Three-week psyllium-husk supplementation: effect cholesterol concentrations, fecal steroid excretion, and carbohydrate absorption in men1

Zara D Abraham, PhD,

ABSTRACT

on plasma

and

Tara
This

Mehta,

PhD
ofpsyllium to elucidate
controlled

total

and

lipoprotein

study was conducted to determine the effect cholesterol in healthy human subjects and
Seven males were given a nutritionally

husk on plasma possible hypodiet based on

cholesterolemic

mechanisms.

their usual intake for x = 3 wk followed by 3 wk in which 21 g/d per person psyllium husk was added to the basal diet. After 10 d and after 3 wk of psyllium supplementation, total, lowdensity, and high-density cholesterol were reduced (p 0.002, p 0.01, and p 0.03, respectively). Fecal steroid excretion, determined from 5-d collections, was not affected by psyllium
< < <

Downloaded from www.ajcn.org by on July 26, 2009

quantitated during meal the last day of each diet period were not different (p 0.05). Thus mechanism of psyllium may not involve increased bile acid excretion absorption. Am J Clin Nutr l988;47:67-74.
>

supplementation. retinyl esters,

Although psyllium tended glucose, insulin, and glucagon

to delay

lipid

absorption,

plasma

triglycerides,

tolerance tests given on the cholesterol-lowering or decreases in nutrient

KEY WORDS sorption Introduction

Psyllium

husk,

plasma

cholesterol,

fecal

steroid

excretion,

carbohydrate

ab-

Of the different gel-forming fibers

cholesterol-lowering

types are
agents,

of dietary effective
particularly

fibers tested, viscous most consistently as

in the low-density

(9) and 10 d (7) was reported tion. The acute supplementation

lipoprotein

(LDL)

fraction

(1).

A fiber

of potential

use-

fulness

is psyllium.
from the

This
seed

highly
husk

branched
of Plantago

arabino
ovata

xylan
and

is obtained

forms a viscous gel when hydrated (2). Psyllium provides the basis for many bulk laxatives (3) and is already used by a significant portion of the population, particularly elderly people. Its efficacy as a cholesterol(especially LDL
cholesterol) lowering

agent

is important

to determine

in

of the known inverse relationship between plasma cholesterol and increased risk of heart disease. Dietary psyllium supplementation has a cholesterollowering effect in humans on some types of diets (3-6). However, there has been only one report of its effect on cholesterol in the lipoprotein subfractions and in that study LDL cholesterol was not quantitated (7). In these earlier studies either no dietary details were reported or low-residue semipurified diets were used. To date, the hypocholesterolemic mechanisms of gelforming fibers such as psyllium are not known. The
view mechanism of action may involve increased fecal excre-

to increase bile acid excreofpsyllium in test meals ofundefined composition was reported to attenuate postprandial plasma glucose and insulin responses (10, 1 1). The results of these studies suggest that both of the frequently hypothesized cholesterol-lowering mechanisms may be involved. However, psyllium-induced changes in gastrointestinal physiology have not been measured on a nonacute basis. Acute physiological effects caused by abrupt dietary changes may not mimic effects occurring after initial physiological adaptations to the diet have occurred. The purpose of this study is to determine if 3-wk psylhum supplementation in diets representative of the sub-

I From the Department of Food Science and Human Nutrition, Washington State University, Pullman, WA. 2 Presented in part at the 69th annual meeting of FASEB. Fed Proc

tion of bile acids and/or changes in the rate of nutrien#{149}s bsorbed a from the small intestine
supplementation
Am I C/in Nuir

or amount (1, 8). The

for 4 d
Society

44:2026(abstr). Scientific paper 7495, project 0475, College of and Home Economics Research Center, Washington State University, Pullman, WA. 3 Supported in part by a grant from Sigma Xi. 4 Address reprint requests to Dr Madeleine Mitchell, Department of Food Science and Human Nutrition, Washington State University, Pull1985;

Agriculture

man, WA 99164-2032.
ReceivedJuly 17, 1986. Accepted for publication

of psyllium-based
l988;47:67-74. Printed

compounds
in USA.

March

10, 1987. 67

1988 American

for Clinical

Nutrition

68 jects usual intake result in significant changes

ABRAHAM

AND

MEHTA

in plasma

total

and

LDL
and

cholesterol
in lipid and

concentrations,
carbohydrate

fecal
absorption.

steroid

excretion,

Subjects
Subjects

and methods

On each of the last 5 d of the two diet periods, total fecal collections were made to determine changes in fecal acidic and neutral steroid excretion. During these collection periods, precise weights of the dietary intake of each individual were recorded. Aliquots of the diet were saved for fat analysis to determine apparent lipid digestibility.
Diet

Adult men were recruited by advertisement from the local community. Each subject filled out a health questionnaire and kept a 3-d diet record before the study. The record format was adapted from Western Regional Project W-l53 diet forms. Ten men participated in the study. However, three did not fall into the selected population because ofage or health or because their plasma cholesterol concentrations were 250 mg/dL, which was defined as hypercholesterolemic. Thus, data from these subjects have not been included. Information on the seven remaining subjects is given in Table 1. The experiment was approved by the Human Subjects Review Committee of Washington State University and informed consent was obtained from the participants.
>

Meals commonly

in a 4-d menu cycle and contained items A typical breakfast comprised fruit, bread or bread substitute with jam, bacon, and milk. A typical lunch comprised fish, chicken or meat sandwich, salad, fruit, and chocolate chip cookie. A typical dinner comprised meat loaf, cooked vegetable, salad, fruit, milk, and cake or pudding. A representative days menu is presented in Table 2. Subjects were allowed 170 mL ofwine/wk, which was served with the Saturday
dinner.

were given consumed.

