Experiences with three different fiber supplements in weight reduction

Abstract

Fiber supplements added to a caloric diet have additional effects on weight reduction in overweight subjects. The aim of this study was to compare the effect of various commercial fiber supplements (glucomannan, guar gum and alginate) on weight reduction in healthy overweight subjects.
One hundred and seventy six men and women were included to receive either active fiber substance or placebo in randomized placebo-controlled studies. The fiber supplements consisted of the viscous fibers glucomannan (Chrombalance), glucomannan and guar gum (Appe-Trim) and glucomannan, guar gum and alginat (Glucosahl).
All fiber supplements plus a balanced 1200 kcal diet induced significantly weight reduction more than placebo and diet alone, during a five week observation period. However, there were no significant differences between the different fibers in their ability to induce weight reduction, which was approximately 0.8 kg/week (3.8 +/- 0.9, 4.4 +/- 2.0, 4.1 +/- 0.6 in the Chrombalance, Appe-Trim and Glucosahl group, respectively).
Glucomannan induced body weight reduction in healthy overweight subjects, whereas the addition of guar gum and alginate did not seem to cause additional loss of weight.

Full text

Experiences with three different fi ber supplements
in weight reduction
Grethe Støa Birketvedt
1,2
ABEF, Mona Shimshi
3
F, Erling Thom
4
CD, Jon Florholmen
1
F
1
Laboratory of Gastroenterology, Institute of Clinical Medicine, University of Tromsø, Tromsø, Norway
2
Department of Cardiology, Mount Sinai School of Medicine, New York, NY, U.S.A.
3
Department of Endocrinology, Mount Sinai School of Medicine, New York, NY, U.S.A.
4
Parexel, Norway
Source of support: Departmental sources.
Summary
Background:
Fiber supplements added to a caloric diet have additional effects on weight reduction in overweight
subjects. The aim of this study was to compare the effect of various commercial fi ber supplements
(glucomannan, guar gum and alginate) on weight reduction in healthy overweight subjects.
Material/Methods:
One hundred and seventy six men and women were included to receive either active fi ber sub-
stance or placebo in randomized placebo-controlled studies. The fi ber supplements consisted of
the viscous fi bers glucomannan (Chrombalance
Ò
), glucomannan and guar gum (Appe-Trim
Ò
) and
glucomannan, guar gum and alginat (Glucosahl).
Results:
All fi ber supplements plus a balanced 1200 kcal diet induced signifi cantly weight reduction more
than placebo and diet alone, during a fi ve week observation period. However, there were no sig-
nifi cant differences between the different fi bers in their ability to induce weight reduction, which
was approximately 0.8 kg/week (3.8±0.9, 4.4±2.0, 4.1±0.6 in the Chrombalance, Appe-Trim
Ò
and
Glucosahl group, respectively).
Conclusions:
Glucomannan induced body weight reduction in healthy overweight subjects, whereas the addi-
tion of guar gum and alginate did not seem to cause additional loss of weight.
key words: alginate • glucomannan • guar gum
Full-text PDF: http://www.MedSciMonit.com/pub/vol_11/no_1/4052.pdf
Word count: 1691
Tables: 5
Figures: —
References: 29
Author’s address: Dr. Grethe Støa Birketvedt, Laboratory of Gastroenterology, Institute of Clinical Medicine, University of Tromsø,
9037 Tromsø, Norway, e-mail: gsb42nor@aol.com
Authors’ Contribution:
A Study Design
B Data Collection
C Statistical Analysis
D Data Interpretation
E Manuscript Preparation
F Literature Search
G Funds Collection
Received: 2003.08.14
Accepted: 2004.02.13
Published: 2005.01.01
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BACKGROUND
Food rich in fi ber has been associated with lower risk of
cardiovascular disease and diabetes [1–7]. Most interest
has been focused on the cholesterol lowering effect of fi b-
er [2,8,9]. Fiber supplements have been shown to induce
weight loss in short term studies [10–15], whereas there are
only few long term studies with successful results [9,16]. A
combination of a low caloric diet, a fi ber supplement and
mild exercise [17] appears to constitute a promising way
for weight reduction.
The mechanisms for the weight lowering effects of fi ber are
not fully characterized. Previously these effects have been
associated with soluble fi ber and to lesser extent with insol-
uble fi ber. A report on dietary fi ber from the World Health
Organization (WHO) recommends that these terms should
be removed because these divisions are not useful analyti-
cally nor physiologically (Joint FAO) [18]. Therefore, fi b-
ers should be classifi ed according to their ability of fermen-
tation generating products that can affect metabolism and
digestive absorption [19]. Moreover, the weight reduction
effect of fi ber have also been linked to the property of vis-
cosity. The viscosity of dietary component is what is felt to
be responsible for the slow absorption of the macronutri-
ents [20] and increased satiety [21,22].
