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They help trap it’s Hodgkin lymphoma erectile dysfunction specialist doctor discount kamagra oral jelly 100mg fast delivery, the lymphocytes disease-causing germs that enter through your will be abnormally large and may have nose or mouth impotence losartan trusted 100mg kamagra oral jelly. Under the microscope Three types of white blood cells erectile dysfunction rings generic 100mg kamagra oral jelly fast delivery, as seen under a microscope erectile dysfunction in middle age kamagra oral jelly 100 mg amex. These oversized Types of Hodgkin lymphoma lymphocytes are called Reed-Sternberg cells. Cancer researchers don’t know why normal There are 2 types of Hodgkin lymphoma: lymphocytes turn into Reed-Sternberg cells. It can transform into an aggressive (fast-growing) type of nonHodgkin’s lymphoma. If left untreated, it will spread to tissue and organs outside the lymphatic system. While widely used in the diagnosis of other types of cancer, it Excisional lymph node biopsy shouldn’t be used by itself to diagnose Hodgkin the best way to diagnose Hodgkin lymphoma lymphoma. A diagnosis can be made depending on which proteins can be Needle biopsies seen (and not seen) using this technique. There are three symptoms in particular that are important for your doctor to be aware of, if you have them. It is used by feel the areas of your body where there are the doctors to decide if you are able to have certain most lymph nodes, including the neck, armpits, treatments. In addition to examining areas where there are lots of lymph nodes, expect your doctor to feel your spleen and liver. A high level of this protein can be a sign You should have a number of common blood of cell damage caused by cancer or other tests as part of the workup (testing) for Hodgkin health problems. This test measures how quickly red blood cells settle at the bottom of a test tube that contains a blood sample. This group of 14 diferent blood tests provides information about the health of your liver and kidneys, and other information including your blood sugar, calcium, electrolytes, and cholesterol. Erythrocyte sedimentation rate this test measures how quickly red blood cells settle at the bottom of a test tube that contains a blood sample. Areas with to see how well the cancer is responding cancer appear brighter (“hotter”) because to treatment. Deauville scores A scoring system is used to describe how much of the tracer is absorbed by areas with cancer compared to how much is absorbed by your Deauville scores liver and by the area between the lungs (but not the lungs themselves). A score of 1 or 2 is generally considered Whether that score goes up or down “negative”, meaning that there are no as a result of treatment is important. A score of 4 or 5 this is how doctors know how well the is generally considered “positive,” meaning that cancer is responding to treatment. If other imaging tests show a large, suspicious mass in the area between the lungs, a chest x-ray is recommended. Chest x-ray A chest x-ray is recommended if a large mass in the middle of your chest is seen with other imaging tests. In order to plan your treatment, fi Spirometry measures the amount of air your doctors will test how well your heart and the lungs can hold, and how fast you can lungs work. It can provide a wide range of important oxygen travels from your lungs into your information, including how much blood is blood. This test measures how much air your lungs can hold and how much air is left in Lung function tests your lungs after you exhale. In order to learn if your lungs can handle treatment with bleomycin, you should have lung testing before starting treatment. Echocardiogram An echocardiogram is one way of measuring ejection fraction, which is the amount of blood pumped out of the left side of your heart each time it beats. Measurement of ejection fraction is recommended for most people before starting chemotherapy that includes doxorubicin. Most people will have chemotherapy with a regimen that is unlikely to cause infertility. Ovarian tissue banking this method involves removing part or all of an If you want the option of having children after ovary and freezing the part that contains the treatment or are unsure, tell your doctors. The frozen tissue that contains the eggs There are ways for cancer patients to be can later be unfrozen and put back in the body. The most common Ovarian transposition methods of fertility preservation are described this method is an option for women who will next. In addition, women diagnosed with be treated with radiation therapy to the pelvis. Hodgkin lymphoma should expect to be tested this surgery moves one or both ovaries and for