All food items were prepared in the Human Nutrition departmental kitchens and were served to the subjects in weighed portions. During the week, breakfasts and dinners were eaten in the departmental metabolic unit and bag lunches were pro-

Downloaded from www.ajcn.org by on July 26, 2009

Experimental

design

The study
consumed

consisted
a nutritionally

ofa 3-wk period

adequate

during

which

participants
(control) diet.

Western-style

A 3-wk treatment period followed during which the subjects consumed the same diet supplemented with 21 g ground psyffium husk/d: 7 g was incorporated into food items ofeach main meal.

vided. On Saturday evenings, the participants were given Sundays breakfast and lunch to eat at home and they returned to the metabolic unit for dinner. The subjects were asked to maintam the same level of phycal activity throughout the study. Subjects kept daily records ofphysical activity, stress level, hunger and satiation, and intake of free food items such as coffee, tea, and noncaloric sodas. The subjects weighed in daily before
breakfast.

To determine
trations,
14, 22,

the effect of psyllium

plasma
42. The

on total cholesterol
was determined
on lipid and

concenon days
carbo-

fasting
32, and

cholesterol
effect

4,

of psyllium

The meal plans were designed to be similar to the diets described in the 3-d food records.

in nutrient

content

hydrate absorption rates was determined with meal tolerance tests (MTT). At the end of the control and psyllium-treatment periods, the subjects consumed a breakfast meal after fasting for 12 h. Blood samples were collected before the meal and postprandially at 0.5, 1, 1.5, 3, 6, and 9 h for the measurement of total plasma cholesterol and cholesterol in lipoprotein subfractions: triglyceride-rich lipoproteins (chylomicrons and verylow-density lipoproteins [CM/VLDL]), LDL, and high-density lipoproteins (HDL). Plasma insulin, glucose, glucagon, total and

Each individuals energy requirements were calculated from the Harris-Benedict formula (13). A 20% activity factor was added on the basis of the assumption that all the subjects were moderately sedentary.
Lipid and protein composition of the diet were analyzed by methods ofThe Association ofAnalytical Chemists (14). Energy content, cholesterol content, and fatty acid composition were calculated from tabulated values (15). Individual daily caloric intake varied but a constant composition of -30% fat, 16% protein, and 54% carbohydrate (as percent of daily energy con-

CM/VLDL
also

triglyceride,

and retinyl

ester concentrations

were

determined. Plasma retinyl esters have been used experimentally as CM markers and thus can be used to estimate the rate of exogenous lipid absorption (12). To obtain measurable amounts of plasma retinyl esters, 10 000 IU (3 mg) of retinol (Aquasol A drops, USV Pharmaceutical Corp. Tuckahoe, NY)

sumption) was maintained. Cholesterol mgJd and the ratio of polyunsaturated

was tion 1. Average was 17 gas daily neutral detergent measured by the method

intake was 300-400 to saturated fatty acids

fiber (NDF) consumpofVan Soest(l6).

was incorporated

into the meal.

TABLE
Individual Subject

1 subject Age y data Weight kg 94.5 Height cm 180.0

167.6

Fasting

plasma

cholesterol*

mg/dL

(mmoL/L) 184 (4.8)

During the treatment period, half of the psyllium husk consumed was baked into muffins and cookies, and halfwas added uncooked to fruit drinks and peanut butter. The psyllium was added to the diet in incremental doses of 7 g, which were given after adjustment periods of 2 d for each dose, building to 21 g/d by 6 d. Foods consumed during the two MiT provided ---40% of the daily caloric intake and contained 20% ofthe energy as protein, 46% as carbohydrate, and 34% as fat. The two MiT were identical except that 10 g of psyllium was added to a cookie (7 g) and fruit drink (3 g) during the second MTT.
Sample collection and analysis

34

2
3 4 5 6 7
*

38
34 33 29 29 26

61.8
89.5 88.2 78.2 78.6 70.9 on blood

203 (5.3)

180.3 182.9 177.8 181.2 170.2 samples taken on day 4.

240 (6.2)
225 (5.8) 132 (3.4) 158 (4.1) 167 (4.3)

Determined

Blood samples were collected by venipuncture into vacutainer tubes containing EDTA for lipid analysis or heparin for glucose, insulin, and glucagon analysis. The tubes for glucagon analysis also contained 1.0 M benzamidine (0.1 mL/mL blood). The plasma was immediately separated by centrifugation at 1200 x g for 20 mm in a darkened room to prevent retinyl ester degradation and then stored at 20 #{176}C.

