Appetite Control by body togs

POSSIBLY EFFECTIVE

• Constipation. Oral guar gum may improve symptoms and stool frequency in adults and children with constipation. Details: Several small clinical studies in adults show that taking partially hydrolyzed guar gum increases stool frequency and relieves straining and pain when compared to baseline. Studied doses include 4-12 grams daily for up to 8 weeks or 11 grams twice daily for up to 3 weeks (12548,25073,93619). Small clinical studies in children with constipation also show that taking guar gum 3-5 grams daily for 4 weeks or partially hydrolyzed guar gum 6 grams daily for 2-15 months moderately increases bowel movement frequency and decreases abdominal pain when compared to baseline (93605,101889). While these improvements appear to be similar to those reported in children treated with lactulose (93605), a direct comparison is lacking.
• Diarrhea. Oral guar gum may reduce the duration of diarrhea in adults and children. Details: Two small clinical studies in patients in the intensive care unit show that adding guar gum 2% or 22 grams/L to enteral feeding formula reduces the number of liquid stools and decreases the percentage of days with diarrhea by around 70% when compared with control enteral formula (10325,54239). A larger clinical trial in children with acute watery diarrhea due to infections also shows that taking guar gum reduces the duration of diarrhea by around 16 hours when compared with a control (54210). Another clinical study in children with persistent watery diarrhea also shows that adding guar gum 20 grams/L daily for 7 days to a comminuted chicken diet improves the odds of diarrhea resolution after 7 days by 3-fold when compared with the chicken diet alone (54243).
• Hypercholesterolemia. Oral guar gum, taken alone or with other dietary fibers, may reduce cholesterol levels in patients with hypercholesterolemia. Details: Several small clinical trials in patients with hypercholesterolemia show that taking guar gum 15-18 grams in single or divided doses daily for up to 24 months lowers cholesterol levels when compared with baseline levels or placebo (4971,10897,54314,54318,54333). Additionally, a meta-analysis of 25 small clinical studies in patients with hypercholesterolemia, diabetes, hypertension, or metabolic syndrome shows that guar gum reduces total cholesterol by around 20 mg/dL and low-density lipoprotein (LDL) cholesterol by around 17 mg/dL, but does not reduce triglyceride levels, when compared with controls. Subgroup analyses suggest that improvements in total and LDL cholesterol are greater in patients with hypercholesterolemia and in those taking at least 15 grams of guar gum daily (107930). Additional clinical evidence shows that taking guar gum along with other dietary fibers can reduce cholesterol levels. Taking 20 grams of a mixture containing guar gum, pectin, and a small amount of the insoluble fibers from soy, pea, and corn bran daily for 36 weeks lowers total and LDL cholesterol, but does not affect high-density lipoprotein (HDL) cholesterol or triglyceride levels (12547,54335). Also, taking a specific product containing guar gum and psyllium (Minolest) 16.5 grams daily for 3 months reduces total and LDL cholesterol when compared with placebo, but does not affect triglyceride levels (54206). Taking 15 grams of a combination of guar gum, psyllium, pectin, and carob gum daily for 6 months also appears to reduce total and LDL cholesterol when compared to baseline (8431).
• Hypertension. Oral guar gum may modestly reduce systolic and diastolic blood pressure, although these reductions may not be considered clinically significant. Details: Several small clinical trials in patients with hypertension show that taking guar gum 7-10 grams with each meal daily for up to 6 weeks modestly reduces systolic and diastolic blood pressure when compared with placebo (54232,54304,54320). However, guar gum does not appear to be as effective for reducing blood pressure as psyllium husk (54260). A meta-analysis of clinical trials in adults also shows that taking guar gum 1-30 grams daily for 6 weeks to 6 months reduces systolic and diastolic blood pressure by approximately 1 mmHg when compared with placebo or no intervention. However, many patients included in these trials did not have hypertension at baseline. Sub-analyses suggest that the effects of guar gum on blood pressure may be larger in patients with hypertension. The validity of this meta-analysis is limited by high heterogeneity (105507).
• Irritable bowel syndrome (IBS). Oral guar gum may improve bowel function and abdominal pain in adults and children with IBS. Details: Clinical trials in adults with IBS show that taking guar gum 5-10 grams daily for 12 weeks improves abdominal pain, bowel function, and quality of life when compared with baseline or wheat bran (10326,54245). A small clinical study in children 8-16 years of age with chronic abdominal pain and IBS shows that taking partially hydrolyzed guar gum 5 grams daily for 4 weeks decreases symptom frequency and normalizes bowel movements when compared with placebo. However, it does not improve abdominal pain (93615). Another small clinical trial in children 1-18 years of age with IBS shows that taking a specific guar gum product (Resource Optifibre, Nestle HealthCare Nutrition) for at least 6-8 weeks improves stool consistency and abdominal pain when compared to baseline (93621).

