Question 2
In this study, fiber supplement intake was not included in
the calculations. The Academy of Nutrition and Dietetics recommends and
emphasizes that food is the primary and preferred source for meeting the daily
fiber Adequate Intake. Why is that? Would you still recommend fiber supplements
to certain population groups or those with a chronic illness or disease? Why or
why not?
posted by Molly D @ 7:19 PM
17 comments
17 Comments:
It is important that food is the primary source for obtaining fiber because you are also receiving macronutrients, vitamins, minerals, antioxidants, and phytochemicals when consuming whole food sources. This is preferred over taking a gummy/chewable or powder that does not provide the same health benefits. However, I would recommend a fiber supplement to a patient or client who does not meet adequate fiber intake on a continual basis. If a food record shows time and time again that fiber intake is low, a supplement may be appropriate. Populations that may benefit from a fiber supplement if not consuming an adequate amount include people with diabetes, cardiovascular disease, and the elderly. Adequate fiber has also been linked to weight management in those striving to achieve an ideal body weight.
The Academy recommend fiber from whole food sources instead of supplements for many reasons. High fiber foods tend to be low in calories, high in satiety, high in phytochemicals, and have the food factors that interact with the fiber to make a person overall a healthier individual. Where as a fiber supplement may give a person fiber but they are missing out on all the other benefits, many of them are the main reasons for fiber in the diet. A person going for a fiber supplement is most likely not already consuming a healthy diet and are looking for a band aide solution to fix whatever problem they are dealing with right then.
However, with every rule there is always an exception and I would recommend fiber supplements to certain populations if I saw a need for them. If a person is unable to eat enough due to some condition causing anorexia or if they have extremely high cholesterol they are unlikely to make the necessary lifestyle/food changes but would be willing to try a supplement I would be torn to not give them at least something. Some people are not going to change their eating habits or maybe unable to get enough fiber from a diet due to some condition. In these times I would recommend a supplement, because something is better than nothing and you don't want to compromise gut health.
I like what Alana brings up the idea of using fiber as a supplement to weight loss. While eating a higher fiber diet to promote weight loss is also recommended. Getting a fiber supplement in as well could help this population to help actualize more weight loss. I especially feel like this could be beneficial while someone is trying to lose weight and start making better food choices help to control their hunger cravings. I would not have thought of this population when recommending supplements on my own, but it makes perfect sense to include them even though their may be less of a clinical reason to have them on this supplement.
The Academy's recommendation is probably based on encouraging people to not only meet the AI for fiber, but to also meet the RDA of all of the other vitamins and minerals. If you use a supplement to achieve the AI of fiber instead of eating whole foods, it is likely that you will fall short on many of the vitamins and minerals. You will also miss out on all of the other goodies in food such as phytochemicals and antioxidants that work synergistically with the vitamins and minerals to promote health and reduce the risk of disease.
That being said, I'm sure we will encounter situations where a fiber supplement may be warranted. Most clients will find making a 180 degree change in eating habits difficult. Supplements can help bridge the gap while incremental changes are made. They may also be appropriate for patients who are unable to orally consume sufficient fiber for a variety of reasons such as cancer patients and those with GI disorders.
I agree with the Academy’s recommendation that fiber should not be relied on by supplements but sources of fiber should come from whole foods because of all the other added benefits that can be associated with them, such as vitamins, minerals, antioxidants, low-fat, and low-calorie intake (which has been linked to management). A supplement should not be used as a substitute! When taken in excess, fiber supplements have the potential to cause unwanted symptoms such as abdominal discomfort, gas, and bloating. Fiber supplements may also have a counter affect on medications such as cholesterol lowering medications, diabetic medications, anti-depressants, aspirin, and warfarin. However, for certain populations and age groups who are continually not able to get the proper amount of fiber intake due to illness or impairment, supplements would be appropriate.
In relation to Angela’s statement about using supplements to “bridge the gap” for those individuals who are working toward change in increasing their fiber intake I think is a good idea. Fiber supplements can be used as a good tool to encourage fiber intake when they are not ready for a complete dietary modification. As I said above, fiber supplements should not be used as substitutes, but when they are used responsibly and appropriately, they can be very beneficial not only for increase fiber intake but for promoting change.