pregnancy before starting treatment. Men who want the option of fathering children after cancer treatment can use sperm banking. The medical term for this is semen Spirometry Spirometry is one of the most common lung function tests. It measures the amount of air the lungs can hold, and how fast you can empty the air out of your lungs. Despite its name, the H-fu does not longer included in the initial testing for Hodgkin cause the common fu. In this case, get vaccinated before treatment against pneumonia, meningitis, Guide 2 Other testing and care you may have before treatment Heart function testing If chemotherapy that includes doxorubicin is planned, measuring your heart’s ejection fraction is needed. The diaphragm is a thin muscle For the purposes of treatment, the stages below the lungs and heart. It can be thought are often grouped together as follows after of as a dividing line between the chest and diagnosis and initial workup: the abdomen. A simplifed description of the symptoms (unexplained fevers, drenching night stages is provided next. The letter are described in more detail on the following “A” after the stage means that there aren’t B pages. It separates the chest from the abdomen and is the primary muscle used for breathing. There may also be cancer in one area or organ outside of the lymphatic system, in the spleen, or both. Or, there may be cancer in one organ outside of the lymphatic system and also in distant lymph nodes. However, fertility preservation methods are available if treatment with a regimen that may cause infertility is planned. Chemotherapy is the most widely used and most efective treatment for Hodgkin Chemotherapy medicines may be given lymphoma. If two or more chemotherapy medicines are given together, it is called a combination regimen. Steroids are drugs Chemotherapy is the use of medicine to kill often used to relieve infammation, but also cancer cells. Most chemotherapy to treat Hodgkin lymphoma chemotherapy drugs are liquids that are slowly include: injected into a vein. The drugs travel in your bloodstream fi Dexamethasone to treat cancer throughout your body. You existing cancer cells or stops new cancer cells may be asked to hold your breath during the from being made. Radiation can also harm simulation scan or treatment in order to limit the normal cells. External radiation simply means that the radiation comes from a machine outside of (external to) your body. A simulation session is required if radiation therapy is planned and is done before the start Radiation therapy Radiation therapy is usually used in addition to chemotherapy to treat Hodgkin lymphoma. A type of external radiation therapy called involved-site radiation therapy targets the lymph nodes where the cancer started and nearby areas of cancer. During the procedure, you may have lightheadedness, Blood stem cells are cells that develop into chills, numbness around the lips, and cramping mature blood cells. The goal of a stem cell transplant is to cure cancer If the stem cells are being collected from by replacing unhealthy blood stem cells with your bone marrow, a procedure called bone healthy ones.

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Increased excretion of albumin is a sensitive marker for chronic kidney disease due to erectile dysfunction questionnaire uk kamagra oral jelly 100 mg without prescription diabetes impotence from diabetes kamagra oral jelly 100mg line,glomerular disease erectile dysfunction stress treatment purchase kamagra oral jelly australia,and hypertension erectile dysfunction causes agent orange discount 100 mg kamagra oral jelly mastercard. Guidelines for Adults and Children • Under most circumstances,untimed (‘‘spot’’) urine samples should be used to detect and monitor proteinuria in children and adults. For example, in diabetic kidney disease, early detection of albuminuria appears to permit effective therapy early in the course of disease. The purpose of this guideline is to review the rationale for methods of assessment of proteinuria and to determine whether detection and monitoring of proteinuria using untimed (‘‘spot’’) urine samples is as accurate as using timed (overnight or 24-hour) urine specimens. In clinical practice, most screening (qualitative) methods use a commercial dipstick, which measures total protein or albumin. However, they afford low sensitivity; ie, they may fail to detect some forms of kidney disease during the early stages, when the level of proteinuria is below the sensitivity of the test strip used. However, in recent years some studies have advocated that the measurement of protein excretion should be done on an overnight specimen. Indeed, evaluation for postural (orthostatic) proteinuria requires