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PubMed2003

Pharmacotherapy for dyslipidaemia--current therapies and future agents.

Current lipid-altering agents that lower low density lipoprotein cholesterol (LDL-C) primarily through increased hepatic LDL receptor activity include statins, bile acid sequestrants/resins and cholesterol absorption inhibitors such as ezetimibe, plant stanols/sterols, polyphenols, as well as nutraceuticals such as oat bran, psyllium and soy proteins; those currently in development include newer statins, phytostanol analogues, squalene synthase inhibitors, bile acid transport inhibitors and SREBP cleavage-activating protein (SCAP) activating ligands. Other current agents that affect lipid metabolism include nicotinic acid (niacin), acipimox, high-dose fish oils, antioxidants and policosanol, whilst those in development include microsomal triglyceride transfer protein (MTP) inhibitors, acylcoenzyme A: cholesterol acyltransferase (ACAT) inhibitors, gemcabene, lifibrol, pantothenic acid analogues, nicotinic acid-receptor agonists, anti-inflammatory agents (such as Lp-PLA(2) antagonists and AGI1067) and functional oils. Current agents that affect nuclear receptors include PPAR-alpha and -gamma agonists, while in development are newer PPAR-alpha, -gamma and -delta agonists, as well as dual PPAR-alpha/gamma and 'pan' PPAR-alpha/gamma/delta agonists. Liver X receptor (LXR), farnesoid X receptor (FXR) and sterol-regulatory element binding protein (SREBP) are also nuclear receptor targets of investigational agents. Agents in development also may affect high density lipoprotein cholesterol (HDL-C) blood levels or flux and include cholesteryl ester transfer protein (CETP) inhibitors (such as torcetrapib), CETP vaccines, various HDL 'therapies' and upregulators of ATP-binding cassette transporter (ABC) A1, lecithin cholesterol acyltransferase (LCAT) and scavenger receptor class B Type 1 (SRB1), as well as synthetic apolipoprotein (Apo)E-related peptides. Fixed-dose combination lipid-altering drugs are currently available such as extended-release niacin/lovastatin, whilst atorvastatin/amlodipine, ezetimibe/simvastatin, atorvastatin/CETP inhibitor, statin/PPAR agonist, extended-release niacin/simvastatin and pravastatin/aspirin are under development. Finally, current and future lipid-altering drugs may include anti-obesity agents which could favourably affect lipid levels.

Animals↗
PubMed1995

Epidemiology of constipation in elderly patients. Drug utilisation and cost-containment strategies.

Constipation is a common complaint among elderly people, resulting in large amounts of money being spent on laxatives. Strategies for improving patient care while reducing this expenditure include: (a) counselling patients that daily bowel movements and purging are not essential to good health, (b) greater use of nonpharmacological measures such as hydration, exercise and dietary fibre, and (c) considering safety, effectiveness and cost in the selection of a laxative. Generic preparations of psyllium and sorbitol can be recommended in this regard. The widespread use of stool softeners, magnesium hydroxide ('milk of magnesia') and stimulant laxatives is difficult to justify from the available data.

Aged↗
PubMed2003

Modification of intestinal flora in the treatment of inflammatory bowel disease.

Because the intestinal microflora play an important role in the development of inflammatory bowel disease (IBD), there is currently some interest in the manipulation of the composition of the microflora towards a potentially more remedial community. This review summarizes the clinical and experimental efficacy of the manipulation of microflora by the use of prebiotics, probiotics, synbiotics, and antibiotics in IBD. Prebiotics, defined as nondigestible food ingredients that beneficially affect the host by selectively stimulating the growth or activity of one or a limited number of bacterial species already resident in the colon, can modulate the colonic microbiota by increasing the number of specific bacteria and thus changing the composition of the microbiota. Prebiotics for IBD include lactosucrose, oligofructose, inulin, bran, psyllium, and germinated barley foodstuff (GBF). GBF, which mainly consists of dietary fiber and glutamine-rich protein, is a prebiotic foodstuff for ulcerative colitis. GBF has shown to be converted into a preferential nutrient for colonocytes through Eubacterium and Bifidobacterium and also inactivate nuclear factor kappa B (NFkB). Moreover, it exhibits a potent water-holding capacity and bile-acid binding capacity. Probiotics, which are microbial food supplements that beneficially affect the host by improving the intestinal microbial balance, have been used to change the composition of colonic microbiota. The approaches for IBD include VSL#3, Nissle1917, Clostridium butyricum and Bifidobacterium-fermented milk. Use of Lactococci secreting IL-10 provides excellent results. The combination of prebiotics and probiotics in a synbiotic has not been studied in IBD but is promising. The use of antibiotics continues to be of interest. Although these strategies hold great promise and appear to be useful in some settings, more clinical study is needed to firmly establish the relevance of these therapies.

