ArticlePDF AvailableLiterature Review

Role of PHGG as a dietary fiber: A review article

Article

Role of PHGG as a dietary fiber: A review article

Abstract

Aim: Functional and metabolic effects of dietary fiber are recognized by the scientific, clinical and nutritional experts. Dietary fiber plays a very significant role in modifying the intestinal microbiota, exerting prebiotic effects such as stimulating the growth and/or function of beneficial intestinal microorganisms. Changes in the gut microbiota composition are classically considered as one of the many factors involved in the pathogenesis of either inflammatory bowel disease or irritable bowel syndrome. The use of particular food products with a prebiotic effect has thus been tested in clinical trials with the objective to improve the clinical activity and well-being of patients with such disorders. Partially Hydrolyzed Guar Gum (PHGG) is a natural dietary fiber (Benefibra™, Novartis CH Italy): it is a white powder, water-soluble, colorless and transparent in water solution and almost tasteless. PHGG is stable and soluble at various pH levels commonly found in foods as well as resistant to heat, acid, salt, high pressure and digestive enzymes. Low viscosity of PHGG provides a distinct advantage for the use of fiber in enteral feeding products to be administered through feeding tubes. It has been studied in adults, both healthy volunteers and patients, in different disorders such as constipation, irritable bowel syndrome (IBS), enteral nutrition, small intestine bacterial overgrowth (SIBO) and, very recently, in children suffering from functional abdominal pain according to the Rome III Criteria definition for functional gastrointestinal disorders (FGIDs). This review takes stock of the situation concerning what is known to date on PHGG as dietary fiber, in order to give the health care professionals, such as gastroenterologists, dieticians and general practitioners, a complete overview on its intrinsic characteristics, preclinical and clinical evaluations, uses in different situations as supportive therapy in the management of the main intestinal functional disorders both in adults and in children. Methods: All the papers on PHGG, published from the early 1990s of the Last Century to the Year 2013, have been considered. All types of publications have been included. PubMed, Medline, Ovid were the main sources adopted for data retrieving. Results: PHGG has been studied in both animals and humans; its safety is well known and several clinical uses are well established. Concerning the modulation of metabolism in human, very little has been done to date and the studies have been focused, for the most part, on the functional diseases: PHGG has been proved to be useful in treating both IBS -C and D symptoms, not only in adults but also in children; data on constipation are relatively scarce and what can be deduced from the Literature is that the high concentration of fiber gives the PHGG the possibility of being used effectively in acceptable dosages (up to 22 g/day) even in situations such as chronic constipation. The use in clinical nutrition has revealed the flexibility of the compound which, owing to its peculiar characteristics, does not gel and remains liquid, PHGG can be used successfully in patients in enteral nutrition lowering the incidence of diarrhea. New open horizons can be glimpsed for SIBO treatment, lowering or maximizing the antibiotics use. Conclusion: Not all the fibers are the same: this is a fact. Promoting the specific knowledge of their characteristics is very important if healthcare professionals want to give their patients the best options for functional gastrointestinal disorders or nutritional needs. PHGG (Benefiber™ Novartis CH) has been proved to be safe and effective in promoting gut health.
G. QUARTARONE
Role of PHGG as a dietary ber:
a review article
Reprinted from MINERVA GASTROENTEROLOGICA E DIETOLOGICA
Vol. 59 - No. 4 - Pages 329-340 (December 2013)
EDIZIONI MINERVA MEDICA - TORINO
PROOF
MINERVA MEDICA
PROFF ID.indd 1 10/09/10 14:28
Vol. 59 - No. 4 MINERVA GASTROENTEROLOGICA E DIETOLOGICA 329
gastrointestinal disorders (FGIDs). This re-
view takes stock of the situation concerning
what is known to date on PHGG as dietary
ber, in order to give the health care pro-
fessionals, such as gastroenterologists, dieti-
cians and general practitioners, a complete
overview on its intrinsic characteristics, pre-
clinical and clinical evaluations, uses in dif-
ferent situations as supportive therapy in the
management of the main intestinal function-
al disorders both in adults and in children.
Methods. All the papers on PHGG, published
from the early 1990s of the Last Century
to the Year 2013, have been considered. All
types of publications have been included.
PubMed, Medline, Ovid were the main sourc-
es adopted for data retrieving.
Results. PHGG has been studied in both ani-
mals and humans; its safety is well known
and several clinical uses are well established.
Concerning the modulation of metabolism in
human, very little has been done to date and
the studies have been focused, for the most
part, on the functional diseases: PHGG has
been proved to be useful in treating both IBS
–C and D symptoms, not only in adults but
also in children; data on constipation are rel-
atively scarce and what can be deduced from
the Literature is that the high concentration
of ber gives the PHGG the possibility of be-
ing used effectively in acceptable dosages
(up to 22 g/day) even in situations such as
chronic constipation. The use in clinical nu-
trition has revealed the exibility of the com-
MedicalAffairsManager
andScienticServiceManager
NovartisCHItaly, Origgio, Varese, Italy
REVIEWS
MINERVA GASTROENTEROL DIETOL 2013;59:329-40
G. QUARTARONE
Role of PHGG as a dietary ber:
a review article
Aim. Functional and metabolic effects of di-
etary ber are recognized by the scientic,
clinical and nutritional experts. Dietary ber
plays a very signicant role in modifying the
intestinal microbiota, exerting prebiotic ef-
fects such as stimulating the growth and/or
function of benecial intestinal microorgan-
isms. Changes in the gut microbiota compo-
sition are classically considered as one of the
many factors involved in the pathogenesis
of either inammatory bowel disease or ir-
ritable bowel syndrome. The use of particu-
lar food products with a prebiotic effect has
thus been tested in clinical trials with the
objective to improve the clinical activity and
well-being of patients with such disorders.
Partially Hydrolyzed Guar Gum (PHGG) is a
natural dietary ber (Benebra™, Novartis
CH Italy): it is a white powder, water-soluble,
colorless and transparent in water solution
and almost tasteless. PHGG is stable and sol-
uble at various pH levels commonly found in
foods as well as resistant to heat, acid, salt,
high pressure and digestive enzymes. Low
viscosity of PHGG provides a distinct ad-
vantage for the use of ber in enteral feed-
ing products to be administered through
feeding tubes. It has been studied in adults,
both healthy volunteers and patients, in dif-
ferent disorders such as constipation, irrita-
ble bowel syndrome (IBS), enteral nutrition,
small intestine bacterial overgrowth (SIBO)
and, very recently, in children suffering from
functional abdominal pain according to the
Rome III Criteria denition for functional
Corresponding author: G. Quartarone, Medical Affairs
Manager and Scientic Service Manager, Novartis CH Italy,
1, largo Boccioni, 21040 Origgio, Varese, Italy.
E-mail: giuseppa.quartarone@novartis.com
Anno: 2013
Mese: December
Volume: 59
No: 4
Rivista: MINERVA GASTROENTEROLOGICA E DIETOLOGICA
Cod Rivista: MINERVA GASTROENTEROL DIETOL
Lavoro:
titolo breve: Role of PHGG as a dietary ber: a review article
primo autore: QUARTARONE
pagine: 329-40
PROOF
MINERVA MEDICA
PROFF ID.indd 1 10/09/10 14:28
330 MINERVA GASTROENTEROLOGICA E DIETOLOGICA December 2013
QUARTARONE ROLE OF PHGG AS A DIETARY FIBER: A REVIEW ARTICLE
pound which, owing to its peculiar character-
istics, does not gel and remains liquid, PHGG
can be used successfully in patients in en-
teral nutrition lowering the incidence of di-
arrhea. New open horizons can be glimpsed
for SIBO treatment, lowering or maximizing
the antibiotics use.
Conclusion. Not all the bers are the same:
this is a fact. Promoting the specic knowl-
edge of their characteristics is very impor-
tant if healthcare professionals want to give
their patients the best options for function-
al gastrointestinal disorders or nutritional
needs. PHGG (Beneber™ Novartis CH) has
been proved to be safe and effective in pro-
moting gut health.
Key words: Dietary ber - Prebiotics - Enteral nu-
trition - Constipation - Irritable bowel syndrome -
Gastrointestinal diseases.
Dietary ber, even if it does not signi-
cantly contributes to calories and nu-
trition, exerts functional and metabolic ef-
fects that makes it an important component
of the human diet. In addition to increase
of satiety and improvement of bowel func-
tion and disorders associated with it, such
as constipation and diverticulosis, the intro-
duction of dietary ber with food has been
linked to reducing the risk for major chron-
ic diseases, particularly colon and rectum
cancer (partly explained by the dilution of
potential carcinogens and the reduction of
their contact time with the intestinal muco-
sa), diabetes and cardiovascular disease (in
part due to a reduction in blood cholesterol
levels).1
Fiber increases stool weight and pro-
motes normal laxation. Stool weight in-
creases as ber intake increases, but the
additional ber tends, in physiological con-
dition, to normalize defecation frequency
and increase gastrointestinal transit. The
increase in stool weight is caused by the
presence of the ber, by the water that the
ber holds, and by partial fermentation
of the ber, which increases, the amount
of bacteria in stool. If the ber is rapidly
fermented in the large bowel, as are most
soluble ber sources, there is little increase
in stool weight.2
Dietary ber plays a very signicant role
in modifying the intestinal microbiota, ex-
erting prebiotic effects such as stimulating
the growth and/or function of benecial
intestinal microorganisms. Looking for a
modern denition of prebiotics the follow-
ing one explains what we have to expect
from a functional point of view: “A dietary
prebiotic is a selectively fermented ingredi-
ent that results in specic changes, in the
composition and/or activity of the gas-
trointestinal microbiota, thus conferring
benet(s) upon host health”.3 The compo-
sition of the human microbiota changes
substantially at three stages in life: from
birth to weaning; from weaning to attain-
ing a “normal” diet; during old age. The
rst bacteria to colonize the gut at birth
are facultative anaerobes; these bacteria
in turn create anaerobic conditions that
promote the growth of obligate anaerobes
(initially Bidobacterium and Bacteroides
spp.) within about 2 weeks. Fecal micro-
biota proles in healthy adults seem to
have substantial stability over time. Gut
microbes, therefore, contribute to the “en-
ergy harvest” from the diet, and this contri-
bution might be vital under conditions of
food scarcity.4 Thus the prebiotic effect is
now well-established. The more data are
accumulating, the more it will be recog-
nized that such changes in the microbiota’s
composition, especially increase in bido-
bacteria, can be regarded as a marker of
intestinal health. Changes in the gut micro-
biota composition are classically consid-
ered as one of the many factors involved
in the pathogenesis of either inammatory
bowel disease or irritable bowel syndrome.
