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Fiber


Overview
Uses
Dietary Sources
Available Forms
 
How to Take It
Precautions
Possible Interactions
Supporting Research

Overview

Dietary fiber, found in all plant-based foods, plays an essential role in human health. There are 2 types of fiber -- soluble and insoluble -- and most whole foods contain a combination of the 2 types. Both types of fiber help maintain the health of your digestive system and promote regular bowel movements.

Soluble fiber pulls in water to form a gel in the digestive tract. This slows digestion, so that your stomach and intestine don’t absorb as much of some nutrients, like starch and sugar. As a result, cholesterol levels go down over time, which may help prevent heart disease and stroke. Consuming soluble fiber may also improve glucose tolerance in people with diabetes. This type of fiber is a common ingredient in many over the counter laxatives. Psyllium husk (which contains both soluble and insoluble fiber), pectin, and the soft parts of fruits, dried beans, and peas are examples of soluble fiber.

Insoluble fiber, on the other hand, can be found in the peels of fruit, such as apples, blueberries, and grapes. It acts as a natural laxative that speeds the passage of foods through the stomach. It also gives stool its bulk and helps it move quickly through the gastrointestinal tract.

Getting more fiber in your diet has been shown to play a role in the treatment of conditions such as gastrointestinal disease, constipation, hemorrhoids, high cholesterol, heart disease, and diabetes. Most Americans don’t get anywhere near the amount of fiber -- 25 - 30 grams per day -- recommended in their daily diet.

Uses

Constipation

Many well designed clinical studies have shown that fiber relieves constipation. Most clinical studies examined wheat bran and psyllium. Researchers think fiber relieves constipation by adding bulk to stool and helping it move faster through the intestines. Do not take fiber supplements if you have impacted stool, a complication of constipation, without first seeking the approval of your doctor.

Diarrhea

Fiber can be used to relieve mild-to-moderate diarrhea. Soluble fiber soaks up water in the digestive tract, which makes stool firmer and slower to pass.

Irritable bowel syndrome (IBS)

Several well designed clinical studies show that soluble fiber helps regulate stool frequency and consistency in people with IBS.

Hemorrhoids

Your doctor may recommend soluble fiber to help soften stool and reduce the pain associated with hemorrhoids.

Inflammatory bowel disease (IBD)

A clinical study of people with ulcerative colitis (a type of IBD) found that psyllium seeds were as effective as the prescription drug mesalamine (Rowasa) in reducing recurrences of the disease.

Diverticulosis

Patients with diverticulosis are often given fiber supplements to prevent constipation and stop the condition from progressing. The American Dietetic Association (ADA) recommends 25 - 30 grams of fiber per day; your doctor may recommend more. Some researchers think that people with diverticulosis should avoid foods such as nuts, pumpkin, caraway, and sesame seeds. It is thought that these small particles may get lodged in the diverticula (pouches in the colon) and cause infection and irritation.

High cholesterol

Soluble fibers, such as those in psyllium husk (which contains both soluble and insoluble fiber), guar gum, flax seed, and oat bran, can help lower cholesterol when added to a low saturated fat, low cholesterol diet. Clinical studies show that psyllium, in particular, is effective in lowering total cholesterol levels as well as LDL (or “bad”) cholesterol levels.

Diabetes

Clinical studies suggest that a high fiber diet may help prevent type 2 diabetes, lower insulin and blood sugar levels, and improve cholesterol and triglyceride (fats in the blood) levels in people with diabetes. In addition, one well designed clinical study suggests that pregnant women with type 1 diabetes may be able to reduce the amount of insulin they use if they eat a high fiber diet.

A clinical study compared people with type 2 diabetes who were eating 50 grams of fiber daily with people getting the American Diabetes Association’s recommended 24 grams of fiber daily. After 6 weeks, people on the higher fiber diet had better control of blood glucose, insulin, and blood lipids. In another clinical study, a group of men with type 2 diabetes who took psyllium twice daily lowered blood glucose and lipid values compared to a control group taking a placebo.

Obesity

Clinical studies and human case reports suggest that soluble fiber (such as psyllium, pectin, and guar gum) may make you feel full and less hungry, so that you eat less and lose weight. Research also suggests that high intakes of dietary fiber may help prevent weight gain in the waist circumference.

Heart disease

Eating more high fiber foods (such as oatmeal, oat bran, psyllium, and legumes) may help lower heart disease risk.

Coloncancer

There are conflicting results from studies examining whether a high fiber diet can help prevent colon cancer. Some studies suggest fiber protects against the development of colorectal cancer. But most large, better designed clinical studies show only a small association between how much fiber people eat and their risk of colorectal cancer. In addition, fiber does not seem to protect against the recurrence of colorectal cancer in people who have already been treated for the condition.

