Guar gum

Guar gum

Guar gum

Clinical overview

Use

dosage

Guar gum has been administered in amounts ranging from 7.5 to 21 g/day for weight loss in clinical trials. For constipation in children, one study used partially hydrolyzed guar gum 3 g/day for patients 4 to 6 years of age, 4 g/day for patients 6 to 12 years of age, and 5 g/day for patients 12 to 16 years of age. Guar gum 8 to 36 g/day and 100 to 150 g/day dried beans or legumes are said to reduce LDL cholesterol (low density lipoprotein) by 5 to 10%.

Contraindications

Contraindications have not yet been identified.

Pregnancy/breastfeeding

There is a lack of information on safety and effectiveness during pregnancy and breastfeeding.

Interactions

Large amounts of guar gum (10 g or more daily) may decrease metformin serum concentrations and should be avoided.

Side effects

Guar gum can cause gastrointestinal obstruction. The most common side effects are abdominal pain, cramps, diarrhea and bloating.

toxicology

There is no published evidence of toxicity from the use of guar gum.

Scientific family

• Fabaceae (Bohne)

botany

The guar plant is a small nitrogen-fixing annual plant that bears pods, each containing a number of seeds. Native to tropical Asia, the plant grows throughout India and Pakistan and has been cultivated in the southern United States since the early 20th century.(1) Another name for this species is C. psoralioides DC.

Guar gum is a fiber obtained from the endosperm of the bean and can make up more than 40% of the seed weight. It is separated and ground into commercially available guar gum. Guar beans can be consumed as green beans, used as fertilizer, or fed to cattle.(2)

Guar gum is said to contain 75% soluble fiber, 7.6% insoluble fiber, 2% crude protein, 0.78% fat, 0.54% ash and 9.6% moisture.(2) Synonyms are Cyamopsis psoralioides DC.

Story

Guar gum has been used as a thickener for foods and medicines for centuries. The largest market for guar gum is the food industry, where guar gum is known by the food additive code E412. (2) Guar gum continues to be used extensively for these applications as well as in the paper, textile, and oil drilling industries.

Chemistry

Guar is a galactomannan polysaccharide that forms a viscous gel when it comes into contact with water. It forms solutions with a slightly acidic to neutral pH value. Even in low concentrations (1% to 2%), guar gum forms gels in water. The viscosity of these gels is generally not affected by the pH of the solution.

Food-grade guar gum contains approximately 80% guaran (a galactomannan composed of D-mannose and D-galactose units) with an average molecular weight of 220 kDa. The overall ratio of mannose to galactose is approximately 2:1.(3) However, guar gum is not a uniform product and its viscosity can vary depending on the degree of galactomannan cross-linking.

Because of this physical composition, guar gum matrix tablets are currently being investigated as a method of sustained-release drug delivery, including diltiazem, (4, 5) and colonic corticosteroid administration to patients with inflammatory bowel disease. (6) )

Use and Pharmacology

Blood pressure

Guar gum has been reported to have varying effects on blood pressure.

Animal data

Research has shown that there are no animal data on the use of guar gum to lower blood pressure.

Clinical data

A small study of 10 elderly subjects showed a reduction in postprandial hypotension (PPH) (defined as a drop in systolic blood pressure of more than 20 mm Hg occurring within 2 hours of the end of a meal). (49) These data were confirmed in a double-blind, randomized, placebo-controlled, crossover study of 22 elderly women in South Korean senior centers, in which significant differences in postprandial systolic blood pressure between Guar gum (9 g before meal) and control groups were found. The largest difference (18.2 mm Hg; P = 0.004) was observed 45 minutes after meal. In addition, the incidence of PPH was 18.2% versus 72.7% in the guar gum and control groups, respectively (P < 0.001). No significant changes in postprandial diastolic blood pressure were noted during the 120-minute follow-up. (65) Conversely, two weeks of guar supplementation was shown to reduce blood pressure by 9% in moderately overweight men. (50) In 141 hypertensive, obese patients, guar gum lowered systolic blood pressure after 2 months of intake (3.5 g 3 times daily); however, there was no difference after 4 and 6 months of supplementation. (32) In another study of 141 patients with metabolic syndrome, guar gum 3.5 grams three times daily was associated with an improvement in systolic blood pressure (−5.3 mm Hg, P < 0.001) after 4 months of treatment. However, this effect was not assessed at further study visits and no effect on diastolic blood pressure was found.(19)

Diabetes mellitus

Guar's ability to change viscosity(20) and thus influence gastrointestinal transit results in delayed absorption of glucose and may contribute to its hypoglycemic activity.