comparison of a measurement of protein excretion in an overnight (‘‘recumbent’’) collection to a daytime (‘‘upright’’) collection. An alternative method for quantitative evaluation of proteinuria is measurement of the ratio of protein or albumin to creatinine in an untimed ‘‘spot’’ urine specimen. The assessment of protein excretion in the urine can be accomplished by several different techniques. In general, the literature does not provide substantial information concerning the relative merits of measuring total protein versus albumin to detect and monitor kidney damage. Evaluation 103 Rationale for Using ‘‘Spot’’ Urine Samples Collection of a timed urine sample is inconvenient and may be associated with errors (R, O). Twenty-four-hour urine collections may be associated with significant collection errors, largely due to improper timing and missed samples, leading to overcollections and under-collections. Timed overnight collections or shorter timed daytime collections may reduce the inconvenience of a 24-hour collection, but are still associated with collection errors. Several studies have addressed the relationships between total excretion of protein or albumin and the ratio of either to creatinine in patients of all ages (Tables 56, 57, 58, and 59). A first morning urine specimen is preferred because it correlates best with 24-hour protein excretion and is required for the diagnosis of orthostatic proteinuria. Table 60 compares the advantages and disadvantages of the various modalities of collecting urine for evaluating kidney function. The differences among these protocols balance ease of collection of samples with the need to collect urine to reflect kidney function over the course of the day or overnight. Rationale for Measurement Methods Screening for proteinuria with urine dipsticks is acceptable. Screening with a dipstick for proteinuria or albuminuria is often a satisfactory first approach to evaluation of kidney disease; however, clinicians need to be cognizant of causes of false positive and more importantly false negative results (Table 61), and in both instances repeat analyses of urine with quantitative total protein or albumin and creatinine analyses are strongly advised when a result may be inconsistent with the clinical evaluation. Quantitative measurements provide a more accurate assessment of changes in proteinuria. In patients with diabetes mellitus, there has been nearly a uniform adoption of albumin as the ‘‘criterion standard’’ in evaluating kidney damage. Preliminary data suggest that elevated albumin excretion is also a marker of kidney damage in adults with hypertension. The interpretation of albuminuria in kidney transplant recipients is more complicated than in other patients with chronic kidney disease. First, depending on the interval since transplantation, the patients’ native kidneys may still excrete small amounts of protein, which may be sufficient to cause a positive test for albumin. It is acceptable to measure total protein-to-creatinine ratio as an index of proteinuria in adults when albumin-to-creatinine ratio is substantially elevated (eg, 500 to 1,000 mg/g). In contrast, the prevalence of kidney disease due to urinary tract abnormalities and congenital tubular disorders is far more common in children than in adults. Other diabetic children are screened using the same algorithms as for other children. Excretion of total protein or albumin in the urine are highly variable in individuals with or without kidney disease. Examples of conditions that affect protein excretion other than kidney disease include activity, urinary tract infection, diet, and menstruation. Some authors have advocated that multiple (up to 5) specimens be obtained in order to obtain a reliable result. However, the Work Group acknowledges the need to repeat abnormal tests, especially low levels of total protein or albumin and the necessity to carefully consider the clinical setting in interpretation of urine protein measurements. A limitation of this guideline is the use of correlation coefficients, rather than more detailed assessments of precision and bias, to assess the accuracy of spot urine measurements of protein-to-creatinine ratios as a measure of protein excretion rates. In addition, other than distinguishing normal from abnormal, the exact level of proteinuria is not usually required for clinical decision-making. Thus, the Work Group concludes that the uniformly high correlation coefficients are sufficiently strong evidence to warrant the conclusions presented here. Such patients may benefit from subsequent changes in management that forestall or prevent additional kidney problems. The prognosis of patients with a variety of kidney disorders often