Treatment of diabetes with guar gum. Reduction of urinary glucose loss in diabetics

When nine diabetic patients supplemented either their normal home diets (four patients) or metabolic ward diets (five patients) with 25 g guar gum daily for 5 or 7 days their mean urinary glucose excretion fell by 46% (P less than 0-05) and 54% (P less than 0-01), respectively. Gel-forming,, unabsorbable carbohydrate may therefore be a useful adjunct to anti-diabetic therapy, irrespective of the type of treatment or insulin dosage used.

Wheat bran as an etiologic factor in certain diseases. Some second thoughts

The author questions "the bran hypothesis" that a deficiency of natural fiber--wheat bran in particular--is responsible for a number of prevalent diseases in Western societies, namely diverticular disease, cancer of the colon, gallstones, and myocardial disease. In re-examining the hypothesis, he cites reports which fail to support the theory. For instance, the incidence of diverticular disease in women has increased since 1925, yet there is no evidence that their diets have changed or are different from those of men. Also, it is a mistake to equate wheat bran with fiber in general, and it cannot be shown that dietary fiber in general has declined. In addition, clinical studies have failed to show beneficial results in treating diverticular disease and irritable colon by adding bran to the diet. Similar problems arise in testing the hypothesis that natural fiber can prevent cancer of the colon and lower serum cholesterol and triglycerides. Recent interest in dietary fiber is welcome, for it has been grossly neglected, but much research is still needed to place it in proper perspective.

Wheat fibre and irritable bowel syndrome. A controlled trial

Twenty-six patients with irritable bowel syndrome entered a controlled trial of diets with a high or low wheat-fibre content. After 6 weeks on the high-wheat fibre regimen there was significant improvement in symptoms and an objective change in colonic motor activity. No such improvement occurred on the low-fibre regimen. Patients with irritable bowel syndrome should be encouraged to increase their daily intake of wheat fibre.

Hypercalciuria in sarcoidosis

In 18 cases of sarcoidosis, 11 presented with hypercalciuria. Absorptive hypercalciuria was usually involved, but 2 patients had probably a calcium renal leak. Therapy with sodium cellulose phosphate was usually effective in lowering the amount of urine calcium, but thiazides had to be used concomitantly in three cases.

Ocular manifestations of toxic epidermal necrolysis associated with allopurinol use

A 54-year-old man was receiving allopurinol therapy to treat hyperuricemia that followed an inferior wall, myocardial infarction. After three weeks of allopurinol therapy, the patient developed signs and symptoms of toxic epidermal necrolysis that included pseudomembranous conjunctivitis with ulcerative lesions on the lids and conjunctiva, and punctate corneal staining with subsequent corneal abrasions. Treatment with topical antibiotics and artificial tears relieved the symptoms somewhat, but punctate staining and dry eyes persisted after 14 months of follow-up. Bilateral corneal ulcers developed and necessitated conjunctival flaps in each eye. Visual acuity in each eye was 20/40.

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.

Silicon, fibre, and atherosclerosis

A logical argument can be made for the hypothesis that lack of silicon may be an important aetiological factor in atherosclerosis. As silicic acid or its derivatives, silicon is essential for growth. It is found mainly in connective tissue, where it functions as a cross-linking agent. Unusually high amounts of bound silicon are present in the arterial wall, especially in the intima. Various kinds of dietary fibre have been reported to be effective in preventing experimental models of atherosclerosis, reducing cholesterol and blood-lipid levels, and binding bile acids in vitro. Exceptionally large amounts of silicon (1000 to 25 000 p.p.m.) were found in fibre products of greatly varying origin and chemical composition which were active in these tests. Inactive materials, such as different types of purified cellulose, contained only negligible quantities of the element. It is concluded that silicate-silicon may be the active agent in dietary fibre which affects the development of atherosclerosis. Two out of three samples of bran also had relatively low levels, which could explain why bran does not lower serum-cholesterol. The fact that atherosclerosis has a low incidence in less developed countries may be related to the availability of dietary silicon. Two instances are presented where silicon is reduced by industrial treatment: white flour and refined soy products were much lower in silicon than--their respective crude natural products. The chemical nature of silicon in different types of fibre is not known. It could exist as orthosilic acid, polymeric silicic acid, colloidal silica (opal), dense silica concentrations, or in the form of organically bound derivatives of silicic acid (silanolates). Possible mechanisms of action are discussed.

Soluble artifical tear inserts

This article reports a new concept in the treatment of tear film abnormalities. Solubilization of an artifical tear insert provides a continuous flow of polymer into the tear film in place of intermittent drop therapy. The physiochemical properties of succinylated collagen were studied in vitro and compared favorably with presently available tear substitutes. The use of this polymer as a solid solubilizable insert was evaluated in normal patients. It was found to be comfortable, resulted in no blurring of vision, and prolonged the tear film breakup time.

