Build up your Fibre intake

What is dietary fibre?

Dietary fibre is used to describe the majority of the carbohydrates that enter the colon, such as non-starch polysaccharides, resistant starch and indigested oligosaccharides. This fraction of carbohydrates cannot be digested in the small intestine and is fermented by bacteria of the colon, producing short-chain fatty acids (SCFA, acetate, propionate and butyrate) and gases (carbon dioxide, hydrogen and methane).

Tips to increase fibre intake ?

  1. Increase your bean intake. All beans are good sources of fibre, whether baked beans, beans like kidney beans in chilli or beans in salads. Half a tin of black beans (200g –> 120g drained weight) is about 8 g of fibre. As well as beans, chickpeas and lentils are rich in fibre, high sources of protein and low fat.walnuts
  2. Wholegrain and wholemeal. Skip white bread and pasta, look out for wholegrain and wholemeal on the labels. Brown or wholegrain rice? Choose wholegrain rice over white rice, white rice doesn’t offer as much fibre.
  3. Nuts: Choose almonds, pecans, and walnuts as they have more fibre than other nuts.SA1TMVCPF8
  4. Fruit and vegetables:Consume at least your 5-a-day portions and the crunchier, the better. A medium-sized apple alone is 2g fibre. If fresh fruit isn’t available, dried fruit can offer a good alternative to boost your fibre intake but beware of the sugar content. A 50g portion of dried figs is 4g fibreYVDRQAGWOP.

5.Choose bran based cereals. As a rule of thumb, a high-fibre food will contain more than 6g of fibre per 100g. A 30g bowl of Bran Flakes delivers 4g of fibre. As an alternative try porridge, which is made from oats and is a great source of fibre.

How much fibre should we consume?

The Recommended Daily Intake for fibre in the United Kingdom until recently was 18 g/day and in Australia it is even higher, recommending daily consumption of 25-30 g. Following Australia this recommendation was raised in July 2015 to 30g/day (SACN report on Carbohydrates and Health).  In the UK most people are not consuming enough, with the average intakes being 12.8 g/day for women (19-64 years) and 14.7 g/day for men (19-64 years) (6). A number of studies have shown that an increase in the intake of dietary fibre has been associated with the treatment and prevention of a number of multifactorial diseases, such as colon cancer, obesity and diabetes and coronary heart diseases.

The role in promoting health:

In order to fully understand the role of fibre in the promotion of health it is useful to outline the effects SCFA and gases have in the body.

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Table 1: The products of fermentation in the colon and their effect on the body.
  1. Colonic Health

As fibre enters the colon water flows in by osmosis, which increases faecal bulk and makes it softer. This results to the laxative effect, which is associated with a decrease in the transit time, increase in faecal bulk and an increase in the frequency of defecation (1) (See Graphs 1,2).

Graphs 1 (left), 2 (right): The inversely proportional relationship between stool weight and colon cancer incidents and the proportional of non-starch polysaccharides and stool weight (7).
Graphs 1 (left), 2 (right): The inversely proportional relationship between stool weight and colon cancer incidents and the proportional of non-starch polysaccharides and stool weight (7).

The decrease in transit time reduces the time toxins are in contact with colonocytes, hence reducing carcinogenesis in the colon, an effect originally introduced by Burkitt (1969) (8). A high fibre diet also contributes to the decrease of diseases related to constipation and abdominal pressure, such as diverticulitis (1). A number of prebiotic health effects have been associated with the balance of gut microflora and in particular with that of bifidobacteria (9) (See Figure 1).

Fig.1 Health benefits associated with bifidobacteria.
Fig.1 Health benefits associated with bifidobacteria.

As mentioned above, butyrate is the preferred substrate for colonocytes and is used in microbial growth. The SCFA produced by the microbial fermentation reduce the pH of the colon, which prevents the growth of pathogenic organisms in the colon (10). The reduced pH of the colon increases the bioavailability of calcium and that leads to greater mineral density (9).

