Psyllium Revival

October 29, 2010 Written by JP       [Font too small?]

The dietary supplement Metamucil has been commercially available for over seventy-five years. For the most part, this familiar product is known the world round as an old fashioned constipation aid. There’s good reason for this reputation. But there’s also more to Metamucil and psyllium than simply promoting regularity. Today I’ll discuss some of the lesser known attributes of this decidedly untrendy supplement. (1,2,3)

Many health authorities recommend that we include more dietary fiber as part of a healthy lifestyle. I tend to agree with this general recommendation. But where we part ways is how to implement such a nutritional shift. Nutritionists will frequently recommend increasing whole grain consumption in the form of bread, cereal and a variety of processed foods, including pasta. Among other reasons, I disagree with this advice because of the allergenic nature of grains and their potential to elevate blood sugar. I think most people would do better to include fiber sources that come from low-glycemic fruits, non-starchy vegetables, nuts and seeds. If you stick to a whole food diet that emphasizes these food categories, constipation and other fiber-related conditions are rarely a problem. If you don’t and you experience the consequences of a lack of roughage, I think it’s worth considering supplementing with psyllium.

Over the past several years psyllium supplements have been extensively investigated with respect to two of the most significant health threats of the modern age: cardiovascular disease and diabetes. Preliminary evidence shows that psyllium husks can reduce blood sugar, body weight and cholesterol – all of which are considered risk factors for the two diseases in question.

The October 2010 issue of The Annals of Pharmacotherapy reviewed the connection between psyllium supplementation and glucose control in type 2 diabetics. The analysis found that a daily dosage of 10.2 grams of psyllium was capable of reducing long term blood sugar levels (A1C) and post-meal blood sugar elevation. Other studies appearing in various publications including the British Journal of Nutrition and the European Journal of Nutrition have noted that the addition of psyllium to diabetic menu plans may lower body fat, body weight, insulin, LDL (“bad”) cholesterol and triglyceride concentrations. The combination of psyllium with other foods has further demonstrated the ability to reduce appetite hormones that are associated with overeating and overweight – ghrelin, glucagon-like peptide 1 and peptide YY. (4,5,6)

The allopathic medical establishment has clearly and consistently adopted the position that high levels of LDL and total cholesterol are perilous to cardiovascular well-being. This is evidenced by the astronomical promotion and sales of multiple medications that lower cholesterol. Psyllium fiber may offer a safer means of reducing lipid levels in at-risk individuals. A current meta-analysis that evaluated twenty-one studies pertaining to this topic concluded that: “Psyllium could produce dose- and time-dependent serum cholesterol-lowering effect in mild and moderate hypercholesterolemic patients and would be useful as an adjunct to dietary therapy for the treatment of hypercholesterolemia”. However, it’s important to note that not all studies have come to the same conclusion about psylliums ability to reduce plasma lipids. Depending on the study population, the treatment effect has varied to some degree. Therefore, it’s vital to test and verify when it comes to the use of fiber therapy as an adjunct or alternative to drug therapy. (7,8,9,10,11)

Psyllium Fiber May Improve Irritable Bowel Syndrome Symptoms
Source: BMJ 2009; 339:b3154 (link)

A final area that I’d like to discuss is the potential of psyllium therapy in patients with irritable bowel syndrome (IBS). A 12 week study published in the August 2009 edition of the British Medical Journal compared the effects of 10 grams of psyllium/day vs. 10 grams of wheat bran/day or a placebo (rice flour) in 275 patients with IBS. According to the authors of the paper: “After three months of treatment, symptom severity in the psyllium group was reduced by 90 points, compared to 48 points in the placebo group and 58 points in the bran group”. Clearly the psyllium intervention was the most effective. What’s more, the wheat bran group presented the largest drop out rate of all three treatment options. The reason cited was “that the symptoms of irritable bowel syndrome worsened” in those who supplemented with wheat bran/fiber. This ties into the reservations I expressed earlier in the column and bolsters my belief that grain-based fiber sources should be used with caution or not at all. (12,13,14)

If you have no interest or need for psyllium supplements, you may ultimately find them in your diet anyway. Food scientists in Brazil are currently attempting to use specially processed psyllium fiber in place of gluten in bread. Gluten is a protein found in wheat and other grains (barley and rye) that gives bread it’s characteristic chewy texture. It’s also a significant cause of food intolerance and a serious medical condition known as celiac disease. A recent experiment revealed up to a 97% acceptance rate when psyllium was used in place of gluten in a specially formulated bread intended for patients with gluten intolerance. Another positive revelation is that the substitution reduced the caloric content of the test bread by 32%. It seems that the granddaddy of all fibers may have a new life in 21st century nutrition after all. (15)

Note: Please check out the “Comments & Updates” section of this blog – at the bottom of the page. You can find the latest research about this topic there!

