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on plasma
and
Tara
This
Mehta,
PhD
ofpsyllium to elucidate
controlled
total
and
lipoprotein
study was conducted to determine the effect cholesterol in healthy human subjects and
Seven males were given a nutritionally
cholesterolemic
mechanisms.
their usual intake for x = 3 wk followed by 3 wk in which 21 g/d per person psyllium husk was added to the basal diet. After 10 d and after 3 wk of psyllium supplementation, total, lowdensity, and high-density cholesterol were reduced (p 0.002, p 0.01, and p 0.03, respectively). Fecal steroid excretion, determined from 5-d collections, was not affected by psyllium
< < <
quantitated during meal the last day of each diet period were not different (p 0.05). Thus mechanism of psyllium may not involve increased bile acid excretion absorption. Am J Clin Nutr l988;47:67-74.
>
to delay
lipid
absorption,
plasma
triglycerides,
Psyllium
husk,
plasma
cholesterol,
fecal
steroid
excretion,
carbohydrate
ab-
types are
agents,
of dietary effective
particularly
lipoprotein
(LDL)
fraction
(1).
A fiber
of potential
use-
fulness
is psyllium.
from the
This
seed
highly
husk
branched
of Plantago
arabino
ovata
xylan
and
is obtained
forms a viscous gel when hydrated (2). Psyllium provides the basis for many bulk laxatives (3) and is already used by a significant portion of the population, particularly elderly people. Its efficacy as a cholesterol(especially LDL
cholesterol) lowering
agent
is important
to determine
in
of the known inverse relationship between plasma cholesterol and increased risk of heart disease. Dietary psyllium supplementation has a cholesterollowering effect in humans on some types of diets (3-6). However, there has been only one report of its effect on cholesterol in the lipoprotein subfractions and in that study LDL cholesterol was not quantitated (7). In these earlier studies either no dietary details were reported or low-residue semipurified diets were used. To date, the hypocholesterolemic mechanisms of gelforming fibers such as psyllium are not known. The
view mechanism of action may involve increased fecal excre-
to increase bile acid excreofpsyllium in test meals ofundefined composition was reported to attenuate postprandial plasma glucose and insulin responses (10, 1 1). The results of these studies suggest that both of the frequently hypothesized cholesterol-lowering mechanisms may be involved. However, psyllium-induced changes in gastrointestinal physiology have not been measured on a nonacute basis. Acute physiological effects caused by abrupt dietary changes may not mimic effects occurring after initial physiological adaptations to the diet have occurred. The purpose of this study is to determine if 3-wk psylhum supplementation in diets representative of the sub-
I From the Department of Food Science and Human Nutrition, Washington State University, Pullman, WA. 2 Presented in part at the 69th annual meeting of FASEB. Fed Proc
tion of bile acids and/or changes in the rate of nutrien#{149}s bsorbed a from the small intestine
supplementation
Am I C/in Nuir
44:2026(abstr). Scientific paper 7495, project 0475, College of and Home Economics Research Center, Washington State University, Pullman, WA. 3 Supported in part by a grant from Sigma Xi. 4 Address reprint requests to Dr Madeleine Mitchell, Department of Food Science and Human Nutrition, Washington State University, Pull1985;
Agriculture
man, WA 99164-2032.
ReceivedJuly 17, 1986. Accepted for publication
of psyllium-based
l988;47:67-74. Printed
compounds
in USA.
March
10, 1987. 67
1988 American
for Clinical
Nutrition
ABRAHAM
AND
MEHTA
in plasma
total
and
LDL
and
cholesterol
in lipid and
concentrations,
carbohydrate
fecal
absorption.
steroid
excretion,
Subjects
Subjects
and methods
On each of the last 5 d of the two diet periods, total fecal collections were made to determine changes in fecal acidic and neutral steroid excretion. During these collection periods, precise weights of the dietary intake of each individual were recorded. Aliquots of the diet were saved for fat analysis to determine apparent lipid digestibility.