  1. Obesity and Type 2 Diabetes

The health benefits of unavailable carbohydrates with respect to obesity and diabetes are associated with the effect they have on the gastrointestinal tract, the digestion of all carbohydrates and their absorption. High-fibre diets usually require longer chewing time compared to low-fibre diets (1). This promotes the secretion of more saliva and gastric juices, decreases gastric emptying and increases gastric distension promoting satiety (4). With the decrease of gastric emptying, chyme enters the ileum at a slower rate decreasing the rate of nutrient absorption. This is useful regarding the management of type 2 diabetes. A high fibre diet slows the absorption of glucose and consequently reduces the release of insulin, lowering the glycaemic index of foods. Carbohydrate-rich diets with low-glycaemic index have been associated with lower risk of diabetes (12). High peaks of insulin levels have been linked to the aetiology of both diabetes and coronary heart diseases (4). Unavailable carbohydrates have a lower energy density, varying from 1.4 – 2.4 kcal/g, are less palatable and hence are associated with reduced food intake and satiety (6). This yield depends upon the degree of fermentation and the proportion of the short-chain fatty acids produced (3). A high-fibre diet would prove beneficial in the management of obesity as it is closely linked to both Type 2 diabetes and coronary heart diseases.

  1. Cardiovascular diseases (CVD)

High intakes of fibre have been associated with a reduced risk of CVD (1). A study on Japanese Men and Women with no previous predisposition of cancer, stroke or coronary heart disease, showed that dietary intakes of fibre, in particular fruits and cereal fibres, could have a reduction in the mortality of coronary heart diseases (13). High levels of blood cholesterol are closely linked to CVD (14). As cholesterol is a precursor of bile, an increase in bile synthesis would reduce the cholesterol level in the blood. Unavailable carbohydrates bind to bile acids, increasing their excretion in faeces while increasing the bile synthesis in the gallbladder (5).

As seen in Table 1, the SCFA produced from the fermentation of the unavailable carbohydrates have antagonistic effects in the hepatic synthesis of cholesterol. This will depend on the rate of production of acetate with respect to propionate, which will either stimulate or inhibit cholesterol synthesis respectively.  A meta-analysis looking at four types of primary sources of fibre, oat products, psyllium, pectin and guar gum showed they had a similar effect on lowering cholesterol levels (14).

The health benefits associated with the increase intake of dietary fibre are an active area of research. The concern still remains why people consume less fibre than is currently recommended and what can be done to change this?

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References

  1. Cummings J., Mann J. Chapter 3 Carbohydrates. In: Mann J. and Truswell A. S. (eds). Essential of Human Nutrition. 4th Oxford: Oxford University Press, 2012; pp. 21- 48.
  2. Widmaier E. P., Raff H, Strang K. T. Vander’s Human Physiology – The Mechanisms of Body Function, 13th edition, New York, McGraw-Hill, 2014. Chapter 15 – The digestion and absorption of food; pp. 533-571.
  3. Bender D. A. (ed) Chapter 6 – Carbohydrate metabolism. In: Geissler C., Powers H. (eds), Human Nutrition, 12th edition, London, Elsevier, 2011; pp. 111-132.
  4. Sanders T., Emery P., Molecular Basis of Human Nutrition, 1st edition, London, Taylor and Francis, 2003 Chapter 4 – Carbohydrates; pp. 44-57.
  5. Mathers J., Wolever T. Chapter 5 – Digestion and Metabolism of Carbohydrates. In: Gibney M. J. et al (eds), Introduction to Human Nutrition, 2nd edition, 2009; pp. 74-85
  6. Scientific Advisory Committee on Nutrition. Draft Carbohydrates and Health report – Scientific consultation: 26 June to 1 September 2014 p 270
  7. Cummings J. H., et al, Fecal Weight, Colon Cancer Risk, and Dietary Intake of Nonstarch Polysaccharides (Dietary Fiber). Gastroenterology 1992, 103: pp. 1783-1789.
  8. Bingham S. A. Mechanisms and experimental and epidemiological evidence relating dietary fibre (non-starch polysaccharides) and starch to protection against large bowel cancer. Proceedings of the Nutrition Society 1990, 49: pp. 153-171.
  9. Brownawell A. M., et al, Prebiotics and the Health Benefits of Fiber: Current Regulatory Status, Future Research, and Goals. Journal of Nutrition 2012, 142: pp. 962–974.
  10. Topping D. L., Clifton P. M. Short-Chain Fatty Acids and Human Colonic Function: Roles of Resistant Starch and Non-starch Polysaccharides. Physiological Reviews 2001, 81 (3): pp. 1032-1054.
  11. Gibson G. R., Roberfroid M. B. Dietary modulation of the human colonic microbiota: Introducing the concept of prebiotics. The Journal of Nutrition 1995, 125 (6): pp. 1401-1412.
  12. Ley S. H., et al Diabetes 1: Prevention and management of type 2 diabetes: dietary components and nutritional strategies. The Lancet 2014, 383: 1999-2007.
  13. Eshak E. S., et al Dietary Fiber Intake Is Associated with Reduced Risk of Mortality from Cardiovascular Disease among Japanese Men and Women. Journal of Nutrition 2010, 140: pp. 1445-1453.
  14. Brown L. et al, Cholesterol-lowering effects of dietary fiber: a meta-analysis. The American Journal of Clinical Nutrition 1999, 69: pp. 30-42.
  15. Scientific Advisory Committee on Nutrition, Report on Nutrition recommendations on carbohydrates, including sugars and fibre. London: TSO;2015.

