19-psyllium fiber valorar

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 .


3/5

.

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 .


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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19-psyllium fiber valorar

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