Effect of ispaghula husk on the faecal output of bile acids in healthy volunteers

Chaplin, Martin F.; Chaudhury, Samiran Roy; Dettmar, PW; Sykes, J. F.; Shaw, AD; Davies, G.

doi:10.1016/s0960-0760(00)00035-2

Cited by 14 publications

(4 citation statements)

References 37 publications

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“…For example, psyllium showed an increase in stool output of 4 to 5 g/g in healthy volunteers, but a smaller increase (1.4 to 3.7 g/g) in patients with chronic idiopathic constipation. 69,92,107,108 Many studies that assess the stool effects of isolated fibers are conducted with healthy subjects. It is important to note that an observed increase in stool output with healthy subjects is not necessarily predictive of a regularity benefit/laxative effect in constipation, particularly when the observed increase in stool output for healthy subjects is minimal (eg, 2 g/g) and is not associated with a significant increase in stool water content (stool-softening effect).…”

Section: Misconception #3b: Insoluble Fiber Has High Water-holding Camentioning

confidence: 99%

Understanding the Physics of Functional Fibers in the Gastrointestinal Tract: An Evidence-Based Approach to Resolving Enduring Misconceptions about Insoluble and Soluble Fiber

McRorie¹,

McKeown²

2017

Journal of the Academy of Nutrition and Dietetics

366

246

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Enduring misconceptions about the physical effects of fiber in the gut have led to misunderstandings about the health benefits attributable to insoluble and soluble fiber. This review will focus on isolated functional fibers (eg, fiber supplements) whose effects on clinical outcomes have been readily assessed in well-controlled clinical studies. This review will also focus on three health benefits (cholesterol lowering, improved glycemic control, and normalizing stool form [constipation and diarrhea]) for which reproducible evidence of clinical efficacy has been published. In the small bowel, clinically meaningful health benefits (eg, cholesterol lowering and improved glycemic control) are highly correlated with the viscosity of soluble fibers: high viscosity fibers (eg, gel-forming fibers such as b-glucan, psyllium, and raw guar gum) exhibit a significant effect on cholesterol lowering and improved glycemic control, whereas nonviscous soluble fibers (eg, inulin, fructooligosaccharides, and wheat dextrin) and insoluble fibers (eg, wheat bran) do not provide these viscosity-dependent health benefits. In the large bowel, there are only two mechanisms that drive a laxative effect: large/coarse insoluble fiber particles (eg, wheat bran) mechanically irritate the gut mucosa stimulating water and mucous secretion, and the high water-holding capacity of gel-forming soluble fiber (eg, psyllium) resists dehydration. Both mechanisms require that the fiber resist fermentation and remain relatively intact throughout the large bowel (ie, the fiber must be present in stool), and both mechanisms lead to increased stool water content, resulting in bulky/soft/easy-to-pass stools. Soluble fermentable fibers (eg, inulin, fructooligosaccharide, and wheat dextrin) do not provide a laxative effect, and some fibers can be constipating (eg, wheat dextrin and fine/smooth insoluble wheat bran particles). When making recommendations for a fiber supplement, it is essential to recognize which fibers possess the physical characteristics required to provide a beneficial health effect, and which fiber supplements are supported by reproducible, rigorous evidence of one or more clinically meaningful health benefits.

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Section: Misconception #3b: Insoluble Fiber Has High Water-holding Camentioning

confidence: 99%

Understanding the Physics of Functional Fibers in the Gastrointestinal Tract: An Evidence-Based Approach to Resolving Enduring Misconceptions about Insoluble and Soluble Fiber

McRorie¹,

McKeown²

2017

Journal of the Academy of Nutrition and Dietetics

366

246

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“…Diet has an obvious and pronounced effect on bile acids as high levels of animal fat and protein increase both secretion and flow (Thompson et al 1985;Villalon et al 1992), but by itself diet cannot be considered harmful, unless in the absence of balancing amounts of carbohydrate (Chaplin, 1998). Fibre (ispaghula husk) has been shown to lower faecal levels of LCA and decrease DCA to LCA ratio (Anderson et al 1988;Chaplin et al 2000).…”

