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