Diet
Adult men were recruited by advertisement from the local community. Each subject filled out a health questionnaire and kept a 3-d diet record before the study. The record format was adapted from Western Regional Project W-l53 diet forms. Ten men participated in the study. However, three did not fall into the selected population because ofage or health or because their plasma cholesterol concentrations were 250 mg/dL, which was defined as hypercholesterolemic. Thus, data from these subjects have not been included. Information on the seven remaining subjects is given in Table 1. The experiment was approved by the Human Subjects Review Committee of Washington State University and informed consent was obtained from the participants.
>
Meals commonly
in a 4-d menu cycle and contained items A typical breakfast comprised fruit, bread or bread substitute with jam, bacon, and milk. A typical lunch comprised fish, chicken or meat sandwich, salad, fruit, and chocolate chip cookie. A typical dinner comprised meat loaf, cooked vegetable, salad, fruit, milk, and cake or pudding. A representative days menu is presented in Table 2. Subjects were allowed 170 mL ofwine/wk, which was served with the Saturday
dinner.
All food items were prepared in the Human Nutrition departmental kitchens and were served to the subjects in weighed portions. During the week, breakfasts and dinners were eaten in the departmental metabolic unit and bag lunches were pro-
Experimental
design
The study
consumed
consisted
a nutritionally
during
which
participants
(control) diet.
Western-style
A 3-wk treatment period followed during which the subjects consumed the same diet supplemented with 21 g ground psyffium husk/d: 7 g was incorporated into food items ofeach main meal.
vided. On Saturday evenings, the participants were given Sundays breakfast and lunch to eat at home and they returned to the metabolic unit for dinner. The subjects were asked to maintam the same level of phycal activity throughout the study. Subjects kept daily records ofphysical activity, stress level, hunger and satiation, and intake of free food items such as coffee, tea, and noncaloric sodas. The subjects weighed in daily before
breakfast.
To determine
trations,
14, 22,
on total cholesterol
was determined
on lipid and
concenon days
carbo-
fasting
32, and
cholesterol
effect
4,
of psyllium
The meal plans were designed to be similar to the diets described in the 3-d food records.
in nutrient
content
hydrate absorption rates was determined with meal tolerance tests (MTT). At the end of the control and psyllium-treatment periods, the subjects consumed a breakfast meal after fasting for 12 h. Blood samples were collected before the meal and postprandially at 0.5, 1, 1.5, 3, 6, and 9 h for the measurement of total plasma cholesterol and cholesterol in lipoprotein subfractions: triglyceride-rich lipoproteins (chylomicrons and verylow-density lipoproteins [CM/VLDL]), LDL, and high-density lipoproteins (HDL). Plasma insulin, glucose, glucagon, total and
Each individuals energy requirements were calculated from the Harris-Benedict formula (13). A 20% activity factor was added on the basis of the assumption that all the subjects were moderately sedentary.
Lipid and protein composition of the diet were analyzed by methods ofThe Association ofAnalytical Chemists (14). Energy content, cholesterol content, and fatty acid composition were calculated from tabulated values (15). Individual daily caloric intake varied but a constant composition of -30% fat, 16% protein, and 54% carbohydrate (as percent of daily energy con-
CM/VLDL
also
triglyceride,
and retinyl
ester concentrations
were
determined. Plasma retinyl esters have been used experimentally as CM markers and thus can be used to estimate the rate of exogenous lipid absorption (12). To obtain measurable amounts of plasma retinyl esters, 10 000 IU (3 mg) of retinol (Aquasol A drops, USV Pharmaceutical Corp. Tuckahoe, NY)
was incorporated
TABLE
Individual Subject
Fasting
plasma
cholesterol*
mg/dL
During the treatment period, half of the psyllium husk consumed was baked into muffins and cookies, and halfwas added uncooked to fruit drinks and peanut butter. The psyllium was added to the diet in incremental doses of 7 g, which were given after adjustment periods of 2 d for each dose, building to 21 g/d by 6 d. Foods consumed during the two MiT provided ---40% of the daily caloric intake and contained 20% ofthe energy as protein, 46% as carbohydrate, and 34% as fat. The two MiT were identical except that 10 g of psyllium was added to a cookie (7 g) and fruit drink (3 g) during the second MTT.