Be well!

JP

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Posted in Diabetes, Heart Health, Nutritional Supplements

19 Comments & Updates to “Psyllium Revival”

  1. Mallory Says:

    interesting….esp the difference in the wheat bran and pysllium… a quick scan through a bodybuilding site shows you many of them suffer constipation when they switch to keto swearing they need starchy fiber to crap… the reality i think is people are poop obsessed and think they need to go all the time when a good diet just isnt going to provide to much excess to get rid of…

    i definitely agree with the fiber in the right sources nuts, coconut, veggies etc being good for colon health and regularity as opposed to wheat bran haha what a bad idea that is. also, im pretty sure fat plays a role in coating the GI tract for effeicient nutrient intake and disposal. i dont think we want to rush things through the GI tract and miss benefits of stuff that is absorbed and used down there

  2. Mark S Says:

    I will be the first in line to hail the effects of a whole food diet on regularity. It WORKS. The only problems I have ever had was when I made the change to healthier eating. Constipation was a problem for a couple of weeks till my body “accepted” the change.

    I will have to give this article to a friend whose husband is a diabetic. He currently uses a cinnamon supplement and this information can give him more ammunition to fight it naturally.

  3. Don S. Says:

    According to the directions on Metamucil, I’m not to take it within a couple hours of taking a medication. That the Metamucil may lessen the effectiveness of the med. In my case, Enalapril for BP. My question is, would this also apply to vitamin supplements, fish oil soft gels, etc.? I’d like to take the Metamucil with meals, but that’s when I also take the vitamins.

  4. JP Says:

    Don,

    I generally suggest separating fiber and nutritional supplements because some forms of supplemental fiber may impair absorption of nutrients.

    Exactly how one should take a fiber supplement largely depends on the reason why you’re taking it in the first place. If it’s to promote regularity, I would take the Metamucil on an empty stomach between meals or before bed.

    If you’re taking the Metamucil with meals because you’re using it to manage cholesterol, then I’d recommend taking your nutritional supplements (fish oil, minerals, vitamins, etc.) at a separate time such as a snack.

    I hope this helps. If you’re stuck on how to fit everything in, let me know what time of day you’re currently taking each medication/supplement and I’ll try to help you figure out a practical schedule.

    Be well!

    JP

  5. Don S. Says:

    I’m taking it for regularity and ease of BM. So I am taking it at the best time as you have suggested. It would be easier to remember for me taking it at meal time, but that’s not really such a big deal. It’s good to know I’m doing it correctly. I’m 74 and have always had constipation, hard stool problems. I take a teaspoon of Metamucil in 8 oz. water, three times daily. It has helped a great deal.

    Thank you for your quick response…

  6. JP Says:

    Update: Diets rich in fiber reduce excessive inflammation in overweight adolescents …

    http://www.ncbi.nlm.nih.gov/pubmed/25728000

    Pediatr Obes. 2015 Mar 2.

    Dietary fibre linked to decreased inflammation in overweight minority youth.

    OBJECTIVE: The objective of this study was to examine the relationship between diet and inflammation, and adiposity in minority youth.

    DESIGN AND METHODS: The study was designed as a cross-sectional analysis of 142 overweight (≥85th body mass index percentile) Hispanic and African-American adolescents (14-18 years) with the following measures: anthropometrics, adiposity via magnetic resonance imaging, dietary intake via 24-h dietary recalls, and inflammation markers from fasting blood draws utilizing a multiplex panel. Partial correlations were estimated and analysis of covariance (ancova) models fit to examine the relationship among dietary variables, inflammation markers and adiposity measures with the following a priori covariates: Tanner stage, ethnicity, sex, total energy intake, total body fat and total lean mass.

