Throughout the research for my first book, I kept hitting on a recurring theme. Dietary fiber is essential for good health. Yes, I know you’ve heard that it’s important to eat fiber and you probably already understand the value of whole food sources of fiber. You and I probably feel a similar disdain for fiber supplements, fiber-enriched cereals and breakfast bars; there’s even fiber-enriched water! But, as much as the food industry has taken “fiber is good for you” to a much more commercial marketing place than just the stereotypical advice to eat more whole grains, there’s compelling science behind this concept. I’m sure you already understand that there’s just as much fiber in vegetables and fruit for a much lower sugar content and much higher vitamin, mineral and antioxidant content than whole grains, but if you want more information on that topic, see this post.
Yes, fiber is good for us. But through my research, I also kept hitting on pieces of information that went contrary to conventional wisdom (even contrary to conventional Paleo wisdom). Tidbits like insoluble fiber is even more beneficial than soluble (in spite of the fact that the vast majority of studies only evaluate the benefits of soluble fiber). Even more mind-blowing for me was learning that the whole insoluble fiber being abrasive thing is a myth. In fact, the deeper I delved into this subject, the more information I learned that completely challenged everything I thought I knew about this non-essential nutrient. And, the more everything started to make much more sense too.
I have been working on this series of posts for six months and am finally ready to share this information with you (and bust some myths too!). I have broken this immense topic into five posts. Up first:
Part 1: What Is Fiber, Anyway? And Why Is It Good?
Fiber is a type of carbohydrate, meaning that fiber is simply a long string of sugar molecules (saccharides). Fiber comes from the cell walls of plants. In plant cells, it acts as a skeleton and helps to maintain the plants’ shape and structure. There are many, many different types of fiber (different length strings composed of different saccharides, some with branches and some without). The only dietary source of fiber are plant-based foods.
What separates fiber from other carbohydrates (starches and sugars), is that the digestive enzymes produced by our bodies that digest carbohydrates by breaking them down into simple sugars (monosaccharides, which are then absorbed across the intestinal barrier and into the body) are not able to break fiber apart into monosaccharides. Instead, fiber passes through the digestive tract, mainly intact.
Some types of fiber (called fermentable fibers) can be digested by the bacteria that in our intestines (these bacteria mainly reside in the large intestine but there are some in the small intestine too). In fact, fiber serves two main functions in the digestive tract: it adds bulk to stool (this makes it easier to pass) and it feed the probiotic bacteria that live in there (there are many ways that this benefits us). When probiotic bacteria eat fiber, they produce short-chain fatty acids—such as acetic acid, propionic acid, and butyric acid. These are extremely beneficial energy sources for the body, including the cells that line the digestive tract and help to maintain a healthy gut barrier. Short-chain fatty acids are also essential for regulating metabolism and they aid in the absorption of minerals, such as calcium, magnesium, copper, zinc, and iron. Healthy gut bacteria have many other important beneficial effects in the body, such as aiding digestion (they release important vitamins and minerals from our food so we can absorb them) and regulating the immune system.
Fiber has other effects, like regulating peristalsis of the intestines (the rhythmic motion of muscles around the intestines that pushes food through the digestive tract), stimulating the release of the suppression of the hunger hormone ghrelin (so you feel more full), slowing down the absorption of simple sugars into the blood stream to regulate blood sugar levels and avoid the excess production of insulin. Fiber also binds to various substances in the digestive tract (like hormones, bile salts, cholesterol and toxins) and depending on the type of fiber, can either facilitate elimination or reabsorption (for the purpose of recycling, which is an important normal function for many substances like bile salts and cholesterol), both of which can be extremely beneficial if not essential for human health.
So, even though fiber doesn’t provide us with energy (like other carbohydrates, fat and protein) and isn’t an essential micronutrient (like vitamins, minerals and phytochemicals), it’s pretty darned important (in fact, one might argue that it’s classification as non-essential is erroneous).
