an d 5 h . S erum in su lin con cen tration s w ere
also m easured f or the f irst 3 h o f th is perio d .
Fiv e h o u rs af te r b reak f as t a stan d ard lu n ch w as eaten b u t n o
p sy lliu m o r p laceb o w as g iv en . S eru m g lu co se co n cen tratio n s
w ere ag ain d e te rm in ed d u rin g th e n ex t 5 h b y u se o f s im ilar
blo od-sam plin g in terv als as th ose
u sed
af ter break f ast. T en ho urs
af te r b reak fast, patien ts too k a second dose o f psy lliu m o r placeb o
f o llo w ed im m ed iate ly b y a stan d ard d in n er m eal. S eru m g lu co se
co n cen tratio n s w ere o n ce m o re d e te rm in ed d u rin g th e n ex t 5 h
at the sam e in terv als as those af te r lun ch . A fter a w ash out perio d
(m edian 7 d), patien ts crossed ov er to the op pos ite treatm ent
an d th e p ro to co l w as rep eated . B o d y w e ig h t w as m o n ito red d u r-
ing the course o f particip atio n w ith a m ean w eig h t redu ctio n o f
0 .6 k g occurrin g be tw een the f irst and second v isit.
u jects
E ig h teen p atien ts, 6 m en an d 1 2 w o m en , m ee tin g th e N atio n al
D iab etes D ata G roup criteria f or non -insu lin -depend en t d iabe tes
w ere en ro lled in th is trial. A ll p atien ts h ad d iab e te s d iag n o sed
2 y
b e fore th e
trial
and n one had additio nal m edical cond itions
or w ere rece iv ing m edications that m igh t hav e conf ou nded the ir
g lu co se o r in su lin co n cen tratio n s . Patien ts ran g ed f ro m 2 9 to
7 1 y of ag e
(5 3 .6 2 .8 9 , 1 S D ) an d w e ig h ed f ro m 1 0 to
100
m o re th an th e ir d es irab le b o d y w e ig h t (1 2 , 1 3 ). Patien t m ed ical
reco rd s in d icated f as tin g b lo o d g lu co se co n cen tratio n s ran g in g
f rom 6 .7 to 1 2 .3 m m ol/L and h em oglo b in A 1 (H g bA 1 con-
cen tration s be tw een 8 and 1 2 . S ix patien ts treated th eir con -
d itio n w ith d ie t alo n e w h ereas tw elv e to o k o ral h y p o g ly cem ic
ag en ts. A ll p atien ts p ro v id ed in f o rm ed co n sen t. T h e U n iv ers ity
of V irg in ias H u m an In v estigation C o m m ittee and C lin ical R e-
search C en te r C o m m ittee b o th rev iew ed an d ap p ro v ed th e stu d y
protocol.
Test meals and medications
S tan d ard te st m eals in th is s tu d y w ere d es ig n ed to m ee t th e
A m erican D iab e te s A sso ciatio n s 1 9 8 6 n u tritio n al reco m m en -
d atio n s (1 4 ) an d to b e s im ilar to w h at p atien ts m ig h t n o rm ally
co n su m e . E ach m eal co n tain ed -2 3 0 1 .2 5 Id ( -5 5 0 k cal) w ith
an av erag e o f 5 3 of calories as carbo hy d rates, 27 as fat, and
2 0 as p ro te in . T h ese m eals p ro v id ed a d aily to tal o f 1 4 g d ie tary
f ib er. T ables 1 and 2 sh ow th e m enu and co m po sition o f each
of the m eals, respec tiv e ly . N utritional analy sis w as calcu lated
b y u s in g th e
Auto Nutritionist I I
so f tw are p ro g ram (N -S q u ared
C o m p u tin g , S alem , O R ), w ith th e ex cep tio n o f d ie tary an d so l-
uble f ibers (T ab le 2).