Animals↗
PubMed1993

Dietary fiber in the management of diabetes.

It generally is accepted that a diet high in fiber, particularly soluble fiber, is useful in the management of the plasma glucose concentration in individuals with diabetes. This is one of the reasons several national diabetes associations have recommended that diabetic individuals ingest a diet high in fiber-containing foods. However, more recent data obtained in carefully controlled studies with more definitive end points, indicate this may not be the case. It has been shown clearly that addition of water-soluble, gel-forming fiber in the form of guar gum and perhaps gum tragacanth to an ingested glucose solution or to a mixed meal will reduce the expected rise in glucose concentration. This has been demonstrated in both normal subjects and subjects with IDDM and NIDDM. However, it is only observed when large amounts of fiber are added. The fiber also must be mixed with the administered glucose or food. Other less viscous soluble fiber sources such as the pectins and psyllium powder are not effective. In long-term, well-controlled trials, guar gum, pectin, beet fiber, or cereal bran fiber ingested with meals has been of little or no value in controlling the plasma glucose concentration in individuals with NIDDM. Several studies have been conducted in which a high-carbohydrate diet has been reported to reduce the plasma glucose concentration. In these diets, foods with a high fiber content have been emphasized. In general, they were not well controlled, and several confounding variables such as weight loss, decreased food energy intake, different food sources with potential for differences in starch digestibility, and decreased dietary fat content were present.(ABSTRACT TRUNCATED AT 250 WORDS)

Diabetes Mellitus↗
PubMed1997

Effects of amount and type of dietary fibre (soluble and insoluble) on short-term control of appetite.

Fibres which are soluble or insoluble in water have different physiochemical properties and may therefore be expected to exert different effects on post-ingestive satiety signals. This study compared the effects on short-term (24 h) appetite of two equienergetic high (22 g) fibre breakfasts, an equienergetic low fibre breakfast and a low energy, 'light' breakfast. Psyllium gum (the soluble fibre) and wheat bran (the insoluble fibre) were incorporated into breakfast cereals and consumed at breakfast by sixteen healthy, normal weight males after an overnight fast using a repeated measures, counterbalanced design. Ad libitum energy intake was assessed at a test snack 1.5 h after breakfast, later in the day using food boxes and the following day using food diaries. Motivation to eat and gastrointestinal sensations were tracked for the next 24 h. Hunger ratings showed a trend towards the subjects being less hungry and they consumed significantly less energy at snack time after the high insoluble than after the high soluble fibre breakfast cereal. The soluble fibre breakfast produced a greater suppression of snack intake than the light breakfast, but smaller suppression than the other breakfasts. Interestingly there was a trend toward reduced hunger and voluntary energy consumption following the soluble fibre compared with the insoluble fibre much later in the day (9.5-13.5 h after breakfast) although this was not significant. There was no significant effect of breakfast type on total day energy intake. The results suggest that different types of fibre modulate the timecourse of appetite control and may produce alterations in the experience of motivation and patterns of eating without necessarily effecting total energy intake.

Adolescent↗
PubMed2002

Dietary counselling for dyslipidemia in primary care: results of a randomized trial.

This study compared the effectiveness of physician advice versus dietitian advice for a fat-reduced diet, and of dietitian advice for a fat-reduced diet versus a soluble fibre-enhanced diet in patients with moderate dyslipidemia. A total of 111 men and women took part in this 26-week, three-group, randomized, clinical trial. The physician advice fat-reduced diet group (n = 38) and the dietitian advice fat-reduced diet group (n = 35) received dietary advice based on the American Heart Association (AHA) Step II guidelines. The dietitian advice soluble fibre-enhanced diet group (n = 38) consumed one-third cup per day of psyllium-containing cereal and was advised to increase soluble fibre intake to over 10 grams a day. LDL-C, TC/HDL-C ratio and body weight reductions over six months were -5.3%, -4.6%, and -1.9%, respectively, regardless of whether a physician or a dietitian provided advice, or whether advice was focused on a fat-reduced diet or a soluble fibre-enhanced diet. Both dietitians and physicians can help moderately dyslipidemic patients make clinically meaningful changes in blood lipid levels. Soluble fibre enhancement of the usual diet leads to similar reductions in LDL-C and TC/HDL-C ratio compared to interventions focused on fat reduction.

Adult↗
PubMed1986

Relationship between dietary fiber and cancer: metabolic, physiologic, and cellular mechanisms.

