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Therapeutic effects of psyllium in type 2 diabetic patients

Abstract

Objective: The aim of this study was to evaluate the effects of psyllium in type 2 diabetic patients.

Design: The study included three phases: phase 1 (1 week), phase 2 (treatment, 14 g fibre/day, 6 weeks) and phase 3 (4 weeks). At the end of each phase a clinical evaluation was performed after the ingestion of a test breakfast of 1824.2 kJ (436 kcal). Measurements included concentrations of blood glucose, insulin, fructosamine, GHbA1c, C-peptide and 24 h urinary glucose excretion. In addition, uric acid, cholesterol and several mineral and vitamin concentrations were also evaluated.

Setting: The study was performed at the Department of Pharmacology, Toxicology and Nursing at the University of León (Spain).

Subjects: Twenty type 2 diabetic patients (12 men and 8 women) participated in the study with a mean age of 67.4 y for men and 66 y for women. The mean body mass index of men was 28.2 kg/m2 and that of women 25.9 kg/m2.

Results: Glucose absorption decreased significantly in the presence of psyllium (12.2%); this reduction is not associated with an important change in insulin levels (5%). GHbA1c, C-peptide and 24 h urinary glucose excretion decreased (3.8, 14.9 and 22.5%, respectively) during the treatment with fibre (no significant differences) as well as fructosamine (10.9%, significant differences). Psyllium also reduced total and LDL cholesterol (7.7 and 9.2%, respectively, significant differences), and uric acid (10%, significant difference). Minerals and vitamins did not show important changes, except sodium that increased significantly after psyllium administration.

Conclusions: The results obtained indicate a beneficial therapeutic effect of psyllium (Plantaben®) in the metabolic control of type 2 diabetics as well as in lowering the risk of coronary heart disease. We also conclude that consumption of this fibre does not adversely affect either mineral or vitamin A and E concentrations. Finally, for a greater effectiveness, psyllium treatment should be individually evaluated.

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References

  • American Diabetes Association. 1987 Nutritional recommendations and principles for individuals with diabetes mellitus: 1986 Diabetes Care 10: 126–132

  • Anderson JW . 1985a Physiological and metabolic effects of dietary fiber Fed. Proc 44: 2902–2906

    CAS  PubMed  Google Scholar 

  • Anderson JW . 1985b High-fiber diets for obese diabetic men on insulin therapy: short-term and long-term effects Curr. Top. Nutr. Dis 14: 49–53

    Google Scholar 

  • Anderson JW, Allgood LD, Turner J, Oeltgen PR, Daggy BP . 1999 Effects of psyllium on glucose and serum lipid responses in men with type 2 diabetes and hypercholesterolemia Am. J. Clin. Nutr 70: 466–473

    Article  CAS  Google Scholar 

  • Behall KM . 1990 Effect of soluble fibers on plasma lipids, glucose tolerance and mineral balance Adv. Exp. Med. Biol 270: 7–16

    Article  CAS  Google Scholar 

  • Behall KM, Scholfield DJ, McIvor ME, Van Duyn MS, Leo TA, Michnowski JE, Cummings CC, Mendeloff AI . 1989 Effect of guar gum on mineral balances in NIDDM adults Diabetes Care 12: 357–364

    Article  CAS  Google Scholar 

  • Bell LP, Hectorne K, Reynolds H, Balm TK, Hunninghake DB . 1989 Cholesterol-lowering effects of psyllium hydrophilic mucilloid. Adjunct therapy to a prudent diet for patients with mild to moderate hypercholesterolemia JAMA 261: 3419–3423

    Article  CAS  Google Scholar 

  • Blake DE, Hamblett CJ, Frost PG, Judd PA, Ellis PR . 1997 Wheat bread supplemented with depolymerized guar gum reduces the plasma cholesterol concentration in hypercholesterolemic human subjects Am. J. Clin. Nutr 65: 107–113

    Article  CAS  Google Scholar 

  • Botha AP, Steyn AF, Esterhuysen AJ, Slabbert M . 1981 Glycosylated hemoglobin, blood glucose and serum cholesterol levels in diabetics treated with guar gum S. Afr. Med. J 59: 333–334

    CAS  PubMed  Google Scholar 

  • Brenelli SL, Campos SD, Saad MJ . 1997 Viscosity of gums in vitro and their ability to reduce postprandial hyperglycemia in normal subjects Braz. J. Med. Biol. Res 30: 1437–1440

    Article  CAS  Google Scholar 

  • Carroll DG, Dykes V, Hodgson W . 1981 Guar gum is not a panacea in diabetes management NZ Med. J 93: 292–294

