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PubMed2005

Efficacy and safety of traditional medical therapies for chronic constipation: systematic review.

OBJECTIVES: Constipation is common, and its treatment is unsatisfactory. Although many agents have been tried, there are limited data to support their use. Our aim was to undertake a systematic review of the efficacy and safety of traditional medical therapies for chronic constipation and to make evidence-based recommendations. METHODS: We searched the English literature for drug trials evaluating treatment of constipation by using MEDLINE and PUBMED databases from 1966 to 2003. Only studies that were randomized, conducted on adult subjects, and published as full manuscripts were included. Studies were assigned a quality score based on published methodology. Standard forms were used to abstract data regarding study design, duration, outcome measures, and adverse events. By using the cumulative evidence of published data for each agent, recommendations were made regarding their use following the United States Preventive Services Task Force guidelines. RESULTS: Good evidence (Grade A) was found to support the use of polyethylene glycol (PEG) and tegaserod. Moderate evidence (Grade B) was found to support the use of psyllium, and lactulose. There was a paucity of quality data regarding many commonly used agents including milk of magnesia, senna, bisacodyl, and stool softeners. CONCLUSIONS: There is good evidence to support the use of PEG, tegaserod, lactulose, and psyllium. Surprisingly, there is a paucity of trials for many commonly used agents. These aspects should be considered when designing trials comparing new agents with traditional therapies because their use may not be well validated.

Adult↗
PubMedDate not supplied

Pharmacobezoar: an evolving new entity.

Pharmacobezoars, bezoars comprised of medications, are unusual entities. Medications reported to cause bezoars include aluminum hydroxide gel, enteric-coated aspirin, sucralfate, guar gum, cholestyramine, enteral feeding formulas, psyllium preparations, nifedipine XL, and meprobamate. They most often occur, as do bezoars of any type, in a background of altered motility or anatomy of the gastrointestinal tract. Bowel hypoactivity, dehydration, and concomitant use of anticholinergics and narcotis appear to contribute to the propensity for bezoar formation by aluminum hydroxide gel and Isocal. The hygroscopic properties of psyllium and guar gum appear to contribute to their propensity to form bezoars. Insolubility of the carrying vehicle of enteric-coated aspirin and nifedipine is the setting in which these medications form bezoars. In contrast to nonmedication bezoars, pharmacobezoars may produce additional symptoms, those related to the release of their active ingredients. In patients with suspected gastrointestinal tract emptying problems, whether esophageal, gastric, small bowel, or colonic, the astute clinician should consider pharmacobezoar in the differential diagnosis.

Bezoars↗
PubMed1993

Fermentation of dietary fibre by human colonic bacteria: disappearance of, short-chain fatty acid production from, and potential water-holding capacity of, various substrates.

Several dietary fibre-rich substrates were fermented in vitro with human colonic bacteria obtained from each of three adult male subjects to assess the extent of substrate fermentation short-chain fatty acid (SCFA) production, and the potential effect of fermented residues on faecal bulk. Substrates tested were two varieties of oat hull fibre, gum arabic, carboxymethylcellulose (CMC), soy fibre, psyllium, and six blends containing oat fibre, gum arabic, and CMC in various proportions. All substrates contained greater than 900 g/kg of total dietary fibre except for CMC (816 g) and soy fibre (778 g). In vitro organic matter disappearance during fermentation was greatest for gum arabic (69.5%), intermediate for soy fibre (56.4%), and less than 20% for the two oat fibres, CMC, and psyllium. Averaged across substrates, acetate, propionate, and butyrate were produced in the molar proportion of 64:24:12. Potential water-holding capacity (PWHC) of substrates, a measure of faecal bulking potential, was greatest for CMC (13.5 g H2O/g substrate) and lowest for gum arabic (1.92 g) and soy fibre (1.71 g). Organic matter disappearance and SCFA production of blends were directly proportional to their gum arabic content. Blend PWHC was proportional to CMC content. In vitro procedures are useful in predicting the actions of fibre blends formulated to produce desirable effects in vivo.

Adult↗
PubMed2000

[Nutrition, dietary supplementation and coronary heart disease].