The relationships between fiber consumption and human cancer rates have been examined, together with an analysis of the effects of individual dietary fibers on the experimental induction of large bowel cancer. The human epidemiology indicates an inverse correlation between high fiber consumption and lower colon cancer rates. Cereal fiber sources show the most consistent negative correlation. However, human case-control studies in general fail to confirm any protective effect due to dietary fiber. Case-control studies indicate that if any source of dietary fiber is possibly antineoplastic then it is probably vegetables. These results may mean that purified fibers alone do not inhibit tumor development, whereas it is likely that some other factors present in vegetables are antineoplastic. Experiments in laboratory animals, using chemical induction of large bowel cancer, have in general shown a protective effect with supplements of poorly fermentable fibers such as wheat bran or cellulose. In contrast, a number of fermentable fiber supplements including pectin, corn bran, oat bran, undegraded carageenan, agar, psyllium, guar gum, and alfalfa have been shown to enhance tumor development. Possible mechanisms by which fibers may inhibit colon tumorigenesis include dilution and adsorption of any carcinogens and/or promoters contained within the intestinal lumen, the modulation of colonic microbial metabolic activity, and biological modification of intestinal epithelial cells. Dietary fibers not only bind carcinogens, bile acids, and other potential toxins but also essential nutrients, such as minerals, which can inhibit the carcinogenic process. Fermentation of fibers within the large bowel results in the production of short chain fatty acids, which in vivo stimulate cell proliferation, while butyrate appears to be antineoplastic in vitro. Evidence suggests that if dietary fibers stimulate cell proliferation during the stage of initiation, then this may lead to tumor enhancement. Fermentation also lowers luminal pH, which in turn modifies colonic microbial metabolic acidity, and is associated with increased epithelial cell proliferation and colon carcinogenesis. Because dietary fibers differ in their physiochemical properties it has been difficult to identify a single mechanism by which fibers modify colon carcinogenesis. Clearly, more metabolic and physiological studies are needed to fully define the mechanisms by which certain fibers inhibit while others enhance experimental colon carcinogenesis.

Animals↗
PubMed1999

[New food allergies].

RISING INCIDENCE OF FOOD ALLERGIES: Food allergies are becoming more and more common, concerning 3 to 4% of the general population. One out of four persons allergic to nuts, the most frequent food allergen, have severe signs and symptoms. A CLASSICAL DIAGNOSIS: Certain diagnosis of food allergy is established on the basis of labial and oral tests. The dose required to induce a reaction is established by the oral test, giving information about the severity of the allergy and its progression. OTHER ALLERGENS: "Emerging" food allergens include spices and condiments, exotic fruits (kiwi, avocado, cashew and pecan nuts, Brazil nuts), sesame seeds, psyllium, sunflower seeds. Endurance exercise following ingestion of a food allergen can lead to severe anaphylactic reactions. Allergen associations "food-pollen", "latex-food", "mitessnails" have been described. INDISPENSABLE PREVENTION: Avoiding contact is essential. Many allergens are "masked" within prepared foods. Precise labeling, with particular attention to nut content, must be reinforced. Individualized counseling on food allergies should be available for school children. Persons with severe allergies should keep at hand an emergency kit with antihistamines, injectable rapid action corticoids and adrenalin (1 mg/ml).

Arachis↗
PubMed2004

Common dietary supplements for weight loss.

Over-the-counter dietary supplements to treat obesity appeal to many patients who desire a "magic bullet" for weight loss. Asking overweight patients about their use of weight-loss supplements and understanding the evidence for the efficacy, safety, and quality of these supplements are critical when counseling patients regarding weight loss. A schema for whether physicians should recommend, caution, or discourage use of a particular weight-loss supplement is presented in this article. More than 50 individual dietary supplements and more than 125 commercial combination products are available for weight loss. Currently, no weight-loss supplements meet criteria for recommended use. Although evidence of modest weight loss secondary to ephedra-caffeine ingestion exists, potentially serious adverse effects have led the U.S. Food and Drug Administration to ban the sale of these products. Chromium is a popular weight-loss supplement, but its efficacy and long-term safety are uncertain. Guar gum and chitosan appear to be ineffective; therefore, use of these products should be discouraged. Because of insufficient or conflicting evidence regarding the efficacy of conjugated linoleic acid, ginseng, glucomannan, green tea, hydroxycitric acid, L-carnitine, psyllium, pyruvate, and St. John's wort in weight loss, physicians should caution patients about the use of these supplements and closely monitor those who choose to use these products.

