Skip to main content
SpringerLink
Log in

Guar Attenuates Fall in Postprandial Blood Pressure and Slows Gastric Emptying of Oral Glucose in Type 2 Diabetes

  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

Abstract

Postprandial hypotension occurs frequently in diabetes; the fall in blood pressure is greatest after ingestion of carbohydrate, particularly glucose and, in type 2 diabetes, is related to the rate of gastric emptying. The aim of this study was to determine whether slowing of gastric emptying by guar gum reduces the fall in blood pressure after oral glucose in patients with type 2 diabetes. Eleven type 2 patients managed by diet alone, age 61.9 ± 1.3 years, had measurements of gastric emptying, blood pressure, blood glucose, and serum insulin on two occasions after ingestion of 300 ml water containing 50 g glucose, with or without 9 g guar gum. The magnitude of the fall in blood pressure was less (P < 0.05) and gastric emptying slower (P < 0.05) after guar. Blood glucose (P < 0.05) and serum insulin (P < 0.01) concentrations were lower after guar. The magnitude of the fall in systolic blood pressure was related to gastric emptying of glucose at 30 min on the control day (r = 0.67, P < 0.05). We conclude that guar gum attenuates the fall in blood pressure after oral glucose in patients with type 2 diabetes mellitus, presumably by slowing glucose absorption.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Mathias CJ, da Costa DF, Fosbraey P, Bannister R, Wood SM, Bloom SR, Christensen NJ: Cardiovascular, biochemical and hormonal changes during food-induced hypotension in chronic autonomic failure. J Neurol Sci 94:255-259, 1989

    Google Scholar 

  2. Mathias CJ: Postprandial hypotension: pathophysiological mechanisms and clinical implications in different disorders. Hypertension 18:694-704, 1991

    Google Scholar 

  3. Jansen RWMM, Hoefnagels WH: Hormonal mechanisms of postprandial hypotension. J Am Geriatr Soc 39:1201-1207, 1991

    Google Scholar 

  4. Jansen RWMM, Lipsitz LA: Postprandial hypotension: epidemiology, pathophysiology, and clinical management. Ann Intern Med 122:286-295, 1995

    Google Scholar 

  5. Jansen RWMM, Connelly CM, Kelley-Gagnon MM, Parker JA, Lipsitz LA: Postprandial hypotension in elderly patients with unexplained syncope. Arch Intern Med 155:945-952, 1995

    Google Scholar 

  6. Jones KL, Tonkin A, Horowitz M, Wishart JM, Carney BI, Guha S, Green L: The rate of gastric emptying is a determinant of postprandial hypotension in non-insulin dependent diabetes mellitus. Clin Sci 94:65-70, 1998

    Google Scholar 

  7. O'Donovan D, Feinle C, Tonkin A, Horowitz M, Jones KL: Postprandial hypotension in response to duodenal glucose delivery in healthy subjects. J Physiol (London) 540:673-679, 2002

    Google Scholar 

  8. Jones, KL, Macintosh C, Su Y-C, Ells F, Chapman IM, Tonkin A, Horowitz M: Guar gum reduces postprandial hypotension in the elderly. J Am Geriatr Soc 49:162-167, 2001

    Google Scholar 

  9. Blackburn NA, Redfern JS, Jarjis H, Holgate AM, Hanning I, Scarpello JH, Johnson IT, Read NW: The mechanism of action of guar gum in improving glucose tolerance in man. Clin Sci 66:329-336, 1984

    Google Scholar 

  10. Lavin JH, Read NW: The effect on hunger and satiety of slowing the absorption of glucose: relationship with gastric emptying and postprandial blood glucose and insulin responses. Appetite 25:89-96, 1995

    Google Scholar 

  11. French SJ, Read NW: Effect of guar gum on hunger and satiety after meals of differing fat content: relationship with gastric emptying. Am J Clin Nutr 59:87-91, 1994

    Google Scholar 

  12. Horowitz M, Edelbroek MA, Wishart JM, Straathof JW: Relationship between oral glucose tolerance and gastric emptying in normal healthy subjects. Diabetologia 36:857-862, 1993

    Google Scholar 

  13. Jones KL, Horowitz M, Carney BI, Wishart JM, Guha S, Green L: Gastric emptying in “early” non-insulin dependent diabetes mellitus relationship to oral glucose tolerance and appetite. J Nucl Med 37:1643-1648, 1996