    CAS  Google Scholar 

  • Chuang LM, Jou TS, Yang WS, Wu HP, Huang SH, Tai TY, Lin BJ . 1992 Therapeutic effect of guar gum in patients with non-insulin-dependent diabetes mellitus J Formos. Med. Assoc 91: 15–19

    CAS  PubMed  Google Scholar 

  • Davidson MH, Maki KC, Kong JC, Dugan LD, Torri SA, Hall HA, Drennan KB, Anderson SM, Fulgoni VL, Saldanha LG, Olson BH . 1998 Long-term effects of consuming foods containing psyllium seed husk on serum lipids in subjects with hypercholesterolemia Am. J. Clin. Nutr 67: 367–376

    Article  CAS  Google Scholar 

  • Driskell WJ, Neese JW, Bryant CC, Bashor MM . 1982 Measurement of vitamin A and vitamin E in human serum by high-performance liquid chromatography J. Chromatogr 231: 439–444

    Article  CAS  Google Scholar 

  • Ebeling P, Yki-Härvinen H, Aro A, Helve E, Sinisalo M, Koivisto VA . 1988) Glucose and lipid metabolism and insulin sensitivity in type 1 diabetes: the effect of guar gum Am. J. Clin. Nutr 48: 98–103

    Article  CAS  Google Scholar 

  • Ellis PR, Dawoud FM, Morris ER . 1991 Blood glucose, plasma insulin and sensory responses to guar-containing wheat breads: effects of molecular weight and particle size of guar gum Br. J. Nutr 66: 363–379

    Article  CAS  Google Scholar 

  • Elsenhans B, Süfke U, Blume R, Caspary WF . 1980 The influence of carbohydrate gelling agents on rat intestinal transport of monosaccharides and neutral amino acids in vitro Clin. Sci 59: 373–380

    Article  CAS  Google Scholar 

  • Elsenhans B, Süfke U, Blume R, Caspary WF . 1981 In vitro inhibition of rat intestinal surface hydrolisis of disaccharides and dipeptides by guaran Digestion 21: 98–103

    Article  CAS  Google Scholar 

  • Elsenhans B, Zenker D, Caspary WF, Blume R . 1984 Guaran effect on rat intestinal absorption Gastroenterology 86: 645–653

    CAS  PubMed  Google Scholar 

  • Fagerberg SE . 1982 The effects of a bulk laxative (Metamucil) on fasting blood glucose, serum lipids and other variables in constipated patients with non-insulin dependent adult diabetes Curr. Ther. Res 31: 165–172

    Google Scholar 

  • Fairchild RM, Ellis PR, Byrne AJ, Luzio SD, Mir MA . 1996 A new breakfast cereal containing guar gum reduces postprandial plasma glucose and insulin concentrations in normal-weight human subjects Br. J. Nutr 76: 63–73

    Article  CAS  Google Scholar 

  • Finley PR, Schifman RB, Williams RJ, Lichti DA . 1978 Cholesterol in high-density lipoprotein: use of Mg2+ dextran sulphate in its enzymatic measurement Clin. Chem 24: 931–933

    CAS  PubMed  Google Scholar 

  • Florholmen J, Arvidsson-Lenner R, Jorde R, Burhol PG . 1982 The effect of Metamucil on postprandial blood glucose and plasma gastric inhibitory peptide in insulin-dependent diabetics Acta Med. Scand 212: 237–239

    Article  CAS  Google Scholar 

  • Frati-Munari AC, Fernandez-Harp JA, Becerril M, Chavez-Negrete M, Bañales-Ham M . 1983 Decrease in serum lipids, glycemia and body weight by Plantago psyllium in obese and diabetic patients Arch. Invest. Med. (Mex.) 14: 259–268

    CAS  Google Scholar 

  • Friedewald WT, Levy RI, Fredrickson DS . 1972 Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge Clin. Chem 18: 499–502

    CAS  PubMed  Google Scholar 

  • Fuessl HS, Williams G, Adrian TE, Bloom SR . 1987 Guar sprinkled on food: effect on glyceamic control, plasma lipids and gut hormones in non-insulin dependent diabetic patients Diabetes Med 4: 463–468

    Article  CAS  Google Scholar 

  • Gatenby SJ, Ellis PR, Morgan LM, Judd PA . 1996 Effect of partially depolymerized guar gum on acute metabolic variables in patients with non-insulin-dependent diabetes Diabetes Med 13: 358–364

    Article  CAS  Google Scholar 

  • Gray DS . 1995 The clinical uses of dietary fiber Am. Fam. Physician 51: 419–423

    CAS  PubMed  Google Scholar 

  • Groop PH, Groop L, Tötterman KJ, Fyhrquist F . 1986 Relationship between changes in GIP concentrations and changes in insulin and C-peptide concentrations after guar gum therapy Scand. J. Clin. Lab. Invest 46: 505–510

