April 2012 Issue
Fill in the Fiber Gaps — Dietitians Offer Practical Strategies to Get Clients to Meet the Daily Requirements
By Sharon Palmer, RD
Vol. 14 No. 4 P. 40
You know how important fiber is to your clients’ health. It can help them maintain proper digestion and elimination, lower blood cholesterol levels, stabilize blood glucose, and even lose weight. Yet only 5% of Americans are meeting the daily recommendations.
In this article, Today’s Dietitian will give you the tools to help your clients fill in their fiber gaps.
Americans Just Don’t Get Enough
It’s a simple fact that people aren’t eating enough whole grains, legumes, fruits, or vegetables—the main sources of dietary fiber. So it shouldn’t be surprising that the average intake of dietary fiber is pitifully low—only 15 g per day on average. In fact, dietary fiber is listed as a “nutrient of concern” in the 2010 Dietary Guidelines for Americans—along with potassium, calcium, and vitamin D—because intake is low enough to be a public health concern. The Adequate Intake for fiber is 14 g/1,000 kcal—25 g per day for women and 38 g per day for men, according to the 2010 Dietary Guidelines.
“Today’s rapid pace and lifestyle hinders people from getting enough fiber. They eat quick pantry food items when they’re hungry, such as chips and crackers, instead of carrots,” says Jessica Crandall, RD, CDE, a national spokesperson for the Academy of Nutrition and Dietetics (the Academy) and a dietitian at Sodexo Wellness and Nutrition.
“People don’t pick high-fiber foods. The highest sources of fiber are first whole grains; second, legumes; third, vegetables; and fourth, fruits. People may think, ‘I ate an apple or some lettuce, so I got my fiber.’ But that doesn’t get the job done,” explains Joanne Slavin, PhD, RD, a professor in the department of food science and nutrition at the University of Minnesota who served on the Dietary Guidelines Advisory Committee.
Fiber, a nondigestible form of carbohydrates that occurs naturally in plant foods, may protect health in many important ways. The 2010 Dietary Guidelines highlight the significance of meeting dietary fiber goals because the scientific evidence shows health protective benefits include promoting a feeling of fullness and healthful laxation. In addition, dietary fiber that occurs naturally in foods also may help to reduce the risk of cardiovascular disease, obesity, and type 2 diabetes, according to the 2010 Dietary Guidelines.
Yet the public doesn’t fully comprehend all they have to gain by boosting their fiber intake. “The biggest impact fiber can have on people’s health is preventing constipation and promoting gut health. This is important for kids; I frequently hear people say that their children have constipation. Digestion and absorption are really important, and it’s much easier to prevent constipation than it is to treat it,” Slavin says.
It’s important to remind people that fiber benefits extend beyond healthful digestion. “Most people think of fiber as helping to promote digestion and bowel regularity. People aren’t getting enough information on other fiber benefits, such as satiety and obesity prevention, as well as keeping cholesterol levels in check and stabilizing blood sugar. These three areas are undereducated and underemphasized,” Crandall says.
Considering the health fallout of the obesity epidemic, it’s important to stress fiber’s role in satiety and weight loss. “The data on fiber and obesity is pretty good; people who eat more high-fiber foods tend to weigh less,” Slavin says.
All Types of Fibers Count
There are many kinds of fiber associated with health benefits. Soluble fiber, which is linked to lowering cholesterol levels, is found in foods such as legumes, oats, barley, nuts, and some fruits and vegetables. Insoluble fiber, found in whole grains, wheat bran, nuts, seeds, and some fruits and vegetables, acts like a sponge, passing through the intestines mostly unchanged, thus helping promote good bowel motility. Nondigestible oligosaccharides found in some fruits, vegetables, seeds, and grains resist digestion and act as a prebiotic to promote gut health. Resistant starches, found in unripe bananas and potatoes, also may help increase energy expenditure and lower glucose levels. Inulin, which is often added to foods as a functional ingredient, isn’t digested in the upper gastrointestinal tract and stimulates the growth of friendly gut bacteria.
So which fibers should you promote to your patients? “Having fibers from a variety of sources is ideal,” Slavin stresses. That’s where the beauty of a diet rich in a variety of plant foods comes in.
The health advantages of consuming food products filled with added isolated fibers, such as inulin or bran, are under debate. The National Institutes of Health reported in August 2010 that the health benefits of added isolated fibers are still unclear. Research suggests they may not have the same effects as the intact fibers found in whole foods. There's little evidence that isolated fibers help lower blood cholesterol, and they have differing effects on regularity, though studies suggest that inulin might boost the growth of good bacteria in the colon.
