Roughage revisited: the effect on intestinal function of inert plastic particles of different sizes and shape

Dietary Fibre for the Prevention of Post-Pancreatitis Diabetes Mellitus: A Review of the Literature and Future Research Directions

Post-pancreatitis diabetes mellitus-the most common sequela of pancreatitis-leads to poorer glycaemic control compared with type 2 diabetes. Because post-pancreatitis diabetes mellitus is an exemplar of secondary diabetes (with a clear underlying cause), much post-pancreatitis diabetes mellitus is preventable or treatable early. Earlier literature established the important role of dietary fibre in reducing plasma glucose in individuals with type 2 diabetes. The present review benchmarks available evidence on the role of habitual dietary fibre intake in pancreatitis and post-pancreatitis diabetes mellitus. It also paves the way for future research on the use of dietary fibre in the post-pancreatitis setting.

All Fiber is Not Fiber

PURPOSE OF REVIEW

Epidemiologic studies and clinical trials have demonstrated the benefits of dietary fiber. This occurs through a combination of the physiochemical properties of fiber and through microbial fermentation that occurs in the colon which result in the production of short-chain fatty acids (SCFA). The purpose of this review is to highlight the physiochemical properties of fiber that result in the range of physiologic effects and to review the literature on the health benefits of acetate, propionate, and butyrate.

RECENT FINDINGS

Of the variety of properties and functions exerted by dietary fibers, the fermentability and production of SCFA's are emphasized in this review. Studies done in both animal and humans reveal the anti-obesity, anti-inflammatory, and possible anti-neoplastic roles SCFAs exert at the mucosal level. Many clinical questions remain regarding the optimal dose, type, and method of delivery of fiber to exert the desired beneficial effects. It has the potential to be used in the management of clinical symptoms, prevention of disease, and improvement in human health. Further studies to address this novel use of fiber has the potential to make a large impact in clinical practice.

Microplastics: A review of analytical methods, occurrence and characteristics in food, and potential toxicities to biota

Microplastics (MPs) are ubiquitous in various environment compartments, including food. Here, we collected research reports of MPs in food published during 2010-2020, and summarized the analytical methods developed and utilized by researchers (e.g., digestion, separation and identification, as well as related QA/QC measures implemented), the occurrence, and the characteristics of MPs in six kinds of food. The potential effects on biota from exposure to MPs were also reviewed. The results showed that most researchers digested food samples using chemical solutions such as HNO₃, H₂O₂, KOH, or NaOH. FT-IR and Raman spectroscopy were the main technique for identifying MPs, and microscopes were used to count MP particles. The abundances MPs were in the ranges of 0-5860, 2.00-1100, 0-698, 4.00-18.7, 0-5.68 × 10⁴ and 900-3000 particles/kg in beverages, condiments, honey, meat, seafood and vegetables, respectively. The "maximum" annual human intake of MPs from these foods is approximately 1.42 × 10⁵-1.54 × 10⁵ particles/capita, equivalent to the consumption of 50 plastic bags (size: 0.04 mm × 250 mm × 400 mm, density: 0.98 g/cm³) each year. Blue-colored and fiber-shaped MP particles were the most commonly observed in food, predominated by PA, PE, PES, PET and PP types. Toxicity studies indicated that MPs, additives of MPs and adsorbents or microorganisms on the surfaces of MPs were all somewhat toxic to cells or biota. Exposure to MPs may induce oxidative stress, inflammation, neurotoxicity, and reproductive toxicity, and change the structure of intestinal microflora in cells or biota. Therefore, we call for more investigation into the residual, excretion and bioavailability of MPs or related absorbents/additives in biota and humans.

Dietary fibres and IBS: translating functional characteristics to clinical value in the era of personalised medicine

Clinical guidelines in the use of fibre supplementation for patients with IBS provide one-size-fits-all advice, which has limited value. This narrative review addresses data and concepts around the functional characteristics of fibre and subsequent physiological responses induced in patients with IBS with a view to exploring the application of such knowledge to the precision use of fibre supplements. The key findings are that first, individual fibres elicit highly distinct physiological responses that are associated with their functional characteristics rather than solubility. Second, the current evidence has focused on the use of fibres as a monotherapy for IBS symptoms overall without attempting to exploit these functional characteristics to elicit specific, symptom-targeted effects, or to use fibre types as adjunctive therapies. Personalisation of fibre therapies can therefore target several therapeutic goals. Proposed goals include achieving normalisation of bowel habit, modulation of gut microbiota function towards health and correction of microbial effects of other dietary therapies. To put into perspective, bulking fibres that are minimally fermented can offer utility in modulating indices of bowel habit; slowly fermented fibres may enhance the activities of the gut microbiota; and the combination of both fibres may potentially offer both benefits while optimising the activities of the microbiota throughout the different regions of the colon. In conclusion, understanding the GI responses to specific fibres, particularly in relation to the physiology of the individual, will be the future for personalising fibre therapy for enhancing the personalised management of patients with IBS.