    RESULTS: Inference based on ancova models showed that the highest tertile of fibre intake (mean intake of 21.3 ± 6.1 g d-1 ) vs. the lowest tertile of fibre intake (mean intake of 7.4 ± 1.8 g d-1 ) was associated with 36% lower plasminogen activator inhibitor-1 (P = 0.02) and 43% lower resistin (P = 0.02), independent of covariates. Similar results were seen for insoluble fibre. No other dietary variables included in this study were associated with inflammation markers.

    CONCLUSIONS: These results suggest that increases in dietary fibre could play an important role in lowering inflammation and therefore metabolic disease risk in high-risk minority youth.

    Be well!

    JP

  7. JP Says:

    Updated 07/25/15:

    http://www.europeanreview.org/wp/wp-content/uploads/1297-1304.pdf

    Eur Rev Med Pharmacol Sci. 2015 Apr;19(7):1297-304.

    Metamucil as an additional source of dietary fiber: impact of the quality of healthcare professionals’ recommendations on users’ experience.

    OBJECTIVE: Metamucil® is a fiber supplementation formed by 100% natural psyllium. This study, conducted in Italy, assessed the impact of quality of pharmacists’ instruction to use this product on subjects’ adherence to and overall satisfaction with this test product.

    SUBJECTS AND METHODS: Open-label post-marketing study involving adult subjects who had purchased Metamucil® (follow-up: 14 ± 7 days). Information was collected using questionnaires dedicated to the participating subject and pharmacy.

    RESULTS: In total, 1480 subjects and 182 pharmacies returned their questionnaires. The mean age of the subjects was 49 years, two-thirds were female and 87% went to the pharmacy with problems related to bowel movements. The median daily dose taken over the 21-day period was 1. Adherence to the test product was associated with the quality of pharmacist’s counseling (p = 0.005). Similarly, satisfaction with the tested product was associated with the quality of counseling (p < 0.001). Consumers’ satisfaction was also associated with the quality of pharmacist’s explanation of the benefits of the test product (p < 0.001) and with adherence (p < 0.001). 93% and 83% of subjects, respectively, stated the ease of use and their overall satisfaction with the test product, with 73% of subjects agreeing that they would continue using it. Similar findings were observed in subjects who had previously taken the most commonly used branded fiber supplements containing either partially hydrated guar gum or psyllium in the previous 6 months. 92% of pharmacists stated they would recommend Metamucil® for bowel regularity and 90% as it provides multiple benefits.

    CONCLUSIONS: Pharmacists’ counseling is associated with consumers’ adherence and satisfaction to Metamucil®. A large proportion of subjects were satisfied and would continue taking the tested product as a fiber supplement.

    Be well!

    JP

  8. JP Says:

    Updated 07/25/15:

    http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=9493197&fileId=S0007114514003419

    Br J Nutr. 2014 Nov 13:1-8.

    Effects of psyllium on LDL-cholesterol concentrations in Brazilian children and adolescents: a randomised, placebo-controlled, parallel clinical trial.

    The present study investigated the LDL-cholesterol (LDL-C)-lowering effects of psyllium in Brazilian dyslipidaemic children and adolescents. A total of fifty-one individuals (6-19 years) with mild-to-moderate hypercholesterolaemia were evaluated by conducting a randomised, double-blind, placebo-controlled, parallel clinical trial. Over an 8-week trial period, the participants were randomly allocated to one of two groups (control: n 25 and psyllium: n 26) using a computer-generated random number sequence. Fasting blood samples, dietary records and anthropometric data were collected. Both groups were treated with the National Cholesterol Education Program Step 2 diet for 6 weeks before randomisation. After this run-in period, a daily supplement of 7·0 g psyllium was given to the intervention group, while an equivalent amount of cellulose was given to the control group. Statistically significant changes between the control and intervention groups over time were observed for total cholesterol (7·7 %; – 0·39 mmol/l; P= 0·003) and LDL-C (10·7 %; – 0·36 mmol/l; P= 0·01). None of the participants reported any aversion to the smell, taste, appearance or texture of psyllium. No serious adverse effects were reported during the study. In addition to causing a significant reduction in LDL-C concentrations, psyllium therapy was found to be both safe and acceptable for the treatment of hypercholesterolaemic children and adolescents.

    Be well!

