Fiber therapy for functional GI disorders
Psyllium offers relief from IBS, constipation; also lowers bad cholesterol
Yearly, around 3.5 million patient visits to physicians are caused by functional gastro-eintestinal disorders, accounting for 41 percent of cases gastroenterologists see in their practice. Among these disorders are irritable bowel syndrome (IBS), nonulcer dyspepsia, functional abdominal pain syndrome, and functional constipation.
Almost invariably, these are related to fiber intake. In the last several years, there has been a 21-percent decline in the Filipino's intake of bowel-regulating food such as fruits and vegetables, according to Dr. Carla Sibulo, head of gastroenterology at the Ospital ng Maynila.
"There is a need to fortify the nation's fiber intake," Sibulo said during the midyear convention of the Philippine Society of Gastroenterology held November last year in Palawan. She discussed the role of fiber therapy in the management of functional gastrointestinal disorders during a symposium hosted by Westmont Pharmaceuticals.
IBS and functional constipation
Zeroing in on IBS and functional constipation, Sibulo distinguished between the two.
IBS is defined as abdominal discomfort or pain for at least 12 weeks, the onset of which is associated with change in either frequency or form of stool and is relieved with defecation.
The diagnosis, according to Sibulo, is mainly clinical, arrived at with thorough review of history, physical examination, and laboratory tests.
Treatment depends on whether the case is mild or complicated. Patient counseling, diet and lifestyle modification, and behavioral therapy may be sufficient for mild cases, but pharmacotherapy may be required for complicated cases.
On the other hand, functional constipation (as per the Rome 2 criteria for diagnosis) involves experiencing 12 weeks (not necessarily consecutive but within a year) of two or more of the following symptoms:
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strain during bowel movement (more than 25 percent of the time)
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lumpy or hard stools
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sensation of incomplete evacuation
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sensation of anorectal obstruction/blockade
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fewer than three bowel movements per week
Persons suffering from consti-pation should be reassured and taught about normal bowel habits. They should be encouraged to defecate when colonic activity is highest (in the morning or after meals), increase dietary-fiber and fluid intake, and exercise.
If nonpharmacologic treatment does not work, patients may be given laxatives. Bulk laxatives such as psyllium, calcium polycarbophil, and methylcellulose can improve stool consistency by increasing water content, stool bulk and weight, thus decreasing colonic transit time. There are also saline (magnesium citrate, magnesium hydroxide, sodium phosphate), osmotic (lactulose, sorbitol), and stimulant laxatives.
The role of fiber
Dietary fibers are found in plant foods like fruits and vegetables, grains, and legumes. They are complex carbohydrates that are neither digested nor absorbed in the small intestine but are excreted from the body. They undergo complete or partial fermentation in the large intestine. They also exhibit laxation and blood-cholesterol or blood-glucose attenuation.
Fiber may be soluble or insoluble. Soluble fibers like gums, mucilages, pectin, and some hemicellulosses dissolve in liquid to form a gel. They bind with bile acids, prolong emptying time so that glucose is released and absorbed more slowly, and increase the bulk and moisture of feces. Oats, dried beans and peas, barley, flax seed, fruits such as oranges and apples, vegetables like carrots and psyllium husk are good sources of soluble fiber.
Apart from helping regulate bowel movement, soluble fiber offers other health benefits. It lowers total cholesterol and low-density lipoproteins (LDL), thereby reducing the risk of heart disease; regulates blood sugar for people with diabetes; and plays a role in weight management.
Insoluble fiber, on the other hand, provides structure to plants and does not dissolve in water. Fiber from whole-wheat products, corn, flax seed, green beans, cauliflower, potato skins, and some fruit skins pass the digestive tract largely intact. It helps control and balance acidity in the intestines to prevent microbes from producing cancer substances. Insoluble fiber is also beneficial to health because it prevents constipation and speeds up removal of toxic wastes through the colon.