    Article  CAS  Google Scholar 

  • Groop PH, Aro A, Stenman S, Groop L . 1993 Long-term effects of guar gum in subjects with non-insulin dependent diabetes mellitus Am. J. Clin. Nutr 58: 513–518

    Article  CAS  Google Scholar 

  • Holman RR, Steemson J, Darling P . 1987 No glycemic benefit from guar administration in NIDDM Diabetes Care 10: 68–71

    Article  CAS  Google Scholar 

  • Holt S, Heading RC, Carter DC, Prescott LF, Tothill P . 1979 Effect of gel fiber on gastric emptying and absorption of glucose and paracetamol Lancet 1: 636–639

    Article  CAS  Google Scholar 

  • Hopman WPM, Houben PGMP, Speth PAJ, Lamers CBHW . 1988 Glucomannan prevents postprandial hypoglycaemia in patients with previous gastric surgery Gut 29: 930–934

    Article  CAS  Google Scholar 

  • Jarjis HA, Blackburn NA, Redfern JS, Read NW . 1984 The effect of ispaghula (Fybogel and Metamucil) and guar gum on glucose tolerance in man Br. J. Nutr 51: 371–378

    Article  CAS  Google Scholar 

  • Jenkins DJ, Leeds AR, Gassull MA, Cochet B, Alberti GM . 1977 Decrease in postprandial insulin and glucose concentrations by guar and pectin Ann. Intern. Med 86: 20–23

    Article  CAS  Google Scholar 

  • Jenkins DJA, Wolever TMS, Leeds AR, Gassull MA, Haisman P, Dilawari J, Goff DV, Metz GL, Alberti KG . 1978 Dietary fibers, fiber analogues, and glucose tolerance: importance of viscosity Br. Med. J 1: 1392–1394

    Article  CAS  Google Scholar 

  • Johnson IT, Gee JM . 1981 Effect of gel forming gums on the intestinal unstirred layer and sugar transport in vitro Gut 22: 398–403

    Article  CAS  Google Scholar 

  • Jones DB, Slaughter P, Lousley S, Carter RD, Jelfs R, Mann JI . 1985 Low-dose guar improves diabetic control J. R. Soc. Med 78: 546–548

    Article  CAS  Google Scholar 

  • Kiehm TG, Anderson JW, Ward K . 1976 Beneficial effects of a high carbohydrate, high fiber diet on hyperglycemic diabetic men Am. J. Clin. Nutr 29: 895–899

    Article  CAS  Google Scholar 

  • Kuzuya T, Saito T, Yoshida S . 1976 Human C-peptide immunoactivity (CPR) in blood and urine: evaluation of radioimmunoassay method and its clinical applications Diabetologia 12: 511–518

    Article  CAS  Google Scholar 

  • Lawaetz O, Blackburn AM, Bloom SR, Aritas Y, Ralphs DNL . 1983 Effect of pectin on gastric emptying and gut hormone release in the dumping syndrome Scand. J. Gastroenterol 18: 327–336

    Article  CAS  Google Scholar 

  • Lembcke B, Ebert R, Ptok M, Caspary WF, Creutzfeldt W, Schicha H, Emrich D . 1984 Role of gastrointestinal transit in the delay of absorption by viscous fibre (guar) Hepatogastroenterology 31: 183–186

    CAS  PubMed  Google Scholar 

  • Lim HS, Ee CH, Aw TC . 1990 Effects of low dose guar gum in non-insulin dependent diabetic patients Ann. Acad. Med. Singapore 19: 455–459

    CAS  PubMed  Google Scholar 

  • Lloyd D, Marples J . 1984 Simple colorimetry of glycated serum protein in a centrifugal analyzer Clin. Chem 28: 59–62

    Google Scholar 

  • MacMahon M, Carless J . 1998 Ispaghula husk in the treatment of hypercholesterolaemia: a double-blind controlled study J. Cardiovasc. Risk 5: 167–172

    Article  CAS  Google Scholar 

  • Nuttall FQ . 1983 Diet and the diabetic patient Diabetes Care 6: 197–207

    Article  CAS  Google Scholar 

  • Oliver SD . 2000 The long-term safety and tolerability of ispaghula husk J. R. Soc. Health 120: 107–111

    Article  CAS  Google Scholar 

  • Pastors JG, Blaisdell PW, Balm TK, Asplin CM, Pohl SL . 1991 Psyllium fiber reduces rise in postprandial glucose and insulin concentrations in patients with non-insulin-dependent diabetes Am. J. Clin. Nutr 53: 1431–1435

    Article  CAS  Google Scholar 

  • Rendell M . 2000 Dietary treatment of diabetes mellitus New Engl. Med. J 342: 1440–1441