PSYLLIUM:
TABLE 2 Representative single days menu (per 2500 kcal)

EFFECT

ON

CHOLESTEROL

69

Item

Amount
g

Protein
g

Fat
g

Carbohydrate
g

Cholesterol mg
19.4 0.0

NDF g
0.0 0.9

Breakfast Bacon English

muffin

24 56

7.0 2.0

12.5 1.0

0.7 25.0

Butter Grapejam
Fruit drinkt Banana Milk Lunch

10 20
50 112

3.9 0.1
0.1 3.9

8.1 0.0
0.1 3.9

0.0 14.0
11.1 5.4

22.0 0.0
0.0
16.0

0.0 0.0
0.7
0.0

Tuna Mayonnaise Wheat bread

Carrots

72 16 98
40

20.0 0.2
9.4 0.4

5.6
12.2 2.3 0.0

0.0 0.4 44. 1 3.8

Celery
Orange

40
320

0.4
3.2 2.5

0.0
0.3
11.2

1.5
36.1
30.1

44.0 1 1.4 0.0 0.0 0.0 0.0

44.9

0.0 0.0 6.0 0.4 0.4 2.6

Cookiet Dinner
Casserole Beef

53

0.3

Downloaded from www.ajcn.org by on July 26, 2009

90

27.0

3.5

0.0

Rice
Carrots

150
40

3.8
0.4 1.0 5.1 5.0 3.9

0.8
0.0 0.2
12.3

38.3
3.8 4.3
41.1

Tomatoes
Muffinst Broccoli Butter

100
92 150 10

62.6 0.0 0.0 0.0

81.5

0.0 0.8 0.4 0.7

0.5
2.9 0.0 0.0 0.0

0.2 8.1

7.7 0.0

Honey
Sherbert
*

32
150 detergent fiber. was added to these items during

0.0
1.4

0.0
1.8

26.3
46.2

0.0 22.0 0.0 0.0

Neutral

t Psyllium husk

the treatment

period.

Three lipoprotein g/mL), LDL 1 .006

>

subfractions,
<

CM/VLDL
1.063 g/mL), on a continuous
<

(density
and

1.063

g/mL)

were

density separated

gradient

(1.000-1.10

g/mL)

by ultracentrifugation

< 1.006 HDL (d KBR density (17). Samples

PEG excretion

during
were

the two diet periods

not used

was not different,

fecal and steroid isolated

so

correction factors excretion data. Bile acids and

in quantitating were saponified

neutral

sterols

were centrifuged in a Ti50 rotor head using a Beckman L8-70 ultracentrifuge (Beckman Instruments mc, Palo Alto, CA) at 165 500 x g for 10 h at 20 #{176}C (slow acceleration, no brake). Recoveries for the subfractions were 94-106%.
Total

according to the method of Nair et al (PP Nair, personal cornmunicatiori), which was a modification of previously published
methods (23). Bile acids were then methylated and quantitated on a gas chrornatograph (Hewlett-Packard Model 5840, Avondale, PA) equipped with a flame ionization detector using a 4-ft glass column packed with 3% OV- 1 7 on gas chrome Q (100120 mesh). Operating conditions were as follows: injection ternperature, 250 #{176}C; column temperature, 275 #{176}C; detector ternperature, 300 #{176}C; flow rate, 30 mL/rnin. and Peaks were quantified using an electronic integrator with cholic, chenodeoxycholic, deoxycholic, and lithocholic acids as standards (Cal Biochem-Behring Diagnostics, San Diego, CA). Neutral sterols

plasma

cholesterol

and cholesterol

in the lipoproteins

was analyzed

by the method

ofRudel

(18); triglyceride

and glu-

cose concentrations were determined by enzymatic methods using kits supplied by Waco Pure Chem Ind Inc (Osaka, Japan) and Sigma Chem (St Louis, MO), respectively. Insulin and glucagon were quantified at the Diabetes Research Center of the University of Washington (Seattle) using double-antibody radioimmunoassays (19, 20). Plasma retinyl esters were separated

on an alumina
sorbance

column

(21) and were quantitated

by UV ab-

at 326 nm. Daily stools were collected in preweighed frozen, and stored at -20 #{176}C. Polyethylene

plastic bags, rapidly glycol (PEG) 4000

were quantitated on a 6-ft 1% QF1 on gas chrome Q were as follows: injection perature, 190 #{176}C; detector
30 mL/min. Coprostanol,

glass column
(80-100 mesh).

packed

with

2% SE-30,
conditions

Operating

temperature, temperature,
coprostanone,

230 #{176}C; column tern230 #{176}C; flow rate, and

and cholesterol (Stera-

was given at the beginning

marker.
aliquoted,

of each collection
were weight. thawed, Five-day weighed,
#{176}C. portion A portions

period
ofeach

as a fecal
aliquot was

Within
and

5 d feces
stored

homogenized, pools were

bids

mc, Wilton,

NH)

were used

as standards.

at -40

lyophiized obtained

to a constant
by combining

dry-matter

Statistics Statistical comparisons for variables quantified done with analysis ofvariance using a repeated over time were measures model

representative

samples.
using

The PEG content

was determined
method of Malawar

ofthe individual in the fecal samples

the turbidimetric

and

Powell

(22).

