Cholesterol lowering with fiber therapy
Aside from aiding digestion, psyllium helps lower CHD risk
We all want a good life, we want good cars, convenient living, we want to be seated all the time at home [watching] TV," said Dr. Eugene Reyes, consulting cardiologist and clinical associate professor at the University of the Philippines-Philippine General Hospital. "These are all changes in the life that we live, and may impact the way we suffer from various diseases."
Speaking at a symposium organized by Westmont Pharmaceuticals in May's Philippine College of Physicians annual convention, Reyes discussed the role of lifestyle changes in cardiovascular-disease prevention, particularly the role of fiber in controlling cholesterol and glucose levels, and in weight management.
"Sea of risk"
The Interheart study (2004) showed the global impact of the different risk factors for coronary heart disease (CHD), with smoking, hypertension, diabetes, and obesity being the most common risk factors. It also found that while the risk for an acute myocardial infarction is relatively low if one is only a smoker, just diabetic, or just hypertensive, three risk factors present in one person considerably raise his or her risk for an MI. The risk goes even higher if other factors are present.
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The study also showed some "negative risk factors," which means, Reyes explained, "they are good if you have them." People who have these "negative risk factors" include those who do not smoke, those engaged in moderate physical activity regularly, and those who drink moderate amounts of alcohol (but Reyes cautioned: "I don't want you to promote alcohol, since alcohol is addictive"), and those who consume the right amounts of fruits and vegetables. Also, having more than one of these "negative risk factors" offers "prominent" benefits. "The more healthy lifestyle you attain, the more you are protected from CVD (cardiovascular disease)."
The Philippine scenario
While the national life expectancy is also getting better, albeit relatively slowly, the prevalence of CVD and associated risk factors has risen alarmingly and steadily. Diseases of the heart and the vascular system are the leading cause of mortality, accounting for more than a quarter of all deaths nationwide.
The risk factors for CVD have also become more widespread. In the 2003 National Nutrition and Health Survey, the prevalence of smoking is 56 percent. Hypertension has also risen in just five years, growing from 17 percent in 1998 to 22.5 percent in 2003. Although relatively low, the prevalence of diabetes has climbed from four percent to 4.6 percent.
People whose total cholesterol is higher than 200 mg/dL have doubled; obese Pinoys have tripled. What is also dismal is the 21-percent drop in the consumption of fruits and vegetables. Reyes remarked: "There is an inverse relationship between the consumption of [fruits and vegetables] and the prevalence of dyslipidemia and obesity."
Said Reyes: "We need to intervene, and the best, I think, is health promotion through good lifestyle changes."
Among the factors that could help prevent CV disease are smoking cessation, weight reduction and diet and exercise, increased consumption of fruits and vegetables, and the use of dietary supplements if necessary.
Fiber and its benefits
Plant food, aside from providing nutrients necessary to health, contains fiber that aids digestion, among other things. It is resistant to digestion and absorption in the small intestine, and is partially or fully fermented in the large intestine. It also forms the bulk of the stools.
Dietary fibers are either insoluble or soluble. Insoluble fiber moves bulk through the intestines, and controls and balances the intestines' acidity. It promotes regular bowel movement and removes toxic waste faster. Good sources of insoluble fiber are whole-wheat products, corn bran, and green beans, as well as the skins of fruits, vegetables, and potatoes.
Meanwhile, soluble fiber binds with bile acids, increases the bulk and moisture of the feces, and prolongs the emptying time of the stomach so that glucose is released and absorbed more slowly. It has been proved to lower low-density lipoproteins (LDL) and total cholesterol, regulate blood sugar in diabetics, regularize bowel movement, and could play a role in weight management. Good sources are oats, dried beans, barley, fruits, vegetables, and psyllium husk. Consuming the necessary amount of fiber from dietary sources alone can be difficult; this is where supplementation may come in.
Psyllium has been globally recognized as a good source of dietary fiber. Containing 35-percent soluble and 65-percent insoluble fibers, psyllium has been shown to have benefits outside of the digestive system. It has been shown to aid cholesterol reduction, blood-glucose control, and weight management.
Anderson (2000) looked at 248 people with high cholesterol, randomized to receive either psyllium or placebo for 26 weeks. It was then shown that 10.2 grams of psyllium every day lowered total cholesterol by five percent, and LDL by seven percent (Figure 1). "Let me remind you that for every one-percent reduction in total cholesterol…you would be able to reduce [CHD] risk by two to three percent," said Reyes. "Dietary change plus psyllium could potentially reduce CHD risk by 10 to 15 percent."
In a pooling of eight randomized, controlled trials that looked into the effects of psyllium on lipids (Am J Clin Nutr, Feb 2000), it was shown that those on psyllium had a four-percent reduction in total cholesterol, and seven percent in LDL. Reyes added: "It was also able to reduce the [apolipoprotein B-apolipoprotein A1] ratio by six percent, which is, as we learned from the Interheart study, the greatest predictor of risk."
Meanwhile, Sierra et al. (2002) found that psyllium helped slow down glucose absorption (12.2 percent) in 20 diabetics. Although no notable association with insulin-level changes was found as well as in measurements of glycosylated hemoglobin and 24-hour urinary glucose excretion, psyllium was again found to lower LDL and total cholesterol.
Lastly, a study of 68 patients with hypercholesterolemia looked into whether psyllium supplementation could have an effect on statin therapy. The participants were randomized to receive simvastatin 10 mg, simvastatin 20 mg, or simvastatin 10 mg plus psyllium. "The addition of soluble fiber (psyllium) to simvastatin 10 mg resulted in the lowering of LDL levels about as effectively as doubling the statin dose," said Reyes. "These findings offer an alternative to patients on statins and who need further LDL reduction, but are concerned about the side effects of increasing the dose of the statin." (Figure 2)
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:
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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.
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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."
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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.
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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.
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