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Fiber Supplements

Yvette C. Terrie, BSPharm, RPh
Published Online: Monday, December 1, 2008   [ Request Print ]


Ms. Terrie is a clinical pharmacy writer based in Haymarket, Virginia.


According to the recommendations of the American Dietetic Association, ideally, healthy adults should have a daily intake of 25 to 30 g of dietary fiber, while children older than 2 years of age should consume a daily intake of dietary fiber equal to their age plus 5 g.1 The Institute of Medicine also recommends that individuals should consume at least 14 g of fiber for every 1000 calories.2 In general, however, the average daily intake of fiber for most individuals in the United States is only 14 to 15 g.1,2

Sources of dietary fiber include fruits, vegetables, whole grains, legumes, and beans. The American Heart Association (AHA) recommends that at least half of daily grain intake come from whole grain foods.2 Dietary fiber can be divided into 2 basic categories: soluble and insoluble.

  1. Soluble fiber slows digestion and assists the body in absorbing vital nutrients from foods.3,4 It dissolves in the water found in the large intestine and forms a gel.3,4 This form of fiber can aid in lowering total cholesterol levels and low-density lipoprotein cholesterol levels, as well as improve glycemic index in patients with diabetes.1-3 Foods high in soluble fiber include oat bran, barley, peas, rice bran, beans, apple pulp, citrus fruits, strawberries, and psyllium husk.2,4
  2. Insoluble fiber does not dissolve in water, but it increases the movement of waste through the intestinal tract.3,4 Insoluble fibers have been associated with decreased cardiovascular risks and slow progression of cardiovascular disease, particularly in high-risk individuals.1,2 In addition to preventing constipation, this type of fiber may also aid in removing toxic waste in the colon. Foods high in insoluble fiber include wheat bran, whole grains, rice, flax seed, nuts, popcorn, cabbage, beets, carrots, Brussels sprouts, turnips, cauliflower, and apple skin, as well as other fruits and vegetables with skins.2,4

Adequate intake of dietary fiber is the most recommended choice for both the prevention and treatment of constipation and also has an important role in the maintenance of normal bowel function. In addition, various studies have demonstrated that an increased intake of fiber can promote various health benefits and possibly prevent or reduce various chronic health problems.1 Examples include lowering the risk of developing hemorrhoids or diverticulosis, aiding in the management of irritable bowel syndrome, promoting better management of glucose levels in patients with diabetes, promoting weight loss, and restoring regularity for individuals on low-carbohydrate diets.1-3 In addition, adequate fiber intake may aid in lowering cholesterol levels and blood pressure, as well as decreasing the risk of colon cancer.1-3

Many patients still find it difficult to consume the American Dietetic Association's recommended intake of dietary fiber; thus, some individuals elect to use the various fiber products on the market to supplement their dietary fiber intake and to maintain normal bowel function to prevent or reduce episodes of constipation. Fiber products on the market may contain various fiber sources that include wheat dextrin, methylcellulose, psyllium husk, inulin, and calcium polycarbophil. Pharmacists can provide essential guidance to patients regarding the proper selection of fiber supplements and can ensure that patients use these products correctly according to the manufacturers' recommendations. Currently, fiber supplements are available in a variety of dosage formulations, such as shakes, chewable tablets, wafers, and powders in several different flavors (Table). Many powder formulations can be mixed with 4 to 8 ounces of water or noncarbonated beverage or in soft foods such as apple sauce. Some fiber supplements contain calcium and vitami ns/minerals. Patients should be advised to read labels of fiber supplements to avoid the possibility of therapeutic duplications.

Role of the Pharmacist

When assisting patients in the selection of fiber supplements, pharmacists should remind patients to gradually increase fiber intake over time to avoid or reduce the incidence of adverse effects, such as intestinal flatulence, bloating, diarrhea, and cramping. The increase should be gradual over a few weeks, and, if possible, patients should also increase water intake. Inadequate fluid intake may decrease efficacy of the product and may cause intestinal or esophageal obstruction.5 Many manufacturers of fiber supplements have reminders on the product label that typically recommend taking fiber supplements with 8 ounces of water to avoid choking.6-8 Patients with preexisting medical conditions, such as those who must restrict fluid intake (eg, patients with renal dysfunction, congestive heart failure)3 and those currently taking any medications should discuss the use of these supplements with their primary health care provider prior to using these products.

