The relation between bacterial degradation of viscous polysaccharides and stool output in human beings

Effect of oat or rice flour on pulse-induced gastrointestinal symptoms and breath hydrogen in subjects sensitive to pulses and controls - a randomised cross-over trial with two parallel groups

Pulses are healthy and sustainable but induce gut symptoms in people with a sensitive gut. Oats, on the contrary, have no fermentable oligo- di-, monosaccharides and polyols compounds and are known for the health effects of their fibres. This 4-day cross-over trial investigated the effects of oat and rice flour ingested with pulses on gut symptoms and exhaled gases (4th day only) in subjects with a sensitive gut or IBS (n 21) and controls (n 21). The sensitive group perceived more symptoms after both meals than controls (P = 0·001, P = 0·001). Frequency, intensity or quality of the symptoms did not differ between meals during the first 3 d in either group. More breath hydrogen was produced after an oat than rice containing meal in both groups (AUC, P = 0·001, P = 0·001). No between-group difference was seen in breath gases. During day 4, both sensitive and control groups perceived more symptoms after the oat flour meal (P = 0·001, P = 0·0104, respectively) as mainly mild flatulence. No difference in moderate or severe symptoms was detected. Increased hydrogen production correlated to a higher amount of perceived flatulence after the oat flour meal in both the sensitive and the control groups (P = 0·042, P = 0·003, respectively). In summary, ingestion of oat flour with pulses increases breath hydrogen levels compared with rice flour, but gastrointestinal symptoms of subjects sensitive to pulses were not explained by breath hydrogen levels. Additionally, consumer mindsets towards pulse consumption and pulse-related gut symptoms were assessed by an online survey, which implied that perceived gut symptoms hinder the use of pulses in sensitive subjects.

Investigation of different dietary-fibre-ingredients for the design of a fibre enriched bread formulation low in FODMAPs based on wheat starch and vital gluten

Consumption of fermentable oligo-, di-, monosaccharides and polyols (FODMAPs) often induces symptoms of irritable bowel syndrome (IBS). Since FODMAPs and dietary fibre (DF) share certain characteristics, IBS-patients have a limited intake of DF. Therefore, enrichment of a low FODMAP model bread (based on 84% wheat starch and 16% vital gluten) with various fibres (bamboo, cellulose, psyllium, guar gum) in two different concentrations (3 g/100 g and 6 g/100 g) was investigated. Physico-chemical properties of doughs and breads were analysed (fermentation quality, gluten development, specific volume and hardness), as well as the release of reducing sugars during in vitro digestion. High performance anion exchange chromatography with coupled pulsed amperometric detection (HPAEC-PAD) was used to determine the FODMAP levels (contents of mannitol, sorbitol, fructose in excess of glucose, fructans and α-galactooligosaccharides) of both dough and bread. Prototypes were compared with wheat flour-based breads (bakers’ flour with and without wheat bran addition) to assess the performance of these prototypes. Prototypes showed a decreased quality compared to a baker’s flour control, however, a quality comparable to commercial wheat bran breads was found. This in combination with a lower release of reducing sugars during in vitro digestion underline the potential of fibre enriched breads as part of a healthier and more palateable low FODMAP diet. Furthermore, this study highlights the importance of the type (viscous and insoluble) and the concentration of fibres used. Application of psyllium in a concentration of 3 g/100 g showed the most beneficial impact on both physical (specific volume, hardness after 0 h and 24 h) and nutritional aspects of bread.

Laxative effects of wheat bran and psyllium: Resolving enduring misconceptions about fiber in treatment guidelines for chronic idiopathic constipation

BACKGROUND

Treatment guidelines for chronic idiopathic constipation (CIC) recommend an "increase in fiber intake" as a first-line therapy, but most epidemiologic studies fail to support an association between a high-fiber diet and a reduced risk of constipation. Furthermore, randomized controlled clinical studies show that most isolated fibers (e.g., supplements) are not different from placebo for a laxative effect, and several may be constipating.

OBJECTIVES

The objective of this review was to compare the effects of two isolated fibers, coarse wheat bran and psyllium, on stool output and stool water content in patients with CIC. This review will also address misconceptions about fiber that are perpetuated by treatment guidelines.

DATA SOURCES

A comprehensive literature review was conducted with the use of the Scopus, SciFinder, and PubMed scientific databases, limited to the previous 50 years (1968-2018; latest date included, December 31, 2018).