    Article  CAS  Google Scholar 

  • Rigaud D, Paycha F, Meulemans A, Merrouche M, Mignon M . 1998 Effect of psyllium on gastric emptying, hunger feeling and food intake in normal volunteers: a double blind study Eur. J. Clin. Nutr 52: 239–245

    Article  CAS  Google Scholar 

  • Rodríguez-Morán M, Guerrero-Romero F, Lazcano-Burciaga G . 1998 Lipid and glucose-lowering efficacy of Plantago psyllium in type II diabetes J. Diabetes Complications 12: 273–278

    Article  Google Scholar 

  • Romero AL, Romero JE, Galaviz S, Fernandez ML . 1998 Cookies enriched with psyllium or oat bran lower plasma LDL-cholesterol in normal and hypercholesterolemic men from Northern Mexico J. Am. Coll. Nutr 17: 601–608

    Article  CAS  Google Scholar 

  • Sandhu KS, el Samahi MM, Mena I, Dooley CP, Valenzuela JE . 1987 Effect of pectin on gastric emptying and gastroduodenal motility in normal subjects Gastroenterology 92: 486–492

    Article  CAS  Google Scholar 

  • Sartor G, Carlström S, Scherstén B . 1981 Dietary supplementation of fibre (Lunelax®) as a mean to reduce postprandial glucose in diabetics Acta Med. Scand. Suppl 656: 51–53

    CAS  PubMed  Google Scholar 

  • Schmidt FH . 1961 Die enzymatische Bestimmung von Glucose und Fructose nebeneinander Klin. Wschr 39: 1244–1247

    Article  CAS  Google Scholar 

  • Segawa K, Kataoka T, Fukuo Y . 1998 Cholesterol-lowering effects of psyllium seed associated with urea metabolism Biol. Pharm. Bull 21: 184–187

    Article  CAS  Google Scholar 

  • Sierra M, García JJ, Fernández N, Diez MJ, Calle AP, Sahagun AM Farmafibra Group. 2001 Effects of Ispaghula husk and guar gum on postprandial glucose and insulin concentrations in healthy subjects Eur. J. Clin. Nutr 55: 235–243

    Article  CAS  Google Scholar 

  • Smith U, Holm G . 1982 Effect of a modified guar gum preparation on glucose and lipid levels in diabetics and healthy volunteers Atherosclerosis 45: 1–10

    Article  CAS  Google Scholar 

  • Stahl M, Berger W . 1990 Comparison of guar gum, wheat bran and placebo on carbohydrate and lipid metabolism in type II diabetics Schweiz. Med. Wochenschr 120: 402–408

    CAS  PubMed  Google Scholar 

  • Uribe M, Dibildox M, Malpica S, Guillermo E, Villallobos A, Nieto L, Vargas F, Garcia Ramos G . 1985 Beneficial effect of vegetable protein diet supplemented with psyllium plantago in patients with hepatic encephalopathy and diabetes mellitus Gastroenterology 88: 901–907

    Article  CAS  Google Scholar 

  • Weatherburn MW, Logan JE . 1966 A simplified quantitative enzymatic procedure for glucose in urine Diabetes 15: 127–129

    Article  CAS  Google Scholar 

  • Weinstock RS, Levine RA . 1988 The role of dietary fiber in the management of diabetes mellitus Nutrition 4: 187–193

    Google Scholar 

  • Wolever TM, Vuksan V, Eshuis H, Spadafora P, Peterson RD, Chao ES, Storey ML, Jenkins DJ . 1991 Effect of method of administration of psyllium on glycemic response and carbohydrate digestibility J. Am. Coll. Nutr 10: 364–371

    Article  CAS  Google Scholar 

  • Wursch P, Pi-Sunyer FX . 1997 The role of viscous soluble fiber in the metabolic control of diabetes: a review with special emphasis on cereals rich in beta-glucan Diabetes Care 20: 1774–1780

    Article  CAS  Google Scholar 

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Acknowledgements

We wish to thank Madaus, S.A. Laboratory for the products supplied and for their economic collaboration in this study, the volunteers for their co-operation and Dr D Carriedo, Head of Service of the Hospital de León, Dr JC Alvarez and MA Gonzalez, members of the INSALUD Program for Diabetes Education and Control for their advice in the setting up and execution of this study

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Sierra, M., García, J., Fernández, N. et al. Therapeutic effects of psyllium in type 2 diabetic patients. Eur J Clin Nutr 56, 830–842 (2002). https://doi.org/10.1038/sj.ejcn.1601398

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  • DOI: https://doi.org/10.1038/sj.ejcn.1601398

Keywords

  • type 2 diabetic patients
  • ispaghula husk
  • psyllium
  • dietary fibre
  • glucose
  • insulin
  • cholesterol
  • capillary blood glucose
  • metabolic variables

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