Lipid- and Glucose-Lowering Efficacy of Plantago Psyllium in Type II Diabetes

doi:10.1016/S1056-8727(98)00003-8

Journal of Diabetes and its Complications

Volume 12, Issue 5, September–October 1998, Pages 273-278

https://doi.org/10.1016/S1056-8727(98)00003-8 Get rights and content

Abstract

The beneficial effect of dietary fiber in the management of type II diabetes is still controversial and has not been totally demonstrated. The purpose of this study was to determine the plasma-lowering effects of 5 g t.i.d. of Plantago Psyllium, as an adjunct to dietary therapy, on lipid and glucose levels, in patients with type II diabetes. Patients were randomly selected from an outpatient clinic of primary care to participate in a double-blind placebo-controlled study in which Plantago Psyllium or placebo was given in combination with a low fat diet. One hundred twenty-five subjects were included in the study that consisted in a 6-week period of diet counseling followed by a 6-week treatment period. Fasting plasma glucose, total plasma cholesterol, LDL cholesterol, HDL cholesterol and triglyceride levels were measured every 2 weeks. The test products (Psyllium or placebo) were supplied to subjects in identically labeled foil packets containing a 5-g dose of product, to consume three doses per day (of 5 g each one), before regular meals. There was an excellent tolerance to Psyllium, without significant adverse effects. No significant changes were observed in the patient’s weight for

both groups (not significant). Fasting plasma glucose, total cholesterol, LDL cholesterol, and triglycerides levels, showed a significant reduction (p < 0.05), whereas HDL cholesterol increased significantly (p < 0.01) following Psyllium treatment. Our results show that 5 g t.i.d. of Psyllium is useful, as an adjunct to dietary therapy, in patients with type II diabetes, to reduce plasma lipid and glucose levels, resolving the compliance conflict associated with the ingest of a great amount of fiber in customary diet.

Introduction

Dietary fiber is defined as the portion of plants that is composed of complex carbohydrate polymers of simples sugars, and is commonly classified by its water solubility.¹ Soluble fibers consist of gel-forming substances, such as pectin, gum, and mucilage that tend to be efficiently degraded by bacteria in the colon. Insoluble fibers consist of structural or matrix fiber such as, lignin, cellulose, and some hemicellulose that passes through the body unchanged.1, 2 The fiber used in this study, Plantago Psyllium, is a water-soluble fiber derived from the husks of blonde Psyllium seeds.² The beneficial effect of dietary fiber for reducing cholesterol levels in patients with hypercholesterolemia is well recognized;1, 2, 3, 4, 5 whereas the effect on glucose serum levels of a diet supplemented with soluble fibers varies according the dosage used;6, 7, 8, 9, 10 in this concern, has been probed different doses of Psyllium, varying from 3.5 g b.i.d.⁶ to 7 g t.i.d.¹¹ immediately before main meals. The beneficial effect of Psyllium is dose related.¹² At low dose (7 g per day), there are no effects on glucose levels;⁶ but when the dose is increased (20 g per day) show a significant reduction in both, basal and postprandial hyperglycemia.7, 8, 9, 11, 13 Nevertheless, the side effects of Psyllium are also dose related affecting the adherence.14, 15 So, the benefits of a high-fiber diet on reducing glucose levels are still controversial,14, 15 and has not been totally studied or appropriately shown in type II diabetes. In this concern, there are data that show the benefits of a high-carbohydrate, high-fiber, low-fat diet for improving the glycemic control in subjects with type II diabetes.⁵ Nevertheless, the great majority of these studies were not well controlled and confounding variables were present.¹⁵

Considering that ingestion of soluble fiber before regular meals could be a factor to improving the customary diet content, the objective of this study was to determine the plasma-lowering-effects of 5 g t.i.d. of Plantago Psyllium, as an adjunct to dietary therapy, on glucose, cholesterol, and triglyceride levels, in patients with type II diabetes.

