Efficacy of guar gum in preventing the dumping syndrome

The occurrence of dumping symptoms during 1 wk of use of 5 g of guar gum or placebo in meals was examined in a double-blind study in 11 patients, who had undergone gastric resection and were suffering from the dumping syndrome. The results show that guar gum prevented the dumping syndrome and increased tolerance to foods not previously tolerated in nine of the 11 patients.     

Effect of guar gum on gastric emptying of test meals of varying energy content in growing pigs

1. Existing information on whether the action of guar gum in decreasing postprandial blood glucose concentrations is due, at least in part, to a reduced rate of gastric emptying is conflicting, possibly because three types of test meals have been used. In order to test whether the type of test meal used influences the action of guar gum, these three types of meal were compared, either without or with guar gum, in growing pigs. The meals were: a high-energy meal (HEM), a low-energy milky drink (LEMD) and a glucose drink (GD). 2. Six pigs were prepared with a simple gastric cannula which allowed complete removal of the stomach contents just before or 0.5, 1, 2 or 4 h after feeding. 3. The three types of test meal without guar gum gave rise to very different postprandial profiles of gastric pH and of digesta and dry matter (DM) emptying from the stomach. 4. Addition of guar gum to the GD significantly raised gastric pH at 0.5 and 1 h after feeding but, when it was added to HEM, gastric pH was only significantly raised 4 h after feeding. No significant effect on gastric pH was seen when guar gum was added to LEMD. 5. Although addition of guar gum to GD had no significant effect on the emptying of digesta from the stomach, when added to HEM the rate of emptying of digesta was significantly reduced 1, 2 and 4 h after feeding. Addition of guar gum to LEMD only significantly increased the amount of digesta remaining in the stomach 2 h after feeding. 6. There was no significant effect on the emptying of DM from the stomach when guar gum was added to either HEM or LEMD. However, addition of guar gum to GD significantly reduced the mean rate of emptying of DM 0.5 h after feeding. 7. Addition of guar gum to either LEMD or GD had no significant effect on the DM concentration of the evacuated gastric digesta. However, addition of guar gum to HEM significantly lowered the DM concentration of the evacuated gastric digesta 1, 2 and 4 h after feeding. 8. It was concluded that differences in test meal composition and also in the methods used to measure gastric emptying could account for the discrepancies previously reported. The results suggest that although guar gum may reduce the rate of gastric emptying under some conditions, this is unlikely to be the only mechanism by which it acts.     

Effect of guar gum on gastric emptying in growing pigs

1. Simple gastric cannulas were surgically fitted to four pigs, initially of 30 kg live weight, to examine the effects of guar gum on gastric emptying. 2. Four semi-purified high-fat diets based on starch, casein, soya-bean oil and tallow were given to each pig. They contained 0 (control), 20, 40 or 60 g powdered guar gum/kg diet. The meals as fed contained 257 g dry matter (DM)/kg. 3. The contents of the stomach were evacuated, with rinsing, before feeding or 0.5, 1, 2 or 4 h after feeding. 4. The mean pH of the digesta was unaffected by guar gum until 4 h after feeding when the value increased as the amount of guar gum in the diet rose. 5. The only significant effects of guar gum on the emptying of digesta and its components (compared with the control diet) were to reduce the rate of emptying of (a) digesta 1 h after feeding (60 g/kg diet) and 4 h after feeding (40 and 60 g/kg diets), (b) dry matter and glucose 1 h after feeding (60 g/kg diet), (c) nitrogen 1 h after feeding (60 g/kg diet) and 4 h after feeding (40 and 60 g/kg diets). 6. When expressed on a half-time (T50) basis, the emptying of digesta and N (but not of DM and glucose) were significantly slower for diets containing 40 and 60 g guar gum/kg than for the control diet. 7. The apparent viscosity of the gastric digesta ranged between 0.5 and 23.7% of the values for the diets as consumed. 8. It was concluded that the effects of guar gum on gastric emptying of high-solid meals were small, and that this was unlikely to be an important aspect of the mechanism by which guar gum reduces postprandial blood glucose concentrations.     

