Bovine immunoglobulin concentrate-clostridium difficile retains C difficile toxin neutralising activity after passage through the human stomach and small intestine.

BACKGROUND: Bovine immunoglobulin concentrate (BIC)-Clostridium difficile is prepared from the colostrum of cows immunised against C difficile toxins and contains high concentrations of neutralising IgG antitoxin. AIMS: To determine the proportion of BIC-C difficile which survives passage through the human stomach and small intestine. METHODS: Six volunteers with an end ileostomy took 5 g of BIC-C difficile containing 2.1 g of bovine IgG on four occasions: alone, with an antacid, during treatment with omeprazole, and within enteric coated capsules. RESULTS: When BIC-C difficile was taken alone, a mean (SEM) of 1033 (232) mg of bovine IgG was recovered in the ileal fluid representing 49% of the total ingested dose. Bovine IgG recovery was not significantly increased by antacid (636 (129) mg) or omeprazole (1052 (268) mg). The enteric capsules frequently remained intact or only partially opened in the ileal effluent and free bovine IgG levels were low in this treatment group (89 (101) mg). Bovine IgG recovery was higher in volunteers with shorter (less than two hours) mouth to ileum transit times (68% versus 36%, p<0. 05). Specific bovine IgG against C difficile toxin A was detected in ileal fluid following oral BIC. Toxin neutralising activity was also present and correlated closely with bovine IgG levels (r=0.95, p<0. 001). CONCLUSION: BIC-C difficile resists digestion in the human upper gastrointestinal tract and specific anti-C difficile toxin A binding and neutralising activity was retained. Passive oral immunotherapy with anti-C difficile BIC may be a useful non-antibiotic approach to the prevention and treatment of C difficile antibiotic associated diarrhoea and colitis.

Metabolic effects of dietary sucrose in type II diabetic subjects.

OBJECTIVE: To assess in diabetic subjects the effects of dietary sucrose on glycemia and lipemia. RESEARCH DESIGN AND METHODS: Twelve type II diabetic subjects consumed, in random order, two isocaloric, 55% carbohydrate study diets for 28 days. In one diet, 19% of energy was derived from sucrose. In the other diet, < 3% of energy was derived from sucrose, and carbohydrate energy came primarily from starch. Both study diets were composed of common foods. All meals were prepared in a metabolic kitchen where foods were weighed during meal preparation. RESULTS: No significant differences were noted between the study diets at any time point in mean plasma glucose. At day 28, mean plasma glucose values for the sucrose diet were 9.6 +/- 0.5 mM and for the starch diet were 9.4 +/- 0.6 mM (P = 0.63). Also, no significant differences were observed between the study diets in urine glucose, fasting serum total, HDL, or LDL cholesterol; fasting serum TG; or peak postprandial serum TG. CONCLUSIONS: A high sucrose diet did not adversely affect glycemia or lipemia in type II diabetic subjects.

Metabolic effects of dietary fructose in diabetic subjects.

OBJECTIVE: To assess the metabolic effects of chronic dietary fructose consumption in diabetic subjects. RESEARCH DESIGN AND METHODS: Six type I and 12 type II diabetic subjects consumed, in random order, two isocaloric study diets for 28 days. In one diet, 20% of energy was derived from fructose. In the other diet, < 3% of energy came from fructose, and carbohydrate energy was derived primarily from starch. Both study diets were composed of common foods. All meals were prepared in a metabolic kitchen where all foods were weighed during meal preparation. RESULTS: Mean plasma glucose, urine glucose, and serum glycosylated albumin values were lower during the fructose diet than during the starch diet, but the differences achieved only marginal statistical significance. The day-28 value for mean plasma glucose was 12.5% lower (P = 0.03) during the fructose diet than during the starch diet. At days 14, 21, and 28, fasting serum cholesterol and LDL cholesterol were both significantly higher during the fructose diet than during the starch diet. The day-28 values for serum cholesterol and LDL cholesterol during the fructose diet were 6.9% (P = 0.008) and 10.9% (P = 0.002) higher, respectively, than the corresponding values during the starch diet. No differences were observed between the study diets in fasting serum HDL cholesterol, fasting serum triglycerides, peak postprandial serum triglycerides, or fasting serum lactate. Peak postprandial serum lactate was significantly higher during the fructose diet. Type I and type II diabetic subjects responded to the diets in a consistent way, but type I subjects experienced significantly more hypoglycemia during the fructose diet than during the starch diet. CONCLUSIONS: A high-fructose diet may result in reduced glycemia in diabetic subjects but at the expense of increased fasting serum total and LDL cholesterol.

Metabolic effects of dietary fructose in healthy subjects.