correlates with their level of and persistence of proteinuria over time—even when other variables are controlled. This is important because of the obvious therapeutic implications for patients who are in the high risk category that is characterized by persistent, heavy proteinuria. Many lines of evidence now indicate that medications that reduce proteinuria may provide significant long term benefits for patients with chronic kidney disease. The first is the widely held belief that 24-hour urine collections provide ‘‘the only accurate method’’ of measuring protein or albumin excretion. This even applies to some pediatricians who continue to request 24-hour urine studies in small children despite the high degree of difficulty involved. The second potential problem involves the adoption of urine protein measurements factored by urine creatinine. This approach has been developed to some extent for urine calcium-to-creatinine measurements, but many physicians are not aware of the accuracy and validity of protein-to-creatinine ratios. A less obvious implementation issue relates to measuring albumin rather than total protein in the urine specimens. Assays for albumin may not be as available as those for total protein in some smaller communities. Additional efforts should be instituted to identify constituents present in blood and/or urine that indicate normal kidney function with high specificity. These studies should incorporate better procedures to examine the efficacy of sustaining kidney function in advanced kidney disease and in reducing the incidence of cardiovascular disease in patients with kidney disease. Constellations of markers define clinical presentations for some types of chronic kidney disease. In addition, these assessments provide clues to the type (diagnosis) of chronic kidney disease. Abnormalities of the Urinary Sediment Examination of the urinary sediment, especially in conjunction with assessment of proteinuria, is useful in the detection of chronic kidney disease and in the identification of the type of kidney disease. Casts form only in the kidneys and result from gelation within the tubules of Tamm-Horsfall protein, a high molecular weight glycoprotein derived from the epithelial surface of the distal nephron. A ‘‘fresh’’ first morning specimen is optimal, and repeated examination may be necessary. Urinary eosinophils have been specifically associated with allergic tubulointerstitial nephritis. However, dipsticks cannot detect tubular epithelial cells, fat, or casts in the urine. The choice of urine sediment examination versus dipstick depends on the type of kidney disease that is being considered. Imaging Studies Abnormal results on imaging studies suggest either urologic or intrinsic kidney diseases. Imaging studies are recommended in patients with chronic kidney disease and in patients at increased risk of developing chronic kidney disease due to urinary tract stones, infections, obstruction, vesico-ureteral reflux, or polycystic kidney disease. Hydronephrosis on ultrasound examination may be found in patients with urinary tract obstruction or with vesico-ureteral reflux. Imaging studies employing iodinated contrast agents can cause acute kidney damage and may present significant risks to some patients with decreased kidney function. The appropriateness and frequency of follow-up studies will vary from case to case. Table 63 provides a brief overview of possible interpretations of abnormalities on imaging studies of the kidney. Evaluation 115 Clinical Presentations of Kidney Disease Some constellations of abnormalities in blood and urine tests or imaging studies comprise specific clinical presentations of kidney disease.

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These claims are used to erectile dysfunction doctor brisbane order kamagra oral jelly 100mg amex market the product and boost its sales by coconut oil companies impotence age 40 cheap 100mg kamagra oral jelly with mastercard. However erectile dysfunction zinc deficiency buy kamagra oral jelly 100 mg without prescription, governmental regulatory agencies in many countries are still sceptical about the benefts obtained by the consumption of coconut oil due to erectile dysfunction lipitor generic 100mg kamagra oral jelly free shipping its high-saturated fatty acid content. In light of such controversy, this review focused on analysing the published literature on the alleged health claims, in order to investigate if there is enough scientifc evidence to support them. It was verifed that the metabolism of lauric acid, the major fatty acid in coconut oil, remains unclear. Also, it has been reported that the consumption of coconut oil increased low-density lipoprotein cholesterol, consequently