Magill, Alexia

HUN3230
Dr. Labyak
The Academy of Nutrition and Dietetics Position on Dietary Fiber Compared with
Recent Research
In 2015, after reviewing current research, a position statement was released by
the Academy of Nutrition and Dietetics on the intake of fiber stating, “It is the position of
the Academy of Nutrition and Dietetics that the public should consume adequate
amounts of dietary fiber from a variety of plant foods.” 1 Dietary fiber is composed of
carbohydrates that are nondigestible in humans and found naturally in plants such as
vegetables, legumes, and fruit. There is also functional fiber which is isolated and added
to fortified foods like cereals and bread products. Total fiber is the sum of the two,
dietary and functional fiber. Foods that contain dietary fiber tend to also contain
phytochemicals like flavonoids and micronutrients to benefit health. While there are
different types and forms of fiber, they all offer varying health benefits. Even though
fiber is deemed essential for a healthy diet, it is not considered a nutrient and has no
Recommended Dietary Allowance (RDA), nor a Tolerable Upper Intake Level (UL)
established but is very important, nonetheless. Consumption of dietary fiber is positively
correlated with the reduced risk of developing various chronic diseases including type 2
diabetes, cardiovascular disease, and certain cancers such as gastric and colorectal
cancer. Thus, the Adequate Intake (AI) for fiber is the mean fiber intake amount
associated with the lowest risk of coronary heart disease. The reduced risk of type 2
diabetes is also taken into consideration for AI. For men aged 19-50 years old, the AI is
38 grams a day and 25 grams for women in the same age group. Majority of people do
not meet the recommended amount, this raised concern in the 2010 Dietary Guidelines.
Public nutrition resources such as MyPlate promote the consumption of fibrous foods.
Vegetables and fruits, which are both good sources of dietary fiber, are recommended
to fill half the plate at mealtime. With grains, it is advised to choose mostly, at least half,
whole grain products. Whole grain products contain dietary fiber and are not refined and
processed like other grains which serves more benefits. Additionally, nuts, seeds,
beans, and legumes are examples of foods that can be incorporated into the protein
section that contain more fiber than meat and other sources. There are many reasons
with evidence to support why fiber should be incorporated into every meal.
Cohort studies showed a 9% risk reduction of coronary heart disease and
cardiovascular disease with each 7-gram increase of dietary fiber. This means that fiber
intake is inversely associated with the risk of these two diseases. The American Society
of Nutrition’s literature review supports this inverse relationship as well. The
mechanisms by which fiber has this ability can be explained by looking at the metabolic
and physiological properties. Absorptive attraction describes fiber’s ability to bind to
organic and inorganic molecules like cholesterol, fatty acids, and bile salts. When fiber
binds to cholesterol in the digestive tract, it restricts it from being absorbed. Decreased
cholesterol
 absorption leads to the liver taking up and using LDL-cholesterol from the blood.
Similarly, when fiber binds to bile salts, it also helps with decreasing blood cholesterol.
Since the bile cannot be absorbed when bound to fiber, it is excreted. This requires
more bile to be made since less is being reabsorbed and cholesterol is needed by the
liver to produce bile.
Alongside absorptive attraction, another positive trait of fiber is viscosity.
Viscosity can be the reason why a diet high in fiber may reduce the risk of developing
type 2 diabetes.2 Several water-soluble fibers form thick, viscous solutions. This
happens in the stomach which produces a feeling of satiety, delays gastric emptying
and slows digestion. When high glycemic foods are consumed with fiber, it traps some
of the glucose and causes a slow absorption which keeps blood glucose levels
controlled verses a spike in blood sugar and insulin that occurs when high glycemic
foods do not contain fiber.
The inverse relationship not only remains true for colorectal cancer and fiber
intake but has become increasingly prevalent as more research is conducted. Various
studies, including prospective cohort and case-cohort, conducted by Aune et al showed
a 10% reduction in the risk of colorectal cancer. 3 By testing individual fiber sources, fruit,
vegetable, and legume fibers did not show any significance in reducing the risk; cereal
fibers showed 10%. Ben et al focused on the occurrence of colorectal adenoma, and
saw a 9% decreased risk with every 10 grams of fiber consumed daily through case-
control studies.4 Again, isolating types of fiber, the two highest relationships were seen
between fruit fiber showing a 21% decreased risk for every 10 grams consumed and
cereal fiber with 30%. Vegetables fiber did not show any significance related to the
occurrence of colorectal adenoma. The reduced risk could be explained by fiber’s ability
to increase fecal bulk and decreased transit time. This way the colorectal epithelium is
exposed to carcinogens in lesser amounts and for a shorter time.
Other benefits from the regular consumption of fiber, meeting the AI, include
prebiotics which encourages growth and activity of microbes to establish and maintain a
healthy, balanced microbiota. Prebiotic consumption is associated with decreased risk
of type 2 diabetes, obesity, and colon cancer while improving mineral bioavailability,
laxation, and overall digestive health.5
Since the World Cancer Research Fund updated their consensus about fiber
from ‘probable’ to ‘convincing’ in 2011, more studies conducted have continued to back
this up. In 2019, a study published by K.B. et al. investigated the soluble dietary fiber
extracted from plantains and its prebiotic potential. 6 The fiber was fermented in a lab
setting using two bacteria strains, Lactobacillus casei and Bifidobacterium Bifidum. The
substrate expressed its potential by encouraging growth of the probiotics. Growth of
these probiotics have ways of protecting the intestine by inhibiting takeover from
pathogenic strains which reduces the occurrence of inflammation and infection.
Ultimately, colon cancer development was hindered by the short chain fatty acids in the
fermentation supernatants. They were able to signal apoptosis in colon cancer cells
leading to cell death. This recent study supports the position of the Academy of Nutrition
and Dietetics of fiber reducing the risk of colon and colorectal cancer.
 The intestinal microbiota is known to play an important role in the prevention of
colon cancer.7 An in vitro study by Chen et al studied the butyrate concentrations, a
short chain fatty acids produced when fiber is processed and fermented in the large
intestine, and its role in colon cancer prevention. Butyrate has a role in immunity, gene
expression, epigenetic modulations and signaling pathways which have all been
considerations for its anticancer effects. This study demonstrated its anticancer effects
from its affect on T-regulatory cells which have a profound anti-inflammatory effect. The
action of T-cells by butyrate was shown to reduce colitis in rats. Rats whose diet was
supplemented with dietary fiber increased bacteria that produce butyrate, thus
increasing the amount of butyrate present in the colon; this also showed a concomitant
reduction in the number of polyps. Various types of inflammation can cause an
increased risk to the occurrence of cancer, such a colitis, obesity, infection, and
autoimmune diseases.8 When inflammation is present, the balance of cell death and
proliferation is dysregulated. Immune cells produce cytokines that are proinflammatory,
which increase cell proliferation and decrease apoptosis of colonocytes, leading to
increased risk of cancer. This study also supports previous studies conducted showing
that the consumption of fiber is inversely associated with the risk of colon cancer.
Since the Academy of Nutrition and Dietetics released its position on fiber intake
in 2015, numerous studies have been conducted and the data still shows the beneficial
effects from dietary fiber. There is research that supports fiber, consumed in adequate
amounts following the AI, reduces the risk of cardiovascular disease, type 2 diabetes,
colon cancer, obesity, inflammation and promotes laxation and a balanced gut
microbiota. It is clear that fiber serves great health benefits and is necessary to
complete a healthy diet to maintain digestive health.
Resources
1. Dahl W, Stewart M. Position of the Academy of Nutrition and Dietetics: Health
Implications of Dietary Fiber. J Acad Nutr Diet. 2015;115(11):1861-1870.
doi:10.1016/j.jand.2015.09.003

