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The most recent published article is the one immediately below from
April 1999 AJKD. One needs to be a professional member of NKF
http://www.kidney.org and/or subscribe to AJKD http://wwww.ajkd.org to
have access to the full text of the 1999 article.
http://www.ajkd.org/cgi/content/full/33/4/633
From full text of Am J Kidney Dis 1999 Apr;33(4):633-46
"Moreover, our results obtained in nephrectomized rats showed that
fermentable carbohydrates were all the more efficient to shift N
excretion from the urinary route toward the fecal
route because the protein level was low. Thus, we have shown that
with a normal protein level (14% casein diet), fecal N represented
23% of the total N excretion in rats fed
fermentable carbohydrate diets versus only 12% in rats in fiber-free
conditions, whereas, with a lower protein level (8% casein diet),
fecal N represented 46% of the total N
excretion (Fig 3B).25 As a result of this increase in fecal N
excretion, the net effect of feeding fermentable carbohydrates with a
dietary protein restriction was to decrease urinary
N excretion from approximately 250 mg/d (14% casein, fiber-free diet)
to approximately 60 mg/d (8% casein, fermentable carbohydrate diet).
This represents a 75% decrease of
urinary N (Fig 5).25 In patients with CRF, supplementation with gum
arabic or ispaghula (hemicellulose) has been shown to reduce serum
urea N levels by 12% and 19%,
respectively.15,20 Wizemann et al122 reported also that lactulose
increased fecal N in uremic patients, together with a 25% decrease in
plasma urea concentration. In parallel, the
total fecal N excretion and particularly the bacteria fraction was
significantly increased with fermentable carbohydrates and accounted
for 59% of the total increase in stool N
contents.18,20 This suggests that the large intestine can partially
compensate for renal failure, provided that an appropriate supply of
fermentable carbohydrates and protein is
allowed."
11.William EM, Maroni BS: Nutritional consideration and the indication
for dialysis. Am J Kidney Dis 31:185-189, 1998[Abstract]
12.Mackenzie HS, Brenner BM: Current strategies for retarding
progression of renal disease. Am J Kidney Dis 31:161-170, 1998[Abstract]
13.Giordano C: Use of exogenous and endogenous urea for protein
synthesis in normal and uremic subjects. J Lab Clin Med 62:231-246, 1963
14.El Nahas AM, Coles GA: Dietary treatment of chronic renal failure:
Ten unanswered questions. Lancet 1:597-560, 1986[Medline]
15.Rampton DS, Cohen SL, Crammond VDB, Gibbons J, Lilburn MF, Rabet
JY, Vince AJ, Wager JD, Wrong OM: Treatment of chronic renal failure
with dietary fiber.
Clin Nephrol 21:159-163, 1984[Medline]
16.Younes H, Demigné C, Behr S, Rémésy C: Resistant starch exerts a
uremia-lowering effect by enhancing urea disposal in the large
intestine. Nutr Res 15:1199-1210, 1995
17.Younes H, Garleb K, Behr S, Rémésy C, Demigné C: Fermentable
fibers or oligosaccharides reduce urinary nitrogen excretion by
increasing urea disposal in the cecum.
J Nutr 125:1010-1016, 1995[Medline]
18.Stephen AM, Dahl WJ, Sieber GM, Blaricom JAV, Morgan DR: Effect of
green lentils on colonic function, nitrogen balance, and serum lipids in
healthy human subjects.
Am J Clin Nutr 62:1261-1267, 1995[Abstract]
19.Tetens I, Livesey G, Eggum BO: Effects of type and level of
dietary fiber supplements on nitrogen retention and excretion patterns.