increasing the risk of cardiovascular diseases. In general, the studies present conficting results and there is a lack of long-term human-based clinical trials. Therefore, as a saturated fat, coconut oil should be consumed with moderation and the health allegations should not be used to market the product, once they are not scientifcally proven so far. Celebrities, digital subtropical countries, with the coconut tree being referred as the ‘tree of life’. In such places, coconut and its products (milk and oil, infuencers, and even doctors have endorsed the use of this oil as among others) are used in daily life by the general population for seva cooking media in substitution to other vegetable oils and as a eral purposes, such as cooking, hair and skin treatment, food ingresupplementary ingredient to be consumed with coffee and vitamin dient, and folk medicine (DebMandal and Mandal, 2011). These benefts include cholesterolheavily located in Asia, which was responsible for 83. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License creativecommons. Both health agencies support that there is not conclusive one tablespoon once to three times a day with a meal (iHerb, 2018b; scientifc evidence about this topic. The excessive ingestion of saturated media, the general public, and the manufacturing companies are fatty acids has been positively correlated with the increase of lowpresented and discussed. As a result, its price per cent limit in a 2000 kcal diet means that the subject would ingest skyrocketed while the soy industry began to expand and develop, an amount of approximately 24 g of saturated fat on a daily basis. Once the also have issued a scientifc opinion on the specifc claims about war was over, even though countries with high-coconut production Figure 1. This refbrous, and thick (3–5 mm), whereas the testa is the thin brown layer jection was associated with the fndings of epidemiological studies separating the kernel from the shell (Pradeepkumar et al. It generates on such data, formulated a hypothesis of the association between most of the products such as milk, oil, and dried coconut, among the consumption of high-saturated fat with a high-blood cholesothers. In the sun drying method, the kernels are placed under the the American Heart Association started in 1956, in parallel to sun for 6 to 8 days. In the direct-fre drying method, nuts are placed Key’s research, informing the population that large consumption of in a bamboo grill platform where heat is provided by the burning high-saturated fat foods, such as butter, lard, eggs, and beef could of coconut shells and husks. The process is conducted in a drying device launched a recommendation stating that adopting a low-fat diet was equipped with a steel plate bottom to isolate the kernels from getting necessary to prevent these diseases. The copra cake usually presents an oil content of appossible explanation for the reported results (Heek and Zilversmit, proximately 7 per cent and an extraction using hexane as solvent 1991; Cox et al. On the other hand, studies that used is performed, reducing the oil content of the cake to 3. After refning, the oil is healthier cooking oil alternative, changing the perception of the bleached and deodorized at 204–245°C (O’Brien, 2004). Regardless of the use of refning or not to obtain scientifc evidence about its effects on health. The origin of this plant is still a subject of number between 8 and 12 (Eyres et al. The proportion of debate, but the most accepted hypothesis is that the coconut tree was saturated, monounsaturated, and polyunsaturated fatty acids in the originated in the India–Indonesia region. Botanically, the coconut major oils and fats consumed in the diet can be observed in Figure 2. Some of saturated fatty acids (93%–100%); therefore, this dosage researchers believe that lauric oils have unique properties, once they surpasses the recommended daily intake of saturated fat (around behave very differently in the metabolism compared with fats ma24–22 g). Butter, lard, and palm oil present a much lower conThere is an ongoing debate whether the lauric acid should be centration of this type of fatty acid (51. Proportion of saturated, monounsaturated, and polyunsaturated fatty acids in the main fats and oil. However, they cannot be absorbed by the intestine in such dermartitis, poor wound healing, impaired growth, and increased state; therefore, they are partially hydrolysed by the action of acidsusceptibility to infections (Simopoulos, 2002). The hydrolysis oil should not be encouraged, once it exhibits a low smoking point promoted by lipases (especially pancreatic lipases) preferentially (171°C) and its use in continuous deep-frying leads to the protakes