The use of particular food products with
a prebiotic effect has thus been tested in
clinical trials with the objective to improve
the clinical activity and well-being of pa-
tients with such disorders. Promising ben-
ecial effects have been demonstrated in
some preliminary studies, including chang-
es in gut microbiota composition.5 By ref-
erence to the prebiotic concept as dened
earlier, criteria for classication as a prebi-
otic are: 1) resistance to gastric acidity, hy-
drolysis by mammalian digestive enzymes
and GI absorption; 2) fermentation by in-
testinal microora; 3) selective stimulation
PROOF
MINERVA MEDICA
PROFF ID.indd 1 10/09/10 14:28
Vol. 59 - No. 4 MINERVA GASTROENTEROLOGICA E DIETOLOGICA 331
ROLE OF PHGG AS A DIETARY FIBER: A REVIEW ARTICLE QUARTARONE
vitro) and humans, clinical review articles,
RCTs.
Information sources
PubMed, Medline, Ovid were the main
sources adopted for data retrieving.
Search
The search was performed using key
words such as dietary ber, intestinal micro-
biota, PHGG, IBS, SIBO, constipation.
Study selection
No particular selection of the studies on
PHGG has been undertaken for drawing up
this review.
Synthesis of results
Concerning dietary ber, the rst ob-
servation from a clinical standpoint is the
very wide range of products, exhibiting
similar characteristics, probably leading to
the same effects but surely chemically and
physically different.
So the rst step is to ensure a compre-
hensive knowledge on that specic dietary
ber for better understanding its interac-
tions with the intestinal environment.
PHGG: PHysical, cHemical and functional
cHaracteristics
PHGG is a polysaccharide obtained by
a controlled enzymatic hydrolysis start-
ing from guar gum (GG) seeds: this kind
of hydrolysis mimics a sort of predigestion
that normally happens for GG in the gut.
The difference between the parent mole-
cule and PHGG is rst of all the molecular
weight that for PHGG is around 20.000 Da
(gel ltration HPLC method) and for GG is
approximately 200.000 Da (Figure 1).8
Another very important difference is the
viscosity: GG is highly viscous and conse-
quently, added to water, forms a gel;9 on
the contrary PHGG does not gel and re-
mains liquid.
of the growth and/or activity(ies) of one or
a limited number of intestinal bacteria ben-
ecially associated with health and well-
being.6
Partially hydrolyzed guar gum (PHGG)
is a natural dietary ber (Benebra™, No-
vartis CH Italy): it is a white powder, water-
soluble, colorless and transparent in water
solution and almost tasteless. PHGG is sta-
ble and soluble at various pH levels com-
monly found in foods as well as resistant to
heat, acid, salt, high pressure and digestive
enzymes.7 Low viscosity of PHGG provides
a distinct advantage for the use of ber in
enteral feeding products to be administered
through feeding tubes. It has been studied
in adults, both healthy volunteers and pa-
tients, in different disorders such as con-
stipation, irritable bowel syndrome (IBS),
enteral nutrition, small intestine bacterial
overgowth (SIBO) and, very recently, in
children suffering from functional abdomi-
nal pain according to the Rome III Criteria
denition for functional gastrointestinal dis-
orders (FGIDs).
This review takes stock of the situa-
tion concerning what is known to date on
PHGG as dietary ber, in order to give the
health care professionals, such as gastro-
enterologists, dieticians and general prac-
titioners, a complete overview on its intrin-
sic characteristics, preclinical and clinical
evaluations, uses in different situations as
supportive therapy in the management of
the main intestinal functional disordersboth
in adults and in children. Basic knowledge
on PHGG could be of some interest as well
as useful in order to make the appropriate
choice in the respective clinical settings.
Materials and methods
Eligibility criteria
All the papers on PHGG, published from
the early 1990s of the last century to the
year 2013, have been considered. Different
types of publications have been included:
biochemical and biophysics tests or re-
views, trials on both animals (ex vivo, in
PROOF
MINERVA MEDICA
PROFF ID.indd 1 10/09/10 14:28
332 MINERVA GASTROENTEROLOGICA E DIETOLOGICA December 2013
QUARTARONE ROLE OF PHGG AS A DIETARY FIBER: A REVIEW ARTICLE
Yoshikawa et al.16 demonstrated that
chronic treatment with PHGG attenuates
dextran sulfate sodium (DSS)-induced co-
lonic injury and inammation in mice, an
animal model for studying inammatory
bowel diseases such as Crohn’s disease
(CD) and ulcerative colitis (UC).
In this study, intestinal injury was as-
sessed by a variety of methods including
Disease Activity Index (DAI), (determined
by scoring changes in weight, occult blood
positivity and gross bleeding, and stool
consistency), length of the colon and histol-
ogy. By each assessment, PHGG treatment
signicantly inhibited colonic injury.
In addition, the authors showed that
mieloperossidase activity, thiobarbituric
Acid-reactive substances (as an index of li-
pid peroxidation) and expression of TNF-α
gene were enhanced in DSS-induced in-
testinal inammation, and these increases
were reversed by PHGG treatment. Inhi-
bition of TNF-α by PHGG-supplemented
diet was accompanied by signicant sup-
pression of intestinal inammation in vivo.
These data suggest that oral administration
of PHGG may be an additional therapeutic
strategy for inammatory bowel diseases.
Very similar data were obtained from Gulay
in a rat model of pouchitis.
Takahashi et al.18 studied how PHGG can
lower glucose absorption in rat, given an
explanation on the possible mode of ac-
tion of PHGG in reducing increases in post-
prandial blood glucose levels in both ani-
mals, such as rats and mice, and humans
such as healthy volunteers 19, 20 and patients
PHGG is a white powder, water-soluble,
colorless and transparent in water solution
and almost tasteless: it is stable and solu-
ble at various pH levels commonly found
in foods as well as resistant to heat, acid,
salt, high pressure and digestive enzymes.
Physical and chemical structure of bers is
an important characteristic in determining
fermentability.10-12
In vitro fermentation of PHGG shows an
active production of shorty chain fatty acids
(SCFAs) with a very important peak of them
between 8 and 12 hours. Molar ratio at 24
hours was respectively 50 for acetate, 42 for
propionate and 8 for butyrate.13
Furthermore in two clinical trials, the rst
one in constipated women and the second
one in healthy volunteers an increase of fe-
cal Lactobacilli and Bidobacteria spp af-
ter the administration of PHGG has been
shown, conrming the prebiotic effect of
this ber.14, 15 In the healthy volunteers trial,
the conditions, after two weeks of PHGG
intake, were described and interestingly it
has been noted that together with the in-
crease of Bidobacterium and Lactobacillus
spp there was a decrease of Clostridium spp,
Enterobacteriaceae and Streptococcaceae.
The fecal pH and fecal bacterialmetabo-
lites such as β-glucuronidase activity, putre-
factive products, and ammonia content were
signicantly decreased by PHGG intake.
animal models
In animal models PHGG has been tested
with very interesting results.
Figure 1.—Chemical structure of partially hydrolyzed guar gum (PHGG). The chemical structure of PHGG: mannose:
galactose=2:1.
PROOF
MINERVA MEDICA
PROFF ID.indd 1 10/09/10 14:28
Vol. 59 - No. 4 MINERVA GASTROENTEROLOGICA E DIETOLOGICA 333
ROLE OF PHGG AS A DIETARY FIBER: A REVIEW ARTICLE QUARTARONE
20 g of PHGG (N.=15 TEN+35 SEN). The
study showed the decrease of diarrhea in
both TEN and SEN when supplemented
with PHGG: so regardless of the way of
administration, the PHGG supplementa-
tion plays a signicant role in modulating
colonocytes absorption of sodium and wa-
ter due to an increase of shorty chain fatty
acid production, and increasing cholecysto-
kinin (CCK), PHGG decreases the colonic
transit time leading to a reduction of di-
arrhea in patients at increasing risk for de-
veloping diarrhea.
Another perspective, randomized, dou-
ble-blind study 27 in patients with severe
sepsis and septic shock demonstrated the
reduction of incidence of diarrhea: enteral
feeding had been provided through a na-
sogastric tube for a minimum of 6 days and
patients were randomly assigned to receive
either an enteral formula supplemented
with 22 g of PHGG per liter or an isocaloric
isonitrogenous control feed without bers.