Other types of cancer

Preliminary clinical evidence suggests that a diet high in fiber (in conjunction with lifestyle changes and conventional medication) may help protect against certain types of cancer such as prostate, breast, and uterine. Further studies are needed to be sure, however.

Dietary Sources

Soluble fiber is found in dried beans and peas, oats, barley, fruits, and psyllium seed husks.

Insoluble fiber is found primarily in fruits and vegetables, whole grain products, whole grain cereals, and wheat and corn bran.

Available Forms

Fiber is available as a supplement in several forms, including fiber tablets, capsules, and powders. Fiber is also available as bulk fiber laxatives, including psyllium.

How to Take It

The following are daily fiber recommendations from the National Academy of Sciences' Institute of Medicine:

Pediatric

Infants and children under 18 years of age: There is no daily fiber recommendation for children. Children with specific fiber needs should increase the amount of foods with fiber they eat slowly over a period of days. Do not give fiber supplements to a child without first asking your doctor.

Adults

The American Dietetic Association recommends 20 - 35 grams per day from a variety of fiber-rich foods. If you are not getting enough fiber, you may need to add more fiber rich foods to your diet. Choose whole grain products, raw or cooked fruits and vegetables, dried beans, and dried peas. Refined or processed foods, including fruit juices, white breads, pastas, and rice, and non whole grain cereals, are lower in fiber. The grain refining process removes the outer coat (bran) from the grain, which lowers its fiber content. Peeling fruits and vegetables also decreases their fiber content.

Precautions

Because supplements may have side effects or interact with medications, you should take them only under the supervision of a knowledgeable health care provider.

In general, fiber supplements may reduce or delay your body's absorption of certain medications. Try to take medications at least 1 hour before or 2 - 4 hours after taking fiber.

You should always drink an 8 oz. glass of water with fiber supplements. It is also important to drink at least 6 - 8 full glasses of water throughout the day to avoid constipation. Taking fiber supplements without enough water may cause the supplement to swell and could cause choking. Do not take this product if you have difficulty swallowing. People with esophageal stricture (narrowing of the esophagus) or any other narrowing or obstruction of the gastrointestinal tract should not take fiber supplements.

If you have chest pain, vomiting, or difficulty swallowing or breathing after taking fiber supplements, seek immediate medical attention.

Fiber can cause gas and bloating.

Do not take fiber supplements if you have impacted stool, a complication of constipation, without first seeking the approval of your doctor.

It is rare, but people who take soluble fiber supplements for a long time may develop allergic reactions (even anaphylaxis).

Possible Interactions

If you are currently being treated with any of the following medications, you should not use fiber supplements without first talking to your health care provider.

Antidepressant medications (Tricyclic antidepressants) -- Dietary fiber may lower the blood levels and effectiveness of tricyclic antidepressant medications. If you take tricyclic medications, talk to your doctor before taking fiber supplements or adding more fiber to your diet. Tricyclic antidepressants include:

  • Amitriptyline (Elavil)
  • Doxepin (Sinequan)
  • Imipramine (Tofranil)

Diabetes medications -- Fiber supplements may help regulate blood sugar levels, but they can also reduce the absorption of some medications, such as glyburide (Diabeta) and metformin (Glucophage). Talk to your doctor before taking fiber supplements if you have diabetes, and don’t take fiber supplements at the same time as your medications. Wait a few hours in between.

Carbamazepine -- Taking soluble fiber such as psyllium with carbamazepine (Tegretol), a medication used to treat seizures, may decrease the absorption and effectiveness of carbamazepine. A doctor should monitor blood levels of anyone taking both soluble fiber and carbamazepine.

Cholesterol lowering medications -- Combining psyllium or other soluble fibers with cholesterol-lowering medications known as bile acid sequestrants may help lower cholesterol levels. If you take these medications, talk to your doctor to see whether psylium is safe and right for you. These drugs include:

  • Cholestyramine (Questran)
  • Colestipol (Colestid)

One study also found that when people taking simvastatin (Zocor) added psyllium supplements to their regimen, they lowered cholesterol levels as much as if they had been taking a double dose of simvastatin.

Digoxin -- Fiber supplements may reduce the body's ability to absorb digoxin (Lanoxin), a medication used to regulate heart function. Do not take fiber supplements at the same time as digoxin.

Lithium -- Clinical reports suggest that psyllium or other soluble fibers may lower lithium levels in the blood, making lithium less effective. Lithium levels should be monitored very closely by a health care provider, especially if there is any big change in fiber intake.

Supporting Research

Alberts DS, Martínez ME, Roe DJ, et al. Lack of effect of a high-fiber cereal supplement on the recurrence of colorectal adenomas. N Eng J Med. 2000;342(16):1156-1162.