Feeling gutted in chronic kidney disease (CKD): Gastrointestinal disorders and therapies to improve gastrointestinal health in individuals CKD, including those undergoing dialysis

Chronic kidney disease (CKD) affects 9.1% of the population worldwide. CKD may lead to structural and functional gastrointestinal alterations, including impairment in the intestinal barrier, digestion and absorption of nutrients, motility, and changes to the gut microbiome. These changes can lead to increased gastrointestinal symptoms in people with CKD, even in early grades of kidney dysfunction. Gastrointestinal symptoms have been associated with lower quality of life and reduced nutritional status. Therefore, there has been considerable interest in improving gastrointestinal health in this clinical population. Gastrointestinal health can be influenced by lifestyle and medications, particularly in advanced grades of kidney dysfunction. Therapies focused on gastrointestinal health have been studied, including the use of probiotics, prebiotics, and synbiotics, yielding limited and conflicting results. This review summarizes the alterations in the gastrointestinal tract structure and function and provides an overview of potential nutritional interventions that kidney disease professionals can provide to improve gastrointestinal health in individuals with CKD.

Chronic Constipation: Is a Nutritional Approach Reasonable?

Chronic constipation (CC) is one of the most common gastroenterological diagnoses in clinical practice. Treatment includes several steps, depending on the severity of symptoms. Lifestyle modifications and increased intake of fiber and water are suggested by most health professionals. Unfortunately, the recommendations in this regard are the most varied, often conflicting with each other and not always based on solid scientific arguments. This paper aims to clarify this topic by providing practical indications for the management of these patients in every day clinical practice. The literature available on this topic is scarce, and dietary studies have important methodological biases. However, fiber, mainly by binding water and acting as bulking agents and/or as prebiotics for the intestinal microbiota, and mineral water, especially if rich in magnesium and/or bicarbonate, are useful tools. An adequate, well-designed diet should be a cornerstone of any effective treatment for chronic constipation. High-quality studies on larger samples are mandatory to give scientific validity to the role of the food in CC therapy and to enable professionals to choose the best approach for their patients, combining nutritional and pharmacological agents.

Investigation of different dietary-fibre-ingredients for the design of a fibre enriched bread formulation low in FODMAPs based on wheat starch and vital gluten

Consumption of fermentable oligo-, di-, monosaccharides and polyols (FODMAPs) often induces symptoms of irritable bowel syndrome (IBS). Since FODMAPs and dietary fibre (DF) share certain characteristics, IBS-patients have a limited intake of DF. Therefore, enrichment of a low FODMAP model bread (based on 84% wheat starch and 16% vital gluten) with various fibres (bamboo, cellulose, psyllium, guar gum) in two different concentrations (3 g/100 g and 6 g/100 g) was investigated. Physico-chemical properties of doughs and breads were analysed (fermentation quality, gluten development, specific volume and hardness), as well as the release of reducing sugars during in vitro digestion. High performance anion exchange chromatography with coupled pulsed amperometric detection (HPAEC-PAD) was used to determine the FODMAP levels (contents of mannitol, sorbitol, fructose in excess of glucose, fructans and α-galactooligosaccharides) of both dough and bread. Prototypes were compared with wheat flour-based breads (bakers’ flour with and without wheat bran addition) to assess the performance of these prototypes. Prototypes showed a decreased quality compared to a baker’s flour control, however, a quality comparable to commercial wheat bran breads was found. This in combination with a lower release of reducing sugars during in vitro digestion underline the potential of fibre enriched breads as part of a healthier and more palateable low FODMAP diet. Furthermore, this study highlights the importance of the type (viscous and insoluble) and the concentration of fibres used. Application of psyllium in a concentration of 3 g/100 g showed the most beneficial impact on both physical (specific volume, hardness after 0 h and 24 h) and nutritional aspects of bread.

Irritable Bowel Syndrome in Pregnancy

Irritable bowel syndrome (IBS) affects a significant percentage of the general population and is more common in women. A large proportion of women affected with IBS are of childbearing age; however, there is a paucity of studies and guidelines to specifically address the epidemiology, course, maternal/fetal prognosis, or management of IBS in pregnancy. This scarcity of literature on IBS and pregnancy poses significant challenges to healthcare providers in counseling and managing patients. In this comprehensive review, we summarize the current literature and knowledge gaps regarding the effects of pregnancy on IBS and vice versa, along with the efficacy and safety profiles of commonly used IBS diets and medications in pregnancy. The management of pregnant women with IBS should be multidisciplinary, with emphasis on education and judicious use of dietary modifications and pharmacologic options that are deemed relatively safe during pregnancy.

Dietary fibre in gastrointestinal health and disease

Epidemiological studies have consistently demonstrated the benefits of dietary fibre on gastrointestinal health through consumption of unrefined whole foods, such as wholegrains, legumes, vegetables and fruits. Mechanistic studies and clinical trials on isolated and extracted fibres have demonstrated promising regulatory effects on the gut (for example, digestion and absorption, transit time, stool formation) and microbial effects (changes in gut microbiota composition and fermentation metabolites) that have important implications for gastrointestinal disorders. In this Review, we detail the major physicochemical properties and functional characteristics of dietary fibres, the importance of dietary fibres and current evidence for their use in the management of gastrointestinal disorders. It is now well-established that the physicochemical properties of different dietary fibres (such as solubility, viscosity and fermentability) vary greatly depending on their origin and processing and are important determinants of their functional characteristics and clinical utility. Although progress in understanding these relationships has uncovered potential therapeutic opportunities for dietary fibres, many clinical questions remain unanswered such as clarity on the optimal dose, type and source of fibre required in both the management of clinical symptoms and the prevention of gastrointestinal disorders. The use of novel fibres and/or the co-administration of fibres is an additional therapeutic approach yet to be extensively investigated.