Fiber treatment was well-tolerated and did
not affect glucose control.
PHGG has been studied in non-enteral
feeding diarrhea too: in children with wa-
tery, persistent diarrhea, PHGG, when add-
ed to comminuted chicken diet, enhances
recovery of little patients. An experience
in neonates and babies aged from 4 to 18
months,29 suffering from acute diarrhea,
showed that added tostandard WHO oral
rehydration solution (ORS),30 PHGG sub-
stantially reduces the duration of diarrhea
and modestly reduced stool output. In
adults with cholera diarrhea the results
were encouraging too, even if it is quite dif-
cult to assess the optimal dose of PHGG
in this kind of patients.
To estimate the suppressive effect of
PHGG on transitory diarrhea induced by in-
gestion of a sufcient amount of maltitol or
lactitol in female subjects, Oku et al.31 dem-
onstrated that PHGG (10 g) can be useful
in suppressing diarrhea caused by maltitol
in particular.
Constipation in elderly 32 who took laxa-
tives has been studied in a small trial with
PHGG: 16 patients, 12 women and 4 men,
with a mean age of 83 years (range=49 to
with non-insulin dependent diabetes.21
Takahashi group concluded that PHGG can
decrease the postprandial blood glucose by
lowering the rate of absorption from the
small intestine in the rat by reducing the
diffusion of glucose in the lumen.
Considering other effects on metabolism,
Kuo et al. shown that dietary supplementa-
tion with PHGG in hamsters fed with high-
fat diet reduced plasma cholesterol and li-
pid proles and increased antioxidant Bcl-2
and HSP-70 protein expression in the ves-
sels. Furthermore, this study demonstrated
that PHGG inhibit FeCl3 enhanced oxida-
tive stress and ICAM-1 expression and de-
lay arterial thrombus formation in hamsters
fed with high-fat diet.22
Safety is a primary concern when evalu-
ating drugs or dietary supplements. In labo-
ratory animals, a PHGG dietary content of
up to 10% showed no signs of toxicity.23 An
experts’ panel commissioned by the Life Sci-
ences Research Organization of the Federa-
tion of American Societies for Experimental
Biology concluded that daily consumption
ofup to 20 gdie of PHGG is safe.24
More recently, in 2006, an Expert Panel
concluded that PHGG is safe for its use in
enteral nutrition at a maximum of 30 g/100
kcal and in foods according to good man-
ufacturing practices (cGMP) based on its
characterization, history of consumption,
and lack of evidence suggestingtoxicity.25
clinical uses of PHGG
Diarrhea is a common issue in enteral
nutrition. In a prospective, double-blind,
randomized trial,26 100 hospitalized pa-
tients (surgical procedures: gastric/es-
ophageal resection, pancreatic resection,
hip replacement; medical illness: meta-
static malignancies, peripheral vascular
diseases,·heartfailure) were randomized
in two main groups: the rst one in total
enteral nutrition (TEN N.=30) and the sec-
ond one in standard enteral nutrition (SEN
N.=70). Every group was subdivided in
two smallergroups receiving respectively a
standard liquid diet (N.=15 TEN+35 SEN)
and the same formula supplemented with
PROOF
MINERVA MEDICA
PROFF ID.indd 1 10/09/10 14:28
334 MINERVA GASTROENTEROLOGICA E DIETOLOGICA December 2013
QUARTARONE ROLE OF PHGG AS A DIETARY FIBER: A REVIEW ARTICLE
abdominal pain in association with altered
bowel habits and no evidence of a structur-
al or easily identiable biochemical abnor-
mality that might explain these symptoms.34
Very recently Camilleri 35 pointed out the
role of genetics in the pathogenesis of IBS:
genes inuencing neural, barrier, mast cell,
or immune function are univariately associ-
ated with colonic transit in IBS, supporting
the hypothesis that local immune activation
and, possibly, altered barrier function, such
as increased permeability, and reex motor
responses may contribute to development
of IBS.
High-ber diet supplementation is com-
monly used in IBS: the aim of Parisi et
al.36 study was to compare the benets of
PHGG with the high-ber diet commonly
used in the clinical management of IBS.
Patients (N.=188) were randomly assigned
to two groups to receive ber or PHGG:
the rst group was trained to adopt a high
ber diet with 30 g per day of commer-
cially available wheat bran. Patients in the
PHGG group were given a beverage of
PHGG at 5 g per day. PHGG was adminis-
tered in 60 mL of apple-avored beverage
to be taken in the morning, shortly before
breakfast. After four weeks patients were
allowed to switch to the other treatment
group if they were not satised with the
treatment they were receiving. Almost half
of the patients in the ber group switched
to PHGG (accounting for 82.1% of the
patients who took the option to switch
group), while only 10 patients (10.9%) in
the PHGG group switched to ber (17.9%
of all those opting to change treatment).
The authors found that PHGG at 5 g per
day normalized bowel habits not only for
constipation, but in all three variants of IBS
diarrhea-predominant (IBS-D), constipa-
tion-predominant (IBS-C) and changeable
bowel habits (IBS-M) and alleviated ab-
dominal pain: PHGG was better tolerated
by patients than a high ber diet. More pa-
tients chose to switch from ber to PHGG
than vice versa during follow-up, and the
success rate was signicantly higher in the
PHGG group than in the ber group (al-
most 65% and 40%, respectively).
95 years) completed all 8 weeks of the treat-
ment with the ber; PHGG was chosen in
alternative to psyllium because psyllium is
too viscous. Baseline or laxative phase in-
formation was collected on laxative use and
bowel function before ber supplementa-
tion. Beginning at week 4 (transitionphase),
each resident’s prescribed laxative dose was
decreased by 50% and all residents began
taking PHGG (4 g dietary ber) mixed in
uid. This ber dose was increased gradu-
ally to 12 g by the end of week 4. At the
beginning of week 5, all laxatives were
discontinued and subjects remained on a
daily dose of PHGG for the next 4 weeks
(weeks 6 to 8=full-ber phase). If the 12 g
ber dose was not tolerated, the dose was
reduced to 8 g per day. Subjects who were
unable to tolerate the 8 g ber dose, or who
had their ber dose withheld for more than
3 consecutive days, were withdrawn from
the study. A signicant reduction in laxa-
tive use was noted during the ber-supple-
mented phases without a signicant change
in the number of bowel movements. The
only side effect from the ber was an in-
creased incidence of moderate atulence
from 14% at baseline to 30% during the b-
er supplemented phases; however, no one
complained or withdrew from the study be-
cause of this side effect.
The same effect 14 was observed during a
trial where PHGG (11 g bid) was studied in
15 constipated women for 3 weeks but the
atulence gradually decreased during the
second and third week of treatment. The ef-
fect of PHGG in functional constipation was
evaluated among hospitalized patients. In a
randomized, single blind, controlled trial,
64 adults were allocated to two groups: one
received daily high-ber diet (30 g) and the
other similar diet plus 10 g of PHGG, dur-
ing 15 days. The authors concluded that di-
etary ber reduced functional constipation
by 78%; PHGG did not show any additional
effect in defecation frequency, fecal consist-
ence, need of laxative drug use, although a
reduction in bowel complaints.33
Between 7% and 20% of adults experi-
ence symptoms compatible with IBS, a
disorder dened by recurring episodes of
PROOF
MINERVA MEDICA
PROFF ID.indd 1 10/09/10 14:28
Vol. 59 - No. 4 MINERVA GASTROENTEROLOGICA E DIETOLOGICA 335
ROLE OF PHGG AS A DIETARY FIBER: A REVIEW ARTICLE QUARTARONE
tom questionnaire and glucose breath test
both in basal condition and 1 month after
withdrawal of therapy. The authors showed
that the combination of PHGG and rifax-
imin was signicantly more effective than
rifaximin alone in the eradication of SIBO.
Thus, this association reached an eradica-
tion rate of 87.1%, which was signicantly
higher than that of rifaximin alone (62.1%).
Methane excretion 44 is associated with
alterations in intestinal motility, particular-
ly favoring those with constipation. Mean
methane excretion seems to be higher in
subjects suffering from functional constipa-
tion than in those with IBS-C.45
There is no specic treatment and an-
tibiotics do not have any effect on both
reduction of methane amount produced
and related symptoms. Furnari et al. evalu-
ated the effectiveness of PHGG in reducing
methane production in IBS-C: 40 methane
producer patients were enrolled and ran-
domized to receive 5 g PHGG daily for 4
weeks or alternatively to have no treatment
(controls); 50 g GBT test and Gastrointes-
tinal Symptoms Score (GSS) questionnaire
were performed at month 1 and 4. The
authors showed that PHGG effectively re-
duced methane excretion and symptoms in
these subjects (P<0.001).
PHGG has been tested in pediatric IBS
children too:46 Romano et al., in a prospec-
tive, randomized, controlled, single-blind
clinical trial, in children and adolescents
aged from 8 to 16 years, suffering from
chronic abdominal pain (CAP) and IBS,
diagnosed according to Rome III criteria,
have shown very recently that PHGG is safe
and effective in improving all the symptoms
such as constipation, diarrhea and pain.
The evaluation was carried out for 8 weeks
and an assessment was performed at week
2-4 and 8.
