Download Health benefits and practical aspects of high-fiber diets1`2

Health
James
benefits
W Anderson,
Belinda
ABSTRACT
as
Over
a leading
chronic
dietary
diseases.
serum
High
control,
improved
gastrointestinal
for
fiber.
plant
fiber
grains,
meet
foods
are
of ample
and
these
dried
coronary
heart
(LDL)
control,
better
body
of
cancer,
can
be
good
and
servings
guidelines.
peas
Am
C/in
heart
disease,
dietary
blood
fiber,
serum
Serum
Elevated
fiber,
the
indigestible
cell
wall
component
of
plant
several
take
Western
diseases.
has been
shown
cardiovascular
cancers
The
zations
dried
and
the
health
aspects
of
(5),
consensus
increased
beans
dietary
fiber
in-
hyperlipidemia
obesity
(3),
(6),
certain
twice the amount
of fiber that Amer( I 1 ). To help people
meet this recom-
consume
advises
high
or treat
disorders
(8), and diabetes
(9).
fiber intake for healthy
adults is 20-
an overwhelming
reviews
tical
hypertension
approximately
currently
time,
(4),
disease
mendation,
that
prevent
(7), gastrointestinal
recommended
dietary
35 g/d (10),
icans
Since
to help
among
consumption
peas,
and
whole
benefits
of fruits
grains
of dietary
implementing
health
and
(12-14).
fiber
and
a high-fiber
This
then
are
of dietary
fiber
such
Although
high
the National
evidence
that
1242S
diseases”
reductions
and
fiber
cereal
with
states
rather
‘
than
products
‘there
the
that
reduces
lower
report
Clin
Nutr
also
and
change
(16).
for
particularly
coronary
LDL
heart
Education
disease
Program
rec-
in fiber,
evidence
augment
suggests
that
high
the cholesterol-lowering
ef-
(3,
diets
enriched
(20,
in serum
terol concentrations
sumed
with a typical
I diet,
research
with
22)
ward
soluble
indicate
fiber
from
oat
can
cholesterol
concentrations
concentrations
indicate
that
fiber, lowers
by 15%
American
recommended
mucilloid
over
24%
wk
(23).
re-
psyllium
mucilloid,
a suppleserum
total and LDL-choles-
by the American
9%
and
24
and 20%. respectively,
diet (24). When used
decreased
an additional
heart
(26).
serum
Heart
when conto augment
Association,
LDL-cholesterol
concentra-
(25).
of
have
lipid
evidence
risk
I
From
Affairs
components
the risk
disease
a lower
Although
serum
incidence
dietary
fiber
concentrations,
suggests
of CHD
may
alter
hypertension.
that
diet
may
than
CHD
nonvegetar-
risk
factors
obesity,
also
and
independently
such
diabeaffect
(4).
the Metabolic
Medical
Center,
Research
Group,
University
of
Medical
Kentucky
Services,
College
Veterans’
of
Medicine
Affairs
Medical
Lexington.
of
2
Address
Center,
i
antioxidants
con-
risk
(13).
Am
high
in LDL-cholesterol
Coronary
prac-
is no conclusive
other
saturated
Cholesterol
or beans
Vegetarians
a recent
changes,
as
factors
may
Additional
studies
ment rich in soluble
diet.
diseases,
diet
such
report
outlines
is associated
of Sciences
it is dietary
fruits,
intake
of the
concentrations,
risk
American
26%
ductions
tes,
chronic
lower
( 1 ). In
produce
net reductions
in
serum
cholesterol
concentrations
of 1 5% and
LDL-cholesterol
concentrations
of 16% over 3 wk (Table
1.) Serum
lipid improvements
with such diets were sustained
over the long-term,
with
tions
fiber
fiber
in several
Academy
of vegetables,
those
dietary
pressure,
nonvegetarians
5, 18).
studies
in a metabolic
diets
clinical
(19-21)
CHD
or improvements
blood
than
heart
hipoprotein
low-cholesterol
diet as a primary
treatment
( 17). Although
diets low in fat and cho-
usually
bran
as
benefits
low-density
content
and
National
also
average
ians
Health
nonvegetar-
coronary
components
cholesterol
of soluble
psyllium
vegetables,
fiber
major
The
(4).