Animal data

In a study on Wistar rats, diets containing 10% and 20% guar gum were associated with lower glucose levels after 30 days of feeding compared to other diets studied. However, blood glucose levels were relatively higher after 60 days of feeding in all diet groups, with no effect found with guar gum.(3) In another study in healthy rats, intragastric administration of guar gum and glucose was associated with a smaller peak increase in plasma glucose, insulin, and glucagon-like peptide-1 concentrations.(21) Guar gum hydrolyzate was found to improve glucose intolerance in rats fed on A fructose-based diet was administered on the 28th day of administration.(8)

A significant improvement in hemoglobin A1c (HbA1c) was noted in diabetic rats fed a 5% guar gum diet for 8 weeks (12.4%) compared to rats fed a basal diet (14.4%, P < 0.05). In addition, the weight of the kidney was lower in the group receiving guar gum than in the group receiving a basal diet (2.76 vs. 3.51 g; P < 0.05). Urinary albumin excretion was highest in the basal diet group and moderate in the guar gum diet group.(22)

In another study, rats with streptozotocin-induced diabetes fed a diet containing 20% ​​guar gum experienced a greater reduction in glucose levels after 28 days of administration compared to rats receiving glibenclamide 2 mg/kg.(23)

Clinical data

Guar gum reduces postprandial glucose and insulin levels in healthy subjects(20) and in patients with type 2 diabetes mellitus.(24, 25, 26, 27, 28, 29) No reduction in plasma C-peptide levels was observed, suggesting that guar gum reduces peripheral venous blood insulin concentration by increasing hepatic insulin extraction. (29) These effects on glucose and insulin appear to be most pronounced when large amounts of guar gum are added to the diet and when the fiber is administered along with the glucose or food. (30) However, when dietary fats and proteins are not adequately controlled in the diet of diabetic patients, the addition of guar has been shown to have little effect on postprandial glucose or C-peptide responses. (31)

In a study of 141 obese, hypertensive patients, ingestion of 3.5 g of guar gum three times daily was associated with a significant reduction in fasting plasma glucose levels of 10 mg/dL at 4 months (P = 0.009) and 12 mg/dL at 6 months (P = 0.009). In addition, HbA1c decreased significantly by 0.7% after 6 months of therapy (P < 0.001).(32)

The effects of 48 weeks of guar gum intake were examined in a single-blind, placebo-controlled study in 15 patients with type 2 diabetes mellitus. Specifically, all patients received placebo for 8 weeks (placebo period 1), followed by 48 weeks of guar gum 15 g/day or placebo divided into 3 doses, and then another 8-week placebo period (placebo period 2). HbA1c levels were lower during guar gum treatment compared to placebo period 1, with no change during placebo period 2. Fructosamine levels were lower after guar gum treatment than at the end of placebo period 1; However, after discontinuation of guar gum, fructosamine levels began to increase, as noted in placebo period 2. Furthermore, C-peptide response increased after 48 weeks of guar gum treatment. However, even after discontinuing guar gum for 8 weeks, C-peptide levels were higher at the end of placebo period 2 compared to placebo period 1 and after 16 weeks of guar gum.(33)

GI effects

Preparations containing guar gum are widely used to promote normal gastrointestinal motility and maintain stool volume.(34) Guar gum preparations may delay gastric emptying time or gastrointestinal tract, but these effects appear to be related to the type of meal and diet.

Animal data

A diet containing 5% partially hydrolyzed guar gum attenuated dextran sulfate sodium-induced colitis in mice. After two weeks of pre-feeding with guar gum, the shortening of the large intestine was reversed. Additionally, disease activity index scores (i.e., measurement of weight loss, stool consistency, blood in stool) were lower in mice that received guar gum compared to controls.(35)

Clinical data

An oral rehydration solution supplemented with guar gum may shorten the duration of diarrhea in young children.(36) Additionally, the addition of enzymatically modified guar gum to enteral formulas has been shown to prolong gastrointestinal transit time and increase fecal nitrogen excretion,(37). ). years, 4 g/day for patients aged 6 to 12 years and 5 g/day for patients aged 6 to 12 years). /day for patients aged 12 to 16 years) for 4 weeks was as effective as lactulose in improving stool frequency per week, stool consistency, and the percentage of participants with abdominal pain and stool retention.(41)