    JP

  9. JP Says:

    Updated 07/25/15:

    http://onlinelibrary.wiley.com/doi/10.1002/nur.21616/abstract

    Res Nurs Health. 2014 Oct;37(5):367-78.

    Dietary fiber supplementation for fecal incontinence: a randomized clinical trial.

    Dietary fiber supplements are used to manage fecal incontinence (FI), but little is known about the fiber type to recommend or the level of effectiveness of such supplements, which appears related to the fermentability of the fiber. The aim of this single-blind, randomized controlled trial was to compare the effects of three dietary fiber supplements (carboxymethylcellulose [CMC], gum arabic [GA], or psyllium) with differing levels of fermentability to a placebo in community-living individuals incontinent of loose/liquid feces. The primary outcome was FI frequency; secondary outcomes included FI amount and consistency, supplement intolerance, and quality of life (QoL). Possible mechanisms underlying supplement effects were also examined. After a 14-day baseline, 189 subjects consumed a placebo or 16 g total fiber/day of one of the fiber supplements for 32 days. FI frequency significantly decreased after psyllium supplementation versus placebo, in both intent-to-treat and per-protocol mixed model analyses. CMC increased FI frequency. In intent-to-treat analysis, the number of FI episodes/week after supplementation was estimated to be 5.5 for Placebo, 2.5 for Psyllium, 4.3 for GA, and 6.2 for CMC. Only psyllium consumption resulted in a gel in feces. Supplement intolerance was low. QoL scores did not differ among groups. Patients with FI may experience a reduction in FI frequency after psyllium supplementation, and decreased FI frequency has been shown to be an important personal goal of treatment for patients with FI. Formation of a gel in feces appears to be a mechanism by which residual psyllium improved FI.

    Be well!

    JP

  10. JP Says:

    Update 08/29/15:

    http://www.biomedcentral.com/1472-6882/15/298

    BMC Complementary and Alternative Medicine 2015, 15:298

    Study of the protective effect on intestinal mucosa of the hydrosoluble fiber Plantago ovata husk

    Background: Several studies have indicated that dietary fiber may have a protective effect on gastrointestinal mucosa. The aim of this study was to evaluate the protective action of the soluble fiber Plantago ovata husk against intestinal damage.

    Methods: To evaluate the anti-ulcerogenic effect on duodenal mucosa of the soluble fiber Plantago ovata husk, low-dose acetylsalicylic acid (10 mg/kg) was given orally to animals once daily for 14 or 28 days with and without Plantago ovata husk (100 mg/kg). 24 h after final dosing duodenal samples were removed for anatomopathological evaluation. Villi were examined by both light and scanning electron microscopy.

    Results: Acetylsalicylic acid induced severe lesions in duodenal mucosa of rabbits, including erosions, epithelium disorganization, and cell vacuolization, increasing as well the amount of mononuclear and caliciform cells. Damage was much more severe in animals treated for 28 days. In groups receiving Plantago ovata husk, a significant attenuation of acetylsalicylic acid-induced lesions was already observed in group treated for 14 days, becoming more evident in those treated for 28 days, all of them with duodenal cytoarchitecture normal and similar to control animals.

    Conclusions: These findings suggest that Plantago ovata husk may protect intestinal mucosa probably by limiting acetylsalicylic acid penetration into epithelial cells, although further studies are needed to confirm the same effect in other experimental models of induced mucosal damage and to elucidate the mechanisms of fiber protection.

    Be well!

    JP

  11. JP Says:

    Updated 09/10/15:

    http://journals.lww.com/dcrjournal/pages/articleviewer.aspx?year=2015&issue=10000&article=00010&type=abstract

    Dis Colon Rectum. 2015 Oct;58(10):983-93.

    Loperamide Versus Psyllium Fiber for Treatment of Fecal Incontinence: The Fecal Incontinence Prescription (Rx) Management (FIRM) Randomized Clinical Trial.

    BACKGROUND: Fecal incontinence is a devastating condition with few US Food and Drug Administration-approved pharmacologic treatment options. Loperamide and psyllium, both first-line treatments, have different mechanisms of action without any comparative data.

    OBJECTIVE: The purpose of this study was to examine the effectiveness and tolerability of loperamide compared with psyllium for reducing fecal incontinence. We hypothesized that psyllium fiber supplementation would be more effective than loperamide for reducing fecal incontinence episodes and have fewer adverse effects.