To determine if dietary fructose causes adverse metabolic effects, we used a crossover design to compare a diet containing 20% of energy from fructose with an isoenergic high-starch diet that contained less than 3% fructose. Fourteen healthy subjects consumed each diet for 28 d. There were no significant differences between the diets in the mean values of hemoglobin A1C, serum glycosylated albumin, fasting plasma glucose, peak postprandial plasma glucose, integrated plasma glucose, fasting serum lactate, or fasting serum triglycerides. Peak postprandial serum lactate was significantly higher during the fructose diet at days 1, 7, and 14 but not at days 21 or 28. Peak postprandial serum triglycerides were significantly higher only at day 1 of the fructose diet. Day-28 fasting serum total and LDL cholesterol for the fructose diet were 9.0% and 11.0% higher, respectively, than the corresponding values for the starch diet. A high-fructose diet compared with a high-starch diet resulted in significantly higher fasting serum total and LDL cholesterol and also caused transient changes in postprandial serum lactate and triglycerides.

Glucose and insulin response in diabetic subjects: acute effect of carbohydrate level and the addition of soy polysaccharide in defined-formula diets.

This single-meal pilot study compared the plasma glucose and serum insulin response to defined-formula diets with two levels of carbohydrate (CHO) (55% and 30% of the kilocalories) with and without added soy polysaccharide (10 g) in subjects with type 2 diabetes mellitus. Subjects received each of the four liquid-formula test meals in a randomly assigned order: 1) high CHO, low fiber (HC, LF), 2) high CHO, high fiber (HC, HF), 3) low CHO, low fiber (LC, LF), and 4) low CHO, high fiber (LC, HF). On the day of each test meal the formula was consumed, eight blood samples were drawn for plasma glucose and serum insulin measurements, and a 4-h urine collection was obtained for measuring glucose excretion. Our results showed that area increments under glucose and insulin curves were significantly lower with both low-CHO formulas (p less than 0.001). The addition of soy polysaccharide to the liquid formula did not result in statistically different area increments for glucose or insulin.

Day-to-day variation in glycemic control in type I and type II diabetes mellitus.

In an attempt to assess day-to-day variation in glycemic control, 12 type I and 12 type II diabetic subjects were hospitalized and had plasma glucose sampled frequently on two consecutive days, during which medication, diet, and physical activity were all held constant. In type I subjects, there was no significant day-to-day correlation in overall mean plasma glucose, mean preprandial plasma glucose, mean postprandial plasma glucose, or urinary glucose excretion. In contrast, these measures were all highly correlated in type II subjects. The data suggest that individuals with type I diabetes may not be able to achieve good glycemic control simply by taking the same dose or doses of insulin each day while rigorously attempting to control diet and exercise.

Comparison of predictive capabilities of diabetic exchange lists and glycemic index of foods.

To determine whether the diabetic exchange lists or the glycemic index of foods better predicts postprandial responses to carbohydrate-containing foods eaten as part of a mixed meal, three test meals were developed and fed to 12 subjects with non-insulin-dependent diabetes mellitus (NIDDM) and 13 healthy subjects. Each test meal contained exactly the same exchanges (1 milk, 4 starch, 2 fruit, 2 meat, 3 fat, 1 vegetable). In one meal, foods of high glycemic index (GI) were used, in a second meal, foods of intermediate GI were used, and in a third meal foods of low GI were used. The total GIs of the meals were: high, 184; intermediate, 131; and low, 107, thus predicting responses to intermediate and low GI, which were 71 and 58%, respectively, of the responses to high GI. Although some of the observed differences in the glycemic responses to the test meals were statistically significant, primarily in healthy subjects, the differences were usually much less than predicted by the GIs of the meals. In NIDDM subjects, peak postprandial plasma glucose, plasma glucose area, plasma glucose area increment, and mean plasma glucose responses after intermediate and low GI were greater than 90% of the corresponding responses to high GI. In healthy subjects, only the plasma glucose area increment after the low-GI meal was close to the predicted response. High GI produced significantly greater insulin responses than low GI in healthy subjects. We conclude that the diabetic exchange lists more accurately predict postprandial responses to carbohydrate-containing foods eaten as part of a mixed meal than does the GI of foods.(ABSTRACT TRUNCATED AT 250 WORDS)

Metabolic effects of dietary fructose and sucrose in types I and II diabetic subjects.

To learn more about the metabolic effects of dietary fructose and sucrose, 12 type I and 12 type II diabetic subjects were fed three isocaloric (or isoenergic) diets for eight days each according to a randomized, crossover design. The three diets provided, respectively, 21% of the energy as fructose, 23% of the energy as sucrose, and almost all carbohydrate energy as starch. The fructose diet resulted in significantly lower one- and two-hour postprandial plasma glucose levels, overall mean plasma glucose levels, and urinary glucose excretion in both type I and type II subjects than did the starch diet. There were no significant differences between the sucrose and starch diets in any of the measures of glycemic control in either subject group. The fructose and sucrose diets did not significantly increase serum triglyceride values when compared with the starch diet, but both increased postprandial serum lactate levels. We conclude that short-term replacement of other carbohydrate sources in the diabetic diet with fructose will improve glycemic control, whereas replacement with sucrose will not aggravate glycemic control.