Anderson JW, Allgood LD, Lawrence A, et al. Cholesterol-lowering effects of psyllium intake adjunctive to diet therapy in men and women with hypercholesterolemia: meta-analysis of 8 controlled trials. Am J Clin Nutr. 2000;71:472-479.

Anderson JW, Baird P, Davis RH, et al. Health benefits of dietary fiber. Nutr Rev. 2009; 67(4):188-205.

Bazzano LA. Effects of soluble dietary fiber on low-density lipoprotein cholesterol and coronary heart disease risk. Curr Atheroscler Rep. 2008 Dec;10(6):473-7. Review.

Bazzano LA, He J, Ogden LG, Loria C, Vupputuri S, Myers L, Whelton PK. Legume consumption and risk of coronary heart disease in US men and women: NHANES epidemiologic follow-up study. Arch Intern Med. 2001;161(21):2573-2578.

Bonithon-Kopp C, Kronborg O, Giacosa A, Rath U, Faivre J. Calcium and fibre supplementation in prevention of colorectal adenoma recurrence: a randomised intervention trial. European Cancer Prevention Organisation Study Group. Lancet. 2000;356(9238):1286-1287.

Botterweck AA, van den Brandt PA, Goldbohm RA. Vitamins, carotenoids, dietary fiber, and the risk of gastric carcinoma: results from a prospective study after 6.3 years of follow up. Cancer. 2000;88(4):737-748.

Burke V, Hodgson JM, Beilin LJ, Giangiulioi N, Rogers P, Puddey IB. Dietary protein and soluble fiber reduce ambulatory blood pressure in treated hypertensives. Hypertension. 2001;38(4):821-826.

Chan MY. Sequential effects of a high-fiber diet with psyllium husks on the expression levels of hepatic genes and plasma lipids. Nutrition. 2008; 24(1):57-66.

Chandalia M, Garg A, Lutjohann D, von Bergmann K, Grundy SM, Brinkley LJ. Beneficial effect of high dietary fiber intake in patients with type 2 diabetes mellitus. N Eng J Med. 2000; 342:1392-1398.

Dahm CC, Keogh RH, Spencer EA, et al. Dietary fiber and colorectal cancer risk: a nested case-control study using food diaries. J Natl Cancer Inst. 2010; 102(9):614-26.

Du H, Van der A DL, Boshuizen HC, et al. Dietary fiber and subsequent changes in body weight and waist circumference in European men and women. Am J Clin Nutr. 2010; 91(2):329-36.

Hermansen K, Sondergaard M, Hoie L, Carstensen M, Brock B. Beneficial effects of a soy-based dietary supplement on lipid levels and cardiovascular risk markers in type 2 diabetic subjects. Diabetes Care. 2001;24(2):228-233.

Howard BV, Manson JE, Stefanick ML, et al., Low-fat dietary pattern and weight change over 7 years: the Women's Health Initiative Dietary Modification Trial. JAMA. 2006;295(1):39-49.

Hu FB, Manson JE, Stampfer MJ, Colditz G, Liu S, Solomon CG, et al. Diet, lifestyle, and the risk of type 2 diabetes mellitus in women. N Engl J Med. 2001;345(11):790-797.

Karhunen LJ. A psyllium fiber-enriched meal strongly attenuates postprandial gastrointestinal peptide release in healthy young adults. J Nutr. 2010; 140(4):734-44.

Jänne PA, Mayer RJ. Chemoprevention of colorectal cancer. N Engl J Med. 2000;342(26):1960-1968.

Jenkins DJ, Kendall CW, Vuksan V. Viscous fibers, health claims, and strategies to reduce cardiovascular disease risk. Am J Clin Nut. 2001;73(3):653-654.

Kalkwarf HJ, Bell RC, Khoury JC, Gouge AL, Miodovnik M. Dietary fiber intakes and insulin requirements in pregnant women with type 1 diabetes. J Am Diet Assoc. 2001;101(3):305-310.

Krauss RM, Eckel RH, Howard B, Appel LJ, Daniels SR, Deckelbaum RJ, et al. AHA Scientific Statement: AHA Dietary guidelines Revision 2000: A statement for healthcare professionals from the nutrition committee of the American Heart Association. Circulation. 2000;102(18):2284-2299.

Kurtz RC, Zhang ZF. Gastric cardia cancer and dietary fiber. Gastroenterology. 2001;120(2):568-70

Liu S, Manson JE, Stampfer MJ, Hu FB, Giovannucci E, Colditz GA, et al. A prospective study of whole-grain intake and risk of type-2 diabetes mellitus in women. Am J Pub Health. 2000;90:1409-1415.

Lu LJ, Anderson KE, Grady JJ, Kohen F, Nagamani M. Decreased ovarian hormones during a soya diet: implications for breast cancer prevention. Can Res. 2000;60(15):4112-4121.