Furthermore, because fiber supplements can decrease the absorption of many medications, patients should always be advised to take supplements 2 to 3 hours before or after other medications and to report any concerns to their physician. Patients should also be reminded that the use of fiber supplements should never be a substitute for a fiber-rich diet that contains other essential vitamins and minerals necessary for health. It is important to remind patients to try to obtain most of their daily intake of fiber through dietary means.

Table 1
Examples of Available Fiber Supplements

Brand Name (Active Ingredient)

Manufacturer

Benefiber Products (wheat dextrin)

Novartis Consumer Health Inc

Benefiber Ultra Caplets
Benefiber Chewable Tablets
Benefiber Powder
Benefiber Plus Calcium (300 mg calcium)

Citrucel Products (methylcellulose)

GlaxoSmithKline

Citrucel Powder
Citrucel Soft Chews
Citrucel Caplets
Citrucel FiberShake
Citrucel FiberSmoothie

FiberChoice (inulin)

GlaxoSmithKline

FiberChoice Chewable Tablets
FiberChoice Weight Management Tablets (also contains chromium picolinate and green tea)
FiberChoice Plus Calcium (contains 500 mg calcium and 200 IU of Vitamin D)
FiberChoice Plus Multivitamins (contains 13 essential vitamins and minerals)

Fibercon Caplets (calcium polycarbophil)

Wyeth Consumer Healthcare

Fibersure Powder (inulin)

Procter & Gamble

Konsyl Products (psyllium hydrophilic mucilloid)

Konsyl Pharmaceuticals Inc

Konsyl-D
Konsyl Easy Mix
Konsyl Fiber Caplets (calcium polycarbophil; for individuals allergic to psyllium fiber)
Konsyl Orange
Konsyl Original
Konsyl Psyllium Capsules
Konsyl SennaPrompt

Metamucil (psyllium husk)

Procter & Gamble

Metamucil Original
Metamucil Fiber Powdered Drink Mixes
Metamucil Fiber Wafers
Metamucil Heart and Digestive Health Capsules
Metamucil Strong Bones (contains 300 mg calcium carbonate)

UniFiber (powdered cellulose)

Alaven Pharmaceuticals LLC


References

  1. Marlett JA, McBurney MI, Slavin JL. Position of the American Dietetic Association: health implications of dietary fiber. J Am Diet Assoc. 2002;102(7):993-1000. www.adajournal.org/article/S0002-8223(02)90228-2/fulltext.
  2. Fiber. American Heart Association Web site. www.americanheart.org/presenter.jhtml?identifier=4574. Accessed September 30, 2008.
  3. Rollins CJ. Functional and Meal Replacement Foods. In Berardi RR, ed. Handbook of Nonprescription Drugs. 15th ed. Washington, DC: American Pharmacists Association; 2006:484-485.
  4. Soluble vs. Insoluble Fiber. MedlinePlus Web site. www.nlm.nih.gov/medlineplus/ency/article/002136.htm. Accessed September 30, 2008.
  5. Curry CE, Butler DM. Constipation. In Berardi RR, ed. Handbook of Nonprescription Drugs. 15th ed. Washington, DC: American Pharmacists Association; 2006:305-309.
  6. Metamucil Product Information. Metamucil Web site. www.metamucil.com. Accessed September 30, 2008.
  7. Fibercon Product Information. Fibercon Web site. www.fibercon.com. Accessed September 30, 2008.
  8. The Fiber Chronicles: Answers to Your Questions. Citrucel Product Information. www.citrucel.com/Ch5_FAQ.aspx#crush. Accessed September 30, 2008.
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