Sample collection and analysis
34
2
3 4 5 6 7
*
38
34 33 29 29 26
61.8
89.5 88.2 78.2 78.6 70.9 on blood
203 (5.3)
240 (6.2)
225 (5.8) 132 (3.4) 158 (4.1) 167 (4.3)
Determined
Blood samples were collected by venipuncture into vacutainer tubes containing EDTA for lipid analysis or heparin for glucose, insulin, and glucagon analysis. The tubes for glucagon analysis also contained 1.0 M benzamidine (0.1 mL/mL blood). The plasma was immediately separated by centrifugation at 1200 x g for 20 mm in a darkened room to prevent retinyl ester degradation and then stored at 20 #{176}C.
PSYLLIUM:
TABLE 2 Representative single days menu (per 2500 kcal)
EFFECT
ON
CHOLESTEROL
69
Item
Amount
g
Protein
g
Fat
g
Carbohydrate
g
Cholesterol mg
19.4 0.0
NDF g
0.0 0.9
muffin
24 56
7.0 2.0
12.5 1.0
0.7 25.0
Butter Grapejam
Fruit drinkt Banana Milk Lunch
10 20
50 112
3.9 0.1
0.1 3.9
8.1 0.0
0.1 3.9
0.0 14.0
11.1 5.4
22.0 0.0
0.0
16.0
0.0 0.0
0.7
0.0
72 16 98
40
20.0 0.2
9.4 0.4
5.6
12.2 2.3 0.0
Celery
Orange
40
320
0.4
3.2 2.5
0.0
0.3
11.2
1.5
36.1
30.1
Cookiet Dinner
Casserole Beef
53
0.3
90
27.0
3.5
0.0
Rice
Carrots
150
40
3.8
0.4 1.0 5.1 5.0 3.9
0.8
0.0 0.2
12.3
38.3
3.8 4.3
41.1
Tomatoes
Muffinst Broccoli Butter
100
92 150 10
0.5
2.9 0.0 0.0 0.0
0.2 8.1
7.7 0.0
Honey
Sherbert
*
32
150 detergent fiber. was added to these items during
0.0
1.4
0.0
1.8
26.3
46.2
Neutral
t Psyllium husk
the treatment
period.
subfractions,
<
CM/VLDL
1.063 g/mL), on a continuous
<
(density
and
1.063
g/mL)
were
density separated
gradient
(1.000-1.10
g/mL)
by ultracentrifugation
PEG excretion
during
were
so
neutral
sterols
were centrifuged in a Ti50 rotor head using a Beckman L8-70 ultracentrifuge (Beckman Instruments mc, Palo Alto, CA) at 165 500 x g for 10 h at 20 #{176}C (slow acceleration, no brake). Recoveries for the subfractions were 94-106%.
Total
according to the method of Nair et al (PP Nair, personal cornmunicatiori), which was a modification of previously published
methods (23). Bile acids were then methylated and quantitated on a gas chrornatograph (Hewlett-Packard Model 5840, Avondale, PA) equipped with a flame ionization detector using a 4-ft glass column packed with 3% OV- 1 7 on gas chrome Q (100120 mesh). Operating conditions were as follows: injection ternperature, 250 #{176}C; column temperature, 275 #{176}C; detector ternperature, 300 #{176}C; flow rate, 30 mL/rnin. and Peaks were quantified using an electronic integrator with cholic, chenodeoxycholic, deoxycholic, and lithocholic acids as standards (Cal Biochem-Behring Diagnostics, San Diego, CA). Neutral sterols
plasma
cholesterol
and cholesterol
in the lipoproteins
was analyzed
by the method
ofRudel
(18); triglyceride
and glu-
cose concentrations were determined by enzymatic methods using kits supplied by Waco Pure Chem Ind Inc (Osaka, Japan) and Sigma Chem (St Louis, MO), respectively. Insulin and glucagon were quantified at the Diabetes Research Center of the University of Washington (Seattle) using double-antibody radioimmunoassays (19, 20). Plasma retinyl esters were separated
on an alumina
sorbance
column
by UV ab-
at 326 nm. Daily stools were collected in preweighed frozen, and stored at -20 #{176}C. Polyethylene
were quantitated on a 6-ft 1% QF1 on gas chrome Q were as follows: injection perature, 190 #{176}C; detector
30 mL/min. Coprostanol,
glass column
(80-100 mesh).