In fact, one of the biggest culprits in the rise of chronic disease seen in the last 50 years is the decrease in fiber consumption relative to total carbohydrates (you know, the part where the carbohydrates we eat are becoming more and more refined, meaning the fiber is stripped out of them).
Take this graph for instance, which I find fascinating. It shows that the current “high carb” consumption in the Standard American Diet isn’t actually that different from a hundred year ago. But how refined those carbohydrates are has changed dramatically. And, during the last 50 years, while the percentage of carbohydrates we consume that come from refined sources has been steadily increasing, so too has been obesity, type 2 diabetes, cardiovascular diseases, immune diseases alike asthma and autoimmune diseases like rheumatoid arthritis.
Certainly, there have been some other important changes in the typical American diet in this time as well. The amount of omega-6 polyunsatruated fats we consume has skyrocketed. The total caloric intake has increased. Our vegetables are less nutrient dense (due to a variety of factors, one of which being that there’s typically a longer period of time between when they are picked and when you buy them and eat them). But, the authors of this paper were able to tease out a very important role for fiber intake, by looking at food availability data (the best measurement we have on what the population as a whole eats) and incidence rates of diabetes over the last 100 years. They found
- dietary fiber is inversely correlated with the prevalence of type 2 diabetes (meaning the lower your fiber intake the higher your risk of developing T2D),
- corn syrup intake (marking refined carbohydrates) is positively correlated with the prevalence of type 2 diabetes (meaning the more corn syrup you consume, the higher your risk of developing T2D), and
- there is no correlation with dietary protein or dietary fat with diabetes incidence once you accounted for total energy intake
The take-home message is that eating whole foods (and therefore avoiding refined carbohydrates) reduces risk of type 2 diabetes. And that it’s much more important that your carbohydrates are coming from whole foods rather than how many grams of them you are eating. Just look at total carbohydrate consumption in the early 1900s versus now… pretty similar, but ten times as many people suffer from type 2 diabetes now compared to 100 years ago.
Diets rich in fiber also reduce the risk of many cancers (especially colorectal cancer, but also liver, pancreas and others) and cardiovascular disease, as well as overall lower inflammation. Prospective studies have confirmed that the higher your intake of fiber, the lower your inflammation (as measured by C-reactive protein). And in fact, a new study showed that the only dietary factor that correlated with incidence of ischemic cardiovascular disease is low fiber intake (and not saturated fat!); and the more fiber you eat, the lower your risk. If you have kidney disease, a high fiber diet reduces your risk of mortality. If you have diabetes, a high fiber diet reduces your risk of mortality. High fiber intake can even reduce your chances of dying from an infection.
Convinced yet?
So, does it matter what types of foods your fiber comes from (and thus what types of fiber you’re eating)? There are an increasing number of studies supporting that the health benefits of high-fiber diets really come from those diets high in vegetables (so vegetable fiber) and, to a lesser extent, fruit and nuts (the health benefits are not experienced when with diets high in cereal grains). These high vegetable diets also reduce cardiovascular disease risk factors and markers of colon cancer risk. How much of this can be directly attributed to the types of fiber in vegetables (mainly insoluble, more on this in Parts 3 and 4 of this series) versus the high vitamin, mineral and phytonutrient content of vegetables compared to other carbohydrate sources remains unknown. Probably, the benefits come from both.
In the next four parts of this series, I will explain the differences between the many different types of fiber (it’s much more complicated than just soluble and insoluble) and get into some details on what types of fiber are the most beneficial (hint: it’s not the party line) and why. But as fun as it’s going to be to delve into these details (and bust some myths!), the take home message is right here:
Eat vegetables. Lots of them.
Burger KN, et al, Dietary fiber, carbohydrate quality and quantity, and mortality risk of individuals with diabetes mellitus. PLoS One. 2012;7(8):e43127.
Grooms KN, et al, Dietary Fiber Intake and Cardiometabolic Risks among US Adults, NHANES 1999-2010. Am J Med. 2013 Oct 9. pii: S0002-9343(13)00631-1.
Gross LS, et al, Increased consumption of refined carbohydrates and the epidemic of type 2 diabetes in the United States: an ecologic assessment. Am J Clin Nutr. 2004 May;79(5):774-9.