    Google Scholar 

  14. Balkau B: The DECODE study: Diabetes epidemiology: collaborative analysis of diagnostic criteria in Europe. Diabetes Metab 26:282-286, 2000

    Google Scholar 

  15. Jones KL, Horowitz M, Wishart MJ, Maddox, Harding PE, Chatterton BE: Relationships between gastric emptying, intragastric meal distribution and blood glucose concentrations in diabetes mellitus. J Nucl Med 36:2220-2228, 1995

    Google Scholar 

  16. Ewing DJ, Clarke BF: Diagnosis and management of diabetic autonomic neuropathy. Br Med J 285:916-918, 1982

    Google Scholar 

  17. Piha SJ: Cardiovascular autonomic reflex tests: normal responses and age-related reference values. Clin Physiol 11:277-290, 1991

    Google Scholar 

  18. Collins PJ, Horowitz M, Cook DJ, Harding PE, Shearman DJC: Gastric emptying in normal subjects—a reproducible technique using a single scintillation camera and computer system. Gut 24:1117-1125, 1983

    Google Scholar 

  19. Cao Y, Smith WC, Bowsher RR: A sensitive chemiluminescent enzyme immunoassay for the bioanalysis of carboxyl-terminal B-chain analogues of human insulin. J Pharm Biomed Anal 26:53-61, 2001

    Google Scholar 

  20. Sepple C, Read N: Gastrointestinal correlates of the development of hunger in man. Appetite 13:183-191, 1989

    Google Scholar 

  21. Mathias CJ, da Costa DF, McIntosh CM, Fosbraey P, Bannister R, Wood SM, Bloom SR, Christensen NJ: Differential blood pressure and hormonal effects after glucose and xylose ingestion in chronic autonomic failure. Clin Sci 77:85-92, 1989

    Google Scholar 

  22. Maurer MS, Karmally W, Rivadeneira H, Parides MK, Bloomfield DM: Upright posture and postprandial hypotension in elderly persons. Ann Intern Med 133:533-536, 2000

    Google Scholar 

  23. Lipsitz LA, Nyquist RPJ, Wei JY, Rowe JW: Postprandial reduction in blood pressure in the elderly. N Engl J Med 309:81-83, 1983

    Google Scholar 

  24. Lipsitz LA, Pluchino FC, Wei JY, Minaker KL, Rowe JW: Cardiovascular and norepinephrine responses after meal consumption in elderly (older than 75 years) persons with postprandial hypotension. Am J Cardiol 58:810-815, 1986

    Google Scholar 

  25. Edwards BJ, Perry JHM, Kaiser FE, Morley JE, Kraenzle D, Stevenson R, Kreutter D: Relationship of age and calcitonin gene-related peptide to postprandial hypotension. Mech Ageing Dev 87:61-73, 1996

    Google Scholar 

  26. Stevens MJ, Edmonds ME, Mathias CJ, Watkins PJ: Disabling postural hypotension complicating diabetic autonomic neuropathy. Diab Med 8:870-874, 1991

    Google Scholar 

  27. Jansen RW, Hoefnagels WH: Influence of oral and intravenous glucose loading on blood pressure in normotensive and hypertensive elderly subjects. J Hypertens 5(suppl 5): S501-S503, 1987

    Google Scholar 

  28. Phillips WT, Schwartz JG, McMahan CA. Rapid gastric emptying in patients with early non-insulin-dependent diabetes mellitus. N Engl J Med 324:130-131, 1991

    Google Scholar 

  29. Schwartz JG, Green GM, Guan D, McMahan CA, Phillips WT: Rapid gastric emptying of a solid pancake meal in type II diabetic patients. Diabetes Care 19:468-71, 1996

    Google Scholar 

  30. Weytjens C, Keymeulen B, Van Haleweyn C, Somers G, Bossuyt A: Rapid gastric emptying of a liquid meal in long-term Type 2 diabetes mellitus. Diabet Med 15:1022-1027, 1998

    Google Scholar 

  31. Heddle R, Collins PJ, Dent J, Horowitz M, Read NW, Chatterton B, Houghton LA: Motor mechanisms associated with slowing of the gastric emptying of a solid meal by an intraduodenal lipid infusion. Gastroenterol Hepatol 4:437-447, 1989

    Google Scholar 

  32. Fone DR, Horowitz M, Read NW, Dent J, Maddox A: The effect of terminal ileal triglyceride infusion on gastroduodenal motility and the intragastric distribution of a solid meal. Gastroenterol 98:568-575, 1990