place at the sn-3 and sn-1 positions, respectively (Bracco, duction of carcinogenic substances, such as polycyclic aromatic 1994). This is due to the fact that the pancreatic lipase exhibits a hydrocarbons and aromatic amines. Oils with higher smoking points high affnity for short-chain saturated fatty acids (lower than 10 are preferred for deep drying, such as canola oil (238°C), corn oil carbons) located at the sn-3 and sn-1 positions, which accounts for (232°C), and soybean oil (238°C) (Srivastava et al. From this point on, the metabolic pathways in diis the argument used to support this claim. The glycerol and the chylomicron remnants the other hand, lower hunger suppression at 240 min, satiety, and are ultimately transported to the liver (Mu and Hoy, 2004). Some acids, due to their smaller molecular weight, are hydrolysed faster limitations such as the fact that this was not a long-term study when compared with long-chain saturated fatty acids. This fatty acid is present in much smaller meal were weighted to measure food intake. The exclusion of per cent of lauric acid is directly transported to the liver (Lockyer obese subjects, the high amount of fat administered, which does not and Stanner, 2016; Clegg, 2017; Sankararaman and Sferra, 2018). The few existing data are not sufaged 20–40 years old presenting abdominal obesity. Both groups fcient to indicate that the metabolism may be accelerated through decreased energy intake and the amount of carbohydrate ingested the consumption of coconut nut. The lipid profle (total cholesterol, primary function of structuring cell membranes, maintaining its Effects of coconut oil, 2019, Vol. On the other hand, this effect would be diminished when within the walls of arteries. The authors highlighted that the lipoprotein metabceride levels were not signifcant between the groups studied. The consumption of foods capable of increasing serum cholesterol and authors reported that this result was expected due to the proportion blood pressure. The consumption of different oils with this chemical and sunfower oil affected the cardiovascular risk factor in humans. After a period of On the other hand, fats rich in saturated fatty acids are known 2 years, their lipid profle, antioxidant mechanism, and endothelial for increasing blood cholesterol, which is one of the prevalent causes function were analysed. No signifcant differences between the two of atherosclerosis, associated with an increased risk for coronary groups were observed. The in American men and women in two prospective longitudinal cohort limitations of this study include the low number of subjects and the studies. The risk was signifcantly decreased when saturated fatty the two oils for a period of over 2 years. However, due to its majorly saturated structure, composed lowering medication by the patients. Also, the media should not take consumption with an improvement of the symptoms of Alzheimer’s. However, more repolyphenol extract (80 mg/kg) exhibited 74 per cent inhibition on search is needed, especially human trials, in order to verify how such adjuvant induced chronic model of infammation and the antioxicomponents can affect the health, and to establish the necessary dant enzymes were also increased on adjuvant-induced arthritis rats. We are grateful to the National Council of Technological and Scientifc Intahphuak et al. Infuence of virgin coconut oil-enriched however, the subjects’ diets were altered during the experiments, diet on the transcriptional regulation of fatty acid synthesis and oxidaincreasing the level of fbre and protein and reducing the ingestion in rats – a comparative study. Effects of dietary coconut oil on the biochemthese studies did not evaluate the lipid profle of the subjects for an ical and anthropometric profles of women presenting abdominal obesity. Effect of dietary triacylglycerol fatty feeding of corn oil and hydrogenated coconut oil. Experimental Biology acid positional distribution on plasma lipid classes and their fatty acid and Medicine, 106 (4): 800–801. Olive oil intake and risk of cardiovascular esterol levels in healthy volunteers: a randomized crossover trial. Novel coconut oil, butter, and saffower oil on lipids and lipoproteins in persons aspects of oxidative stress in cardiovascular diseases.