A Guide to Recommending Fiber Supplements for Self-Care

The health benefits of dietary fiber are extensive and wide-ranging, yet most Americans do not consume the recommended amount of fiber from their diet. Fiber supplements may be used as a means to augment a low-fiber diet. But which, if any, of the benefits of dietary fiber are achieved through supplementation? And are all fiber supplements equally effective? An evidence-based approach to recommending fiber supplements for self-care will be discussed.

Laxative effects of wheat bran and psyllium: Resolving enduring misconceptions about fiber in treatment guidelines for chronic idiopathic constipation

BACKGROUND

Treatment guidelines for chronic idiopathic constipation (CIC) recommend an "increase in fiber intake" as a first-line therapy, but most epidemiologic studies fail to support an association between a high-fiber diet and a reduced risk of constipation. Furthermore, randomized controlled clinical studies show that most isolated fibers (e.g., supplements) are not different from placebo for a laxative effect, and several may be constipating.

OBJECTIVES

The objective of this review was to compare the effects of two isolated fibers, coarse wheat bran and psyllium, on stool output and stool water content in patients with CIC. This review will also address misconceptions about fiber that are perpetuated by treatment guidelines.

DATA SOURCES

A comprehensive literature review was conducted with the use of the Scopus, SciFinder, and PubMed scientific databases, limited to the previous 50 years (1968-2018; latest date included, December 31, 2018).

CONCLUSIONS

In patients with CIC, nonfermented gel-forming psyllium was 3.4 times more effective than insoluble wheat bran for increasing stool output. Both psyllium and coarse wheat bran increased stool water content, a stool-softening effect, but finely ground wheat bran decreased stool water content, a stool-hardening effect.

IMPLICATIONS FOR PRACTICE

It is a misconception that dietary fiber and all isolated fibers provide a laxative effect in patients with CIC. Our analysis suggests that treatment guidelines for CIC should make specific evidence-based recommendations as it pertains to fiber. To do otherwise takes the risk of perpetuating myth and misunderstanding and depriving patients of an effective therapy for CIC. A generic recommendation to "increase fiber intake" is akin to a recommendation to "increase pill intake" without regard to therapeutic or adverse effects.

Potential toxicity of polystyrene microplastic particles

Environmental pollution arising from plastic waste is a major global concern. Plastic macroparticles, microparticles, and nanoparticles have the potential to affect marine ecosystems and human health. It is generally accepted that microplastic particles are not harmful or at best minimal to human health. However direct contact with microplastic particles may have possible adverse effect in cellular level. Primary polystyrene (PS) particles were the focus of this study, and we investigated the potential impacts of these microplastics on human health at the cellular level. We determined that PS particles were potential immune stimulants that induced cytokine and chemokine production in a size-dependent and concentration-dependent manner.

Effect of fiber source and particle size on chick performance and nutrient utilization

The addition of fiber in chick feeds is known to dilute nutrients; as a result, this may reduce nutrient digestibility and performance. However, recent studies suggest that moderate inclusion of insoluble fibers (2 to 3%) may stimulate gizzard development, which could result in better nutrient utilization and chick growth. The previous fiber sources evaluated were subject to wide fluctuation in their nutritional and chemical composition due to variation in processing. Miscanthus giganteus is a C4 grass purposefully grown for its fiber content which has a consistent fiber composition compared to food process residues. The objectives of this study were to determine the effect of dietary fiber source and particle size on day-old chick performance and nutrient digestibility. Day-old chicks (8 chicks per cage, 5 cages per treatment) were fed diets containing 3% of either sepiolite (SEP), cellulose (CEL), coarse beet pulp (BP), fine BP, coarse Miscanthus grass (MG), and fine MG. At the end of days 7, 14, and 21, chicks and experimental diets were weighed to compute average daily gain and feed intake. In addition, excreta from the previous 48 h of each data capture point was collected to determine nutrient digestibility. In general, chicks fed diets containing fiber consumed more feed, gained more weight, and had better feed conversion rate than birds fed the SEP diet. Particle size of the fiber had no effect on chick performance; however, nutrient utilization was higher (P < 0.05) for chicks fed coarse fiber particles compared to these fed fine fiber particles. Birds fed diets containing MG performed similar to chicks fed CEL (P > 0.05), but digestibility coefficients of birds fed BP diets were generally higher than chicks fed MG diets. In conclusion, chicks performed better with fiber in their diet and MG was comparable to CEL.

