Water & Fibre

Dr Orla Flannery
Assess the evidence base behind fluid recommendations
Discuss the SACN dietary recommendations for fibre

Illustrate the ways in which fibre is beneficial for health

Justify whether probiotics are beneficial for health

Water
• Human body contains 35-45l water
• 50-70% of today body weight
• Depending on weight of the person
• Fat tissue can contain 60-80% water weight
• Fat in fat tissue holds no water
• Water is held in cells, blood, cavities

• ACUTELY ESSENTIAL FOR ALL BODILY PROCESSESS

Function of Water in the body
• Intracellular vital biochemical reactions
• Extracellular * Transport & Communication Cell to cell
• Cell to environment
• [Nutrients, metabolites, hormones, heat, waste products &
respiratory gases]
* Lubrication [movements of joints, tissue etc]
*Cooling [thermoregulatory- sweating]
*Excretion [urine]
Function of Water in the body
Fluid balance
• Remains relatively constant
• Daily weighing is a good indicator of fluid balance
• Loss of water causes shrinkage of cell and increase osmolarity
• Hypothalamus causes thirst and releases ADH – causes kidneys to
retain more water
• In reverse- swelling of the cells switch off signals…
Fluid balance II
• INTAKE
• Solid food – 1l per day
• Fluids – 1l per day (may be
more)
• Metabolic water – 0.3l per day
• - Oxidation of hydrogen
• OUTPUT
• Evaporation – 1l/day or more
up to 2l if above 6000m
• Excretion – 0.1l/day. up to
10/12l if diarrhoea
• Sweat – up to 15l/day to cool
down
• Urine – 0.6l/day up to 10l with
Diabetes Insipidus
Deficiency of Water
• 1 -5% body weight: thirst, vague discomfort, economy of movement, no
appetite, flushed skin, impatience, increased pulse rate, nausea
• 6–10% body weight: dizziness, headache, laboured breathing, tingling
in limbs, absence of saliva, blue body (cyanosis), indistinct
speech, inability to walk
• 11–12% body weight: delirium; twitching; swollen tongue; inability to
swallow; deafness; dim vision; shrivelled skin; numb skin.
• ‘A man can exist for days without food, but only for 2–5 days without
water.’ Source: Hildreth B. (1979) How to survive in the bush, on the
coast, in the mountains of New Zealand. Government Printer, Wellington.
Who could be at risk?
• Infants
• Elderly
• Patients in ITU
Excess intake of Water
• Body sodium is essential for balancing fluid between cells and the
blood
• Too much water causes a dilution of the sodium in the blood
• This in turn will move across the cell membrane into the cell
• This causes swelling of the cells including brain
• Causing headaches, feeling unwell, diarrhoea, nausea & vomiting
• Similar to heatstroke – will cause seizures and finally coma and death
• Hyponatraemia
Who could be at risk and why?
• Patients on parenteral / enteral nutrition
• Patients with trauma
• Those with end stage renal failure
• Babies- very sensitive
What are the current guidelines for water
intake?
• What is the evidence base for this?
• Waterlogged?
• by McCartney, Margaret
• BMJ, 07/2011, Volume 343
• ...BMJ 2011;343:d4280 doi: 10.1136/bmj.d4280
• 
https://www.nhs.uk/news/food-and-diet/six-to-eight-glasses-of-water
-still-best/#does-this-article-debunk-the-advice-to-drink-about-six-to-
eight-glasses
Fibre
Function of the colon
• absorbing water and electrolytes
• producing and absorbing vitamins
• forming and propelling faeces toward the rectum
• 90% of water absorbed in small intestine
What’s in a definition?
CHO classification
Soluble, Insoluble Fibre
• Originally called non-starch polysaccharides
• Soluble – pectin, β-glucans
Feed gut bacteria
Increase faecal mass

• Insoluble – cellulose, hemi-cellulose

• Influence gut transit
• Increase faecal mass
From: Metabolic Effects
of Dietary Fiber
Consumption and
Prevention of Diabetes
J Nutr. 2008;138(3):439-442.
doi:10.1093/jn/138.3.439
J Nutr | © 2008 American
Society for Nutrition

FIGURE 1 Potential effects of DF consumption. Colonic fermentation with the production of SCFA can be
observed with most types of DF to some extent, but it tends to be more pronounced with soluble DF in naturally
available foods.
Previously…
In the UK, dietary fibre has been defined as non-starch polysaccharide,
comprising cellulose and non-cellulose polysaccharides (e.g. pectins,
glucans, arabinogalactans, arabinoxylans, gums and mucilages) (COMA,
1991; COMA, 1994).

This is analytically defined using an enzymic–chemical method (Englyst

et al., 1994) and does not include resistant starches, non-digestible
oligosaccharides or lignin.
Task
• What is the current definition of dietary fibre as stated by SACN
(2015)?

• What were the criteria set by SACN (2015) to be included as dietary

fibre?

• What additional CHO are not included in the definition?

SACN defined dietary fibre as material that is resistant to digestion and
absorption in the small intestine and that has a demonstrable physiological
effect potentially associated with health benefits in the body, such as
increasing stool bulk, decreasing intestinal transit time, decreasing the
lowering of total cholesterol and LDL-cholesterol concentrations. This
includes non-starch polysaccharides.

