Academy Position Paper

Position of the Academy of Nutrition and Dietetics: Health Implications
of Dietary Fiber

Written by Wendy J Dahl, PhD, RD, and Maria L. Stewart, PhD and
provided in the Journal of the Academy of Nutrition and Dietetics in
November 2015

Kyla Kurczewski
NFS 4950: Senior Seminar
February 8, 2016

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. This position is in effect until December 31, 2018. Written by
Wendy J. Dahl and Maria L. Stewart.
“Dietary fiber” is described as nondigestible carbohydrates intact in
plants, and “functional fiber” is isolated or purified nondigestible
carbohydrates that have beneficial physiological effects in our bodies.1 “Total
fiber” is the sum of these fibers. Fiber is not considered a nutrient because it
is neither digested nor absorbed in our body. This means that there is no
Recommended Dietary Allowance as no state of deficiency has been
demonstrated to allow for calculations. The Adequate Intake (AI) for fiber is
based on the median fiber intake level observed to achieve the lowest risk of
coronary heart disease.1 The reduction in the risk of type 2 diabetes was
considered a secondary endpoint in support of this recommendation.
Carbohydrates, in general, are the most widely consumed source of
dietary fiber. Many people consume adequate amounts of total
carbohydrates, but the problem lies in the fact that much of these
carbohydrates are made up of added sugars and refined grains with added
fat and a very small amount of dietary fiber. Many say that potatoes are
America’s favorite vegetable, but most of the time they are consumed, the
method of preparation (i.e. frying) results in more saturated fat and other
unhealthy outcomes than positive benefits, such as the fiber content, of a
vegetable. The mean intake of dietary fiber in the United States is only 17


grams per day1, which falls very short of the Adequate Intake values of about
25 grams per day for women and 38 grams per day for men. Only 5% of the
population actually meets these values.
Whole grains are a highly recommended source of dietary fiber, but the
actual fiber content of these foods can range greatly, leading to insufficient
fiber intake. Grain-based foods, not including desserts, are the major source
of dietary fiber, and grain mixtures (i.e. pasta meals, pizza, and noodle
soups) make up 17.8% of fiber intake on their own. Fruits follow next at
14.9%, vegetables at 13.7%, and then beans, peas, other legumes, nuts, and
seeds at only 6.3% due to low consumption.1
Higher dietary fiber intake reduces the risk of many diseases including
cardiovascular disease, type 2 diabetes, and some cancers. Consuming
dietary fiber from grain products is associated with lower total death rates as
well, specifically cardiovascular, infectious, and respiratory deaths. This
relationship also extends to cancer deaths in men, but not in women.
In researching the benefits of dietary fiber in relation to cardiovascular
disease and coronary heart disease, a risk reduction of 9% for each increase
of 7 grams of fiber per day was found.1 Insoluble, cereal, and vegetable
fibers were associated with both diseases, but fruit fiber was only shown to
reduce the risk of cardiovascular disease. Dietary fiber intake is also
inversely associated with total cholesterol, LDL cholesterol, and triglycerides,
and positively associated with HDL cholesterol. With improved serum lipid
levels, lower blood pressure, and reduced inflammation as well, these


benefits may explain fiber’s protective properties against cardiovascular
disease. The risk for metabolic syndrome can be reduced with a higher
dietary fiber intake as well, and reaching an adequate intake with sources of
soluble, viscous, and insoluble fiber is key to receiving all of fiber’s benefits.
In a study of 19,033 cases out of 488,293 participants, the risk of type
2 diabetes decreased with total dietary fiber, cereal fiber, fruit fiber, and
insoluble fiber intake.1 Being aware of the glycemic load of particular foods is
important in managing or preventing diabetes as well, so increasing fiber
intake by choosing low glycemic index foods is the best way to reduce the
risk of type 2 diabetes.
Over the past few years, the inverse association between dietary fiber
intake and risk of colon cancer has gotten much stronger. One publication
reporting data from the World Cancer Research Fund noted a 10% cancer risk
reduction for every 10 grams of dietary fiber consumed daily.1 Cereal fiber
was the only type of fiber associated with a dose-dependent reduction in
risk, but because fiber results in amplified fecal bulk and decreased transit
time, leading to a shorter exposure of less toxins in the colorectal epithelium,
all types of dietary fiber may protect against colon cancer.
Soluble fiber and vegetable fiber are proven to have a strong inverse
association with breast cancer risk. Soluble fiber showed a 9% risk reduction
per 10 grams of fiber each day, and fiber from vegetables reduced the risk of
breast cancer by 10% in the highest intake group.1 Dietary fiber has also
shown a significant protective effect against gastric cancer, but the role of