POSSIBLY INEFFECTIVE

• Obesity. Oral guar gum may not improve body weight in patients with obesity. Details: Several small clinical trials in overweight or obese adults show that taking guar gum 10.5-20 grams in divided doses daily for up to 14 months does not reduce body weight or improve satiety when compared with placebo or other controls (54212,54260,54353,54360). Additionally, a meta-analysis of 11 small clinical studies of various patient populations, including postmenopausal adults and those with hyperlipidemia or diabetes, shows that taking guar gum 7.5-21 grams daily for 3 weeks to 6 months does not reduce body weight when compared with placebo (8305).

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Anal fissures. It is unclear if oral guar gum is beneficial in patients with anal fissures. Details: A small clinical study in patients with chronic anal fissures treated with topical application of glyceryl trinitrate shows that taking partially hydrolyzed guar gum 5 grams daily as maintenance therapy for a total of 10 months increases success rate by 53% and decreases the risk for recurrence of anal fissures by 52% when compared with control (93617).
• Autism spectrum disorder. It is unclear if oral guar gum is beneficial in children with autism spectrum disorder. Details: A very small clinical study in children 4-9 years of age with autism and constipation shows that taking partially hydrolyzed guar gum (Sunfiber, Taiyo Kagaku Co. Ltd.) 6 grams daily for 2-15 months moderately improves irritability, but not other measures of behavior, when compared to baseline (101889). The validity of this finding is limited by the lack of a comparator group.
• Chemotherapy-induced diarrhea. It is unclear if oral guar gum is beneficial for the prevention or treatment of chemotherapy-induced diarrhea. Details: A clinical study in patients receiving 5-fluorouracil chemotherapy for colorectal cancer shows that adding guar gum (Novasource GI control, Novartis Nutrition) 11 grams daily on cycle days 7-14 for 24 weeks to treatment with Lacticaseibacillus rhamnosus GG does not reduce the rate of severe diarrhea or other abdominal complaints when compared with no treatment or L. rhamnosus GG alone (16736).
• Cholera. It is unclear if oral guar gum is beneficial for improving diarrhea in patients with cholera. Details: A small clinical study in adults with cholera treated with doxycycline shows that adding guar gum 25-50 grams to oral rehydration solution for 2 days does not reduce the duration of diarrhea, but might reduce stool weight over the first 24 hours, when compared with oral rehydration solution alone (54262).
• Cholestasis. Small clinical studies suggest that oral guar gum may not improve symptoms of cholestasis during pregnancy. Details: Two small clinical studies in patients with cholestasis during pregnancy show that taking a specific granulated guar gum product (Guarem, Orion Pharmaceutical) 5-15 grams daily until delivery does not reduce the intensity of pruritus or improve liver function when compared with placebo (54209,54356).
• Diabetes. Small clinical studies suggest that oral guar gum might improve postprandial glucose levels in patients with type 1 diabetes; whether guar gum is effective for improving glycemic control in patients with type 2 diabetes is unclear. Details: Two small clinical studies in patients with type 1 diabetes show that taking guar gum 5 grams with meals four times daily for 4-6 weeks lowers postprandial glucose levels when compared with placebo (10896,12545). However, clinical trials in patients with type 2 diabetes show conflicting results. Several very small clinical studies suggest that taking guar gum 5-7.6 grams with each meal daily for up to 48 weeks lowers blood glucose when compared with baseline levels or placebo in patients with type 2 diabetes (12540,12541,12542,12543,12544). However, other small clinical trials in these patients show that taking guar gum 5-7 grams with each meal for up to 3 months does not improve glycemic control (54270,54275,54320,54326). The reasons for these discrepant findings are unclear; however, all of the studies in patients with type 2 diabetes were very small and likely underpowered to identify significant treatment effects. In addition to glycemic control, the effect of guar gum on serum lipids in patients with diabetes has also been evaluated. A meta-analysis of 11 small clinical studies in patients with type 2 diabetes with or without hypercholesterolemia shows that taking guar gum 5-30 grams daily for up to 6 months reduces total cholesterol by around 20 mg/dL and low-density lipoprotein (LDL) cholesterol by around 15 mg/dL. Doses of guar gum 20 grams daily or greater also appear to reduce triglyceride levels by around 13 mg/dL, while lower doses have no effect (107929).
• Influenza. It is unclear if oral guar gum is beneficial for the prevention of influenza. Details: Observational research in hospitalized patients has found that taking partially hydrolyzed guar gum 5.2 grams daily for the duration of a hospital stay is associated with a lower risk of influenza when compared with those not taking guar gum. One additional case of influenza appears to be prevented for every 14 patients taking guar gum over placebo (107928).
• Malnourishment-related diarrhea. It is unclear if oral guar gum is beneficial in children with malnourishment-related diarrhea. Details: A small clinical study in children aged 6-36 months with acute watery diarrhea related to malnutrition shows that adding guar gum 15 grams/L to oral rehydration solution reduces the duration of diarrhea by around 18 hours when compared with oral rehydration solution alone (93616).
• Postprandial hypotension. Small clinical studies suggest that oral guar gum may be beneficial for the prevention of postprandial hypotension in older females and patients with type 2 diabetes. Details: A small clinical study in older females with postprandial hypotension shows that taking guar gum 9 grams along with a meal decreases the risk of postprandial hypotension by 75% when compared with placebo (93618). Another small clinical study in patients with type 2 diabetes shows that taking guar gum 9 grams prior to a meal reduces the risk of postprandial decreases in blood pressure when compared to baseline (12540).
• Small intestinal bacterial overgrowth (SIBO). It is unclear if oral guar gum is beneficial in patients with SIBO. Details: A small clinical study in patients with SIBO shows that taking guar gum 5 grams daily along with rifaximin 1200 mg daily for 10 days increases the chance for eradication of SIBO by 37% to 40% when compared with rifaximin alone. However, overall clinical improvement appears to be similar for guar gum plus rifaximin and rifaximin alone (93622). More evidence is needed to rate guar gum for these uses.