The total score and the three subscale
scores for constipation, diarrhea and pain
symptoms of the Birmingham score were
signicantly improved at week 4 and 8
evaluations compared to the baseline in
the PHGG group. The supplementation re-
sponse was similar both in IBS-D and IBS-C
subgroups.47-49
Parisi et al. continued their experience
with PHGG exploring gastrointestinal
symptoms by means of Gastrointestinal
Symptoms Rating Scale (GSRS), quality of
life by means of SF-36, and psychologi-
cal symptoms by means of Hospital Anxi-
ety and Depression Scale (HADS).37 They
shown that, 10 or 5 g of PHGG, per day, for
12 weeks, were effective in improving so-
matic (gastrointestinal symptoms) and psy-
chological (quality of life and psychological
distress) symptoms over the short term.
Russo et al.38 observed a difference of
response, gender linked in IBS-C patients
treated with PHGG. Thirty IBS patients, 22
females and 8 males, were recruited ac-
cording to the Rome III criteria. The study
was planned with a 2-week (run-in peri-
od) followed by a 4-week treatment with
PHGG. During both periods, patients lled
in a daily questionnaire to assess, by Visual
Analogue Scale (VAS), the presence of ab-
dominal pain/discomfort, bloating and the
sensation of incomplete evacuation (IE).
The number of evacuations per day (ED),
the daily need for laxatives/enemas and
stool consistency-form according to the
Bristol scale (BS) were also evaluated. At
the baseline and at the end of the study,
all patients also performed RX colonic tran-
sit time (CTT). The authors observed that
abdominal bloating improved in males, in
<45 year old and in those with BMI<25,
a decreased use of laxatives was seen in
females, <45 year old and with a BMI<25.
CTT decreased at the end of the study re-
gardless of the gender.
Another very interesting eld, modula-
tion of pathologic intestinal microbiota,
has been studied. Small Intestinal Bac-
terial Overgrowth, SIBO, is a condition
mainly characterized by diarrhea, bloat-
ing, atulence and abdominal pain due
to an abnormal amount of bacteria in the
small intestine.39-42 Furnari et al.43 consid-
ered 77 patients, who had been diagnosed
with SIBO after a 50 g glucose breath test
(GBT), and randomized them to receive ri-
faximin 1200 mg per day or rifaximin 1200
mg per day plus partially PHGG 5 g per
day for 10 days. Patients completed a symp-
PROOF
MINERVA MEDICA
PROFF ID.indd 1 10/09/10 14:28
336 MINERVA GASTROENTEROLOGICA E DIETOLOGICA December 2013
QUARTARONE ROLE OF PHGG AS A DIETARY FIBER: A REVIEW ARTICLE
table i.—PHGG studies in humans.
Reference Trial Population Design and treatment Primary end-point
J Nutr Sci 1994;40:251-9.14 Inuence of partially hydrolyzed
guar gum on constipation in
women
Women with
constipation Perspective, open
label. PHGG 5.5 g/die Efcacy in constipation
JPEN J Parenter Enteral Nutr
1994;18:486-90.26
Reduction in diarrhea incidence
by soluble ber in patients
receiving total or supplemental
enteral nutrition.
Patients in
enteral nutrition Perspective, double
blind, randomized,
controlled vs standard
enteral formula. PHGG
20 g/L
Efcacy in reducing
diarrhea associated
with enteral nutrition
Nutr Metab Cardiovasc Dis
1995;5:141-8.21
The effect of a liquid
supplement containing guar
gum and fructose on glucose
tolerance in non-insulin
dependent diabetic patients
NIDD Diabetic
patients, in
enteral nutrition
Perspective, open
label. PHGG 20 g/L Efcacy in lowering
glucose absorption
J Am Diet Assoc
1998;98:912-4.32
Effect of supplements of
partially hydrolyzed guar
gum on the occurrence of
constipation and use of laxative
agents
Elderly with
chronic
constipation
Dual-center
perspective. PHGG 4
g/day
Efcacy as a reduction
of laxatives usage
J Pediatr Gastroenterol Nutr
2000;31:503-7.29
Partially hydrolyzed guar gum–
supplemented oral rehydration
Solution in the Treatment of
Acute Diarrhea in Children
Acute diarrhea
in children Double-blind,
randomized, controlled
vs WHO ORS. PHGG
20 g/L
Efcacy in reducing
diarrhea
Br J Nutr 2001;86.47 The prebiotic effects of biscuits
containing partially hydrolyzed
guar gum and fructo-
oligosaccharides – a human
volunteer study
Healthy
volunteers Open label, single
blind. PHGG 3.4 g/die Prebioticeffectof PHGG
Clin Nutr 2001;20:301-5.27 Soluble ber reduces the
incidence of diarrhea in septic
patients receiving total enteral
nutrition: a prospective,
double-blind, randomized, and
controlled trial
Patients with
sepsis Perspective, double
blind, randomized,
controlled vsisocaloric,
isonitrogenous enteral
diet
Efcacy in reducing
diarrhea associated to
enteral formula
Dig Dis Sci 2002;47:1697-
704.36
High-ber diet supplementation
in patients with irritable
bowel syndrome (IBS) a
multicenter, randomized, open
trial comparison between
wheat bran diet and partially
hydrolyzed guar gum (PHGG)
Patients with IBS Multicenter,
randomized, open
label, controlled vs.
bran. PHGG 5 g/die
Efcacy in controlling
IBS symptoms
Nutrition 2003;19:549-52.2Partially hydrolyzed guar gum:
clinical nutrition uses Patients in
enteral nutrition Review article Efcacy, tolerability and
safety
Biosci Biotechnol Biochem
2004;68:1135-8.48
Suppressive effects of dietary
ber in yogurt in postprandial
serum lipid levels in healthy
adult male volunteers
Healthy subjects Randomized, single
blind, placebo
controlled, within
subject cross-over.
PHGG 6 g/die
Efcacy in lowering
lipid absorption
Dig Dis Sci 2005;50:
1107-12.37
treatment effects of partially
hydrolyzed guar gum on
symptoms and quality of
life of patients with irritable
bowel syndrome. a multicenter
randomized open trial
IBS sufferers Multicenter open label,
randomized. PHGG 5
and 10 g/day
Efcacy in IBS-C, D and
M. Other assessments:
QoL and Hospital
Anxiety Depression
Scale
Arch Dis Child 2005;90:
195-9.28
Partially hydrolyzed guar gum
supplemented comminuted
chicken diet in persistent
diarrhea: a randomized
controlled trial
Children
suffering from
persistent
diarrhea
Open, randomized,
controlled vs standard
diet. PHGG 20 g/L (?)
Efcacy in reducing
diarrhea
Nutrition 2006;22:334-42.49 Role of partially hydrolyzed
guar gum in the treatment of
irritable bowel syndrome
IBS Review article on
PHGG in IBS Efcacy, tolerability and
safety
Eur J Clin Nutr
2007;61:1086-93.31
Suppressive effect of partially
hydrolyzed guar gum on
transitory diarrhea induced by
ingestion of maltitol and lactitol
in healthy humans
Healthy subjects Perspective, open
label. PHGG 5 or 10
g/die
Suppression of diarrhea
induced by lactitol and
maltitol ingestion
PROOF
MINERVA MEDICA
PROFF ID.indd 1 10/09/10 14:28
Vol. 59 - No. 4 MINERVA GASTROENTEROLOGICA E DIETOLOGICA 337
ROLE OF PHGG AS A DIETARY FIBER: A REVIEW ARTICLE QUARTARONE
ing to its peculiar characteristics, does not
gel and remains liquid, PHGG can be used
successfully in patients in enteral nutrition
lowering the incidence of diarrhea.
New open horizons can be glimpsed for
SIBO treatment, lowering or optimizing the
antibiotics use.
Limitations of the study
Despite regard to chronic disorders such
as IBS the results are very encouraging, no
long term studies have been carried out and
this could be very useful for studying toler-
ability and compliance.
There are very few studies on constipa-
tion outside the range of constipation in
IBS.
Conclusions
Not all the bers are the same: this is
a fact. Promoting the specic knowledge
of their characteristics is very important if
Discussion
Summary of evidence
PHGG is a very well-known compound:
it has been studied in both animals and hu-
mans as summarized in Table I.
Its safety is established and some clinical
uses are, in many ways, still at an explora-
tory stage. Concerning the modulation of
metbolism in human, very little has been
done to date and the studies have been ori-
ented, for the most part, on the functional
diseases: PHGG has been proved to be ef-
fective in treating both IBS-C and IBS-D
symptoms, not only in adults but also in
children; data on constipation are relative-
ly scarce, what can be deduced from the
Literature is that the high concentration of
ber (galactomannans) gives the PHGG the
possibility of being used effectively in ac-
ceptable dosages (up to 22 g/die) even in
situations such as chronic constipation.
The use in clinical nutrition has revealed
the exibility of the compound which, ow-
table i.—PHGG studies in humans.
Reference Trial Population Design and treatment Primary end-point
Digestion 2008;78:24-9.30 Efcacy of partially hydrolyzed
guar gum-added oral
rehydration solution in the
treatment of severe cholera in
adults
Patients with
cholera Randomized, open
label, controlled vs
ORS. PHGG 25 or 50 g
Efcacy in reducing
diarrhea
Arq Gastroenterol
2008;45:93-6.33
EfeitoTerapeutico da Fibra
Goma-Guar Parcialmente
HidrolisadanaConstipacao
Intestinal Funcional em
Pacientes Hospidalizados
Functional
constipation
in hospitalized
patients
Single blind,
randomized, controlled
vs high ber diet.