In a randomized, double-blind, placebo-controlled study, 60 women aged 18 to 65 years who had fewer than 3 bowel movements per week were randomized to receive supplementation with 5 g/day of inulin and partially hydrolyzed guar gum 3 times daily or placebo for three weeks. There was an increase in stool frequency and patient satisfaction in both groups, which was not statistically significant. Inulin and guar gum treatment was associated with a decrease in total Clostridium species (5.23 ± 0.67 cells/µL at baseline compared to 4.76 ± 0.92 cells/µL after treatment, P = 0.046), whereas women treated with placebo had an increase in total Clostridium sp. (5.14 ± 0.92 cells/mcL at baseline versus 5.50 ± 0.91 cells/mcL after treatment, P = 0.047). The results were statistically significant when comparing inulin/guar gum with placebo (P = 0.045).(42)

Seventy-seven patients with small intestinal bacterial overgrowth were randomized to receive 1,200 mg/day rifaximin or 1,200 mg/day rifaximin plus 5 g/day partially hydrolyzed guar gum for 10 days. The eradication rate of small intestinal bacterial overgrowth was 62% in the group that received rifaximin alone, compared with 87% in the per-protocol group that received rifaximin plus guar gum (P = 0.017) and 85% in the intention-to-treat group that received rifaximin plus guar gum (P = 0.036). Clinical improvement was noted in 87% of patients who received rifaximin alone, compared to 91% of patients who received rifaximin plus guar gum (P = 0.677).(43)

A prospective, open-label study examined the effect of guar gum on colonic transit time (CTT) in adults (n = 39) with chronic constipation; Bisacodyl or glycerin suppositories were approved as rescue therapy during the study period. Daily partially hydrolyzed guar gum (5 mg) for 4 weeks significantly improved CTT, exercise, and weeks of pain, particularly in patients with slow transit time at baseline (P = 0.016, P < 0.001, and P = 0.027, respectively). The number of complete spontaneous bowel movements, spontaneous bowel movements, weeks with bloating, number of days/week in which laxatives were taken, and stool form were significantly improved in patients with slow or normal baseline transit times. No serious adverse events were reported.(63)

At 12 months after standard therapy with topical nitroglycerin 0.4% ointment for chronic anal fissures, patients who received oral supplementation with partially hydrolyzed guar gum (PHGG) at 5 g/day for 10 months (7 cycles of 4 weeks spaced 2 weeks apart) achieved higher success rates (58.5% vs. 38.3%; P = 0.019) and lower Recurrence rates (14.5% vs. 30.2%; P = 0.0047) than those without PHGG maintenance therapy.(64)

Hyperlipidemia

Animal data

In a 60-day study in Wistar rats, diets containing 10% and 20% w/w guar gum resulted in lower serum cholesterol, triacylglycerol, and LDL cholesterol levels, as well as higher high-density lipoprotein (HDL) cholesterol levels. (3) Rats fed guar gum had significantly lower lymph flow compared to cellulose-fed rats (3.88 ± 1.31 and 11.9 ± 1.1 ml, respectively; P < 0.005). In addition, guar gum-fed rats had significantly reduced transport of cholesterol (4.6 ± 1.77 and 18.1 ± 1.1 mg, respectively; P < 0.0005), triacylglycerols (66.8 ± 35.3 and 297 ± 27 mg, respectively; P < 0.05), and phospholipids (13.7 ± 6.7 and 36 ± 36, respectively). 2.5 mg P < 0.05).(7) Plasma and liver triglycerides were lower in rats administered fructose and additional guar gum hydrolyzate.(8)

Clinical data

Guar gum has been shown to have positive effects on cholesterol levels in doses of 12 to 15 g/day. Most short-term studies (less than 1 year) in patients with mild to moderate hypercholesterolemia have shown reductions in serum total cholesterol levels by approximately 6.5% to 15% and LDL cholesterol levels by 10.5% to 25%, without affecting triglycerides and HDL cholesterol levels.(9, 10, 11, 12, 13) A Long-term study in 40 patients showed that the effects of guar gum on total cholesterol and LDL cholesterol were sustained with continued use over a period of 24 months.(14) A comprehensive review of the lipid-lowering effects of guar gum described a general hypothesis for the mechanism of this effect: guar gum reduces cholesterol absorption and increases bile excretion, leading to increased cholesterol turnover in the liver. Guar's effects on LDL cholesterol metabolism have been suggested to be similar to those of bile sequestrants.(15)

