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Other names: Nebilet
RISK FACTORS OF HEART DISEASE: LACK OF FOOD FIBRE (ROUGHAGE)
Cereals, fruit and vegetables contain a group of substances for which fibre is the best-known name. Fibre is not digested by man, though it is altered by bacteria as it passes through the large bowel. It includes cellulose, pectins and gums. The amount we eat varies widely: it is highest in parts of the world where much of the diet is from vegetable sources, especially among the subsistence farmers in developing countries. In westernized countries fibre intake has fallen steeply in the past century, largely due to new techniques in flour-milling.
Scientists have noted that several ‘diseases of civilization’ seem to be related to these geographical and time trends. Communities eating low-fibre diets often have a much higher frequency of not only heart attack, but also diabetes and at least three diseases of the intestine: cancer of the colon, diverticulitis and appendicitis.
Here we are mainly concerned with the first of these disorders, and the crux of the problem is to decide whether a high intake of fibre is in some way ‘protective’ to the heart, or merely an accidental association. A great deal of research is being carried out at present, and the matter is really subjudice. The work is made more difficult by the fact that the various kinds of fibre have different effects. Bran (wheat fibre) has a valuable effect on the large intestine – increasing the bulk and softness of its contents, so leading to lower pressures in the colon and, perhaps, to dilution and quicker excretion of toxic or mutation-promoting substances. Such substances were, until recently, hypothetical; but one, resembling gamma-carboline, has been found in fried and grilled meat. Changing to a high-fibre diet is an effective way to deal with chronic constipation; and most doctors are convinced that an increased fibre intake alleviates the symptoms of diverticulitis. Whole-meal bread and bran-containing breakfast cereals are readily available sources of fibre, as are green vegetables and most fruit.
It was described how rabbits and many other animals develop atherosclerosis when fed on a diet rich in saturated fat, in cholesterol, or in both substances. Dr David Kritchevsky in Philadelphia has studied these effects in two such diets in which fibre was present or absent: one diet contained a high proportion of fibre and the other had glucose instead. Blood cholesterol increased less, and there was less atherosclerosis, in the rabbits whose diet contained fibre.
Some kinds of fibre reduce the blood cholesterol in man: pectins (found in fruit and jam), oat bran and gums used e.g. in making ice-creams also have this effect; wheat bran does not. But the amount of fibre required to do so is quite large. We would have to change our pattern of eating rather drastically to achieve low cholesterol levels by this means alone. However, the cholesterol-lowering effect of pectin is additive to that of a low intake of saturated fat; moderate changes in the amount and type of fat we eat, together with some increase in fibre-containing foods, may be an easy way to reduce our cholesterol levels. Another likely benefit of adding fibre to the diet is that diabetes becomes easier to control, as shown by Dr Ruth Kay in Toronto.
A higher intake of fibre is one of the features of the diet recommended by some distinguished nutritionists in evidence to a U.S. Senate Select Committee in 1977. Chaired by Senator George McGovern, the Committee has sought to define dietary goals for the U.S.A.
Although millions of people habitually follow a high-fibre diet, we cannot rule out the possibility of ill-effects. A tendency to flatulence is one result, caused by the action of bacteria on fibre as it enters the large bowel. This is trivial; but there is also the suspicion that some fibre-rich foods may impair the absorption of essential minerals including iron, zinc and calcium. This is unlikely to matter unless the diet is relatively poor in those substances; but adding fibre to the diet could compromise the health of people whose intake of these minerals is only just adequate.
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