Effect of guar gum added to the diet of patients with duodenal ulcer

In a randomized, double-blind, controlled clinical study, the effects of 5 g of guar gum, a dietary fiber composed of galactose and mannose, or placebo added to the diet of 20 patients with duodenal ulcer for 1 wk each were examined. Ten patients derived evident benefit and five some help from guar gum, on comparing symptoms during administration of guar gum with those experienced earlier or during the placebo week, whereas four patients found that neither guar gum nor placebo had any effect (p less than 0.001). The beneficial effect was associated with increased feelings of repletion after meals. Patients with fewest symptoms benefited only slightly, or not at all, from guar gum. In one patient, guar gum abolished pain felt earlier and on placebo, but also caused severe gastric retention after meals. This patient had pyloric stenosis. In patients who were intolerant to berries, fruits, sugar, sweet rolls, and pizza these foodstuffs were better tolerated during guar gum administration. The diarrhea which occurs in some patients ingesting guar gum was avoided by giving low initial doses. In three patients unpalatability of guar gum was a minor complaint. It is concluded that guar gum is helpful to many patients with uncomplicated duodenal ulcer, but that it is harmful to those having increased gastric emptying, eg, pyloric stenosis patients, and that guar gum may exert its effects by increasing gastric emptying time.     

The effect of guar gum on carbohydrate-, fat- and protein-stimulated gut hormone secretion: modification of postprandial gastric inhibitory polypeptide and gastrin responses

The effect of incorporating guar gum into predominantly single-component meals of carbohydrate, fat or protein on liquid gastric emptying and on the secretion of gastric inhibitory polypeptide (GIP), gastrin and motilin, was studied in healthy human volunteers. Volunteers were given either 80 ml Hycal (carbohydrate meal), 150 g cooked lean minced beef (protein meal) or 200 ml double cream (fat meal) either with or without 5 or 6 g guar gum. Liquid gastric emptying was monitored in the fat and protein meals by taking 1.5 g paracetamol, consumed in water, with the meals and monitoring its appearance in circulation. Postprandial insulin and GIP levels were both significantly reduced by addition of guar gum to the carbohydrate meal. Postprandial GIP secretion was also reduced by addition of guar gum to the protein meal, but protein-stimulated gastrin secretion was enhanced by guar gum. There was a significant negative correlation between peak circulating gastrin levels and the corresponding GIP levels. Postprandial GIP secretion and plasma motilin levels were unaffected by addition of guar gum to the fat meal. 5 and 10 g guar gum/l solutions in water possessed buffering capacities between pH 2.75 and 5.5. Guar gum at 5 g/l caused no detectable change in liquid gastric-emptying time. The observed augmentation of gastrin secretion by guar gum following a protein meal could be due either to the buffering capacity of guar gum or to the attenuation of GIP secretion. It is possible that the chronic use of guar gum could be associated with changes in gastric acid secretion.     

The effect of ispaghula (Fybogel and Metamucil) and guar gum on glucose tolerance in man

The effects of incorporating Fybogel (3.5 and 7 g doses), Metamucil (7 g) or guar gum (2.5 and 14.5 g doses) in a drink containing 50 g glucose on plasma glucose, plasma insulin and gastric emptying were studied in thirty-eight normal volunteers. In addition, the effects of Fybogel (7 g) on glucose tolerance, plasma insulin and gastric emptying were measured in fourteen non-insulin-dependent diabetics. Both doses of guar gum significantly lowered plasma glucose and plasma insulin responses to the oral glucose load in normal subjects, although 14.5 g guar gum did not delay the half-time for gastric emptying. Neither Fybogel nor Metamucil had significant effects on plasma glucose responses in normal subjects. In addition, Fybogel (at either dose) had no significant effects on plasma insulin levels, or on gastric emptying in normal subjects or on plasma glucose and insulin responses in diabetic patients. The viscosity of ispaghula solutions ( Fybogel ) was lower than that of guar gum solutions.     

