Murad Day

The correction of lipid disorders in Plantago

INTRODUCTION

Plantago psyllium or herbs, or is claimed ispágula to be effective in reducing cholesterol levels in the blood of those who consume it. Several studies show a cholesterol reduction attributed to a diet includes dietary fiber as reported by medical researchers ispaghula.1 research concluded that the use of Plantago is an effective and well tolerated with a prudent diet for the treatment of mild to moderate hyperlipidemia. Some studies showed rcent ispágula or psyllium incorporated into food products is more effective in reducing glucose in blood using a soluble fiber supplement that is independent of food 0.2, 3,5,6 Although the cholesterol reducing properties and glycemic response psyllium containing foods are fairly well documented, the effect of including long-term ispágula diet has not been determined.4 ,1-2 The bioactive agent is psyllium soluble fiber, viscous xylan. It is believed that the polysaccharide stimulates the conversion of cholesterol to bile acids and stimulates the fecal excretion of bile acids. Psyllium may also decrease intestinal absorption of cholesterol.5 ,7-8Hyperlipidemia may be primary or secondary, depending on the cause. Hyperlipidemia is a major cause coronary heart disease (CHD) and atherosclerosis. There is evidence that there is a relationship between serum cholesterol and risk of coronary heart disease. A decrease 1% in serum cholesterol reduces the risk of coronary heart disease by 2% 0.6 Arteriosclerosis of the coronary and peripheral vessels is the leading cause of death men and women in the United States and worldwide.7Human body uses cholesterol to produce many hormones, vitamin D and bile acids that help digest fats. Only a small amount of cholesterol in the blood to meet these needs.8 If the man's body has too much cholesterol in the blood, the excess is deposited in arteries, including arteries heart, where it contributes to the reduction and the bottlenecks that cause the signs and symptoms of heart disease.9-11

Patients and methods
Study was conducted in the Department of Pharmacology, Institute of Basic Medical Sciences, Jinnah Postgraduate Medical Centre, Karachi, from January to July 2006.Forty patients with primary hyperlipidemia were enrolled in the study, selected wards and OPD of National Institute of Cardiovascular Diseases (NICVD), Karachi. Previously patients undiagnosed and untreated primary hyperlipidemia age or sex, from 21 to 60 were randomly selected. Patients with peptic ulcer, liver disease, alcoholism, hypothyroidism, diabetes mellitus and renal disease were excluded from the study that this disease may mask patients.10 hyperlipidemia written consent was obtained from all participants. The study period was 90 days every two weeks follow-up visits. Patient's name, age, sex, occupation, address, medications preceding the date of the follow-up visit and laboratory tests, etc. Each patient was recorded on a Performa specially designed for the study. All baseline assessments took the day baseline (Day-0) in the study and a similar assessment was made on day-90 treatment. Having met the inclusion criteria of the patients were divided into two groups, ieDrug-1 (3 ispágula ball grams) and drug-2 (placebo capsules, containing the same amount partly crushed wheat) groups. Twenty hyperlipidemic patients in group 1 received packets containing 3 grams of dye and ispágula were invited to take a package of three times a day to control of diet and exercise for 40-60 minutes (on foot depth). This pattern was followed for three months.

Twenty patients with hyperlipidemia group-2 drugs with moderate lipid profile "high" were included in this group of acquisitions, and were invited to continue in the isocaloric weight maintenance, ie step 1 and walk diet8 regularly supported during the next three months. Patients in this group received capsules containing the same amount of ground wheat and Orange part, take one capsule three times daily after meals for three months.

Patients were asked to come in OPD, every two week follow-up to check blood pressure, weight, pulse and general appearance of the individual. Treatment compliance in dose was followed by an interview and advice at each clinic visit. Total cholesterol was estimated by enzymatic colorimetric (Rivella et al, 1994) using the game of cat. # 303113050 by Eli diagnosis triglycerides France: 10 advanced also estimated enzymatic colorimetric method, using cat game. # 304710050 by Eli modern diagnosis. France. HDL-C was determined using kit cat. # 303210040 by Eli advanced diagnostic France. Serum LDL cholesterol was calculated using the formula Friedewald et al11 described by Davidson (LDL = Total cholesterol (triglycerides / 5 + HDL) was also cited by Delong et al (1986) 12 Beamount et al (1970) 13 Data were expressed as mean ± standard deviation and t test was used to determine statistical significance of the difference. A probability value <0.05 was the limit of significance.