E ach patien t took tw o do ses o f psy lliu m or p lacebo d urin g
each crosso v er perio d , o ne d ose b ef ore break f ast and the o ther
b e f o re d in n er. N o lead -in d o sin g p erio d w as u sed . E ach p rem eal
psy llium do se con sisted o f6 .8 g psy lliu m h y d rop hilic m u c illo id
as sug ar-f ree , oran ge-f lav ored M etam u c il (Proc ter & G am ble ,
C in c in n ati). T h e p sy lliu m w as d isp en sed as tw o 3 .4 -g p ack ets ,
each m ix ed in to a 2 4 0 -m L g lass o f w ate r. T h e p laceb o co n s is ted
of f ib er-f ree ex c ip ien ts o f M etam uc il (co lorin gs, f lav orin gs, and
c itrate ) in th e sam e ratio as in th e ac tiv e treatm en t. E ach p laceb o
dose w as also d iv ided w ith each h alf m ix ed in to a 240 -m L glass
o f w ater. H en ce, p atien ts d ran k 4 8 0 m L w ater b ef o re b reak f as t
an d d in n er w ith each treatm en t. T en p atien ts rece iv ed p laceb o
an d e ig h t p atien ts rece iv ed p sy lliu m as th e ir f irst treatm en t. A ll
sub jec ts w ere questio ned to
assess
su b jectiv e gastro in testinal sid e
e f f ec ts o f th e f ib er, if an y .
C l ini ca l mea su rements
S eru m g lu co se co n cen tratio n s w ere d e te rm in ed b y g lu co se
o x id ase m e th o d s b y us ing a B eck m an G lu co se A n aly z er II.
T A B L E 2
N utrien t co m po s itio n o f m eals4
D aily to tal B reak f as t
L u n ch D in n er
E n erg y [k J(k cal)] 6 9 2 0 .5 0 (1 6 5 4 ) 2 1 0 0 .4 2 (5 0 2 )
2 2 8 4 .5 2 (5 4 6 ) 2 2 0 9 .2 0 (5 2 8 )
C arb o h y d rate (g )
2 1 9 [5 3 ] 7 3 [5 6 ] 7 6 [5 3 ] 7 0 [5 0 ]
P r o t e i n g
8 4 [ 2 0 ] 2 0 [15] 3 2 [2 2 ]
3 2 [2 3 ]
Fat (g) 50 [2 7]
1 7 [2 9 ] 1 6 [2 5 ] 1 7 [2 7 ]
D ie tary f ib er(g )t 1 3 .0 5 1 .7
5 1 6 25
S o lu b le f ib er(g ) 4 .3 4 0 .5 3
1 5 2 . 3 1
4 Percen tag e o f n u trien t in b rack e ts.
tR e f e ren ce 1 5 .
1:R ef ere nce s 16 an d 17 .
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8/12/2019 19-Psyllium Fiber VALORAR
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.
0
E
E
0,
8
0
F IG 2. E ffect of p syllium fib er (#{149};
=
18) or placebo (0;
n =
I 8) on
postprandial glucose concentrations after a dinner test m eal. I SEM .
4 . S M V alues calculated as the percent difference betw een m e an values
for p sy lliu m and placebo. P ercent d ifferen ce is in brack ets.
T im e M in ute s )
8
E
0
0
8
0
FIG I . E ffect of psyllium fiber (#{149};
=
I 8) or placebo (0; n
=
1 8) on
postprandial glucose concentrations after a breakfast test m eal. i SE M .
60 120
180
240 300
T im e M in u te s ) T im e M in u te s )
PSY LLIU M R ED U C ES PO STPR A N D IA L G LU C O SE 1433
F IG 3 . E ffect ofp syllium fiber (#{149};
=
18) or placebo (0;
n =
18 on
postprandial insulin concentrations after a breakfast test m eal. I SE M .
