Summary of “Position of the Academy of Nutrition and Dietetics: Health Implications of

Dietary Fiber” From The Academy

Kristin Gonzalez

Based on The Academy of Nutrition and Dietetics: Health Implications of Dietary Fiber,
their position states that the public should be consuming adequate amounts of dietary fiber. Their
main point to get across is that fiber is beneficial and Americans should be consuming far more
than they typically do in one day. There is no set tolerable upper intake level for fiber since there
is no deficiency state fiber is not considered a nutrient. 1 This means that the adequate intake
amount for fiber is solely based off of the median fiber intake level. This could confuse
Americans deciding how much fiber they want to raise or decrease their intake levels. It was
explained that in 2010, there was a mean intake of only 17 g/day for adults. 1 Table 1 graph
emphasizes the number of grams/day that women and men should be consuming daily, and it is
upwards of 38 for men, and 25 for women. Most Americans believe their majority of fiber comes
from carbohydrates, but most of the carbohydrates consumed are made up of added sugar and
refined grains/ These forms of carbohydrates contain little amounts of dietary fiber. 1 The tables
in this article give the reader a better idea as to what foods they should be eating and how much
grams of fiber they need to be intaking. For example, Table 2 shows a list of foods per serving
size and shows the amount of total dietary fiber along with the energy derived from fermentation.
Other countries regulated by the European Union believe that fiber should be measured in a
different way than the United States measures the amount of fiber. The US Department of
Agriculture (USDA) calculates the energy based on the amount of soluble fiber and insoluble
fiber. While other countries measure it by taking into account the amount of energy provided
during fermentation. Approximately 70% of dietary fiber is fermented, while not all soluble fiber
is fermentable. 1 Since the US is looking solely at the amount of soluble fiber and how much kcal
is in that source of fiber, they are lacking the awareness that fermentation could be undergone by
insoluble fiber. 1 This could result in the miscalculation of fiber intake in one day. “Fermentation
of fiber by the average human gut microbiota is estimated to yield approximately 2.5 kcal/g and
may provide up to 10% of daily energy intake in humans.” 1 This shows that for calculations to
be accurate, it is important to take into account the fermentability of fiber.
Along with emphasizing the importance of understanding the different kinds of fiber and
how they get digested, this article goes into detail on how the benefits of fiber affects one’s diet,
along with their risk of certain diseases. The academy goes over the research behind how fiber
could benefit someone suffering from cardiovascular disease, type 2 diabetes, colorectal cancer,
breast cancer, other cancers. First, cardiovascular disease. The Academy begins by explaining
how these articles’ position is based on recent research that is focused more on dietary fiber
versus functional fiber. Wendy Dahl et. al explains how there is a report done on the Nurses
Health Study, that there is an inverse association between cereal fiber and all-cause mortality. 1
By having an inverse relationship, this means that as cereal fiber increases, mortality rates have
the inverse relationship causing these rates to decrease, and vice versa. Starting with
cardiovascular disease, this is what the adequate intake of fiber is based on. The adequate intake
is based on the amount of fiber necessary to lower the risk of coronary heart disease, which is a
type of cardiovascular disease. Regarding the inverse relationship between fiber intake and
cardiovascular disease, the specific amount necessary would be an additional 7 g/day to see a 9%
risk reduction. 1 This has to do with the way that fiber affects the factors associated with heart
disease, such as cholesterol. Not only has total dietary fiber intake was inversely associated with
total cholesterol, low-density lipoprotein cholesterol, and triacylglycerides, but viscous fibers
have also been known to lower blood cholesterol levels. 1 Viscous fibers could potentially be the
main mechanism by which fiber affects cardiovascular disease. But the problem with most
research being done is that research is testing the effects of fiber are testing functional fiber
versus dietary fiber. This shows that there is still a lot of research to be done regarding fiber
because there are many different types that have different effects on our bodies. Regarding type 2
diabetes, The Academy shows the importance of the addition of fiber in one’s diet. The main
way that fiber would reduce the risk of type 2 diabetes is by reducing inflammation in the body.
The Academy explains how viscous dietary fiber plays a role in type 2 diabetes prevention by
slowing gastric emptying rates, digestion, and absorption of glucose to benefit immediate
postprandial glucose metabolism. 1 Regarding cancer, there are many cancers discussed
throughout this article and how the intake of fiber affects the risk of these diseases. Colorectal
cancer has been shown to have a 9% reduced risk for every 10g of total dietary fiber consumed
daily. 1 It is cereal fiber that is associated with the reduction in risk, whereas vegetable fiber did
not significantly reduce risk. Though there is a correlation between fiber and the risk of
colorectal cancer, The Academy suggests that dietary fiber may be protective, but there are other
factors that may be equally influential, such as phytochemicals, energy intake, body weight, and
genetics. The way that dietary fiber would help aid in the risk of colorectal cancer development
would be through increasing fecal bulk and decreasing transit time. 1 This would allow the colon
to spend less time being in contact with carcinogens. Similarly, breast cancer is discussed
comparably manner as colorectal cancer. There is not a direct link between the impact of dietary
fiber and breast cancer survival; however, soluble fiber has been shown to have a strong inverse
association with breast cancer by producing a 9% risk reduction. 1 Opposite of that with
colorectal cancer, it is shown that the fiber from vegetables had a 10% reduced risk of breast
cancer observed. The reason why both total fiber and vegetable fiber intake has a significant
effect on breast cancer is because of the resulting increased estrogen excretion in the feces. 1
There are other cancers discussed, with similar discussion points regarding the relationship
between fiber and cancer risk reduction.
Along with the benefits of dietary fiber intake concerning diseases, there are also other
bodily functions that fiber aids in. One of them being body weight. The article suggests that
populations that consume a diet high in fiber, are likely to have a lower body weight. Whereas,
American data from the International Study of Macro-/Micronutrients and Blood Pressure
(INTERMAP) showed that by consuming a lower amount of dietary fiber, there was a link to a
higher body mass index. 1 While most of these studies were conducted using isolated fibers, it is
important to remember that isolated fibers do not induce satiety or reduce energy intake.
Additionally, there are many benefits to digestive health regarding fiber intake. The
digestion is set to run smoothly if there is a balanced microbiota community functioning in the
colon. The Academy states the significance of a balanced diet in relation to preventing digestive
symptoms. “Adequate dietary fiber intake, particularly cereal fiber, promotes optimum laxation.
Also, as diet modulates microbiota, adequate dietary fiber may be a requirement for an optimal
balance of the microbiota.” 1 The digestion system has a community of microorganisms that live
in the gut, and it is shown that dietary fiber helps promote the community, allowing for smoother
digestion.
Throughout the article written by Wendy Dahl et. al, it is emphasized how little fiber is
received in the traditional American diet. It shows the effect that the addition of dietary fiber,
viscous fiber, and isolated fiber has on our diet. Not only can it affect our body weight, it can
also be a preventative measure against some diseases. The Academy explains the addition of
fiber through various plant sources should be beneficial in more ways than one. The position of
The Academy is that there should be an increase in fiber intake. This is emphasized throughout
the article by showing the different types of foods and their yield of fiber. It also shows the
different types of benefits that different fibers have on the body. “Dietary fiber is beneficial to
health and if consumed in adequate amounts, reduces the risk of several chronic diseases, such as
cardiovascular disease, type 2 diabetes, and some cancers.” 1 Overall, this article shows the
positive effect that an increased amount of fiber in one’s diet has on their health.