Guar gum is also used as an adjunct to more conventional lipid-lowering therapy. Coadministration with lovastatin resulted in a greater reduction in total cholesterol levels (44%) after 18 weeks of treatment than with lovastatin alone (34%). (16) Placebo-controlled studies have attempted to mask guar gum's unpleasant taste, including uncoated granules, (17) powder, crispbreads, and other flavored formulations. (18)

In a study of 141 patients with metabolic syndrome, administration of 3.5 g of guar gum three times daily was found to improve LDL cholesterol and apolipoprotein B after 6 months of treatment.(19)

The 2017 joint statement of the Italian Society of Diabetology (ISD) and the Italian Society for Arteriosclerosis Research (ISSA) on nutraceuticals for the treatment of hypercholesterolemia strongly recommends the use of fiber (i.e. oat beta-glucan, chitosan, glucomannan). , guar gum, HPMC, pectin, psyllium) to lower LDL levels in the general population, which does not lead to an increase in fiber intake; in patients with mild hypercholesterolemia and low to moderate cardiovascular risk; or in patients with mild hypercholesterolemia and metabolic syndrome (Stage I, Grade A).(66)

Intrahepatic cholestasis and pruritus in pregnancy

Animal data

Research has shown that there are no animal data on the use of guar gum for intrahepatic cholestasis and pruritus in pregnancy.

Clinical data

In two double-blind studies, guar gum reduced or prevented exacerbation of itching in 96 pregnant women with intrahepatic cholestasis. This result is related to bile acid concentration, which remained unchanged in guar gum-treated patients but increased in placebo recipients. (51, 52) The authors suggest that guar gum represents a safe alternative and possible treatment option in these patients.

weight loss

Since bulky fiber can make you feel full, it is used to control appetite. Feelings of fullness are thought to be a secondary consequence of delayed gastric emptying.(2, 44)

Animal data

Research has shown that there is no animal data on the use of guar gum for weight loss.

Clinical data

Results from a small study suggest that guar gum may have a greater impact on satiety when added to a high-fat meal than when added to a low-fat meal. (45) A meta-analysis presented the combined results of 20 randomized controlled trials comparing guar gum (average daily dose 9 to 30 g) with placebo. (46) It was conclusively shown that guar gum is not effective in reducing body weight. Additionally, a number of studies using a partially hydrolyzed form of guar gum, which has no viscosity or bulking effect, found no effect on appetite (47) or weight maintenance (48). However, while there is a lack of evidence supporting the effectiveness of fiber products as an appetite suppressant, they remain popular ingredients in over-the-counter weight loss supplements.

In a study of 141 patients with metabolic syndrome, administration of 3.5 g of guar gum three times daily was found to significantly reduce waist circumference after 4 months of treatment (−4.6 cm, P = 0.011). Waist circumference decreased even further after 6 months of treatment (-5.2, P < 0.004).(19)

dosage

Guar gum has been administered in clinical trials for weight loss in amounts of 7.5 to 21 g daily.(53) For constipation in children, one study used partially hydrolyzed guar gum 3 g/day and in patients aged 4 to 6 years, 4 g/day for patients aged 6 to 12 years and 5 g/day for patients aged 12 to 16 years.(41) Guar gum 8 up to 36 g/day and 100 to 150 g/day of dried beans or legumes have been recommended to reduce LDL cholesterol by 5 to 10%.(2)

Pregnancy/breastfeeding

There is a lack of information on safety and effectiveness during pregnancy and breastfeeding. Guar gum is non-teratogenic and does not affect reproduction in rats.(54)

Interactions

Digoxin: Guar gum (partially hydrolyzed) may decrease the serum concentration of digoxin. No action required.(67)

Glipizide: Guar gum (partially hydrolyzed) may reduce the absorption of glipizide. No action required.(68)

Glyburide: Guar gum (partially hydrolyzed) may reduce the absorption of glyburide. No action required.(58)

Metformin: Guar gum (partially hydrolyzed) may decrease the serum concentration of metformin. Monitor therapy.(53)

Penicillin V potassium: Guar gum (partially hydrolyzed) may decrease the serum concentration of penicillin V potassium. Monitor therapy.(67)

Trimethoprim: Guar gum (partially hydrolyzed) may decrease the absorption of trimethoprim. No action required.(69)

Side effects

In the large intestine, guar gum is fermented to produce short-chain fatty acids. Both guar and its resulting byproducts do not appear to be absorbed by the intestines. The most common side effects are related to the gastrointestinal tract, including abdominal pain, cramps, diarrhea and bloating. (55) Approximately 50% of people who take guar experience bloating, which usually occurs early in treatment and disappears with continued use. A dose of approximately 3 g three times daily, not exceeding 15 g/day, may minimize gastrointestinal effects.(2, 56)