a Step
organi-
and
lower
dietary
minerals,
are
of
that
materials,
plays
an important
role in human
health
(I). In the
1970s,
Burkitt
and Trowell
(2) linked
how dietary
fiber intake to
total
lifestyles
dietary
serum
cholesterol,
Careful
Introduction
serum
than
of
lipids
intake
pressure
rates
although
some studies
document
specific
effects
of dietary
effects
ofthe
entire high-fiber
diet must also be considered.
fects
Dietary
the
other
fats,
lesterol
cholesterol,
intakes
lower
healthier
ommends
a low-fat,
for hypercholesterolemia
Diabetes.
fiber
have
concentrations,
of
(CHD)
Nutr
12425-75.
WORDS
Thus,
fiber,
and
help
lower
and
when
unsaturated
will
J
addition,
dietary
also
cholesterol
Dried
arc good
of
higher
cancer,
weights,
centrations
of fruits
and
diets1’2
Vegetarians
and
catego-
sources
have
(15).
disease
form of insoluble
of dietary
fiber in-
beans
ians
lower
components.
vegetables
bran is a concentrated
advise
a doubling
Inclusion
whole
coronary
Most
of
forms
Dietary
Vegetarians
of
with
weight
certain
emerged
treatment
associated
risk
of high-fiber
J Gustafson
has
and
and water-insoluble
and certain
fruits
and
Americans.
1994;59(suppl):
of
Nancy
fiber
enhanced
risk
and wheat
guidelines
individuals
KEY
are
aspects
1994;59(suppl):1242S-7S.
reprint
Cooper
Printed
Drive
in USA.
requests
to JW
Anderson,
Division
(IIIC),
©
American
1994
Veterans’
Lexington,
Society
KY 40511.
for
Clinical
Nutrition
Downloaded from www.ajcn.org by on December 29, 2009
take
intakes
function.
soluble
vegetables,
y dietary
prevention
lower
reduced
insoluble
fiber
fiber. Current
and
the
pressure,
into water-soluble
oat products,
of
20
in
fiber
blood
glycemic
sources
past
Smith,
concentrations,
reduced
rized
beans,
the
practical
M
factor
cholesterol
disease,
and
HIGH
TABLE
1
Percent change in serum lipids of hypercholesterolemic
metabolic
ward to oat bran, bean, and control diets’
Serum
Study and
fiber amount
- 13.0
Recent
Triglyceride
-9.3
-19.3
-12.8
-15.0
-21.6
-12.1
-5.6
-18.7
-7.4
-10.2
-15.8
-5.0
-12.7
-18.7
-23.1
-12.7
-11.6
-10.0
-11.7
-14.5
-15.2
-16.7
-12.2
-8.8
-0.9
-0.6
-2.3
average
reports
cers
that
of the respiratory
the human
body
and
that
cancer
references
be
related
to serum
Barrett-Conner
(28)
effect
ment
concentrations.
that
a 6-g
Khaw
increase
in dietary
with a 25% reduction
in CHD
of other dietary
variables.
The
and
fiber
mortality
protective
mortality
from
CHD
multivariate
was
fourfold
lower fiber
fiber intakes.
adjustment
higher
in Dutch
intakes
than in males
This effect remained
for other
CHD
risk
males
whose
contribute
to 35%
of all cancers;
energy,
fat,
higher
fiber
high
cancer
(30,
and
fiber
31).
A critical
and
in individuals
intakes.
intake
review
low
attracted
An odds
in the
highest
the
observational
ratio
fiber
of 0.57
group
was
was
cancer
deaths
deaths
were
intakes
greatest
studies
attention
computed
when
compared
with
recently
re-
the majority
of
for colonectal
the prevalence
that
in the
lowest
group,
suggesting,
only 57% of the
simplistically,
that
chance
of developing
the high-fiber
group
had
colonectal
cancer
as the
low-fiber
Lanza
results
group.