Br J Nutr 75:461-469, 1996[Medline]
20.Bliss DZ, Stein TP, Schleifer CR, Settle RG: Supplementation with
gum arabic fiber increases fecal nitrogen excretion and lowers serum
urea nitrogen concentration in
chronic renal failure patients consuming a low-protein diet. Am J
Clin Nutr 63:392-398, 1996[Abstract]
21.Younes H, Rémésy C, Behr S, Demigné C: Fermentable carbohydrate
exerts a urea-lowering effect in normal and nephrectomized rats. Am J
Physiol 272:G515-G521,
1997[Medline]
Clin Nephrol 1984 Mar;21(3):159-63
Treatment of chronic renal failure with dietary fiber. Rampton DS, Cohen
SL, Crammond VD, Gibbons J, Lilburn MF, Rabet JY, Vince AJ, Wager JD,
Wrong OM
We have tested the hypothesis that dietary
fiber, by inhibiting colonic bacterial ammonia generation and increasing
fecal nitrogen
excretion, might decrease hepatic urea
synthesis and thereby reduce plasma urea in patients with chronic renal
failure. Six and 8 week courses of two different hemicelluloses,
arabinogalactan and ispaghula, reduced mean plasma urea in uremic
subjects by 11% and 19% respectively. Ispaghula also reduced the rate of
rise of plasma creatinine to zero and, in one formal balance study,
increased fecal nitrogen excretion by 39%. Experiments in vitro showed
that ispaghula depressed anaerobic fecal bacterial net ammonia
generation by 30%, and adsorbed neither urea nor ammonia. The reduction
in plasma urea caused by dietary fiber is likely to be due to inhibition
of colonic
bacterial production of ammonia; such therapy could conceivably
alleviate some of the symptoms of uremia and postpone dialysis in
patients with endstage renal disease.
Am J Clin Nutr 1996 Mar;63(3):392-8
Supplementation with gum arabic fiber
increases fecal nitrogen excretion and lowers serum urea nitrogen
concentration in chronic renal failure patients consuming a low-protein
diet.
Bliss DZ, Stein TP, Schleifer CR, Settle
RG
University of Pennsylvania School of
Nursing, Philadelphia, USA.
In chronic renal failure (CRF), plasma
concentrations of the products of protein metabolism are increased.
Current dietary management is to prescribe a decrease in protein intake.
The use of dietary fiber to increase fecal excretion of retained
metabolites in CRF may be a beneficial adjunct to a low-protein diet
(LPD). Colonic bacteria ferment dietary fiber, providing them with
energy for growth and nitrogen incorporation, in turn, increasing
nitrogen excretion in feces. Sixteen CRF patients consuming an LPD were
randomly assigned to receive a supplement of a highly fermentable fiber,
gum arabic (50 g/d), or a placebo (1 g pectin/d) in a prospective,
single-blind, crossover design. Fecal bacterial mass and fecal nitrogen
content were significantly increased during supplementation with gum
arabic compared
with the baseline LPD or supplementation with pectin. Serum urea
nitrogen was significantly decreased during supplementation with gum
arabic compared with the baseline LPD or supplementation with pectin.
Nitrogen balance did not change significantly.
Am J Kidney Dis 1999 Apr;33(4):633-46
Role of fermentable carbohydrate
supplements with a low-protein diet in the course of chronic renal
failure: experimental bases.
Younes H, Alphonse JC, Behr SR, Demigne C,
Remesy C INRA, Centre de Recherches en Nutrition Humaine de
Clermont-Ferrand/Theix, St-Genes-Champanelle, OH, USA.
younes@clermont.inra.fr
During the past few years, considerable
attention has been given to the impact of nutrition on kidney disease.
The question arises of whether the effect of a moderate dietary protein
restriction could be reinforced by enrichment of the diet with
fermentable carbohydrates. Feeding fermentable carbohydrates may
stimulate the extrarenal route of nitrogen (N) excretion through the
fecal route. Such an effect has been reported in several species,
including healthy humans and patients with chronic renal failure (CRF).
Furthermore, studies of these subjects show that the greater fecal N
excretion during the fermentable carbohydrate supplementation period was
accompanied by a
significant decrease in plasma urea concentration. In animal models of
experimental renal failure, the consumption of diets containing
fermentable carbohydrates results in a greater rate of urea N transfer
from blood to the cecal lumen, where it is hydrolyzed by bacterial
urease before subsequent microflora metabolism and proliferation.
Therefore, this results in a greater fecal N excretion, coupled with a
reduction in urinary N excretion and plasma urea concentration. Because
elevated concentrations of serum urea N have been associated with
adverse clinical symptoms of CRF, these results suggest a possible
usefulness of combining fermentable carbohydrates with a low-protein
diet to increase N excretion through the fecal route. Further
investigations in this population of patients of whether fermentable
carbohydrates in the diet may be beneficial in delaying or treating the
symptoms and chronic complications of CRF will certainly emerge in the
future. This should be realized without adversely affecting nutritional
status and, as far as possible, by optimizing
protein intake for the patients without being detrimental to renal
function.
Dig Dis Sci 2000 May;45(5):946-51
Cholera toxin-induced secretion in rats is
reduced by a soluble fiber, gum arabic.