The effects of diets varying in fibre sources on nutrient utilization, stool quality and hairball management in cats

Pet food companies use fibrous ingredients in cat foods to aid weight and hairball management. Miscanthus grass could be an alternative novel fibre source for cat foods. The objectives of this work were to determine the effects of Miscanthus grass as a fibre source on nutrient utilization, stool quality and hairball management in cats. Dry extruded cat foods (average chemical composition; digestibility trial: 94.54% dry matter-DM, 34.47% crude protein-CP, 11.67% crude fat, 7.06% ash and 13.04% total dietary fibre-TDF; and hairball trial: 94.88% DM, 34.60% CP, 11.30% crude fat, 7.02% ash and 9.77% TDF) were fed to 12 cats for a 9-day (digestibility trial) or 16-day (hairball trial) adaptation period followed by a 5-day total faecal collection period. Digestibility trial was performed as a replicated Latin square design, and the hairball trial was performed as a switchback design. In general, the cats fed the beet pulp diet (BPD) had higher DM, organic matter, gross energy and TDF digestibility than cats fed Miscanthus grass (MGD) or cellulose (CED) diet (p < .05). However, CP digestibility was lower for cats fed BPD (82.1 vs. 84.7 and 85.1%, respectively, for BPD, MGD and CED). These differences could be due to the differences in dietary fibre content and(or) composition. Faecal scores were lower for cats fed BPD (2.84) compared with MGD (3.32) and CED (3.21; p < .05). No effects due to fibre were reported on the faecal hairball variables, with the exception of less total hair weight and hair clumps per gram of dry faeces for cats fed Miscanthus grass (MGH) compared with control diet (COH; p < .05). In conclusion, Miscanthus grass could be used as an alternative ingredient to cellulose in cat diets.

An assessment of the toxicity of polypropylene microplastics in human derived cells

Environmental pollution caused by plastic waste is a growing global problem. Discarded plastic products and debris (microplastic particles) in the oceans detrimentally affect marine ecosystems and may impact human. Humans are exposed to plastic debris via the consumption of seafood and drinking water, contact with food packaging, or inhalation of particles. The accumulation of microplastic particles in humans has potential health risks such as cytotoxicity, hypersensitivity, unwanted immune response, and acute response like hemolysis. We investigated the cellular responses of secondary polypropylene microplastics (PP particles) of approximately ~20 μm and 25-200 μm in different condition and size to normal cells, immune cells, blood cells, and murine immune cells by cytokine analysis, ROS assay, polarization assay and proliferation assay. We found that PP particles showed low cytotoxicity effect in size and concentration manner, however, a high concentration, small sized, DMSO method of PP particles stimulated the immune system and enhanced potential hypersensitivity to PP particles via an increase in the levels of cytokines and histamines in PBMCs, Raw 264.7 and HMC-1 cells.

Review article: dietary fibre in the era of microbiome science

BACKGROUND

Explanations for the health benefits of dietary fibre have, in the past, been inconsistent and studies of the physiological effects of dietary fibre were, perhaps, directed at the wrong read-outs. Confounding factors included a failure to appreciate the molecular diversity and varied properties of fibre-types and the role of fibre as a substrate for microbial metabolism in the gut.

AIM

To present a modern perspective on fibre science and to encourage clinicians to re-consider the health impact of dietary fibre and how best to approach adjustments in dietary consumption.

METHODS

This perspective is drawn selectively from recent microbiome science; no attempt was made to perform an exhaustive review of all articles related to every aspect of dietary fibre.

RESULTS

Advances in microbiome science have revealed not only the functional impact of dietary fibre on the composition and function of the microbiota but have also demonstrated the physiologic responses to microbial-derived metabolites from fibre digestion. Moreover, studies have shown the personalised nature of host responses to dietary fibre intervention, with outcomes being dependent on individual pre-treatment gut ecology.

CONCLUSIONS

The physical properties of dietary fibres are important for homeostasis within the gut, but the predominant health benefits extend beyond the gut to enhanced metabolic welfare, including protection against obesity and related metabolic diseases. Fibre is a form of functional food joining a growing list of examples of diet-microbe-host interactions which link microbe-host metabolic and immune cascades.

Dietary fiber in irritable bowel syndrome (Review)

Irritable bowel syndrome (IBS) is a common chronic gastrointestinal disorder. It is widely believed that IBS is caused by a deficient intake of dietary fiber, and most physicians recommend that patients with IBS increase their intake of dietary fiber in order to relieve their symptoms. However, different types of dietary fiber exhibit marked differences in physical and chemical properties, and the associated health benefits are specific for each fiber type. Short-chain soluble and highly fermentable dietary fiber, such as oligosaccharides results in rapid gas production that can cause abdominal pain/discomfort, abdominal bloating/distension and flatulence in patients with IBS. By contrast, long-chain, intermediate viscous, soluble and moderately fermentable dietary fiber, such as psyllium results in a low gas production and the absence of the symptoms related to excessive gas production. The effects of type of fiber have been documented in the management of IBS, and it is known to improve the overall symptoms in patients with IBS. Dietary fiber acts on the gastrointestinal tract through several mechanisms, including increased fecal mass with mechanical stimulation/irritation of the colonic mucosa with increasing secretion and peristalsis, and the actions of fermentation byproducts, particularly short-chain fatty acids, on the intestinal microbiota, immune system and the neuroendocrine system of the gastrointestinal tract. Fiber supplementation, particularly psyllium, is both safe and effective in improving IBS symptoms globally. Dietary fiber also has other health benefits, such as lowering blood cholesterol levels, improving glycemic control and body weight management.