Jenkins DJ, et al, Effect of a very-high-fiber vegetable, fruit, and nut diet on serum lipids and colonic function. Metabolism. 2001 Apr;50(4):494-503.
Jenkins DJ, et al, Effect of a diet high in vegetables, fruit, and nuts on serum lipids. Metabolism. 1997 May;46(5):530-7.
Krishnamurthy VM, et al, High dietary fiber intake is associated with decreased inflammation and all-cause mortality in patients with chronic kidney disease. Kidney Int. 2012 Feb;81(3):300-6.
Norat T, et al, Fruits and Vegetables: Updating the Epidemiologic Evidence for the WCRF/AICR Lifestyle Recommendations for Cancer Prevention. Cancer Treat Res. 2014;159:35-50.
Park Y et al, Dietary fiber intake and mortality in the NIH-AARP diet and health study. Arch Intern Med. 2011 Jun 27;171(12):1061-8.
Wallström P, et al Dietary fiber and saturated fat intake associations with cardiovascular disease differ by sex in the Malmö Diet and Cancer Cohort: a prospective study. PLoS One. 2012;7(2):e31637.
Yunsheng Ma, et al, Association between dietary fiber and serum C-reactive protein Am J Clin Nutr. 2006 April; 83(4): 760–766.
Zhang J, et al Physical activity, diet, and pancreatic cancer: a population-based, case-control study in Minnesota. Nutr Cancer. 2009;61(4):457-65.
TPV Podcast, Episode 63: Rise Above
Once again, you nailed it. Thank you so much for this GREAT article. It leaves me happy that my teenagers and I are eating 75% vegetables almost everyday now (wash wash, peel peel, chop chop)…need the husband to get on board. Erg.
This comment just made my day. Thank you!
Such great information. Thanks, Sarah. I’ m anxious to read the next installment.
Great, thank you! Fiber is one of those topics that tends to be confusing to me because there’s conflicting messages out there. I’m glad there’s someone like you who is able to read and understand these studies.
Awesome Post. As a Registered Nurse I am asked nutritional questions often and many about fiber. Looking forward to passing it forward and to the rest of the story. 🙂 Thank you so much for sharing all of your hard work with me.
I’d really like to see a picture of how much fruit and veg you eat in a typical day. How much is too much?
I sometimes post my meals on instagram… I eat A LOT of vegetables.
I love learning new food facts. This is so informative and easy to understand. I love veggies and eat them with every meal and snacks in between. I tell my kids they’re ‘colon friendly’ and they give me a look like “OH MOM”. It’s true! They’ll thank me some day. 🙂
Do we still get good fiber from veggies that are pureed or in smoothie form? This question from a mom of a 4 year old 🙂
Yes! And some people actually find that it’s easier to digest that way (I have a friend with Crohn’s who can’t eat salad, but if she makes a smoothie with lettuce in her vitamix, she’s fine).
Good to know, thanks! I recently made a tropical green smoothie loaded with spinach and carrots and my little guy LOVED it, so I think I will be serving that one more often! He will also still eat the organic puree pouches. I figure veggies however we can get them in…
Comment. Testing!
http://www.gutsense.com/
Are you familiar with this doctor? If so, I’d be very interested in a brief comment from you. I found his website and videos very compelling, but your information seems to be slightly different. I admit, though, that I’ve mostly skimmed it–no time to read the details just now!
No rush. =)
I’ve heard of his first book, but not his second. Similar to me, he’s not an MD (he was a pharmacist, I was a medical researcher). His approach to the field is definitely different than mine. He draws very similar conclusions to what I do from grain-based fiber diets and high soluble fiber diets, but he ignores the nuances of the different types of fiber and generalizes to all fiber. This also ignores the many, many studies showing diverse benefits from diets rich in vegetables and fruit. I don’t know if his books contain scientific references from peer-reviewed journals the way my posts and book do, so that would be something to look for when evaluating whose information makes more sense to you.