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Pectins frequently have side chains of neutral sugars impotence 21 year old generic kamagra oral jelly 100mg amex, and the galactose units may be esterified with a methyl group erectile dysfunction tumblr purchase 100mg kamagra oral jelly, a feature that allows for its viscosity causes of erectile dysfunction in 20s purchase kamagra oral jelly amex. While fruits and vegetables contain 5 to impotence or erectile dysfunction buy 100mg kamagra oral jelly 10 percent naturally occurring pectin, pectins are industrially extracted from citrus peels and apple pomace. Isolated, high methoxylated pectins are mainly added to jams due to their gelling properties with high amounts of sugar. Low methoxylated pectins are added to low-calorie gelled products, such as sugar-free jams and yogurts. Polydextrose is a polysaccharide that is synthesized by random polymerization of glucose and sorbitol. Polydextrose serves as a bulking agent in foods and sometimes as a sugar substitute. Polydextrose is not digested or absorbed in the small intestine and is partially fermented in the large intestine, with the remaining excreted in the feces. Psyllium refers to the husk of psyllium seeds and is a very viscous mucilage in aqueous solution. The psyllium seed, also known as plantago or flea seed, is small, dark, reddish-brown, odorless, and nearly tasteless. Indigestible components of starch hydrolysates, as a result of heat and enzymatic treatment, yield indigestible dextrins that are also called resistant maltodextrins. Unlike gums, which have a high viscosity that can lead to problems in food processing and unpleasant organoleptic properties, resistant maltodextrins are easily added to foods and have a good mouth feel. Resistant maltodextrins are produced by heat/acid treatment of cornstarch, followed by enzymatic (amylase) treatment. The average molecular weight of resistant maltodextrins is 2,000 daltons and consists of polymers of glucose containing fi-(1-4) and fi-(1-6) glucosidic bonds, as well as 1-2 and 1-3 linkages. Resistant dextrins can potentially be classified as Functional Fibers when sufficient data on physiological benefits in humans are documented. Resistant starch is naturally occurring, but can also be produced by the modification of starch during the processing of foods. Resistant starch is estimated to be approximately 10 percent (2 to 20 percent) of the amount of starch consumed in the Western diet (Stephen et al. Along the gastrointestinal tract, properties of fiber result in different physiological effects. Effect on Gastric Emptying and Satiety Consumption of viscous fibers delays gastric emptying (Low, 1990; Roberfroid, 1993) and expands the effective unstirred layer, thus slowing the process of absorption once in the small intestine (Blackburn et al. A slower emptying rate means delayed digestion and absorption of nutrients (Jenkins et al. For example, Stevens and coworkers (1987) showed an 11 percent reduction in energy intake with psyllium gum intake. Postprandial glucose concentration in the blood is thus lower after the consumption of viscous fiber than after consumption of digestible carbohydrate alone (Benini et al. The extended presence of nutrients in the upper small intestine may promote satiety (Sepple and Read, 1989). Fermentation Fibers may be fermented by the colonic microflora to carbon dioxide, methane, hydrogen, and short-chain fatty acids (primarily acetate, propionate, and butyrate). Foods rich in hemicelluloses and pectins, such as fruits and vegetables, contain Dietary Fiber that is more completely fermentable than foods rich in celluloses, such as cereals (Cummings, 1984; Cummings and Englyst, 1987; McBurney and Thompson, 1990). There appears to be no relationship between the level of Dietary Fiber intake and fermentability up to very high levels (Livesey, 1990). Butyrate, a four-carbon, short-chain fatty acid, is the preferred energy source for colon cells (Roediger, 1982), and lack of butyrate production, absorption, or metabolism is thought by some to contribute to ulcerative colitis (Roediger, 1980; Roediger et al. Others have suggested that butyrate may be protective against colon cancer (see “Dietary Fiber and the Prevention of Colon Cancer”). However, the relationship between butyrate and colon cancer is controversial and the subject of ongoing investigation (Lupton, 1995). Once absorbed into the colon cells, butyrate can be used as an energy source by colonocytes (Roediger, 1982); acetate and propionate travel through the portal vein to the liver, where propionate is then utilized by the liver. A small proportion of energy from fermented fiber is used for bacterial growth and maintenance, and bacteria are excreted in feces, which also contain short-chain fatty acids (Cummings and Branch, 1986). Differences in food composition, patterns of food consumption, the administered dose of fiber, the metabolic status of the individual. Because the process of fermentation is anaerobic, less energy is recovered from fiber than the 4 kcal/g that is recovered from carbohydrate. While it is still unclear as to the energy yield