Primary Research Studies

Since the publication of the article ‘Health Implications of Dietary Fiber’ written by The
Academy, the following studies have provided extra information on how fiber affects the body in
different ways.
Somaye Fetahi and colleagues published a parallel randomized controlled trial to see
what the effect of different types of dietary fiber had on overweight and obese women. 2 The
position of this article stood at the fact that there has been previous evidence regarding the effect
of diets rich in fiber, but not specifically on how different fibers affect the body solely, not in
combination. They researched for 10 weeks, splitting women up into three groups: one eating a
diet rich in whole grains, one rich in fruits and vegetables, and one rich in both. Their position
does stand in the fact that by increasing one’s consumption of whole grains, fruits, and
vegetables, it is the most effective way to increase the amount of fiber in their diet. 2 They then
go on to explain that the results in this study were very interesting regarding LDL and HDL
cholesterol levels. Somaye Fetahi, et. al, concluded that while weight, waist circumference, and
fasting body glucose improved significantly in all groups, LDL cholesterol levels only improved
in the fruits and vegetables group. 2 Alternatively, the whole-grain group had a higher increase in
HDL cholesterol compared to the other groups. 2 In relation to the article written by Wendy Dahl
et. al the conclusion was made that total dietary intake is inversely associated with total
cholesterol and LDL cholesterol. 1 While conclusions are drawn from the article written by The
Academy cover the result of total dietary intake, the results from Somaye Fetahi et. al concluded
that there is a slight difference in the way the body process fiber found in different sources. This
could be because that whole grains have a higher content of vitamin E, phytic acid, and selenium
compared with fruits and vegetables. 2 These antioxidants can be shown to act independently
with fiber to improve weight loss and/or cardiovascular risk factors. The conclusion of this study
showed that fiber source and composition has a different effect on weight loss and risk factors of
cardiovascular disease. The position of both articles could go together, because of the supporting
evidence that fiber does have an effect on body weight and cholesterol levels in the body.