Hey, I’m with you on your conclusions, and I’m a Paleo guy too. But you have made a big mistake in your reasoning. It’s the same mistake that got us into the “fat is bad sugar is OK” paradigm in the first place.
Here’s the error: Correlation is not causation. Relating the incidence of diabetes with observations of consumption of fiber doesn’t prove that it’s the fiber consumption change that’s causing the diabetes incidence change, just as relating heart disease in seven countries with fat consumption in those countries doesn’t show a cause and effect relationship.
True… I go into far more detail about the prospective and mechanistic studies in the next four parts of this series.
Here’s a link to a related post you may find interesting:
http://wholehealthsource.blogspot.com/2009/12/butyric-acid-ancient-controller-of.html
It’s an old post (12/09) but I found it recently so it’s new to me. It confirms much of what you’ve mentioned here but identifies butyrate as the primary benefactor and extrapolates your logic to food sources that are typically considered ‘unhealthy’ (i.e. Butter, Fermented Butter e.g. Ghee, etc.)
This was a great post.
Thanks again for such a good read.
sarah and assistants. i think veges is the way to go …but was interested in your response to the russian (oh please help me with his name) re constipation…would you say he doesn’t recommend fibre…but is that just in terms of avoiding bulk up when already blocked do you think?
As Sarah concludes at the end of this series, all kinds of fiber are essential for digestion and “getting too much” or “the wrong kinds” is largely an unfounded fear. She discusses Paleo ways of treating constipation here: https://www.thePaleomom.com/2012/05/treating-constipation-without.html – Christina, Sarah’s assistant
thank you so much chritina….really very helpful!
I listened to podcast form 1/1/15 and followed the link to this page. Since this was posted a year ago I expected to find links to Parts 2-5. Where might I find them
Judy
The problem I’ve always had with eating lots of vegetables is that it makes me get full on eating vegetables. I’ve been struggling to gain weight my entire life and have this habit of going for high calorie foods over low calorie ones. I have memories of trying to eat raw carrots as a kid and getting wads of stuff I couldn’t chew or swallow, (even after 10 minutes or so,) and ended up spitting it out. Same with celery. Even now I have a hard time justifying eating vegetables instead of something like cheese, but I recently got a stool profile done and found that I have high beta-glucuronidase and low n-butyrate. So I need more fiber.
My question is: does cooking vegetables (possibly for a long time?) have any negative impact on the fiber? My favourite way to eat vegetables is in soups.
By the way, I am grateful for your book, The Paleo Approach. I haven’t been diagnosed with any autoimmune diseases, but my stool test found that I have a leaky gut and food allergies and I’ve had a bunch of troubling symptoms for a while, so I’m glad to catch it early-ish. It’s pretty tough to give up some of my favourite foods, but I’ve been more-or-less Paleo for 3 years now so it’s not like night and day. I’ve also gone back and forth about whether all of this is real or in my head. It’s nice to have actionable test results to go on. It’s so tempting to hope that I have the power to heal my body, and to keep it that way, but you’re right that some things are just down to luck. And so much is not fully understood. So best of luck to you, and thanks. 🙂
What about the people suffering with IBS? My husband was on a Paleo diet with lots of fruits and vegetables. He was also constipated and bloated. He couldn’t lose weight despite sport sessions 4 times a week. He has stopped gluten a few years ago but still have a belly becoming bloated after some meals. He read studies and books about IBs and remove raw vegetables, onions, apples and more. He eats mostly soluble fibers now and cooked vegetable (with meat of course). Do you know anything about IBs? Any advice?
Another good read is “Fat Chance” by Robert H. Lustig who focuses a lot on fiber.
I just ran across this and I am SO EXCITED to read the rest of the series! I’ve always been pro-fiber! But then I found out that fiber wasn’t helping me. I have active SIBO, so I was feeding the bugs in the wrong part of my gut and not getting the benefits of the fiber in my own body. I can’t wait to see how you address the complexities of fiber. Once I eradicate this SIBO, I want to make sure that I feed the good guys in the right way.