Denis Burkitt (1911–1993), a British surgeon and medical researcher, is usually credited with popularizing the idea that dietary fiber may protect against the development of chronic diseases such as diabetes, hypercholesterolemia, heart disease, diverticular disease, and colon cancer that are prevalent in Western countries. Writing in the 1970s and 1980s, Burkitt described the relationship between large stools, which reflect a high intake of plant foods rich in dietary fiber, and a lack of "Western diseases," as he called them.
Dietary fiber is plant cell material that resists digestion by the endogenous enzymes of humans. It is not really an accurate term, as many of its components are not fibrous. Gums and mucilages, for example, are classified as dietary fiber because mammalian enzymes or secretions do not digest them. Only one component of dietary fiber, cellulose, is truly fibrous; yet "dietary fiber" is the accepted term for describing the roughage in the human diet.
Dietary fiber is found only in plant products, including fruits, vegetables, nuts, and grains. The most concentrated sources of dietary fiber are the bran layers of grains, such as wheat bran. Because of their higher water content, fruits and vegetables provide less dietary fiber per gram of ingested material than grains and cereals.
Recommendations for adult dietary fiber intake generally fall in the range of 20 to 35 grams per day. For children, the general rule is to add five to a child's age to determine the number of grams of fiber to be consumed daily. Thus, a ten-year-old child should consume 15 grams of dietary fiber a day. Usual intakes of dietary fiber in the United States average only 11 grams per day, so few people get the recommended amount. Most of the popular foods Americans consume contain little dietary fiber. For example, most servings of grains, fruits, and vegetables contain 1 to 3 grams of dietary fiber. Thus, to get the recommended amounts of dietary fiber one would need to consume at least ten servings of fiber-containing foods per day. Dietary fiber content of foods is listed on the Nutrition Facts panel on food packages. Foods particularly high in dietary fiber include bran cereals, which contain up to 13 grams of dietary fiber per serving, and beans and legumes, which contain more than 5 grams of dietary fiber per serving.
Several epidemiologic studies indicate that a high intake of dietary fiber protects against most chronic diseases. This is true even when confounding variables such as fat and calorie intake are accounted for. Dietary fiber may protect against large bowel cancer by enhancing the environment of the large intestine. Dietary fiber escapes digestion in the small intestine and is fermented in the large intestine by intestinal microflora. This fermentation yields short-chain fatty acids and gases. Short-chain fatty acids, including butyrate and propionate, have interesting physiological properties. Butyrate is a preferred gut fuel for the cells in the colon. Additionally, propionate may be involved in the cholesterol-lowering effects of certain dietary fiber. Dietary fiber fermentation may also enhance the number of beneficial microflora, such as bifidobacteria and lactobacillus. However, two recent large intervention studies did not find any protection in polyp prevention, which has led to questions about whether fiber should be recommended to prevent colon cancer (Goodlad, 2001).
Dietary fiber is an accepted therapy for gastrointestinal disorders such as constipation and diarrhea, and is often consumed as bulk laxatives or high-fiber breakfast cereals. Fiber may also protect against other cancers. International comparisons show an inverse correlation between breast cancer death rates and consumption of fiber-rich foods.
Dietary fiber has also been shown to be effective in reducing serum cholesterol, and it may decrease the risk of coronary heart disease by decreasing serum lipids, lowering blood pressure, improving glucose metabolism, and aiding in weight control. Soluble fibers appear to be the most effective in lowering serum cholesterol. The U.S. Food and Drug Administration (FDA) has accepted health claims for the cholesterol-lowering ability
Some clinical research suggests that dietary fiber may also play a role in improving blood-sugar control in diabetes. Dietary fiber, especially soluble fiber, can delay glucose absorption and reduce insulin requirements in both insulin-dependent and non-insulin-dependent diabetes mellitus. Obese persons with diabetes often respond to a high-fiber diet with weight loss and decreased insulin requirements.
The best way to get dietary fiber in the diet is to consume a wide range of grains, legumes, fruits, and vegetables. Concentrated fiber sources such as bulk laxatives, fiber supplements, and foods fortified with fiber may be useful in the prevention and treatment of bowel disorders and as lipid-lowering therapies. Fiber supplements should be taken under medical supervision, since bowel obstructions, dehydration, and other medical contra-indicators have been reported with their use.
Burkitt, D. P.; Walker, A. R.; and Painter, N. S. (1972). "Effect of Dietary Fiber on Stools and the Transit-Times, and its Role in the Causation of Disease." Lancet 2(7792):1408–1412.
Goodlad, R. A. (2001). "Dietary Fiber and Risk of Colorectal Cancer." GUT 48:587–589.
Schatzkin, A.; Lanza, E.; Corle, D.; Lance, P.; Cann, B.; Shike, M.; Weissfeld, J.; Burt, R.; Cooper, M. R.; Kikendall, J. W.; Cahill, J.; and the Polyp Prevention Trial Study Group (2000). "Lack of Effect of a Low-Fat, High-Fiber Diet on the Recurrence of Colorectal Adenomas." New England Journal of Medicine 342:1149–1155.