The Committee considered that evidence only of increased fermentation

in the gut should not be included in this definition, since although this
has a direct effect on the microbiota, it would also need to be shown to
have a demonstrable benefit to the host for material to be considered as
dietary fibre.
Recommendations – Dietary fibre (SACN)
• Dietary fibre – carbohydrates not digested/ absorbed in the small intestine
• DRV - adults should be 30g/day
• Recommended intake for children aged 2 to 5y ~15g/day,
• for children aged 5 to 11 years 20g/day
• for children aged 11 to 16 years 25 g/day
• for adolescents aged 16 to 18 years about 30g/day.
• Fibre intakes should be achieved through a variety of food sources.
• Children aged under 2 y - gradual diversification of the diet to provide
increasing amounts of whole grains, pulses, fruits and vegetables from
weaning
Task
• Using information from national surveys what is the average fibre intake in
the UK?
• https://www.nutrition.org.uk/nutritioninthenews/new-reports/ndnsyears7a
nd8.html
• Are there differences between:
• men and women
• Socioeconomic position

• What are the main sources of fibre in the UK diet?

• https://assets.publishing.service.gov.uk/government/uploads/system/uploa
ds/attachment_data/file/699241/NDNS_results_years_7_and_8.pdf
• Is there any evidence to suggest that this has changed over time?
Evidence for health – Dietary fibre (SACN)
• Prospective cohort studies
• increased intakes of total dietary fibre (cereal fibre and wholegrain)
associated with lower risk of cardio-metabolic disease and colorectal
cancer.
• RCT
• total dietary fibre (wheat fibre & other cereal fibres) - increase faecal
mass and decrease intestinal transit times.
• RCT
• higher intake of oat bran and isolated β-glucans leads to lower total
cholesterol, LDL cholesterol, triacylglycerol & lower BP
Fibre & CVD
• Fibre = CVD & CHD
• Insoluble & cereal fibre was inversely associated with CVD & CHD
• Fruit fibre was inversely associated with CVD (Evans et. al. BMJ 2013)
• Clearly there are differences in how different fibre are associated with
CVD & CHD.
Fibre intake and known benefit for over 2
decades
• Sline graphs

• https://
assets.publishing.service.gov.uk/government/uploads/system/upload
s/attachment_data/file/445503/SACN_Carbohydrates_and_Health.pd
f
• P 201
 Link between Dietary fibre and human health
(Kendal 2009)

https://www.sciencedirect.com/science/article/pii/S0268005X0
9001611
Produced by Kelloggs nutrition
Excess intake of Fibre
• Bloating
• Diarrhoea
• Malnutrition if transit time is too short
What factors might impact on consumption of
Water and Fibre
• Environment
• Physical
• Financial
• Educational
• Availability
Lets ascertain what is normal stool
• Important indicator of health
• Useful in diagnosing various
conditions and effectiveness of
treatment
• What is normal
• Frequency
• Consistency
• https://onlinelibrary.wiley.com/d
oi/full/10.1111/apt.13746
Task
“A probiotic drink a day will keep the Grim Reaper away”
Pre, pro and synbiotics
• Presence of dietary fibre stimulates the growth of and/or activity
of bacteria in the colon
• Prebiotics – including fructo-oligosaccharides (FOS), oligofructose (OF),
inulin & galacto-oligosaccharides (GOS)
•  beneficial bacteria &  SCFA production
• Probiotics – contain micro-organisms to alter microflora in
host
• Synbiotics – contain a pre- & probiotic

• Role in the management of diarrhoea, inflammatory bowel

disease (Crohn’s disease), cancer and immune function
• Inhibit pathogenic bacteria, reduce gut pH, compete for nutrients
and space
 Short Chain Fatty Acids (SCFAs)

• Dietary fibre fermented in large intestine by commensal microbiota – cellulolytic

enzymes

• Fermentation process releases gas (CO2, H2, methane). End products of

fermentation = acetate, propionate & butyrate
• Butyrate accounts for ~20% of SCFAs – is primary energy source for gut mucosa
Health-promoting effect of SCFAs
• Inhibit growth of pathogenic organisms
• SCFAs stimulate the GI immune system
• SCFAs induce vitamin & antioxidant production
• Promote secretion of bactericidal substances
• Fermentation of NSPs to SCFAs →  colonic pH
• Beneficial for bifidobacteria & lactobacilli
• SCFAs stimulate
• proliferation of colonic epithelial cells
• ↑ absorptive capacity of the epithelium
• stimulates repair of damaged colon
• fluid & electrolyte uptake (colonic Na & water
absorption)
• colonic blood flow – enhances oxygenation
•  smooth muscle activity – dose-dependent effect
 Colorectal cancer

• High intake dietary fibre – esp. cereal fibre & wholegrains =  risk of
colorectal cancer
• 10% risk reduction per 10g/day total dietary fibre & cereal fibre

• 20% reduction for each 3 servings (90g) wholegrain daily

Aune (2011)
 Wholegrain action

• In vitro – wholegrains may act as nitrite scavenger

• countering carcinogenic effects of N-nitroso compounds (NOCs)
• red meat intake