Numerous types of fi ber supplements have been introduced
during the last decade claiming special effects on weight
reduction. In some reports the water-soluble and viscous
fi ber guar gum has been shown to reduce the body weight
[10,11], whereas in a meta analysis [12] guar gum was not
found to be effective to reduce the body weight. The water-
soluble and highly viscous fi ber glucomannan has been re-
ported to reduce the body weight in some studies [14,15],
but not in other studies [23–25]. Alginate is a viscous fi ber
that reduces cholesterol secretion and has been proposed
as dietary fi ber to reduce body weight [26], but this is not
well documented [27].
So far there has been no comparative study of the effect of
the different fi ber supplements. The object of this study was
therefore to compare the effi cacy of three different viscous
fi ber supplements in various combinations, glucomannan,
guar gum and alginate, in overweight subjects in a rand-
omized double blind placebo-controlled design, without dis-
closing any signifi cant differences between the dietary fi bers
used. The intention was to distinguish one type of fi ber sup-
plement from the other with regard to weight reduction.
MATERIAL AND METHODS
Otherwise healthy overweight subjects, age 30 till 60,
(BMI>25.0 kg/m
2
and <30 kg/m
2
, mean BMI=27.7kg/m
2
)
attending a primary care practice were invited to participate
in the trial. Excluded were subjects with a history of gastroin-
testinal disease, type 1 diabetes and pregnancy. Subjects us-
ing diuretics, antacids, H
2
blockers, bulk laxatives, anorectics,
and oral contraception started within a 6 months period be-
fore commencing treatment were also excluded. All subjects
gave their informed consent. The studies were approved by
the Local Ethical Committee and conducted according to
the declaration of Helsinki and Venice. The trial was con-
ducted as a randomized, double blind, parallel-group study
of three different fi ber supplements groups and three pla-
cebo groups. The studies were planned to last for 5 weeks
each and the subjects were randomized for age, sex and
BMI in each of the three fi ber groups.
The content of the three different fi ber supplements,
Glucosahl, Chrombalance and Appe-Trim is shown in Table 1.
The diet consisted of 1200 kcal/day (5000 kJ/day) divided
into 35% fat, 15% protein and 55% carbohydrates. The ad-
herence to the treatment and the diet was evaluated each
weekly visit during the treatment period using a standardized
questionnaire. Fiber tablets or placebo tablets with identical
taste and look were given to the participants at start and at
each weekly visit. The dosage was 6 tablets taken 3 times dai-
ly with 250ml of water 15 minutes before meals and 4 tablets
taken at 3 PM. In addition, each subject received one multi-
vitamin tablet per day. For most vitamins and minerals, the
content was equal to 100% of Recommended Daily Allowance
(RDA). In order to keep the subjects motivated they were in-
formed in groups about health consequences of overweight
at each weekly visit during the treatment period. The subjects
were free to ask any questions that might occur.
All participants underwent a medical examination before
inclusion. Blood pressure in supine position after 5 minutes
of rest, as well as heart rate (bpm), body weight (kg), BMI
(body weight in kilogram divided by square of height in me-
ters) were recorded. Each study continued for 5 weeks, with
visits to the clinic scheduled at the same time each week.
Subjects were weighed weekly. Compliance with drug treat-
ment was checked by returned dose packets; 80% compli-
ance was considered acceptable.
Statistical methods
All results are given as mean ±SD. In the analyses of differ-
ences, one-tailed test was used. Differences were consid-
ered statistically signifi cant if the p-value was less than or
equal to a level of 5%. To test differences between groups,
Wilcoxon rank sum test was applied. To test differences of
paired variables within the groups, Wilcoxon signed rank
sum test or Students t-test was used, depending on wheth-
er the distribution pattern appeared to be non-paramet-
ric or parametric.
The intention to treat principle was applied. Patients who dis-
continued the trial for reasons not related to the treatment
regimen were designed as “drop-outs”, while those who dis-
continued for reasons related to the treatment, were defi ned
as “withdrawals”. For “drop-outs” the last weight before ter-
Product Fiber type Amounts/day (mg)
Glucosahl
Glucomannan
Guar
Alginat
4320 mg
900 mg
900 mg
Chrombalance
Ò
Glucomannan 1240 mg
Appe-Trim
Ò
Glucomannan
Guar
420 mg
420 mg
Table 1. Fiber supplement studies. Overview.
Product Investigation Med Sci Monit, 2005; 11(1): PI5-8
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mination was recorded, whereas the highest weight observed
during treatment was recorded for “withdrawals”.
RESULTS
Glucosahl
In the Glucosahl study 60 healthy overweight (BMI>25 kg/m
2
<30 kg/m
2
) women were included. There were 5 subjects in
the active group and 2 subjects in the placebo group that
did not fulfi ll the inclusion criteria at Day 1 as they had lost
weight since the randomized period. Therefore, 53 moder-
ately overweight women fulfi lled the inclusion criteria. All
the women followed the study according to the study pro-
tocol and were included in the analysis. The study medica-
tion was well tolerated. The active and the placebo groups
did not differ signifi cantly with regard to the background
variables as shown in Tables 2–5.