“There are more benefits with foods that have naturally occurring sources of fiber vs. foods with fibers added to them. I’m not recommending that people should get most of their fiber from fiber-enriched foods,” Crandall says. “I always encourage my patients to eat clean and natural, but that can be a challenge to do. My motto is that you need to meet people where they are at; ideally they should eat fresh fruit, vegetables, whole grains, and legumes, but in the modern situation, they’re struggling to meet the guidelines for appropriate foods. Fiber-fortified foods can be helpful for some people. I’d rather them meet the fiber guidelines with the help of fiber-fortified foods than fail.”
“We need to be flexible with our recommendations on fiber,” Slavin adds. “So many people fall short on fiber. Ideally, I want people to get fiber from food, but I want people to get fiber, even if it’s the type added to food products.”
Helping Patients Meet Their Fiber Potential
To assist patients in getting the fiber they need, we asked our experts to offer their best strategies to help fill the fiber gap. Here are their top eight:
1. Break down the barriers. “Beans make me gassy; fiber makes me bloated.” Such are the common objections you’ll encounter among people when you’re trying to boost their fiber intake. Crandall says, “People may be hesitant to increase fiber because of [these] concerns, so you need to break down the education to help people take the next step.” It may be important to discuss the basics on how fiber works in the digestive tract in order to get through to your patients.
2. Cut through the confusion. Fiber can be a puzzling concept. RDs tell clients to eat more plant foods to increase fiber, but when it comes to fiber, all plant foods aren’t created equal. Clients may think they’re doing fine in the fiber department, but if they’re not choosing high-fiber plant foods such as whole grains and legumes, they could be getting minimal intake. “People are confused,” Crandall says. “They think that a salad every night gives them a lot of fiber, but it may only provide 2 or 3 g, and they need to get more.” Telling clients specifically which whole grains and legumes to eat will help clear up any confusion.
3. Don’t underestimate challenges. As dietitians, it’s easy to say that meeting fiber goals is a breeze. But when was the last time we as RDs took our own 24-hour food recall and analyzed it for fiber intake? Getting 25 g to 38 g of fiber a day can be tough for anyone. Dietary restrictions, such as weight loss diets with lower carbohydrate recommendations, can make getting enough fiber even more difficult. “Meeting fiber needs isn’t as simple as we think it is. We need to help people by offering them lots of solutions,” says Slavin, who suggests that fiber-enriched foods may be one way to add needed grams to their diet.
4. Demystify whole grains. Whole grains are one of the best sources of fiber, but “the whole grain message is confusing,” Slavin says. “There are many new whole grain food products that are really low in fiber. Foods such as cookies and breakfast cereals may say they have whole grains in them, but they can be low in fiber.” So educate your patients on methods for identifying whole grains, such as looking for the Whole Grains Council’s Whole Grain Stamp on food labels that indicates they’re a good source of whole grains.
5. Make it practical. Move beyond a lecture on how good fiber is for the body. Tell patients how they can incorporate fiber into their diets. “People need practical tips on how to eat more high-fiber foods, such as pulling out a vegetable tray from the refrigerator, how to look for whole grains, examples of using beans on salads, and which fruits, such as berries, are high in fiber,” Crandall says.
6. Keep it simple. As much as RDs want clients to eat a minimally processed, whole-foods diet that’s naturally rich in fiber, it’s just not going to happen for many of them. It’s an RD’s job to meet clients where they are and give them simple methods that will work, whether it’s finding the perfect breakfast cereal the whole family will like or suggesting portable high-fiber snacks such as snap peas or bananas, Crandall says.
7. Be specific. Instead of general recommendations, Crandall suggests RDs give patients specific suggestions—down to the actual brand of foods or type of whole grain or fruit—they should eat every day. “For example, tell them to have oatmeal for breakfast, add bell peppers and mushrooms to scrambled eggs, or have berries with yogurt,” Crandall says.
8. Suggest fiber extras. Offer tips for regularly increasing fiber every day through the addition of “extras,” such as 1 oz of flaxseed sprinkled on foods for an extra 8 g of fiber or a high-fiber granola bar providing 5 g of fiber as a routine snack.
Pushing Fiber, One Meal at a Time
Another practical way to encourage clients to eat more fiber is to break down their fiber goals one meal or snack at a time. “Micromanage your patients’ fiber intake; help them plan how they’ll get sources through the day,” Crandall suggests. “Break it up into 7 to 10 g of fiber per meal. Focus on fiber-rich foods at breakfast, lunch, and dinner.”