Section snippets

Subjects

Patients, men and women with type II diabetes, randomly selected from an out patient clinic of primary care and volunteered to participate in the study were included. All admitted subjects gave informed consent to participate in the clinical study, which was reviewed and approved by the Mexican Social Security Institute Investigation Committee of Durango, Durango, Mexico. Entry criteria were as follows: age 30–75 years and a 6-week period for diet counseling. Exclusion criteria included

Results

One hundred twenty-five subjects were included, 62 and 63 in Psyllium and placebo group, respectively. Dietary compliance was excellent. Patients don’t modify the composition of their diet, were on Psyllium or placebo. In both groups there were no significant changes in percentages of calories derived from fat and carbohydrates when baseline and posttreatment values were compared, Table 1. Patients consumed 93% of the Psyllium and 96.2% of the placebo doses. There were two dropouts in group A,

Discussion

Viscous fiber affects the body metabolism by its actions within the proximal digestive tube.2, 4 In the bowel, soluble fibers bind, adsorb, or sequester bile acids, products of fat digestion, fatty acids and monoglycerides during passage through the intestinal lumen.2, 17, 18 Also, soluble fibers delay gastric emptying and increase unstirred water in the small bowel producing satiety.¹ Epidemiological and clinical data suggest that dietary fiber plays an important role in controlling

References (33)

U Smith et al.
Effect of a modified guar gum preparation on glucose and lipid levels in diabetic and healthy volunteers
Atherosclerosis
(1982)
T.K Ray et al.
Long-term effects of dietary fiber on glucose tolerance and gastric emptying in non-insulin dependent diabetic patients
Am J Clin Nutr
(1983)
R.R Gupta et al.
Lipid-lowering efficacy of Psyllium hydrophilic mucilloid in non insulin dependent diabetes mellitus with hyperlipidaemia
Indian Med Res
(1994)
J.G Pastors et al.
Psyllium fiber reduces rise in postprandial glucose and insulin concentrations in patients with non-insulin-dependent diabetes
Am J Clin Nutr
(1991)
D.S Gray
The clinical uses of dietary fiber
AFP
(1995)
R Hunt et al.
Therapeutic role of dietary fibre
Can Fam Physician
(1993)
L.P Bell et al.
Cholesterol-lowering effects of Pysllium hydropholic mucilloid
JAMA
(1989)
D.L Sprecher et al.
Efficacy of Psyllium in reducing serum cholesterol levels in hypercholesterolemic patients on high- or low-fat diets
Ann Intern Med
(1993)
W.G Bennet et al.
Benefits of dietary fiber
Postgrad Med
(1996)
H.A Jarjis et al.
The effect of ispaghula (Fybogel and Metamucil) and guar gum on glucose tolerance in man
Br J Nutr
(1984)

B.A Leatherdale et al.

Guar and gastric emptying in non-insulin dependent diabetes

Acta Diabetol Lat

(1982)

A Aro et al.

Improved diabetic control and hypocholesterolemic effect induced by long-term dietary supplementation with guar gum in type 2 (insulin-dependent) diabetes

Diabetologia

(1981)

F.A Frati-Munari et al.

Efecto de diferentes dosis de mucilago de plantago psyllium en la prueba de tolerancia a la glucosa

Arch Invest Med

(1989)

K.M Behall

Effect of soluble fibers on plasma lipids, glucose tolerance and mineral balance

Adv Exp Med Biol

(1990)

R Tattersal et al.

Benefits of fibre itself are uncertain

BMJ

(1990)

F.Q Nuttall

Dietary fiber in the management of diabetes

Diabetes

(1993)

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Original ArticleLipid- and Glucose-Lowering Efficacy of Plantago Psyllium in Type II Diabetes

Abstract

Introduction

Section snippets

Subjects

Results

Discussion

Atherosclerosis

Am J Clin Nutr

Indian Med Res

Am J Clin Nutr

The clinical uses of dietary fiber

AFP

Therapeutic role of dietary fibre

Can Fam Physician

Cholesterol-lowering effects of Pysllium hydropholic mucilloid

JAMA

Efficacy of Psyllium in reducing serum cholesterol levels in hypercholesterolemic patients on high- or low-fat diets

Ann Intern Med

Benefits of dietary fiber

Postgrad Med

The effect of ispaghula (Fybogel and Metamucil) and guar gum on glucose tolerance in man

Br J Nutr