RESULTS
Of the 40 patients, 38 completed the study period. Two patients withdrew from a group (Group ispágula) due to a metallic taste ispaghula ball. Tables showing baseline and post-treatment values are explicit. When results were summarized and the test parameters were compared, we found that after 90 days of treatment with ispágula terminal, total serum cholesterol decreased of 228.27 ± 4.89 mg / dl to 199.22 ± 2.30 mg / dl, which is statistically significant (P <0.001). The overall percentage change from one day to 0-90 was -12.72, As shown in Table 1. LDL-cholesterol these patients on day 0 was 159.72 ± 5.70 mg / dl, which was reduced by 90 days of treatment to 129.55 ± 2.81 mg / dl, which is very significant statistically (p <0.001). The overall percentage change from one day to 0-90 was -18.88, as shown in Table 1. In the placebo group on day 0, serum total cholesterol of 215.95 ± 2.47 mg / dl, which decreased to 208.70 ± 5.38 mg / dl, which is not statistically significant (P> 0.05). The percentage decrease in the total value was -3.35, as shown in Table 2. LDL cholesterol in the placebo group on day-or 150.75 ± 2.67 mg / dl, which decreased to 148.80 ± 2.28 mg / dl, which is not statistically significant (P> 0.05) as shown in Table 3.

DISCUSSION
fibric acid, HMG-CoA reductase inhibitors, nicotinic acid and psyllium are important and used more lipid-lowering drugs among drugs.14 ispágula has its own significant role in reducing serum total cholesterol and LDL-cholesterol.15 In our study, total cholesterol decreased by 12.72% within 90 days of treatment ispágula legume hyperlipidemic patients. Our study is the study of Anderson et al.5 who observed almost the same changes in serum total cholesterol and LDL cholesterol of 26 male patients, treated with 3.4 grams three times daily for two ispágula months. Our study is also consistent with the study and that observed Maciejko al6 12.00% decrease in total serum cholesterol and a 16.12% decrease in LDL-cholesterol in 40 hyperlipidemic patients treated with about 4 grams ispágula for the four months period. Our results in lower total serum cholesterol level contrasts with the results of research conducted by Haskell and observed al7who cholesterol total only 6.11% lower in 40 patients with hyperlipidemia, when two balls were used in 18 grams ispágula female patients two months. This change results may be due to changes in the gender of the patients and duration of drug use. Mentioned the mechanism of action of the ball ispágula ispaghula these fibers stimulate the synthesis of bile acids in the liver 7 α-hydroxylase activity. second mechanism, described the diversion of hepatic cholesterol for the synthesis of bile acids. Ispágula the ball effect in the absorption of cholesterol and lipids appears to be minimal, but can make a small contribution to reduce cholesterol. Other mechanisms such as inhibition of hepatic cholesterol synthesis by propionate side effects and slow absorption Glucose can also play a role.3 placebo in our study showed 3.35% of the reduction of serum total cholesterol and 1.29% reduction in LDL-cholesterol. These results coincide with a study of Spence et al20 who observed the same effects as those receiving placebo to 44 patients hyperlipidemic men and women with moderate serum total and LDL cholesterol. Their study shows a reduction of 2.89% of total serum cholesterol and 2.21% reduction in LDL-cholesterol. Results of the research study by Levy et al 21 does not correspond with our results. They found 5.98% and 9.97% reduction in total serum cholesterol and LDL cholesterol, respectively, in 109 patients with hyperlipidemia treated ispágula bullet 3 grams per day during the period of 24 weeks. These changes in the results may be because the sample size to research design, double-blind, large and environmental factors, as in this study, all patients were admitted to the Lipid Research Center Hyperlipidemia, at which have been monitored closely and advised to walk quickly and take a step controlled drug diet.8 respect between our and their study was the same, is say, in our study, patients taking ispágula abandoned due to its metallic taste. In their study of eleven patients stopped taking ispágula, mainly due to metallic taste. Another study by AT Erkkilla al2 and is also in contradiction with our study, we observed that 12.22% reduction in LDL-cholesterol when 3 ispágula program was administered in 14 patients hyperlipidemic women over 40. Our study showed that 18.88% reduction in LDL-cholesterol is much higher to 12.22%. Change these results may be due to the female gender and age are especially above 4 th year in his studio. . Our study included patients hyperlipidemic men and women aged 21-60 years.

REFERENCES

1. Khossousi A CW Binns, SS Dhaliwal, S Pal (2008). The acute effects of psyllium on postprandial lipemia thermogenesis in overweight and obese men. Br J Nutr. May 1999 (5) :1068-75

2. Agrawal AR, Tandon M, Sharma PL. Plantago combinig effects with statins on lipid profile in patients with hyperlipidemia (2007). Int J Clin Pract November;. 61 (11) :1812-18

3. Olson BH, Anderson SM, Becker MP, Anderson JW, Hunninghake DB, Jenkins DJ, JM LaRosa JC, Rippe, Roberts DB, DC, Stoy, Summerball CD, Truswell AS, Wolever TM, Morris DH, Fulgoni VL., 3 º (1995). psyllium-enriched cereals lower total cholesterol and LDL cholesterol but not HDL cholesterol, in adults with hypercholesterolemia: Results of a meta-analysis. J. Nutr, 127: 1973-1980.

