Carbohydrate Intolerance In Patients Research Articles

PROTECTIVE ROLE OF POMEGRANATE JUICE BLENDED WITH WHEATGRASS AND LEMON EXTRACTS FOR RELIEVE CARBOHYDRATE INTOLERANCE

Characteristics and protective effect of pomegranate juice (PJ), lemon juice (LJ), wheatgrass juice (WGJ) and their functional blends were evaluated. Total phenolics (TP), flavonoids (TF) content as well as free radical scavenging activity were determined. Meanwhile, total acidity, pH values were determined and the organoleptic attributes were evaluated. Also, the protective effect of functional blending juice against carbohydrate intolerance in patients was investigated by hydrogen breath test. The results revealed that the WGJ are low acidic in nature. While, the PJ and LJ showed high acidity which raised the total acidity in the functional blending juice. PJ had high content of total phenolics 17.45 mg/ml followed by 5.85 mg/ml for functional blending juice. While, the LJ showed high acidity which raised the total acidity in the in the functional blending juice. PJ had high content of total phenolics 17.45 mg/ml followed by 13.25 mg/ml for functional blending juice. While, significant increase in the TF 22.15 mg/ml in the wheatgrass juice followed by functional blending juice 5.70 mg/ml significant increase in the TF 25.25 mg /ml in the functional blending juice followed by 22.15 mg/ml for wheatgrass juice. Whereas, the results showed that functional blending juice recorded the highest antioxidant activity, which revealed great free radical scavenging activity 98.16%. Depending on sensory evaluation, the proportions of fourth blend WGJ: PJ: LJ in ratio 20:70:10 was most preferred for consumption by the panelists compared to other blending ratios. After one month for patients group treated by functional blending juice at blinds ratio (WGJ 20: PJ 70: LJ 10), showed a significant decrease in the concentration of the hydrogen level in the exhalation air to reach a significant level of the control patients group, indicating the ability of the active compounds in functional blending juice to relieve the problems of carbohydrate intolerance. Accordingly, healthy promoting beverages can be produced by addition blending of pomegranate juice, lemon juice and wheatgrass juice.

Optimal Testing for Diagnosis of Fructose Intolerance: Over-dosage Leads to False Positive Intolerance Test.

TO THE EDITOR: We read with interest the recent article by Goebel-Stengel et al 1 and wish to express our appreciation and enthusiasm for their work on small intestinal bacterial overgrowth (SIBO) and carbohydrate intolerance in patients with irritable bowel syndrome (IBS). However, we have significant concerns regarding their methodology and basis for diagnosis of fructose intolerance. Goebel-Stengel et al 1 used a supra-physiologic dose of 50 g fructose in 200 mL water for performing the fructose breath test. The rationale for this high dose is unclear, and whether healthy controls from their population can fully absorb 50 g dose of fructose has not been reported by these authors. If the test was positive, an additional breath test was performed with 25 g in 100 mL water. Patients were then classified as subjects with moderate symptomatic fructose malabsorption if they were positive with 50 g dose and negative with 25 g dose, and severe fructose malabsorbers as patients who were positive at both doses. Since almost all healthy subjects can absorb up to 25 g of fructose, and 70% malabsorb at 50 g dose, 2 it is unclear why the authors chose a 50 g fructose dose. Authors have partially justified this dose stating that daily consumption of fructose may be higher than 25 g, and fructose concentration less than 50 g has low yield. These assumptions are incorrect. Whilst it is possible that patients may consume up to 50 g fructose/day, this amount is usually not ingested all at once. Because the maximum absorptive capacity for a single dose is 25 g for healthy subjects, a higher dose will give a higher and false positive diagnosis of fructose malabsoption/ intolerance. This finding may lead to incorrect diagnosis and unnecessary restriction of fructose products in diet, when in fact the subject may have normal fructose absorption capacity. Also performing 2 tests for identifying fructose intolerance seems impractical and should be avoided. Also, we disagree with recommendation that fructose breath test should be performed only for research purposes, 3 as doing so will deprive patients of an important diagnosis. Also many of them will be falsely labelled as IBS. It was somewhat surprising that the authors did not reference the only well controlled, dose-response, fructose absorption study in healthy humans. 4 We believe that the ideal test dose for patients with suspected fructose intolerance is 25 g, and breath samples should be obtained every 30 minutes for 3 hours, and analyzed for H2 and CH4 levels. 4 This standardized diagnostic approach for fructose breath test should facilitate better characterization of fructose malabsorption in patients with unexplained gas and bloating, and this has been shown to be clinically useful in a large group of 429 consecutive patients. 5