Influence of feeding conditions on slowing of gastric emptying by edible gums

The feeding of 4% guar or xanthan gum versus 4% cellulose in a final test meal was expected to slow the gastric emptying of accompanying nutrients, and the degree of this slowing was examined in rats trained to three feeding regimens. Gastric emptying of nutrient energy was calculated from the measured disappearance of fat and of either carbohydrate or total diet residue from the stomach. In experiment 1, rats were ad libitum fed a diet containing 4% cellulose for 6 1/2 days and, after 12 to 14 hours without food, were given a test meal containing either 4% guar or 4% cellulose. In experiment 2, a growth-restricting amount of 6% and 2% guar diets was fed as a single meal on each of 7 days, and the same diets were used for the final test meals. In experiment 3, rats ate 2-hour meals containing 4% and 0% guar gum, or 4% and 0% xanthan gum, on alternate days, and again the same diets were used for the test meal. The feeding of both xanthan and guar gums in a dry form did slow gastric emptying of nutrient energy, although the feeding of 6% versus 2% guar gum was without demonstrable effect (experiment 2). The slowing effect varied with past feeding conditions, being greater in experiment 1 than in experiment 3.     

Dietary guar gum effects on postprandial blood glucose, insulin and hydroxyproline in humans

Meals (425 kcal) containing various doses of guar gum (0, 2.5, 7.5 or 12.5 g) were ingested by nine healthy male subjects after a 12-h fast. The rise in blood glucose was higher after the control meal without guar gum than after the guar gum-containing meals, which all gave a similar rise in glucose. In contrast, increased doses of guar gum led to a greater reduction in the postprandial rise in insulin. The postprandial increase in serum hydroxyproline, an amino acid added to all meals, was decreased in a similar manner by all of the guar gum doses. Gastric emptying was measured after the control meal without guar gum and the meal containing 12.5 g of guar gum by monitoring 51Cr, which was added to the meals. Guar gum was found to reduce the variation between individuals, as well as the initial rate of gastric emptying, which correlated with changes in both serum hydroxyproline (rs = 0.93, P less than 0.01) and blood glucose (rs = 0.83, P less than 0.01). The effectiveness of guar gum in reducing postprandial response was lost after heating and homogenization for canning. A threshold in the reduction in rise of glucose or hydroxyproline was reached with the lowest dose (2.5 g) of viscous guar gum; larger doses had no additional effects. The reduced absorption seems to be an effect of a slower gastric emptying rate.     

The effect of different dosages of guar gum on gastric emptying and small intestinal transit of a consumed semisolid meal

BACKGROUND: There is no consensus about the effect of guar gum supplementation on gastrointestinal transit. It has been suggested that guar gum slows gastric emptying and intestinal transit, thus inducing an increased feeling of satiety. OBJECTIVE: To investigate whether addition of guar gum to a semisolid meal affects gastrointestinal transit. DESIGN: Eight male subjects were randomly studied four times. They consumed a standard semisolid test meal containing either 0 g, 2.5 g, 3.5 g, or 4.5 g of guar gum. The test meals contained 1 mCi 99mTc-hepatate for scintigraphy and 5 g lactulose for the H2-breath test. Scintigraphic scanning was performed for at least two hours, and gastric half-emptying time (T1/2) was calculated. Breath samples were collected at 15 minute intervals and analyzed for H2-enrichment. The orocecal transit time (OCTT) was then determined. A parameter of intestinal transit (PIT) was obtained by subtracting the T1/2 from the OCTT. RESULTS: There were no significant differences (in minutes) between the different tests in both T1/2 (0 g, t = 88.2 +/- 11, 2.5 g, t = 83.3 +/- 11.9, 3.5 g, t = 83.3 +/- 13.6, 4.5 g, t = 72.4 +/- 7.2, p = 0.86) and PIT (0 g, t = 149.9 +/- 26.6, 2.5 g, t = 145.5 +/- 25.6, t = 3.5 g, t = 175.3 +/- 17.6, t = 4.5 g, t = 152.6 +/- 22.4, p = 0.52). CONCLUSION: Addition of guar gum to a semisolid meal up to a dosage of 4.5 g does not affect gastrointestinal transit. Other mechanisms than gastrointestinal motility are involved in a possible satiating effect of guar gum supplementation.     