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LIKELY SAFE ...when used orally and appropriately. Guar gum has been safely used in doses up to 15 grams daily for up to two years (10326,10897,12541,12543,12544,12548,54212,54245,54260,54275)(54333,93617,93619,93622,101888). Doses up to 20 grams daily have been safely used for up to 51 weeks (10896,12545,12547,54314). Guar gum has Generally Recognized as Safe (GRAS) status as a food additive in the US (4912).

CHILDREN: POSSIBLY SAFE
when used orally and appropriately. Guar gum has been safely used in doses of 4-5 grams daily for 4 weeks in children 6-16 years of age (93605,93615). Guar gum 3 grams daily for 4 weeks has been safely used in children 4-6 years of age (93605).

PREGNANCY: POSSIBLY SAFE
when used orally and appropriately in medicinal amounts. Guar gum has been safely used at doses of 5-15 grams daily for up to 4 weeks during pregnancy (54209,54356).

LACTATION:
There is insufficient reliable information available about the safety of using medicinal amounts of guar gum during lactation; avoid using.

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DIGOXIN (Lanoxin) Interaction Rating = Minor Be watchful with this combination. Severity = Insignificant •  Occurrence = Possible •  Level of Evidence = B Guar gum might slow digoxin absorption, but it does not seem to impact how much digoxin is absorbed overall.  Details Two small studies in healthy volunteers show no change in the overall extent of digoxin absorption, although early absorption was slowed, when taken with guar gum (533,25074).

ETHINYL ESTRADIOL Interaction Rating = Moderate Be cautious with this combination. Severity = High •  Occurrence = Possible •  Level of Evidence = D Theoretically, guar gum might reduce the absorption of ethinyl estradiol, potentially decreasing its effectiveness.  Details Animal research shows that taking guar gum with ethinyl estradiol decreases ethinyl estradiol absorption (12421). However, this effect has not been reported in humans.

METFORMIN (Glucophage) Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Probable •  Level of Evidence = B Guar gum might reduce the absorption of metformin, potentially decreasing its effectiveness.  Details A small study in healthy volunteers shows that guar gum reduces the absorption rate of metformin (532,12546).

ORAL DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = B Guar gum might reduce the absorption of some oral drugs, potentially decreasing their effectiveness.  Details Clinical research shows that guar gum reduces or slows absorption of medications such as penicillin and metformin (532,533). To avoid changes in absorption, take guar gum 30-60 minutes after oral medications.

PENICILLIN Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Probable •  Level of Evidence = B Guar gum might reduce the absorption of penicillin, potentially decreasing its effectiveness.  Details A small clinical study in healthy volunteers shows that taking guar gum with penicillin results in decreased penicillin absorption and reduced penicillin levels (533).

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General ...Orally, guar gum is generally well tolerated.
Most Common Adverse Effects:
Orally: Abdominal pain, bloating, diarrhea, flatulence, heartburn, gas, and loose stools.
Serious Adverse Effects (Rare):
Orally: Severe esophageal and small bowel obstruction when taken with an inadequate amount of fluid.

Gastrointestinal ...Orally, guar gum may cause gastrointestinal adverse effects such as abdominal cramps, abdominal pain, bloating, diarrhea, flatulence, heartburn, gas, and loose stools (10896,10897,12541,12543,12545,12547,12548,54209,54212,54232)(54260,54314,54333,93617,93619). Gastrointestinal side effects can be minimized by starting with small doses and titrating up. In one clinical study, taste aversion to guar gum leading to withdrawal from the study has been reported (16736).
When guar gum is consumed with inadequate amounts of fluids, it can cause severe esophageal and small bowel obstruction. Tell patients to take guar gum with at least 8 ounces (250 mL) of water (602,54230).

Pulmonary/Respiratory ...Occupational exposure to guar gum may cause asthma (600,601).

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