Anti-Obesity Agents↗
PubMed1991

[Improvement in blood lipids and lipoproteins by simple nutritional modification, exemplified by a high-fiber modified so-called "heart diet" of a West German clinic: the therapeutic gain due to expanding and high fiber foods].

In a clinical study with 40 patients with cardiovascular disease or severe hypercholesterolamia is shown the beneficial cholesterol-lowering effect of a high fibre diet with a high part of soluble plant fibres (pectines, beta-glucanes, psyllium hydrophilic mucilloid). This by fibre content selectet nutrition was integrated in a so called "prudent heart diet" over 3 to 33 weeks. Total cholesterol was lowered from 356 mg/dl (in average) to 246 mg/dl (-20.3%), APO B from 126.3 mg/dl to 103.1 mg/dl (-15.2%) triglycerides from 251 mg/dl to 222 mg/dl (-11.8%) HDL-cholesterol increased from 46 mg/dl to 49 mg/dl (+7.6%), APO A-I from 123 mg/dl to 136 mg/dl (+10.1%).

Adult↗
PubMed1991

[Dietary supplementation in the treatment of hyperlipidemia].

While dietary and pharmacological therapies are the mainstay of treatment of hyperlipidemia, there has been a surge of interest for nonpharmacological treatments such as dietary fibre and food flavourings. In placebo-controlled studies, oat bran in relatively large doses of 56-95 grams per day have been shown to reduce serum cholesterol by 5-9%. Psyllium has caused a 5-15% reduction of serum cholesterol with doses of 10.2 grams per day, and guar gum a reduction of 5-17% with doses of 15 grams per day. Documentation of long-term effects is inadequate. Fresh garlic contains over 70 compounds containing sulphur, which may be biologically active. In animal experiments cholesterol is reduced by supplementing the diet with large doses of fresh, boiled, or dried products. Human studies are poor methodologically, and none has documented constancy of diet during the study.

Cholesterol↗
PubMed1991

Collagenous colitis: report of nine cases and review of the literature.

Collagenous colitis is characterized clinically by chronic watery diarrhea and pathologically by a distinctive band of collagen deposited below the colonic epithelium and an inflammatory cell infiltrate of the lamina propria. Since 1976, more than 100 cases have been described. We report an additional nine cases occurring in five women and four men ranging in age from 18 to 80 years. Diarrhea was present before diagnosis for 2 to 4 months in four cases and for 1 to 25 years in another four cases. One patient did not have diarrhea. Results of radiologic and stool studies were normal in all cases. All patients had flexible sigmoidoscopy or colonoscopy. Microscopic examination of biopsy material was interpreted as characteristic of collagenous colitis. Two cases resolved with psyllium mucilloid therapy alone. Of the five patients treated with azulfidine, three had marked improvement, one had partial response, and one had no change.

Adolescent↗
PubMed1990

[Hemorrhoids. Medico-surgical treatment].

The clinical history of 300 patients examined by the author at San Fernando Clinic and 90 consecutive cases operated at CHMCSS were studied. The frequency and characteristics of symptoms, the gender prevalence, the physical findings, the clinical classification and the various therapeutic methods used were determined. It was noticed that 84% of the patients received conservative treatment and 16% were subjected to surgery. The conservative treatment consisted of high fiber diets, warm sits baths, psyllium, hemorrhoidal sclerosis or ligature with rubber bands. The surgical treatment consisted of the ligature and excision of the three primary hemorrhoids and of the hemorrhoidal plexus(5), which is a simple, fast and effective technique, because the removal of the hemorrhoidal cushion avoids recurrences. Furthermore, the suturing of the longitudinal fibers and the pedicle and their fixation to the external sphincter avoids the upward retraction of the pedicle and the formation of denuded areas in the anal canal that can lead to stenosis at the level of the anorectal ring.

Adolescent↗
PubMed1995

Risk of bowel dysfunction with diarrhea after continent urinary diversion with ileal and ileocecal segments.

PURPOSE: In a retrospective study we evaluated the risk of diarrhea after continent urinary diversion using ileal and ileocecal segments. MATERIALS AND METHODS: We interviewed 100 patients of whom 65 underwent ileal and 35 underwent ileocecal resection. RESULTS: Of the 65 patients who underwent ileal resection 7 (11%) and of the 35 who underwent ileocecal resection 8 (23%) reported chronic diarrhea of greater than 6 months in duration, which subsided spontaneously in 2 patients in each group. In each group 3 patients responded well to cholestyramine treatment and 3 responded to loperamid or psyllium. Two patients with ileocecal resection failed to respond to drug therapy. CONCLUSIONS: The risk of diarrhea after ileocecal resection seems to be twice as high as after ileal resection. Most patients responded to symptomatic drug therapy. Alternative surgical therapies should be considered when risk factors are present.

