Tuesday, November 6, 2012

Confusion in the Marketplace over the Role of Fiber

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Some people are so confused that they do not know what to believe
anymore. For example, two recent studies about fiber received sen­
sational coverage by the media after appearing in the April 20, 2000, New England Journal of Medicine}  Newspapers  proclaimed  the  bold
headlines  HIGH-FIBER  DIET  DOES  NOT  PROTECT AGAINST COLON  CANCER. 
NO wonder our population is so confused by conflicting messages about nutrition. Some people have actually given up trying to eat health­ fully because one day they hear one claim and the next week they hear the opposite. There's a lesson to be learned here: Don't get your health advice from the media.
I am bringing up this issue so you realize not to jump to conclu­ sions on the basis of one study or one news report. You can see how research information is often (mis)reported in the news. I have re­
viewed more than two thousand nutritional research papers in prep­ aration for this book and many more in prior years, and there is not much conflicting evidence. As in a trial, the evidence has become overwhelming and irrefutable — high-fiber foods offer significant pro­ tection against both cancer (including colon cancer) and heart disease. I didn't say fiber. I said high-fiber foods. We can't just add a high-fiber candy bar or sprinkle a little Metamucil on our doughnut and French fries and expect to reap the benefits of eating high-fiber foods, yet this is practically what the first study did. The studies mentioned above did not show that a diet high in fresh fruits, vegetables, beans, whole grains, and raw nuts and seeds does not protect against colon cancer. It has already been adequately dem­ onstrated in hundreds of observational studies that such a diet does of­
fer such protection from cancer at multiple sites, including the colon. The first study merely added a fiber supplement to the diet. I
wouldn't expect adding a 13.5-gram fiber supplement to the disease-causing American diet to do anything. It is surprising that this study was actually conducted. Obviously, adding supplemental fiber does not capture the essence of a diet rich in these protective plant foods. The second study compared controls against a group of people who were counseled on improving their diet. The participants con­ tinued to follow their usual (disease-causing) diet and made only a moderate dietary change — a slight reduction in fat intake, with a modest increase in fruits and vegetables for four years. The number of colorectal a d e n o m a s four years later was similar. Colorectal ade­ nomas are not colon  cancer; they are benign polyps.  Only a very small percentage of these polyps ever advance to become colon can­ cer,  and  the  clinical significance of small benign  adenomas  is not clear. In any case, it is a huge leap to claim that a diet high in fruits and vegetables does not protect against cancer. This study did not even attempt to address colon cancer, just benign polyps that rarely progress to cancer. In both studies, even t h e groups supposedly consuming a high-fiber intake were on a low-fiber diet by my standards. The group consuming the most fiber only ate 25 grams of fiber a day. The high-fiber intake  is  merely a  marker of many anti-cancer properties of natural foods, especially phytochemicals. The diet plan I recommend is not based on any one study, but on m o r e t h a n two t h o u s a n d stud­ ies and the results I've seen with thousands of my own patients. Fol­ lowing this plan, you will consume between 50 and 100 grams of fiber   (from real food, not supplements) per day.
In an editorial, published in the same issueoftheNewEnglandJournalof Medicine, Tim Byers, M.D., M.P.H., basically agreed, stating, "Observational studies around the world continue to find that  the risk of colorectal cancer is lower among populations with high in­ takes of fruits and vegetables and that the risk changes on adoption of a different d i e t . " 5 7 He further explained that the three- or four-year period assessed by these trials is too brief and cannot assess the effects of long-term dietary patterns that have already been shown to protect against colorectal cancer. The reality is that healthy, nutritious foods are also very rich in liber and that those foods associated with disease risk are generally fiber-deficient. Meat and dairy products do not contain any fiber, and foods made from refined grains (such as white bread, white rice, and pasta) have had their fiber removed. Clearly, we must substantially reduce our consumption of these fiber-deficient foods if we expect to lose weight and live a long, healthy life. Fiber intake from food is a good marker of disease risk. The amount of fiber consumed may better predict weight gain, insulin levels, and other cardiovascular risk factors than does the amount of total fat consumed, according to recent studies reported in the October 27, 1999, issue of the Journal of the American Medical Association}s Again,
data show that removing the fiber from food is extremely dangerous. People who consume the most high-fiber foods are the healthi­
est, as determined by better waist measurements, lower insulin lev­
els, and other markers of disease risk. Indeed, this is one of the key
themes of this book — lor anyone to consider his or her diet healthy, it must be predominantly composed of high-fiber, natural foods. It  is not  the  fiber  extracted  from  the plant package  that  has miraculous health properties. It is the entire plant package consid­ ered as a whole, containing nature's anti-cancer nutrients as well as being rich in fiber.
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