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Academy Position Paper

Position of the American Dietetic Association: Health Implications of Dietary Fiber

Written by Joanne L. Slavin, PhD, RD and provided in the Journal of the American Dietetic
Association in October 2008

Bonnie Green
NFS 4950: Senior Seminar
October 14, 2014

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It is the position of The American Dietetic Association that the public should consume
adequate amounts of dietary fiber from a variety of plant foods. This position is in effect until
December 31, 2013. The author of this position is Joanne L. Slavin, PhD, RD.
In order for people to get enough dietary fiber in their diets, it is first necessary to define
what dietary fiber is. The Institute of Medicine defines dietary fiber as the nondigestible
carbohydrates and lignin that are intrinsic and intact in plants. It is partially made up of
polysaccharides, which are often part of the plant cell wall. Dietary fiber is also made up of
lignin, or nutrients, such as starch and protein. Resistant starch can also be considered dietary
fiber.
The fact that dietary fiber is nondigestible means that it is neither digested nor absorbed
by humans. Dietary fiber is not absorbed in the small intestine, so it cannot have a
Recommended Dietary Allowance like other nutrients; instead, an Adequate Intake (AI), or
Daily Reference Intake (DRI), was created. The Adequate Intake of total fiber for adults is based
on the average amount of fiber that is shown to lower ones risk of coronary heart disease (CHD;
also known as cardiovascular disease) the most; it is also supported by how much fiber is needed
to reduced ones risk for type-2 diabetes. This AI is 14 grams of fiber per 1,000 kilocalories
consumed each day. For men, the total amount of fiber they should get each day is 38 grams, and
for women, it is 26 grams.
In order to encourage people to get more fiber, Nutrition Facts labels usually recommend
25 grams of fiber per day for a 2,000 kilocalorie diet, but in the United States, the average fiber
intake for adults is only 15 grams. As a whole, the American population consumes very little
dietary fiber. This is due to the fact that frequently consumed fruits, vegetables, and grains
among Americans only have 1 to 3 grams of fiber per serving, and the two most popular sources
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of dietary fiber in the American diet are white flour and white potatoes; they are not high in fiber
by any means, they are just very commonly consumed. In order to reap the health benefits of
fiber, more light must be shed on how certain sources of dietary fiber work in the body.
Dietary fiber has been shown to provide health benefits (if adequate amounts are
consumed) in four main areas: cardiovascular disease (CVD), bowel function, weight control,
and diabetes. The correlation between dietary fiber and cancer risk yields very inconsistent
results, so it shall not be discussed.
Studies have shown that dietary fiber from whole grains, fruits, and vegetables, or
supplements may lower hypertension, improve blood cholesterol levels, and reduce
inflammation. In order to achieve these benefits, 12-33 grams of fiber from whole foods must be
eaten per day or up to 42.5 grams from supplements. The Academy gives this claim a Grade II
Fair, meaning that the correlation is valid. This makes sense, given that the AI for dietary fiber is
based on how much is needed to lower the risk of cardiovascular disease. A study conducted by
Bazzano and colleagues asked 9,776 adults who did not have CVD to do a 24-hour diet recall.
They found that a higher intake of dietary fiber, especially soluble fiber, lowered risk for CHD.
Pereira and colleagues analyzed studies done in the United States and Europe to further explore
this concept; they found that, throughout 6 to 10 years of follow-up, for every 10 grams of total
dietary fiber that a person was eating, his/her risk for any coronary events decreased by 14%, and
his/her risk for coronary death decreased by 27%. However, fiber that was found to decrease risk
for CHD was only found in cereal grains or fruits. This is also true for older adults; consuming
more whole cereal grains later in life is linked to a lower risk of CVD. This occurs because
whole grains contain soluble and viscous fiber that helps eliminate low-density lipoproteins
(LDL) from the bloodstream without getting rid of high-density lipoproteins (HDL). When
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viscous fiber is ingested, it prevents bile acids from being absorbed in the small intestine;
therefore, LDL is removed from the bloodstream and is then converted into bile acids to replace
the bile acids in the small intestine that were lost via the stool. This process has been reported to
lower cholesterol in the same capacity as statin drugs. Therefore, dietary fiber, particularly that
from grains, gives enough epidemiologic evidence that it protects against CVD, and this can be
used to set a guideline on how much fiber should be consumed in one day.
While there is not much data on how dietary fiber from plant food sources affects
gastrointestinal diseases, fiber supplements may be beneficial in improving laxation of healthy
adults. The Academy gives this claim a Grade IIILimited, meaning that there is still research
to be done, but some research supports this claim. It is common knowledge that numerous fiber
sources increase stool weight and help regularity, hopefully to about one bowel movement per
day. The greater stool weight is brought about by the fiber itself, any water it traps, as well as the
increased bacteria in stool, which is caused by fermentation of the fiber. Cummings and
colleagues account that stool weights in Western areas are only 80 to 120 grams per day, when it
is suggested that for a healthy colon, daily stool weight should be 160 to 200 grams per day.
Luckily, a great number of foods are naturally laxatives; they contain carbohydrates that can
neither be digested nor absorbed, as well as other compounds that act as laxatives. Some