João Encarnação and colleagues published an article surrounding the position that a diet
rich in fiber would lower the risk of developing colorectal cancer. It is explained that dietary
fiber fermentation by the microflora in the intestine results in the production of butyrate, which
has been reported as a chemopreventive agent and a histone deacetylase inhibitor (HDACi). 3
The study is used to evaluate the effects of butyrate on cell proliferation. Their study shows that
as the concentration of butyrate increases, cell death also increases in the cell. 3 This relates to
the article written by The Academy because it explains that SCFAs such as butyrate, enhance the
health of colonocytes. 1 The Academy explains that this would prevent the development of
colorectal cancer, which is supported by João Encarnação et. al. João Encarnação et. al,
emphasizes that “dietary fibers have been demonstrated as being capable of promoting bowel
health improvement by bacterial fermentation products of SCFAs, especially butyrate, which is
strongly described as having the ability to inhibit HDACs.” 3 Both articles support the position
that an increase in dietary fiber would lead to a decreased risk in the chance of getting colorectal
cancer.
Martin Weickert et. al conducted a prospective cohort study with the position that high
dietary fiber intake reduced risk of developing type 2 diabetes. This has a similar position as the
article written by The Academy because they write that by increasing dietary fiber intakes it may
reduce risk of type 2 diabetes. 1 Though, they both have similar concerns. Martin Weickert et. al
writes that although these studies clearly indicate that diets high in insoluble cereal and whole
grains might significantly reduce diabetes risk, there is also a lack of compelling evidence that
soluble dietary fiber from fruits and vegetables play a key role in this context. 4 In the article
written by The Academy it is explained that although there is considerable evidence that shows
the addition of viscous dietary fibers benefit immediate postprandial glucose metabolism, there
is not a clear amount of evidence about how fiber affects insulin sensitivity. 1 Martin Weickert et.
al explains that there should be further investigation done in the study of the interference of
insoluble cereal fibers with the absorption or digestion of dietary protein, which is something
similarly stated in the article written by The Academy. 1,4 Both articles state the same position on
the benefits of fiber in the body, but there is not a substantial amount of evidence linking the
correlation of type 2 diabetes because of the different types of fibers that are not solely focused
on throughout research studies.

Overall, these three supporting articles had a similar position to the article written by The
Academy. They all supported the position that an increased amount of fiber would help lower the
risk for certain diseases. The researchers also emphasized the importance of doing further
research because a lot of research done on fiber is not as in depth as it should be to yield the
results that are desired. But as a result, the combination of all four articles show the benefits of
increasing the amount of fiber in one’s diet to receive health and gut benefits.
References

1. Dahl WJ, Stewart ML. Position of the academy of nutrition and dietetics: Health implications
of dietary fiber. J Acad Nutr Diet. 2015;115(11):1861-1870. Accessed Oct 6, 2019. doi:
10.1016/j.jand.2015.09.003.

2. Fatahi S, Daneshzad E, Kord-Varkaneh H, Bellissimo N, Brett NR, Azadbakht L. Impact of

diets rich in whole grains and fruits and vegetables on cardiovascular risk factors in overweight
and obese women: A randomized clinical feeding trial. J Am Coll Nutr. 2018;37(7):568-577.
https://login.dax.lib.unf.edu/login?url=http://search.ebscohost.com/login.aspx?
direct=true&db=rzh&AN=132111828&site=ehost-live&scope=site. doi:
10.1080/07315724.2018.1444520.

3. Encarnao JC, Pires AS, Amaral RA, et al. Butyrate, a dietary fiber derivative that improves
irinotecan effect in colon cancer cells. J Nutr Biochem. 2018;56:183-192.
https://login.dax.lib.unf.edu/login?url=http://search.ebscohost.com/login.aspx?
direct=true&db=rzh&AN=129792122&site=ehost-live&scope=site. doi:
10.1016/j.jnutbio.2018.02.018.

4. Weickert MO, Pfeiffer AFH. Impact of dietary fiber consumption on insulin resistance and the
prevention of type 2 diabetes. J Nutr. 2018;148(1):7-12. https://login.dax.lib.unf.edu/login?
url=http://search.ebscohost.com/login.aspx?direct=true&db=rzh&AN=127812175&site=ehost-
live&scope=site. doi: 10.1093/jn/nxx008.