packed
with
2% SE-30,
conditions
Operating
temperature, temperature,
coprostanone,
of each collection
were weight. thawed, Five-day weighed,
#{176}C. portion A portions
period
ofeach
as a fecal
aliquot was
Within
and
5 d feces
stored
bids
mc, Wilton,
NH)
were used
as standards.
at -40
lyophiized obtained
to a constant
by combining
dry-matter
Statistics Statistical comparisons for variables quantified done with analysis ofvariance using a repeated over time were measures model
representative
samples.
using
was determined
method of Malawar
the turbidimetric
and
Powell
(22).
70
(24). Fecal excretion t tests (25). Areas
ABRAHAM
AND
MEHTA
data were compared using paired Students under the plasma concentration curve were
calculated
<
using
the trapezoidal
method.
Differences
with p
-j
0
120
0.05 were
considered
to be significant.
LDL
ioo
Results The control diet was well tolerated by the subjects. After an initial bloated feeling, subjects ate the psyllium supplement without any reports of digestive distress. Changes in fasting plasma cholesterol over course of the study for subjects are shown in Figure 1. Fasting values were not different (p > 0.05) during the control period. With psyllium supplementation, fasting total cholesterol was decreased (p 0.002). The cholesterol concentration was lowest by a mean decrease of 35 mg/dL 10 d after starting supplementation. Concentrations remained lower, by a mean value of 30 mg/dL at the end of the 3-wk period of psyllium supplementation. The magnitude of the decrease tended to be greater in subjects with higher initial plasma cholesterol concentrations. Fasting and postprandial lipoprotein cholesterol concentrations after each MTT are presented in Figure 2. Fasting lipoprotein concentrations were not significantly different (p > 0.05); however, repeated measures analysis of all points indicated that psyllium supplementation reduced cholesterol concentrations in both LDL (p 0.01)
< <
(D
z
80
IF-
z
0
LU
z
0
C-)
80
..___-.
HOt.
-j
0
LU FC,)
:::::::::::2:::
4O
LU 0
C-)
20
A-
HOURS
FIG 2. Changes (mg/dL) over time mented (- A -) (HDL), low-density density lipoprotein eraged 44, 25, and psyllium-husk suppletests. For high-density lipoprotein lipoprotein (LDL), and chylomicrons and very-low(CM/VLDL) subfractions; standard deviations av59% oftheir respective means. The CM/VLDL levels
(-)
lipoprotein
cholesterol
concentration
#{149}and
-I 0
(D I
were not different, but the levels of LDL and HDL subfractions were significantly reduced with psyllium-husk supplementation (p < 0.01 and p < 0.03, respectively).
220
z
0
.< F-
-0---0--fr-----
1 2 3 4
F-
z
LU 0
180
.5
z
0
U
S
-A
6
7
and HDL (p 0.03) subfractions; the average decreases in the two subfractions were 15 mg/dL and 4 mg/dL, respectively (Fig 2). The CM/VLDL subfraction was not reduced (p 0.05) with psyllium. During both MTT, postprandial CM/VLDL cholesterol concentrations tended to rise during the first 1 .5 h, plateau, and then return to fasting values by 9 h. This pattern was not ob< >
I U,
served
in either
LDL
or HDL
subfractions.
-J
0.
The effects ofcontrol and psyllium-supplemented diets on colonic function and apparent lipid digestibility are summarized in Table 3. Data are means of 5-d fecal collections at the end of each treatment period. Fecal mass and dry matter were increased during the psyllium treatment
a i#{226}ao#{252}4o DAYS
period.