Chrombalance
In the Chrombalance study 60 healthy women with mild to
moderate overweight were intended to be included. There
were 7 subjects in the active group and 1 subject in the pla-
cebo group that did not fulfi ll the inclusion criteria at Day
1 as they had lost weight since randomizing period. All the
women followed the study according to the study protocol
and were included in the analysis. The study medication
was well tolerated. There were no differences between the
other background variables (Table 3). All subjects followed
the protocol and were included in the analysis.
Appe-Trim
In the Appe-Trim study 60 healthy overweight subjects were
included, 30 in each of the Appe-trim group and placebo
group. All the subjects followed the study according to the
study protocol and were included in the analysis. The study
medication was well tolerated. The active and the placebo
groups did not differ signifi cantly with regard to the back-
ground variables (Table 4).
Weight reduction
In table 5 the changes in the body weight during the various
fi ber supplements are shown. Compared to placebo there
were signifi cant weight losses in all the three different fi b-
er groups. However, there were no signifi cant changes be-
tween the three different fi ber supplements or between the
three different placebo groups.
DISCUSSION
The present results support previous fi ndings that fi ber sup-
plements combined with energy intake restriction have ad-
ditional effects on weight reduction. During the observa-
tion time, the weight reduction attained was approximately
3 kg per month. This is what is expected as an initial effect
of fi ber supplements in combination with a restricted ca-
loric diet of 1200 kcal. This is a consistent fi nding in other
short-term studies as well [28,29].
The main objective of the present study was to compare
the weight reducing effect of various fi ber supplements in
overweight subjects. The fi ber supplements used were glu-
comannan, guar and alginat which are commonly used in
various combinations. Glucomannan was a constituent in
all fi ber combinations. When used alone, (Chrombalance)
there was a modest, but signifi cant weight reduction com-
pared to the control group. This agrees with some previous
reports [14,15,23–25]. Moreover, our study shows that among
Placebo Glucosahl
Number of subjects 28 25
Age (mean ±SD) 38.5±5.1 37.9±4.8
Range in age 19–60 20–58
Start weight (kg)
(mean ±SD)
82.7±3.7 86.0±4.5
Table 2. Anthropometric data in Glucosahl study.
Placebo Chrombalance
Ò
Number of subjects 29 23
Age (mean ±SD) 40.1±5.6 39.7±4.0
Range in age 19–57 21–60
Start weight (kg)
(mean ±SD)
76.8±3.9 79.0±5.4
Table 3. Anthropometric data in the Chrombalance
Ò
study.
Placebo Appe-Trim
Number of subjects 30 30
Age (mean ±SD) 35.4±4.0 38.7±4.1
Range in age 19–57 21–60
Start weight (kg)
(mean ±SD)
79.4±3.6 82.7±4.9
Table 4. Anthropometric data in Appe-Trim study.
Type of fi ber
supplement
Weight
reduction (kg)
Active
Weight
reduction (kg)
Placebo
Statistical
signifi cance
Glucosahl 4.4±2.0 2.7±1.3 P<0.001
Chrombalance
Ò
3.8±0.9 2.5±0.5 P<0.01
Appe-Trim
Ò
4.1±0.6 2.1±0.5 P<0.01
Table 5. Changes in body weight during treatment with diff erent
fi ber supplements.
Med Sci Monit, 2005; 11(1): PI5-8 Støa Birketvedt G et al – Experiences with different fi bers
PI7
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three commercial products, Glucosahl, Chrombalance
Ò
and
Appe-Trim
Ò
, there were no signifi cant differences in their
ability to induce weight reduction in overweight subjects.
Another interesting observation was the comparisons of var-
ious fi ber content in Appe-Trim and Glucosahl. When in-
creasing the daily content of glucomannan from 420 mg
to 4320 mg and guar from 420 mg to 900 mg there were
no signifi cant differences in the weight reduction (2.0 kg
versus 1.7 kg). This indicates that increasing the fi ber con-
tent of glucomannan and guar gum in the supplement had
no signifi cant effects on weight reduction. Therefore, our
study indicates that using glucomannan as a single fi ber
supplement induced modest weight reduction, and com-
bined with guar and alginate it did not give additional ef-
fects on weight reduction in the short term. What the low-
est optimal dose of glucomannan would be in order to give
the most weight reducing effect, is unknown and was be-
yond the scope of this study. According to our study, the dai-
ly dose of glucomannan as a single fi ber supplement should
be at least 1240 mg. Moreover, whether there would be dif-
ferences between the effects of the three fi ber supplements
in the long term, are unknown. However, weight reduction
induced by fi ber supplements is usually strongest initially,
and attenuates throughout an observation time of approx-
imately 6 months [3]. Thus, it is unlikely that the three dif-
ferent fi ber supplements used, have signifi cantly different
quantitative weight reducing effects, even in the long term.
But this awaits further studies.
CONCLUSIONS
Fiber supplements in addition to a diet restriction elicits
additional effects on weight reduction. However, there ap-
pears to be no apparent differences among various fi ber
supplements in their ability to induce weight loss in short
term studies.
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