studies using high viscosity hydroxypropylmethylcellulose

There are at least two studies using high viscosity
hydroxypropylmethylcellulose. The newer study (2007) was in overweight
and obese subjects whereas the 1993 article was in type 2 diabetics.
Dow Chemicals produces a product called FORTEFIBER which is a version of
high viscosity hydroxypropylmethylcellulose. I have not found a product
that includes FORTEFIBER as an ingredient.


1. RESULTS—Peak glucose was significantly lower (P < 0.001) after both
HV-HPMC–containing meals (7.4 mmol/l [4 g] and 7.4 mmol/l [8 g])
compared with the control meal (8.6 mmol/l). Peak insulin concentrations
and the incremental areas for glucose and insulin from 0 to 120 min were
also significantly reduced after both HV-HPMC doses versus control (all
P < 0.01).
CONCLUSIONS—These findings indicate that HV-HPMC consumption reduces
postprandial glucose and insulin excursions, which may favorably alter
risks for diabetes and cardiovascular disease.
High-Viscosity Hydroxypropylmethylcellulose Blunts Postprandial Glucose
and Insulin Responses -
http://care.diabetesjournals.org/cgi...full/30/5/1039


2. High viscosity hydroxypropylmethylcellulose reduces postprandial
blood glucose concentrations in NIDDM patients.
Reppas C, Adair CH, Barnett JL, Berardi RR, DuRoss D, Swidan SZ, Thill
PF, Tobey SW, Dressman JB.

Department of Pharmacy, University of Athens, Greece.

The ability of high viscosity hydroxypropylmethylcellulose (HPMC) to
reduce postprandial glucose concentrations was assessed in patients with
non-insulin-dependent diabetes (NIDDM) and healthy volunteers. The study
design consisted of a two-way crossover, single-dose administration of
10 g prehydrated high viscosity HPMC, or placebo, with a standard
carbohydrate-rich meal. In patients with NIDDM, HPMC reduced blood
glucose concentrations at the 60-, 75-, 90-, 120- and 150-min sampling
intervals, with an average reduction in the maximum postprandial blood
glucose concentration, Cmax, of 24% (P < 0.05). The time at which the
maximum concentration was reached, Tmax, remained unchanged. The area
under the blood concentration versus time plot, AUC0-6h, was reduced by
an average of 15% (P < 0.05). The blood concentration profile of insulin
followed that of glucose. Concentrations were significantly lower than
in the placebo phase only at the 120-min sampling time, while
pharmacokinetic parameters (Cmax, Tmax and AUC0-6h) were unchanged.
These results suggest that alterations in the blood glucose profile are
mediated by luminal events rather than by changes in hormonal response.
In contrast to the NIDDM patients, neither the pharmacokinetic
parameters nor the blood glucose concentrations at specific sampling
times were significantly affected by the co-administration of HPMC in
healthy volunteers. Overall, the results of this study suggest that HPMC
may be a useful adjunct in the management of NIDDM.
PMID: 8137718 [PubMed
http://www.ncbi.nlm.nih.gov/pubmed/8137718

Don't take the following article as an indication that I don't support a
low carbohydrate diet for type 2 diabetics.

"Additionally, from a nutritional standpoint, these diets
(Low-carbohydrate–high-protein diets) are seriously deficient in several
micronutrients and dietary fiber, thus creating a need for nutritional
supplements." Source: Low-carbohydrate–high-protein diets: Is there a
place for them in clinical cardiology? -
http://content.onlinejacc.org/cgi/content/full/43/5/725
Table 2 "Adverse" Consequences of LC-HP Diets -
http://content.onlinejacc.org/cgi/co...ll/43/5/725/T2

Yet it does seem that some form of fiber supplementation can be useful
for health. FiberOne cereal is heavy in fiber but may have too much
carbohydtrate for many T2s. Guar gum and psyllium husks are available.
A few diabetics use defatted flax seed fiber as their fiber source.
Beta-glucans are also a useful fiber for delaying carbohydrate digestion.

"Supplementation of a high-carbohydrate breakfast with barley
beta-glucan improves postprandial glycaemic response for meals but not
beverages.

[...] There is evidence of postprandial blunting of blood glucose and
insulin responses to dietary carbohydrates when oat soluble fibre is
supplemented into the diet but few trials have been carried out using
natural barley or enriched barley beta-glucan products. The aim of this
trial was to investigate the postprandial effect of a highly enriched
barley beta -glucan product on blood glucose, insulin and lipids when
given with a high-CHO food and a high-CHO drink. [...] We conclude that
a high dose barley beta-glucan supplement can improve glucose control
when added to a high-CHO starchy food, probably due to increased
gastro-intestinal viscosity, but not when added to a high-CHO beverage
where rapid absorption combined with decreased beta-glucan concentration
and viscosity may obviate this mechanism." PMID: 17215176 [PubMed