Guar gum can affect the absorption of medicines administered at the same time. Delayed absorption of digoxin, acetaminophen, and bumetanide, as well as decreased absorption of metformin, penicillin V, and some formulations of glyburide, have been reported.(57) Bezafibrate, glipizide, and glyburide(58) are generally not affected by coadministration.(9)

In one patient who exceeded the recommended dosage, guar gum in a weight loss product was considered to cause an esophageal obstruction.(59) One review linked 18 cases of esophageal obstruction, 7 cases of small bowel obstruction, and possibly one death to the use of Cal-Ban 3000, a diet pill containing guar gum.(60) The water holding capacity of the Gum tissue can cause it to swell 10 to 20 times and can lead to obstruction of the lumen, especially if an anatomical predisposition exists. Guar should be taken with large amounts of liquid.

Occupational asthma has been observed in people working with guar gum.(61, 62) One case report suggests a possible anaphylactic reaction to a meal replacement containing guar gum, where the patient tested positive on a skin test.(62)

toxicology

There is little or no information available about the toxicity of using guar gum.

Index terms

• Cyamopsis psoralioides DC

References

Disclaimer

This information relates to an herbal, vitamin, mineral or other dietary supplement. This product has not been evaluated for safety or effectiveness by the FDA and is not subject to the quality and safety information collection standards that apply to most prescription drugs. This information should not be used to decide whether or not to take this product. This information does not confirm that this product is safe, effective, or approved to treat any patient or medical condition. This is just a brief summary of general information about this product. It does NOT contain all information about the possible uses, instructions, warnings, precautions, interactions, side effects or risks that may apply to this product. This information does not constitute specific medical advice and does not replace the information you receive from your healthcare provider. You should speak to your doctor to get complete information about the risks and benefits of using this product.

This product may interact negatively with certain health and medical conditions, other prescription and over-the-counter medications, foods or other dietary supplements. This product may be unsafe if used before surgery or other medical procedures. It is important to fully inform your doctor about the herbs, vitamins, minerals, or other supplements you are taking before any surgery or medical procedure. With the exception of certain products generally considered safe in normal amounts, including the use of folic acid and prenatal vitamins during pregnancy, this product has not been adequately studied to determine whether it is safe for use during pregnancy, breastfeeding, or in those younger than 2 years of age.