BACKGROUND: During the last decade, lipid lowering agents, in particular statins, have become increasingly important in the treatment of cardiovascular diseases and dyslipidaemias. This might imply that emphasis on diet and supplementary nutrients do not receive sufficient attention. MATERIAL AND METHODS: On the basis of studies of the literature, the scientific documentation for a possible beneficial effect of the following elements are reviewed: intake of fat, fish and fish oil, alpha-linolenic acid, folic acid, vitamin B6 and vitamin B12, nuts, plant sterols and psyllium. RESULTS: Reduced intake of saturated fat causes improvement in serum lipid values and prevents cardiovascular events. Intake of fish, fish oils and alpha-linolenic acid has positive effects on several clinical end points, often without marked decrease in serum cholesterol. Homocysteine appears to be an independent risk factor for cardiovascular diseases, but a causal relationship remains to be proven. The cofactors folic acid, vitamin B6 and B12 reduce the homocysteine level, but effects of this intervention on hard clinical end points are lacking. There are indications that intake of nuts can prevent coronary events. Plant sterols and psyllium in the diet reduce cholesterol levels. INTERPRETATION: Thus, dietary intervention is important in the prevention and treatment of coronary heart disease. Also when drug treatment is indicated, a focus on diet and nutrient supplementation is highly warranted. Some nutrients may have preventive effect in relation to coronary events, despite their small effect on cholesterol levels.

Coronary Disease↗
PubMed1995

Dietary fibre, complex carbohydrate and coronary artery disease.

Animal studies indicate that viscous, soluble fibres such as psyllium, oat gum, guar gum and pectin have substantial hypocholesterolemic effects. Epidemiologic data suggest that the intake of complex carbohydrate and dietary fibre is associated in an inverse manner to risk for coronary artery disease (CAD). Two long term clinical trials indicate that increasing soluble fibre intake as part of a low fat, low cholesterol diet reduces serum cholesterol concentration from 3 to 5% below that for the low fat, low cholesterol diet. Short term, controlled clinical trials indicate that oat bran or beans, in a metabolic ward setting, decrease serum cholesterol concentrations of hypercholesterolemic individuals by 10 to 12%. Studies of free-living hypercholesterolemic individuals document that incorporation of oat products, psyllium or guar gum into the diet decreases serum cholesterol by 6 to 8%. Other studies suggest that increased fibre intake may decrease blood pressure slightly, assist in weight management, alter blood clotting factors, and increase insulin sensitivity. Intake of dietary fibre and complex carbohydrate appear to have a protective role for CAD. Further controlled clinical trials are required to examine the role of fibre and complex carbohydrate in prevention or regression of CAD.

Animals↗
PubMed1996

Effects of dietary sucrose and fibers on blood pressure in hypertensive rats.

In spontaneously hypertensive rats (SHR), two separate studies examined effects on systolic blood pressure (SBP) and other cardiovascular parameters of different concentrations of sucrose compared to starches, soluble fibers (guar, psyllium), and insoluble fibers (cellulose, wheat bran). In the initial study, four diets were tested. The first diet was relatively high in sucrose calories (50%) and low in protein calories (17%)--"high sucrose"; the second diet was relatively low in sucrose (11%) and high in protein (56%) calories--"low sucrose". The third and fourth diets resembled the first and second diets respectively, but cornstarch replaced sucrose--"high and low starch". Initial SBP in each group averaged approximately 168 mmHg. After 2 weeks of ingesting the special diets, SBP of the high sucrose group rose rapidly and significantly, eventually rising above 200 mmHg by the termination of examination. The other 3 groups maintained the original SBP until after the 3rd week when the low sucrose group developed a rapid and significant SBP elevation approaching 200 mmHg. SBP of high starch and low starch remained below 181 mmHg for the two months of study. Platelets obtained at the termination of the study from the sucrose groups compared to the starch groups showed increased aggregatory responses to collagen and ADP. Further, significant elevations of triglycerides and cholesterol in the high sucrose group were found. The former parameter was also significantly elevated in the low sucrose group. In the second study, adding guar and psyllium to high sucrose diets delayed sugar-induced hypertension, while cellulose and wheat bran virtually showed no effects. Serum insulin concentrations correlated positively with SBP, serum triglycerides, and glucose--not cholesterol. Accordingly, sucrose compared to starch ingestion in SHR can adversely influence SBP and various other cardiovascular risk factors. These effects can be delayed by the presence of soluble fibers, but not insoluble fibers, in the diets.