    DESIGN: We conducted a randomized, double-blind, placebo-controlled crossover trial comparing loperamide (followed by psyllium) with psyllium (followed by loperamide).

    SETTINGS: Our sites included outpatient clinics within a Veterans Affairs medical center and university affiliate.

    PATIENTS: Participants included community-dwelling adults (n = 80) with at least 1 fecal incontinent episode on a 7-day bowel diary.

    INTERVENTION: Participants received either daily loperamide (plus placebo psyllium powder) or psyllium powder (plus loperamide placebo) for 4 weeks. After a 2-week washout, participants crossed over to 4 weeks of alternate treatment.

    MAIN OUTCOME MEASURES: The primary outcome was the number of fecal incontinence episodes from 7-day bowel diaries. Secondary outcomes included symptom severity, quality of life, and tolerability.

    RESULTS: Mean age was 60.7 ± 10.1 years; 68% were men. After determining nonsignificant carryover effects, combined analyses showed no differences between the loperamide and psyllium groups for reducing fecal incontinent episodes, symptom severity, or quality of life. Within each group, both loperamide and psyllium reduced fecal incontinent episodes and improved symptom severity and quality of life. Constipation occurred in 29% of participants for loperamide vs 10% for psyllium.

    LIMITATIONS: Limitations include the washout period length and dropout rate after crossing over to the second intervention.

    CONCLUSIONS: Both loperamide and psyllium improve fecal incontinence. Loperamide was associated with more adverse effects, especially constipation.

    Be well!

    JP

  12. JP Says:

    Updated 12/30/15:

    http://ajcn.nutrition.org/content/102/6/1604.long

    Am J Clin Nutr. 2015 Dec;102(6):1604-14.

    Psyllium fiber improves glycemic control proportional to loss of glycemic control: a meta-analysis of data in euglycemic subjects, patients at risk of type 2 diabetes mellitus, and patients being treated for type 2 diabetes mellitus.

    BACKGROUND: A number of health benefits are associated with intake of soluble, viscous, gel-forming fibers, including reduced serum cholesterol and the attenuation of postprandial glucose excursions.

    OBJECTIVE: We assess the effects of psyllium, which is a soluble, gel-forming, nonfermented fiber supplement, on glycemic control in patients who were being treated for type 2 diabetes mellitus (T2DM) and in patients who were at risk of developing T2DM.

    DESIGN: A comprehensive search was performed of available published literature (Scopus scientific database) and clinical records stored by Procter & Gamble with the use of key search terms to identify clinical studies that assessed the glycemic effects of psyllium in nondiabetic, pre-T2DM, and T2DM patients.

    RESULTS: We identified 35 randomized, controlled, clinical studies that spanned 3 decades and 3 continents. These data were assessed in 8 meta-analyses. In patients with T2DM, multiweek studies (psyllium dosed before meals) showed significant improvement in both the fasting blood glucose (FBG) concentration (-37.0 mg/dL; P < 0.001) and glycated hemoglobin (HbA1c) [-0.97% (-10.6 mmol/mol); P = 0.048]. Glycemic effects were proportional to baseline FBG; no significant glucose lowering was observed in euglycemic subjects, a modest improvement was observed in subjects with pre-T2DM, and the greatest improvement was observed in subjects who were being treated for T2DM.

    CONCLUSIONS: These data indicate that psyllium would be an effective addition to a lifestyle-intervention program. The degree of psyllium’s glycemic benefit was commensurate with the loss of glycemic control. Because the greatest effect was seen in patients who were being treated for T2DM, additional studies are needed to determine how best to incorporate psyllium into existing prevention and treatment algorithms with concomitant hypoglycemic medications.

    Be well!

    JP

  13. JP Says:

    Updated 04/16/16:

    http://www.ncbi.nlm.nih.gov/pubmed/27080737

    Clin Gastroenterol Hepatol. 2016 Apr 9.

    Psyllium Fiber Reduces Abdominal Pain in Children with Irritable Bowel Syndrome in a Randomized, Double-blind Trial.

    BACKGROUND & AIMS: We sought to determine the efficacy of psyllium fiber treatment on abdominal pain and stool patterns in children with irritable bowel syndrome (IBS). We evaluated effects on breath hydrogen and methane production, gut permeability, and microbiome composition. We also investigated whether psychological characteristics of children or parents affected the response to treatment.