(32)
tabulated
from
48 epidemi-
ologic
studies
on dietary
fiber and colorectal
cancer
that 38 reported
an inverse
relationship,
7 reported
tion,
and
dominant
foods
3 reported
data
protects
a direct
available
the
body
association.
suggest
from
that
development
Thus,
the
and found
no associa-
although
intake
of
of colorectal
the prehigh-fiber
cancer,
maladaptation
and
fruits.
blood
several
to blood
pressure
pressures
diet
than
and
lifestyle
differences
that changing
is accompanied
(1).
from an omnivby a significant
interpnetation
or more
of
of the
control
group,
loss (38-41).
these
following
lower
fat intakes,
Rouse,
Mangetts,
and colleagues
(42-45)
critically
studied
the
effects
of a vegetarian
diet on blood
pressure
and attempted
to
determine
the independent
effects
of dietary
fiber.
Vegetarian
diets
compared
blood
pressure
sion.
However,
with
omnivorous
in individuals
with
an independent
could
diets
significantly
decrease
mild
on moderate
hyperten-
effect
not be ascertained
of dietary
fiber
on blood
statistically.
Obesity
The routine
use of high-fiber
foods
reduces
and assists
in weight
loss and weight
maintenance
fiber foods tend to be high in carbohydrate
and
the
foods may
through
decrease
of peptides
enhance
adherence
that
to weight
impact,
diet
thought
(1,
46).
diabetic
studies
ument
the
weight
loss.
has
may
eating
rates
such
they
may
behavior;
of
constimwhich
of dietary
as
short-chain
stimulate
and
the
they
hong-term
as an adjunct
may
theoretical
potential
weight
management,
benefits.
have
may
high-fiber
as
Several
china significant
to a weight-reducing
have
particular
benefits
individuals
(47). Because
of encouraging
(48-50),
further
clinical
studies
are needed
effectiveness
in-
insulin
insulin
(1).
and
diets
increases
thereby
of nutrients,
increase
considerable
to be small,
which
decrease
serum
intake because
not documented
these
that fiber supplements
High-fiber
obese
mary
emptying,
intake;
modify
loss
clinical
studies
have
ical studies
document
to eat,
products,
food
to the diet
fiber
longer
absorption
fermentation
long-term
weight
of the following
gastric
they
decrease
dietary
adjunct
the
risk for obesity
because
highlow in fat (1, 6).
loss and
of some
they
food
availability;
may
Although
slow
of fullness;
decreasing
their
acids,
take
they
they
energy
release
an
foods
of satiety;
appetite;
fatty
promote
weight
the interactions
high-fiber
feeling
ulates
studies
was
indicated
that
were protective
colon
(37) postulates
of plant foods
from
lower
However,
thermogenesis;
compared
between
epidemiologic
of 23 case-control
(31). Both types of analyses
suggest
that fiber-rich
diets
cancer.
fiber
the relationship
has
of 37
a meta-analysis
ported
studies
with
However,
to total
cancer
studies
as vegetables
subjects,
of one
decreases
threefold
to have
because
noted that fiber
to a surprising
was inversely
related
in The Netherlands;
foods,
These
Potter
intake
results
pressure.
and fiber intake
are more closely
linked
to overall
cancer
deaths
than other individual
dietary
factors
(13, 29). Kromhout
et al (7)
with
tend
be related
creasing
the feeling
centrations,
thereby
intake
degree
between
(34-36).
such
in blood
mechanisms:
factors
that
foods
is hampered
High-fiber
maintenance
factors.
Cancer
Dietary
be a disease
control
could
pressure
whose
diets insignificant
after
relationship
of higher
amounts
of vegetables
and
but not universally,
with reduced
and particularly
with epithehial
can-
of plant
sex-matched
reduction
was still statistically
significant
after multivaniate
adjustfor other CHD risk factors.
Knomhout
et al (7) reported
that
diets included
cluded
higher
cancer
concerns:
lack of an appropriate
lower sodium
intakes,
or weight
cholesterol
reported
intake
was associated
that was independent
the relationship
and
Several
clinical
studies
document
orous
diet to a vegetarian
diet
Morris
et al (27) reported
that men
with
a high
intake
of cereal
fiber have a lower rate of CHD than men with a low cereal-fiber
intake.