Animals↗
PubMed2001

Management of faecal incontinence and constipation in adults with central neurological diseases.

BACKGROUND: People with neurological disease have a much higher risk of both faecal incontinence and constipation than the general population. There is often a fine dividing line between the two conditions, with any management intended to ameliorate, one risking precipitating the other. Bowel problems are observed to be the cause of much anxiety and may reduce quality of life in these people. Current bowel management is largely empirical with a limited research base. OBJECTIVES: To determine the effects of management strategies for faecal incontinence and constipation in people with neurological diseases affecting the central nervous system. SEARCH STRATEGY: We searched the Cochrane Incontinence Group Trials Register, the Cochrane Controlled Trials Register, MEDLINE, EMBASE and all reference lists of relevant articles. Date of the most recent searches: May 2000. SELECTION CRITERIA: All randomised or quasi-randomised trials evaluating any types of conservative, or surgical measure for the management of faecal incontinence and constipation in people with neurological diseases were selected. Specific therapies for the treatment of neurological diseases that indirectly affect bowel dysfunction have also been considered. DATA COLLECTION AND ANALYSIS: All three reviewers assessed the methodological quality of eligible trials and two reviewers independently extracted data from included trials using a range of pre-specified outcome measures. MAIN RESULTS: Only seven trials were identified by the search strategy and all were small and of poor quality. Oral medications for constipation were the subject of four trials. Cisapride does not seem to have clinically useful effects in people with spinal cord injuries (two trials). Psyllium was associated with increased stool frequency in people with Parkinson's disease but not altered colonic transit time (one trial). Some rectal preparations to initiate defecation produced faster results than others (one trial). Different time schedules for administration of rectal medication may produce different bowel responses (one trial). Mechanical evacuation may be more effective than oral or rectal medication (one trial). The clinical significance of any of these results is difficult to interpret. REVIEWER'S CONCLUSIONS: It is not possible to draw any recommendation for bowel care in people with neurological diseases from the trials included in this review. Bowel management for these people must remain empirical until well-designed controlled trials with adequate numbers and clinically relevant outcome measures become available.

Central Nervous System Diseases↗
PubMed2006

Management of faecal incontinence and constipation in adults with central neurological diseases.

BACKGROUND: People with neurological disease have a much higher risk of both faecal incontinence and constipation than the general population. There is often a fine line between the two conditions, with any management intended to ameliorate one risking precipitating the other. Bowel problems are observed to be the cause of much anxiety and may reduce quality of life in these people. Current bowel management is largely empirical with a limited research base. OBJECTIVES: To determine the effects of management strategies for faecal incontinence and constipation in people with neurological diseases affecting the central nervous system. SEARCH STRATEGY: We searched the Cochrane Incontinence Group Specialised Trials Register (searched 26 January 2005), the Cochrane Central Register of Controlled Trials (Issue 2, 2005), MEDLINE (January 1966 to May 2005), EMBASE (January 1998 to May 2005) and all reference lists of relevant articles. SELECTION CRITERIA: All randomised or quasi-randomised trials evaluating any types of conservative or surgical measure for the management of faecal incontinence and constipation in people with neurological diseases were selected. Specific therapies for the treatment of neurological diseases that indirectly affect bowel dysfunction were also considered. DATA COLLECTION AND ANALYSIS: Two reviewers assessed the methodological quality of eligible trials and two reviewers independently extracted data from included trials using a range of pre-specified outcome measures. MAIN RESULTS: Ten trials were identified by the search strategy, most were small and of poor quality. Oral medications for constipation were the subject of four trials. Cisapride does not seem to have clinically useful effects in people with spinal cord injuries (three trials). Psyllium was associated with increased stool frequency in people with Parkinson's disease but did not alter colonic transit time (one trial). Prucalopride, an enterokinetic did not demonstrate obvious benefits in this patient group (one study). Some rectal preparations to initiate defaecation produced faster results than others (one trial). Different time schedules for administration of rectal medication may produce different bowel responses (one trial). Mechanical evacuation may be more effective than oral or rectal medication (one trial). There appears to be a benefit to patients in one-off educational interventions from nurses. The clinical significance of any of these results is difficult to interpret. AUTHORS' CONCLUSIONS: There is still remarkably little research on this common and, to patients, very significant condition. It is not possible to draw any recommendation for bowel care in people with neurological diseases from the trials included in this review. Bowel management for these people must remain empirical until well-designed controlled trials with adequate numbers and clinically relevant outcome measures become available.