    METHODS: We performed a randomized, double-blind trial of 103 children (mean age, 13±3 years) with IBS seen at primary- or tertiary-care settings. After 2 weeks on their habitual diet, children began an 8 day diet excluding carbohydrates thought to cause symptoms of IBS. Children with less than 75% improvement in abdominal pain continued in the study (n=85). Children were randomly assigned to groups given psyllium (n=37) or placebo (maltodextrin, n=47) for 6 weeks. Two-week pain and stool diaries were compared at baseline and during the final 2 weeks of treatment. We assessed breath hydrogen and methane production, intestinal permeability, and the composition of the microbiome before and after administration of psyllium or placebo. Psychological characteristics of children were measured at baseline.

    RESULTS: Children in the psyllium group had a greater reduction in mean number of pain episodes than children in the placebo group (mean reduction of 8.2±1.2 after receiving psyllium vs mean reduction of 4.1±1.3 after receiving placebo; P=.03); level of pain intensity did not differ between groups. Psychological characteristics were not associated with response. At the end of the study period, percent of stools that were normal (Bristol scale scores of 3-5), breath hydrogen or methane production, intestinal permeability, and microbiome composition were similar between groups.

    CONCLUSIONS: Psyllium fiber reduced the number of abdominal pain episodes in children with IBS, independent of psychological factors. Psyllium did not alter breath hydrogen or methane production, gut permeability, or microbiome composition.

    Be well!

    JP

  14. JP Says:

    Updated 05/13/16:

    http://www.ncbi.nlm.nih.gov/pubmed/27166077

    Appetite. 2016 May 7. pii: S0195-6663(16)30173-8.

    Satiety effects of psyllium in healthy volunteers.

    Controlling hunger between meals is a challenge for many individuals. This manuscript comprises 2 sequential clinical trials investigating the effects of psyllium (Metamucil) on satiety, both using a randomized, double-blind, placebo-controlled cross-over design. The first study determined the effects of 3.4 g, 6.8 g, and 10.2 g of psyllium taken before breakfast and lunch for 3 days. The second study determined the effects of 6.8 g (taken before breakfast and lunch on Days 1 and 2 and before breakfast on Day 3) on the satiety of participants receiving an energy restricted meal in the morning (breakfast) for 3 days. Efficacy endpoints were mean inter-meal hunger, desire to eat, and Satiety Labeled Intensity Magnitude Visual Analog Scale scores. In Study 1, all 3 psyllium doses resulted in directional or statistically significant mean reduction in hunger and desire to eat, and increased fullness between meals compared to placebo, with both higher doses better than placebo or 3.4 g. The 6.8 g dose provided more consistent (p ≤ 0.013) satiety benefits versus placebo. In Study 2, satiety was assessed similarly to Study 1. A significant (p ≤ 0.004) decrease in the 3-day mean hunger and desire to eat, as well as an increase in fullness for psyllium relative to placebo was observed. Most adverse events were mild gastrointestinal symptoms and were similar for psyllium compared to placebo. These results indicate that psyllium supplementation contributes to greater fullness and less hunger between meals.

    Be well!

    JP

  15. JP Says:

    Updated 06/27/16:

    http://onlinelibrary.wiley.com/doi/10.1111/apt.13647/abstract

    Aliment Pharmacol Ther. 2016 Jul;44(1):35-44.

    Randomised clinical trial: mixed soluble/insoluble fibre vs. psyllium for chronic constipation.

    BACKGROUND: Fibre supplements are useful, but whether a plum-derived mixed fibre that contains both soluble and insoluble fibre improves constipation is unknown.

    AIM: To investigate the efficacy and tolerability of mixed soluble/insoluble fibre vs. psyllium in a randomized double-blind controlled trial.

    METHODS: Constipated patients (Rome III) received mixed fibre or psyllium, 5 g b.d., for 4 weeks. Daily symptoms and stool habit were assessed using stool diary. Subjects with ≥1 complete spontaneous bowel movement/week above baseline for ≥2/4 weeks were considered responders. Secondary outcome measures included stool consistency, bowel satisfaction, straining, gas, bloating, taste, dissolvability and quality of life (QoL).