The protective
effects
of cereal
fiber in this study
could
not
may
vegetarians
and
differences
19-22.
this
foods
as
an
for
prelimto doc-
adjunct
to
fiber
in-
Diabetes
Diabetes
takes
than
is more
in those
prevalent
in populations
with
fiber
high
intakes
with
(51).
low
Recent
studies
Downloaded from www.ajcn.org by on December 29, 2009
from
examined
and alimentary
tract.
is adapted
to a high
intake
Although
age-
-12.7
before
pressure
studies
Adapted
have
ingredients,
concluded
that consumption
fruit is associated
consistently,
risk for cancer
at most sites
Blood
-3.0
to be answered
(33).
of food
to a reduced
-2.0
remain
be clarified
instead
HDL
cholesterol
13.6
-
questions
can
% change
Oat bran
94 g/d
96g/d
106g/d
99g/d
Bean
101 g/d
67g/d
83 g/d
Control
1243S
DIETS
many
men in a
lipids
LDL
cholesterol
Cholesterol
FIBER
1244S
ANDERSON
further
support
the concept
that individuals
whose
diets
are
high
in fiber are less likely
to develop
diabetes
than those
whose
diets
arc low in fiber.
Since
1976 extensive
clinical
studies
have
documented
individuals
offer
with
persuasive
intakes
lower
(6, 9, 52,
53).
that
supplements
glycemic
of 53
of fiber
Two
intakes
types
for
fiber
sensitivity
blood
improved
and
not report
and
the glycemic
that fiber
subjects.
8 (15%)
assist
high-fiber
diets
no change,
Of
these
53
2 (4%)
studies,
or long-term
these
effects
33
control,
indicate
that,
to improvement
in diabetic
worsening
of gly-
cholesterol
was
de-
diets
betic
the
quickly
the
for
decrease
benefits
that
hong-term
fiber
weight
low-fat
diets
diets
provides
for
facilitating
obese
agents
(1, 6, 55).
Because
of
loss
and
weight
high-carbohydrate,
especially
suited
for
dia-
promptly
hypoglycemic
lipids
has many
(56).
fecal
high-fiber,
obese
health-promoting
Fiber
Madar
weight
and
Odes
diabetic
effects
maintains
and
(8)
individ-
normal
stool
and
pro-
fiber, such as oat products,
satiety
(57). Foods
rich in
decrease
transit
time and
number
recently
on the gastro-
function
(57,
and
other
fibers
reviewed
the
effects
or
bowel
for
individuals
prevention
syndrome
of
is still
of fruits,
and
six to eleven
whereas
whole-grain
that
serving
have
and
breads
with
constipation.
They
also
other
under
conditions
such
as
adequate
a high-fiber
consensus
in the
study.
servings
countries
Currently
Id)
(10).
g/4l86
(63,
64)
Americans
States
arc
some
high-fiber
of fruit,
4-8
2
U (10).
a 50-
consume
Consistent
of breads,
which
content
provide
2
7-
should
intake
conserv-
cereals,
rice
nuts
in the
and
1 g fiber
g fiber
provide
group
fiber
provide
beans
2-5
cereals
of breads,
recommend
two to four
per
serving
per serving.
Cc-
2-5
per
g fiber
1 1 g per
provide
per day.
g per serving,
serving.
one-half
to
Two to four
should
provide
g fiber/d.
Three to five servings
of vegetables,
g fiber per serving,
should
provide
another
this
sensible
To
tailor
high-fiber
food
diets
lipidemia,
and other
(high-carbohydrate,
guide,
an individual
intakes
with
59-62)
100%
10-23
are
health
and
increase
g flben/d
from
6-
would
which
12 g
adopt
to individuals
metabolic
high-fiber)
a high-fiber
with
conditions
exchange
eating
plan
diabetes,
hyper-
we developed
the HCF
system
to help individAs shown
in Table
the HCF exchange
system
consists
of eight
food
that are grouped
according
to nutrient
and fiber content.
categories
By using
the exchange
(68,
69).
groups,
meal
plans
may
be adapted
to a variety
of
taste preferences
and lifestyles.