T A B LE 3
P ostpran dial glycem ic respo nse after breakfast and dinn er
Psyllium
n=1 8 )
Placebo
n=1 8 )
B reakfast
Peak glucose elevation
(m m ol/L)
6.03
0.65 [-141 7.02
0 .62 0 .08
T im e to
peak
(m m )
97.5 6 .7 [ 9 ] 89 .2 7 .7
0 . 26
A rea under glucose curve
(mm ol.h .L )
13.0
2 .6 [ -13]
1 4 .9 2 .4 0 .37
D inner
Peak glucose elevation
(m m ol/L)
2.98
0 .42 [-21]
3.76 0 .42 0 .06
T im e to peak (m m )
90.8
7 .8 [ 9 ]
83 .3 7 .3 0 .35
A rea under glucose curve
mmo l . h . L
4 . 9 2 . 0
[-4 1] 8 .3 1 .7
0 . 07
R esults
M easurem ents at each tim e point w ere determ ined in triplicate
from a single blood sam p le, im m ediately after blood sam p ling.
T hese triplicate readings w ere averaged for statistical analysis.
Serum insulin concentrations w ere determ ined by radioim -
m unoassay techniques m odified from Freedlander et al (18).
The interassay C V w as 3% for glucose and 6% for.insulin.
t t i s ti c l m e t ho d s
C hanges in serum glucose and insulin concentrations w ere
calculated separately for each postm eal period by using the serum
concentration at each m ealtim e as the baseline. Treatm ents w ere
com pared for m axim um increase, tim e to peak increase, and
increm ental area under the glucose and insulin curves for each
m eal according to standard crossover analysis of variance tech-
niques (19). A s part ofthis analysis, order and tim e effects w ere
investigated and found to be negligible. A rea increm e nts under
the curves for a given m eal w ere determ ined for the 5-h period
after the m eal. D ifferences in response betw een m odes of diabetes
therapy (diet alone vs oral hypoglycem ics) w ere investigated by
tw o -w ay analysis ofvariance testing for interaction (19). A ll sta-
tistical analyses w ere done w ith the
SAS
statistical softw are
package (S tatistical A nalysis S ystem , release 5. 16, SA S Institute
Inc, C ary, N C ). T w o -tailed
P
values
0.05 w ere considered
statistically significant w hereas
P
values betw een 0.05 and 0.10
w ere considered supportive of the effect.
T he proxim ate hypoglycem ic effects ofpsyllium (adm inistered
w ith a m eal) are dem o nstrated by com p aring postprandial serum
glucose concentrations for both breakfast and dinner. The re-
sponse to psyllium w as generally greater after dinner than after
b reakfast, su ggestin g a possible cum ulative effect (T able 3). F iv e-
ho ur profiles display in g th e rise and decline in glucose are show n
in Figures 1
and
2 for breakfast and dinner, respectively. Psyllium
produced a significant
P
< 0.05) decrease in peak postprandial
glucose concentrations for up to 90 m m after breakfast and for
up to 75 m m after dinner. A verage glucose elevations w ith psyl-
hum w ere 14% low er after breakfast
P =
0.08) and 20% low er
after dinner
P =
0.06), and area under the glucose curve w as
lower after dinner
P
= 0.07) although not low er after breakfast.
The increase in tim e to peak glucose elevations w as not statis-
tically significant.
S erum insulin concentrations w ere also significantly
P
< 0.05)
low er w ith psyllium ingestion for the first 90 m m after breakfast
(F ig 3). T he area under the curve for insulin w as significantly
low er (17% ,
P
= 0.02) w ith psyllium , supported by a 12% re-
duction in peak insulin elevations
P =
0.09) w ith psyllium (T a-
ble4).
Second-m eal effects of psyllium on glucose concentrations are
show n in Figure
4.
T his graph displays glucose elevations after
a standard lunch eaten 5 h after psyllium adm inistration at
breakfast. Psyllium reduced postprandial peak glucose concen-
trations by 3 1%
P =
0.01) and area under the curve by
6
P =
0.02) (T able 5).
