Dietary Fibers and Their Uses

 

Dr Dhanasekhar KesaveluM.B., MRCPCH, FRCPCH, CCT (UK)

Consultant pediatric gastroenterologist

Apollo Childrens hospital

Shafee Mohammed Road

Chennai 600006

Email drdskgastro@gmail.com

+91 97911 71468

Introduction to Fibers

The universally accepted definition of dietary fibers “Dietary fiber is a type of carbohydrate that cannot be digested by our bodies enzymes”. Fiber is a very important non-nutrient. Foods rich in fiber improves satiety as it needs more clearing than other foods and it absorbs water and swells in the stomach and gives a feeling of fullness.

The types of fiber that are known are

  • Soluble fiber
  • Insoluble fiber

Fibers have played an important role in the diet of our civilization and finds an inevitable role in all civilizations and all ages. The Indus, Aryan, Iron, Bronze, Neolithic all have quotes and food patterns where dietary fibers find a significant role in the diet.

The chart below quotes the role of fibers and documentation in the past eras.

Metabolism of Fibers

Dietary consumption of carbohydrates consists of absorbable and non-absorbable sugars. The absorbed sugars undergo a different pathway which involves the amylase (pancreatic enzyme) for digestion and conversion in the small intestine.

  • The non-digestible fibers include Cellulose, fructose, Starch, xylose, Gums, pectin. These fibers are fermented by colonic bacteria and they get converted to: Butyrate, Propionate, Acetate, Carbon-di-oxide which gets converted to Hydrogen.
  • Where SCFA (Short chain fatty acids) are formed and it leads to the absorption by the colonic epithelial cells.

Let’s see an example of a food that is believed to “cure” or “treat” constipation in the Indian sub-continent: Banana.

Banana is not digested by the small intestine and escapes the “digestion” by Amylase resistant starch and is directly delivered to the colon which leads to formation of ‘SCFA” and also gives a trophic effect, with increased absorption of Increase salt, water absorption

Provides energy.

 

Below are well known benefits of dietary fibers:

  • Normalizes bowel movements
  • Bowel health
    • Decreases risk of developing hemorrhoids
    • Decreases production of diverticula (diverticulosis)
  • Lowers Cholesterol
    • VLDL
  • May reduce blood pressure and inflammation
  • Improves blood sugar due to soluble fibers (better Glycemic control)
  • Reduce the risk of developing type 2 diabetes
  • Insoluble fiber
  • Help reduce weight
  • Less caloric dense
  • Prevents colorectal cancer-controversial topic!

The Current Food Era

Most recently, nutrition has garnered prominent attention and commercially available foods have a label affixed on the top to highlight the nutritional value.

Fibers are also ‘highlighted” alongside sugars, protein, vitamins etc. The ‘FSSAI” has emphasized the labelling of foods to raise consumer awareness.

What should I know as a clinician-value of dietary fibers!

Daily Recommended Intake of Fiber by Age and Gender (age+5)

Age Fiber (grams/day)
1-3 years
Male & Female 19
4-8 years
 Male & Female 25
9-13 years
Male 31
Female 26
14-18 Years
Male 38
Female 29

 

Scientific evidence for constipation

 

Let’s look at the review

Multiple studies have emphasized the role of fibers in primarily childhood constipation and various functional gastrointestinal disorders.

  • There is some evidence to suggest that fiber is more effective than:
    • Probiotics
    • Placebo
    • Laxatives
    • Drugs
  • In the safety and management of childhood constipation in increasing the Gut transit time and promoting regular evacuation
  • The commonly used fibers in the management of constipation are:
    • Cocoa husk
    • Glucomannan
    • Ispaghula

Diet and Fibers

The following are foods that are rich in fiber

  • Whole cereals like whole wheat, barley, ragi, oatmeal etc.
  • Legumes and germinated pulses like rajma, channa etc
  • Green leafy vegetables like spinach, cabbage, lettuce etc.
  • Salads and boiled vegetables (Cauliflower, Broccoli, Capsicum)
  • Fruits with skin eg. Apple, guava, pears

 

 

A sample food list is given below for various meals of the day

Breakfast

North Indian

  • Phulkas (2) / Chapathis (2) / Veg. Poha (1 cup) / Quinoa (1 cup)
  • Dhal / Cooked vegetable preparation- 1 cup
  • Tomato / Onion / Dhal Chutney / mint / Coriander chutney (No Coconut / Groundnut) -1 cup (OR)

Continental

  • Brown Bread / Multi-grain Toast /Veg s/w -2 slices (½tsp Jam)
  • (OR)
  • Thick Oats / Wheat Porridge/ Muesli -1½ cup+/- (½tsp sugar)

Mid-morning snack

  • 30 am-Vegetable Soup- 1 cup (add salt to taste)
  • Digestive Marie / Marie Biscuits-2-3 nos.

Lunch sample menu

  • Chappathi/Rice-(½ cup Rice = 1 Chappathi) -2 ( no) or / 1 cup
  • Dhal / Sambar -1 cup
  • Vegetable Curry / Subji -1- 2 cups
  • Vegetable – Kootu or Poriyal-1-2 cups
  • Salad / Boiled Vegetables -1- 2 cups
  • Curd-1 cup

Snack sample menu

  • 00 pm-Fruits- 200 g

Tea time

  • Tea / Coffee / Milk-100 ml
  • ½ tsp- sugar
  • Sundal (channa) / Boiled gram / Boiled Corn- ¾ cup

Dinner sample menu

  • Same as Breakfast / Lunch
  • Flaxseed – 2 tablespoon

* Note:

For reference:

    • 1 cup = 150 ml capacity
  • 1 glass = 200 ml capacity
  • 1 teaspoon = 5 gm

Conclusion

The use of dietary fibers in clinical practice is expanding and the clinician has been enriched in the wider uses are yet to be discovered. The use of dietary fibers cannot be ruled out and they are here to stay for long term. Dietary fibers are safe with few or no side effects and they form a vital role in non-pharmacological treatment.

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