1. Leung AY. Encyclopedia of common natural ingredients used in foods, medicines, and cosmetics. New York, NY: John Wiley and Sons; 1980.2. Butt MS, Shahzadi N, Sharif MK, Nasir M. Guar gum: a miracle therapy for hypercholesterolemia, hyperglycemia and obesity. Crit Rev Food Sci Nutr. 2007;47(4):389-396.174577233. Theuwissen E, Mensink RP. Water-soluble fiber and cardiovascular disease. Physiol. Behave. 2008;94(2):285-292.183029664. Altaf SA, Yu K, Parasrampuria J, Friend DR. Sustained-release guar gum-based diltiazem. Pharm Res. 1998;15(8):1196-1201.97060495. Khullar P, Khar RK, Agarwal SP. Evaluation of Guar Gum in the Production of Sustained Release Matrix Tablets. Drug Dev Ind Pharm. 1998;24(11):1095-1099.98765666. Kenyon CJ, Nardi RV, Wong D, Hooper G, Wilding IR, Friend DR. Colonic delivery of dexamethasone: a pharmacoscintigraphic evaluation. Aliment Pharmacol Ther. 1997;11(1):205-213.90429957. Shirouchi B, Kawamura S, Matsuoka R, et al. Dietary guar gum reduces lymphatic flow and decreases lipid transport in thoracic cannulated rats. Lipids. 2011;46(8):789-793.216118508. Suzuki T, Hara H. Ingestion of guar gum hydrolyzate, a soluble and fermentable indigestible saccharide, improves glucose intolerance and prevents hypertriglyceridemia in fructose-administered rats. J Nutr. 2004;134(8):1942-1947.152843809. Todd PA, Benfield P, Goa KL. Guar gum. A review of its pharmacological properties and its use as a dietary supplement in hypercholesterolemia. Drugs. 1990;39(6):917-928.216446710. Knopp RH, Superko R, Davidson M, et al. Long-term blood cholesterol-lowering effects of a fiber supplement. Am J Previous Med. 1999;17(1):18-23.1042974811. Jensen CD, Haskell W, Whittam JH. Long-term effects of water-soluble fiber in the treatment of hypercholesterolemia in healthy men and women. Am J Cardiol. 1997;79(1):34-37.902473212. Hunninghake DB, Miller VT, LaRosa JC, et al. Long-term treatment of hypercholesterolemia with fiber. Am J Med 1994;97(6):504-508.798570813. Blake DE, Hamblett CJ, Frost PG, Judd PA, Ellis PR. Wheat bread enriched with depolymerized guar gum reduces plasma cholesterol concentrations in people with hypercholesterolemia. Am J Clin Nutr. 1997;65(1):107-113.898892114. Salenius JP, Harju E, Jokela H, Riekkinen H, Silvasti M. Long-term effects of guar gum on lipid metabolism after carotid endarterectomy. BMJ. 1995;310(6972):95-96.783373515. Turner PR, Tuomilehto J, Happonen P, La Ville AE, Shaikh M, Lewis B. Metabolic studies on the hypolipidemic effect of guar gum. Arteriosclerosis. 1990;81(2):145-150.215745016. Uusitupa MI, Miettinen TA, Happonen P, et al. Lathosterol and other noncholesterol sterols during treatment of hypercholesterolemia with lovastatin alone and with cholestyramine or guar gum. Arteriosclerosis thrombus. 1992;12(7):807-813.131973517. Aro A, Uusitupa M, Voutilainen E, Korhonen T. Effects of guar gum on male subjects with hypercholesterolemia. Am J Clin Nutr. 1984;39(6):911-916.632656218. Jenkins DJ, Leeds AR, Slavin B, Mann J, Jepson EM. Fiber and blood lipids: Lowering serum cholesterol in type II hyperlipidemia with guar gum. Am J Clin Nutr. 1979;32(1):16-18.21625919. Cicero AF, Derosa G, Bove M, Imola F, Borghi C, Gaddi AV. Psyllium alleviates dyslipidemia, hyperglycemia, and hypertension, while guar gum reduces body weight more rapidly in patients with metabolic syndrome following a stage 2 AHA diet. Mediterr J Nutr Metab. 2010;3(1):47-54,20. Fairchild RM, Ellis PR, Byrne AJ, Luzio SD, Mir MA. A new breakfast cereal containing guar gum reduces postprandial plasma glucose and insulin concentrations in normal-weight people. Br J Nutr. 1996;76(1):63-73.877421721. Prieto PG, Cancelas J, Villanueva-Peñacarrillo ML, Malaisse WJ, Valverde I. Short- and long-term effects of guar on postprandial plasma glucose, insulin and glucagon-like peptide-1 concentrations in healthy rats. Horm Metab Res. 2006;38(6):397-404.1682372222. Gallaher DD, Olson JM, Larntz K. Dietary guar gum stops further kidney enlargement in rats with established diabetes. J Nutr. 1992;122(12):2391-2397.145322423. Saeed S, Mosa-Al-Reza H, Fatemeh AN, Saeideh D. Antihyperglycemic and antihyperlipidemic effects of guar gum on streptozotocin-induced diabetes in male rats. Pharmacogn Mag. 2012;8(26):65-72.2243866624. Smith U, Holm G. Effect of a modified guar gum preparation on glucose and lipid levels in diabetics and healthy subjects. Arteriosclerosis. 