4. Moreyra AE, Wilson CA, Koraym A. (2005). Effect of combination psyllium fiber with simvastatin in lowering cholesterol. Arch Intern M ed; 165: 1161-6

5. Anderson JW, Davidson MH, Blonde L, et al (2000). Long term cholesterol-lowering effects of psyllium as an adjunct to diet therapy in the treatment of hypercholesterolemia. Am J Clin. Nutr, 71:1433-8.

6. JJ Maciejko R, Brazg, Shah A, Rubenfire M. (1994). Psyllium for the reduction of gastrointestinal symptoms associated with cholestyramine in the treatment of primary hypercholesterolemia. Arch. Fam Med, 3: 955-60

7. Haskell WL, Spiller GA, Jansen CD, Ellis BK, Gates JE (1992). Role of water-soluble fiber special diets in the management of plasma cholesterol high in healthy patients and hyperlipidemia. Am J Cardiol, 69: 433-39

8. Wei ZH, Wang H, Chen XY, Wang BS, Rong ZX, Wang SB, BH Su, Chen HZ (2009).

In fact, in time and dose dependent psyllium on serum lipids Mild to moderate cholesterol: a meta-analysis of controlled clinical trials. Clin Nutr euros in July J;. 63 (7) :821-7

9. Ganji V, Betts N (1995). intake of fat, cholesterol, fiber and sodium in the U.S. population: evaluation of diets reported in 1987-88 National Survey of Food Intake. Euro J Clin Nutr, 49: 915-920

10. Rivellese AA, Auletta P, Marotta G, et al (1994). In the long-term metabolic two methods of treatment of hyperlipidemia special diets. BMJ, 5: 10-14.

11. Davidson MH, Rosenson RS (2009). New targets affect lipoprotein metabolism high density: the next frontier. I J Cardiol. November 16, 104 (10 Suppl): 52E-57E.

12. DM Delong Delong ER, Wood PD, K Lippel, Rifkind BM (1986). A comparison of methods for estimation of plasma cholesterol lowand very low density lipoproteins. JAMA, 256:2372-2377.

13. Beamount JL, Carlson LA, Cooper GR (1970). Classification and hyperlipidemia hyperlipidemia. Toro. WHO, 43: 891-908.

14. Charland SL, Malone DC (2010). Prediction of reducing the incidence of cardiovascular risk associated with changes in lipid treatment by the power of secondary dyslipidemia. Curr Med Res Opin. February 26 (2) :365-75.

15. Vega-Lopez S, K Conde-Knape, Vidal-Quintanar RL, Shachter NS, Fernandez ML. (2002). Sex and hormonal status influence the effects of psyllium in remodeling and composition of lipoproteins. Metabolism. 51: 500-507.

16. Anderson JW, Davidson MH, Blonde L, et al (2000). lowering effects Long-term cholesterol psyllium as an adjunct to diet therapy in treating hypercholesterolemia. Am J Clin. Nutr, 71:1433-8.

17. JJ Maciejko R, Brazg, Shah A, Rubenfire M. (1994). Psyllium for the reduction of gastrointestinal symptoms associated cholestyramine in the treatment of primary hypercholesterolemia. Arch. Fam Med, 3: 955-60

18. Haskell WL, Spiller GA, Jansen CD, Ellis BK, Gates JE (1992). Role of water-soluble fiber special diets in the management of plasma cholesterol in Patients with high health and hyperlipidemia. Am J Cardiol, 69: 433-39

19. Olson BH, Anderson SM, Becker MP, Anderson JW, Hunninghake DB, Jenkins DJ, LaRosa JC, Rippe JM, Roberts DB, DC, Stoy, Summerball CD, Truswell AS, Morris TM Wolever DH, Fulgoni VL., 3 º (995). psyllium-enriched cereals lower blood total cholesterol and LDL cholesterol but not HDL cholesterol in hypercholesterolemic adults: Results of a meta-analysis. J. Nutr, 127: 1973-1980.

20. JD Spence, MW Huff, Heidenheim P, et al (1995). Combination therapy with colestipol and psyllium psyllium among patients with hyperlipidemia. Ann. Intern. Med 123: 493-99

21. Levy RI, Fredrickson DS, Shulman R, (1972). special dietary treatment and medicine for primary hyperlipoproteinemias. Ann. Int Med, 77: 267-94.

About the Author

Authors:

• Shah Murad, Professor, Pharmacology, Lahore Medical and Dental College, Lahore.
• Moosa Khan, Assistant Professor, Pharmacology, BMSI, JPMC, Karachi.
• Manzoor Ahmad Unar, Assistant Professor, Pharmacology, CMC, Larkana.
• Amar Lal Ghurbakhshani, Assistant Professor, Physiology, Chandka Medical College, Larkana.
• Samina Karim, Associate Professor, Pharmacology, SIMS, Lahore.
• Ghazi Mahmood, Senior Registrar, ENT, GTTH, LM&DC, Lahore

 

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