of fibers in humans, current data indicate that the yield is in the range of 1. Physiological Effects of Isolated and Synthetic Fibers this section summarizes the fibers for which there is a sufficient database that documents their beneficial physiological human effects, which is the rationale for categorizing them as Functional Fibers. It is important to note that discussions on the potential benefits of what might eventually be classified as Functional Fibers should not be construed as endorsements of those fibers. While plant-based foods are a good source of Dietary Fiber, isolated or synthetic fibers have been developed for their use as food ingredients and because of their beneficial role in human health. In 1988 Health Canada published guidelines for what they considered to be “novel fiber sources” and food products containing them that could be labeled as a source of fiber in addition to those included in their 1985 definition (Health Canada, 1988). The rationale for these guidelines was that there were safety issues unique to novel sources of fiber, and if a product was represented as containing fiber, it should have the beneficial physiological effects associated with dietary fiber that the public expects. The guidelines indicated that both safety and efficacy of the fiber source had to be established in order for the product to be identified as a source of dietary fiber in Canada, and this had to be done through experiments using humans. Detailed guidelines were later produced for the clinical studies required to assess laxation effects, as this was the physiological function most often used by industry when seeking approval for a novel fiber source (Health Canada, 1997). For each of the fiber sources discussed below, studies will be summarized that relate to one of the three measures of efficacy identified by Health Canada, as these are the three most commonly accepted beneficial effects of fibers. A more complete discussion of these three measures of efficacy may be found later in this chapter. In addition, other potentially efficacious effects will be noted where studies are available. As interest has increased in fiber, manufacturers have isolated various types of fiber from a wide range of carbohydrate sources added to foods. Many of these isolated materials are used as food additives based on functional properties such as thickening or fat reduction. As enzymatic and other technologies evolve, many types of polysaccharides will continue to be designed and manufactured using plant and animal synthetic enzymes. Examples in this category include modified cellulose, in which the hydroxyl groups on the glucose residues have been substituted to varying degrees with alkyl groups such as methyl and propyl; fructooligosaccharides manufactured from sucrose; and polydextrose synthesized from glucose. In some instances, fibers isolated from plants or manufactured chemically or synthetically have demonstrated more powerful beneficial physiological effects than a food source of the fiber polysaccharide. From a meta-analysis of about 100 studies of changes in stool weight with various fiber sources, investigators have calculated the increase in fecal weight due to fiber ingestion (Cummings, 1993). As noted later in this chapter, an increase in fecal weight does not necessarily equate with enhanced laxation, so this needs to be considered in interpreting the results of fecal bulking studies. In a randomized, crossover study designed to compare the effects of supplemental pectin (12 g/d), cellulose (15 g/d), and lignin (12 g/d) on stool characteristics of healthy volunteers, cellulose was the only fiber that significantly decreased (–27 percent) mean stool transit time and increased mean wet stool weight (+57 percent) (Hillman et al. Cellulose is often used as the placebo in studies designed to test the efficacy of fibers on decreasing serum cholesterol concentrations. Cellulose is either neutral with respect to blood cholesterol concentrations (Hillman et al. Similar to the relationship between cellulose and serum cholesterol concentrations, cellulose is also often used as a placebo in studies that evaluate the effect of fiber on blood glucose and insulin concentrations. Cellulose is ineffective in decreasing the postprandial glucose response (Librenti et al. There are a number of animal studies that have suggested that chitin and chitosan may decrease lipid absorption and thus the amount of fat entering the blood (Gallaher et al. Therefore, blood cholesterol and triacylglycerol concentrations have been shown to be reduced with chitosan intake in animals (Chiang et al. These results, however, have not always been observed in controlled intervention trials with humans.