http://www.smh.com.au/news/Health/B...6415699078.html

Bottom line on high fibre
January 27, 2005

Fibre levels are under scrutiny, writes Nicholas Bakalar.

Despite the barrage of television commercials that insist otherwise, a diet low in fibre is usually not the cause of constipation, and taking fibre supplements is probably not the cure, according to a new study.

In fact, a fibre supplement can make symptoms worse in some patients, particularly the most severely afflicted. A review study published in the January issue of The American Journal of Gastroenterology suggests many other common beliefs about constipation are also little more than durable myths.

In one study, fewer than half of the patients with self-described constipation had any response to added fibre, and studies comparing people with chronic constipation to groups without the condition showed no difference in their dietary fibre intake.

At best, a diet low in fibre may be a contributory factor in a minority of patients, and fibre supplements may help them, the reviewers, led by Dr Stefan Mueller-Lissner, a professor of medicine at Humboldt University in Berlin, found.

Drinking more liquid is often recommended, but studies show it does not work. Although it may seem that adding water to hard stools will soften them, this is not so.

Will increasing exercise help?

The studies say no. Exercise is largely ineffective in preventing constipation. It seems to help in the elderly if it is part of a broader program, but it does not work in young, severely constipated patients.

So what does work?

"I do start with a trial of dietary fibre," Mueller-Lissner says. "Prunes and other fruits may be effective, although bloating can occur as a side-effect."

If those measures do not work, Mueller-Lissner recommends laxatives.

In addition to the fibre additives, there are three other types: stool softeners (Colonlytely and Glycoprep, for example, both available in Australia) , saline laxatives such as milk of magnesia, and stimulant laxatives, including Durolax and Bisalaz, among others.

"I prescribe macrogol [the active ingredient in Colonlytely and Glycoprep, among others]," Mueller-Lissner says.

"If this is ineffective or not tolerated, I switch to bisacodyl [the active ingredient in Durolax and Bisalax] or a related compound."

These drugs are not harmful in normal doses, he says. Some experts believe that stimulant laxatives, which amplify bowel motility, can increase the risk for colorectal cancer, but the evidence is weak.

Chronic constipation is itself associated with an increased risk of the cancer, but no evidence supports a belief that laxatives used in recommended doses increase the risk.

The New York Times

...or, "High Fiber Is A Load of Crap." (Sorry, couldn't resist.)

I'm definitely a high-fiber skeptic. 'Enough' is good enough. Some people may need more than others, but I disagree with that 30-40 g per day recommendation that floats around out there. That's a lot! Fiber binds with many nutrients and inhibits their absorption.

And it's worth reading what Barry Groves says about fibre too:
http://www.second-opinions.co.uk/ch...rol_myth_3.html

Roz

Lutz and Kwasniewski have been saying all along that the high-fiber approach was not correct. Particularly Lutz in his book dealing with intestinal/stomach disorders...

Ever notice that original pushers of the 30g fiber myth are the same folks who told us we needed 6-12 servings of breads and cereals to get it?

Doreen

I second that entirely, the only thing that high fiber ever did for me is gas and bloating...
For me, coffee with heavy cream does the trick.

Prunes' laxative effect is due to the high sorbitol content, not fiber. That's why prune juice is also effective, even though it has little fiber.

Apples, pears and sweet cherries also contain sorbitol, but much smaller quantities than in prunes.


Doreen

Reminds me of going to Weight Watchers during their "Fat and Fibre" stage. We had to eat less than 30g fat, and more than 30g fibre.
Funny, that didn't last long. I think it was after that nonsense that they switched to the "points" system, which was just calorie counting made "simple."

Roz

Constipation is a sign of GI distress, not lack of fiber per se. It's mostly due to lack of good bacteria and/or slugish liver, however, lack of movement does play a part. Naturally occuring fiber in vegetables and fruits does work, but adding fiber supplements can make this matter worse. What works is good oil combined with something acidic, like vinegar or lemon juice. Great as a salad dressing, cream works too, and anything fried in fatty. Water is not helping but exercises do work, especially walking and jogging.

I have to admit that the need for fiber has always stumped me. Fiber is something that the body does not digest. If more fiber was better, then we should all be eating hay.

I do not intentionally add fiber to my diet, it just comes with the vegetables that I eat. I do not eat the fibrous parts of the plants.

Regularity has never been a problem for me, so I have never experimented with adding more fiber for that.

When I was a nursing student, we were taught one of the main causes for constipation was not responding to nature's call. So many of us have hectic jobs or class schedules, long commutes to and from, and chauffeuring kids all over the place .. which doesn't allow the opportunity to go when we need to. The main function of the colon is to reabsorb water from the stool, so needless to say, the longer it sits there the drier it will be

Fats and oils are very important, but not so much because they "lubricate" the bowel. Quite simply, fat triggers the release of bile, and it's the presence of bile in the stool which stimulates normal intestinal contractions, called peristalsis. Low fat diets need lots of fiber to compensate for the reduced amount of bile in the intestinal contents.

Doreen

Doreen, I find that to be very true for me. If I miss an opportunity to go on a daily basis, sure enough, I get constipated the next day. Fiber and water aren't a big factor for me, it seems, if I respond to nature's call when it comes lol.

Serre

Odd that I never considered that being constipated. I thought being constipated meant having the urge to go but being unable. Now I know differently.

I spent a good part of my adult life having the urge only a couple times a week. I am now sure it had less to do with what I ate than the fact that I never slowed down enough to SIT!

I just got off a fiber thing. I'd had a blood test that showed elevated cholesterol. While I suspected it was because I had recently started Atkins and my blood was flushing out the fats, I decided to eat more fiber and was rather bemused by the daily recommendations. I found that to eat enough fiber meant going over my CCL. And sure enough, the more carbs I ate, the more carbs I craved. You know the rest.

About to start Induction again and get my fiber from salad and veggies.

I do like to take a hefty dose of a sugar-free metamucil-type product on a fairly regular basis (couple times a week). Not because I get constipated, I just think it does the entire intestinal system some good to "sweep it out" now and then.

I don't take a supplement if I am drinking the fiber, I figure it is a waste because the fiber binds everything up and rushes it through the system, thereby interfering with absorption.

I do get quite a bit of fiber from my veggies, and I'm not sure you absolutely have to have a supplement. But it is easier to drink this stuff, than try and eat extra servings of veggies.

Interesting about the sorbitol in prunes, I had never heard that! Kind of the same reaction as what I had when I ate a whole box of Russell Stovers SF candy. Whoa.

Organic natural (unsweetened) yogurt, stevia, and fresh/frozen strawberries or blueberries does it for me. Don't know if that can be called high fiber but it sure tastes great and works like a charm.