 

TOFI

Thin Outside, Fat Inside. What does that mean?

This is something that I have to confess was quite shocking to me when I first heard about it. It relates to people that appear to be slim on the outside but still have an excess amount of visceral fat – or internal fat as opposed to subcutaneous fat, which is found just beneath the skin. Visceral fat lies around vital organs, the muscle and heart. Accumulation of visceral fat leads eventually to insulin resistance, diabetes and heart conditions;

Recently, I attended a talk given by Professor Jimmy Bell and organised by the KCL Pharmacology Society, which really changed my perspective on appearance. Professor Bell discussed many aspects of his research, which aims to the development and maintenance of Optimal Health throughout adult life.

Using Magnetic Resonance Imaging (MRI) he was able to show that people of similar age, gender, BMI and same Percent Body Fat had completely different body fat distribution.

Coronal_Image_of_a_TOFI_and_a_Normal_Control MRI comparing two males of similar age, BMI and same Percent Body Fat. Fat shown as bright and lean tissue as dark.

He stressed that this referred to men and women that have a BMI of 25 or lower and do moderate or no exercise. To my surprise one of the TOFI examples he used, were also underweight people, such as fashion models; Whereas on the other hand, he used the example of Sumo wrestlers that have a BMI of 56 and consume up to 8,000 calories per day but exercise daily and have little visceral fat;

So is BMI adequate to determine if someone is healthy?

Body Mass Index:

Underweight Less than 18.5 kg/m2
Normal Weight 18.5 to 25 kg/m2
Overweight 25 to 30 kg/m2
Obese 30kg/m2 and above
Morbidly Obese 40kg/m2 and above

Although the value for BMI is used commonly to distinguish people that are underweight, normal weight, overweight, obese and morbidly obese, Professor Bell stressed that it is not a definitive measure of health in relation to body fat particularly on the lower range of BMI.

Take Home message: Stay Active!

Whatever the type of exercise, try and complete a workout everyday!

Whether you aim to complete 12,000 steps a day, play a tennis game or just brisk walk 30 minutes a day, add exercise to your routine! Professor Bell’s activity recommendations for those not in favour of the activities mentioned above was to stand up, balance on one foot for a minute then change foot and balance again and make sure this is repeated during the day several times.

Goodbye Fat!

Further Reading if you are interested:

Shojaee – Moradie F., et al. Exercise training reduces fatty acid availability and improves the insulin sensitivity of glucose metabolism. Diabetologia (2007) 50: 404 -413

Thomas E.L., et al. The Missing Risk: MRI and MRS Phenotyping of Abdominal Adiposity and Ectopic Fat. Obesity Journal (2012) 20, 1: 76 – 87

Research Struggles

Like every new beginning, every new job has its benefits and also its struggles. As I have already explained, this summer I had the amazing opportunity to work in the Nursing and Midwifery Department at King’s College London to conduct a systematic review.