How psyllium works
Psyllium (available commercially as Fibermate) is a short-stemmed or stemless annual herb native to India and Iran. Its small and reddish brown seeds absorb water and become surrounded with mucilage, which has excellent emulsifying power and is prized as a laxative. The psyllium seed consists of 35 percent soluble and 65 percent insoluble polysaccaharides (cellulose, hemicellulose, and lignin).
Psyllium is universally recognized as a premier source of dietary fiber. When given to healthy volunteers, 18 g daily of psyllium husk increased fecal weight. The additional bulk in stools stimulated the walls of the bowel to contract, increased peristalsis, and resulted in evacuation of feces. Most of the psyllium was shown to reach the cecum four hours after ingestion in an intact and highly polymerized form. The husk appears to be relatively resistant to fermentation. Psyllium husk also significantly increased the level of stool moisture, as well as wet and dry stool weight.
Sibulo cited a three-week, open-label, randomized, crossover study in a geriatric population that compared psyllium mucilloid and calcium polycarbophil.1 The study showed that stool consistency and median strain improved in both groups over baseline. "Psyllium fared better than calcium polycarbophil in improving stool frequency," noted Sibulo.
Psyllium also offers other benefits like lowering LDL and total cholesterol2 and taming the rise in postprandial blood glucose.3
Sibulo said fiber therapy may also be indicated for hemorrhoids, colonic diverticulosis, functional diarrhea, and prevention of colon cancer. Fiber aids in functional diarrhea therapy "because soluble fiber like psyllium absorbs water, decreasing the amount of water in the stool," explained Sibulo.
The role of fiber in preventing colon cancer has also been widely documented and reported. In the case of psyllium, Sibulo said a study4 showed that "it provided colonocytes some pretection from deoxycholic acid-induced lysis."
G. Gamboa
About Fibermate
Fibermate, a high-fiber supplement containing psyllium, is available in sweetened but sugar-free natural and orange flavors. It offers the following benefits:
Promotes bowel regularity and prevents constipation.
Fibermate (psyllium) absorbs and traps water, keeping the stool soft and bulky. It "bulks up" waste and moves it through the colon more rapidly, preventing constipation and possibly colon cancer.
Helps lower blood-cholesterol levels, especially LDL-cholesterol or the "bad" cholesterol.
Fibermate (psyllium) decreases blood cholesterol by binding to bile acids, which are made of cholesterol, in the gastrointestinal tract and carrying them out of the body as waste.
The United States Food and Drug Administration approved the following health claim for Fibermate: "Diets low in saturated fat and cholesterol that include seven grams of soluble fiber per day from psyllium husk may reduce the risk of coronary heart disease by lowering blood-cholesterol levels."
Helps control blood sugar in the body.
Fibermate (psyllium) delays and spreads out the absorption of carbohydrates, resulting in a more normal pattern of insulin secretion, thus preventing blood sugar from rising rapidly.
Helps control weight.
Fibermate (psyllium) is a weight watcher's dream. Fiber takes up space in the stomach, making a person feel full, thereby requiring less food intake. Because fiber is filling, it delays hunger sensation.
Fibermate may be taken one to three times daily, preferably with meals or as prescribed by a health professional. People who take it should also drink more--additional six to eight glasses of fluids throughout the day. Inadequate fluid intake may cause psyllium to swell and block the throat, esophagus, or intestines.
Patients who have difficulty swallowing should not take Fibermate. Pregnant women and nursing mothers should only use it if recommended by their physicians.
References
1. Comparative laxation of calcium polycarbophil with psyllium mucilloid in an ambulatory geriatric population, Current Therapeutic Research 1988; 44: 1013-1018.
2. Cholesterol-lowering effects of psyllium intake adjunctive to diet therapy in men and women with hypercholesterolemia: metaanalysis of eight controlled trials. American Journal of Clinical Nutrition 2000; 71: 472-479.
3. Effects of psyllium on glucose and serum lipid responses in men with type-2 diabetes and hypercholesterolemia. American Journal of Clinical Nutrition 1999; 4: 446-473.
4. Friedman, et al., Cancer Lett 1988; 43: 121-124.
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