70
(24). Fecal excretion t tests (25). Areas

ABRAHAM

AND

MEHTA

data were compared using paired Students under the plasma concentration curve were

calculated
<

using

the trapezoidal

method.

Differences

with p
-j
0

120

0.05 were

considered

to be significant.

LDL
ioo

Results The control diet was well tolerated by the subjects. After an initial bloated feeling, subjects ate the psyllium supplement without any reports of digestive distress. Changes in fasting plasma cholesterol over course of the study for subjects are shown in Figure 1. Fasting values were not different (p > 0.05) during the control period. With psyllium supplementation, fasting total cholesterol was decreased (p 0.002). The cholesterol concentration was lowest by a mean decrease of 35 mg/dL 10 d after starting supplementation. Concentrations remained lower, by a mean value of 30 mg/dL at the end of the 3-wk period of psyllium supplementation. The magnitude of the decrease tended to be greater in subjects with higher initial plasma cholesterol concentrations. Fasting and postprandial lipoprotein cholesterol concentrations after each MTT are presented in Figure 2. Fasting lipoprotein concentrations were not significantly different (p > 0.05); however, repeated measures analysis of all points indicated that psyllium supplementation reduced cholesterol concentrations in both LDL (p 0.01)
< <

(D

z
80

IF-

z
0

LU

z
0
C-)

80
..___-.

HOt.

-j

0
LU FC,)

:::::::::::2:::
4O

LU 0

Downloaded from www.ajcn.org by on July 26, 2009

C-)

20

A-

HOURS
FIG 2. Changes (mg/dL) over time mented (- A -) (HDL), low-density density lipoprotein eraged 44, 25, and psyllium-husk suppletests. For high-density lipoprotein lipoprotein (LDL), and chylomicrons and very-low(CM/VLDL) subfractions; standard deviations av59% oftheir respective means. The CM/VLDL levels
(-)

in the plasma with control meal tolerance

lipoprotein

cholesterol

concentration

#{149}and

-I 0

(D I

were not different, but the levels of LDL and HDL subfractions were significantly reduced with psyllium-husk supplementation (p < 0.01 and p < 0.03, respectively).
220

z
0
.< F-

-0---0--fr-----

1 2 3 4

F-

z
LU 0

180

.5

z
0
U

S
-A

6
7

and HDL (p 0.03) subfractions; the average decreases in the two subfractions were 15 mg/dL and 4 mg/dL, respectively (Fig 2). The CM/VLDL subfraction was not reduced (p 0.05) with psyllium. During both MTT, postprandial CM/VLDL cholesterol concentrations tended to rise during the first 1 .5 h, plateau, and then return to fasting values by 9 h. This pattern was not ob< >

I U,

served

in either

LDL

or HDL

subfractions.

-J
0.

The effects ofcontrol and psyllium-supplemented diets on colonic function and apparent lipid digestibility are summarized in Table 3. Data are means of 5-d fecal collections at the end of each treatment period. Fecal mass and dry matter were increased during the psyllium treatment
a i#{226}ao#{252}4o DAYS

period.

Fecal

moisture

content

was

increased

more

than

dry matter; thus, the percent creased with psyllium. Fecal defecation
different with the two diets. Psyllium

dry

maUer

was
was affect not

denot apdif-

frequency did not (Table 4) was

FIG I Fasting plasma cholesterol concentrations for subjects over the course ofthe study. Theuirst three blood samples were taken during the control period and the last two during the psyllium-husk treatment period.
.

parent lipid digestibility. The total fecal steroid excretion ferent during the two diet periods. significant increase in cholesterol

There was a small excretion psyllium,

nonand

PSYLLIUM:

EFFECT

ON

CHOLESFEROL

71

TABLE

3
fat digestibility for control and psyllium-

Discussion Psyllium-husk
erate-fat

Fecal excretion and apparent treatment periods

supplementation

of conventional

mod-

Control
Fecalmass(g/d) Frequency (n/d) Dry matter (g/d) Dry master (%) Apparent fat 10463 I 1 26 8 27 4

Psyllium
223104 1 1 36 12 18 5 96 as

p
<0.001 NS < 0.004 < 0.001 NS

digestibiity
*

(%)
fat digestibility

96

Apparent

was calculated
-

diets can significantly decrease plasma cholesterol, particularly LDL cholesterol, in subjects whose cholesterol values are within the normal range. LDL cholesterol was the major lipoprotein decreased with psyllium but a significant decrease in HDL was also measured. Effects of water-soluble fibers on plasma HDL levels have not been consistent. Oat bran (26) and guar gum (27) supplementation resulted in slight decreases in HDL concentrations. There are no data for normal subjects but

hyperlipidemic
5-d intake
541

subjects
reported

given Guar

psyllium-supplemented
to have a 16% increase in

5 dexcretion intake

100

diets

for

10 d were

total

neutral

parison with Carbohydrate

sterol excretion the control diet.