    RESULTS: Seventy-two subjects (mixed fibre = 40; psyllium = 32) were enrolled and two from psyllium group withdrew. The mean complete spontaneous bowel movement/week increased with both mixed fibre (P < 0.0001) and psyllium (P = 0.0002) without group difference. There were 30 (75%) responders with mixed fibre and 24 (75%) with psyllium (P = 0.9). Stool consistency increased (P = 0.04), straining (P = 0.006) and bloating scores decreased (P = 0.02) without group differences. Significantly more patients reported improvement in flatulence (53% vs. 25%, P = 0.01) and felt that mixed fibre dissolved better (P = 0.02) compared to psyllium. QoL improved (P = 0.0125) with both treatments without group differences.

    CONCLUSIONS: Mixed fibre and psyllium were equally efficacious in improving constipation and QoL. Mixed fibre was more effective in relieving flatulence, bloating and dissolved better. Mixed fibre is effective and well tolerated.

    Be well!

    JP

  16. JP Says:

    Updated 10/25/16:

    http://nutritionj.biomedcentral.com/articles/10.1186/s12937-016-0207-4

    Nutr J. 2016 Oct 12;15(1):86.

    Soluble fibers from psyllium improve glycemic response and body weight among diabetes type 2 patients (randomized control trial).

    BACKGROUND: Water-soluble dietary fibers intake may help control blood glucose and body weight.

    OBJECTIVE: The objective of the study was to determine whether soluble fiber supplementation from psyllium improves glycemic control indicators and body weight in type 2 diabetic patients.

    METHOD: Forty type 2 diabetes patients, non-smoker, aged >35 years were stratified to different strata according to sex, age, body mass index (BMI) and fasting blood sugar level (FBS) and randomly assigned into two groups; The intervention group which consists of 20 participants was on soluble fiber (10.5 g daily), and the control group which consist of 20 participants continued on their regular diet for eight weeks duration.

    RESULTS: After 8 weeks of intervention, soluble fiber supplementation showed significant reduction in the intervention group in BMI (p < 0.001) when compared with the control group. Moreover, water soluble fiber supplementation proven to improve FBS (163 to 119 mg/dl), HbA1c (8.5 to 7.5 %), insulin level (27.9 to 19.7 μIU/mL), C-peptide (5.8 to 3.8 ng/ml), HOMA.IR (11.3 to 5.8) and HOMA-β % (103 to 141 %).

    CONCLUSION: The reduction in glycemic response was enhanced by combining soluble fiber to the normal diet. Consumption of foods containing moderate amounts of these fibers may improve glucose metabolism and lipid profile in type 2 diabetes patients.

    Be well!

    JP

  17. JP Says:

    Updated 11/30/16:

    https://nutritionandmetabolism.biomedcentral.com/articles/10.1186/s12986-016-0141-7

    Nutr Metab (Lond). 2016 Nov 17;13:82.

    Effect on body weight and composition in overweight/obese Australian adults over 12 months consumption of two different types of fibre supplementation in a randomized trial.

    BACKGROUND/OBJECTIVES: Higher fibre intakes are associated with risk reduction for chronic diseases. However, many people find difficulty in consuming sufficient fibre through their diet. Supplements may be an effective alternative. We aimed to investigate the effects of PolyGlycopleX® (PGX®), a proprietary polysaccharide complex and a proprietary Psyllium product (PgxSyl™) (PSY) on diet, body weight and composition in overweight and obese individuals.

    SUBJECTS/METHODS: This was a double-blind 52 weeks study with 159 people randomized to 3 groups: control (rice flour); PGX (PGX) and proprietary psyllium (PSY). Participants did not change any of their usual habits or diet except they consumed 5 g of supplement taken with a total of 500 ml of water 5-10 min before meals.

    RESULTS: Weight was significantly lower in the PGX group compared to control at 3 (-1.6 kg [0.57, 2.67, p = 0.003]), 6 (-2.6 kg [1.01, 4.13, p = 0.001]) and 12 months (-2.6 kg [0.59, 4.64, p = 0.012]) and in the PSY group compared to control group at 3 (-1.1 kg [0.07, 2.12, p = 0.037]) and 6 months (-2.4 kg [0.95, 3.93, p = 0.002]). This was a difference of - 2.8% for the PGX group and - 1.5% for the PSY group compared to control after 12 months supplementation. Body Fat was significantly lower in PGX compared to control at 6 (-1.8 kg [0.63, 2.95, p = 0.003]) and 12 months (-1.9 kg [0.43, 3.36, p = 0.012]) and in PSY compared to control at 6 (-1.9 kg [0.84, 3.04, p = 0.001]) and 12 months (-1.4 kg [0.08, 2.71, p = 0.038]).