Understanding the Physics of Functional Fibers in the Gastrointestinal Tract: An Evidence-Based Approach to Resolving Enduring Misconceptions about Insoluble and Soluble Fiber

Enduring misconceptions about the physical effects of fiber in the gut have led to misunderstandings about the health benefits attributable to insoluble and soluble fiber. This review will focus on isolated functional fibers (eg, fiber supplements) whose effects on clinical outcomes have been readily assessed in well-controlled clinical studies. This review will also focus on three health benefits (cholesterol lowering, improved glycemic control, and normalizing stool form [constipation and diarrhea]) for which reproducible evidence of clinical efficacy has been published. In the small bowel, clinically meaningful health benefits (eg, cholesterol lowering and improved glycemic control) are highly correlated with the viscosity of soluble fibers: high viscosity fibers (eg, gel-forming fibers such as b-glucan, psyllium, and raw guar gum) exhibit a significant effect on cholesterol lowering and improved glycemic control, whereas nonviscous soluble fibers (eg, inulin, fructooligosaccharides, and wheat dextrin) and insoluble fibers (eg, wheat bran) do not provide these viscosity-dependent health benefits. In the large bowel, there are only two mechanisms that drive a laxative effect: large/coarse insoluble fiber particles (eg, wheat bran) mechanically irritate the gut mucosa stimulating water and mucous secretion, and the high water-holding capacity of gel-forming soluble fiber (eg, psyllium) resists dehydration. Both mechanisms require that the fiber resist fermentation and remain relatively intact throughout the large bowel (ie, the fiber must be present in stool), and both mechanisms lead to increased stool water content, resulting in bulky/soft/easy-to-pass stools. Soluble fermentable fibers (eg, inulin, fructooligosaccharide, and wheat dextrin) do not provide a laxative effect, and some fibers can be constipating (eg, wheat dextrin and fine/smooth insoluble wheat bran particles). When making recommendations for a fiber supplement, it is essential to recognize which fibers possess the physical characteristics required to provide a beneficial health effect, and which fiber supplements are supported by reproducible, rigorous evidence of one or more clinically meaningful health benefits.

Fermented Fiber Supplements Are No Better Than Placebo for a Laxative Effect

BACKGROUND

Misconceptions about the effects of dietary fiber and 'functional' fiber on stool parameters and constipation persist in the literature.

METHODS

A comprehensive literature review was conducted with the use of the Scopus and PubMed scientific databases to identify and objectively assess well-controlled clinical studies that evaluated the effects of fiber on stool parameters and constipation.

RESULTS

The totality of well-controlled randomized clinical studies show that, to exert a laxative effect, fiber must: (1) resist fermentation to remain intact throughout the large bowel and present in stool, and (2) significantly increase stool water content and stool output, resulting in soft/bulky/easy-to-pass stools. Poorly fermented insoluble fiber (e.g., wheat bran) remains as discreet particles which can mechanically irritate the gut mucosa, stimulating water & mucous secretion if the particles are sufficiently large/coarse. For soluble fibers, some have no effect on viscosity (e.g., inulin, wheat dextrin) while others form high viscosity gels (e.g., β-glucan, psyllium). If the soluble fiber is readily fermented, whether non-viscous or gel-forming, it has no effect on stool output or stool water content, and has no laxative effect. In contrast, a non-fermented, gel-forming soluble fiber (e.g., psyllium) retains its gelled nature and high water-holding capacity throughout the large bowel, resulting in soft/bulky/easy-to-pass stools.

CONCLUSION

When considering a recommendation for a fiber supplement regimen to treat and/or prevent constipation, it is important to consider which fibers have the physical characteristics to exert a laxative effect, and which fiber supplements have rigorous clinical evidence of a significant benefit in patients with constipation.

Resistant starch alters colonic contractility and expression of related genes in rats fed a Western diet

BACKGROUND AND AIM

Dietary fiber shortens gut transit time, but data on the effects of fiber components (including resistant starch, RS) on intestinal contractility are limited. We have examined RS effects in male Sprague-Dawley rats fed either a high-amylose maize starch (HAMS) or a wholemeal made from high-amylose wheat (HAW) on ileal and colonic contractility ex vivo and expression of genes associated with smooth muscle contractility.

METHODS

Rats were fed diets containing 19 % fat, 20 % protein, and either low-amylose maize starch (LAMS), HAMS, wholemeal low-amylose wheat (LAW) or HAW for 11 week. Isolated ileal and proximal colonic sections were induced to contract electrically, or by receptor-independent (KCl) or receptor-dependent agents. Colonic gene expression was assessed using an Affymetrix microarray.

RESULTS

Ileal contractility was unaffected by treatment. Maximal proximal colonic contractility induced electrically or by angiotensin II or carbachol was lower for rats fed HAMS and LAW relative to those fed LAMS (P < 0.05). The colonic expression of genes, including cholinergic receptors (Chrm2, Chrm3), serotonin receptors (Htr5a, Htr7), a protease-activated receptor (F2r), a prokineticin receptor (Prokr1), prokineticin (Prok1), and nitric oxide synthase 2 (Nos2), was altered by dietary HAMS relative to LAMS (P < 0.05). HAW did not significantly affect these genes or colonic contractility relative to effects of LAMS.