Central Nervous System Diseases↗
PubMed2000

Functional foods and cardiovascular disease.

Functional foods are foods that, by virtue of physiologically active food components, provide health benefits beyond basic nutrition. Many functional foods have been found to be potentially beneficial in the prevention and treatment of cardiovascular disease, the leading cause of mortality in the United States. These foods include soybeans, oats, psyllium, flaxseed, garlic, tea, fish, grapes, nuts, and stanol- and sterol ester enhanced margarine. When eaten in adequate amounts on a consistent basis, these foods may aid in decreasing the risk of cardiovascular disease by several potential mechanisms: lowering blood lipid levels, improving arterial compliance, reducing low-density lipoprotein oxidation, decreasing plaque formation, scavenging free radicals, and inhibiting platelet aggregation.

Cardiovascular Diseases↗
PubMed2002

High-soluble-fiber foods in conjunction with a telephone-based, personalized behavior change support service result in favorable changes in lipids and lifestyles after 7 weeks.

OBJECTIVE: To evaluate whether an intervention of foods high in soluble fiber from psyllium and/or oats plus a telephone-based, personalized behavior change support service improves serum lipids and elicits cholesterol-managing lifestyle changes vs usual care. DESIGN: 7-week randomized, controlled intervention. SUBJECTS/SETTING: 150 moderately hypercholesterolemic men and women, age range 25 to 70 years. INTERVENTION: The intervention group consumed 4 servings/day of high-fiber foods and had weekly telephone conversations with a personal coach who offered support and guidance in making lifestyle changes consistent with the National Cholesterol Education Program's (NCEP) cholesterol-lowering guidelines. The usual care group received a handout describing the NCEP Step-1 diet. MAIN OUTCOME MEASURES: Serum lipids and lipoproteins and self-reported lifestyle changes. STATISTICAL ANALYSES: For physiologic and dietary changes, mixed linear models for repeated measures were applied. Models were simplified using analysis of covariance where age in years was the covariate. Traditional general linear models were used to assess lifestyle changes. RESULTS: In the intervention group total cholesterol (TC) decreased 5.6%, low-density lipoprotein (LDL) cholesterol 7.1%, LDL/high-density lipoprotein (HDL) cholesterol ratio 5.6%, and triglycerides (TG) 14.2% (P<.0167); decreases in TC and LDL were significantly different from the usual care group. In the usual care group TC decreased 1.9%, LDL 1.2%, LDL/HDL 1.9%, and TG 4.4% (all not significant). The intervention group also reported an increase in their knowledge, ability, and confidence to make cholesterol-managing diet and exercise changes compared with the usual care group (P<.05). The intervention group had a greater decrease in energy intake from saturated fat (-1.6%) and increase in soluble fiber intake (7.3%) than the usual care group (P<.05). The intervention group reported an increase in exercise vs the usual care group (P<.05). Both intervention and control groups had a minimal reduction (<1%) in body weight compared with baseline (P<.0167). APPLICATIONS/CONCLUSIONS: A 7-week intervention that includes both functional foods and individualized, interactive support for behavior change could be an effective model for dietitians to use with patients at risk for CVD, pending results of long-term studies.

Adult↗
PubMed1999

Soluble dietary fiber protects against cholesterol gallstone formation.

BACKGROUND: Epidemiological studies have suggested that soluble dietary fibers are hypocholesterolemic and may inhibit cholelithiasis. METHODS: Thirty prairie dogs were placed on a cholesterol-supplemented lithogenic diet. Ten animals received 5% psyllium (PSY) and 10 animals received 5% cellulose. After 6 weeks all gallbladders were inspected for stones; blood and bile were collected for analysis. RESULTS: Cholesterol stones were present in 8 of 10 of the control animals, in 6 of 10 of the cellulose group, and 3 of 10 of the PSY animals (P <0.05). Concentrations of cholesterol and chenodeoxycholic acid (CDCA) were significantly lower in the PSY group compared with controls (0.49 versus 0.88 mM and 4.2 versus 9.2 mM, respectively) leading to a significant reduction in the cholesterol saturation index (0.62 versus 1.2). CONCLUSIONS: A dietary soluble fiber (PSY) inhibits cholesterol stone formation by reducing the biliary cholesterol saturation index. This protective effect is associated with a selective decrease in biliary cholesterol and CDCA.