The effect of soluble- and insoluble-fibre supplementation on post-prandial glucose tolerance, insulin and gastric inhibitory polypeptide secretion in healthy subjects

Six healthy non-obese male subjects were given three test meals containing 100 g carbohydrate and 1.5 g soluble paracetamol, supplemented on one occasion with 10 g guar gum and on another with 10 g sugarbeet fiber. A further six subjects were given the same test meal supplemented on one occasion with 10 g soya-bean-cotyledon fibre and on another, 5 g glucomannan. Venous blood samples were taken before, and at intervals for 180 min following the meal, and analysed for insulin, gastric inhibitory polypeptide (GIP) and paracetamol (as an index of gastric emptying). Arterialized blood samples were taken and analysed for glucose. Meal supplementation with both guar gum and sugar-beet fibre improved glucose tolerance, but circulating glucose levels were unaffected by the addition of either soya-bean-cotyledon fibre or glucomannan to the meals. Supplementation with guar gum and glucomannan lowered post-prandial insulin levels. Insulin levels were enhanced by addition of soya-bean-cotyledon fibre to the meal and unaffected by sugar-beet fibre. Post-prandial GIP levels were lowered in the guar-gum-supplemented meal and augmented with sugar-beet fibre supplementation. Addition of glucomannan and soya-bean-cotyledon fibre did not affect circulating GIP levels. The study failed to confirm previous reports of improved glucose tolerance following glucomannan and soya-bean-cotyledon fibre supplementation. The failure of sugar-beet fibre to reduce post-prandial insulin secretion despite improved glucose tolerance may be due to the observed increased secretion of GIP. The increased insulin levels seen following soya-bean-cotyledon fibre supplementation cannot be attributed either to changes in glucose tolerance, GIP secretion or gastric emptying.(ABSTRACT TRUNCATED AT 250 WORDS)     

Method for the quantitation of gastric emptying time of gel test meals

Isotopic markers were developed to allow measurement of the gastric emptying times of homogeneous and nonhomogeneous gel meals. Meals containing the dietary fibers psyllium and guar gum presented as homogeneous, viscous gels while meals containing the synthetic polymer polycarbophil presented as discrete gel particle-water mixtures. Fiber meals were labeled differently than polycarbophil meals. Fiber meals were labeled with 51Cr-CM-Sephadex. The marker was uniformly suspended in meals containing at least 1% guar or 2% psyllium. In contrast, polycarbophil particles were labeled by hydrating the dried granules with saline in which Na2(51)CrO4 had been dissolved. Use of the markers to measure gastric emptying was demonstrated in dogs fitted with duodenal cannulas. Half of the fiber meals emptied from the stomach in about 40 min without significant dilution by secretions. In contrast, only 8% of the polycarbophil particles emptied by 90 min. Particle-specific labeling of polycarbophil was important because the meal effluent was diluted extensively by secretions. We conclude that 51Cr-CM-Sephadex and soluble Cr-51 may be used as meal markers for estimation of the gastric emptying times of certain homogeneous and nonhomogeneous gel-type meals, respectively.     

Does guar gum improve post-prandial hyperglycaemia in humans by reducing small intestinal contact area?

The possibility that viscous polysaccharides, such as guar gum, could lower post-prandial blood glucose levels in part by restricting carbohydrate solutions to a smaller area of small intestine was investigated in twenty healthy human volunteers. Addition of guar gum (22.5 g/l) delayed the mouth-to-caecum transit time of a hypotonic lactulose drink, but did not affect gastric emptying. When a 250 ml solution containing 50 g glucose was confined to a 550 mm length of intestine by an occluding balloon attached to an intestinal tube, maximum blood glucose response was significantly reduced (P less than 0.05) though only by 0.9 mmol/l. Addition of guar gum (36 g/l) had no effect on the distribution of a radio-labelled glucose drink (250 ml; 200 g glucose/l) in the small intestine, monitored using a gamma camera, although it significantly delayed gastric emptying (t 1/2 (min): guar gum v. control 115 (SE 15) v. 73 (SE 8)). Reduced contact area is unlikely to be one of the mechanisms by which guar gum improves glucose tolerance.     