I believe that they emphasize this so strongly so that people do not rely on supplements to meet needs and focus on obtaining the nutrition through food. The U.S. has a supplement for everything it seems like and moving away from these and concentrating on whole foods is definitely an important issue. For those not consistently receiving fiber from whole foods with a lack of motivation to change their diet I think supplements would be a good option. I think emphasizing that this is not the preferred method for fiber intake should be stressed to the person. Asking them to slowly incorporate small amounts of foods that contain fiber into their diet may be a good compromise. I feel that the same goes for those with diseases or illnesses, always stressing that whole foods is the best option is a priority but when consulting a person that refuses to eat more fiber, a supplement will be beneficial nonetheless.
I believe that getting fiber from a food source is recommended because food sources supply so many other necessary vitamins, minerals, and antioxidants. If you supplement fiber, you would be missing all of these beneficial aspects that work in conjunction with the fiber to keep people well. In addition, fiber from a food source is much more affordable than buying a supplement. For the most part, I believe food sources should be highly encouraged but if a client is just not going to eat fruits, vegetables, or whole grains, then fiber supplementation is better than nothing.
The best source of fiber will always be food because there are so many more benefits than just fiber. High fiber foods are generally high in many other good things such as vitamins, antioxidants,and fill you up faster. I would definitely recommend a supplement to those clients that have chronic illness or simply can't seem to get enough fiber throughout the day. I feel like as long as they are still consuming whole foods and not simply getting their fiber from supplements alone, that is appropriate.
Angela made a good point about how using a supplement for fiber can cause a deficiency in vitamins and minerals. Emphasizing the importance of consuming food over supplements and the negative consequences that can occur if someone relies on supplements to provide for their needs is important. As women we are told constantly that we need more iron, calcium and folate and many women rely on multivitamins for these nutrients but encouraging consuming these nutrients through food should be a priority.
Food should be the primary source of fiber intake because the foods highest in fiber, whole grains, legumes, fruits & vegetables, are extremely nutrient dense. A fiber supplement will not contain the amount of vitamins, minerals, and phytonutrients that whole foods contain. Yes, I would still recommend a fiber supplement to certain pt populations. The key word being SUPPLEMENT, as in, supplementing their diet of whole foods that is already rich in fiber.
For those who don't have a GI issue, dyslipidemia, or aren't elderly, I really don't think we should be recommending a fiber supplement to "bridge the gap" for normal, healthy individuals. I feel we should absolutely exhaust all efforts to get that pt. to consume more whole foods before we just decide, well, looks like you don't like fruits and vegetables, so go buy some Metamucil.
I appreciate Angela's comment regarding client's difficulty with changing their eating habits. They will most likely not be able to change their lifestyle in a day and fiber supplementation may be necessary for the integrity of the GI tract. I also continue to agree that a whole foods approach is obviously the best solution.
To help you answer this question and respond to others I would suggest finding the Academy of Nutrition and Dietetics (formerly ADA) Position Paper on Dietary Fiber (October, 2008) to help further your knowledge.
Although I agree with the AND's recommendation, I may recommend a fiber supplement on a very individual basis. Clearly, whole foods naturally high in fiber are very nutrient dense, not necessarily energy dense. After several attempts to help an elderly or severely ill patient incorporate more whole foods in their diet, I would inform them of the option to supplement their whole food intake with a fiber supplement.
Kelsey, I think that's a great point about how we are encouraged to consume our vitamins/minerals in multivitamin form. I would be interested to see the numbers of individuals who consume a multivitamin verses those who consume whole foods with the goal of meeting their nutrient needs. I know many people who consume a multivitamin, and I assume it is because they are marketed so well and people are convinced it's a healthy thing to do. If only RDs had the marketing money that pharmaceuticals and supplement companies do. It's also frustrating, like you said, that people are encouraged to get these vitamins/minerals from a pill from the start. The option of including more whole foods into their diet is not even addressed.
Kelsey and Emily make an interesting point about American's tendency to just grab a multi-vitamin to address nutrients of concern. It makes me think of women who plan to get pregnant or become pregnant. OBs write you an Rx for a prenatal vitamin, but I doubt much dietary education is provided. At the time I was pregnant, becoming a dietitian wasn't not even a thought in my head, but it sure would have been nice to know about what to eat instead of taking the horse pill provided. A fiber discussion would have been welcome in relation to dealing with the lovely GI side effects of all the Iron in the darn things!
Post a Comment
<< Home