Animals↗
PubMed1982

Components of fiber impair iron absorption in the dog.

We have demonstrated previously that semipurified components of fiber bind ferrous iron in vitro. The present studies examined the possibility that these same fibers would decrease absorption of iron by the canine small bowel. Healthy and anemic dogs were studied chronically. Two preparations were needed; soluble components of fiber were tested by continuous perfusion of a duodenojejunal segment of approximately 100 cm, insoluble components were tested in Thiry-Vella fistulae of jejunum (25 cm). The results confirm that, 1) anemic dogs absorb iron more efficiently than do healthy animals, and 2) that there is a slight, but significant, decrease in iron absorption during the 4 to 6 h of an acute experiment. To obviate problems of interpretation because of the latter point, all studies featured a control period, before and after, the test period. Lignin and psyllium mucilage were potent inhibitors of iron absorption, pectin less so, and cellulose was without effect in this system. The results in vivo correlate well with the binding of iron in vitro.

Anemia, Hypochromic↗
PubMed1977

Effects of diet on growth and survival of rats fed toxic levels of tartrazine (FD & C Yellow No. 5) and sunset yellow FCF (FD & C Yellow No. 6).

Tests were conducted on the effects of diet on the response of immature male rats to massive doses of tartrazine (FD&C Yellow No.5) and Sunset Yellow FCF (FD&C Yellow No. 6). When incorporated at a 5% level in a stock diet, tartrazine and Sunset Yellow FCF had no grossly observable toxic effects. When fed with a purified diet, however, both tartrazine and Sunset Yellow FCF at 5% level in the diet resulted in a marked retardation in growth, an unthrifty appearance of the fur and death of 50% or more of the rats within an experimental period of 14 days. The toxic effects obtained by feeding the latter diets were counteracted by the concurrent feeding of blond psyllium seed powder, carrot root powder, alfalfa leaf meal and wheat bran. Supplements of the known nutrients had little if any protective effect. Supplements of purified cellulose were without protective effect for the rats fed tartrazine but had a moderate protective effect for those fed Sunset Yellow FCF.

Animals↗
PubMed1992

Postprandial lipid response following a high fat meal in rats adapted to dietary fiber.

Rats were adapted to diets containing 5 g/100 g cellulose (CL), 5 g/100 g oat bran fiber (OB) or 5 g/100 g psyllium husk (Psy) for 4 wk. Following a 12-h fast, animals were either killed at 0 h (baseline) or fed 4.5 g of a test meal that provided 50% energy from fat, then killed at 1, 4 or 6 h postprandially. Fasting plasma and HDL cholesterol concentrations were lower in Psy-fed animals than in rats fed either CL or OB. Plasma triglycerides increased significantly from baseline (0 h) in all groups but did not differ among diet treatments. Increases in triglyceride content of the treatments. Increases in triglyceride content of the chylomicron/VLDL fraction occurred in the CL- and OB-fed groups and in the HDL fraction of the Psy-fed group during the postprandial period. In unfed animals the hepatic and intestinal levels of apolipoprotein A-IV mRNA were higher in the CL-fed group than in the groups fed OB and Psy. Apolipoprotein B mRNA was higher in the intestine of the OB-fed group than in the groups fed CL and Psy and had a significant gradient along the small intestine, increasing in the distal third. The results suggest that chronic consumption of fiber is less likely to modify the acute plams triglyceride response to a fat-containing test meal than if a fiber supplement is incorporated into the meal.

Animals↗
PubMed1998

Dietary soluble fiber lowers plasma LDL cholesterol concentrations by altering lipoprotein metabolism in female guinea pigs.

