Pectin

Scientific Name(s): Pectin

Common Name(s): Pectin

Uses

Pectin has been used in antidiarrheal products and to lower blood lipoprotein levels. Pectin also has been investigated for its ability to reduce the consequence of exposure to radiation and to inhibit prostate cancer growth, but more study is needed.

Dosing

Pectin and/or modified pectin have been used in clinical studies in doses of 10 to 20 g daily.

Contraindications

Contraindications have not yet been identified.

Pregnancy/Lactation

Information regarding safety and efficacy in pregnancy and lactation is lacking.

Interactions

Coadministration of pectin with beta-carotene–containing foods or supplements can reduce beta-carotene blood levels by more than 50%. Concomitant use of pectin and lovastatin, and other HMG-CoA reductase inhibitors may decrease absorption of the HMG-CoA reductase inhibitor.

Adverse Reactions

Pectin is generally well tolerated when ingested. Occupational asthma has been associated with the inhalation of pectin dust, along with cross-sensitivity to cashew and pistachio nuts.

Toxicology

No major toxicities have been reported with the use of pectin.

History

Pectin is found in the cell walls of all plant tissue where it acts as an intercellular cement, giving the plant rigidity. The compound is found at concentrations of 15% to 30% in the fiber of fruits, vegetables, legumes, and nuts. 1 Lemon and orange rinds are among the richest sources of pectin, containing up to 30% of this polysaccharide. 2 Pectin is also found in the roots of most plants. 3

Pectin has been used in the food industry to add body and texture to jellies, jams, puddings, and other gelatinous products. It has also been added to antidiarrheal products and has been particularly effective when combined with adsorbing clays, such as kaolin.

Chemistry

Pectin is a polysaccharide with a variable molecular weight ranging from 20,000 to 400,000, depending on the number of carbohydrate monomers. 2 The core of the molecule is formed by linked D-polygalacturonate and L-rhamnose residues. The neutral sugars D-galactose, L-arabinose, D-xylose, and L-fucose form the side chains on the pectin molecule. Once extracted, pectin occurs as a coarse or fine yellowish powder that is highly water soluble and forms thick colloidal solutions. In the presence of calcium ions, pectin forms a gel that is more resistant to disruption in the gut than alginate gel. 3 The parent compound, protopectin, is insoluble but is readily converted by hydrolysis into pectinic acids (also known generically as pectins). 4

Pectin that has been pH-modified into smaller, less complex molecules is called modified citrus pectin. This modification allows better dissolution in water and more complete absorption by the body. 5

Uses and Pharmacology

The widespread usage of pectin preparations by humans makes animal experiments largely irrelevant, except in cancer studies.

Cancer

Dietary fiber has been associated with a reduction in the risk of colon cancer; however, this association has been questioned in a pooled analysis of prospective cohort studies. 6 After accounting for other dietary risk factors, no association was found with risk of colorectal cancer, and analysis by specific food sources also found no association. 6

Modified pectin has been evaluated for efficacy in cancer treatment. The mechanism by which pectins may exert their effect is suggested to be the ability to bind to cancer cell surface galectins (galactose-binding lectins) and cause mitochondrial disruption. 7 , 8 , 9 , 10 , 11 Consequent interference with cell-cell or cell-matrix adhesion and induction of apoptosis has been described. 8 Pectin-derived galectin-3 receptor binding agents (GBC-590 and GCS-100) have entered phase 2 trials. 7 , 10

Animal data

Modified citrus pectin was studied in a rat prostate cancer model for its effectiveness against prostate cancer metastasis. Although primary tumor growth was not affected, metastasis was reduced when compared with control. 12 In vitro experiments have demonstrated efficacy of modified pectin on human prostate cell lines in inducing apoptosis 8 ; and skin, colon, lung, and melanoma lines in inhibiting cell proliferation. 13

Clinical data

A nonrandomized intervention study using modified citrus pectin demonstrated a statistically significant increase in prostate-specific antigen (PSA)-doubling time in 7 out of 10 patients with refractory prostate cancer. 5 , 9 Survival times were not measured in this study, but a slowing of disease progression was postulated based on the increase in PSA–doubling time. Phase 2 trials have evaluated the effect of pectin-derived galectin-3 receptor binding agents in refractory or relapsed colorectal and pancreatic cancer and have reported tumor stabilization and reduction of tumor growth in some patients. 7 , 10

Cardiovascular

Despite many large trials evaluating the effect of dietary fiber on cardiovascular outcomes, few trials specifically investigate the role of pectin, and controversy remains regarding its efficacy in affecting the lipid profile. 14 , 15 , 16 , 17 Most studies have evaluated pectin in combination with other gums. Varying results have been found in these trials, with some showing decreases in total cholesterol level and triglycerides (although high-density lipoprotein [HDL] cholesterol levels remained unaffected) and others failing to lower cholesterol in hypercholesterolemic patients. 18 , 19 , 20 , 21 , 22 Trials evaluating the effect of pectin alone on serum lipids have also found varying results. 15 , 23 , 24 , 25 , 26 A meta-analysis of cholesterol-lowering effects of dietary fiber (comparison of pectin, oat bran, guar gum, and psyllium) showed that increasing soluble fiber may make only a small contribution to dietary therapy to lower cholesterol. 17 Mechanisms of action have been investigated and include an ability to protect against low-density lipoprotein (LDL) peroxidation, 27 , 28 upregulation of HDL metabolism, 16 and the higher water-holding capacity of pectin compared with cereals or bran. 16 Systolic blood pressure was decreased in pectin-treated adults versus placebo in a double-blind, randomized clinical trial, 23 while hypertension remained unaltered in another study. 29