absorption,

was

not

changed

in com-

as measured

by postprandial

gum supplementation of Fredrickson phenotype Type IIB subjects for 3 wk resulted in increased HDL (mean = 4.5%) but guar decreased HDL concentrations (mean = 8%) in Type hA subjects. In the same study after 8 wk ofguar supplementation, all subjects had HDL levels close to control values (28). Thus the
Downloaded from www.ajcn.org by on July 26, 2009
effect ofwater-soluble fibers may be influenced by genetic and length of the supplementation period. In five of seven subjects in this study, the HDL:LDL ratio increased. This indicates that the proportion ofplasma cholesterol carried by the HDL particle was increased in most subjects with psyllium supplementation. Thus, the decrease in HDL concentration observed in this study may not have had any clinical significance. Total excretion of the measured fecal steroids was not increased with psyllium supplementation, although as a result of the increase in fecal mass steroid concentration with psyllium was decreased. The only slight difference compared with the control diet was the small increase in fecal cholesterol with psyffium supplementation. In four ofthe subjects, the relative amount ofcholesterol increased as the relative amount of coprostanol and coprostanone decreased. Several investigators reported that humans can

HDL

cholesterol

(7).

changes in glucose, insulin, and glucagon, was not altered with psyllium supplementation (Table 5). Plasma glucose responses during both MTT were minimal. Insulin levels increased above fasting concentrations and peaked at 0.5 h; glucagon concentrations were slightly elevated from 1-3 h postprandially. Figure 3 illustrates retinyl ester, total triglyceride, and CM/VLDL triglyceride responses during the two MTT. No differences (p > 0.05) between treatments in lipid responses to the MiT were determined. However, plasma triglyceride and retinyl ester concentrations tended to be reduced postprandially (p < 0.09 and p < 0.08, respectively) with psyllium supplementation because of decreased plasma concentrations during the first 3 h. The
calculated area under the concentration curve (0-9 h) for

factors

the three lipid variables were, for control and psylliumsupplemented MiT, respectively, 103 1 460 and 1009 543 mg h/dL for total triglycerides, 647 370 and 685 377 mg h/dL for CM/VLDL triglycerides, and
. #{149}

be classified
lesterol changes

either

as nonconverters

or converters

of cho-

264

125 and

197 47

zg

h/dL

for retinyl

esters.

to bacterial have been

degradation products (29). Dietary reported to result in shifts from con-

TABLE 4 Mean fecal steroid

excretion

(mmol/d)

for control

(C) and psyllium

(P) treatment Neutral

periods*
steroids

Coprostanol C P
1.230

Cholesterol C 0.047 0.124

P
0.269

Coprostanone
C
0.036

Total
P
0.331

C
1.390

P
1.830

Mean
SD

1.307

0.396

0.499

0.258
Bile acids

0.083

0.124

0.306

0.665

Lithocholic

Deoxycholic

Chenodeoxycholic P 0.520 0.438 C 0.097 0.234 P 0.1 17 0.285 C 0.015 0.020

Cholic P 0 0 C 0.750 0.632

Total P 0.828 0.617

C Mean SD
*

P
0.720 0.202
>

C
0.484 0.637 between treatments

0.154 0. 154 No significant

(p

0.05)

differences

were found

for any variable.

72 TABLE
Postprandial 5 changes in glucose, insulin, Glucose Time h 0 0.5 1
1.5

ABRAHAM

AND

MEHTA

and glucagon

with control

(C) and psyllium Insulin

(P)-supplemented

meal

tolerance

tests Glucagon

C mmol/L 4.40.2 4.90.9 4.60.7 4.40.7 5.40.8 4.90.3 4.80.4

pmol/L
4.60.3
5.10.8

pmol/L
36 12 417161 280 95 274173 89 54 42 18 42 18 measured. 17 18 19 1911 19 17 16 5 6 7 6 9 6 175 185 205 216 216 175 186

4.30.4
4.50.7

3 6 9
*

5.20.6 4.90.4 5.10.4 between treatments were

36 18 357173 280107 214 60 143107 42 6 36 12 found

No significant

(p

>

0.05)

differences

for any of the variables

verters to nonconverters and vice versa. Generally it is believed that changes are the result of alterations in the intestinal microbial population (30). Psyllium is a preferential substrate for Bacteroides ovatus, a normal bacterial component of human fecal flora (3 1). It is possible

The lack ofincrease

in this Forman
subjects

in fecal

study is in contrast et al (32) reported

consumed

bile acid to the results that when

excretion reported of earlier studies. two healthy male g psyllium/d,

Downloaded from www.ajcn.org by on July 26, 2009

the

equivalent

of 9.6

plasma

cholesterol

was decreased

by an average

of 20%

that consumption
these sumption
in

ofpsyllium

resulted

in relative

increases

bacteria. induces

It is also possible that other species of bacteria

psyllium conor alters en-

zyme

activity.