If one had asked me back in May how would I go about starting a systematic review, I would have no idea what to answer. Although I had read systematic reviews by the time I started the Research Fellowship, it had never occurred to me what the actual process actually involved. Before starting the Fellowship I decided to keep a diary of everything I did each day, I took note of things that went well and other things that I found more challenging.

Here are my top 5 Research Struggles:

1. Getting familiar with the search engines! 

In the end they do become your best friend, but I had to spend about two weeks familiarising with the different engines Medline/ PubMed, Embase, PsycINFO, Web of Science and getting a feel of what each had to offer. Initially, the tricky part was identifying how each engine was worked – where to set limited criteria and also how to export the papers. My Medline search brought up a very large number of papers of which only a few were relevant in the end. Embase is a pharmaceutical engine and therefore had limited papers relevant to the topic I was looking for; similarly, PsycINFO had only very few relevant sources. Web of Science brought up some useful papers, it was particularly easy to use and particularly helpful as it projected on the side of the search the times the paper had been cited, something I learnt to appreciate over time.

2. Setting inclusion and exclusion criteria

Setting Inclusion and Exclusion criteria was mainly associated with the building of the Protocol for the study. A protocol is a document that describes the reason for conducting the systematic review, the rationale, sets objectives and outlines the organisation of the research project. When setting inclusion/exclusion criteria the struggle was thinking about all the possible parameters that had to be taken into account and making sure everything was included. This is challenging at times, particularly when one is not very familiar with the relevant topic.

3. AND or OR

Finding the correct keywords to use for my search.

Although in some studies this can be fairly simple in the study I conducted it was quite challenging as both cancer and diabetes are two very broad terms. I used many different combinations of keywords until we were happy with both the quantity and the relevance of the papers the search was bringing up. I am not going to lie, it did get frustrating at times spending days doing a search and then realising I had to start all over again. However, I realised that this is the only way to do it.

What I found particularly helpful was creating a visual of the combination of terms I would ideally like to find in a paper. I literally took a paper and drew two circles: one had cancer and all the terms associated (eg. Malignancy, melanoma etc.) and the other had diabetes and all the terms associated (diabetes mellitus, insulin etc.) and this is what lead me to the keywords we ended up using!

What I realised is that there isn’t a right or wrong way for doing this: You Search, You Check for Relevance, You Search, You Check for Relevance…

4. A Large – 4 – Digit Number

Being a stressed person from nature I was initially overwhelmed by the quantity of information! Although for some a large 4-digit-number of results might not seem like a lot, it was enough to make me go up and down the stairs of the eight – floor – building every 2 hours to rejuvenate and restore my frame of mind!

While conducting my searches and reviewing the papers I was overwhelmed with the amount of papers and was also at times scared that I would not be able to complete the project. Although reviewing is overwhelming to start off with, it does actually become better as you go along and this is something I learnt through experience and will have in mind when I conduct research again in the future.

5. Management

I am not sure if everyone feels this way but whenever I start a new job or even start a new project I always get that boost of excitement and that kick followed by slight stress – I like to call that productive stress!

However, when I was presented with that Large – 4 – Digit Number I became so preoccupied that this task would not be completed on time that I ended up constantly feeling that I had not made enough progress and disappointed about my performance. I was however very lucky to have my supervisor beside me along the way. She guided me and reassured me I was on the right track by having a mini – review of the goals accomplished each week. This allowed me to develop a mechanism to cope with managing my time and my stress and was able to complete what I had set to do.

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I have realised that although I have mentioned all the above as ‘Research Struggles’, these where the things I took away and appreciated during this amazing experience. Entering my second year of studies I have already been able to apply the knowledge that I attained during the summer in a variety of modules and this has made me very happy!

I am very interested to hear what were your ‘Struggles’ when you first had to conduct a review? I am sure there will be similar and different points for each person and I am looking forward to hearing your experience!