Long-term effects of dietary fiber on glucose tolerance and gastric emptying in noninsulin-dependent diabetic patients

Effects of long-term (2 months) supplementation of diet with 20 g of guar gum and 10 g of wheat bran on metabolic control was studied in 12 obese, poorly controlled noninsulin-dependent diabetic patients. Addition of fiber reduced urinary excretion of glucose from 30.5 +/- 6 to 8.3 +/- 2 g/24 h, (p less than 0.025), fasting plasma glucose concentration from 301 +/- 24 to 184 +/- 15 mg/dl (p less than 0.025), and plasma cholesterol concentration from 277 +/- 24 to 193 +/- 9 mg/dl (p less than 0.025). No significant changes were observed in the patients weight and serum concentrations of triglycerides, high-density lipoproteins, free fatty acids, and insulin. Addition of fiber also delayed gastric emptying of liquids and solids. This effect became statistically significant 60 and 90 min after intake of a test meal for liquids and solids, respectively. We conclude that addition of guar and bran to the diet resulted in long-term improvement of metabolic control in these patients and that delayed gastric emptying may be one of the mechanisms responsible for this beneficial effect.     

Effects of structural and non-structural polysaccharides in the diet of the growing pig on gastric emptying rate and rate of passage of digesta to the terminal ileum and through the total gastrointestinal tract.

Six experiments were made in growing pigs to investigate the effects of substituting bran, oatmeal byproduct, pectin and guar gum for barley on gastric emptying rate, pH and dry matter of digesta and on the dry matter content and rate of passage of digesta to the terminal ileum and overall. Twelve pigs with cannulas sited at the pyloric/fundic junction of the stomach were used to measure gastric emptying. Seventy-two pigs were kept in metabolism cages for the total collection of faeces and nine pigs were fitted with simple cannulas 150 mm cranial to the ileo-caecal junction. For the overall transit measurements the barley was ground through a 4.68 mm screen (C) and for the other studies either through this screen or a 1.56 mm screen (F). Gastric emptying rates were significantly faster for F diets than for C diets, but bran and oatmeal by-product substitutions were without significant effect on this variable or on rate of passage to the terminal ileum. Guar gum and pectin significantly speeded up gastric emptying and transit to the terminal ileum in C diets. Guar gum and pectin did not significantly affect overall transit time, but bran accelerated it. The results are discussed in relation to the depressive effects on nutrient utilization which have been recorded for the four polysaccharides: it is postulated that gastric emptying rate and transit time to the terminal ileum are likely to have a minimal effect on overall transit time.     

Guar gum does not impair the absorption and utilization of dietary nitrogen but affects early endogenous urea kinetics in humans

BACKGROUND: Viscous gums enhance viscosity in the upper gastrointestinal lumen, quickly disturbing motility and promoting fluid secretion. OBJECTIVE: We sought to determine whether guar gum could acutely affect the absorption and utilization of dietary nitrogen and whether these luminal effects could also perturb the kinetics of urea. DESIGN: We studied the short-term effect of adding 1% of highly viscous guar gum to a (15)N-labeled protein meal (30 g soy protein isolate in 500 mL water) during the postprandial phase in humans. The effects on bioavailability were studied by using the [(13)C]glycine breath test (to assess gastric emptying) and (15)N enrichment in plasma amino acids (for systemic amino acid bioavailability). The kinetics of dietary and endogenous urea were assessed in plasma and urine. RESULTS: Guar gum modulated the gastric emptying kinetics of the liquid phase of the meal slightly (P < 0.05), but had no significant effect on either the systemic appearance of dietary amino acids or plasma and urinary dietary urea kinetics. Without significantly affecting plasma urea concentrations, guar gum reduced by approximately 40% the urinary excretion of endogenous urea for the first 2-h period after the meal (P < 0.01), although endogenous urinary excretion was similar at later stages. CONCLUSIONS: Guar gum did not significantly affect the bioavailability or utilization of dietary protein. We showed an early effect of guar gum on endogenous urea kinetics, which most probably arose from very early, short-term stimulation of the intestinal disposal of endogenous urea, at the expense of its urinary excretion.     