These daily menu tips will help boost your clients’ fiber intake one meal at a time:
High-Fiber Breakfast Foods
• Whole grain hot cereals, such as oats (2 g fiber per 1/2 cup)
• Whole grain and/or high-fiber cold cereal, such as Kellogg’s All Bran (10 g fiber per 1/2 cup), Fiber One (14 g fiber per 1/2 cup), and Kashi Go Lean Crunch cereal (6 g fiber per 3/4 cup)
• Whole grain breads, such as Oroweat Double Fiber (5 g fiber per slice) and Nature’s Own Double Fiber (5 g fiber per slice)
• Whole grain and/or high-fiber bagels, English muffins, waffles, and pancakes, such as Kellogg’s Eggo FiberPlus Calcium Waffles (4.5 g fiber per waffle) and Oroweat Double Fiber English Muffins (8 g fiber per muffin)
• High-fiber fruits, such as raspberries (4 g fiber per 1/2 cup), blueberries (4 g fiber per 1/2 cup), and strawberries (3 g fiber per 1 cup)
• Whole grain and/or high-fiber muffins, such as bran muffins (3 g fiber per small muffin)
• Sprinkle nuts and seeds over cereals, such as almonds (4 g fiber per 1 oz) and flaxseed (8 g fiber per 1 oz)
• High-fiber yogurts, such as Dannon Light n’ Fit with Fiber (3 g fiber per 4 oz) and Fiber One (5 g fiber per 4 oz)
High-Fiber Lunch Foods
• Sandwiches made with whole grain and/or high-fiber breads, such as Sara Lee Delightful 100% Whole Wheat With Honey (2.5 g fiber per slice)
• Sliced tomatoes on sandwiches or salads (2 g fiber per small tomato)
• Fresh vegetables, such as baby carrots (2 g fiber per 3 oz serving) and snow peas (3 g fiber per 1 cup)
• High-fiber bean, lentil, or vegetable soup, such as Progresso High Fiber Homestyle Minestrone (7 g fiber per 1 cup)
• Cooked beans or lentils added to soups, wraps, or salads, such as kidney beans (7 g fiber per 1/2 cup)
• Fresh fruit, such as bananas (3 g fiber per small banana) or apples (4 g fiber per small apple)
• Nut butter on bread or crackers, such as peanut butter (2 g fiber per 2 T)
High-Fiber Dinner Foods
• Whole grain side dishes, such as whole-wheat spaghetti noodles (3 g fiber per 1/2 cup), bulgur (4 g fiber per 1/2 cup), and quinoa (3 g fiber per 1/2 cup)
• Beans and lentils in soups, side dishes, stews, and entrées, such as white beans (6 g fiber per 1/2 cup), lentils (8 g fiber per 1/2 cup), and chickpeas (6 g fiber per 1/2 cup)
• Fresh or cooked vegetables, such as artichokes (7 g fiber per 1/2 cup), mixed vegetables (4 g fiber per 1/2 cup), and broccoli (3 g fiber per 1/2 cup)
• Baked potatoes with skin (5 g fiber per medium potato)
• Whole grain and/or high-fiber rolls and crackers, such as Wasa Fiber Crispbread (6 g fiber per 3 slices)
High-Fiber Snack Foods
• Fresh fruit, such as pears (5 g fiber per small pear) and oranges (4 g fiber per large orange) as a single snack or added to cottage cheese or yogurt
• Dried fruit, such as dates (7 g fiber per 1/2 cup) and figs (4 g fiber per 2 dried figs)
• Fresh veggies, such as edamame (3 g fiber per 1/2 cup), bell peppers (3 g fiber per 1 cup), and celery (2 g fiber per 4 oz serving)
• Nuts and seeds, such as walnuts (2 g fiber per 1 oz) and sunflower seeds (2 g fiber per 1 oz)
• Whole grain and/or high-fiber granola or nutrition bars, such as Fiber One Oats & Peanut Butter Bar (9 g fiber per bar) and Kellogg’s FiberPlus Antioxidants Dark Chocolate Almond Bar (9 g fiber per bar)
• Whole grain and/or high-fiber crackers, such as RyKrisp (6 g fiber per 4 crackers)
Your patients have much to gain by achieving their fiber goals. To meet their fiber challenge head on, equip them with the skills they need to boost their intake, starting with basic education on digestion and moving up to identifying fiber sources in food products.
— Sharon Palmer, RD, is a contributing editor at Today’s Dietitian, a freelance food and nutrition writer in southern California, and author of the forthcoming book The Plant-Powered Diet.