Carbohydrate intolerance in patients with self-reported food hypersensitivity: Comparison of lactulose and glucose

Objective. Malabsorption of low-digestible carbohydrates is physiological, but poorly tolerated in some patients. We investigated symptom anticipation and microbial fermentation as possible mechanisms of carbohydrate intolerance in patients with self-reported food hypersensitivity. Material and methods. In a randomized, double-blind, cross-over study, 27 consecutive patients with unexplained, self-reported food hypersensitivity were given 10 g lactulose and 10 g glucose (placebo). Symptoms and pulmonary excretion of hydrogen and methane were assessed. Short-chain fatty acids (SCFAs), lactate and prostaglandin E2 (PGE2) were analyzed in rectal dialysis fluid, and compared to dialysates from nine healthy volunteers. Results. Post-lactulose symptom scores were correlated with habitual symptom scores (r = 0.6, p = 0.001), significantly higher than post-glucose symptom scores (p = 0.01) and significantly higher in patients than controls (p = 0.0007). Levels of SCFAs, lactate and PGE2 in rectal dialysates were not significantly different after lactulose and glucose, or between patients and controls. Hydrogen excretion was not correlated with symptom scores. Conclusions. The findings suggest that self-reported food hypersensitivity is related to microbial fermentation of malabsorbed carbohydrates and not to symptom anticipation solely. Levels of SCFAs, lactate and PGE2 in rectal dialysates could not explain the fermentation-associated hypersensitivity.

Plasma glucagon-like peptide 1 and peptide YY levels are not altered in symptomatic fructose-sorbitol malabsorption

Objective. Carbohydrate malabsorption causes more symptoms in patients with functional gastrointestinal disorders than in healthy individuals. The purpose of this study was to investigate whether this could be explained by differences in ileal brake hormone secretion. Material and methods. Eighteen consecutive patients with functional abdominal complaints, referred to our clinic for investigation of self-reported food hypersensitivity, were included in the study and compared with 15 healthy volunteers. All subjects ingested a mixture of 25 g fructose and 5 g sorbitol. Pulmonary hydrogen and methane excretion and plasma glucagon-like peptide 1 (GLP-1) and peptide YY (PYY) levels were measured during the next 3 h. Both habitual and post-test symptoms were assessed. Results. Malabsorption of fructose and sorbitol was present in 61% of the patients and 73% of the controls. Nevertheless, the patients experienced significantly more symptoms following carbohydrate challenge, and 78% of the patients claimed that the challenge replicated their habitual gastrointestinal complaints. No significant differences in gas excretion or GLP-1 and PYY levels were found between patients and controls or between symptomatic and asymptomatic carbohydrate malabsorbers. A weak correlation between hydrogen excretion and PYY levels was demonstrated in non-producers of methane. Conclusions. Neither intestinal gas production nor ileal brake hormone secretion seems to play a role in the symptomatology of carbohydrate intolerance in patients with self-reported food hypersensitivity. Other mechanisms related to bacterial fermentation may be involved and should be investigated further.