    CONCLUSIONS: PGX was better than PSY at maintaining dietary changes and weight loss over the 12 month intervention period, with no change to exercise. A simple strategy of PGX supplementation may offer an effective solution to long-term weight-loss and then management without the need for other nutrient modification.

    Be well!

    JP

  18. JP Says:

    Updated 09/23/18:

    https://www.sciencedirect.com/science/article/pii/S096522991830133X?via%3Dihub

    Complement Ther Med. 2018 Oct;40:1-7.

    Effects of psyllium vs. placebo on constipation, weight, glycemia, and lipids: A randomized trial in patients with type 2 diabetes and chronic constipation.

    OBJECTIVE: To compare the effects of baked psyllium supplementation versus those who received a placebo on constipation symptoms, body weight, glycemic and lipids control in patients with type 2 diabetes (T2D) and chronic constipation.

    METHODS: In a single-blinded, randomized controlled trial, 51 patients with T2D and chronic constipation with body mass index (BMI) 20-47 kg/m2 received either 10 g of psyllium pre-mixed in cookies twice per day or placebo cookies for 12 weeks. Constipation symptoms, body mass index (BMI), fasting plasma glucose (FPG), glycosylated hemoglobin (HbA1c), and lipid profile were determined at the beginning and end of 4, 8, and 12-week period. Constipation was evaluated with a stool diary (ROME III).

    RESULTS: The psyllium group showed improvement in constipation symptoms, body weight, glucose and lipid values compared with the baseline and the placebo group. Body weight and FPG decreased from baseline in the psyllium group (P < 0.001 and P = 0.056, respectively). The differences (95% CI) of absolute change of body weight (-2.0 (-3.0, -1.0) kg; P < 0.001), FPG (-13.6 (-24.3, -2.9) mg/dl; P = .040), and HbA1c (-1.7 (-2.9, -0.5)); P = 0.002) between the groups were statistically significant. Cholesterol (-21.5 (-25.6, -14.4); P < 0.001), triglycerides (-20.0 (-32.3, -7.7); P = 0.021) and constipation symptoms (1.5 (0.4, 2.3); P < 0.001) decreased in the psyllium group. The compliance was good and no adverse effects were observed.

    CONCLUSION: In patients with T2D and chronic constipation, psyllium supplementation decreased constipation symptoms, body weight, glycemic, cholesterol, and increased HDLC levels.

    Be well!

    JP

  19. JP Says:

    Updated 01/24/19:

    https://www.mdpi.com/1422-0067/20/2/433/htm

    Int J Mol Sci. 2019 Jan 20;20(2).

    The Effect of Psyllium Husk on Intestinal Microbiota in Constipated Patients and Healthy Controls.

    Psyllium is a widely used treatment for constipation. It traps water in the intestine increasing stool water, easing defaecation and altering the colonic environment. We aimed to assess the impact of psyllium on faecal microbiota, whose key role in gut physiology is being increasingly recognised. We performed two randomised, placebo-controlled, double-blinded trials comparing 7 days of psyllium with a placebo (maltodextrin) in 8 healthy volunteers and 16 constipated patients respectively. We measured the patients’ gastrointestnal (GI) transit, faecal water content, short-chain fatty acid (SCFA) and the stool microbiota composition. While psyllium supplement had a small but significant effect on the microbial composition of healthy adults (increasing Veillonella and decreasing Subdoligranulum), in constipated subjects there were greater effects on the microbial composition (increased Lachnospira, Faecalibacterium, Phascolarctobacterium, Veillonella and Sutterella and decreased uncultured Coriobacteria and Christensenella) and alterations in the levels of acetate and propionate. We found several taxa to be associated with altered GI transit, SCFAs and faecal water content in these patients. Significant increases in three genera known to produce butyrate, Lachnospira, Roseburia and Faecalibacterium, correlated with increased faecal water. In summary, psyllium supplementation increased stool water and this was associated with significant changes in microbiota, most marked in constipated patients.

    Be well!

    JP

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