Fecal
moisture
content
was
increased
more
than
dry matter; thus, the percent creased with psyllium. Fecal defecation
different with the two diets. Psyllium
dry
maUer
was
was affect not
denot apdif-
FIG I Fasting plasma cholesterol concentrations for subjects over the course ofthe study. Theuirst three blood samples were taken during the control period and the last two during the psyllium-husk treatment period.
.
parent lipid digestibility. The total fecal steroid excretion ferent during the two diet periods. significant increase in cholesterol
nonand
PSYLLIUM:
EFFECT
ON
CHOLESFEROL
71
TABLE
3
fat digestibility for control and psyllium-
Discussion Psyllium-husk
erate-fat
supplementation
of conventional
mod-
Control
Fecalmass(g/d) Frequency (n/d) Dry matter (g/d) Dry master (%) Apparent fat 10463 I 1 26 8 27 4
Psyllium
223104 1 1 36 12 18 5 96 as
p
<0.001 NS < 0.004 < 0.001 NS
digestibiity
*
(%)
fat digestibility
96
Apparent
was calculated
-
diets can significantly decrease plasma cholesterol, particularly LDL cholesterol, in subjects whose cholesterol values are within the normal range. LDL cholesterol was the major lipoprotein decreased with psyllium but a significant decrease in HDL was also measured. Effects of water-soluble fibers on plasma HDL levels have not been consistent. Oat bran (26) and guar gum (27) supplementation resulted in slight decreases in HDL concentrations. There are no data for normal subjects but
hyperlipidemic
5-d intake
541
subjects
reported
given Guar
psyllium-supplemented
to have a 16% increase in
5 dexcretion intake
100
diets
for
10 d were
total
neutral
was
not
changed
in com-
as measured
by postprandial
gum supplementation of Fredrickson phenotype Type IIB subjects for 3 wk resulted in increased HDL (mean = 4.5%) but guar decreased HDL concentrations (mean = 8%) in Type hA subjects. In the same study after 8 wk ofguar supplementation, all subjects had HDL levels close to control values (28). Thus the
Downloaded from www.ajcn.org by on July 26, 2009
effect ofwater-soluble fibers may be influenced by genetic and length of the supplementation period. In five of seven subjects in this study, the HDL:LDL ratio increased. This indicates that the proportion ofplasma cholesterol carried by the HDL particle was increased in most subjects with psyllium supplementation. Thus, the decrease in HDL concentration observed in this study may not have had any clinical significance. Total excretion of the measured fecal steroids was not increased with psyllium supplementation, although as a result of the increase in fecal mass steroid concentration with psyllium was decreased. The only slight difference compared with the control diet was the small increase in fecal cholesterol with psyffium supplementation. In four ofthe subjects, the relative amount ofcholesterol increased as the relative amount of coprostanol and coprostanone decreased. Several investigators reported that humans can
HDL
cholesterol
(7).
changes in glucose, insulin, and glucagon, was not altered with psyllium supplementation (Table 5). Plasma glucose responses during both MTT were minimal. Insulin levels increased above fasting concentrations and peaked at 0.5 h; glucagon concentrations were slightly elevated from 1-3 h postprandially. Figure 3 illustrates retinyl ester, total triglyceride, and CM/VLDL triglyceride responses during the two MTT. No differences (p > 0.05) between treatments in lipid responses to the MiT were determined. However, plasma triglyceride and retinyl ester concentrations tended to be reduced postprandially (p < 0.09 and p < 0.08, respectively) with psyllium supplementation because of decreased plasma concentrations during the first 3 h. The
calculated area under the concentration curve (0-9 h) for
factors
the three lipid variables were, for control and psylliumsupplemented MiT, respectively, 103 1 460 and 1009 543 mg h/dL for total triglycerides, 647 370 and 685 377 mg h/dL for CM/VLDL triglycerides, and
. #{149}
be classified
lesterol changes
either
as nonconverters
or converters
of cho-
264
125 and
197 47
zg
h/dL
for retinyl
esters.