The HCF diet is particularly
applicable
for vegetarian
meal planning.
Tables
3 and 4 illustrate
a sample
HCF vegetarian
meal plan and menu and a sample
HCF
meal
plan
and
TABLE
menu.
We
typically
recommend
a daily
intake
of
2
High-carbohydrate,
Exchange
and
high-fiber
serving
size
20
to 35
the recommendations
organiza-
other
Western
in fiber
intake.
(6-10
g/4l86
g/d
or
10-13
to increase
(HCF)
Energy
exchange
Protein
list’
Fat
kcal
skim
(245
mL
/ cup)
g or 1 -2
I oz)
or
‘/
(122
g or
Fats (5 g or I tsp)
/2
Fiber
g
oz)
85
8
12
0
25
1
0
5
2
95
7
0
17
5
50
8
2
0
0
90
3
0
20
4
2
.5
cup:
28 g or I slice)
Fruits
Carbohydrate
or
(80 g or ‘/ cup)
Beans (90 g or
Proteins (28-57
Cereals (28 g or
Starches (100 g
of leading
(12-14,
for
Recommended
servings
from 25 to 50 g fiber/d.
Milk,
diet
recommendations
United
servings
fiber
irritable
Recommendations
The
or more
food guides
of vegetables,
provide
Six to 1 1 servings
from this
two-thirds
of the recommended
Vegetables
tions
adof
and pasta; this food pyramid
also includes
protein-rich
group
(65).
White
bread,
rice, and pasta provide
icup)
Implementing
low
Academy
of Sciences
of five or more servings
of dietary
presented
the rationale
for including
fiber in the diet to protect
against
diverticulosis
of the colon.
The role of dietary
fiber in the
treatment
six
veg-
and
58).
fiber on gastrointestinal
function
and diseases.
They summarized
the literature
and indicated
the clear benefits
of wheat bran, psylhum,
and
fruits,
2,
motes regularity.
Foods rich in soluble
delay
gastric
emptying
and enhance
insoluble
fiber, such as wheat
bran,
increase
vegetables
and legumes
(13). Current
of three to five servings
grains,
in carbohydrate
ingest
oral
and
fiber
as whole
high
by following
high-fiber
or
glucose
tract
such
de-
for
disorders
Dietary
and
cereals,
sumption
uals
intestinal
in fiber,
are naturally
and
advantages
uals.
Gastrointestinal
high
5 g
Fiber
Thus,
maintenance,
seem
are
legumes,
fiber/d.
Three
servings
of beans per week,
which
provide
per serving,
would contribute
another
2 g fiber, on average.
values
are estimated
from our published
sources
(66, 67).
special
insulin
serum
that
and
have
Weight-reducing
need
Foods
another
provide
may
individuals.
crease
of com-
in most instances,
an increase
in dietary
in glycemic
control
and serum
lipids
individuals.
High-fiber
deintake
of fiber
reals
creased
in 22 and unchanged
in 4 whereas
serum
triglycerides
were decreased
in 12 and unchanged
or increased
in 5. Both sets
of studies
fiber leads
Sources
ings
choalso
studies,
glycemic
serum
consumption
daily
53 studies,
noted
recommend
of energy
cup)
70
2
0
15
60
0
0
15
45
0
5
0
2.5
0
I Cereal
exchanges
include cold and hot cereals.
Starch exchanges
include
breads.
muffins, crackers,
pasta. rice, and starchy vegetables.
For more detailed
food descriptions
and serving
sizes, see reference
69.
Downloaded from www.ajcn.org by on December 29, 2009
control.
and
increasing
intake,
foods
fruits
sup-
Of these
improved
while
(13).
etables,
recently
fiber
no change,
Of
to 30% of energy
phex carbohydrate
were
decreased
serum
review
article
(54)
individuals.
that
37%
or long-term
noted
the short-
in diabetic
that
noted
responses.
guidelines
the current
of the National
cat a minimum
that
12 (22%)
supplements
The same
that examined
diets
reported
control,
reported
dietary
from
in fat. A recent
report
vises that Americans
short-
individuals
36 (67%)
glycemic
53 studies
of high-fiber
studies,
fiber intake
arc current
creasing
fat consumption
to in-
pressure,
the
in diabetic
Of these
36 (67%)
reported
lesterol
in diabetic
discussed
examined
supplements
plements
6 did
that
AL
of studies
or high
increase
decrease
studies
(54).
cemic
control,
lipids,
reviewed
(62%)
fiber
fiber
management.