CONCLUSIONS

RS and other fiber components could influence colorectal health through modulation of stool transit time via effects on muscular contractility.

Evidence-Based Approach to Fiber Supplements and Clinically Meaningful Health Benefits, Part 2: What to Look for and How to Recommend an Effective Fiber Therapy

Dietary fiber that is intrinsic and intact in fiber-rich foods (eg, fruits, vegetables, legumes, whole grains) is widely recognized to have beneficial effects on health when consumed at recommended levels (25 g/d for adult women, 38 g/d for adult men). Most (90%) of the US population does not consume this level of dietary fiber, averaging only 15 g/d. In an attempt to bridge this “fiber gap,” many consumers are turning to fiber supplements, which are typically isolated from a single source. Fiber supplements cannot be presumed to provide the health benefits that are associated with dietary fiber from whole foods. Of the fiber supplements on the market today, only a minority possess the physical characteristics that underlie the mechanisms driving clinically meaningful health benefits. In this 2-part series, the first part (previous issue) described the 4 main characteristics of fiber supplements that drive clinical efficacy (solubility, degree/rate of fermentation, viscosity, and gel formation), the 4 clinically meaningful designations that identify which health benefits are associated with specific fibers, and the gel-dependent mechanisms in the small bowel that drive specific health benefits (eg, cholesterol lowering, improved glycemic control). The second part (current issue) of this 2-part series will focus on the effects of fiber supplements in the large bowel, including the 2 mechanisms by which fiber prevents/relieves constipation (insoluble mechanical irritant and soluble gel-dependent water-holding capacity), the gel-dependent mechanism for attenuating diarrhea and normalizing stool form in irritable bowel syndrome, and the combined large bowel/small bowel fiber effects for weight loss/maintenance. The second part will also discuss how processing for marketed products can attenuate efficacy, why fiber supplements can cause gastrointestinal symptoms, and how to avoid symptoms for better long-term compliance.

Effects of young barley leaf powder on gastrointestinal functions in rats and its efficacy-related physicochemical properties

Young barley leaf is consumed as a popular green-colored drink, which is named “Aojiru” in Japan. In the present study, we examined effects of young barley leaf powder (BL) on gastrointestinal transit time (GTT) and fecal moisture and weight in comparison with wheat bran (WB) in male Sprague-Dawley rats. In addition, an attempt was made to identify BL components responsible for these effects by using various fractions of BL. Additionally, we examined the water-holding capacity and setting volume of BL in vitro. We also examined the granular structures of BL with a scanning electron microscope. As a result, BL supplementation in the diet increased the fecal weight and shortened GTT. Our results demonstrate that the active component responsible for the effect on increasing the fecal volume in BL is the water-insoluble dietary fiber fraction and that this effect is thought to be caused by stimulation of the gut tract by the pH lowering. Furthermore, the high laxative action of BL was thought to be ascribable to the high water-holding capacity due to the complicated structures of BL.

Fiber and functional gastrointestinal disorders

Despite years of advising patients to alter their dietary and supplementary fiber intake, the evidence surrounding the use of fiber for functional bowel disease is limited. This paper outlines the organization of fiber types and highlights the importance of assessing the fermentation characteristics of each fiber type when choosing a suitable strategy for patients. Fiber undergoes partial or total fermentation in the distal small bowel and colon leading to the production of short-chain fatty acids and gas, thereby affecting gastrointestinal function and sensation. When fiber is recommended for functional bowel disease, use of a soluble supplement such as ispaghula/psyllium is best supported by the available evidence. Even when used judiciously, fiber can exacerbate abdominal distension, flatulence, constipation, and diarrhea.

Short term (14 days) consumption of insoluble wheat bran fibre-containing breakfast cereals improves subjective digestive feelings, general wellbeing and bowel function in a dose dependent manner

This study investigated whether increasing insoluble (predominantly wheat bran) fibre over 14 days improves subjective digestive feelings, general wellbeing and bowel function. A single centre, multi-site, open, within subjects design with a 14 day non-intervention (baseline) monitoring period followed by a 14 day fibre consumption (intervention) period was performed. 153 low fibre consumers (<15 g/day AOAC 985.29) completed a daily symptom diary for 14 days after which they consumed one bowl of ready-to-eat breakfast cereal containing at least 5.4 g fibre (3.5 g from wheat bran) for 14 days and completed a daily symptom diary. Significant improvements were demonstrated in subjective perception of bowel function (e.g., ease of defecation) and digestive feelings (bloating, constipation, feeling sluggish and digestive discomfort). Significant improvements were also found in subjective perception of general wellbeing (feeling less fat, more mentally alert, slim, happy and energetic whilst experiencing less stress, mental and physical tiredness, difficulty concentrating and fewer headaches). In general, improvements in study outcomes increased with increasing cereal/fibre consumption. However, consuming an additional minimum 5.4 g of fibre (3.5 g wheat bran) per day was shown to deliver measurable and significant benefits for digestive health, comfort and wellbeing. Encouraging consumption of relatively small amounts of wheat bran could also provide an effective method of increasing overall fibre consumption.