1982;45(1):1-10.629751525. Aro A, Uusitupa M, Voutilainen E, Hersio K, Korhonen T, Siitonen O. Improved diabetes control and hypocholesterolemic effect by long-term dietary supplementation with guar gum in type 2 diabetes (insulin independent). Diabetology. 1981;21(1):29-33.626847526. Lakhdar A, et al. Fiber and patients with diabetes [letter]. Br Med J (Clin Res Ed). 1988;296(6634):1471.283730727. Kirsten R, Heintz B, Nelson K, Oremek G, Speck U. Influence of two guar preparations on glycosylated hemoglobin, total cholesterol and triglycerides in patients with diabetes mellitus. Int J Clin Pharmacol Ther Toxicol. 1992;30(12):582-586.133544128. Landin K, Holm G, Tengborn L, Smith U. Guar gum improves insulin sensitivity, blood lipids, blood pressure, and fibrinolysis in healthy men. Am J Clin Nutr. 1992;56(6):1061-1065.144265829. Gatenby SJ, Ellis PR, Morgan LM, Judd PA. Effect of partially depolymerized guar gum on acute metabolic variables in patients with non-insulin-dependent diabetes. Diabet Med. 1996;13(4):358-364.916261230. Nuttall FQ. Fiber in the treatment of diabetes. Diabetes. 1993;42(4):503-508.838413131. Sels JP, De Bruin H, Camps MH, et al. Lack of guar efficacy in complex spaghetti meals on postprandial glucose and C-peptide levels in healthy controls and non-insulin-dependent diabetes mellitus patients. Horm Metab Res Suppl. 1992;26:52-58.133705932. Cicero AF, Derosa G, Manca M, Bove M, Borghi C, Gaddi AV. Differential effect of psyllium and guar supplementation on blood pressure control in hypertensive obese patients: a six-month randomized clinical trial. Clin Exp Hypertens. 2007;29(6):383-394.1772905533. Groop PH, Aro A, Stenman S, Groop L. Long-term effects of guar gum in patients with non-insulin-dependent diabetes mellitus. Am J Clin Nutr. 1993;58(4):513-518.839748434. Rajala SA, Salminen SJ, Seppänen JH, Vapaatalo H. Treatment of chronic constipation with lactitol-sweetened yogurt supplemented with guar gum and wheat bran in elderly hospitalized patients. Compr Gerontol A. 1988;2(2):83-86.285254035. Naito Y, Takagi T, Katada K, et al. Partially hydrolyzed guar-guerim downregulates the colonic inflammatory response in dextran sulfate sodium-induced colitis in mice. J Nutr Biochem. 2006;17(6):402-409.1621433136. Alam NH, Meier R, Schneider H, et al. Oral rehydration solution enriched with partially hydrolyzed guar gum for the treatment of acute diarrhea in children. J Pediatr Gastroenterol Nutr. 2000;31(5):503-507.1114443437. Lamp JW, Effertz ME, Larson JL, Slavin JL. Gastrointestinal effects of modified guar gum and soy polysaccharide as part of an enteral diet. JPEN J Parenter Enteral Nutr. 1992;16(6):538-544.133736238. Homann HH, Kemen M, Fuessenich C, Senkal M, Zumtobel V. Reduction of diarrhea incidence by soluble fiber in patients receiving complete or supplemental enteral nutrition. JPEN J Parenter Enteral Nutr. 1994;18(6):486-490.760272239. Alam NH, Meier R, Rausch T, et al. Effects of a partially hydrolyzed guar gum on intestinal absorption of carbohydrates, proteins and fat: a double-blind controlled study in volunteers. Clin Nutr. 1998;17(3):125-129.1020532940. Paul SP, Barnard P, Edate S, Candy DCA. Stool consistency and abdominal pain in irritable bowel syndrome can be improved with partially hydrolyzed guar gum. J Pediatr Gastroenterol Nutr. 2011;53(5):582-583.2183295041. Üstündağ G, Kuloğlu Z, Kirbaş N, Kansu A. Can partially hydrolyzed guar gum be an alternative to lactulose in the treatment of constipation in children? Turk J Gastroenterol. 2010;21(4):360-364.2133198842. Linetzky Waitzberg D, Alves Pereira CC, Logullo L, et al. Microbiota benefits following inulin and partially hydrolyzed guar gum supplementation: a randomized clinical trial in constipated women. Nutr Hosp. 2012:27(1):123-129.2256631143. Furnari M, Parodi A, Gemignani L, et al. Clinical Study: The combination of rifaximin with partially hydrolyzed guar gum is more effective than rifaximin alone in eliminating bacterial overgrowth in the small intestine. Aliment Pharmacol Ther. 2010;32(8):1000-1006.2093704544. Yen M, Ewald MB. Toxicity of weight loss agents. J Med Toxicol. 