Proinsulin, proinsulin intermediate and insulin in cystic fibrosis

We determined the changes in insulin, intact proinsulin and 32-33 split proinsulin as markers of beta cell damage in assessing the state of carbohydrate intolerance in patients with cystic fibrosis. Measurements of insulin, proinsulin and 32-33 proinsulin concentrations in cystic fibrosis following oral glucose tolerance test (OGTT). Sixteen cystic fibrosis patients attending the chest outpatient clinic for follow-up, age range 14-42 years, and 14 healthy controls matched for age and body mass index. Insulin, intact proinsulin and 32-33 split proinsulin were measured immunoradiometrically at 0, 30, 60, 90 and 120 minutes after an OGTT. Glucose and HbA1 were also measured. Cystic fibrosis patients were divided into two groups according to their OGTT results: those with diabetes mellitus or impaired glucose tolerance and those with normal glucose tolerance. Insulin concentrations and insulin/glucose ratios at 30 minutes were lower in both cystic fibrosis groups in comparison with the control. There was also a significant increase in the time to reach peak insulin levels in both cystic fibrosis groups. Fasting intact proinsulin concentrations and the proportion of proinsulin-like molecules were significantly higher in cystic fibrosis with diabetes mellitus or impaired glucose tolerance than in the control group, but not in the normal glucose tolerance cystic fibrosis group. There was no significant difference in the plasma concentrations of 32-33 split proinsulin amongst the three groups. Abnormal beta cell function in cystic fibrosis patients was reflected initially in a diminished 30-minute insulin response to oral glucose. A significant rise in fasting intact proinsulin and the proportion of proinsulin-like molecules was seen only in cystic fibrosis patients who had progressed to impaired glucose tolerance or diabetes mellitus. Cystic fibrosis patients with normal glucose tolerance showed changes intermediate between the control and the other group.

Verapamil reverses glucose intolerance in preexisting chronic renal failure: studies on mechanisms.

Glucose-induced insulin secretion is impaired in chronic renal failure (CRF), and this abnormality is due to the elevation of cytosolic calcium [Ca2+]i and other derangements in pancreatic islet metabolism. Verapamil given to rats from day 1 of CRF prevented the rise in [Ca2+]i of islets and the impairment in insulin secretion. However, it is not known whether verapamil can reverse the abnormalities of islet function and metabolism in animals with preexisting renal failure. Such a documentation has important clinical implications for the treatment of carbohydrate intolerance in patients with CRF. The present study examined this question. After 6 weeks of CRF, rats were randomized into two subgroups and maintained for additional 6 weeks. One subgroup received intraperitoneal injections of verapamil (0.1 micrograms/kg body weight twice daily) and the other received vehicle only. At the time of randomization, there were no significant differences between the two subgroups in their body weight, plasma levels of calcium, phosphorus and creatinine, serum parathyroid hormone and creatinine clearance. Similarly, at the time of sacrifice (12 weeks), there were no significant differences in these parameters except for a modestly lower plasma level of creatinine and modestly higher creatinine clearance.(ABSTRACT TRUNCATED AT 250 WORDS)

Carbohydrate intolerance in patients receiving oral tocolytics

Carbohydrate intolerance in patients receiving oral tocolytics

Carbohydrate intolerance in patients receiving oral tocolytics

This prospective study was designed to evaluate the effects on glucose metabolism of terbutaline used as an oral tocolytic agent. Eighty-six patients were studied when admitted for preterm labor from 24 to 35 weeks' gestation. After intravenous tocolysis, these patients were maintained on 5 mg of terbutaline every 4 or 6 hours. An oral 50 gm, 1-hour glucose challenge test was done 48 hours after terbutaline dosing began. All abnormal glucose challenge test results (greater than or equal to 135 mg/dl) were followed by a standard 100 gm oral glucose tolerance test. Sixty-three percent (54 of 86) of the terbutaline group had an abnormal 1-hour screening result, which was significantly different than the 26.7% (23 of 86) observed in the control group (p less than 0.001). The mean fasting blood sugar and 1-hour postchallenge values were significantly higher in the study than in the control group (p less than 0.0001). Ten of 86 in the treated group (11.6%) and 2 of 86 in the control group (2.3%) with abnormal results met the criteria for gestational diabetes. These numbers achieve statistical significance at p less than 0.05. This study shows a significant effect of oral terbutaline therapy on glucose tolerance during pregnancy. Patients receiving oral terbutaline therapy for suppression of preterm labor should undergo screening for gestational diabetes.

A prospective study of glucose tolerance, insulin, C-peptide, and glucagon responses in patients with pancreatic carcinoma

Ninety-nine patients suspected of having pancreatic carcinoma were studied prospectively for carbohydrate tolerance. Thirty-two patients were proven subsequently to have pancreatic carcinoma; the remainder served as a control group. There was an increased incidence of carbohydrate intolerance in patients with pancreatic carcinoma compared to the control group. Insulin and C-peptide measurements during glucose tolerance tests suggest abnormal beta cell function and possibly insulin resistance as causes for this abnormality. Although factors related to malignancy in general could partly account for the results, a specific factor occurring in patients with pancreatic carcinoma must also be considered as it could serve as a marker for the early detection of this disease.