CONCLUSIONS

In patients with CIC, nonfermented gel-forming psyllium was 3.4 times more effective than insoluble wheat bran for increasing stool output. Both psyllium and coarse wheat bran increased stool water content, a stool-softening effect, but finely ground wheat bran decreased stool water content, a stool-hardening effect.

IMPLICATIONS FOR PRACTICE

It is a misconception that dietary fiber and all isolated fibers provide a laxative effect in patients with CIC. Our analysis suggests that treatment guidelines for CIC should make specific evidence-based recommendations as it pertains to fiber. To do otherwise takes the risk of perpetuating myth and misunderstanding and depriving patients of an effective therapy for CIC. A generic recommendation to "increase fiber intake" is akin to a recommendation to "increase pill intake" without regard to therapeutic or adverse effects.

Review article: dietary fibre in the era of microbiome science

BACKGROUND

Explanations for the health benefits of dietary fibre have, in the past, been inconsistent and studies of the physiological effects of dietary fibre were, perhaps, directed at the wrong read-outs. Confounding factors included a failure to appreciate the molecular diversity and varied properties of fibre-types and the role of fibre as a substrate for microbial metabolism in the gut.

AIM

To present a modern perspective on fibre science and to encourage clinicians to re-consider the health impact of dietary fibre and how best to approach adjustments in dietary consumption.

METHODS

This perspective is drawn selectively from recent microbiome science; no attempt was made to perform an exhaustive review of all articles related to every aspect of dietary fibre.

RESULTS

Advances in microbiome science have revealed not only the functional impact of dietary fibre on the composition and function of the microbiota but have also demonstrated the physiologic responses to microbial-derived metabolites from fibre digestion. Moreover, studies have shown the personalised nature of host responses to dietary fibre intervention, with outcomes being dependent on individual pre-treatment gut ecology.

CONCLUSIONS

The physical properties of dietary fibres are important for homeostasis within the gut, but the predominant health benefits extend beyond the gut to enhanced metabolic welfare, including protection against obesity and related metabolic diseases. Fibre is a form of functional food joining a growing list of examples of diet-microbe-host interactions which link microbe-host metabolic and immune cascades.

Constipation: Pathophysiology and Current Therapeutic Approaches

Chronic constipation is a common, persistent condition affecting many patients worldwide, presenting significant economic burden and resulting in substantial healthcare utilization. In addition to infrequent bowel movements, the definition of constipation includes excessive straining, a sense of incomplete evacuation, failed or lengthy attempts to defecate, use of digital manoeuvres for evacuation of stool, abdominal bloating, and hard consistency of stools. After excluding secondary causes of constipation, chronic idiopathic or primary constipation can be classified as functional defecation disorder, slow-transit constipation (STC), and constipation-predominant irritable bowel syndrome (IBS-C). These classifications are not mutually exclusive and significant overlap exists. Initial therapeutic approach to primary constipation, regardless of aetiology, consists of diet and lifestyle changes such as encouraging adequate fluid and fibre intake, regular exercise, and dietary modification. Laxatives are the mainstay of pharmacologic treatment for potential long-term therapy in patients who do not respond to lifestyle or dietary modification. After a failed empiric trial of laxatives, diagnostic testing is necessary to understand underlying anorectal and/or colonic pathophysiology. No single test provides a comprehensive assessment for primary constipation; therefore, multiple tests are used to provide complementary information to one another. Dyssynergic defecation, a functional defecation disorder, is an acquired behavioural disorder of defecation present in two-thirds of adult patients, where an inability to coordinate the abdominal, recto-anal, and pelvic floor muscles during attempted defecation exists. Biofeedback therapy is the mainstay treatment for dyssynergic defecation aimed at improving coordination of abdominal and anorectal muscles. A large percentage of patients with dyssynergic defecation also exhibit rectal hyposensitivity and may benefit from the addition of sensory retraining. Our understanding of the pathophysiology of STC is evolving. The advent of high-resolution colonic manometry allows for the improved identification of colonic motor patterns and may provide further insight into pathophysiological mechanisms. In a minority of cases of STC, identification of colonic neuropathy suggests a medically refractory condition, warranting consideration of colectomy. The pathophysiology of IBS-C is poorly understood with multiple etiological factors implicated. Pharmacological advances in the treatment of primary constipation have added therapeutic options to the armamentarium of this disorder. Drug development in the secretagogue, serotonergic prokinetic, and ileal bile acid transporter inhibition pathways has yielded current and future medical treatment options for primary chronic constipation.