PHGG 10g/die
Efcacy in treatment of
functional constipation
Aliment Pharmacol Ther
2010;32:1000-6.43
Clinical trial: the combination
of rifaximin with partially
hydrolyzed guar gum is more
effective than rifaximin alone
in eradicating small intestinal
bacterial overgrowth
Patients with
SIBO Perspective,
randomized, open
label. PHGG 5 g/die
plus rifaximin 1200
mg/die or rifaximin
1200 mg/die
Efcacy in SIBO
Dig Liver Dis
2011;43S:S115-S264.38
Partially hydrolyzed guar gum
(PHGG) in the treatment of
irritable bowel syndrome (IBS)
with constipation: effects of
gender, age and Body Mass
Index (BMI)
C-IBS patients Perspective, open
label. PHGG 5 g/die Difference of response
gender linked
Gastroenterology
2012;142:S-391.45
Efcacy of partially hydrolyzed
guar gum in reducing
methane excretion and clinical
manifestation of subjects
suffering from irritable bowel
syndrome
Patients
suffering
from IBS and
methane-
producers
Perspective, open label
vs control. PHGG 5
g/die
Efcacy in lowering
methane production,
attenuating IBS
symptoms
World J Gastroenterol
2013;19:235-40.46
Partially hydrolyzed guar
gum in pediatric functional
abdominal pain
Children with
CAP and IBS Double-blind,
randomized vs
placebo, pilot study
Efcacy in CAP and IBS
table i.—Continues from previous page.
PROOF
MINERVA MEDICA
PROFF ID.indd 1 10/09/10 14:28
338 MINERVA GASTROENTEROLOGICA E DIETOLOGICA December 2013
QUARTARONE ROLE OF PHGG AS A DIETARY FIBER: A REVIEW ARTICLE
PubMed, Medline, Ovid sono state le principali fonti
adottate per la ricerca dei dati.
Risultati. Il PHGG è stato studiato negli animali
e nell’uomo, è sicuro e diversi usi clinici sono ben
consolidati. Per quanto riguarda la modulazione del
metabolismo in umano, molto poco è stato fatto
no ad oggi e gli studi si sono concentrati, per la
maggior parte, sui disturbi funzionali: PHGG si è
dimostrato utile nel trattamento sintomatico di en-
trambe le forme di sindrome dell’intestino irritabile
C e D, non solo negli adulti ma anche nei bambini;
dati sulla stipsi sono molto scarsi dalla Letteratura si
deduce che l’alta concentrazione di bra permette
di usare il PHGG efcacemente a dosi accettabili
(no a 22 g/die) in situazioni quali la stipsi cro-
nica. L’impiego del PHGG in nutrizione clinica ha
dimostrato la essibilità del composto che, grazie
alle sue peculiari caratteristiche, non gelica e ri-
mane liquido, pertanto il PHGG può essere usato
con successo in pazienti in nutrizione enterale ri-
ducendo l’incidenza della diarrea. Nuovi orizzonti
si intravedono per il trattamento della SIBO, che
permetterebbero di ridurre o minimizzare l’uso di
antibiotici.
Conclusioni. Non tutte le bre sono uguali: que-
sto è un dato di fatto. Promuovere la specica cono-
scenza delle loro caratteristiche è molto importante
se gli operatori sanitari vogliono dare ai loro pa-
zienti le migliori opzioni per disturbi gastrointesti-
nali funzionali o per esigenze nutrizionali. PHGG
(Benebra™) si è dimostrato sicuro ed efcace nel
promuovere la salute intestinale.
Parole cHiave: Dieta, bre - Prebiotici - Nutrizione
enterale - Costipazione - Sindrome del colon irrita-
bile - Disturbi gastrointestinali.
References
1. SINU (Italian Nutrition Society) 2013 [Homepage] [In-
ternet]. Available at www.sinu.it [cited 2013, Sep 27].
2. Slavin JL, Greenberg NA. Partially hydrolyzed guar
gum: clinical nutrition uses. Nutrition 2003;19:549-52.
3. Proceedings from the ISAPP (2008) 6th Meeting of the
International Scientic Association of Probiotics and
Prebiotics, London, Ontario.
4. Flint HJ, Scott KP, Louis P, Duncan SH. The role of
the gut microbiota in nutrition and health. Nat Rev
Gastroenterol Hepatol 2012;9:577-89.
5. Roberfroid M, Gibson GR, Hoyles L, McCartney AL,
Rastall R, Rowland I et al. Prebiotic concept and
health. Br J Nutr 2010;104(Suppl 2):S1-63.
6. Gibson GR, Probert HM, Loo JV, Rastall RA, Rober-
froid MB. Dietary modulation of the human colonic
microbiota: updating the concept of prebiotics. Nutr
Res Rev 2004;17:259-75.
7. Yoon SJ, Chu DC, Raj Juneja L. Chemical and physical
properties, safety and application of partially hydro-
lyzed guar gum as dietary ber. J Clin Biochem Nutr
2008;42:1-7.
8. Akiyama T, Sekiguchi W, Yamazaki T, Akiyama H.
[Assessment of three methods for the identication of
enzymatically hydrolyzed guar gum]. [Article in Japa-
nese] Shokuhin Eiseigaku Zasshi 2013;54:71-4.
healthcare professionals want to give their
Patients the best options for functional gas-
tro-intestinal disorders or nutritional needs.
PHGG (Beneber™) has been proved
to be safe and effective in promoting gut
health.
Riassunto
Ruolo del PHGG come bra alimentare: una review.
Obiettivo. I beneci per la salute delle bre ali-
mentari sono riconosciuti da esperti a livello scien-
tico, clinico e nutrizionale. La bra alimentare
svolge un ruolo altamente signicativo nell’equi-
librio del microbiota intestinale, esercitando effetti
prebiotici, come stimolare la crescita e/o la fun-
zione di microorganismi beneci a livello intesti-
nale. Variazioni nella composizione del microbiota
intestinale sono considerate classicamente come
uno dei molti fattori coinvolti nella patogene-
si della malattia inammatoria intestinale o della
sindrome del colon irritabile. L’uso di particolari
prodotti alimentari con effetto prebiotico è stato
pertanto testato attraverso studi clinici con l’obiet-
tivo di migliorare la risposta clinica e il benesse-
re dei pazienti affetti da tali patologie. La Gomma
Guar Parzialmente Idrolizzata (PHGG) è una bra
naturale (Benebra™, Novartis CH Italia): si tratta
di una polvere bianca, solubile in acqua, incolore
e trasparente in soluzione acquosa e quasi insapo-
re. PHGG è stabile e solubile a vari livelli di pH,
normalmente presente negli alimenti e resistente
a calore, acido, sale, ad alta pressione ed enzimi
digestivi. La bassa viscosità di PHGG è vantaggio-
sa con nei prodotti per l’alimentazione enterale da
somministrare attraverso sonde. È stata studiata ne-
gli adulti, sia nei volontari sani sia in pazienti con
disturbi diversi come la stipsi, la sindrome dell’in-
testino irritabile (SII), la nutrizione enterale, la so-
vracrescita batterica nel piccolo intestino (SIBO) e,
molto recentemente, in bambini affetti da dolore
addominale funzionale, secondo la denizione di
Roma III per i disturbi gastrointestinali funzionali
(FGIDs). Questa review fa il punto sulla situazione
relativa a ciò che è noto ad oggi sul PHGG come
bra alimentare, al ne di dare ai professionisti sa-
nitari, come gastroenterologi, dietologi e medici di
medicina generale, una panoramica completa del-
le sue caratteristiche intrinseche, sulle valutazioni
precliniche e cliniche, sugli usi in differenti situa-
zioni come terapia di supporto nel trattamento dei
principali disturbi funzionali intestinali, sia negli
adulti sia nei bambini.
Metodi. Sono stati presi in considerazione studi
sugli animali ed in umano con PHGG, pubblicati
a partire dai primi anni Novanta no al 2013. Sono
state incluse diverse tipologie di pubblicazione.
PROOF
MINERVA MEDICA
PROFF ID.indd 1 10/09/10 14:28
Vol. 59 - No. 4 MINERVA GASTROENTEROLOGICA E DIETOLOGICA 339
ROLE OF PHGG AS A DIETARY FIBER: A REVIEW ARTICLE QUARTARONE
26. Homann H-H, Kemen M, Fuessenich C, Senkal M,
Zumtobel V. Reduction in diarrhea incidence by sol-Reduction in diarrhea incidence by sol-
uble ber in patientsreceiving total or supplemen-
tal enteral nutrition. JPEN J Parenter Enteral Nutr
1994;18:486-90.
27. Spapen H, Diltoer M, Vanmalderen C, Opdenacker
G, Suys E, Huyghens L. Soluble ber reduces the in-
cidence of diarrhea in septic patients receiving total
enteral nutrition: a prospective, double-blind, rand-
omized, and controlled trial. Clin Nutr 2001;20:301-
5.
28. Alam NH, Meier R, Sarker SA, Bardhan PK, Schnei-
der H, Gyr N. Partially hydrolysed guar gum supple-
mented comminuted chicken diet in persistent diar-
rhoea: a randomized controlled trial. Arch Dis Child
2005;90:195-9.
29. Alam NH, Meier R, Schneider H, Sarker SA, Bardhan
PK, Mahalanabis D et al. Partially hydrolyzed guar
gum-supplemented oral rehydration solution in the
treatment of acute diarrhea in children. J Pediatr Gas-
troenterol Nutr 2000;31:503-7.
30. Alam NH, Ashraf H, Sarker SA, Olesen M, Troup J,
Salam MA, Gyr N, Meier R. Efcacy of partially hy-
drolyzed guar gum-added oral rehydration solution
in the treatment of severe cholera in adults. Digestion
2008;78:24-9.