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T im e M in u te s )
1434
P A S T O R S E T A L
T A B L E 4
P ostp ran d ial insu lin response afte r b reakfast
Psyll ium
n=18
Placebo
n=l8
P eak in su l in e lev ation
(pmol /L )
T im e to pe a k ( m m )
A rea un der insu lin c urv e
( p m o l
.
h
.
L )
486 .2
48 .1 [- l2 )
1 1 2. 1
6.3 [ 12]
840 .9
105.5 - 17]
551 .3 57.1
100.0 6. 8
1008.2 I 1 3.0
0.09
0 .15
0.02
4 5 S E M . V alu es ca lcu late d as pe rcen t d iffere nce betw ee n m e an va lues fo r
psy l l ium a nd p la ce bo . P erc en t d if fe re nc e i s i n b ra ck et s.
T he pa tien ts m o de o fd iab etic th erapy h ad no appa ren t e ffec t
on psy llium s ab ility to redu ce b lood g lucose con cen tra tions . In
pa tien ts trea ted by on ly d ie ta ry the rap y , peak g lucose
elevat ion
decreased
1 8% after b reak fa st, 32 % afte r lun ch , and 19 % afte r
d inner. S im ila rly , g lucose e leva tion decreased 1 3% afte r b reak-
fast, 3 1% afte r lun ch , and 22 % after d inn er in pa tien ts rece iv ing
ora l
hyp og ly cem ic th erapy . N o sign if ican t adve rse reac tions w ere
repo rted fo r eith er p sy llium o r p lacebo during the stu dy .
Discussion
F ind ings of th is s tudy ind icate tha t psy llium redu ces p ost-
p ran d ial g lucose an d in su lin concen tra tions in n on-insu lin -dc-
p en den t d iabe tic pa tien ts bo th w h en tak en w ith m ea ls an d a fte r
a second m ea l ea ten up to 5 h afte r fibe r inges tion . P sy llium
appears to be eq ua lly e ffec tiv e in p atien ts receiv ing e ith er d iet
o r o ra l h ypog ly cem ic-agen t the rapy . T hese effects w ere ach ieved
by a re la tiv ely m odest fibe r supp lem en t to the d ie t and by m ea ls
tha t d iabe tic pa tien ts m igh t reason ab ly be expec ted to con sum e
o u tside the c lin ic .
In n ond iabe tic sub jects , stud ies dem on stra ted the ab ility o f
g uar o r h igh -fibe r foods to reduce the pos tp rand ia l g lucose rise
o f m ea ls ea ten seve ral h ou rs a f ter f ibe r ingestion (9 - 1 1 ) . D a ta
f rom th is s tu dy in d icate tha t psy llium has a s im ila r e ffec t in
d iabe tic pa tien ts . T h is secon d-m eal re su lt sho w s tha t the e ffec t
o f psy llium given w ith one m ea l carr ies ov er to th e nex t.
Psy lliu m s m echan ism of ac tio n fo r g lucose red uc tio n in d i-
abe tic pa tien ts is p robab ly s im ila r to tha t o fo ther so lub le fib ers .
Severa l c losely re lated m echan ism s h av e been p ro posed . F irs t,
because p sy llium form s a v iscou s g el in aqu eo us so lu tion , it m ay
slow th e access o f g lucose to the sm all in testine s abso rp tive
ep ith elium , the reby b lun ting pos tp rand ia l g lucose peaks. T h is
has been pos tu la ted fo r g uar (20 , 2 1). S econd , so lub le fibe rs m ay
de lay gastr ic em pty in g , slow ing ca rb ohy dra te up take (22 ) . O th e r
re sea rche rs , h ow ev er , d id no t con firm th is co rrela tion be tw een
de layed g astric em pty ing and redu ced po stp rand ia l g lucose con-
cen tra tion s (23) . A th ird m echan ism tha t m ay con tribu te to the
po stp ran d ia l e ffect is the sequestratio n of ca rboh ydra tes ingested
w ith th e m ea l, re tard ing carb ohydrate access to d ig estive enzym es
(24 ). T h e design of th is stud y does no t a llo w these m echan ism s
to b e d is tin gu is he d.