Viscous versus nonviscous soluble fiber supplements: mechanisms and evidence for fiber-specific health benefits

PURPOSE

This review focuses on the health benefits of viscous versus nonviscous soluble fibers, why symptoms can occur with increased fiber consumption, and how to avoid symptoms to improve adherence with a high-fiber diet.

DATA SOURCES

Review of scientific literature as well as evidence-based guidelines and resources.

CONCLUSIONS

While it is generally known that "fiber is good for you," it is less well known that specific health benefits are associated with specific fiber characteristics. Many of the health benefits of fiber can be directly correlated with the viscosity of soluble fibers when hydrated (i.e., gel-forming). A reduction in viscosity of a given fiber will attenuate these health benefits, and a nonviscous fiber does not exhibit these health benefits.

IMPLICATIONS FOR PRACTICE

Increasing the viscosity of chyme with a viscous soluble fiber has been shown clinically to lower cholesterol for cardiovascular health, improve glycemic control in type 2 diabetes, normalize stool form in both constipation (softens hard stool) and diarrhea (firms loose/liquid stool), and improve the objective clinical measures of metabolic syndrome (glycemic control, lipoprotein profile, body mass index/weight loss, and blood pressure).

Effects of adlay, buckwheat, and barley on transit time and the antioxidative system in obesity induced rats

In the present study, we examined whether four grains including adlay (AD), buckwheat (BW), glutinous barley (GB), and white rice (WR) affect the duration of food residence in the gastrointestinal tract and hepatic enzyme activities in rats fed different combinations of the grains. The rats were raised for 4 weeks on a high fat diet based on the American Institute of Nutrition-93 (AIN-93G) diets containing 1% cholesterol and 20% dietary lipids. Forty male rats were divided into four groups and raised for 4 weeks with a diet containing one of the grains. Corresponding to the dietary fiber contents of the experimental grains, gut transit time was shortest in the rats fed GB and increased in the order of BW, AD, and WR. In addition, the accumulated shortest transit time occurred in the GB group. Gut transit time affected weight gain and major organ weight, as it was closely related to the absorption of nutrients. The level of thiobarbituric acid reactive substance (TBARS) in liver was higher in rats fed WR, AD, BW, and GB, indicating that the other grains decreased oxidative stress in vivo more than WR. Glutathione, glutathione peroxidase, and glutathione S-transferase levels in the AD, BW, and GB groups were significantly higher than those in the WR group. In conclusion, reduced colonic transit time has been implicated in reducing the incidence of colon cancer, as evidenced by populations consuming diets rich in fiber. Whole grains such as AD, BW, and GB may contribute to a significant supply of antioxidants to prevent oxidative stress if they are consumed in large amounts.

Manipulating digestion with foods designed to change the physical characteristics of digesta

We explore how foods can be designed to modulate digestion and to promote health by changing the physical properties of digesta. The physical characteristics of digesta are discussed along with their impact on the physiology of digestion with special reference to sites where these characteristics are likely to influence digestive efficiency. Evidence is reviewed regarding the effects of supplementation with viscoactive agents on the flow and mixing of digesta in particular segments of the human gut that, by changing the rheology and liquid permeability of digesta in that segment, influence specific aspects of digestion and absorption.

Appropriate use of laxatives in the management of constipation

Chronic constipation is a frequent complaint in clinical practice. It is usually amenable to laxatives, which are available with and without prescription. An overemphasis on evidence-based analysis and aggressive marketing of newly developed laxative agents has tilted the recommendations toward more expensive, but not necessarily more effective, agents. This review addresses each of the four classes of laxatives and provides suggestions about their appropriate use in clinical practice.

Alginate as a source of dietary fiber

Alginate, an algal polysaccharide, is widely used in the food industry as a stabilizer, or as a thickening or emulsifying agent. As an indigestible polysaccharide, alginate may also be viewed as a source of dietary fiber. Previous work has suggested that dietary fibres may protect against the onset and continuation of a number of cardiovascular and gastrointestinal diseases. This article aims to examine what is currently understood about the fiber-like activities of alginate, particularly its effects on intestinal absorption and the colon, and therefore aims to gauge the potential use of alginate as a dietary supplement for the maintenance of normal health, or the alleviation of certain cardiovascular or gastrointestinal diseases.

Small intestinal mucins are secreted in proportion to the settling volume in water of dietary indigestible components in rats