2012;8(2):145-152.2235129945. French SJ, Read NW. Effect of guar gum on hunger and satiety after meals with different fat content: association with gastric emptying. Am J Clin Nutr. 1994;59(1):87-91.827940946. Pittler MH, Ernst E. Guar gum for reducing body weight: meta-analysis of randomized trials. Am J Med. 2001;110(9):724-730.1140375747. Heini AF, Lara-Castro C, Schneider H, Kirk KA, Considine RV, Weinsier RL. Effect of hydrolyzed guar fiber on fasting and postprandial satiety and satiety hormones: a double-blind, placebo-controlled study during controlled weight loss. Int J Obes Relat Metab Disord. 1998;22(9):906-909.975625048. Pasman WJ, Westerterp-Plantenga MS, Muls E, Vansant G, van Ree J, Saris WH. The effectiveness of long-term fiber supplementation for weight maintenance in weight-reduced women. Int J Obes Relat Metab Disord. 1997;21(7):548-555.922648449. Jones KL, MacIntosh C, Su YC, et al. Guar gum reduces postprandial hypotension in the elderly. J Am Geriatric Soc. 2001;49(2):162-167.1120787050. Krotkiewski M. Effect of guar gum on arterial blood pressure. Acta Med Scand. 1987;222(1):43-49.363077851. Riikonen S, Savonius H, Gylling H, Nikkilä K, Tuomi AM, Miettinen TA. Oral guar gum, a gel-forming fiber, relieves itching in intrahepatic cholestasis during pregnancy. Acta Obstet Gynecol Scand. 2000;79(4):260-264.1074683952. Gylling H, Riikonen S, Nikkilä K, Savonius H, Miettinen TA. Oral guar gum treatment of intrahepatic cholestasis and pruritus in pregnant women: effects on serum cholesterol and other non-cholesterol sterols. Your J Clin Invest. 1998;28(5):359-363.965000853. Gin H, Orgerie MB, Aubertin J. The influence of guar gum on the absorption of metformin from the intestine in healthy subjects. Horm Metab Res. 1989;21(2):81-83.272213354. Collins TF, Welsh JJ, Black TN, Graham SL, O’Donnell MW Jr. Study of the teratogenic potential of guar gum. Food Chemical Toxicol. 1987;25(11):807-814.369238655. Pittler MH, Schmidt K, Ernst E. Side effects of herbal dietary supplements for body weight reduction: systematic review. Obes Rev. 2005;6(2):93-111.1583645956. Tuomilehto J, Silvasti M, Manninen V, Uusitupa M, Aro A. Guar gum and gemfibrozil - an effective combination in the treatment of hypercholesterolemia. Arteriosclerosis. 1989;76(1):71-77.292006657. Fugh-Berman A. Herb-drug interactions. Lancet. 2000;355(9198):134-138.1067518258. Uusitupa M, Södervik H, Silvasti M, Karttunen P. Effects of a gel-forming fiber, guar gum, on glibenclamide absorption and metabolic control and serum lipids in patients with non-insulin-dependent (type 2) diabetes. Int J Clin Pharmacol Ther Toxicol. 1990;28(4):153-157.211093759. Anon. Australian Adverse Drug Reactions Bulletin. August 1989.60. Lewis JH. Esophageal and small intestinal obstruction caused by “diet pills” containing guar gum: Analysis of 26 cases reported to the Food and Drug Administration. Am J Gastroenterol. 1992;87(10):1424-1428.132949461. Lagier F, Cartier A, Somer J, Dolovich J, Malo JL. Occupational asthma caused by guar gum. J Allergy Clin Immunol. 1990;85(4):785-790.232441662. Castano R. Occupational rhinitis caused by simultaneous sensitization to two different allergens. Occup Med (Lond). 2012;62(6):466-468.2266160663. Partially hydrolyzed guar gum accelerates intestinal transit and relieves symptoms in adults with chronic constipation. Dig Dis Sci. 2014;59:2207-2214.2471107364. Brillantino A, Iacobellis F, Izzo G, Di Martino N, Grassi R, Renzi A. Maintenance therapy with partially hydrolyzed guar gum in the conservative treatment of chronic anal fissures: results of a prospective, randomized study. Biomed Res Int. 2014;2014:964942.2508928065. Jang AL, Hwang SK, Kim DU. Effects of Guar Gum Ingestion on Postprandial Blood Pressure in Older Adults. J Nutr Health Aging. 2015;19(3):299-304.66. Pirro M, Vetrani C, Bianchi C, Mannarino MR, Bernini F, Rivellese AA. Joint statement on “Nutraceuticals for the treatment of hypercholesterolemia” from the Italian Society of Diabetology (SID) and the Italian Society for Research on Arteriosclerosis (SISA). Nutr Metab Cardiovasc Dis. 2017;27(1):2-17. PMID: 279560242795602467. Huupponen R, Seppala P, Iisalo E. Effect of guar gum, a dietary fiber preparation, on digoxin and penicillin absorption in humans. Eur J Clin Pharmacol. 1984;26(2):279-281.632731868. Huupponen R, Karhuvaara S, Seppala P. Effect of guar gum on glipizide absorption in humans. Eur J Clin Pharmacol. 1985;28(6):717-719.299880369. Hoppu K, Tuomisto J, Koskimies O, Simell O. Food and guar reduce the absorption of trimethoprim. Eur J Clin Pharmacol. 1987;32(4):427-429.3609121

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