excretion
(mmol/d)
for control
periods*
steroids
Coprostanol C P
1.230
Coprostanone
C
0.036
Total
P
0.331
C
1.390
P
1.830
Mean
SD
1.307
0.396
0.499
0.258
Bile acids
0.083
0.124
0.306
0.665
Lithocholic
Deoxycholic
C Mean SD
*
P
0.720 0.202
>
C
0.484 0.637 between treatments
(p
0.05)
differences
were found
72 TABLE
Postprandial 5 changes in glucose, insulin, Glucose Time h 0 0.5 1
1.5
ABRAHAM
AND
MEHTA
and glucagon
with control
(P)-supplemented
meal
tolerance
tests Glucagon
pmol/L
4.60.3
5.10.8
pmol/L
36 12 417161 280 95 274173 89 54 42 18 42 18 measured. 17 18 19 1911 19 17 16 5 6 7 6 9 6 175 185 205 216 216 175 186
4.30.4
4.50.7
3 6 9
*
No significant
(p
>
0.05)
differences
verters to nonconverters and vice versa. Generally it is believed that changes are the result of alterations in the intestinal microbial population (30). Psyllium is a preferential substrate for Bacteroides ovatus, a normal bacterial component of human fecal flora (3 1). It is possible
in fecal
the
equivalent
of 9.6
plasma
cholesterol
was decreased
by an average
of 20%
that consumption
these sumption
in
ofpsyllium
resulted
in relative
increases
bacteria. induces
zyme
activity.
Such
degradation
changes
could
have
altered
the rate
of bacterial
of cholesterol.
z
0
FF-
.z cr
from control values and this decrease was sustained for the 6-wk supplementation period. They measured no change in neutral sterol excretion, but a significant increase in bile acid excretion (302% ofcontrol values) was observed. However, the subjects diets were not controlled and throughout the study fecal steroids were measured only from 24-h fecal collections (32). Results ofthis magnitude have not been reported elsewhere with psyllium or in other studies where a water-soluble fiber was fed to healthy subjects (33). Short-term studies have been conducted by two other groups. Stanley et al fed 15 g/d Metamucil#{174}, a product containing psyllium, to normal subjects and measured the fecal excretion of 4-4C-cholate and its bacterial products. After 4 d ofsupplementation, fecal cholate concentrations were 1 .7 times control values (9). Miettinen fed nine hypercholesterolemic subjects 30 g/d of another psyllium-based preparation for 10 d and measured changes in plasma cholesterol, cholesterol absorption, and fecal steroid excretion. He reported significant decreases in plasma free cholesterol, and fecal bile acid excretion
z
0
Ui C)
C-)
a
0. -4
Plasma
trIgIyC.rjdes (mg/dI)
-J
I
was increased
by an average
of 122 mg/d.
No changes
occurred (7).
in
in
C,)
-J
0.
The increase in fecal bile acid excretion reported in these short-term studies may have been transient effects associated with the initial physiological adaptation period and related to large decreases in blood cholesterol such
as we measured 10 d after initiating psyllium supplementation. These acute effects may not, however, be associated with a longer-term cholesterol-lowering mechanism observed in our study. None of the above studies gave any details about their control diets. It is possible that differences in the composition ofcontrol diets can help to explain inconsistencies in results between this study and earlier reports. If lowresidue control diets were used in earlier studies, then
HOURS in plasma lipid concentrations over time with control and psyllium-husk-supplemented (A -) meal tolerance tests. For plasma triglycerides, chylomicrons and very-low-density lipoprotein (CM/VLDL) triglycerides, and retinyl esters, SDs averaged 53, 59, and 40% of their respective means.