Results
effects
of high
diabetes
serum
in weight
benefits
evidence
improve
sulin,
the
ET
HIGH
at least
three
at least
six servings
servings
each
from
from
the vegetable
a combination
and
fruit
of cereals
and
and one serving
of beans
daily to ensure
adequate
intake
and to make
the combining
of complementary
proteins
groups,
starches,
soluble-fiber
vegetable
DIETS
TABLE
increase
tially
following
diabetes
their
a more
reinforcement
lemic men
fiber
or hyperlipidemia
intakes.
nutritious
men
The
and
for continued
maintained
fiber
40 diabetic
8372
are
rapid
able
benefits
fiben-nich
diet
fiber
intakes
derived
provide
from
of > 40 g/d
for an
in our experience,
healthy
individuals
who are free
of disease
are often not able to achieve
these high
intakes.
healthy
After
individuals
as participants
g/d
intensive
instruction
with
increased
their
fiber
in a clinical
trial
(72).
12 weekly
intake
from
classes,
19 to 25
(2000
Kcal/8372
high- fiber (HCF)
vegetarian
meal plan and menu
Id)
Menu
/2 Milk
1 Cereal
1 Fruit
122 mL (‘/2 cup) Skim milk
37 g (3/4 cup) Oat-bran
flakes
84 g (‘/2 cup) Sliced peach
1 Fat
6 Almonds
1 Starch
Bagel (28 g)
5 g (1 pat) Margarine
240 mL (1 cup) Coffee
1 Vitamin-mineral
supplement
exchanges
Menu
Breakfast
1 Cereal
1 Milk
1 Fruit
I Shredded-wheat
biscuit (24 g)
184 mL (3/4 cup) Skim milk
/2 Banana
(60 g)
2 Starch
1 (60
1 Fat
5 g (1 pat) Margarine
240 mL (1 cup) Herb tea
1 Vitamin-mineral
supplement
Snack
1 Cereal
1 Fruit
Lunch
1 Garden
g) Cinnamon
oat-bran
1 Fat
Snack
1 Starch
Lunch
1 Free vegetable
1 Garden vegetable
I Garden vegetable
18 g (3 cups)
vegetable
55 g (1 cup) Mixed salad greens
26 g (V4 cup) Cucumber
slices
16 g (1 tablespoon)
Light, creamy
Starch
Bean
Fruit
Milk
6 Rye crackers
1 fat
248
Caesar
dressing
(40 g)
g (1 cup)
Cream
of asparagus
soup
1 1 1 g (3/4 cup) Strawberries
Iced water with lemon
80 g (‘/2 cup) Refried beans
28 g (1 oz) Roast chicken
2 Stanch
2 Flour
1 Fat
1 Garden
2 Starch
5 g (1 pat) Margarine
60 g (‘/2 cup) Green pepper and onion
1 Baked potato (160 g) topped with
vegetable
tortillas
(80
g)
salsa
28 g (1 oz) Imitation
173 g (1 cup) Melon
Iced tea
sour cream
balls
vegetable
vegetable
I fruit,
1 fat
1 fat
55 g (1 cup) Raw spinach
17 g (‘/4 cup) Fresh sliced mushrooms
16 g (1 tablespoon)
Low-fat ranch dressing
210 g (1 /2 cup) Spaghetti
noodles
122 g Cl2 cup) Tofu-tomato
sauce
6 g (1 tablespoon)
Parmesan
cheese
90 g (‘/2 cup) Asparagus
spears
28 g (1 slice) Garlic bread
5 g (1 pat) Margarine
150 g (V2 cup) Apple-oat
crisp dessert
Iced coffee
1 Seasoned
roast ear of corn
1 Starch
4 Graham
1 Sweet
28 g (1 oz) Marshmallows
crackers
(28
g)
italian
Snack
2 Starch,
16 g (1 tablespoon)
1 Starch
1 Starch,
1 Fruit
2 tablespoons
28 g (1 slice) Whole-wheat
bread
226 g (8 oz) Nine-bean
soup
122 g (‘/2 cup) Chunky fruit salad
142 g (5 oz) Low-fat vanilla yogurt
Spring water
3 Starch
Protein
Fat
Garden
Starch
Fat
Cereal,
corn
Snack
1 Fat
1
1
1
1
1
1
1 Fat
1 Fat
1 Fruit
dressing
Supper
1 Garden
Air-popped
55 g (1 cup) Iceberg lettuce
80 g (‘/2 cup) Artichoke
hearts
100 g total (2 tablespoons
each) Bean sprouts,
chopped
onion, mushrooms
and tomato
8 Small black olives (24 g)
muffin
23 g (‘/2 cup) Oat squares
85 g (3 oz) Figs
1 Fat
1
1
1
1
(7 g)
/2
Supper
1 Bean, 1 fat
1 Protein
Meal plan
and
Kcal/
(229 g)
Practical
considerations
Almost
foods
intake
all
individuals
penience,
problems
As
can
adapt
increase
to the diet.
