Dietary Fiber: Basic and Clinical Aspects PDF
Preview Dietary Fiber: Basic and Clinical Aspects
DIETARY FIBER Basic and Clinical Aspects DIETARY FIBER Basic and Clinical Aspects Edited by George V. Vahouny The George Washington University Medical Center Washington, D.C. and David Kritchevsky The Wi star Institute Philadelphia, Pennsylvania PLENUM PRESS • NEW YORK AND LONDON Library of Congress Cataloging in Publication Data Washington Symposium on Dietary Fiber (2nd: 1984: Washington, D.C.) Dietary fiber. "Proceedings of the second Washington Symposium on Dietary Fiber, held April 25-28, 1984, in Washington, D.C."-T.p. verso. Includes bibliographies and index. 1. High·fiber diet-Congresses. 2. Fiber deficiency diseases-Congresses. I. Vahouny, George V., 1932- . II. Kritchevsky, David, 1920- . III. Title. !DNLM: 1. Dietary Fiber-congresses. W3 WA33 2nd 1984d/WB 427 W319 1984dl RM237.6.W36 1984 613.2/8 85·19159 ISBN·13:978·1·4612·9249-4 e-ISBN-13:978-1-4613-2111-8 DOl: 1O.lO07/978-1-4613-21l1-8 Proceedings of the Second Washington Symposium on Dietary Fiber, held April 25-28, 1984, in Washington, D.C. © 1986 Plenum Press, New York Softcover reprint of the hardcover 1st edition 1 986 A Division of Plenum Publishing Corporation 233 Spring Street, New York, N.Y. 10013 All rights reserved No part of this book may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, microfilming, recording, or otherwise, without written permission from the Publisher Contributors MARGARET J. ALBRINK. Department of Medicine, West Virginia University School of Medicine, Morgantown, West Virginia R. ALI. Nutritional Research and Development, Bristol-Meyers International Division, New York, New York JAMES W. ANDERSON. Medical Service, Veterans Administration Medical Center, and Department of Medicine, University of Kentucky College of Medicine, Lexington, Kentucky ARNOLD BERST AD. Department of Medicine, Lovisenberg Hospital, Oslo, Norway SHEILA A. BINGHAM. University of Cambridge and MRC Dunn Clinical Nutrition Centre, Cambridge, United Kingdom CHARLES T. BONFIELD. Farma Food, Washington, D.C. CYNTHIAL. BOULANGER. Department of Nutrition and Food Science, and The Statistics Center, Massachusetts Institute of Technology, Cambridge, Massachusetts WILLIAM J. BRANCH. MRC Dunn Clinical Nutrition Centre, Cambridge, United Kingdom W. GORDON BRYDON. Wolfson Gastrointestinal Laboratories, Department of Medicine, Western General Hospital, Edinburgh, United Kingdom ARTHUR W. BULL, Jr.. Department of Surgery, Wayne State University School of Medicine, Detroit, Michigan DENIS P. BURKITT. The Old House, Stroud, Gloscestershire, United Kingdom RITVA R. BUTRUM. National Cancer Institute, Bethesda, Maryland F. ANN CARR. Department of Nutrition and Food Sciences, and The Statistics Center, Massachusetts Institute of Technology, Cambridge, Massachusetts K. K. CARROLL. Department of Biochemistry, University of Western Ontario, London, Ontario, Canada v vi CONTRIBUTOR5 MARIE M. CASSIDY. Department of Physiology, George Washington University School of Medicine and Health Sciences, Washington, D. C. W. J. L. CHEN. Medical Service, Veterans Administration Medical Center, and Department of Medicine, University of Kentucky College of Medicine, Lexington, Kentucky BERTRAM I. COHEN. Departments of Surgery, Beth Israel Medical Center and Mount Sinai School of Medicine of the City University of New York, New York, New York BARBARA H. CONNER. Department of Nutrition and Food Science, and The Statistics Center, Massachusetts Institute of Technology, Cambridge, Massach usetts JOHN H. CUMMINGS. MRC Dunn Clinical Nutrition Centre, Cambridge, United Kingdom WILLIAM D.DEWYS • National Cancer Institute, Bethesda, Maryland WILLIAM H. DUMOUCHEL. Department of Nutrition and Food Science,and The Statistics Center, Massachusetts Institute of Technology, Cambridge, Massachusetts MARTIN A. EASTWOOD. Wolfson Gastrointestinal Laboratories, Department of Medicine, Western General Hospital, Edinburgh, United Kingdom HANS N. ENGL YST. MRC Dunn Clinical Nutrition Centre, Cambridge, United Kingdom KATHLEEN FADDEN. PHLS Centre of Applied Microbiology and Research, Bacterial Metabolism Research Laboratory, Salisbury, Wiltshire, United Kingdom LEO R. FITZPATRICK. Department of Physiology, George Washington University School of Medicine and Health Sciences, Washington, D. C. THOMAS FRANCIS. Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Canada PETER GREENWALD. National Cancer Institute, Bethesda, Maryland ERIK GREGERSEN. Department of Gynecology and Obstetrics, Sct. Maria Hospital, Vejle, Denmark K. W. HEATON. Department of Medicine, University of Bristol, and Bristol Royal Infirmary, Bristol, United Kingdom MICHAEL J. HILL. PHLS Centre for Applied Microbiology and Research, Salisbury, Wiltshire, United Kingdom KATSUMIIMAIZUMI. Laboratory of Nutrition Chemistry, Kyushu University School of Agriculture, Fukuoka, Japan LUCIEN R. JACOBS. Department of Internal Medicine, Division of Gastroenterology, School of Medicine, University of California, Davis, California CONTRIBUTORS vii ALEXANDRA L. JENKINS. Department of Nutritional Sciences, Faculty of Medicine, and Division of Endocrinology and Metabolism, St. Michael's Hospital, University of Toronto, Toronto, Canada DAVID J. A. JENKINS. Department of Nutritional Sciences, Faculty of Medicine, and Division of Endocrinology and Metabolism, St. Michael's Hospital, University of Toronto, Toronto, Canada PATRICIA A. JUDD. Department of Nutrition, Queen Elizabeth College, University of London, London, United Kingdom JUNE L. KELSAY. Carbohydrate Nutrition Laboratory, U. S. Department of Agriculture Agricultural Research Service, Beltsville, Maryland DAVID M. KLURFELD. The Wi star Institute of Anatomy and Biology, Philadelphia, Pennsylvania DAVID KRITCHEVSKY. The Wistar Institute of Anatomy and Biology, Philadelphia, Pennsylvania SOON Y. LEE. Department of Nutrition and Food Science, and The Statistics Center, Massachusetts Institute of Technology, Cambridge, Massachusetts ANTHONY R. LEEDS. Department of Nutrition, Queen Elizabeth College, University of London, and Department of General Medicine and.Endocrinology, Central Middlesex Hospital, London, United Kingdom MICHAEL LEFEVRE. Department of Nutrition, University of California, Davis, California LI NDA F. MCKAY. Wolfson Gastrointestinal Laboratories, Department of Medicine, Western General Hospital, Edinburgh, United Kingdom ERWIN H. MOSBACH. Departments of Surgery, Beth Israel Medical Center and Mount Sinai School of Medicine of the City University of New York, New York, New York NORMAN D. NIGRO. Department of Surgery, Wayne State University School of Medicine, Detroit, Michigan M. I. ODENDAAL • Department of Physiology, University of Potchefstroom, Potchefstroom, South Africa G. M. OWEN. Nutritional Research and Development, Bristol-Meyers International Division, New York, New York LEON PROSKY • Experimental Nutrition Branch, Division of Nutrition, Bureau of Foods, Food and Drug Administration, Washington, D. C. A. VENKETESHWER RAO. Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Canada N. W. READ. Clinical Research Unit, Royal Hallamshire Hospital, Sheffield, United Kingdom viii CONTRIBUTORS BANDARU S. REDDY. Naylor Dana Institute for Disease Prevention, American Health Foundation, Valhalla, New York ADRIANNE E. ROGERS. Department of Pathology, Boston University School of Medicine, Boston, Massachusetts ANDREAS RYDNING. Department of Medicine, Lovisenberg Hospital, Oslo, Norway ABIGAIL A. SALYERS. Department of Microbiology, University of Illinois, Urbana, Illinois L. M. SCHANBACHER. Nutritional Research and Development, Bristol-Meyers International Division, New York, New York BARBARA OLDS SCHNEEMAN. Department of Nutrition, University of California, Davis, California I. SEGAL. Department of Gastoenterology, Baragwanath Hospital, Johannesburg, South Africa DAVID A. T. SOUTHGATE. AFRC Food Research Institute, Norwich, United Kingdom JON A. STORY. Department of Foods and Nutrition, Purdue University, West Lafayette, Indiana MICHIHIRO SUGANO. Laboratory of Nutrition Chemistry, Kyushu University School of Agriculture, Fukuoka, Japan RODNEY H. TAYLOR. Department of Gastroenterology and Nutrition, Central Middlesex Hospital, University of London, London, United Kingdom LILIAN U. THOMPSON. Department of Nutritiqnal Sciences, Faculty of Medicine, University of Toronto, Toronto, Canada IRMA H. ULLRICH. Department of Medicine, West Virginia University School of Medicine, Morgantown, West Virginia GEORGE V. VAHOUNY. Department of