DSN expert Q&A: GI expert Dr. Robynne Chutkan

Dr. Robynne Chutkan is the founder of the Digestive Center for Women, an integrative gastroenterology practice in Chevy Chase, Md. She’s on the faculty at Georgetown Hospital, a former board member of the American Society for Gastrointestinal Endoscopy and the author of “Gutbliss: A 10-Day Plan to Ban Bloat, Flush Toxins and Dump Your Digestive Baggage.”

As a gastroenterologist, how do you counsel your patients on maintaining a healthy GI system?
A healthy digestive system is a critical component of a healthy body, as proper digestion and absorption of nutrients and minerals are essential to maintaining proper performance of the body’s functions. A healthy, functioning GI tract contributes to a range of important factors in our health, including energy, heart health, weight management and more. I counsel my patients on the importance of healthy habits in general: good nutrition, plenty of exercise and adequate water consumption. A critical element, though, is consumption of dietary fiber, which plays an important role in GI health and overall wellness. This includes plenty of GI-friendly, fiber-rich foods, like fruits, vegetables and whole grains. The United States Department of Agriculture and the Institute of Medicine recommend adults consume sufficient quantities of dietary fiber every day — 25 g/day for women ages 19 years to 50 years and 38 g/day for men ages 19 years to 50 years.1,2 Unfortunately, most people simply don’t get enough fiber from their diets, so often I recommend that my patients consider adding a fiber supplement to their diet

What are all the benefits of dietary fiber?
The health benefits of dietary fiber have been well-studied. The utility of fiber for regularity and treating constipation has been recognized and appreciated for years. However, other key health benefits of dietary fibers have been increasingly recognized, including reducing the risk of coronary heart disease by lowering cholesterol and maintaining healthy glycemic control. Despite the availability of dietary sources of fiber, I find that patients just do not eat enough fiber. Although dietary sources of fiber also contribute vitamins, minerals and other nutrients, fiber supplements can play an important role for persons who find it difficult to meet their daily fiber intake through diet alone.

What are the main types of fiber?
There are different types of fiber, and not all deliver the same benefits. Fiber sources vary in their chemical and physical properties, as well as the health benefits they each provide. Fiber types can be characterized by their solubility (the ability to dissolve in fluids in the GI tract), their viscosity (the ability to thicken or form a gel when mixed with fluids) and their fermentability (the degree to which the fiber is degraded/digested by bacteria in the colon forming gases and short chain fatty acids). The fiber found in fruits, vegetables, whole grains and fiber supplements vary in these features.

What health benefits can fiber supplements offer?
Since the physiologic effects and health benefits among different types of fibers vary considerably, it is important to choose a fiber that complements a patient’s individual health goals. Viscosity is associated with cardiovascular benefits due to the ability to form a gel-like substance that helps trap some sugars, fats and cholesterols in the upper intestine and transport them through the GI tract. Soluble viscous fibers reduce cholesterol and have beneficial glycemic effects. Effects related to regularity and laxation are common to various soluble and insoluble fibers.

Can fiber supplements contribute to heart health and glycemic control?
There are numerous clinical trials that have demonstrated the benefit of soluble viscous (i.e., gel-forming) fiber in conjunction with a low-fat diet in lowering cholesterol. Psyllium is the most-studied fiber in this regar, with studies demonstrating reductions in total and LDL cholesterol. Oat fibers also have demonstrated cholesterol lowering benefits in clinical studies. In addition, some viscous soluble fibers help maintain healthy blood-glucose levels when used in conjunction with a healthy diet.

What is psyllium fiber and what makes it unique?
Psyllium is a natural source of dietary fiber that is derived from the seed of the plantago ovata plant. Most healthcare professionals are aware of psyllium’s ability to help promote and maintain regularity, but it has additional health benefits. Evidence has suggested that healthy diets incorporating 7 g of soluble fiber per day from psyllium may reduce the risk of heart disease by lowering cholesterol.3 In fact, psyllium is the only fiber supplement recognized by the Food and Drug Administration for its heart health benefits.3 Further research indicates regular consumption of psyllium fiber helps manage blood glucose levels, as it traps sugars in the gel and releases them slowly as it passes through the small intestine.

1. United States Department of Agriculture. Report of the dietary guidelines advisory committee on the dietary guidelines for Americans, 2010. May 2010. Available at http://www.cnpp.usda.gov/DGAs2010-DGACReport.htm. Accessed May 13, 2014.
2. Institute of Medicine of the National Academies. Dietary reference intakes: macronutrients. 2002/2005. The National Academies Press. Available at: http://www.iom/edu/Reports/2002/Dietary-Reference-Intakes-for-Energy-Carbohydrate-Fiber-Fat-Fatty Acids-Cholesterol-Protein-and-Amino-Acids.aspx. Accessed May 13, 2014.
3. Food and Drug Administration, US Department of Health and Human Services. Code of Federal Regulations, Title 21, Volume 2, Section 101.81. Health claims: Soluble fiber from certain foods and risk of coronary heart disease (CHD). Available at: http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfcfr/CFRSearch.cfm?fr=101.81. Accessed May 13, 2014.

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