Fermented Fiber Supplements Are No Better Than Placebo for a Laxative Effect

BACKGROUND

Misconceptions about the effects of dietary fiber and 'functional' fiber on stool parameters and constipation persist in the literature.

METHODS

A comprehensive literature review was conducted with the use of the Scopus and PubMed scientific databases to identify and objectively assess well-controlled clinical studies that evaluated the effects of fiber on stool parameters and constipation.

RESULTS

The totality of well-controlled randomized clinical studies show that, to exert a laxative effect, fiber must: (1) resist fermentation to remain intact throughout the large bowel and present in stool, and (2) significantly increase stool water content and stool output, resulting in soft/bulky/easy-to-pass stools. Poorly fermented insoluble fiber (e.g., wheat bran) remains as discreet particles which can mechanically irritate the gut mucosa, stimulating water & mucous secretion if the particles are sufficiently large/coarse. For soluble fibers, some have no effect on viscosity (e.g., inulin, wheat dextrin) while others form high viscosity gels (e.g., β-glucan, psyllium). If the soluble fiber is readily fermented, whether non-viscous or gel-forming, it has no effect on stool output or stool water content, and has no laxative effect. In contrast, a non-fermented, gel-forming soluble fiber (e.g., psyllium) retains its gelled nature and high water-holding capacity throughout the large bowel, resulting in soft/bulky/easy-to-pass stools.

CONCLUSION

When considering a recommendation for a fiber supplement regimen to treat and/or prevent constipation, it is important to consider which fibers have the physical characteristics to exert a laxative effect, and which fiber supplements have rigorous clinical evidence of a significant benefit in patients with constipation.

Systematic review: dietary fibre and FODMAP-restricted diet in the management of constipation and irritable bowel syndrome

BACKGROUND

Dietary fibre supplements have been advocated for the management of chronic constipation (CC) and irritable bowel syndrome (IBS). Recently, a fermentable oligosaccharide, disaccharide, monosaccharide and polyol (FODMAP) restricted diet has been recommended for IBS.

AIM

To systematically examine recent evidence for dietary interventions with fibre in CC and IBS and FODMAP-restricted diet in IBS, and provide recommendations.

METHODS

We searched PUBMED, MEDLINE, OVID and COCHRANE databases from 2004 to 2014. Published studies in adults with CC and IBS and constipation-predominant IBS (IBS-C) that compared fibre with placebo/alternative and FODMAP-restricted diet with alternative were included.

RESULTS

Of 550 potentially eligible clinical trials on fibre, 11 studies were found and of 23 potentially eligible studies on FODMAPs, six were found. A meta-analysis was not performed due to heterogeneity and methodological quality. Fibre was beneficial in 5/7 studies in CC and 3/3 studies in IBS-C. FODMAP-restricted diet improved overall IBS symptoms in 4/4 and IBS-C symptoms in 1/3 studies and three studies did not meet inclusion criteria. There were significant disparities in subject selection, interventions and outcome assessments in both fibre and FODMAPs studies.

CONCLUSIONS

Fibre supplementation is beneficial in mild to moderate CC and IBS-C, although larger, more rigorous and long-term RCTs are needed (Fair evidence-Level II, Grade B). Although the FODMAP-restricted diet may be effective in short-term management of selected patients with IBS (Fair evidence-Level II, Grade C) and IBS-C (Poor evidence-Level III, Grade C), more rigorous trials are needed to establish long-term efficacy and safety, particularly on colonic health and microbiome.

Fiber and functional gastrointestinal disorders

Despite years of advising patients to alter their dietary and supplementary fiber intake, the evidence surrounding the use of fiber for functional bowel disease is limited. This paper outlines the organization of fiber types and highlights the importance of assessing the fermentation characteristics of each fiber type when choosing a suitable strategy for patients. Fiber undergoes partial or total fermentation in the distal small bowel and colon leading to the production of short-chain fatty acids and gas, thereby affecting gastrointestinal function and sensation. When fiber is recommended for functional bowel disease, use of a soluble supplement such as ispaghula/psyllium is best supported by the available evidence. Even when used judiciously, fiber can exacerbate abdominal distension, flatulence, constipation, and diarrhea.

Evaluation of the effect of four fibers on laxation, gastrointestinal tolerance and serum markers in healthy humans

BACKGROUND

Average dietary fiber intake in the United States is roughly half of the recommended amount. As new dietary fiber products are introduced to increase fiber intake, it is critical to evaluate the physiological effects of such fibers.

AIMS

This study examined the effect of 4 fibers derived from maize or tapioca on fecal chemistry, gastrointestinal (GI) symptoms and serum markers of chronic disease.