Biochemistry, George Washington University School of Medicine and Health Sciences, Washington, D. C. JOHN E. VANDERVEEN. Food and Drug Administration, Division of Nutrition, Washington, D. C. A. R. P. WALKER. School of Pathology, South African Institute of Medical Research, and University of the Witwatersrand, Johannesburg, South Africa MAXINE M. WEBER. The Wistar Institute of Anatomy and Biology, Philadelphia, Pennsylvania THOMAS M. S. WOLEVER. Department of Nutritional Sciences, Faculty of Medicine, and Division of Endocrinology and Metabolism, St. Michael's Hospital, University of Toronto, Toronto, Canada Foreword Only 15 years ago a conference on dietary fiber, let alone an international conference, would have been considered an extremely unlikely, and in fact an unthinkable, event. Yet in recent years a number of such conferences have taken place at the international level and in different parts of the world; the conference of which the present volume is an outgrowth is the second to have been held in Washington, D.C. This extraordinary development of interest in a hitherto largely neglected component of diet has been reflected by a veritable explosion of scientific literature, with published articles increasing 40-fold, from around ten to over 400 per year, within the decade 1968-1978. Not only has the growth of interest in and knowledge of fiber made it perhaps the most rapidly developing aspect of nutritional science in recent history if not in all time, but epidemiologic studies relating fiber intake to disease patterns, subsequently broadened to include other food components, have been largely responsible for the current concept of diseases characteristic of modern Western culture and lifestyle. The potential importance of this realization is forcefully underlined by the considered judgment of Thomas MacKeown, epidemiologist and medical historian of Birmingham University, England. He has asserted that just as the recognition that infective disease was related to factors in the environment that could be controlled was the greatest single medical advance in the 19th century, the recognition that the chronic noninfective diseases characteristic of modern Western culture are likewise due to factors in the environment that can be controlled may prove to be the greatest medical advance of the 20th century. When fiber is seen in this light there is no need to emphasize the signifi cance of what might appear to the uninitiated to be just another conference on fiber. With work and knowledge expanding at its present rate, the poten tial benefits of bringing together authorities on the increasingly expanding and varied aspects of the subject for an interchange of ideas and discussion of problems could scarcely be exaggerated. ix x FOREWORD It might be appropriate here to consider fiber's curriculum vitae, and the incredibly slow and ignominious progress of its early life, before it took root and began its rapid growth to its present stature. In the fourth century B.c. Hippocrates commented, "To the human body it makes a great difference whether the bread be made of fine flour or coarse, whether of the wheat with the bran or the wheat without the bran." Thirteen centuries later a Persian physician, Hakim, wrote: "Wheat is a beneficial cereal. Chuppatis are made from wheat flour. Chuppatis containing more bran come out of the digestive tract quicker. Those containing little bran take a long time to be excreted." In Shakespeare's play Coriolanus, the gut proclaims its unselfish nature. All the nourishment that is put into it is given out again to the various parts of the body. But the gut then says, "Though all at once cannot see what I deliver out to each, yet I can make my audit up, that all from me do back receive the flour of all, and leave me but the bran" (Coriolanus, Act 1, Scene 1). In the 19th century Graham in the U. S. endeavored to draw attention to roughage, as did Allinson in the U. K. The latter had his name erased from the medical register for the unethical practice of selling whole meal (whole wheat) bread, and henceforth the name plate outside his London consulting rooms announced him as "Ex. L.R.C.P."