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Don't Eat Your Fiber Naked

By Marty Root, Ph.D

The news on preventing colon cancer has not been good lately. Two human experiments trying to prevent recurrence of precancerous polyps with dietary fiber have failed. A report from the well-known Nurses Health Study also reports no protective effect of fiber against colon cancer.

Now the American Gastroenterological Association (AGA) has issued a report. These are the fun people you go to when you get colorectal cancer (CRC). They have issued an official decree on fiber and CRC. Is this more bad news? Actually it's not, although vegan-espousing nutritionists could wish for more. The AGA went about as far as their medical literature will allow in recommending the old-fashioned fiber recommendation. Their recommendation was that, on average, Americans should triple their fiber intake to 30-35 grams per day. They also recommend, and I paraphrase slightly from the official language, "Don't eat your fiber naked."

It would have been very tempting for them to recommend that we do this tripling trick by all eating fiber pills (naked fiber). But instead they recommended, "Because the purported protective effect of dietary fiber against CRC is demonstrated better by fiber-rich foods (e.g. vegetables, fruits, grains, cereals) than by dietary fiber alone, it is also reasonable to recommend consumption of 5-7 servings of vegetables and fruit per day and generous portions of whole-grain cereals." (Underlinings are mine.) They make several other recommendations like less fat, less red meat, less alcohol and more exercise. They suggest starting this high fiber diet by age 30-40.

We can wish that they had recommended going further, such as starting a high fiber diet as early as possible, maybe at weaning. Or they could have recommended the level of fiber regularly consumed in countries with low CRC of 40-50 grams per day. The trouble is that medical research is not unequivocal on these issues of diet and CRC. Based on the popular notion of the importance of fiber in preventing colon cancer one might expect the medical research to be 100% supportive. This is actually not the case as recent studies have shown. Very few of the big prospective cohort studies (some of the best epidemiologic research) have shown either a protective effect of fiber or the harmful effects of specific animal-based foods for CRC.


A closer look

Let's take a closer look at these recent studies to see if we can make sense of this diet-CRC story. The international data is quite clear. CRC is highest in the countries of Europe and North America that practice a high meat, low vegetable Western-style diet. Immigrant studies show that when people migrate from low CRC countries to high CRC countries, their CRC rates go up over the first few generations to match those of the new country. Genetics plays only a small role. But when we come to studies done in Europe and the US, the results are more confusing. The anti-cancer mantra of the health and vegan communities‹less meat, more fruits and vegetables, more whole grains‹all have strong counter examples in recent cancer reports.


Why the differences in study outcomes?

Here are some of the problems. Studies such as the Nurses Health Study and the Health Professional Follow up Study are rather homogeneous groups of Americans. There is only about a 2-fold range of fiber intakes from the lowest to the highest groups (quintiles), and even the highest groups are not over the AGA recommendation. In other words, very few people in these studies are eating fiber at the levels eaten in countries with low CRC rates.

Dietary fiber intake is difficult to measure and may be over estimated in these two studies due to older analytical techniques and the difficulty in accounting for the destructive effects of processing and for the differing methods of food preparation.

Intervention trials are typically short (2-4 years) compared to the probable length of the whole disease process from the first mutation to the final CRC tumor (10-20 years). Most theories on how fiber may work in preventing cancer suggest that it works best in the early stages - probably starting in childhood. The amount of fiber used in these studies still is often not within even the modest AGA recommendation. When higher intakes are attempted, as in a recent study in Toronto, the subjects drop out or simply refuse to eat that much fiber.

Another problem is bias in reported intakes. In these studies, a group of people is intensively instructed in how to change their diets to be healthier. When they are then interviewed about their eating habits, they tend to report what they think the researcher wants to hear about what they ate. Thus, in a fiber and CRC study, subjects would tend to eat less fiber than they report . This dilutes any positive findings in the study.

Finally, many intervention studies use subjects who have had adenomas polyps removed. These are a precursor growth to CRC. They then ask these subjects to change their diets to see if they can prevent the recurrence of polyps. Unfortunately the growth of polyps is only one short step in the CRC process and it may not be the step that extra fiber prevents.


The total diet makes the difference

We are left with the frustrating conclusion that almost nothing seems to prevent colon cancer in Western subjects. What can those of us who are Westerners do to prevent the second most deadly cancer (after lung cancer)? Actually there are lots of indications in the literature that there is hope if we think more about food patterns and not just about single foods or single nutrients. If we consider fruits and vegetables as a whole, the epidemiologic literature is fairly consistent. People who have been eating a lot of these foods for a long time have lower rates of CRC, sometimes 40-50% lower. On the other hand, the big studies on causes of cancer seem to indicate that meats in general increase the risk of CRC. There are disagreements about which meats and how they are cooked but the big picture on meats is clearly negative.

A series of recent studies have taken the novel approach of comparing dietary patterns as a whole and their effect on CRC. Using a statistical method called factor analysis; they examined the eating patterns of 1290 subjects in a case-control study of CRC. They found that they could identify a half dozen or so unique ways that people eat. The most predominant pattern was the Western diet, consisting of high intake of meats, refined grains and sugar, fast food and eggs, among other things. When subjects were ranked into groups from low consumption of a Western diet to high consumption, they found a progressive rise up to a 50% increase in CRC in the highest group.

In other words, the total diet makes the difference. The consistent message in a field of inconsistent findings seems to be "don't eat your fiber naked" but eat it with the packaging, that is the fruits, the vegetables and the whole grains. Eat it with your whole family so that your kids get started at the age when it makes a difference and when life-long dietary habits are formed. Do not feel like you have arrived when you meet the AGA dietary fiber guidelines of 35 grams per day - allow your fiber intake to increase to 40 or 50 grams per day. There are lots of yummy ways to clothe your fiber and improve your health.

From "New Century Nutrition"

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