Such
degradation

changes

could

have

altered

the rate

of bacterial

of cholesterol.

z
0
FF-

.z cr

from control values and this decrease was sustained for the 6-wk supplementation period. They measured no change in neutral sterol excretion, but a significant increase in bile acid excretion (302% ofcontrol values) was observed. However, the subjects diets were not controlled and throughout the study fecal steroids were measured only from 24-h fecal collections (32). Results ofthis magnitude have not been reported elsewhere with psyllium or in other studies where a water-soluble fiber was fed to healthy subjects (33). Short-term studies have been conducted by two other groups. Stanley et al fed 15 g/d Metamucil#{174}, a product containing psyllium, to normal subjects and measured the fecal excretion of 4-4C-cholate and its bacterial products. After 4 d ofsupplementation, fecal cholate concentrations were 1 .7 times control values (9). Miettinen fed nine hypercholesterolemic subjects 30 g/d of another psyllium-based preparation for 10 d and measured changes in plasma cholesterol, cholesterol absorption, and fecal steroid excretion. He reported significant decreases in plasma free cholesterol, and fecal bile acid excretion

z
0

Ui C)

C-)

a
0. -4

Plasma

trIgIyC.rjdes (mg/dI)

-J
I

was increased

by an average

of 122 mg/d.

No changes
occurred (7).

in
in

C,)
-J
0.

fecal neutral sterols or cholesterol response to the psyllium-based

(mg/dp)

absorption bulking agent

The increase in fecal bile acid excretion reported in these short-term studies may have been transient effects associated with the initial physiological adaptation period and related to large decreases in blood cholesterol such
as we measured 10 d after initiating psyllium supplementation. These acute effects may not, however, be associated with a longer-term cholesterol-lowering mechanism observed in our study. None of the above studies gave any details about their control diets. It is possible that differences in the composition ofcontrol diets can help to explain inconsistencies in results between this study and earlier reports. If lowresidue control diets were used in earlier studies, then

HOURS in plasma lipid concentrations over time with control and psyllium-husk-supplemented (A -) meal tolerance tests. For plasma triglycerides, chylomicrons and very-low-density lipoprotein (CM/VLDL) triglycerides, and retinyl esters, SDs averaged 53, 59, and 40% of their respective means.
(-

FIG 3. Changes
I
-)

PSYLLIUM:

EFFECT

ON

CHOLESTEROL

73 secretogogue
release.

there would be a comparison between a diet with fiber vs a diet without fiber rather than a measure of the effect of a specific type offiber. For example, Miettinen (7) reported that fecal bile acid excretion was not significantly different between cellulose and a psyllium-based supplement. This suggests that a low-residue control diet may have been
used because fiber sources properties caused increased with very different bile acid excretion
what constitutes

glucose
only

is a potent
stimulant

for

insulin,

it is not
other compo-

the

of insulin

Possibly

physical compared
fiber

with

the control.
data defining a normal

Population

intake in the United States not available data from British studies (34), however,

presently. From it appears that the average daily NDF intake of 17 g used in this study is fairly typical of Western nonvegetarian diets. Our results, then probably represent effects in a realistic situation.

nents of our test meal such as amino acids, which also stimulate insulin secretion, caused the postprandial rises. Psyllium supplementation did appear to have a small effect on the rate oflipid absorption. Plasma triglycerides and particularly retinyl esters were reduced postprandially with psyllium. In four subjects in our study, the decrease in retinyl ester concentration after the psylliumsupplemented MTT was most pronounced during the first 1 .5 h postprandially; plasma concentrations were equal
to or greater than control values

at later times.

Similarly,

Thus, psyllium the major bile typical Western

husk did not cause increased excretion of acids when used in conjunction with a diet.

plasma total triglycerides 3 h of the MTT but The methods we used not separate CM from glycenides specifically information about the

were decreased during the first CM/VLDL triglycerides were not. for lipoprotein determination did VLDL. Changes in plasma CM tnwould have given more conclusive rate ofexogenous lipid absorption.

No effect of psyllium was noted in plasma glucose, insulin, or glucagon responses during control and psyllium MiT. Also, there was no significant postprandial blood glucose rise. These results are in contrast to earlier pub-