(-
FIG 3. Changes
I
-)
PSYLLIUM:
EFFECT
ON
CHOLESTEROL
73 secretogogue
release.
there would be a comparison between a diet with fiber vs a diet without fiber rather than a measure of the effect of a specific type offiber. For example, Miettinen (7) reported that fecal bile acid excretion was not significantly different between cellulose and a psyllium-based supplement. This suggests that a low-residue control diet may have been
used because fiber sources properties caused increased with very different bile acid excretion
what constitutes
glucose
only
is a potent
stimulant
for
insulin,
it is not
other compo-
the
of insulin
Possibly
physical compared
fiber
with
the control.
data defining a normal
Population
intake in the United States not available data from British studies (34), however,
presently. From it appears that the average daily NDF intake of 17 g used in this study is fairly typical of Western nonvegetarian diets. Our results, then probably represent effects in a realistic situation.
nents of our test meal such as amino acids, which also stimulate insulin secretion, caused the postprandial rises. Psyllium supplementation did appear to have a small effect on the rate oflipid absorption. Plasma triglycerides and particularly retinyl esters were reduced postprandially with psyllium. In four subjects in our study, the decrease in retinyl ester concentration after the psylliumsupplemented MTT was most pronounced during the first 1 .5 h postprandially; plasma concentrations were equal
to or greater than control values
at later times.
Similarly,
husk did not cause increased excretion of acids when used in conjunction with a diet.
plasma total triglycerides 3 h of the MTT but The methods we used not separate CM from glycenides specifically information about the
were decreased during the first CM/VLDL triglycerides were not. for lipoprotein determination did VLDL. Changes in plasma CM tnwould have given more conclusive rate ofexogenous lipid absorption.
No effect of psyllium was noted in plasma glucose, insulin, or glucagon responses during control and psyllium MiT. Also, there was no significant postprandial blood glucose rise. These results are in contrast to earlier pub-
However,
our data
on the other
two
variables
indicate
a
Downloaded from www.ajcn.org by on July 26, 2009
lished
results
with
psyllium
(10,
of these
1 1) and guar
fiber sources
and
into
pectin
test
normal subjects resulted in significant decreases in postprandial blood glucose and insulin responses. The lack ofglucose response we observed may have resulted from the relative nutrient composition of our test meal, which contained 46% of the energy as carbohydrate, 34% as fat, and 20% as protein. Although dietary details ofthe psyffium test meals in the earlier studies were not given, the guar and pectin test meals that were used were proportionately higher in carbohydrate (> 55%). Morgan et al (36) measured plasma glucose and hormonal responses to meals consisting primarily of carbohydrate, fat, or protein with or without 5 g guar gum. Both the fat and the protein meals elicited no rise of plasma glucose from baseline levels. In response to the carbohydrate meal, there were rises in both glucose and insulin that were attenuated with the addition of guar
(38). Coulston et al (39) compared postprandial glucose
delay in absorption. The intestine and liver are both sources of triglycerides in postprandial CM/VLDL partides. Initially after consuming a meal, insulin release stimulates hepatic synthesis of VLDL. It is possible that with psyllium a relatively smaller early contribution of triglycerides of intestinal origin together with the insulin
stimulus resulted in a greater initial release of hepatic
VLDL
early
in comparison
elevation
with
the control
observed
MTT.
in the
Thus,
psyllium
the of
of CM/VLDL
MTT
could
represent
proportionately
more
particles
hepatic origin. The cholesterol-lowering mechanism of psyllium does not appear to involve the increased excretion of fecal steroids. Our results on the effect of psyllium on lipid absorption are preliminary; further research will be necessary to determine if delayed lipid absorption is a consistent
effect.
#{163}3
We acknowledge the assistance given by Dr PP Nair in determining fecal steroids. Much appreciation is given to the 10 individuals who were our subjects and who made this study possible.
high (40%
plasma
carbohydrate on an energy
glucose not on the
(60% basis)
highThe
References
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carbohydrate
diet
the
to be higher
than
were
the control
significant.
at each
changes in insulin concentrations on the 60% carbohydrate diet also were greater than on the 40% diet. In this study, MTT were given after 3 wk of psyllium
supplementation. In most other studies, MTT were given
on an acute basis with no time for adaptation to the test fiber. Longer-term physiological effects offiber consumption may not mimic acute effects. For example, Tarpila
(40) fed a psyllium-based preparation for In this 10 d and study oh-
served
sponse
no attenuation
to a glucose
of plasma
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insulin
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