METHODS

Twenty healthy subjects completed the single-blind crossover study in which 12 g/day of fiber (pullulan, Promitor Resistant Starch, soluble fiber dextrin or Promitor Soluble Corn Fiber) or placebo (maltodextrin) were consumed for 14 days followed by a 21-day washout. GI symptom surveys were completed (days 3 and 14), stools were collected (days 11-14), diet was recorded (days 12-14) and fasting blood samples were obtained (day 15).

RESULTS

The 4 test fibers were well tolerated, with mild to moderate GI symptoms. Total short-chain fatty acid (SCFA) concentrations did not differ among the treatments. Fecal pH and individual SCFAs were affected by some treatments. Stool weight and serum markers of chronic disease did not change with these treatments.

CONCLUSION

Increasing fiber intake by 12 g/day was well tolerated and may have a positive impact on colon health due to fermentation.

Ballaststoffe: Mehr als ein Diätmittel

Dietary fibre is a heterogeneous group of substances which have only one common characteristic: the non-digestability in the small bowel. With one exception all fibres are carbohydrates (poly- or disaccharides). Some fibres are water-soluble, others are unsoluble. This property is associated with physiological effects. Soluble (viscous) fibres can bind water and thus form hydrocolloids or gels, unsoluble ones cannot. Dietary fibres play an essential role in the physiology of the gastrointestinal tract. They modify the absorption of nutrients (particularly carbohydrates and lipids) in the small bowel. They accelerate the gut transit time and determine stool composition and quantity. They are the main nutritional source for the colonic microflora. During the bacterial fermentation short-chain fatty acids are formed which are essential for nutrition and integrity of the colonocytes and for colonic function. Moreover gases, detoxicating enzymes, antioxidants and carcinogen-inactivating compounds arise. The most important fibres are cellulose, hemicellulose, pectin, guar, psyllium, beta-glucan, Klason lignin and digestion-resistant starch; they are present in varying amounts in plant foods and in fibre preparations. The usual daily intake of dietary fibre in Europe and the USA amounts to only 15-20 g, while health authorities and nutrition societies recommend a reference value of at least 30 g. Dietary fibres are applied as food-integrated, as supplement and as purified substances.

Patient and physician evaluation of a new bulk fiber laxative tablet

Occasional constipation is a frequent complaint in medical practice. Bulk-fiber laxatives are often recommended as a safe and effective treatment of this disorder. The viscous suspensions required for administering most bulk-fiber laxatives, however, can negatively affect compliance. This study summarizes physician and patient assessment of a new, oral bulk-fiber laxative caplet following 2 weeks of open-label use for the treatment of constipation and related disorders. Forty-two patients recruited from colorectal surgical practices and who were recommended bulk-fiber as part of their treatment completed the study. Recommended dosage was 2 caplets b.i.d., with each 2-caplet dose providing 1 gram of methylcellulose. Patient diaries reported average daily use of 3.13 +/- 1.20 caplets/day and a total of 577 patient-days of use (calculated as total days product used x number of subjects). Ninety percent of the diaries reported at least one bowel movement daily. Fourteen days of treatment progressively and significantly increased the percentage of complete bowel movements, bowel movements having normal stool consistency, and reduced straining. Physicians rated more than 75% of patients' responses to treatment with methylcellulose caplets as "very good" or "excellent," and considered the responses equal or better than that expected for a fiber treatment in 90% of subjects. Among 24 patients who had previously used fiber, 21 preferred the caplets over prior fiber products. Methylcellulose tablets may provide a useful alternative for improving compliance among patients using fiber therapy.

Supplementation with dietary fiber improves fecal incontinence

BACKGROUND

Human studies have shown that dietary fiber affects stool composition and consistency. Because fecal incontinence has been shown to be exacerbated by liquid stools or diarrhea, management strategies that make stool consistency less loose or liquid may be useful.

OBJECTIVE

To compare the effects of a fiber supplement containing psyllium, gum arabic, or a placebo in community-living adults who were incontinent of loose or liquid stools. Mechanisms underlying these effects (e.g., fermentation of the fibers and water-holding capacity of stools) were examined.

METHODS

Thirty-nine persons with fecal incontinence of loose or liquid stools prospectively recorded diet intake and stool characteristics and collected their stools for 8 days prior to and at the end of a 31-day fiber supplementation period. During the fiber supplementation period, they ingested psyllium, gum arabic, or a placebo by random assignment.

