Psyllium: The Gel-Forming Nonfermented Isolated Fiber That Delivers Multiple Fiber-Related Health Benefits
Psyllium is a natural, predominantly soluble isolated fiber that forms a gel when hydrated. The psyllium gel is not fermented and transits the entire gastrointestinal tract intact. In the small intestine, the psyllium gel increases chyme viscosity, which slows the degradation and absorption of nutrients, which significantly improves fasting blood glucose and hemoglobin A1c levels in individuals with metabolic syndrome and type 2 diabetes mellitus (eg, −37 mg/dL). This delay in nutrient absorption prolongs satiety/delays hunger, leading to decreased energy intake and weight loss in overweight and obese patients. In the distal small intestine (terminal ileum), psyllium becomes more concentrated as water is absorbed, and the highly viscous gel interferes with the active reuptake of bile acids, which are captured in the gel and eliminated via stool. This decrease in the bile acid pool stimulates the liver to produce more bile. As cholesterol is a component of bile, the liver expresses low-density lipoprotein (LDL) cholesterol receptors to harvest LDL-cholesterol from the blood, thereby lowering both LDL-cholesterol (up to 24%) and total cholesterol (up to 20%) levels without affecting high-density lipoprotein cholesterol level. The cholesterol-lowering benefit of psyllium is also additive to the effects of statin drugs, with an effect equivalent to doubling the statin dose. In the large intestine, the nonfermented psyllium gel has a paradoxical “stool normalizing&rdqu...
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ConclusionWhile smoking has been associated with weight loss in the general population, most current evidence demonstrates that smoking habits are not associated with weight loss outcomes after bariatric surgery. However, due to the heterogeneity in study design and analysis, no definitive conclusions can be made, and more robust studies are needed to investigate any relationship between smoking and long-term weight loss outcomes. Given the established increased risk of surgical complications and mortality in smokers, smoking cessation should be encouraged.
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