Cecum↗
PubMed1995

[Is atopy a risk factor of occupational asthma?].

General reviews about occupational asthma divide the susceptible allergens capable of initiating asthma into two distinct groups: those of high and of low molecular weight. Atopy would be a risk factor for developing occupational asthma to high molecular weight allergens but not to those of low molecular weight. In this work we have examined several studies and have analysed in a critical manner the relationship which exists between atopy and occupational asthma. The high molecular weight allergens studied were: snow crabs, laboratory animals, flour, proteolytic enzymes and psyllium. Those of low molecular weight were: red cedar, isocyanates, phthalic anhydride. Amongst allergens of high molecular weight there is a undeniable relationship between atopy and sensitisation to the allergen incriminated. However, the relation between atopy and asthma is more debatable except for baker's asthma. For more allergens of low molecular weight, atopy does not seem to favour the appearance of asthma, however, it may play a role in the occurrence of asthma to red cedar. The difference between the two groups of allergens is not as clear-cut as in the work that has appeared up until now and the exclusion of atopics from being hired would appear excessive.

Allergens↗
PubMedDate not supplied

[Metabolic diseases and the high-fiber diet].

There is no doubt that fiber, in particular viscous dietary fiber, has a positive effect on human health both in the prevention and treatment of chronic diseases. Over 30 years of intensive clinical research with guar, psyllium, oat and other fiber-rich foods has repeatedly demonstrated the health benefits of dietary fiber in lowering insulin requirements and improving blood glucose control in diabetics, as well as reducing serum lipid levels in hyperlipidemics. Accumulating epidemiological evidence is also supporting the link between high-fiber diets and the reduction of risk for heart disease and cancer. As a result, increased dietary fiber is recommended by health authorities worldwide. However, the mechanism of fibers' action is not fully understood and the effect is not always consistent with the expected results. One of the reasons could be the large intra- and inter-fiber variability due to its complex structural and physicochemical characteristics. As a consequence, some of the health agencies focus their recommendations more on the type of dietary fat rather than a high carbohydrate/high-fiber.

Coronary Disease↗
PubMed1997

Systematic review of the effectiveness of laxatives in the elderly.

OBJECTIVES: To determine the effectiveness and cost of laxatives in the prevention and treatment of constipation in the elderly. HOW THE RESEARCH WAS CONDUCTED: Randomised controlled trials (RCTs) of treatment or prevention of constipation were included in the review. INTERVENTIONS: The four classes of laxatives, bulk, osmotic, stimulant laxatives and faecal softeners, were covered by the review. The main laxatives included in the trials were bran, psyllium, prucara, cascara, dioctyl sodium, lactulose, and lactitol. PARTICIPANTS: Elderly people suffering from chronic functional constipation. A trial was eligible for inclusion if all participants were aged 55 years or older and being treated for chronic constipation. The trials reviewed did not provide further subcategorisation by aetiology. MAIN OUTCOMES: Number of bowel movements per week; symptom improvement; stool consistency; abdominal pain. DATA SOURCES: The recent systematic review by Tramonte and colleagues was used as a source of trials (J Gen Intern Med 1997;12:15-24). In addition, the following databases were searched: Embase, Psychlit, Medline, the Cochrane library, the nursing database CINAHL, International Pharmaceutical Abstracts, and the alternative therapies database, AMED. Authors and manufacturers were also asked for information. Studies in any language were eligible for inclusion. Decisions on the relevance of primary studies were made independently by two reviewers. Economic information was searched for in Current Contents/Clinical Medicine, Medline, and the NHS Economic Evaluation Database (NEED). VALIDITY ASSESSMENT: The quality of primary studies was summarised on a 6-item scale. This covered reporting of inclusion and exclusion criteria, randomisation method, standardised assessmment of adverse effects, double-blind design, description of withdrawals, and statistical analysis. The assessment of validity of included studies was carried out independently by two reviewers. Data were extracted from studies independently by two reviewers. Authors were contacted for more information where necessary to obtain unpublished information. CLINICAL TRIALS INCLUDED: Ten trials comparing single agents with placebo were identified, with a total of 367 patients were identified, with a total of 367 patients who had a mean age of about 74 years. Two of these presented no information on the numbers of men and women (54%) in the remaining eight trials. The majority of patients were in an institutional setting, such as a nursing home or hospital. Ten trials compared one laxative agent with another. The mean age of participants in these trials was estimated at 77 years. Only one trial examined patients in an outpatient setting; the other trials were carried out in nursing homes or hospitals. (ABSTRACT TRUNCATED)

Adult↗