2. Wannamethee SG, Whincup PH, Thomas MC, Sattar N. Associations between dietary
fiber and inflammation, hepatic function, and risk of type 2 diabetes in older men:
Potential mechanisms for the benefits of fiber on diabetes risk. Diabetes Care.
2009:32(10): 1823-1825

3. Aune D, Chan DS, Lau R, et al. Dietary fibre, whole grains, and risk of colorectal cancer:
Systematic review and dose-response meat-analysis of prospective studies. BMJ.
2011:343:d6617.

4. Ben Q, Sun Y, Chai R, Qian A, Xu B, Yuan Y. Dietary fiber intake reduces risk for
colorectal adenoma: A meta-analysis. Gastroenterology. 2014:146(3):689-699.e6.
5. Roberfroid M, Gibson GR, Hoyles L, et al. Prebiotic effects: Metabolic and health
benefits. Br J Nutr. 2010:104(suppl 2):S1-63

6. K. B. A, Madhavan A, T. R. R, Thomas S, Nisha P. Short chain fatty acids enriched

fermentation metabolites of soluble dietary fibre from Musa paradisiaca drives HT29
colon cancer cells to apoptosis. PLoS ONE. 2019;14(5):1-20.
doi:10.1371/journal.pone.0216604.

7. Park SY, Wilkens LR, Kolonel LN, Henderson BE, Marchand LL. Inverse associations of
dietary fiber and menopausal hormone therapy with colorectal cancer risk in the
Multiethnic Cohort Study. Int J Cancer. 2016(139):1241-1250

8. Chen J, Vitetta L. Inflammation-Modulating Effect of Butyrate in the Prevention of Colon

Cancer by Dietary Fiber. Clin Colorectal Cancer. 2018;17(3):e541-e544.
doi:10.1016/j.clcc.2018.05.001