With
individuals
fluid
increase
intake.
on diabetes
their
augments
Low-fat
grains
>
fiber
Medications
intake
of fiber-rich
effect
which
of high fiber
subsides
as
patient-years
10 000
may
need
diets
the health
that
are appropriate
are
intake,
for
they
of cx-
also
in
on discontinued
of high
fruits,
for all individuals
fiber
under
to
cx-
intake.
vegetables,
aged
in-
hyperten-
should
also be encouraged
such as walking,
because
benefits
rich
no major
should
hyperhipidemia,
to be reduced
a physician’s
direction.
Individuals
engage
in regular
aerobic
activity
encise
their
The major side
gas production,
our metabolic
research
group has encountered
using high-fiber,
high-carbohydrate
diets.
crease
sion,
individuals
if they do so gradually.
is increased
intestinal
>
and
whole
2 y (73).
Thus,
such a diet can become
a lifetime
eating plan for an entire family.
Nutrition
counselors
should
emphasize
those positive
eating
habits that are already
developed
and foster change
of less desirable
Downloaded from www.ajcn.org by on December 29, 2009
3
High-carbohydrate,
(2000
plan
exchanges
1 Fat
TABLE
meal plan and menu
Breakfast
positive
struction.
fiber
(HCF)
to substan-
adherence.
Nine
hypencholesterointakes
of 51 g/d for 24-99
wk (70)
maintained
high-fiber
Id)
Meal
average
of 100 wk (71). One of our typical
diabetic
patients
continued
to follow
the HCF guidelines,
consuming
27% of energy
from fat and 40 g fiben/d
for 18 y after the initial
inpatient
inHowever,
of symptoms
4
and
with
1245S
High-carbohydrate,
convenient.
Patients
and
FIBER
12465
ones
ANDERSON
gradually.
not daily
A healthy
perfection,
balance
should
of high-fiber
be the goal
foods
of nutrition
over
ET
time,
AL
16. Margetts
BM, Beihin U,
izcd
trial
counseling.
controlled
Vandongen
of the effects
R, Armstrong
of dietary
BK. A random-
fibre
on blood
pressure.
Chin Sci l987;72:343-50.
17.
Conclusions
fiber reduces
the risk for predominant
diseases
people.
Clinical
evidence
has established
the
Dietary
Western
high-fiber
intakes
in reducing
dividuals,
improving
serum
glycemic
control
diabetic
individuals,
facilitating
for insulin
or oral agents
in obese
taming
a healthy
fiber-rich
are
also
pressure
sion,
an
High
to have
with
independent
fiber
in
of
fiber
not
yet
the
mounting
evidence
in nutrition
guidelines
for
that is generous
in fruits,
a practical
nutrition
plan
overall
health
benefits
be made to incorporate
for metabolic
conditions
Anderson
JW,
health
promotion.
vegetables,
beans,
and
to adopt for a lifetime.
whole
22.
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effects
JW,
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human
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