Clinical use of high-fiber diets.
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Biomedical subjects
Publications and source records attributed to M H Floch.
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The gastrointestinal tract contains a unique microecology. Microorganisms living in the mouth, stomach, and most importantly in the small and large intestines produce enzymes which help metabolize certain ingested foods, as well as maintain important body homeostatic mechanisms such as the bile salt enterohepatic circulation. Recent awareness of the importance of poorly digested foods such as cellulose, hemicellulose, pectins, and lignins, as well as selectively absorbed long-chain polysaccharides, has stressed the importance of the relationship of food to the microflora. This intestinal microecology has definite effects on the human host in cholesterol metabolism, glucose tolerance, and may explain such diseases as carcinoma. The exacting details of the intestinal microecology need further elaboration.
Selective aerobic and anaerobic plate media were employed to isolate the predominant faecal flora of patients with cancer of the colon (CC), cancer with non-gastrointestinal involvement (NGI), and with non-malignant diseases (N). The CC and N groups did not differ significantly in either total aerobic or anaerobic counts. The CC group did have a significantly lower anaerobic/aerobic ratio compared with the N group (2.42 vs. 2.96, P less than 0.05). This was the result of a greater predominance of aerobic bacteria and a decrease in anaerobic cocci, Eubacterium and Fusobacterium in the CC group. Previous studies report that aerobic organisms have a greater ability to produce amines than non-spore forming anaerobes. If the intestinal flora can produce carcinogenic nitrosamines in vivo from amines and nitrites, the aerobic bacterium in the faeces may be of importance in supplying the amine substrate for nitrosation. The comparison of the NGI group with the N group showed a significant variation in the total anaerobic count (11.02 vs. 11.41, P less than 0.05) and in the composition of the faecal flora. This indicates that discretion must be used in analysing the data obtained from cancer patients, as the presence of a carcinoma may be responsible for changes in bacterial flora.
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Six healthy subjects, four males and two females, were studied for 8 weeks with daily dietary history, 72-hr weekly stool collections, and analysis of stool specimens for fecal weight, water, pH, and total aerobic and anaerobic qualitative and quantitative bacteria. Subjects were studied first for a 3-week control period, followed by 3 weeks of 5.4 g of crude fiber supplementation daily (Kellogg's "All Bran"), and then by a 2-week control period. Analysis of diets revealed that the mean intake of crude fiber rose to at least 10 g/day, and stool volume increased significantly during the high-fiber intake. The stools remained at the same pH, and the same percentages of water and solids were present durin- control and high-fiber-intake periods. Bacteriological analysis revealed no significant differences in qualitative or quantitative counts; however, the ratio of anaerobic to aerobic organisms appeared to increase.
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Recent theories have postulated that low fiber diets are related to colon cancer and diverticulosis, and to atherosclerosis. These theories are based on British and African diet history information. There has been no recent assessment of fiber intake in an area of high incidence of colonic disease in the United States. Using recall diet histories in subjects with no disease and with colon disease, and correcting our data to account for any loss in recall history, we find a low daily fiber intake in all 21 subjects evaluated, mean 3.5 g, range 1.6 to 11 g. There was no statistical difference in intake among patients with or without colon disease. The data agree with the British findings. Since the incidence of the diseases in question is not uniform in the United States it is suggested that diet surveys are needed in areas where colon carcinoma is of low incidence.
Six subjects were studied for an 8-week period that consisted of a 3-week control period, followed by a 3-week period during which their daily diets were supplemented with 3 oz of a high fiber breakfast food, All-bran, and a final 2 weeks on their regular diet. Daily diet records of food intake were recorded and analyzed for seven dietary constituents; carbohydrates, proteins, fats, cholesterol, fiber, alcohol, and total calories. The most significant change in eating behavior due to the fiber food supplementation was a decrease in eating eggs, butter, and breakfast meats. These foods were most often replaced because all six subjects chose to eat the major portion of All-bran during breakfast. An increase in milk and fruit also occurred during the supplemented feeding. These particular foods were added to make All-bran more palatable and served to increase carbohydrate and protein intake. Five subjects added the supplement to the between meal-time intake and thus caused an increase in total daily caloric intake. At lunch and dinner few foods were altered with no particular pattern of substitution. Notwithstanding the knowledge that increased fiber content may have beneficial effects, none of the subjects modified his eating behavior to include even 1 oz of a high fiber food daily after the experimental period was concluded. Thus behavior modification by forced diet intake of a high fiber breakfast food resulted in definite diet pattern changes that did not persist following the experimental period.
Fecal weight and water content and fecal quantitative and qualitative bacterial studies were compared on six volunteer subjects during regular diet periods and when on 5.4 g of diet fiber supplementation. There was a statistical mean stool weight increase for the group from 103 +/- 40 g to 226 +/- 90 g. The water content of the stool remained constant under the diet conditions of this study. The total anaerobic counts increased significantly while the subjects were on the high fiber diet. Trends in bacterial genus changes appeared but were not significant and total aerobic counts were stable.
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