A diffe ren t m ech an ism m ay underlie psy lliu m s second -m eal
e ffect. R ecen t resea rch ind ica te s tha t so lu b le f ibe r m ay evok e a
low er pos tp rand ia l rise in insu lin concen tra tio ns w ith a corre -
sp ond ing sm aller cou n te rregu la to ry respo nse to a m ea l (9 , 10).
A cou n te rregu la to ry re sp onse is elic ited by an un de rsh oo t o f
b lo od g lucose . W h en fibe r is ad m in is tered w ith a m ea l, a
reduced
FIG 4 . E ffec t o fpsy lliu m fiber ( {149 };= 18) o r p lacebo (0 ; n
18) on
p ostp ran d ial g lu co se concen tra tio ns a fte r a lun ch test m eal ea ten 5 h
after
tes t m edicat ion . i
S E M .
in su lin response m ay cause a sm alle r und ersho o t o f the b lood
g lucose , w h ich in tu rn m igh t resu lt in a reduced coun te rregu -
lato ry respon se produc ing less insu lin resis tan ce a t the tim e of
the second m ea l. T hus , so lub le fibe r m ay sm ooth the large fluc -
tua tio n in postp ran d ia l g lucose concen tra tion s ty p ica l o f d iab e tic
pa tien ts , resu lting in an im p roved respo nse to la te r m ea ls .
In th is s tudy psy llium cau sed a reduc tion in insu lin af te r th e
te st b reak fa st a s w e ll a s a sub sequen t redu ctio n in po stp ran d ia l
g lycem ic response afte r lunch . H ow ever, the g lucose pro file fo r
p lacebo does n o t ex h ib it the theo rized dec line o fserum gluco se
to concen tra tions be low the in itial fas tin g concen tra tio n , and
m easurem en ts o f g lucagon , catecho lam ine , and o th er cou n ter -
regu la to ry ho rm one concen tra tions w ould be needed to con firm
such a m echan ism . C lear ly , add itiona l w ork is needed to probe
th e im portance o f th is o r o the r m echan ism s u nde rly ing the sec -
o nd-m ea l e ffec t dem o nstra ted in th is re search .
W h ichever m echan ism is respons ib le fo r psy lliu m s e ffec t, o ra l
hyp og lycem ic agen ts do no t appear to a ffec t th e ou tcom e. T h is
find ing is ind icated by the lack ofd iffe rence in po stp rand ia l g lu -
cose
resp onse dem ons trated by pa tien ts rece iv ing e ithe r d ie ta ry
the rapy alon e or o ra l h ypog ly cem ic agen ts. D iffe rences be tw een
p sy llium and p lacebo in peak g lucose e leva tions an d tim es to
peak w ere no t sta tistically d iffe ren t fo r the tw o groups . So lub le
f ibe rs such as psy llium m ay a lte r e ithe r cou n te rreg u la to ry o r g u t
h o rm on e re sp onses, b lun ting the p ostp rand ial g lucose rise .
H ow eve r, fu r the r re sea rch
is need ed to und erstand so lub le fibe rs
e ffec t o n th ese ac tiv itie s .