examples are cabbage, oatmeal, figs, prunes, and raspberries. These are currently not commonly
consumed by the American public as a whole, but it is suggested that eating more of these types
of foods would help better overall gastrointestinal health. However, other issues besides food can
have an effect on stool output, such as stress or personality.
According to current studies, consuming dietary fiber from whole plant foods and/or
supplements may promote weight loss. The Academy gives this claim a Grade IIILimited.
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Dietary fiber is suggested to block calorie intake in three ways: displacing calories present in the
small intestine; increasing time and effort to chew food, thereby increasing satisfaction during a
meal due to the lower rate of ingestion; and decreasing how well the small intestine can absorb
calories. Also, foods that are high in dietary fiber are usually less energy dense, so,
automatically, fewer calories are being eaten. Many studies have found that increased fiber
causes subjects to feel fuller, and, thus, they do not feel hungry as quickly after the meal. An
extra 14 grams of fiber throughout the day produced a 10% decrease in energy consumption;
after 3.8 months of studies, the overall weight loss of the subjects was over 1.9 kilograms (4.19
pounds). As a result, it is thought that increasing the populations average fiber intake to 25 to 30
grams per day would be overall very helpful for health, and perhaps even diminish obesity.
Current studies show that people that follow diets with 30 to 50 grams of fiber per day
from plant foods tend to have lower blood glucose levels. The Academy gives this claim a Grade
IIILimited. Foods that are high in fiber take longer to digest, so nutrients are absorbed over a
longer length of time, thereby reducing blood sugar spikes. There is a significant amount of
experimental evidence that shows that adding viscous fiber makes the stomach empty slower and
digestion take longer, which is helpful for people with diabetes. A diet of 50 grams of dietary
fiber each day for 24 weeks shows substantial glycemic control and fewer hypoglycemic
episodes for people with type 1diabetes. For people with type 2 diabetes, higher dietary fiber is
thought to decrease their need for insulin. However, fiber does not stop working there;
consuming at least 30 grams of dietary fiber per day (especially from whole grains) can even
help prevent type 2 diabetes.
As with any other nutrient, getting too little or too much dietary fiber can pose negative
effects. Getting too much dietary fiber can block vitamins, minerals, proteins, and calories from
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being absorbed, but this is highly improbable for healthy adults getting the recommended amount
of fiber for their calorie intake. Surplus dietary fiber can also cause diarrhea, but because stool
output varies so much from person to person, it is not appropriate to use stool consistency as a
way to measure how much fiber is recommended for all individuals. Dietary fiber can also cause
other symptoms in the intestine such as flatulence, bloating, or abdominal cramps, which can
discourage people from eating foods high in fiber. As long as a person is getting enough fiber to
keep him/her regular and at an overall state of wellbeing, that amount of fiber is enough; s/he
does not need to strive for the recommended amount if a lower amount is giving the desired
benefits. It is also important to increase fluid intake along with fiber intake to give the
gastrointestinal tract time to become accustomed.
The role of a Registered Dietitian or Nutrition Professional, based on the Academys
position on dietary fiber, would be to advise clients to get more dietary fiber in their diets,
especially from whole grains. This would be necessary for patients that are at risk for
cardiovascular disease, suffering from constipation, need to modify their diet because they want
to lose weight, or because they have or are at risk for diabetes. They would also need to remind
their clients to increase fluid intake as well to help with any abdominal discomfort.
I agree with the Academys position; the typical American diet of meat, potatoes, and
refined grains does not provide the dietary fiber that people need in order to keep them healthy.
Foods that are rich in dietary fiber (such as fruits and vegetables) also have countless other
benefits, such as vitamins, minerals, and antioxidants that cannot be provided in the typical
American diet or in a pill. In Table 2 (on the next page) of the Academys Position Paper, the
dietary fiber content of commonly consumed fruits, vegetables, and grains are shown. However,
only 8 out of 34 of these foods contain more than 4 grams of fiber per serving (which I consider
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to be a decent amount of fiber in one sitting). More fiber in foods provides more bulk when you
are eating, which makes a meal more satisfying. I find this to be true for myself; when I eat a
whole apple as a snack or brown rice with my meal, I feel fuller for longer than if I just drank
apple juice or ate white pasta. This is proven in a study conducted by Haber and colleagues in
which they gave subjects an apple, apple sauce, or apple juice with added fiber before a meal.
Even though they all contained the same amount of calories and fiber, those who ate an apple
before the meal actually ate less of that meal compared to those that ate the applesauce or the
apple juice (1). Like many Americans, I do not get enough fiber in my diet; like any other
healthy diet, it requires planning. However, as a dietetics student and soon-to-be Registered
Dietitian, it is important that I make sure that I get enough dietary fiber in my diet, as well as
advise future clients to do the same.


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References
1. Slavin J. Position of the American Dietetic Association: Health Implications of Dietary
Fiber. Journal of the American Dietetic Association. 2008; 108: 1716-1731.