RESULTS

In the baseline period, the groups were comparable on all variables measured. In the fiber supplementation period, (a) the proportion of incontinent stools of the groups ingesting the fiber supplements was less than half that of the group ingesting the placebo, (b) the placebo group had the greatest percentage of stools that were loose/unformed or liquid, and (c) the psyllium group had the highest water-holding capacity of water-insoluble solids and total water-holding capacity. The supplements of dietary fiber appeared to be completely fermented by the subjects as indicated by nonsignificant differences in total fiber, short chain fatty acids and pH in stools among the groups in the baseline or fiber supplementation periods.

CONCLUSIONS

Supplementation with dietary fiber from psyllium or gum arabic was associated with a decrease in the percentage of incontinent stools and an improvement of stool consistency. Improvements in fecal incontinence or stool consistency did not appear to be related to unfermented dietary fiber.

An unfermented gel component of psyllium seed husk promotes laxation as a lubricant in humans

BACKGROUND

In addition to increasing stool weight, supplements of psyllium seed husk produce stools that are slick and gelatinous.

OBJECTIVE

Our purpose was to test the hypothesis that a gel-forming fraction of psyllium escapes microbial fermentation and is responsible for the characteristics that enhance laxation.

DESIGN

Fifteen healthy adults consumed controlled diets for two 7-d periods, one of which included 8.8 g dietary fiber provided by 15 g/d of a psyllium seed husk preparation. All stools were collected and evaluated and diet was monitored throughout.

RESULTS

Psyllium significantly increased the apparent viscosity of an aqueous stool extract, stool moisture, and wet and dry stool weights. A very viscous fraction, not present in low-fiber stool and containing predominantly 2 sugars that are also found in abundance in psyllium husk, was isolated from psyllium stool.

CONCLUSIONS

In contrast with other viscous fibers that are fermented completely in the colon, a component of psyllium is not fermented. This gel provided lubrication that facilitated propulsion of colon contents and produced a stool that was bulkier and more moist than were stools resulting with use of comparable amounts of other bowel-regulating fiber sources.

The effects of psyllium hydrophilic mucilloid on diarrhea in enterally fed patients

OBJECTIVE

To investigate the efficacy of psyllium hydrophilic mucilloid (PHM) for prevention of diarrhea and to compare methods of PHM delivery.

DESIGN

Experimental.

SETTING

University-affiliated Department of Veterans Affairs Medical Center.

SUBJECTS

Sixty patients from medical-surgical and intensive care units who received newly initiated enteral feeding via feeding tube.

OUTCOME MEASURES

Diarrhea, stool frequency and consistency, and feeding tube obstruction.

INTERVENTION

Receipt of PHM (7 gm, twice-daily) added to continuous feeding or given as a bolus with intermittent feeding, or receipt of No PHM for 7 days after initiation of enteral feeding.

RESULTS

Fifteen subjects (25%) developed diarrhea (defined as 3 or more liquid stools per day, or 2 or more liquid stools on successive days). There were no significant differences in incidence of diarrhea or percentage of days of diarrhea between subjects who did and did not receive PHM. However, subjects who received PHM in their continuous feedings had a significantly higher number of gelatinous stools, and the combined PHM groups had a significantly lower number of liquid stools and a higher number of normal stools than did subjects who did not receive PHM. For the combined PHM groups, there was a 12% incidence of small-bore feeding tube occlusion--requiring replacement.

CONCLUSIONS

Further study with a larger sample is necessary to evaluate trends found in this pilot study and to determine PHM efficacy for prevention of diarrhea. PHM administration may result in small-bore feeding tube obstruction, and thus requires adequate dilution and close monitoring.

Estimation of the fermentability of dietary fibre in vitro: a European interlaboratory study

Five European laboratories tested a simple in vitro batch system for dietary fibre fermentation studies. The inoculum was composed of fresh human faeces mixed with a carbonate-phosphate buffer complex supplemented with trace elements and urea. Five dietary fibre sources (cellulose, sugarbeet fibre, soyabean fibre, maize bran and pectin) were used by each laboratory on three occasions to determine pH, residual non-starch polysaccharides (NSP) and short-chain fatty acid production during fermentation. Cellulose and maize bran degradabilities were very low (7.2(SE 10.8) and 6.2 (SE 9.1)% respectively after 24 h), whereas pectin and soyabean fibre were highly degraded (97.4 (SE 4.4) and 91.1 (SE 3.4)% respectively after 24 h). Sugarbeet fibre exhibited an intermediate level of degradability (59.5 (SE 14.9)%). Short-chain fatty acid production was closely related to NSP degradation (r 0.99). Although each variable was ranked similarly by all laboratories, some differences occurred with respect to absolute values. However, the adaptation of donors to the experimental substrates was not an influential factor. Interlaboratory differences could be reduced either by adding less substrate during incubations or using less-diluted inocula. In vitro fermentations with inocula made from human faeces and from rat caecal contents gave similar results. There was a close correspondence between the data obtained in the present experiment and those previously published in in vivo studies in the rat using the same fibres. The in vitro batch system tested during the present study provides a rapid means of obtaining quantitative estimates of the fermentation and the estimation of the energy content of new sources of dietary fibre.

