Manual of Clinical Nutrition

High-Fiber Diet

Manual of Clinical Nutrition Management D- 8 Copyright © 20 13 Compass Group, Inc.

Planning the Diet
 Promote food intake patterns consistent with the 2010 Dietary Guidelines for Americans and MyPlate that
encourage a wide variety of plant foods to achieve fiber intakes goals. Emphasize fruits, vegetables, and
whole-grain breads and cereals.
 Foods made with whole-grain flours are substituted for foods made with refined flours and starches.
 People who experience difficulty in chewing fruits and vegetables may increase fiber in their diet by
consuming one or more servings daily of a high-fiber cereal, such as bran; substituting whole-wheat
bread for white bread; and consuming soft or cooked fruits and vegetables.
 If unprocessed bran is consumed, it must be served thoroughly moistened and mixed with food and be
incorporated gradually into the diet. One tablespoon of bran contains 4.5 g of dietary fiber. To
incorporate bran into the diet, begin with 1 tsp/day and gradually increase in divided doses, as tolerated,
to 4 to 6 tbsp/day. Three tablespoons of bran, consumed daily in divided doses, is adequate to promote
normal bowel functioning.
 High-fiber foods should be added to the diet gradually. An increase in fiber consumption may initially
generate bloating and flatulence. Patients should be advised that these conditions may occur but will
generally subside as the digestive system adjusts to increased fiber consumption.
 Fiber gathers water in the colon, hence its stool-bulking property. For this reason, a high-fiber diet
should also include a liberal intake of fluids, consisting of at least 8 cups or 64 oz of extra fluid per day (1).
Consuming increased amounts of fiber without increasing fluid consumption can lead to the formation of
hard, dry stools that are difficult to eliminate.
 Consider use of probiotics and prebiotics for patients with Irritable Bowel Syndrome (IBS) and
Diverticulosis (13).

*The Academy of Nutrition and Dietetics has assigned grades, ranging from Grade I (good/strong) to Grade V (insufficient evidence), to
evidence and conclusion statements. The grading system is described in Section III: Clinical Nutrition Management A Reference Guide,
page III-1.

References

1. Slavin, JL. Position of the American Dietetic Association: health implications of dietary fiber. J Am Diet Assoc. 2008;108:1716-
   1731.


2. Institute of Medicine’s Food and Nutrition Board. Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids,
   Cholesterol, Protein, and Amino Acids. National Academy of Sciences, 2002:265- 334. Preprint available at:
   http://www.nap.edu.books/0309085373/html/index.html. Accessed September 16, 2002.


3. Fungwe TV, Bente L, Hiza H. USDA Center for Nutrition Policy and Promotion. The Food Supply and Dietary Fiber: Its
   Availability and Effect on Health. Available at: http://www.cnpp.usda.gov/Publications/NutritionInsights/Insight36.pdf.
   Accessed July 28, 2008.


4. Slavin JL. Dietary fiber: classification, chemical analyses, and food sources. J Am Diet Assoc. 1987;87:1164-1171.


5. Dietary Reference Intakes: Proposed Definition of Dietary Fiber. Washington, DC: National Academy Press; 2001:1-64.


6. Cummings JH. The effect of dietary fiber on fecal weight and composition. In: Spiller GA, ed. CRC Handbook of Dietary Fiber in
   Human Nutrition. 2nd ed. Boca Raton, Fla: CRC Press; 1993:263-349.


7. Kurasawa S, Haack VS, Marlett JA. Plant residue and bacteria as bases for increased stool weight accompanying consumption
   of higher dietary fiber diets. J Am Coll Nutr. 2000;19:426-433.


8. Salzman H, Lillie D. Diverticular disease: diagnosis and treatment. Am Fam Physician. 2005;72:1229-1234.


9. National Digestive Diseases Information Clearinghouse. Diverticulosis and Diverticulitis. 2008. Available at:
   http://digestive.niddk.nih.gov/ddiseases/pubs/diverticulosis/index.htm. Accessed September 4, 2008.


10. Strate LL, Liu YL, Syngal S, Aldoori WH, Biovannucci EL. Nut, corn, and popcorn consumption and the incidence of diverticular
    disease. JAMA. 2008;300:907-914.


11. Marcason W. What is the latest research regarding the avoidance of nuts, seeds, corn and popcorn in diverticular disease? J
    Am Diet Assoc. 2008;108:1956.


12. American College of Gastroenterology Task Force on IBS. An evidence-based systematic review on the management of irritable
    bowel syndrome. Am J Gastroenterol. 2009;104 (suppl 1): S1-S35.


13. Douglas LC, Sanders ME. Probiotics and probiotics in dietetics practice. J Am Diet Assoc. 2008; 108:510-521.


14. Ong DK, Mitchell SB, Barrett JS, Shepherd S, Irving PM, Biesiekierski JR, Smith S, Gibson PR, Muir JG. Manipulation of dietary
    short chain carbohydrates alters the pattern of gas production and genesis of symptoms in irritable bowel syndrome. J
    Gastroenterology and Hepatology. 2010; 25: 1366-1373.


15. Shepherd SJ, Parker FC, Muir JG, Gibson PR. Dietary triggers of abdominal symptoms in patients with irritable bowel
    syndrome: randomized placebo controlled evidence. Clin Gastroenterol Hepatol. 2008; 6: 765-771.


16. Marlett JA. Sites and mechanisms for the hypocholesterolemic actions of soluble dietary fiber sources. In: Kritchevsky D,
    Bonfield C, eds. Dietary Fiber in Health and Disease. New York, NY: Plenum Press; 1997:109-121.


17. Marlett JA. Dietary fiber and cardiovascular disease. In: Cho SS, Dreher ML, eds. Handbook of Dietary Fiber. New York, NY:
    Marcel Dekker; 2001:17-30.


18. US Food and Drug Administration. Health claims: soluble fiber from certain foods and risk of heart disease. Code of Federal
    Regulations. 2001;21:101.81.


19. Marlett JA, Hosig KB, Vollendorf NW, Shinnick FL, Haack VS, Story JA. Mechanism of serum cholesterol reduction by oat bran.
    Hepatology. 1994;20:1450-1457.