Effect of dietary bran on serum lipids in patients with previous myocardial infarction, with gallstones, and in normal subjects

Sixteen subjects received between 50 g to 121 g of wheat bran in their diet for between 6 to 26 weeks. Five were normal subjects, 5 had gallstones, and 6 young men had suffered a previous myocardial infarction. The serum cholesterol did not show any consistent change in the normal subjects, but there was a fall in cholesterol at 20 weeks in patients with gallstones; patients with previous myocardial infarction had a rise in cholesterol which returned to normal at 20 weeks. There was no significant change in the serum triglyceride.

Natural fiber and bowel dysfunction

This paper reviews the current status of knowledge with relation to the effects of natural fiber on intestinal physiology. The one clear feature that emerges from literature is that most types of natural fiber increase the bulk of the stool. It is probable also that transit time is affected. Transit time appears to be decreased in persons with initially a slow time when they use certain forms of natural fiber and it may be that persons with rapid transit have a decrease in the rate of passage as fiber is added to the diet. Data on colonic intraluminal pressures are scanty, but those that exist seem to indicate that the addition of bran to the diet results in a decrease in overall colonic pressures. Much has been written and speculated about the role of natural fiber in the prevention or therapy of irritable colon and diverticular disease. Clinical studies, while enthusiastic, are preliminary and there are no hard data to indicate that the use of these materials are, in fact, helpful. Such clinical trials that have been published are, in general, small, poorly controlled and overall equivocal in their conclusions. A great deal of further work requires to be done to justify the claims that have been made on the role of fiber in altering normal or abnormal bowel habit.

Colon cancer and diet, with special reference to intakes of fat and fiber

Colon cancer, rare in the past, and in developing populations, currently accounts for 2 to 4% of all deaths in Western populations. Evidence suggests the primary cause to be changes in diet, which affect the bowel milieu intérieur. It is possible that in sophisticated populations, the higher concentrations of fecal bile acids and sterols, and longer transit time, favor the production of potentially carcinogenic metabolites. Of secular changes in diet, evidence suggests that the following may have etiological importance: 1) the fall in intake of fiber-containing foods with its effects on bowel physiology, and 2) the decreased fiber but increased fat intakes, in their respective capacities to raise concentrations of fecal bile acids, sterols, and other noxious substances. For possible prophylaxis against colon cancer, recommendations for a lower fat intake, or a higher intake of fiber-containing foods (apart from fiber ingestion from bran) are extremely unlikely to be adopted. For future research, western populations with considerably lower than average mortality rates, e.g., Seventh Day Adventists, Mormons, the rural Finnish population, as well as developing populations, demand intensive study. Also requiring elucidation are the respective roles of diet and of genetic constitution on concentrations of fecal bile acids, etc., and on transit time, in prone and nonprone populations.

Crystalluria in normal subjects and in stone formers with and without thiazide and cellulose phosphate treatment

Quantitative and qualitative studies have been made of the urinary crystals from a series of normal subjects and from stone formers with idiopathic hypercalciuria with and without treatment with thiazide diuretics and/or cellulose phosphate. The results obtained from mid-morning unprepared subjects seemed more helpful than those obtained following overnight collections or after a dry breakfast. Crystalluria was more common in stone formers than in normal subjects, but was seen in both groups. The most striking difference between these 2 groups was the almost complete absence of aggregation of oxalate crystals in the normal subjects. Cellulose phosphate greatly reduced phosphate crystals but resulted in a large increase in small oxalate crystals but without change in the incidence of aggregation of oxalate crystals. Thiazides also reduced occurrence of phosphate crystals but only gave a very small increase in oxalate crystals and also without change in aggregation of oxalate crystals.

Changes in fecal composition and colonic function due to cereal fiber

The effect on colonic function of adding wheat fiber for 3 weeks to the metabolically-controlled diets of six healthy volunteers has been studied. Increasing dietary fiber intake from 17 to 45 g/day increased fecal weight from 79 +/- 6.6 g/day to 228 +/- 29.9 g/day and shortened mean transit time, measured by a continuous marker method, from 57.8 +/- 8.3 hr to 40.3 +/- 8.9 hr. The increase in fecal weight was largely due to water. Fiber caused a dilution of fecal marker and an increase in fecal fat, nitrogen, and calcium output. Fecal sodium, potassium, and chloride showed only small changes but volatile fatty acid output increased significantly without concentrations changing. Fecal bile acid output increased from 199 +/- 46 mg/day to 279 +/- 46 mg/day. These changes are discussed in light of current views of the role of dietary fiber in protecting against colon cancer.