Urine C-peptide and creatinine (Jaffe method) excretion in healthy young adults on varied diets: sustained effects of varied carbohydrate, protein, and meat content.

We studied effects of isocaloric diets of varied composition (each diet offered for 5 to 7 days) on urine C-peptide and creatinine excretion in eight healthy subjects. C-peptide excretion was higher on the high carbohydrate (60% CHO, 20% PRO) and high protein (45% CHO, 30% PRO) diets than on the low carbohydrate (30% CHO, 20% PRO) and low protein diets (45% CHO, 10% PRO). C-peptide excretion correlated with total kilocalories ingested (r = 0.594, p less than 0.001), and also with CHO (r = 0.469, p = 0.003) and PRO intake (r = 0.453, p = 0.004). Multiple regression analysis is given by the formula: Urine C-peptide (nmol/24 h) = 17.3 + 0.01 (kcal/24 h) + 0.021 (gm CHO/24 h) + 0.049 (gm PRO/24 h) Creatinine excretion was related to body weight (r = 0.959, p less than 0.001) and also to total PRO intake (r = 0.569, p less than 0.001) and meat intake (r = 0.367, p less than 0.05). We conclude that diet composition, especially protein intake, is an important stimulus to sustained insulin production as measured by C-peptide in healthy subjects. Diet composition has a significant impact on creatinine excretion. Urine creatinine cannot be assumed to reflect only lean body weight when it is used as a measure of the adequacy of timed urine collections.

Postprandial glucose and insulin responses to meals containing different carbohydrates in normal and diabetic subjects.

To examine whether the form of dietary carbohydrate influences glucose and insulin responses, we studied the glucose and insulin responses to five meals--each containing a different form of carbohydrate but all with nearly identical amounts of total carbohydrate, protein, and fat--in 10 healthy subjects, 12 patients with Type I diabetes, and 10 patients with Type II diabetes. The test carbohydrates were glucose, fructose, sucrose, potato starch, and wheat starch. In all three groups, the meal containing sucrose as the test carbohydrate did not produce significantly greater peak increments in the plasma concentration of glucose or greater increments in the area under the plasma glucose-response curves than did meals containing potato, wheat, or glucose as test carbohydrates. Urinary excretion of glucose in patients with diabetes was not significantly greater after the sucrose meal. The meal containing fructose as the test carbohydrate produced the smallest increments in plasma glucose levels, but the differences were not always statistically significant. In healthy subjects and patients with Type II diabetes, peak serum concentrations of insulin were not significantly different in response to the five test carbohydrates. Our data do not support the view that dietary sucrose, when consumed as part of a meal, aggravates postprandial hyperglycemia.

Cholesterol excretion studies in familial hypercholesterolemic children and their normolipidemic siblings.

Twenty children ages 3 to 17 yr, eight with normal lipids and 12 with familial hypercholesterolemia were studied on a metabolic unit for 14 days to evaluate fecal bile acid and fecal neutral sterol excretion. The diet contained a moderately low cholesterol content, 180 to 200 mg/day. Stools were collected in three separate, 3-day pools. Fecal bile acids and fecal neutral sterols were measured using two stool markers and thin-layer, and gas-liquid chromatography techniques. Fecal neutral sterol and fecal bile acid excretion were the same for normal and familial hypercholesterolemic children on a mg/kg basis. Fecal neutral sterols in familial hypercholesterolemic children decreased with age, p less than 0.001; fecal bile acid excretion also appeared to decrease with age, but less significantly, p less than 0.07. Although the familial hypercholesterolemic children have significantly increased plasma and potentially elevated tissue or total body cholesterol, the excretion of fecal bile acids and fecal neutral sterols did not differ between familial hypercholesterolemic and normal children.

Lightly hydrogenated soy oil versus other vegetable oils as a lipid-lowering dietary constituent.

Fully refined, bleached, deodorized corn oil and soy oil, and lightly hydrogenated, winterized soy oil were compared for effectiveness in lowering plasma cholesterol. Twenty-four, healthy, young college students were the subjects for the 10-wk studies. At the 300 cal level, the corn oil and unhydrogenated soy oil diets contained approximately 53 g of polyunsaturated and 26 g of saturated fat. The hydrogenated soy oil diet contained 42 and 25 g, respectively. All diets contained approximately 700 mg of cholesterol. Corn oil and unhydrogenated soy oil were equally effective in lowering both total and low density lipoprotein cholesterol. Lightly hydrogenated soy oil was also quite effective, but less so that the more unsaturated oils. Triglycerides were also lowered, but very low density and high density lipoprotein cholesterol concentrations, as well as total high density lipoproteins, were scarcely affected. All of the polyunsaturated fat diets produced small but statistically significant reductions in the cholesterol to protein ratio of all three lipoproteins.