Grain processing and nutrition. -
http://www.ncbi.nlm.nih.gov/pubmed/11307845

Frank

On Wed, 02 Jul 2008 22:32:37 -0400, Jefferson
<Jefferson@comcast.net> wrote:

>Don't take the following article as an indication that I don't support a
>low carbohydrate diet for type 2 diabetics.
>
>"Additionally, from a nutritional standpoint, these diets
>(Low-carbohydrate–high-protein diets) are seriously deficient in several
>micronutrients and dietary fiber, thus creating a need for nutritional
>supplements." Source: Low-carbohydrate–high-protein diets: Is there a
>place for them in clinical cardiology? -
>http://content.onlinejacc.org/cgi/content/full/43/5/725
>Table 2 "Adverse" Consequences of LC-HP Diets -
>http://content.onlinejacc.org/cgi/co...ll/43/5/725/T2

I don't disagree on the need for fibre; that's one of the
reasons I add psyllium husk to my menu.

However, as a lay reader, I think some very poor science and
assumptions have been made in the referenced papers.

I'll try to keep it brief, so this is just some quick
comments on the first link. I'm sure a detailed analysis by
our experts will find deeper difficulties; I'll follow with
the second one.

First, they start with a definition for the LC-HP diet that
appears to be based on their flawed understanding of Atkins
induction, and extend that to apply to all versions of LC-HP
by assumption.

"Usually, LC-HP diets are those that contain significant
quantities of animal protein and relatively low amounts of
carbohydrates, rendering them ketogenic. Individuals who
consume such diets are in a perpetual state of ketosis,
which leads to a disproportionate use of fat stores for
energy." They use references 5 and 6 referring to Atkins and
Eades. My limited knowledge of both is enough to know that
definition is incorrect for both. Maybe Susan or another
expert could enlighten us.

The whole paper is based on that false presumption,
compounded by others as to calorie content at starvation
levels. In effect, their whole concept of the LC-HP diet is
an extreme version of LC-HP, not the form usually promoted
by those succeeding in it's use, whether for weight loss or
diabetes management.

This is relevant section on nutrition:

"Poor long-term nutrition

One of the main concerns regarding the uncritical use of
LC-HP diets is the relative absence of many micronutrients
and fiber."

Relative absence compared to what? I regularly check my
micronutrient and macronutrient intake using DWIDB and
almost always exceed the RDAs for all those listed there.

" When these deficiencies are considered in conjunction with
the hypocaloric nature of the diet, there is a real danger
of malnutrition in the long term. It is self-evident that
humans cannot endure a daily deficit of 400 to 500 calories
on an ongoing basis unless strict goals are set regarding
weight loss."

Nowhere in the references is there any suggestion of a diet
with an ongoing daily deficit of 400 to 500 calories.
They've built a straw man to argue against.

"If such precautions are not taken, it is indeed possible to
generate a malnutrition-modulated type of diabetes mellitus
that is associated with insulin resistance (37,38)."

Those references are:

"Molecular mechanisms involved in the etiopathogenesis of
malnutrition-modulated diabetes mellitus."
and
"Immunogenetic studies on malnutrition-modulated diabetes
mellitus."

They have again presumed, without support, that LC-HP by
their definition equates to malnutriton.

" However, it has to be recognized that these issues can
only be resolved by undertaking long-term studies of the
effects of ketogenic diets with caloric restriction in
normal subjects and patients with a variety of clinical
syndromes affecting the cardiovascular system. A fruitful
area of inquiry would be the examination of how an
individual could be weaned off a LC-HP diet without a
rebound increase in weight. Some proponents of these diets
have suggested that when the weight target has been reached
one could introduce more carbohydrates with reversion to the
initial low-carbohydrate state if weight gain recurs, a
perpetual "dietary yo-yo state" that has little relation to
healthy eating (5). This "weight cycling," which is not
unique to LC-HP diets, has been well described and may be
associated with adverse effects on health (39)."

Their argument here is to presume that yo-yoing is
inevitable as carbs are added back. With no evidence of any
sort to support their case other than the acceptance that it
has happened in the past in low-fat diets; the irony of that
would be totally lost on them.

I'll continue to add fibre to my menu, but for totally
different reasons to the nonsense written in this paper.

Cheers, Alan, T2, Australia.
--
d&e, metformin 1500mg, ezetrol 10mg
Everything in Moderation - Except Laughter.
http://loraldiabetes.blogspot.com
http://www.flickr.com/photos/alan_s/
http://loraltravel.blogspot.com (On Indian Roads)

On Wed, 02 Jul 2008 22:32:37 -0400, Jefferson
<Jefferson@comcast.net> wrote:

>Table 2 "Adverse" Consequences of LC-HP Diets -
>http://content.onlinejacc.org/cgi/co...ll/43/5/725/T2

In sequence, these are the claimed Adverse Consequences.

I have added the actual references after each claim.