! His name is perpetuated in the U. K. in "Allinson's Bread." Other lone voices cried largely in the wilderness prior to World War II. Sir Albuthnot Lane, the English society surgeon whose name is still linked to anatomic anomalies and surgical instruments, believed that many ailments were related to stagnation of colonic contents. It is stated, whether apo cryphally or factually is open to question, that he treated this condition by excising the colon, before he recognized that the administration of Miller's bran was an equally effective and less drastic remedy. Sir Robert McCarrison attributed the health of the tribesmen of northern India among whom he worked to their largely vegetarian diet and their con sumption of minimally processed foods. The brothers John and William Kellogg extolled the virtues of bran. Unfortunately, when one of them began to make commercial products, they quarreled to the extent of instituting litigation against one another. Their name is of course perpetuated in breakfast cereal products that continue to make fiber-rich foods available. The outstanding British protagonist of fiber, then considered as cellu lose, in the 1920s, was the British surgeon Arthur Rendle-Short. He was the first doctor to argue convincingly with abundant epidemiological and other evidence that cellulose-depleted diets played a dominant role in the causation of appendicitis. FOREWORD xi At about the same time Cowgill and Anderson (1932) were extolling the laxative virtues of wheat bran in the U. S. A few years later, Ted Dimmock, who subsequently worked as a family physician both in Britain and abroad, demonstrated the role of fiber in treating constipation and piles. It was after World War II that three of the pioneers most responsible for the early development of the fiber hypothesis emerged. T. L. Cleave, a physician in the Royal Navy, acquired a reputation, not always compli mentary, for successfully treating constipation in sailors at sea by using Miller's bran. Subsequently he put his ideas in a popular book, The Sac charine Disease, published in the mid-1960s. He was among the first to draw attention to the relationship between certain characteristically Western dis eases and diets, with emphasis on the danger of sugar, but at the same time recognizing the benefits of fiber. It was not until a few years before his death in 1983 that his work was in any way adequately recognized by the conferral of two prestigious medals. While Cleave was thinking his revolutionary ideas in England, Dr. Hugh Trowell was thinking along similar lines in East Africa, where he worked as a physician for 35 years. He was the first to list in a medical textbook diseases common in the West but rare in Africa. Although he did not specifically incriminate refined carbohydrate foods in the way Cleave had done, he suspected that the bulky stools passed by Africans were some how protective against some of these diseases. It was he who first coined the term "dietary fiber." He was one of the first, if not the first, to suggest that fiber could confer protection against diabetes, obesity, and ischemic heart disease. A third name that must be linked with those of Cleave and Trowell is Walker of South Africa. During the war years he began to recognize a rela tionship between fiber intake, large stools, and a low incidence of certain gastrointestinal diseases, and he has been making significant contributions to this subject ever since. My interest in this field was first stimulated by Cleave, whose observa tions opened my eyes to the enormous possibility of massive disease preven tion. However, I had an advantage denied to Cleave, because of my previous work in another field. I was accorded credibility and consequently given the hearing that had been denied to others. Moreover, the information collection network that I had built up in much of the Third W orId for gathering infor mation on cancer distribution was tailor-made for confirming or refuting Cleave's hypothesis. Although this information might in the initial stages have been considered anecdotal, massive and consistent information of this nature has to be and was taken seriously. Only a few others, notably South gate and Eastwood, entered the field before the end of the 1960s. Until recently, those actively involved in the study of dietary fiber and
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