Abstract
BackgroundOnly 5% of adults consume the recommended level of dietary fiber. Fiber supplements appear to be a convenient and concentrated source of fiber, but most do not provide the health benefits associated with dietary fiber.PurposeThis review will summarize the physical effects of isolated fibers in small and large intestines, which drive clinically meaningful health benefits.Data sourcesA comprehensive literature review was conducted (Scopus and PubMed) without limits to year of publication (latest date included: October 31, 2016).ConclusionsThe physical effects of fiber in the small intestine drive metabolic health effects (e.g., cholesterol lowering, improved glycemic control), and efficacy is a function of the viscosity of gel‐forming fibers (e.g., psyllium, β‐glucan). In the large intestine, fiber can provide a laxative effect if (a) it resists fermentation to remain intact throughout the large intestine, and (b) it increases percentage of water content to soften/bulk stool (e.g., wheat bran and psyllium).Implications for practiceIt is important for nurse practitioners to understand the underlying mechanisms that drive specific fiber‐related health benefits, and which fiber supplements have rigorous clinical data to support a recommendation.Clinical pearlFor most fiber‐related beneficial effects, “Fiber needs to gel to keep your patients well.”
Highlights
There are numerous fiber products on the market today
While the term “fiber supplement” implies that the product can help make up for a shortfall in dietary fiber consumption from whole foods such as fruits, vegetables, and whole grains, it is important for nurse practitioners to understand which supplements have clinical evidence of a beneficial physiologic effect and qualify as functional fibers
The purpose of this review is to provide nurse practitioners with an understanding of (a) the physical effects of isolated fibers in different regions of the gut that drive each specific health benefit, (b) which specific fibers possess the physical characteristics required to provide each specific health benefit, and (c) which specific fiber supplements are supported by rigorous evidence of a clinically meaningful health benefit
Summary
Some contain a natural fiber, such as inulin (i.e., chicory root), psyllium (i.e., husk of blond psyllium seed), or β-glucan (i.e., oat or barley; McRorie & Fahey, 2015). Others contain an artificially created product, such as polydextrose (synthetic polymer of glucose and sorbitol), wheat dextrin (heat/acid treated wheat starch), or methylcellulose (semisynthetic, chemically treated wood pulp; McRorie & Fahey, 2015). To be considered a functional fiber, the isolated nondigestible carbohydrate found in a fiber supplement must have clinical evidence of a beneficial physiologic effect. While the term “fiber supplement” implies that the product can help make up for a shortfall in dietary fiber consumption from whole foods such as fruits, vegetables, and whole grains, it is important for nurse practitioners to understand which supplements have clinical evidence of a beneficial physiologic effect and qualify as functional fibers
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