Chelating effects

Modified citrus pectin 15 g/day significantly increased the urinary excretion of arsenic, cadmium, and lead in healthy adults (normal metal load) after 6 days of administration. 30 This chelating effect has been attributed to the presence of rhamnogalacturonan in pectin. In children from Belarus with moderate and high cesium loads, the administration of apple-derived pectin ( Vitapect ) 10 g/day reduced the level of cesium. 29 , 31 Beneficial effects on the antioxidant level of hematologic systems have also been demonstrated. 32

Diabetes

Meals high in soluble fiber have been shown to reduce the rise in postprandial blood glucose and insulin concentrations. 15 However, a few trials specifically evaluating the effect of pectin on markers of diabetes have been less convincing. No change in fasting plasma glucose levels and no effect on postprandial glucose response were noted for pectin in healthy adults or adults with dietary-controlled type 2 diabetes, 23 , 33 while hypoglycemic actions were noted in nondiabetic patients with hyperlipidemia. 26

GI
Diarrhea

Pectin has been used in the management of diarrhea for many years. Pectin supplementation was as effective as green bananas in the management of persistent diarrhea in children. Both pectin and banana reduced the volume of stool, improved stool quality, decreased the amount of oral replacement solutions and intravenous fluids for hydration needed, and shortened the duration of illness. 34 , 35 In a study of 44 critically ill, tube-fed adults receiving antibiotics, there was a trend toward decreased diarrhea in those receiving fiber and pectin. Pectin stimulates epithelial growth in the colon, thus reducing diarrhea. 36 Additional suggested mechanisms of action in the GI tract include the effect of peptic oligosaccharides on the intestinal microflora. 37 , 38 , 39

Gastroesophageal reflux

A pectin-based, raft-forming, antireflux agent available in Europe has been studied for use in patients with heartburn. This product reduces the amount of food and acid concentration reaching the esophagus, thus reducing heartburn. 40 , 41 , 42 The pectin-based agent also has been shown to delay the recurrence of moderate or severe heartburn and erosive esophagitis when used as maintenance treatment. 43 However, in a study of patients with an ileal pouch-anal anastomosis, neither pectin nor fiber had any effect on stool frequency. 44 Gastric emptying rate was increased with coadministration of pectin in an experiment in healthy adults. 45

Other
Drug delivery systems

A combination of alginate-pectin-polylysine particulates shows promise as a vehicle for controlled-release medications. The presence of a rigid pectin gel inside the particulates imparts a stronger and more stable vehicle in acidic and alkaline solutions, which could prolong drug release. This particulate system may have potential use as a carrier for drugs that are poorly absorbed after oral administration. 3 , 46

Immunomodulation

Pectic polysaccharides, including arabinogalactin, rhamnogalacturonan, and comaruman originating in various plants used in traditional medicine, have been evaluated for their effect on the immune system. There also have been reports describing the evaluation of plants such as Comarum palustre , Glinus oppositifolus , Vernonia kotschyana , and Bergenia crassifola . 47 , 48 , 49 , 50 , 51 , 52 Various actions have been described from in vitro experiments, including interference with neutrophil adhesion, complement-fixing actions, and upregulation of cytokine secretion.

Allergy

Galacto-oligosaccharides have been evaluated for their preventive effect on food sensitization in infants. Insufficient data exist to support or refute a use for prebiotic supplementation to prevent food allergy. 53 A physical influence by pectin on the digestion of food proteins as allergens has been suggested. 54 However, allergy to pectin itself has been reported. 55

Dosage

Pectin and/or modified pectin have been used in clinical studies of cholesterol reduction at doses of 10 to 20 g daily. 19 , 25 , 29 , 30

Pregnancy/Lactation

Information regarding safety and efficacy in pregnancy and lactation is lacking.

Interactions

Coadministration of pectin with beta-carotene–containing foods or supplements can reduce beta-carotene blood levels by more than 50%. 56 There is some evidence that concomitant ingestion of pectin with high-energy diets may reduce the nutritional benefits of these diets, as demonstrated in a controlled trial of undernourished children; urea production also was shown to be lower in children who ingested pectin with their caloric supplement. 57

In 3 patients with hypercholesterolemia, concomitant use of pectin 15 g and lovastatin 80 mg daily produced an increase in LDL cholesterol compared with taking lovastatin alone. 58 When pectin was stopped, the LDL cholesterol decreased. Pectin may decrease the GI absorption of lovastatin. Based on pharmacologic and pharmacokinetic considerations, a similar interaction may be expected to occur with concurrent use of pectin and other HMG-CoA reductase inhibitors (eg, atorvastatin).

Adverse Reactions

Pectin is a fermentable fiber that results in the production of short-chain fatty acids and methane. 59

Occupational asthma associated with the inhalation of pectin dust is a well-recognized hazard. 60 , 61 , 62 , 63 Positive skin test results for pectin indicate that an immunoglobulin E (IgE)–mediated hypersensitivity reaction is probably involved. 63 Case reports exist of allergy (anaphylaxis) to pectin and cross-reactivity to cashews and pistachios. 55 , 64

Doses of pectin 50 to 100 mg/kg increased the number of gastric mucosal lesions produced by ethanol or aspirin when studied in rats. No increase was produced by application of pectin 25 mg/kg. 65 Whether these pectin-induced physicochemical changes are reproducible in humans has yet to be studied.

Toxicology

No major toxicities have been reported with the use of pectin.

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