Abstract
BACKGROUND: Both flaxseed and psyllium have previously been shown to reduce constipation symptoms, weight, glycemic and lipid levels, and we postulate that treatment with flaxseed and psyllium may have similar benefits. OBJECTIVE: To compare constipation symptoms, weight, glycemia, and lipids in constipated patients with type 2 diabetes (T2D) who received baked flaxseed or psyllium versus those who received a placebo. METHODS: In a single-blinded, randomized controlled trial, 77 constipated patients with T2D were randomized into three groups. Patients received either 10 g flaxseed or psyllium pre-mixed in cookies or placebo cookies twice per day for a total of 12 weeks. The constipation symptoms, body mass index (BMI), fasting plasma glucose (FPG), glycosylated hemoglobin (HbA1c), and lipid profile were determined at the beginning and end of 4, 8, and 12-week period. Constipation was assessed with the ROME III criteria score. RESULTS: The flaxseed appear to be superior to psyllium for improving constipation symptoms, weight, glycemic, and lipid control. The change from baseline of constipation symptoms (P = 0.002), stool consistency (P < 0.001), weight (P < 0.001), BMI (P < 0.001), FPG (P = 0.004), cholesterol (P = 0.010), LDLC (P = 0.031), and cholesterol/HDLC ratio (P = 0.019), was significantly improved in both flaxseed and psyllium groups than in the placebo group. The compliance was good and no adverse effects were observed. CONCLUSION: Although both flaxseed and psyllium may decrease constipation symptoms, weight, glycemic and lipid levels, treatment with flaxseed appear to be superior to psyllium.
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Key Points
No clinical trial have compared the effect of flaxseed with psyllium on reducing constipation symptoms, weight, glycemic and lipid levels in constipated patients with type 2 diabetes (T2D). This study postulated that treatment with flaxseed and psyllium may have benefits. The aim of this single-blinded, randomized, placebo-controlled trial was to compare the beneficial effects of flaxseed or psyllium versus a placebo among constipated patients with T2D. The study tested the hypothesis that 10 g flaxseed and 10 g psyllium will reduce constipation symptoms, body weight and improve the glycemic and lipid levels in constipated patients with T2D. In the present study, although both flaxseed and psyllium groups increased the subjective measures of constipation, the flaxseed treatment group was superior to the psyllium group. This study revealed significant, clinically meaningful reduction of 1.5 and 0.7 kg/m2 BMI and 3.8 and 2.0 kg body weight when the flaxseed and psyllium groups at baseline was compared with the flaxseed and psyllium groups after 12 weeks therapy. This study shows that the flaxseed treatment group is superior at weight loss to the psyllium treatment group. In addition, the superior weight loss effect of flaxseed increased over the 12-week treatment period, suggest that the effect may increase with continued consumption. The improved glycemic and lipid control in both flaxseed and psyllium groups could be attributed to changes in body weight. Effect of flaxseed on glycemic control which showed an improvement in both FPG and HbA1c, is clinically meaningful which is comparable to the effect of many medications that are used to treat T2D. It found that although consumption of both 10 g of flaxseed or psyllium baked in cookies daily for 12 weeks may decrease constipation symptoms, weight, glycemic and lipid levels, treatment with flaxseed is superior to psyllium.