This experiment was designed to evaluate the effects of pectin (PE), guar gum (GG) and psyllium (PSY) intake on VLDL and LDL metabolism in female guinea pigs fed high dietary cholesterol. Guinea pigs were fed a 15 g/100 g fat diet containing 0.25 g/100 g cholesterol with 12.5 g/100 g PE, 12.5 g/100 g GG, 7.5 g/100 g PSY or 12.5 g/100 g cellulose (control diet) for 4 wk. Plasma cholesterol concentrations were 29, 43 and 39% lower in guinea pigs fed PE, GG or PSY, respectively, compared with the control group (P < 0.0001). Plasma apolipoprotein (apo) B concentrations were 16-22% lower in the groups fed soluble fiber compared with the control group (P < 0.01). In contrast, hepatic cholesterol and triglyceride concentrations were not different among the PE, GG, PSY and control groups. No differences in triacylglycerol (TAG) or apo B secretion rates, measured by blocking VLDL catabolism by triton (WR 1339) injection, were observed, whereas plasma LDL apo B fractional catabolic rates (FCR), determined by injection of radiolabeled LDL, were higher in guinea pigs fed GG or PSY than in those from the control group. All sources of dietary soluble fiber reduced LDL apo B flux (P < 0.05). These results suggest that the mechanisms of plasma LDL cholesterol lowering by dietary soluble fiber are distinctive for each fiber source and result in specific alterations in lipoprotein metabolism in female guinea pigs. Differences between male and female guinea pigs in response to these diets are discussed.

Animals↗
PubMed2002

The seeds from Plantago ovata lower plasma lipids by altering hepatic and bile acid metabolism in guinea pigs.

Psyllium, the husks from Plantago ovata (PO), is recognized as a potent agent in lowering plasma cholesterol. In this study, we tested the potential hypolipidemic effects of the seeds from PO and the mechanisms associated with the lowering of plasma lipids. Male Hartley guinea pigs (n = 30; 10 per group) were fed either a control diet or diets containing 7.5 or 10 g/100 g PO for 4 wk. Diets were identical in composition except for the fiber source. The control diet contained 10 g/100 g cellulose and 2.5 g/100 g guar gum, whereas the PO diets were adjusted to a total of 12.5 g/100 g fiber with cellulose. Although a dose response was not observed, plasma triglycerides and LDL cholesterol were 34 and 23% lower in the PO groups compared with the control (P < 0.01). Lecithin cholesterol acyltransferase (LCAT) and cholesterol ester transfer protein (CETP) activities were significantly affected by the PO diets. The control group had 100 and 36% higher LCAT and CETP (P < 0.01) activities, respectively, compared with the PO groups. Hepatic total and free cholesterol concentrations were not affected by PO, but cholesteryl ester concentrations were 50% (P < 0.01) lower in the PO groups compared with the control. The activity of 3-hydroxy-3-methylglutaryl coenzyme A reductase, the rate-limiting enzyme of cholesterol synthesis was up-regulated in the PO groups by 37%. Similarly, the activity of cholesterol 7alpha-hydroxylase, the regulatory enzyme of cholesterol catabolism to bile acids was 33% higher in the PO groups (P < 0.02). Fecal bile acids were 3 times higher in the PO groups than in the control group. These results suggest that PO exerts its hypolipidemic effect by affecting bile acid absorption and altering hepatic cholesterol metabolism.

Animals↗
PubMed1989

Perdiem causes esophageal impaction and bezoars.

Perdiem is a bulk laxative (mostly psyllium) formulated as granules; these granules can adhere together and cause esophageal impaction and gastric bezoars. I have reported three cases of esophageal impaction caused by Perdiem. Although endoscopic manipulation is the currently favored treatment, bougienage relieved these impactions easily. One patient also had a gastric bezoar. Doctors and patients need to be aware of this potential complication from Perdiem.

Adult↗
PubMed1979

Occupational allergy in nurses to a bulk laxative.

Finely ground psyllium (Plantago ovata) seeds, so-called ispaghula powder is used in bulk laxatives. During the dispensing of these medicines some dust is generated. Allergic symptoms from exposure to this dust was reported by two nurses, one of whom was wroking in a department where exposure to the powder could be considered high. Nineteen other subjects working in the same department were investigated with regard to allergy to ispaghula powder. An extract from ispaghula powder was made and used in RAST and skin tests. Exposure tests with ispaghula powder mixed with crushed rusks were made in symptomatic subjects. Eight out of the 20 investigated subjects from this department reported symptoms which could possibly have been elicited by ispaghula powder. Evidence of sensitization was found in five of them. The use of less dusty (granulated) forms of ispaghula laxatives might diminish the risk of sensitization.

Adult↗