In vivo imaging of intragastric gelation and its effect on satiety in humans

Previous studies indicated that physical characteristics of food influence satiety, but the relative importance of the oral, gastric, and intestinal behaviors of the food is unclear. The aim of this study was to investigate the satiating effects of 2 types of alginates, which gel weakly or strongly on exposure to acid, compared with guar gum whose viscosity is unaffected by acid. Subjects (n = 12; 3 men, 9 women) ingested a 325-mL sweetened, milk-based meal replacer beverage on 4 separate occasions, either alone as a control or including 1% by weight alginate or guar gum. Intragastric gelling, gastric emptying, and meal dilution were assessed by serial MRI while satiety was recorded for 4 h. MR images showed that all of the meals became heterogeneous in the stomach except for guar, which remained homogeneous. The alginate meals formed lumps in the stomach, with the strong-gelling alginate producing the largest volume. Although gastric emptying was similar for all 4 meals, the sense of fullness at the same gastric volume was significantly greater for all 3 viscous meals than for the control. Compared with the control meal, the strong-gelling alginate (P = 0.031) and guar (P = 0.041) meals increased fullness at 115 min, and the strong-gelling alginate decreased hunger by the 115-min (P = 0.041) and 240-min (P = 0.041) time points. Agents that gel on contact with acid may be useful additions to weight-reducing diets. We hypothesize that this effect is due to distension in the gastric antrum and/or altered transport of nutrients to the small intestine in the lumps.     

Dietary fibers affect viscosity of solutions and simulated human gastric and small intestinal digesta

Two experiments were conducted to determine the viscosities of both soluble and insoluble dietary fibers. In Expt. 1, corn bran, defatted rice bran, guar gum, gum xanthan, oat bran, psyllium, soy hulls, stabilized rice bran, wheat bran, wood cellulose, and 2 methylcellulose controls (Ticacel 42, Ticacel 43) were hydrated in water overnight at 0.5, 1, 1.5, or 2% concentrations. In Expt. 2, guar gum, oat bran, psyllium, rice bran, wheat bran, and wood cellulose were subjected to a 2-stage in vitro gastric and small intestinal digestion simulation model. Viscosity was measured every 2 and 3 h during gastric and small intestinal simulation, respectively. Viscosities in both experiments were measured at multiple shear rates. Viscosities of all fiber solutions were concentration- and shear rate-dependent. Rice brans, soy hulls, and wood cellulose had the lowest viscosities, whereas guar gum, psyllium, and xanthan gum had the highest viscosities, regardless of concentration. During gastric simulation, viscosity was higher (P < 0.05) at 4 h than at 0 h for guar gum, psyllium, rice bran, and wheat bran. During small intestinal simulation, viscosities were higher (P < 0.05) between 3 and 9 h compared with 18 h for guar gum, oat bran, and rice bran. Guar gum, psyllium, and oat bran exhibited viscous characteristics throughout small intestinal simulation, indicating potential for these fibers to elicit blood glucose and lipid attenuation. Wheat and rice brans and wood cellulose did not exhibit viscous characteristics throughout small intestinal digestion; thus, they may be beneficial for laxation.     

Dumping syndrome in a child with an incorrectly positioned gastrostomy catheter

A 13-month-old girl experienced an epileptic fit due to hypoglycaemia. She was born with a posterolateral diaphragm defect and at the age of 1.5 months had undergone a Nissen fundoplication with which a gastrostomy was also performed. The tip of the gastrostomy catheter was found to be lying in the bulbus duodeni. Once this had been pulled back, the patient made a good recovery. Dumping syndrome is usually the result of a quicker gastric emptying time or a smaller gastric capacity, and in children it is mostly due to a Nissen fundoplication. In patients fed by tube who exhibit symptoms of dumping syndrome, the position of the feeding tube must be checked before other diagnostic or therapeutic steps are undertaken.     

慢性疲劳综合征的胃肠道症状和对胃排空影响的调查

目的调查慢性疲劳综合征(CFS)患者胃肠道症状的发生情况与胃排空功能的相关性。方法采用问卷调查43例CFS患者胃肠道症状的发生情况并对胃部症状进行评分,通过同位素测定其液相和固相胃排空功能,与38例健康对照者比较。结果CFS患者胃肠道症状的发生率较健康对照组显著升高。胃部症状评分与固相(r=0.81)和液相(r=0.65)胃排空减慢显著相关(P<0.001)。结论CFS患者的胃部症状与胃动力异常有关。     

Medical Curricula Failing Today's Health Challenges,AAMC Told

Although the majority of patients who develop dumping syndrome after partial gastrectomy can be treated successfully by medical means, some inevitably require a second operation. In the case presented, as in others, interposing a segment of jejunum in the anti rather than isoperistaltic relationship was highly effective in delaying the emptying of the gastric remnant and restoring its reservoir function.