Form your own opinion of the false (IMO) presumptions they
have made about the macronutrient and micronutrient content
of LC-HP diets and whether those references support their
claims - or are even relevant to those claims.

Incidentally, one of the two diets they mention is the Eades
diet. See
http://www.lowcarb.ca/atkins-diet-an...ein-power.html
for a description of that.

Effect
Mild dehydration
Cause
Water loss and ketosis
20. Yang MU, Van Itallie TB. Composition of weight lost
during short-term weight reduction. Metabolic responses of
obese subjects to starvation and low-calorie ketogenic and
nonketogenic diets. J Clin Invest. 1976;58:722–730[Medline]

Effect
Constipation
Cause
Lack of fiber

13.# Westman EC, Yancy WS, Edman JS, Tomlin KF, Perkins CE.
Effect of 6-month adherence to a very low carbohydrate diet
program. Am J Med. 2002;113:30–36[Medline]


Effect
Bad breath
Cause
Dehydration (?)
Reference: see 13 above.

Effect
Headaches
Cause
Dehydration (?)
Reference: see 13 above.

Effect
Malnutrition
Cause
Caloric deprivation
No reference given. Purely assumption.

Effect
Potential long-term health problems, such as cancer
Cause
Deficiency of fiber and phytochemicals

40# Slavin JL. Mechanisms for the impact of whole grain
foods on cancer risk. J Am Coll Nutr.
2000;19:300S–307S[Abstract/Free Full Text]
and
42# Heber D, Bowerman S. Applying science to changing
dietary patterns. (review)J Nutr.
2001;131(Suppl):3078S–3081S[Abstract/Free Full Text]

Effect
Osteoporosis and fractures
Cause Increased rate of bone loss
36# Sebastian A, Sellmeyer DE, Stone KL, Cummings SR.
Dietary ratio of animal to vegetable protein and rate of
bone loss and risk of fracture in postmenopausal women. Am J
Clin Nutr. 2001;74:411–412[Free Full Text]

Effect
Renal insufficiency
Cause
Reduction GFR
43# Knight EL, Stampfer MJ, Hankinson SE, Spiegelman D,
Curhan GC. The impact of protein intake on renal function
decline in women with normal renal function or mild renal
insufficiency. Ann Intern Med.
2003;138:460–467[Abstract/Free Full Text]

Cheers, Alan, T2, Australia.
--
d&e, metformin 1500mg, ezetrol 10mg
Everything in Moderation - Except Laughter.
http://loraldiabetes.blogspot.com
http://www.flickr.com/photos/alan_s/
http://loraltravel.blogspot.com (On Indian Roads)

x-no-archive: yes

Alan S wrote:

> However, as a lay reader, I think some very poor science and
> assumptions have been made in the referenced papers.
>
> I'll try to keep it brief, so this is just some quick
> comments on the first link. I'm sure a detailed analysis by
> our experts will find deeper difficulties; I'll follow with
> the second one.
>
> First, they start with a definition for the LC-HP diet that
> appears to be based on their flawed understanding of Atkins
> induction, and extend that to apply to all versions of LC-HP
> by assumption.
>
> "Usually, LC-HP diets are those that contain significant
> quantities of animal protein and relatively low amounts of
> carbohydrates, rendering them ketogenic. Individuals who
> consume such diets are in a perpetual state of ketosis,
> which leads to a disproportionate use of fat stores for
> energy." They use references 5 and 6 referring to Atkins and
> Eades. My limited knowledge of both is enough to know that
> definition is incorrect for both. Maybe Susan or another
> expert could enlighten us.

Well, it's flat out inaccurate. Folks on LC diets aren't eating high
protein, typically that doesn't change. They/we eat higher fat.

Further, ketosis isn't maintained long term, at least not to the intense
degree that one enters initially. Any time anyone burns fat, or sleeps
for hours, there's some ketosis, low carber or not.

>
> The whole paper is based on that false presumption,
> compounded by others as to calorie content at starvation
> levels. In effect, their whole concept of the LC-HP diet is
> an extreme version of LC-HP, not the form usually promoted
> by those succeeding in it's use, whether for weight loss or
> diabetes management.

And even if folks *did* eat the extreme diet, a la Atkins induction, one
would not be eating high protein, though on Eade's plan they'd increase
it if they hadn't been eating enough, according to their formula.

>
> This is relevant section on nutrition:
>
> "Poor long-term nutrition
>
> One of the main concerns regarding the uncritical use of
> LC-HP diets is the relative absence of many micronutrients
> and fiber."

HUH?????

Low carbers substitute nutrient and fiber dense low carb veggies loaded
with anti oxidants and all those colors they're always telling us to eat
for high caloric density, nutrient impoverished starches. Totally
ignorant blather.

>
> Relative absence compared to what? I regularly check my
> micronutrient and macronutrient intake using DWIDB and
> almost always exceed the RDAs for all those listed there.

It's just made up, no fact checking at all.

Susan