If the short-te rm benefits psy llium dem ons tra ted in non-in -
su lin -depend en t d iabe tic pa tien ts in th is s tu dy can be ex tended
by regu la r in take of the fib e r, lo ng-te rm glycem ic co n tro l cou ld
T A B L E
5
Second -m eal p ostp rand ia l g lycem ic response afte r d in ner
Psy l l ium
n=18
Placebo
n=l8 P
P e a k g lu co se e le va ti on
(m m ol/L ) 2 .5 8 0 .41 [-3 l] 3 .7 6 0 .42 0 .0 1
T im e to peak (m m ) 1 1 0 .0
1 3 .0 [+ 16 J 9 5 .0
8. 0
0 .13
A r e a under g lucose curve
(m m ol.h .L ) 2 .76
1 .58 [-64] 7 .57 1 .96 0 .02
C SE M . V alues ca lcu la ted as percen t d iffe rence be tw een m ean
va lu es fo r psy llium and p lacebo . Percen t d iffe rence is in b rack e ts .
-
8/12/2019 19-Psyllium Fiber VALORAR
5/5
PS Y L L IU M R E D U C E S PO S T PR A N D IA L G L U C O S E 1 4 3 5
b e im p ro v ed . L ip id co n cen tratio n s in th ese p atien ts m ig h t also
b e red u ced , as seen in a larg e -b ase trial in w h ich p sy lliu m w as
ad m in iste red to h y p erch o le s tero lem ic , n o n d iab etic p atien ts (2 5 ) .
Pre lim in ary stud ies in d iab etic patien ts dem on strated red uc tions
in f as tin g g lu co se an d H g b A 1 co n cen tratio n s as w e ll as lo w ered
lip id co n cen tratio n s (2 6 -2 8 ). H o w ev er, in terp re tatio n o f th ese
stu d ie s is co m p licated b y lack o f a p laceb o co n tro l (2 6 ), th e
p resen ce o f o th er d iseases (2 7 ) , p atien t w e ig h t lo ss, an d sm all
b ase s iz es (2 8 ). T h u s , trials co n f irm in g th e ab ility o f lo n g -te rm
p sy lliu m ad m in istratio n to im p ro v e d iab e tic p atien ts H g b A 1
an d lip id co n cen tratio n s are n eed ed .
It w o uld also be v aluable to d eterm ine th e e f f ec ts o f lo ng-term
p sy lliu m u se o n th e p o s tp ran d ial g lu co se an d in su lin re sp o n se
d u rin g su ch a trial. C h an g es p sy lliu m m ay p o ten tially e licit in
p erip h eral in su lin sen sitiv ity , co u n te rreg u lato ry resp o n se ,
an d
in tes tin al m o rp h o lo g y co u ld b eco m e m an if e s t. In th is reg ard , a
trial in n in e n o n -in su lin -d ep en d en t d iab e tic p atien ts g iv en p sy l-
h u m f o r 1 w k in d icated an im p ro v em en t in p o stp ran d ial re sp o n se
o v er th e co u rse o f th e s tu d y , b u t n o t en o u g h p atien ts w ere as -
sessed to ob tain statistical sig n if icance (3).
In conc lus ion , resu lts f rom th is trial ind icate that the
u se o f
p sy lliu m as a m eal su p p lem en t red u ces p o s tp ran d ial g lu co se an d
in su lin e lev atio n s in n o n - in su lin -d ep en d en t d iab e tic p atien ts.
T h is ef f ec t ap pears to be ind ependent o fd iabe tic therap y because
s im ilar re su lts are seen in p atien ts treated w ith d ie t alo n e an d
in p atien ts o n a d ie t an d tak in g o ral h y p o g ly cem ic ag en ts. T h e
resu lts also in d icate th at p sy lliu m can ex ert th ese e f f ec ts h o u rs
af ter its ad m in is tration and can produ ce a sig n if ican t reduc tion
in g luco se af te r a second m eal.
W e thank N orbert G ilm an, Joy ce W atson , Jod i L av in-T o m pk ins, and
M ary L o u
Price f o r th e ir ex p ert ass is tan ce. In ad d itio n , w e w o u ld lik e
to th an k th e U V A C lin ical R esearch C en te r, sp ec if ically f o r th e ass istan ce
o f S an d ra Jack so n an d S y n d i W oo d so n .
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