However,

our data

on the other

two

variables

indicate

a
Downloaded from www.ajcn.org by on July 26, 2009

lished

results

with

psyllium

(10,
of these

1 1) and guar
fiber sources

and
into

pectin
test

(35-37). Incorporation meals for diabetic and

normal subjects resulted in significant decreases in postprandial blood glucose and insulin responses. The lack ofglucose response we observed may have resulted from the relative nutrient composition of our test meal, which contained 46% of the energy as carbohydrate, 34% as fat, and 20% as protein. Although dietary details ofthe psyffium test meals in the earlier studies were not given, the guar and pectin test meals that were used were proportionately higher in carbohydrate (> 55%). Morgan et al (36) measured plasma glucose and hormonal responses to meals consisting primarily of carbohydrate, fat, or protein with or without 5 g guar gum. Both the fat and the protein meals elicited no rise of plasma glucose from baseline levels. In response to the carbohydrate meal, there were rises in both glucose and insulin that were attenuated with the addition of guar
(38). Coulston et al (39) compared postprandial glucose

delay in absorption. The intestine and liver are both sources of triglycerides in postprandial CM/VLDL partides. Initially after consuming a meal, insulin release stimulates hepatic synthesis of VLDL. It is possible that with psyllium a relatively smaller early contribution of triglycerides of intestinal origin together with the insulin
stimulus resulted in a greater initial release of hepatic

VLDL
early

in comparison
elevation

with

the control
observed

MTT.
in the

Thus,
psyllium

the of

of CM/VLDL

MTT

could

represent

proportionately

more

particles

hepatic origin. The cholesterol-lowering mechanism of psyllium does not appear to involve the increased excretion of fecal steroids. Our results on the effect of psyllium on lipid absorption are preliminary; further research will be necessary to determine if delayed lipid absorption is a consistent
effect.

#{163}3

We acknowledge the assistance given by Dr PP Nair in determining fecal steroids. Much appreciation is given to the 10 individuals who were our subjects and who made this study possible.

and insulin on an energy

diets. time They although

responses with basis) vs control

reported mean differences

high (40%
plasma

carbohydrate on an energy
glucose not on the

(60% basis)
highThe

References
1. Anderson JW, Wen JLC. Plant fiber, carbohydrate and lipid metabolism. Am J Gin Nutr 1979:32:346-63. 2. Sandhu iS, Hudson Gi. The gel nature and structure of the carbohydrate of ispaghula husk cx Plantago ovala. Forsk Carbohydr Res 198 1;93:247-59. 3. Kies C. Purified psyllium seed fiber, human gastrointestinal tract function, and nutritional status ofhumans. In: Fuida I. Unconventional sources offiber. Washington, DC: American Chemical Society, 1983:61-70. (ACS Symposium series#2 14.) 4. Lieberthal MM, Martens RA. Lowered serum cholesterol following the ingestion ofa hydrophilic colloid. Dig Dis 1975;20:469-74. 5. Danielsson A, Ek B, Nyhlin H, Steen L. Effect oflong-term treatment with hydrophilic colloid on serum lipids. Acts Hepatogastroenterol (Stuttg) l979;26: 148-53. 6. Garvin JE, Forman DT, Eiseman WR, Phillips CR. Lowering of human serum cholesterol by an oral hydrophilic colloid. Proc Soc

carbohydrate

diet
the

to be higher

than
were

the control
significant.

at each

changes in insulin concentrations on the 60% carbohydrate diet also were greater than on the 40% diet. In this study, MTT were given after 3 wk of psyllium
supplementation. In most other studies, MTT were given

on an acute basis with no time for adaptation to the test fiber. Longer-term physiological effects offiber consumption may not mimic acute effects. For example, Tarpila
(40) fed a psyllium-based preparation for In this 10 d and study oh-

served
sponse

no attenuation
to a glucose

of plasma
tolerance test.

insulin

or glucose

in rechanges

in both plasma insulin and glucagon concentrations did not differ between the two MTT, but in contrast to glucose, postprandial rises in insulin were measured. Although

Exp Biol Med 1965;l20:744-6.

74
7. Miettinen cholesterol TA. Effects metabolism of dietary in man. In: Carlson New York:

ABRAHAM

AND

MEHTA cholesterol-cholestanol pair in human Statistical JH. principals fecal extracts. in experimental

fibers and ion-exchange

resins on

Am J Clin Nutr
designs. 2nd

conference
193-8.

on atherosclerosis.

LA, ed. International Raven Press, 1978:

1984;40:952-6.
24. Winer 25. Steel 26. Judd fecal 27. Aro gum ai, comps. GD, Tome

ed. New York: McGraw-Hill, York, NY: McGraw-Hill,

PA, Truswell

1962.

8. Stasse-Wolthuis M. Influence ofdietary fiber on cholesterol metabolism and colonic function in healthy subjects. World Rev Nutr Diet l981;36:lOO-40. 9. Stanley MM, Paul D, Gacke D, Murphy J. Effects of cholystyramine, Metamucil and cellulose on fecal bile salt excretion in man. Gastroenterol l973;65:889-94.
10. Florholmen i, Arvidsson-Lenner R, Jorde R, Burhol PG. The effect ofMetamucil on postprandial blood glucose and plasma gastric inhibitory peptide in insulin-dependent diabetics. Acta Med Scand l982;212:237-9. 1 1. Sarto G, Carlstrom S, Schersten B. Dietary supplementation of fiber (Lunelox) as a mean to reduce postprandial glucose in diabetics. Acts Med Scand 1981;656:5l-3. 12. Wilson DE, Chan IF, Boll M. Plasma lipoprotein retinoids after vitamin A feeding in normal man: minimal appearance among lowdensity lipoproteins. Metabolism 1983;32:5 14-7. 13. lloyd LE, McDonald BE, Crampton EW. Fundamentals of nutrition. 2nd ed. San Franciso: WH Freeman, 1978:397-423. 14. Horowitz W, ed. MethOds ofanalysis ofthe Association of Official Analytical Chemists. 1 lth ed. Washington, DC: AOAC, 1970. 15. Goering HK, Van Soest PJ. Forage fiber analysis. Agricultural

Principals and procedures of statistics New 1960. AS. The effect ofrolled oats on blood lipids and

steroid excretion

in man. Am J Gin Nutr

l981;34:206l-7.