31. Nakamura S, Hongo R, Moji K, Oku T. Suppressive
effect of partially hydrolyzed guar gum on transitory
diarrhea induced by ingestion of maltitol and lactitol
in healthy humans. Eur J Clin Nutr 2007;61:1086-93.
32. Patrick PG, Gohman SM, Marx SC, DeLegge MH,
Greenberg NA. Effect of supplements of partially
hydrolyzed guar gum on the occurrence of consti-
pation and use of laxative agents. J Am Diet Assoc
1998;98:912-4.
33. Belo GMS, Diniz AS, Pereira APC. Effect of partially
hidrolized guar-gum in the treatment of functional
constipation among hospitalized patients. Arq Gas-
troenterol 2008;45:93-6.
34. Shanti E, Tack J, Chey W D. Food: the forgotten factor
in the irritable bowel syndrome. Gastroenterol Clin N
Am 2011;40:141-62.
35. Camilleri M, Katzka DA. irritable bowel syndrome:
methods, mechanisms, and pathophysiology. genet-
ic epidemiology and pharmacogenetics in irritable
bowel syndrome. clinical enteric neuroscience trans-
lational and epidemiological. Am J Physiol Gastroin-
test Liver Physiol 2012;302:G1075-G1084.
36. Parisi GC, Zilli M, Miani MP, Carrara M, Bottona E,
Verdianelli G et al. High-ber diet supplementation in
patients with irritable bowel syndrome (IBS). A mul-
ticenter, randomized, open trial comparison between
wheat bran diet and partially hydrolyzed guar gum
(PHGG). Dig Dis Sci 2002;47:1697-704.
37. Parisi G, Bottona E, Carrara M, Cardin F, Faedo A,
Goldin D, Marino M, Pantalena M, Tafner G, Verdi-
anelli G, Zilli M, Leandro G. Treatment effects of par-
tially hydrolyzed guar gum on symptoms and qual-
ity of life of patients with irritable bowel syndrome.
A multicenter randomized open trial. Dig Dis Sci
2005;50:1107-12.
38. Russo L, Vozzella L, SavinoI G, Di Palma S, Sarnelli G,
Cuomo R. Partially hydrolyzed guar gum (PHGG) in
the treatmentof irritable bowel syndrome (IBS) with
constipation: effects of gender, age and Body Mass
Index (BMI). Dig Liver Dis 2011;43S:S115-S264.
39. Husebye E. The pathogenesis of gastrointestinal bac-
terial overgrowth. Chemotherapy 2005;51:1-22.
40. Gegg CR. Enteric bacterial ora and bacterial
overgrowth syndrome. Semin Gastrointest Dis
2002;13:200-9.
9. Sadiq Butt M, Shahzadi N, Kamran Sharif M, Nasir
M. Guar gum: a miracle therapy for hypercholeste-
rolemia, hyperglycemia and obesity. Crit Rev Food
Science Nutr 2007;47:389-96.
10. Rycroft CE, Jones MR, Gibson GR, Rastall RA. A com-
parative in vitro evaluation of the fermentation prop-
erties of prebiotic oligosaccharides. J Appl Microbiol
2001;91:878-87.
11. Velazquez M, Davies C, Marett R, Slavin JL, Feirtag
JM. Effect of oligosaccharides and ber substitutes on
shortchain fatty acid production by human faecalmi-
croora. Anaerobe 2000;6:87-92.
12. Pylkas AM, Juneja LR, Slavin JL. Comparison of dif-
ferent bers for in vitro production of short-chain
fatty acids by intestinal microora. J Med Foods
2005;8:113-6.
13. Stewart ML, Slavin JL. Molecular weight of guar gum
affects short-chain fatty acid prole in model intesti-
nal fermentation. Mol Nutr Food Res 2006;50:971-6.
14. Takahashi H, Wako N, Okubo T, Ishihara N, Ya-
manaka J, Yamamoto T. Inuence of partially hydro-
lyzed guar gum on constipation in women. J Nutr Sci
1994;40:251-9.
15. Okubo T, Ishihara N, Takahashi H, Fujisawa T, Kim
M, Yamamoto T et al. Effects of partially hydro-
lyzed guar gum intake on human intestinal micro-
ora and its metabolism. Biosci Biotechnol Biochem
1994;58:1364-9.
16. Naito Y, Takagi T, Katada K, Uchiyama K, Kuroda M,
Kokura S et al. Partially hydrolyzed guar gum down-
regulates colonic inammatory response in dextran
sulfate sodium-induced colitis in mice. J Nutr Bio-
chem 2006;17:402-9.
17. Atila K, Terzi C, Canda AE, Akhisaroglu ST, Avci HS,
Sarioglu S et al. Partially hydrolyzed guar gum attenu-
ates the severity of pouchitis in a rat model of ileal j
pouch-anal anastomosis. Dig Dis Sci 2009;54:522-9.
18. Takahashi T, Yokawa T, Ishihara N, Okubo T, Chu
DC, Nishigaki E et al. Hydrolyzed guar gum decreas-
es postprandial blood glucose and glucose absorp-
tion in the rat small intestine. Nutr Res 2009;29:419-
25.
19. Maenaka T. Effects of partially hydrolyzed guar gum
on postprandial blood glucose level and disacchari-
dase. J Jpn Soc Med Use Func Foods 2007;4:195-201.
20. Gu Y, Yamashita T, Suzuki I, Juneja LR, Yokawa T.
Effect of enzyme hydrolyzed guar gum on the el-
evation of blood glucose levels after meal. Med Biol
2003;142:19-24.
21. Golay A. The effect of a liquid supplement contain-
ing guar gum and fructose on glucose tolerance in
non-insulin-dependent diabetic patients. Nutr Metab
Cardiovasc Dis 1995;5:141-8.
22. Dar-Chih K, Shih-Ping H and Chiang-Ting C. Partially
hydrolyzed guar gum supplement reduces high-fat
diet increased blood lipids and oxidative stress and
ameliorates FeCl3-induced acute arterial injury in
hamsters. J Biomed Sci 2009;16:15.
23. Lina B. Sub-chronic (13 week) oral toxicity study
with Sunber and Sunber ST in rats. TNO report
V97.080. Amsterdam: TNO Nutrition and Food Re-
search Institute; 1997.
24. Anderson SA, Fischer KD, Talbot JM. Evaluation of
the health aspects of using partially hydrolyzed guar
gum as a food ingredient. Bethesda, MD: Life Scienc-
es Research Ofce, Federation of American Societies
for Experimental Biology; 1993
25. Finley JW, Soto-Vaca A, Heimbach J, Rao TP, Juneja
LR, Slavin J et al. Safety assessment and caloric value
of partially hydrolyzed guar gum. J Agric Food Chem
2013;61:1756-71.
PROOF
MINERVA MEDICA
PROFF ID.indd 1 10/09/10 14:28
340 MINERVA GASTROENTEROLOGICA E DIETOLOGICA December 2013
QUARTARONE ROLE OF PHGG AS A DIETARY FIBER: A REVIEW ARTICLE
46. Romano C, Comito D, FamianiA, CalamaràS, Loddo I.
Partially hydrolyzed guar gum in pediatric functional
abdominal pain. World J Gastroenterol 2013;19:235-
40.
47. Tuohy KM, Kolida S, Lustenberger AM, Gibson GR.
The prebiotic effects of biscuits containing partially
hydrolysed guar gum and fructo-oligosaccharides - a
human volunteer study. Br J Nutr 2001;86.
48. Kondo S, Xiao JZ, Takahashi N, Miyaji K, Iwatsuki
K, Kokubo S. Suppressive effects of dietary bers in
yogurt in postprandial serum lipid levels in healthy
adult male volunteers. Biosci Biotechnol Biochem
2004;68:1135-8.
49. Giannini EG, Mansi C, Dulbecco P, Savarino V. Role
of partially hydrolyzed guar gum in the treatment
of irritable bowel syndrome. Nutrition 2006;22:334-
42.
Conicts of interest.—The authors certify that there is no
conict of interest with any nancial organization regarding
the material discussed in the manuscript.
Received on September 23, 2013.
Accepted for publication on September 27, 2013.
41. Sherman P, Lichtman S. Small bowel bacterial over-
growth syndrome. Dig Dis 1987;5:157-71.
42. Bouhnik Y, Alain S, Attar A, Flourié B, Raskine L, San-
son-Le Pors MJ et al. Bacterial populations contami-Bacterial populations contami-
nating the upper gut in patients with small intestinal
bacterial overgrowth syndrome. Am J Gastroenterol
1999;94:1327-31.
43. Furnari M, Parodi A, Gemignani L, Giannini EG,
Marenco S, Savarino E et al. Clinical trial: the com-
bination of rifaximin with partially hydrolysed guar
gum is more effective than rifaximin alone in eradi-
cating small intestinal bacterial overgrowth. Aliment
Pharmacol Ther 2010;32:1000-6.
44. Furnari M, Savarino E, Bruzzone L, Moscatelli A,
Gemignani L, Giannini EG et al. Reassessment of the
Role of Methane Production between Irritable Bowel
Syndrome and Functional Constipation. J Gastroin-
testin Liver Dis 2012;21:157-63.
45. Furnari M, Bruzzone L, Savarino E, Gemignani L,
Moscatelli A, Bodini G et al. efcacy of partially hy-
drolyzed guar gum in reducing methane excretion
and clinical manifestation of subjects suffering from
irritable bowel syndrome Sa2058. Gastroenterology
2012;142:S-391.