Targeting drugs to the colon: delivery systems for oral administration

The oral delivery of drugs to the colon has applications in a variety of therapeutic areas. This review is concerned with the approaches taken to achieve a universal system for delivery. The design of such a system requires the identification and exploitation of a unique feature of the colonic environment. The use of transit times, pH and bacterial enzymes are critically assessed. In addition, the system must provide protection for the drug during transit to the colon. Upper gastro-intestinal physiology and the transit of pharmaceuticals through these regions are reviewed with reference to their relevance in achieving site specificity.

Dietary fibre: its composition and role in protection against colorectal cancer

Dietary fibre has a complex and highly variable composition. Although some dietary fibres may protect against colorectal cancer, it is unlikely that all are equally protective. Dietary fibre is principally composed of plant cell walls, but it also includes components obtained from cell walls (e.g. cellulose, pectin, and lignin), and non-starch polysaccharides (NSPs) from other sources (e.g. seaweeds and micro-organisms). The AOAC and Englyst methods are commonly used to determine the total amount of dietary fibre in foods. Most of the cell walls in food plants are from parenchyma cells, which are extensively degraded by bacteria in the colon. Cell types with walls containing the hydrophobic polymers lignin, suberin, or cutin also occur in food plants in small numbers, but they may be important in preventing colorectal cancer. Lignin, and possibly the other polymers, protect these walls from degradation. Epidemiological, human intervention, and animal studies can be used to try to identify the most protective dietary fibres. Epidemiological studies are difficult to interpret because usually only the total amount of dietary fibre eaten is reported. Intervention studies indicate that wheat bran dietary fibre may be protective. The results of animal carcinogenesis studies are variable, but sources of insoluble dietary fibres, including wheat bran, appear more protective than soluble dietary fibres, and some dietary fibres appear to enhance carcinogenesis. Possible mechanisms for protection by dietary fibres can be divided into two groups: those where the dietary fibre is acting directly, and those which result from the dietary fibre being degraded by colonic bacterial enzymes and the products fermented. Possible direct mechanisms include the binding of carcinogens to undegradable dietary fibres, and the absorption of water by undegradable dietary fibre resulting in increased faecal bulk and shortened transit times. Possible indirect mechanisms include the lowering of the colon pH by the short-chain fatty acids produced by bacterial fermentation, and the specific effects of butyrate. There are also a number of possible mechanisms by which some dietary fibres may enhance carcinogenesis. Use of better defined dietary fibres will increase our understanding of the role of dietary fibres in modulating colorectal cancer.

Effect of a liquid diet with and without soluble fiber supplementation on intestinal transit and cholecystokinin release in volunteers

The effect of adding fiber to liquid formula diets on gastrointestinal transit is still controversial. Different fiber types (soluble vs insoluble) and different methodology of transit time measurements yielded variable results. Factors affecting transit include colonic fermentation, neural, and hormonal factors. We have therefore compared the effects of a standardized normal diet and two liquid formula diets with and without supplementation of a soluble fiber (21 g/L) on orocecal transit time measured by the hydrogen lactulose breath test, colonic transit time measured by radiopaque markers with an abdominal x-ray, bowel movements, stool consistency, and cholecystokinin release in 12 healthy male volunteers. The diets were consumed in a randomized order, each one for 7 days. The addition of soluble fiber did not affect orocecal transit time. Colonic transit time, however, was significantly prolonged (55 h) with fiber supplementation compared with the liquid diet (39 h) and the self-selected diet (30 h) (p < .01). Stool frequency and consistency was not significantly affected. During administration of both liquid diets, fasting cholecystokinin concentrations were significantly elevated compared with the concentrations found with a self-selected diet (p < .05). The fasting cholecystokinin concentration correlated significantly with the increase of segmental (right colon) colonic transit time (p = .02). The prolongation of colonic transit time in liquid diet-fed volunteers might be caused by the combined effect of increased colonic fermentation and high basal cholecystokinin concentrations.