Section: Secondary Bile Acidsmentioning

confidence: 99%

Diet and cancer: assessing the risk

2002

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Globally, colorectal cancer (CRC) is a leading cause of mortality from malignant disease. Case–control and cohort studies provide strong support for a role of diet in the aetiology of CRC. However to establish causal relationships and to identify more precisely the dietary components involved, intervention studies in human subjects are required. Cancer is an impractical endpoint in terms of numbers, cost, study duration and ethical considerations. Consequently, intermediate biomarkers of the disease are required. This review aims to provide an overview of the intermediate endpoints available for the study of CRC, particularly non-invasive faecal biomarkers. Examples of their use in dietary intervention studies are given.

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“…In February, 1998, the U.S. Food and Drug Administration authorized the use, on food labels and food labelling, of health claims on the association between soluble fibre from psyllium seed husk and a reduced risk of coronary heart disease [6]. Among the suggested mechanisms by which soluble fibre lowers cholesterol is the binding of bile acids in the intestinal lumen resulting in decreased absorption and increased faecal excretion of them [7-15]. The ensuing bile acid depletion increases hepatic demand for the de novo synthesis of bile acids from cholesterol.…”

Section: Introductionmentioning

confidence: 99%

Effect of time of administration on cholesterol-lowering by psyllium: a randomized cross-over study in normocholesterolemic or slightly hypercholesterolemic subjects

Rosendaal

Shaffer

Edwards

et al. 2004

Nutr J

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BackgroundReports of the use of psyllium, largely in hypercholesterolemic men, have suggested that it lowers serum cholesterol as a result of the binding of bile acids in the intestinal lumen. Widespread advertisements have claimed an association between the use of soluble fibre from psyllium seed husk and a reduced risk of coronary heart disease. Given the purported mechanism of cholesterol-lowering by psyllium, we hypothesized that there would be a greater effect when psyllium is taken with breakfast than when taken at bedtime. Secondarily, we expected to confirm a cholesterol-lowering effect of psyllium in subjects with "average" cholesterol levels.MethodsSixteen men and 47 women ranging in age from 18 to 77 years [mean 53 +/- 13] with LDL cholesterol levels that were normal or slightly elevated but acceptable for subjects at low risk of coronary artery disease were recruited from general gastroenterology and low risk lipid clinics. Following a one month dietary stabilization period, they received an average daily dose of 12.7 g of psyllium hydrophilic mucilloid, in randomized order, for 8 weeks in the morning and 8 weeks in the evening. Change from baseline was determined for serum total cholesterol, LDL, HDL and triglycerides.ResultsTotal cholesterol for the "AM first" group at baseline, 8 and 16 weeks was 5.76, 5.77 and 5.80 mmol/L and for the "PM first" group the corresponding values were 5.47, 5.61 and 5.57 mmol/L. No effect on any lipid parameter was demonstrated for the group as a whole or in any sub-group analysis.ConclusionThe timing of psyllium administration had no effect on cholesterol-lowering and, in fact, no cholesterol-lowering was observed. Conclusions regarding the effectiveness of psyllium for the prevention of heart disease in the population at large may be premature.

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Effect of ispaghula husk on the faecal output of bile acids in healthy volunteers

Cited by 14 publications

References 37 publications

Understanding the Physics of Functional Fibers in the Gastrointestinal Tract: An Evidence-Based Approach to Resolving Enduring Misconceptions about Insoluble and Soluble Fiber

Understanding the Physics of Functional Fibers in the Gastrointestinal Tract: An Evidence-Based Approach to Resolving Enduring Misconceptions about Insoluble and Soluble Fiber

Diet and cancer: assessing the risk

Effect of time of administration on cholesterol-lowering by psyllium: a randomized cross-over study in normocholesterolemic or slightly hypercholesterolemic subjects

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