Turvill JL, Wapnir RA,
Wingertzahn MA, Teichberg S, Farthing MJ
Digestive Diseases Research Centre, St.
Bartholomew's & The Royal London School of Medicine & Dentistry, UK.
Gum arabic (GA), a soluble fiber with
emulsifying properties, enhances intestinal water and electrolyte
absorption in normal and secreting rats. Our aim was to assess the
effect of GA, 2.5 and 5.0 g/liter, on cholera toxin-induced water and
electrolyte secretion in rat jejunum in
vivo. After a 2-hr exposure to cholera toxin, jejunal segments of adult
rats were perfused in vivo with at plasma electrolyte solution
containing GA, 0, 2.5 or 5.0 g/liter. 24Na was used as a marker of
sodium influx. Cholera toxin-induced secretion was reduced by GA, 2.5
and 5.0 g/liter. 24Na secretion into the lumen was reduced by GA. GA
caused a morphological expansion of intercellular spaces in the villi
but not crypts. In conclusion, GA promotes lumen to blood intestinal
transport of water and sodium despite cholera toxin
activation. These observations support a potential role for GA in
enhancing the efficacy of ORS.
Pediatr Gastroenterol Nutr 1999 Oct;29(4):411-7
Effect of gum arabic in an oral
rehydration solution on recovery from diarrhea in rats. Teichberg S,
Wingertzahn MA, Moyse J, Wapnir RA
Department of Pediatrics, North Shore
University Hospital, New York University School of Medicine, Manhasset,
USA.
BACKGROUND: It has been shown that gum
arabic, a soluble fiber, enhances water, electrolyte, and glucose
absorption from oral
rehydration solutions in jejunal perfusion of healthy rats and in
animals with theophylline-induced secretion or chronic osmotic-secretory
diarrhea. This report concerns a study of the effectiveness of an oral
rehydration solution supplemented with gum arabic, during recovery from
chronic osmotic secretory diarrhea in free-living rats. METHODS: Chronic
diarrhea was induced in 60- to 80-g juvenile rats by providing a
magnesium citrate-phenolphthalein solution as the sole fluid source for
7 days. This led to diarrhea characterized by dehydration, soft stools,
increased cecal volume, decreased food and fluid intake and failure to
gain weight. After 7 days of diarrhea, rats
recovered for 24 hours with either tap water or an oral rehydration
solution (90 mM Na, 111 mM glucose, 20 mM K, 80 mM chloride, 20 mM
citrate) with or without 2.5 g/l gum arabic. RESULTS: Although all three
solutions improved the diarrhea, optimal recovery fromdiarrhea was
achieved with the gum arabic-supplemented oral rehydration solution.
After 4 hours and 24 hours, rats drinking the gum
rabic-supplemented solution gained more weight and had lower fecal
output than rats receiving water or the rehydration solution without gum
arabic. All three solutions normalized plasma osmolality after 24 hours.
CONCLUSIONS: The positive effects of the gum arabic-supplemented
rehydration solution on fluid and electrolyte absorption seen during
jejunal perfusion also occurred during recovery from chronic osmotic
secretory diarrhea, when free-living animals drank the solution ad
libitum.
Food Addit Contam 1998 Apr;15(3):251-64
Acacia gum (Gum Arabic): a nutritional
fibre; metabolism and calorific value. Phillips GO
Newtech Innovation Centre, Wrexham
Technology Park, UK.
Gum Arabic (Acacia gum, INS 414: E414) is
extensively used as a food additive, but there is no regulatory or
scientific consensus about its calorific value. It is a complex
polysaccharide, primarily indigestible to both humans and animals, not
degraded in the intestine, but
fermented in the colon under the influence of microorganisms. Despite a
range of animal studies, there are no usable data for humans which can
quantify the utilizable energy of Gum Arabic. Estimates in the
literature from animal experiments vary from 0 to 4 kcal/g. After
certain allowances are made for the energy losses from volatile and
gaseous fermentation products, an upper level of 2 kcal/g for rats has
been set. The situation in man is demonstrably different, with greatly
reduced amounts of such products, and the need to adapt for
varying periods before Gum Arabic is attacked by colonic bacteria. In
the absence of an agreed scientific assignment, the FDA in the USA
insist upon 4 kcal/g in nutritional labelling, whereas in Europe, no
value has been assigned to soluble dietary fibre, such as Gum Arabic.
This review argues that based on present
scientific knowledge only an arbitrary value can be used for regulatory
purposes.
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