fiber in protecting against endometrial, ovarian, and prostate cancer is
Fiber promotes digestive health through its laxation and fermentation
properties, as well as effects on microbiota. Many dietary fibers increase
fecal bulk, stool frequency, and reduce transit time, impacting laxation in the
body. Fermentable fibers lower the pH level in the colonic lumen, which
increases mineral bioavailability and inhibits the growth of pathogenic
bacteria. Microbiota shifts rapidly in response to dietary changes due to
dietary fiber being its key substrate, and can also be altered by consuming
prebiotic fibers. The role of this gut microbiota on our health has reached the
forefront of research in recent years. Current work suggests that dietary fiber
from rye, barley, wheat, lentils, and chickpeas may have a prebiotic effect,
which could improve laxation and digestive health, reduce the risk of obesity,
type 2 diabetes, and colon cancer, and improve mineral bioavailability.1
A lower dietary fiber intake is associated with a higher body mass
index, and most isolated fibers do not leave one feeling more full or cause a
reduction in their overall energy intake. No intake level of dietary fiber has
been shown to have a significant negative effect on mineral balance or
gastrointestinal function, resulting in no Tolerable Upper Limit being set. Very
high intakes of functional fibers, as opposed to dietary fibers, may contribute
to gas, bloating, and diarrhea, but dietary fiber from a variety of sources has
not shown significant adverse effects.1 Fermentation of dietary fiber may also


contribute to gas and other unavoidable gastrointestinal side effects, but the
benefits derived from this fiber far outweigh the very tolerable reactions.
As a Registered Dietitian, one is responsible for guiding patients toward
choosing fiber-rich foods from varied, naturally occurring sources as opposed
to fiber supplements. Dietary fiber sources, as opposed to functional fiber,
contain micronutrients and phytochemicals that can synergistically work to
improve health. Encouraging moderate portions throughout the day is critical
to keeping the digestive system healthy and comfortable as well. Fiber could
be the key to improving a patient’s constipation, aiding in weight loss, or
decreasing the risk of cardiovascular disease and/or diabetes. A diet that
encourages fiber will also tend to be lower in saturated and trans-fatty acids,
sodium, and added sugars. Registered Dietitians should encourage increased
fluid intake to these clients too, because fiber requires more water to
comfortably move through the body.
I am in complete agreement with the position of the Academy on the
importance of dietary fiber, the general recommended guidelines given to
receive optimal health benefits from this fiber, and also the fact that
although fiber may sometimes come with unwanted side effects, the benefits
are more than worth it. Dietary fiber helps to keep us regular, satiated,
maintain a healthy weight, and also helps to keep our insides clear of fungus
and unwanted bacteria. All of the evidence shown to reduce the risk of
chronic diseases is yet another reason to consume adequate amounts of
dietary fiber from the right sources and again demonstrates the importance


of fiber. It is very beneficial to our health, and I would strongly suggest to a
client or patient to consume quality sources of dietary fiber from a variety of
foods all throughout the day, each and every day. A healthy diet with an
adequate amount of dietary fiber should be initiated early in life and
maintained all throughout.

1. Dahl WJ, Stewart ML. Position of the Academy of Nutrition and
Dietetics: Health Implications of Dietary Fiber. Journal of the Academy
of Nutrition and Dietetics. 2015;115:1861-1870.