PROOF
MINERVA MEDICA
PROFF ID.indd 1 10/09/10 14:28
... La fibra dietética, por sus efectos funcionales y metabólicos, es un componente importante de la dieta humana (1). Teniendo en cuenta que cada tipo de fibra tiene efectos específicos a nivel metabólico y en el funcionamiento gastrointestinal, en cada patología concreta habremos de elegir la fibra óptima en función de sus propiedades químicas, físicas y fisiológicas (2). ...
... Con un peso molecular de 200.000-300.000 dalton (Da), su estructura química se basa en una larga cadena de moléculas α-D-manopiranosilo, unidas mediante enlaces glucosídicos tipo β-D- (1)(2)(3)(4). La hexosa ligada a esta cadena es la α-D-galactopiranosa y la ratio manosa: galactosa es de 2:1 (9). Esta estructura química puede degradarse a altas temperaturas. ...
Article
Full-text available
Introducción: la fibra dietética es un componente importante de la dieta humana. Cada tipo de fibra tiene efectos específicos a nivel metabólico y en el funcionamiento gastrointestinal, por lo que en cada patología concreta habremos de elegir la fibra óptima teniendo en cuenta sus propiedades químicas, físicas y fisiológicas.Objetivo: encuadrar la goma guar parcialmente hidrolizada en su lugar en el complejo marco de la fibra dietética, revisar sus propiedades físico-químicas y posibles mecanismos de acción; así como su potencial utilidad en distintas situaciones clínicas en pacientes adultos.Métodos: revisión no sistemática en Medline.Resultados:la goma guar parcialmente hidrolizada (GGPH) se obtiene a partir de una hidrólisis enzimática parcial de la goma guar mediantela enzima β-endo-mananasa. Se trata de una fibra soluble, altamente fermentable y de baja viscosidad. La fermentación de la GGPH a nivel colónico produce ácidos grasos de cadena corta, implicados en los principales mecanismos fisiopatólogicos responsables de sus efectos a nivel clínico. Su uso en la diarrea asociada a la nutrición enteral está avalada por diversos estudios y por la recomendaciones de sociedades científicas como la European Society for Clinical Nutrition and Metabolism y la American Society for Parenteral and Enteral Nutrition. Se ha estudiado la utilidad de la GGPH en otras muchas situaciones clínicas, como diabetes, hipercolesterolemia, sobrecrecimiento bacteriano, etc. con resultados prometedores. Conclusiones: la GGPH es útil en el manejo de la diarrea asociada a nutrición enteral. Respecto a otras situaciones clínicas, serían necesarios más estudios de calidad para poder hacer recomendaciones concretas.
... В период с 1990-х гг. по настоящее время проводили многочисленные, включая рандомизированные, двойные плацебоконтролируемые исследования физиологических эффектов частично гидролизованных пищевых волокон (ЧГПВ) циамопсиса, растворимого ПВ, вырабатываемого путем частичного гидролиза (на российском рынке представлен под торговым наименованием ОптиФайбер) [33,44]. Главным преимуществом данного полисахарида является химическая структура, обеспечивающая его более медленное брожение в кишечнике по сравнению с другими ПВ, благодаря чему исключаются такие побочные эффекты, как повышенное газообразование и вздутие живота. ...
Article
Antibiotic-associated gut microbiocenosis disorders develop on average in every third patient in the form of both mild disorders and severe life-threatening conditions. The negative impact of antibacterial agents on the gut microbiota causes a decrease in the number and species diversity of microorganisms that produce butyric acid. Low concentrations of butyric acid can often induce inflammatory and atrophic processes of the gut mucosa, the water-electrolyte balance regulation disorders and, as a result, the gut motility and functions disorders. Long-term gut microbiocenosis disorders themselves can cause the development of the disease and in future, they become factors of its progression, thereby launching a whole cascade of new pathological processes. The article analyzes a representative clinical data published in authoritative international magazines from 1990 to 2020, indicating the effectiveness of the dietary fiber (DF) management for the correction of gut microbiocenosis disorders caused by antibacterial drugs intake. Partially hydrolyzed guar gum, registered in our country under the trade name “OptiFiber”, due to its effects such as the gut regulation, abdominal pain reduction, flatus and bloating reduction, increase the resident gut microflora amount and its metabolic activity, helps to restore and maintain of the gut eubiosis. Conclusion. “OptiFiber” can be administered for a long-term intake in order to increase the effectiveness of antibiotic therapy for various infectious diseases, as well as for the correction and prevention of gut microbiocenosis disorders associated with antibacterial drugs intake
... Goma guar Es una fibra soluble no viscosa 37,38 . Un ensayo aleatorizado, controlado y doble ciego, realizado en 126 niños de 6 a 36 meses de edad con desnutrición severa y diarrea aguda menor a 7 días de evolución, los cuales fueron tratados con solución de rehidratación oral (SRO) suplementada con goma guar parcialmente hidrolizada. ...
Article
Full-text available
Among adults, the influence of dietary fiber on mechanical effects at the gastrointestinal level, the composition and modulation of the intestinal microbiota and function in the metabolic and nutritional activity is known. However, in children and adolescents, these effects are less known, generating interesting areas of research and development that could provide additional knowledge at the physiological and pathophysiological level. The aim of this review was to provide updated information about the different classifications of fiber, the principal digestive and metabolic functions, as well as recommendations for daily intake for pediatric populations.
... Некрахмальные полисахариды входят в состав клеточных стенок, а также слизи и камеди (клейкого сока, смолистых веществ) на поверхности и в мякоти растений. К ним относятся целлюлоза, гемицеллюлоза, пектины, β-глюканы и гидроколлоиды [9]. В кишечнике человека нет ферментов для переваривания некрахмальных полисахаридов, и основная их часть перерабатывается микрофлорой. ...
Article
Full-text available
Aim. The aim of this work was to investigate the problem of constipation associated with a deficiency in dietary fibre and to develop principles for the nutritional management of this condition. Main findings. In countries characterized by the Western-style diet, only about 10% of people consume an optimal amount of fibre daily. As a result, primary normal-transit constipation is a common problem. A special role in maintaining the function of the colon belongs to carbohydrates. Keeping a food diary helps to choose an optimal type of nutrition for a patient and reduce the likelihood of flatulence. Food fibres (oligosaccharides and polysaccharides) play an especially important role. Viscous fibres are most capable of swelling, thus exhibiting metabolic effects at the level of the small intestine. Non-viscous and insoluble fibres increase the volume of feces, stimulate peristalsis and exert a prebiotic effect. A low content of fibre in the diet is a factor provoking intestinal dysbiosis followed by a decrease in Bacteroides and Ruminococcus populations. Flavonoids also play an important role in the regulation of intestinal peristalsis and secretion. Under constipation of functional origin, the microbiota contains a significantly reduced amount of Bifidobacterium and Bacteroides. Changes in the composition of microflora correlate with psychopathological symptoms. Strains capable of exhibiting a therapeutic effect in constipation include Escherichia coli Nissle 1917, a probiotic mixture of VSL#3, Florasan-D combined bacterium, DN-173 010 Bifidobacterium lactis (B. lactis), HN019 Bifidobacterium lactis and Lactobacillus rhamnosus GG. For the prevention and management of constipation, functional food products enriched with oligo-, polysaccharides and probiotics are developed. Thus, various products of the Activia brand contain DN-173 010 Bifidobacterium lactis (ActiRegularis) at a concentration of at least 108 CFU / g. The consumption of fermented milk products with DN-173-010 Bifidobacterium lactis contributes to the elimination of subclinical discomfort in the abdomen in practically healthy people, reduces the time of colon transit and helps to normalise the frequency of defecation. Conclusion. In most cases, the first stage in managing constipation is the normalisation of the diet by means of adding dietary fibre and probiotics into the composition of functional foods or medical preparations.
Article
Objectives: To assess the effectiveness of partially hydrolyzed guar gum (PHGG) in improving constipation and reducing the use of laxatives among long term care facility (LTCF) residents. Design: A single-center, prospective, randomized, placebo-controlled, single-blinded parallel-group trial from September 2021 to November 2021. Setting: Four LTCF in Hong Kong. Participants: Fifty-two LTCF residents with chronic constipation (mean age: 83.9±7.6 years, male 38%). Intervention: 5g PHGG mixed with 200ml water per day for 4 weeks was given to intervention group participants. Control group received 200ml water for 4 weeks. Participants continued their usual as-needed laxative (lactulose, senna or dulcolax) on their own initiative. Measurements: Baseline measurements included age, gender, Charlson comorbidity index, Roackwood's Clinical Frailty Scale, body mass index and daily dietary fiber intake. Outcome measures were fecal characteristics assessed by Bristol Stool Form Scale, bowel opening frequency and laxative use frequency at baseline, first, second, third and fourth week of trial. Adverse events were measured. The study was registered on ClinicalTrial.gov; identifier: NCT05037565. Results: There was no significant difference in bowel frequency and stool characteristics between the treatment group and control group. However, there was a significantly lower frequency of lactulose, senna, and total laxative use in the treatment group compared with controls in the third and fourth week. There was no significant difference in adverse effects between the two groups. Conclusion: This study showed that daily dietary fibre supplementation by using PHGG for 4 weeks in LTCF residents results in significantly less laxative use than placebo. It may be an effective way to reduce laxative dependence among older people living in LTCFs.