The effect of feeding xanthan gum on colonic function in man: correlation with in vitro determinants of bacterial breakdown

Xanthan gum (15 g/d) was given for 10 d to eighteen normal volunteers. In vivo measurements of stool output, transit time, frequency of defaecation and flatulence were compared with a preceding control period of 10 d. At the end of the control and test periods fresh faecal homogenate from each subject was anaerobically incubated with xanthan gum and control solutions to assess the ability of the bacteria to break down the gum. Xanthan gum was found to be a highly efficient laxative agent causing significant increases in stool output (P < 0.01), frequency of defaecation (P < 0.05) and flatulence (P < 0.01) whilst having variable effects on transit time. Before feeding xanthan gum, faecal samples from twelve of the eighteen subjects could reduce the viscosity of the gum in vitro. This rose to sixteen of the eighteen with significantly greater amounts (P < 0.05) of hydrogen and short-chain fatty acids also being produced, indicating bacterial adaptation in the presence of the substrate. Correlations between the in vivo and in vitro findings did not substantiate claims that the in vivo effect of a given polysaccharide can be predicted from its fermentation characteristics in vitro.

Gastrointestinal effects of modified guar gum and soy polysaccharide as part of an enteral formula diet

Dietary fiber supplementation may improve gastrointestinal tolerance and decrease diarrhea in patients receiving enteral formula diets. To compare the effects of two dietary fibers on bowel function parameters and short-chain fatty acid excretion we fed 11 healthy men three defined enteral formula diets in random order for 18 days each. The test diets consisted of a fiber-free formula and daily intakes of maltodextrin (0 g of fiber), 15 g of total dietary fiber as an enzymatically modified guar gum, and 15 g of total dietary fiber as soy polysaccharide. Data were also collected while subjects consumed self-selected diets for 5 days. Mean transit time was longer and fecal moisture content was lower on 0 g of fiber and modified guar than on the self-selected and soy diets. Furthermore, mean transit time was slightly longer and fecal nitrogen excretion greater on modified guar compared with 0 g of fiber. Daily fecal output and frequency of defecation were greater, fecal pH was lower, and fecal butyrate concentrations were higher on the self-selected diet compared with the enteral formula diets. However, there was no difference in these parameters among the three liquid diets. Thus, despite significant differences in mean transit time, few differences in other parameters of bowel function were observed when healthy subjects consumed enteral formula diets containing 0 g of fiber and 15 g of total dietary fiber as modified guar and soy.

The effect of weaning diet on the subsequent colonic metabolism of dietary fibre in the adult rat

The effect of the weaning diet on the subsequent colonic metabolism of bran and pectin in the adult rat has been investigated. Feeding a fibre-reduced diet on its own or supplemented with bran (WB) and pectin (P) from weaning (fibre-reduced (weaning)) was compared with introducing the same diet to age-matched rats reared on a standard laboratory diet from weaning (fibre-reduced (6 weeks)). The effects of the diets on colonic metabolism were measured by wet and dry caecal contents and stool weights, caecal sac weight, and caecal and faecal short-chain fatty acids (SCFA). Final body-weights were greater for fibre-reduced (6 weeks) and fibre-reduced (6 weeks) + P groups, but not fibre-reduced (6 weeks) + WB, than those of the fibre-reduced (weaning) rats. Rats fed on fibre-reduced (6 weeks) diet had a higher total caecal SCFA content than fibre-reduced (weaning) control rats. Fibre-reduced (weaning) + P-fed rats had a threefold higher caecal concentration of both propionate and butyrate than the matched fibre-reduced (6 weeks) + P group. Fibre-reduced (weaning) + WB animals had a significantly higher butyrate caecal concentration compared with their matched fibre-reduced (6 weeks) + WB group. Fibre-reduced (weaning) + P-fed rats had a lower faecal output than the fibre-reduced (6 weeks) + P rats. There was no difference in faecal output in rats fed on either fibre-reduced (6 weeks) + WB or fibre-reduced (weaning) + WB. The faecal concentration of SCFA was in general higher in the rats fed on fibre-reduced (weaning) alone, + P, or + WB than in those fed on fibre-reduced (6 weeks) alone, + P or + WB. Faecal output of total and individual SCFA was increased on the fibre-reduced (weaned) + WB diet compared with fibre-reduced (6 weeks) + WB-fed animals. The diet at weaning may be important in determining the pathways of caecal bacterial metabolism in the adult rat. In studying the effect of a dietary fibre on caecal metabolism and faecal output, when the diet is changed appears to be important.