A Place for Fiber Supplements
Consider suggesting fiber supplements to clients to help them meet their daily fiber goals as well as to control bowel irregularity, reduce appetite, and lower blood sugar and cholesterol levels. “Fiber supplements have their place for helping certain people meet their requirements. Some patients may find vegetables unpalatable because of texture aversions, or you may encounter bariatric or diabetic patients with limited carbohydrate intake who may have a difficult time meeting their fiber goals,” says Jessica Crandall, RD, CDE, who provided information for the following table.
Fiber supplements, available in powder, tablet, capsule, or water, contain differing amounts of soluble fiber per dose. The general recommendation is a maximum of 10 g of fiber per day from a fiber supplement, Crandall says. Dosages should be evenly dispersed throughout the day, with no more than 3 to 5 g taken per serving. Patients should start fiber supplements in small doses at first, with plenty of water, and work their way up to the recommended dose.
Type of Fiber
• Plant fiber
• Bulks stool
Metamucil, Fiberall, Hydrocil, Konsyl, Perdiem, Serutan
• Created from plants
• Creates a softer stool
• Synthetic ingredients
• Creates a bulkier and softer stool
Fibercon, Fiber-Lax, Equalactin, Mitrolan
Partially hydrolyzed guar gum
• Seed of the cluster bean
• Increases production of beneficial bacteria in the gut
• Benefiber (chewables with calcium)
• By-product of gluten being extracted from wheat
• Reduces cholesterol, improves immune system function, and improves vitamin and mineral absorption
• Benefiber (powder and caplets)
• From the gum of the acacia tree
• Slows down colonic fermentation, which decreases gas and bloating
Heather’s Tummy Fiber
Double-Grain Bean Soup
1 cup small red beans
3 T olive oil, divided
1/4 lb pancetta, diced
1 large onion, chopped
2 garlic cloves, minced
1 large celery stalk, chopped
2 medium carrots, chopped
1/4 cup pearl barley
1 cup triticale berries
1 T finely chopped fresh sage leaves
6 cups reduced sodium chicken stock, divided
Kosher salt (optional) and freshly ground black pepper
1 T chopped fresh flat-leaf parsley
1. Cover the beans with three inches of cold water in a heavy saucepan; bring to a boil, then immediately remove from heat. Cover and let sit 1 hour, then drain and rinse the beans.
2. Heat 1 T of the olive oil in a large, heavy saucepan or Dutch oven over medium-low heat. Add the pancetta. Cook until crisp, about 5 minutes. Stir in the onion and cook until softened, 5 to 10 minutes. Add the garlic and cook a few more minutes, stirring frequently to prevent browning.
3. Add another tablespoon of the olive oil, then stir in the celery and carrots and cook 5 minutes. Add the remaining tablespoon of olive oil and stir in the beans, barley, triticale, and sage. Stir well to combine and thoroughly coat the grains with the oil. Add 2 cups water and 4 cups stock, bring to a boil, then reduce heat and simmer, partially covered, until the beans and grains are tender, 1 to 11/2 hours.
4. Transfer 1 cup of the soup to a food processor, let cool slightly, then purée until smooth. Stir the purée back into the soup, add the remaining 2 cups stock, and bring to a simmer. Season to taste with salt and pepper. Serve sprinkled with parsley.
Nutrition Analysis per serving: Calories: 264; Total fat: 7 g; Sat fat: 0 g; Cholesterol: 7 mg; Sodium: 195 mg; Total carbohydrates: 41 g; Fiber: 9 g; Protein: 12 g
Recipe courtesy of Miriam Backes and Bob's Red Mill from the Whole Grains Council
Southwestern Black Bean, Quinoa, and Mango Salad
Makes six 1-cup servings
1 15-oz can black beans, no salt added, rinsed, drained (1 3/4 cups)
1 cup cooked quinoa (according to package directions)
1 cup frozen corn
1 small red bell pepper, chopped
1 cup chopped fresh mango
1/4 cup chopped red onion
1/2 cup fresh cilantro, chopped (or 2 tsp dried)
1 small fresh jalapeño pepper, seeded, finely diced
1 lemon, juiced
1 1/2 T extra virgin olive oil
2 garlic cloves, minced
1/2 tsp cumin
1/2 tsp chili powder
1/4 tsp turmeric
1. Mix beans, quinoa, corn, bell pepper, mango, onion, cilantro, and jalapeño together in a mixing bowl.
2. Whisk lemon juice, olive oil, garlic, cumin, chili powder, and turmeric in a small bowl. Toss into the salad mixture and chill salad until serving time.
Nutrient Analysis per serving: Calories: 164; Total fat: 4 g; Sat Fat: 1 g; Sodium: 93 mg; Total carbohydrates: 27 g; Fiber: 7 g; Protein: 6 g
Recipe courtesy of The Plant-Powered Diet by Sharon Palmer, RD