A, Urisitupa M, Voutilainen E, Korhonen T. Effects of guar in male subjects with hypercholesterolemia. Am J (in Nutr 1984;39:9l 1-6. 28. Jenkins DJA, Reynolds D, Slavin B, Leeds AR, Jenkins AL, iepson EM. Dietary fiberand blood lipids: treatment of hypercholesterolemia with guar crispbread. Am J Clin Nutr l980;33:575-8l. 29. Wilkins T, Hackman AS. Two patterns ofneutral steroid conversion in the feces of normal North Americans. Cancer Res l974;34:

2250-4.
30. Crowther iS, Drasar

ofa chemically

BS, Goddard P, Hill Mi, Johnson K. The effect defined diet on the fecal flora and fecal steroid conhydrointestinal

Handbook prepared.

16. Watt BK, Merrill

no 379. Washington, DC: US Dept ofAgriculture, 1970. AL, comps. Composition offoods: raw, processed, Agricultural handbook no 8. Washington, DC: US Dept
Ci, Sanchez-Muniz ofserum lipoproteins visualization by pre-staining FJ. Improved tech-

TD. Breakdown ofpsyllium colloid by strains of Bacteroides ovatus from the human tract. Can J Microbiol 1978;24:336-8. 32. Forman DT, Garvin JE, ForestnerJE, TaylorCB. Increased offecal bile acids by an oral hydrophilic colloid. Proc Soc Med 1968;l27:1060-3. 33. Kay RM. Dietary fiber. J Lipid Res l982;23:22l-42. 34. Bingham S, Cummings JH, McNeil NI. Intake and sources
35.

centration. Gut I973;l4:790-3. 3 1 . Salyers AA, Harris CI, Wilkins

Downloaded from www.ajcn.org by on July 26, 2009

excretion Exp Biol

ofAgriculture, 1963. 17. Terpstro AH, Woodward niques for the separation

ultracentrifugation: ofserum lipoproteins

from small volumes

by density gradient and rapid separation ofserum. Anal Biochem

36.

198l;1 11:149-57. 18. Rudel LL, Morris MD. Determination of cholesterol using opthalaldehyde. J Lipid Res l973;14:364-6. 19. Morgan CR, Lazaro A. Immunoassay of insulin: two antibodies. Diabetes l963;21:l15-26. 20. Hanquin JC, Malvaux P, Lambert AE. Glucagon immunoassay using polyethylene glycol to precipitate antibody-bound hormone. Dia-

37.

38.

betologia

1974;lO:61-8.
39.

21. Chew BP, Holpuch DM, OFallon iv. Vitamin A and fl-carotene in bovine and porcine plasma, liver, corpora lutea and follicular fluid. J Dairy Sci 1984;67: 1316-22. 22. Malawar SS, Powell DW. An improved turbidimetric analysis of polyethylene glycol utilizing an emulsifier. Gastroenterol 1967;53: 250-6. 23. Tuijman N, Nair PP. In situ bromination for the separation of the

40.

of dietary fiber in the British population. Am J Gin Nutr l979;32:13I3-9. Mclvor ME, Cummings CC, Leo TA, Mendeloff Al. Plotting of postprandial blood glucose responses with guar gum: acute effects. Diabetic Care 1985;8:274-8. Jenkins DJA, Leeds AR, Gassull MA, Cocket B, Alberti GMM. Decrease in postprandial insulin and glucose concentrations by guar gum and pectin. Ann Intern Med 1977;86:20-3. Wolever TMS, Jenkins DJA, Ninehome R, Alberti KGM. Guar gum and reduction ofpostprandial glycemia: effect of incorporation into solid food, liquid food, and both. Br J Nutr l979;41:505-10. Morgan LM, Tredger JA, Madden A, Kwasowsli P, Marks V. The effect of guar gum on carbohydrate fat and protein-stimulated gut hormone secretion: modification of postprandial gastric inhibitory polypeptide and gastric responses. Br J Nutr 1985;53:467-75. Coulston AM, Liu GC, Reoven GM. Plasma glucose insulin and lipid responses to high-carbohydrate low-fat diets in normal humans. Metabolism 1983;32:52-6. Tarpila S, Miettinen TA. Effects of plantago fiber on serum lipids and fecal composition in hypercholesterolemic patients. Scand J Gastroenterol 1977;12(suppl 45):l05(abstr).