Article
Alginate is a low-cost polysaccharide found abundantly in seaweeds which consists of mannuronate and guluronate, and it is considered a sustainable gum source for dietary fiber. To solve the high viscosity–related problems while retaining its physiological properties, four partially degraded alginate products (PDA1-4) with molecular weight of 1.05–0.40×10⁵ g mol⁻¹ and intrinsic viscosity of 170.9–38.9 mL g⁻¹ were enzymatically prepared and characterized. ¹H NMR analysis showed the used alginate lyase had a preference to degrade guluronate-blocks. PDA1 and PDA2 presented random coil conformation, whereas PDA3 and PDA4 displayed compact spherical-coil conformation over random coil conformation in solution. In vitro assays suggested a glucose-adsorption capacity order of PDA1<PDA2<alginate<PDA3<PDA4 and a glucose-diffusion retardation capacity order of PDA3<PDA1≤alginate<PDA2<PDA4, indicating that partially degraded alginate reinforced the hypoglycemic effect, especially mannuronate-rich PDA4. Overall, the study may have important implications for development of PDA as dietary fiber with potential hypoglycemic activity.
Article
Digestive health is an expanding area in nutrition research due to the interest in how food components such as fiber affect gastrointestinal tolerance, stool form, defecation frequency, transit time, and gut microbial composition and metabolic activity. In children, however, digestive health studies that intervene with dietary fiber are limited due to legal and ethical concerns. To better understand if fiber improves digestive health in children, a literature review was conducted to answer the following research question: What are the effect(s) of fiber-containing foods and/or supplements on digestive health outcomes in children? A search of the PubMed database identified a total of 12 studies that fit the inclusion criteria established for this review. Most of the evidence in children shows beneficial effects of partially hydrolyzed guar gum, glucomannan, and bran on digestive health outcomes; however, the existing evidence is not conclusive. Furthermore, limited data exists on the effect of whole-grain sources of dietary fiber, such as oats. Additional well-designed intervention trials are needed to determine whether outcomes of digestive health such as stool form, gastrointestinal tolerance, and stool frequency are improved by increasing the fiber content of children's diets with whole-grain sources. © The Author(s) 2017. Published by Oxford University Press on behalf of the International Life Sciences Institute.
Article
Aim: Glutamine has various beneficial functions in the gastrointestinal tract. The present study was designed to investigate the effect of two different glutamine supplements on bowel movement at the start of enteral feeding in elderly inpatients. Methods: This was a double-blind, prospective, randomized comparison study. A total of 25 patients aged >75 years recovering from a critical illness in a non-intensive care unit and scheduled for tube feeding were recruited. Of them, 22 consenting patients were randomly assigned to two groups: glutamine-fiber-oligosaccharide treatment group (n = 11) and glutamine F treatment group (n = 11). They were given glutamine three times daily at a dosage of 9 g/day. Enteral nutrition was given at the same dosage to both groups for the duration of the study. The end-points were stool frequency, Bristol Scale Form Score, bowel function index (Bristol Scale Form Score × stool frequency), the percentage of patients with stool frequency over three per day and those with a BSFS of 6 or 7 in each group. Results: There were no significant differences between the two groups in terms of patient characteristics before the study. All the end-points in the glutamine F group were significantly lower than those in the glutamine-fiber-oligosaccharide group. Conclusions: Compared with glutamine-fiber-oligosaccharide, glutamine F administration resulted in stool hardening and reduced stool frequency in elderly inpatients recovering from acute critical illness in non-intensive care units. The effects might be caused by the different additive components of glutamine supplements. Geriatr Gerontol Int 2017; ••: ••-••.
Article
Partially hydrolysed guar gum (PHGG), a soluble dietary fibre, has been shown to provide many health benefits. Previous studies had suggested that the combination of PHGG with protein provided a significant satiation effect on visual analogue scales (VAS). What was lacking was only the effect of administration of small doses of PHGG on post-meal satiation and subsequent energy intake. The objectives of the present investigations were to find the subjective perception of post-meal satiety with acute and long term administration of small amounts of PHGG alone with food, its effects on subsequent energy intake and the comparative effects among different types of soluble fibres. The following three separate studies were conducted: in study 1, healthy subjects ( n 12) consumed PHGG along with breakfast, lunch and an evening snack; in study 2, healthy subjects ( n 24) consumed 2 g of PHGG or dextrin along with yogurt as breakfast for 2 weeks; in study 3, healthy subjects ( n 6) took 6 g each of either PHGG or indigestible dextrin or inulin along with lunch. In all the studies, various satiety parameters were measured on VAS before and after consumption of PHGG. The addition of PHGG showed significant ( P < 0·05) acute (studies 1 and 3) and long-term (studies 1 and 2) satiety effects compared to the control and/or an equal amount of carbohydrate or other types of soluble fibre. Study 2 also indicated that the prolonged consumption of PHGG may significantly ( P < 0·05) reduce energy intake from whole-day snacking. PHGG could be an ideal natural soluble fibre for delivering acute and long term satiety effects for comfortable appetite control.
Article
Full-text available
Partially hydrolyzed guar gum (PHGG) relieves symptoms in constipation-predominant irritable bowel syndrome (IBS) and may have prebiotic properties. However, the correlation between the effectiveness of PHGG and patient characteristics has not been examined. We aimed to investigate the effect of PHGG in symptom relief on constipation-predominant IBS according to gender, age, and body mass index (BMI). Sixty-eight patients with IBS entered a 2-week run-in period, followed by a 4-week study period with PHGG. Patients completed a daily questionnaire to assess the presence of abdominal pain/discomfort, swelling, and the sensation of incomplete evacuation. The number of evacuations/day, the daily need for laxatives/enemas and stool consistency-form were also evaluated. All patients also underwent a colonic transit time (CTT) evaluation. PHGG administration was associated with a significant improvement in symptom scores, use of laxatives/enemas, stool form/consistency and CTT. At the end of the study period and compared with baseline, the number of evacuations improved in women, patients aged ≥ 45 years and those with BMI ≥ 25 (P < 0.05 for all comparisons); abdominal bloating improved in males (P < 0.05), patients < 45 years (P < 0.01) and those with BMI < 25 (P < 0.05). A decrease in the number of perceived incomplete evacuations/day was reported in patients with a BMI ≥ 25 (P < 0.05). Reductions in laxative/enema use were recorded in females (P < 0.05), patients < 45 years (P < 0.01), and patients with BMI < 25 (P < 0.05). Gender, age, and BMI seem to influence the effect of PHGG supplementation in constipated IBS patients. Further studies are needed to clarify the interaction of such parameters with a fiber-enriched diet.
Article
Full-text available
Avaliação do impacto da fibra goma-guar parcialmente hidrolisada na constipação intestinal funcional em pacientes hospitalizados. Ensaio clínico com 64 adultos, randomizados para duas dietas: grupo 1 dieta laxante (± 30 g de fibras) e grupo 2 mesma dieta + 10 g de fibra goma-guar parcialmente hidrolisada, durante 15 dias. A dieta laxante ou acrescida da referida fibra reduziu em 78% a constipação intestinal funcional, assim como sua adição não provocou efeito adicional na freqüência evacuatória, consistência fecal, uso de laxativos, embora tenha reduzido a sintomatologia gastrointestinal. Fibras devem ser utilizadas no tratamento da constipação intestinal funcional; entretanto, a suplementação com fibra goma-guar parcialmente hidrolisada precisa ser melhor investigada.
Article
Objective This paper provides a review of research on partially hydrolyzed guar gum that is relevant to clinical nutrition practice.
Article
Enzymatically hydrolyzed guar gum (EHGG), which is used as a thickener or a soluble dietary fiber, is produced by partial hydrolysis of the guar gum (GG) backbone using mannan endo-β-1,4-mannosidase. In this study, we compared and evaluated 3 methods to distinguish EHGG from other polysaccharides used as food additives or monosaccharides. The first method is based on cross-linking reaction of saccharide hydroxyl groups mediated by borate ions. EHGG showed gelation and was distinguished from some soluble polysaccharides, which did not form gels, and also from polysaccharides with low solubility in water. The second method is based on co-gelation with xanthan gum. It was applicable to GG, but not to EHGG. The third method is based on the alcohol precipitation of hydrophilic polymers. EHGG, some soluble polysaccharides and monosaccharides were dissolved in water at the concentration of 10%, while GG and some polysaccharides were not. The 10% solutions thus obtained were mixed with 2-propanol at the ratio of 1 : 1 (v/v). A white precipitate was formed in the EHGG solutions and the tested soluble polysaccharide solutions, while it was not produced in the monosaccharide solutions. This result demonstrated that soluble polysaccharides including EHGG can be distinguished from polysaccharides with low solubility or monosaccharides by the third method.
Article
Guar gum and partially hydrolyzed guar gum (PHGG) are food ingredients that have been available for many years. PHGG is the partially hydrolyzed product produced from guar gum obtained from the Indian cluster bean (Cyanopsis tetragonolopus). The gum (CAS RN 9000-30-0) is composed of galactomannan, a gel-forming polysaccharide with a molecular weight ranging from 200 to 300 kilodaltons (kDa). The intact and partially hydrolyzed forms have multiple food applications. The intact material can be used to control viscosity, stability and texture of foods. PHGG is highly soluble and has little physical impact on foods. Both forms are indigestible but are excellent sources of fermentable dietary fiber. The caloric value of intact guar gum is accepted as 2.0 whereas the caloric value of PHGG has not been firmly established. It is the goal of this paper to review the chemistry, the safety, the in vivo effects and the caloric value of PHGG.