Scintigraphic demonstration of lactulose-induced accelerated proximal colon transit

Although lactulose, a widely used cathartic, is known to increase stool frequency, details of its site of action in the colon are obscure. In the present study a noninvasive scintigraphic technique was used to closely follow the movements of proximal colonic contents. Lactulose, 10-20 mL three times daily, significantly accelerated mean transit through the ascending colon from 12.9 +/- 3.7 to 7.0 +/- 2.5 hours (n = 11; P less than 0.01). This was associated with the occurrence of mass movements, with six such events seen during lactulose treatment whereas only one was seen during the control study (P less than 0.05). Lactulose also accelerated movement through the rest of the colon so that at 24 hours after dosing the geometric center of the isotope bolus was distal to that seen during the control study (6.6 +/- 1.2 vs. 4.7 +/- 1.3; n = 11, P less than 0.001). This model of diarrhea in otherwise normal subjects was subsequently used to study the effects of viscous gels in diarrhea. The viscous and relatively poorly fermented gel ispaghula, 3.5 g three times daily, abolished mass movements and was associated with a small but significant increase in proximal colonic transit time, which increased from 6.1 +/- 2.1 to 7.7 +/- 1.5 hours (n = 8; P less than 0.05). By contrast, the viscous but readily fermentable gelling agent guar gum, 5 g three times daily, further accelerated the cathartic effect of lactulose, with the mean transit time decreasing from 6.4 +/- 2.3 to 4.7 +/- 1.7 hours (n = 8; P less than 0.05). The acceleration of proximal colonic transit by lactulose may be a useful model to study diarrhea and its modification by therapy.

Effect of method of administration of psyllium on glycemic response and carbohydrate digestibility

To determine whether there was any advantage to taking a soluble fiber supplement separate from food, as opposed to incorporated into a food, we used psyllium as a model, either taken in water just before a flaked bran cereal test meal, sprinkled on top of the cereal, or actually incorporated into the flake. In normal subjects, psyllium reduced the glycemic response when sprinkled onto or incorporated into the cereal, but not when taken before the cereal. Varying the amount of psyllium incorporated into the cereal from 0 to 20% resulted in a linear dose-dependent reduction of the glycemic index (GI) (GI = 101 -2.2 x % psyllium; r = 0.950; p less than 0.002). In subjects with diabetes, the blood-glucose-lowering effect of the psyllium flake cereal was similar to that in normal subjects. Mixing psyllium with the cereal or incorporating it into the cereal reduced the rate of digestion of bran flakes in vitro but was not associated with increased breath hydrogen levels in vivo as an index of rapid colonic fermentation. The bran flakes with psyllium incorporated was rated as no less palatable than the bran flakes cereal alone, and significantly more palatable (p less than 0.05) than taking psyllium in water before the cereal or sprinkling psyllium onto the cereal. These studies confirm earlier reports that viscous fibers must be intimately mixed with the food to have the effect of reducing blood glucose responses, and that the mechanism of action relates to a reduced rate of digestion rather than carbohydrate malabsorption.(ABSTRACT TRUNCATED AT 250 WORDS)

A comparative study of the effects on colon function caused by feeding ispaghula husk and polydextrose

Polydextrose is a new soluble food ingredient which cannot be digested by intestinal enzymes and so may affect colonic function. Studies in healthy volunteers compared the effects of diet supplementation with 30 g/day polydextrose, a standard dose of 7 g/day ispaghula and two mixtures containing 2 g/day ispaghula with either 30 g/day polydextrose or 10 g/day polydextrose with a control period. During the 10-day periods, the mass, frequency and consistency of faeces were assessed as well as the whole-gut transit time, ease of defaecation, flatulence and palatability of the preparations. All preparations significantly increased the weekly faecal mass above control values (P less than 0.05) but there were no significant differences between the preparations. Transit time and stool frequency were not affected significantly by any of the preparations (P greater than 0.05). Both preparations supplying 30 g/day polydextrose softened stool consistency equally but the other preparations had no effect. All preparations caused flatulence and other gas-related problems but polydextrose caused more than ispaghula, even at the lowest dose of 10 g/day. More volunteers preferred taking the polydextrose drinks than the sachets of ispaghula which formed a viscous drink with water. Despite superior palatability and equally effective stool bulking, polydextrose is unlikely to be an alternative laxative to ispaghula because of the unacceptable levels of flatulence.