MacDermott RP. Treatment of irritable bowel syndrome in outpatients with inflammatory bowel disease using a food and beverage intolerance, food and beverage avoidance diet. Inflamm Bowel Dis. 2007 Jan;13(1):91-6. Review.

Ma Y, Hébert JR, Li W, Bertone-Johnson ER, Olendzki B, Pagoto SL, Tinker L, Rosal MC, Ockene IS, Ockene JK, Griffith JA, Liu S. Association between dietary fiber and markers of systemic inflammation in the Women's Health Initiative Observational Study. Nutrition. 2008 Oct;24(10):941-9.

Mayne ST, Risch HA, Dubrow R, Chow WH, Gammon MD, Vaughan TL, et al. Nutrient intake and risk of subtypes of esophageal and gastric cancer. Cancer Epidemiol Biomarkers Prev. 2001;10(10):1055-1062.

Mellen PB, Liese AD, Tooze JA, Vitolins MZ, Wagenknecht LE, Herrington DM. Whole-grain intake and carotid artery atherosclerosis in a multiethnic cohort: the Insulin Resistance Atherosclerosis Study. Am J Clin Nutr. 2007 Jun;85(6):1495-502.

Michels KB, Giovannucci E, Joshipura KJ, Rosner BA, Stampfer MJ, Fuchs CS, et al. Prospective study of fruit and vegetable consumption and incidence of colon and rectal cancers. J Natl Cancer Inst. 2000;92(21):1740-1752.

Mumford SL, Schisterman EF, Siega-Riz AM, et al. Effect of dietary fiber intake on lipoprotein cholesterol levels independent of estradiol in healthy premenopausal women. Am J Epidemiol. 2001;173(3):145-56.

National Cholesterol Education Program. Executive summary of the third report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III). JAMA. 2001;285(19):2486-2497.

North CJ, Venter CS, Jerling JC. The effects of dietary fibre on C-reactive protein, an inflammation marker predicting cardiovascular disease. Eur J Clin Nutr. 2009 Feb 18.

Park Y, Brinton LA, Subar AF, Hollenbeck A, Schatzkin A. Dietary fiber intake and risk of breast cancer in postmenopausal women: the national Institutes of Health-AARP Diet and Health Study. Am J Clin Nutr. 2009; 90(3):664-71.

Schatzkin A, Lanza E, Corle D, Lance P, Iber F, Caan B, et al. Lack of effect of a low-fat, high-fiber diet on the recurrence of colorectal adenomas. N Engl J Med. 2000;342(16):1149-1155.

Sola R, Godas G, Ribalta J, et al., Effects of soluble fiber (Plantago ovata husk) on plasma lipids, lipoproteins, and apolipoproteins in men with ischemic heart disease. Am J Clin Nutr. 2007;85(4):1157-63.

Soler M, Bosetti C, Franceschi S, Negri E, Zambon P, Talamini R, et al. Fiber intake and the risk of oral, pharyngeal, and esophageal cancer. Int J Cancer. 2001;91(3):283-287.

Stampfer MJ, Hu FB, Manson JE, Rimm EB, Willett WC. Primary prevention of coronary heart disease in women through diet and lifestyle. N Engl J Med. 2000;343(1):16-22.

Tariq N, Jenkins D, Vidgen E, Fleshner N, Kendall CW, Story JA, et al. Effect of soluble and insoluble fiber diets on serum prostate specific antigen in men. J Urol. 2000;163:114-118.

Terry P, Lagergren J, Ye W, Wolk A, Nyren O. Inverse association between intake of cereal fiber and risk of gastric cardia cancer. Gastroenterology. 2001;120(2):387-391.

Tuomilehto J, Lindstrom J, Eriksson JG, Valle TT, Hamalainen H, Ilanne-Parikka P, et al. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med. 2001;344(18):1343-1350.

Wei ZH, Wang H, Chen XY, Wang BS, Rong ZX, Wang BS, Su BH, Chen HZ. Time- and dose-dependent effect of psyllium on serum lipids in mild-to-moderate hypercholesterolemia: a meta-analysis of controlled clinical trials. Eur J Clin Nutr. 2008 Nov 5.

Zhang C, Liu S, Solomon CG, Hu FB. Dietary fiber intake, dietary glycemic load, and the risk for gestational diabetes mellitus. Diabetes Care. 2006;29(10):2223-30.


Review Date: 5/24/2011
Reviewed By: Steven D. Ehrlich, NMD, Solutions Acupuncture, a private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.
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Uses of this Supplement
Atherosclerosis
Breast cancer
Colorectal cancer
Constipation
Crohn's disease
Diabetes
Diarrhea
Hemorrhoids
Hypercholesterolemia
Hypertension
Irritable bowel syndrome
Obesity
Prostate cancer
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