The aim of this study was to clarify the effect of dietary indigestible components on small intestinal mucin secretion. We prepared polystyrene foam (PSF) with different expansion ratios (PSF-30, -60 and -90) in which powders had different settling volumes in water (SV). Rats were fed a purified diet containing 0, 10, 30, or 90 g of PSF-60/kg for 10 d. After 8 h of food deprivation, rats were refed 3 g of their respective diets within 90 min. Small intestinal mucin fractions were prepared, and periodic acid/Schiff-reactive substances and O-linked oligosaccharide chains were determined as mucin markers. Feeding of PSF-60 increased the small intestinal mucin secretion dose dependently (control vs. 30 or 60 g of PSF-60/kg, P < 0.05). When rats were fed either purified diet or diets containing PSF-30, 60, or 90 at 10 g/kg for 7 d, small intestinal mucins were greatly affected by the SV of the respective PSF tested. Rats fed the diet containing PSF-90 with the highest SV had the highest amount of mucins (vs. control, P < 0.05). In some natural dietary fibers, the small intestinal mucins and SV were correlated (r = 0.967, P = 0.002). Finally, rats were fed a purified diet or that diet containing 50 g of PSF-60/kg for 7 d. Then, each dietary group was further divided into 2 groups. After 8 h of food deprivation, rats were refed 3 g of purified or PSF diet. Greater mucins in the small intestine were manifest only in rats previously fed the PSF diet whether they were refed purified or PSF diet (control vs. PSF, P < 0.05). These results suggest that the small intestinal mucins are secreted in proportion to the SV of dietary indigestible components, and chronic ingestion of indigestible components is required for the appearance of enhanced mucin secretion.

The effect of a polymeric enteral formula supplemented with a mixture of six fibres on normal human bowel function and colonic motility

BACKGROUND AND AIMS

Fibres with varying fermentability may improve bowel function during enteral feeding. Two studies in healthy volunteers aimed to 1) investigate effects of Nutrison Multi Fibre (NMF) on gastrointestinal function, and 2) compare effects of NMF administered orally and nasogastrically on distal colonic motor activity.

METHODS

(1) Ten subjects were randomly assigned to 3x7 days self-selected diet (SSD), 2 litres Nutrison Standard (NS), or 2 l NMF. Objective and subjective indices were measured. (2) Two groups (n=6) received 2x250 ml boluses of NMF 2 hourly either nasogastrically or orally. Distal colonic motility was measured for 8 h (3 pre/5 post) first bolus.

RESULTS

Whole gut transit time was prolonged during NS (P<0.05) compared with SSD or NMF. Stool wet weight was higher during SSD (P<0.05) than during NS or NMF. Bowel frequencies were comparable. NMF was well tolerated. 2. Colonic activity index was maintained after oral administration with no associated diarrhoea. Activity index decreased after nasogastric bolus (P<0.05), but recovered to higher than fasting levels (P<0.05). 5 subjects had watery stools.

CONCLUSIONS

Oral NMF is well tolerated, normalises whole gut transit time and maintains colonic motility. Recovery of colonic activity after nasogastric bolus suggests a putative protective effect of NMF over a longer period of feeding.

Effects of wheat bran and Olestra on objective measures of stool and subjective reports of GI symptoms

OBJECTIVE

The aim of this study was to compare the effects of two nondigested, nonabsorbed dietary components on objective and subjective measures of gastrointestinal (GI) function.

METHODS

A placebo-controlled parallel study compared the effects of wheat bran (20 g/day or 40 g/day in cereal), a well-known dietary fiber, with those of olestra (20 g or 40 g/day in potato chips), a nonabsorbed fat, on stool output, stool apparent viscosity (log peak force for extrusion [PF]), stool water content, and GI symptoms. Sixty subjects resided on a metabolic ward for 9 days: 3 days baseline and 6 days treatment.

RESULTS

Compared with placebo, consumption of 20 g/day wheat bran for 6 days resulted in a rapid (within 38 h) increase in mean (+/-SE) stool output (placebo, 150 +/- 29 g/day; bran, 246 +/- 35 g/day, p < 0.05), a directional increase in mean stool water content (placebo, 81.2 +/- 0.8%; bran, 83.9 +/- 0.8%), stool water output (placebo, 159 +/- 54 g/day; bran, 238 +/- 30 g/day), and bowel movement frequency (BM/day) (placebo, 2.2 +/- 0.4; bran, 2.6 +/- 0.4), and no stool-softening effect (placebo log PF, 2.9 +/- 0.1 g; bran log PF, 2.9 +/- 0.1 g). Wheat bran 40 g/day results were not significantly different from wheat bran 20 g/day. Compared with placebo, consumption of olestra 20 g/day and 40 g/day for 6 days showed no significant difference in mean stool output (151 +/- 18 g/day and 204 +/- 28 g/day, respectively), mean BM frequency (1.8 +/- 0.2 BM/day and 2.1 +/- 0.3 BM/day, respectively), and stool water output (138 +/- 13 g/day and 184 +/- 31 g/day, respectively), a significant (p < 0.05) decrease in stool water content (75.5 +/- 1.7% and 72.6 +/- 2.2%, respectively), and either no effect on stool apparent viscosity (olestra 20 g/day, mean log PF, 3.0 +/- 0.1 g) or a gradual stool-softening effect beginning study day 6 (olestra 40 g/day, log PF, 2.7 +/- 0.1 g). None of the treatment groups showed a significant increase in GI symptoms compared with placebo.

CONCLUSIONS

Consumption of wheat bran in excess of levels in a typical Western diet significantly increased stool output, but did not soften normal-viscosity stool nor result in an increase in common GI symptoms. The observed plateau effect for wheat bran at 40 g/day suggests a maximal mechanical stimulatory effect. Consumption of olestra in excess of usual snacking conditions did not result in a significant increase in stool output or common GI symptoms. At the highest level tested, olestra resulted in a gradual stool-softening effect after several days of consumption.