    Google Scholar 

  33. Jenkins DJ, Jenkins AL, Wolever TM, Vuksan V, Rao AV, Thompson LU, Josse RG: Effect of reduced rate of carbohydrate absorption on carbohydrate and lipid metabolism. Eur J Clin Nutr 49(suppl 3):S68-S73, 1995

    Google Scholar 

  34. Trinick TR, Laker MF, Johnston DG, Keir M, Buchanan KD, Alberti KG: Effect of guar on second-meal glucose tolerance in normal man. Clin Sci 71:49-55, 1986

    Google Scholar 

  35. Woodward ER: The early postprandial dumping syndrome: clinical manifestations and pathogenesis. Major Probl Clin Surg 20:1-13, 1976

    Google Scholar 

  36. Hasegawa Y, Okamoto S: Parkinson's disease with syncope as a chief complaint induced by prominent postprandial hypotension. Rinsho Shinkeigaku 32:1017-21, 1992

    Google Scholar 

  37. Lin HC: Abnormal intestinal feedback in disorders of gastric emptying. Dig Dis Sci 39(suppl):54S-55S, 1994

    Google Scholar 

  38. Jansen RW, Peeters TL, Lenders JW, van Lier HJ, v't Laar A, Hoefnagels WH: Somatostatin analog octreotide (SMS 201–995) prevents the decrease in blood pressure after oral glucose loading in the elderly. J Clin Endocrinol Metab 68:752-756, 1989

    Google Scholar 

  39. Sasaki E, Goda K, Nagata K, Kitaoka H, Ohsawa N, Hanafusa T: Acarbose improved severe postprandial hypotension in a patient with diabetes mellitus. J Diab Complic 15:158-161, 2001

    Google Scholar 

  40. Collins PJ, Horowitz M, Maddox A, Myers JC, Chatterton BE: Effects of increasing solid component size of a mixed solid/liquid meal on solid and liquid gastric emptying. Am J Physiol 271:G549-G554, 1996

    Google Scholar 

  41. Puvi Rajasingham S, Mathias CJ: Effect of meal size on postprandial blood pressure and on postural hypotension in primary autonomic failure. Clin Auton Res 6:111-114, 1996

    Google Scholar 

  42. Welch IMcL, Bruce C, Hill SE, Read NW: Duodenal and ileal lipid suppresses postprandial blood glucose and insulin responses in man: possible implications for the dietary management of diabetes mellitus. Clin Sci 72:209-216, 1987

    Google Scholar 

  43. Horowitz M, Maddox A, Bochner M, Wishart J, Bratasiuk R, Collins PJ, Shearma DJC: Relationships between gastric emptying of solid and caloric liquid meals and alcohol absorption. Am J Physiol 257:G291-G298, 1989

    Google Scholar 

  44. Niemi MK, Keinanen-Kiukaanniemi SM, Salmela PI: Long-term effects of guar gum and microcrystalline cellulose on glycaemic control and serum lipids in type 2 diabetes. Eur J Clin Pharmacol 34:427-429, 1988

    Google Scholar 

  45. Jenkins DJ, Jenkins AL: Dietary fiber and the glycemic response. Proc Soc Exp Biol Med 180:422-431, 1985

    Google Scholar 

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

    Google Scholar 

  47. Phillips WT, Schwartz JG, McMahan CA: Reduced postprandial blood glucose levels in recently diagnosed non-insulin-dependent diabetics secondary to pharmacologically induced delayed gastric emptying. Dig Dis Sci 38:51-58, 1993

    Google Scholar 

  48. Pasman WJ, Saris WH, Wauters MA, Westerterp-Plantenga MS: Effect of one week of fibre supplementation on hunger and satiety ratings and energy intake. Appetite 29:77-87, 1997

    Google Scholar 

Download references

Authors
  1. Antonietta Russo
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Julie E. Stevens
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Toni Wilson
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Fiona Wells
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Anne Tonkin
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Michael Horowitz
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Karen L. Jones
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Russo, A., Stevens, J.E., Wilson, T. et al. Guar Attenuates Fall in Postprandial Blood Pressure and Slows Gastric Emptying of Oral Glucose in Type 2 Diabetes. Dig Dis Sci 48, 1221–1229 (2003). https://doi.org/10.1023/A:1024182403984

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1023/A:1024182403984

Search

Navigation