Nature's laxative: Fiber

J Nature's Laxative: Fiber PEGGY KLOSTER YEN I once heard a physician tell a story of an older patient who called him at 8 o'clock Sunday morning for a prescription because he hadn't moved his bowels at 7 o'clock sharp, his habit for over 10 years. While this reaction may sound exaggerated, it is not unusual and reflects the anxiety and preoccupation elders can have with the issue of regularity. Weakening of intestinal muscles, decreased peristalsis, and altered activity patterns occur with advancing age. Constipation can result when these changes are combined with the dietary changes that are common to old age. Chemical laxatives can relieve the problem temporarily, but may eventually make it worse. Continued use of laxatives causes the bowel to lose the ability to perform naturally because it becomes dependent on an artificial signal. To help prevent this problem, nurses and dietitians recommend that older patients eat adequate fiber. It is a good suggestion, but where can elders get the fiber they need? From a variety of foods? From granular supplements and wafers? From super-fiber cereals? Dietitians want their clients to get necessary nutrients from a variety of foods an d for good reason. Eating a variety of foods in adequate amounts assures that older adults will obtain all of the more than 40 nutrients needed for good health. This recommendation also comes from the Dietary Guidelines for Americans promoted by the United States Department of Agriculture and the Department of Health and Human Services. These guidelines state the

principle that it is better to eat foods that naturally contain fiber, rather than add fiber to foods that do not contain it. Animal foods like meat and milk do n o t contain fiber. However, whole Fiber in Food and Supplements

Fiber per Calories per Serving (g) Serving Apple with skin, 1 medium Pear, 1 medium Broccoli, V2cup Carrots, 1/2cup Lentils, V2cup cooked Whole wheat bread, 1 slice Kellogg's Nutri-Grain cereal, 2/3cup Ralston Bran Chex, 2/3 cup Kellogg's All Bran with • Extra Fiber, 1/2cup FiberMed, 1 wafer

3.5 4.6 2.2 2.3

80 97 20 24

3.7

97

1.9

65

4.0

90

5.0

90

14.0

50

5.0

60

grain breads and cereals, fruits, vegetables, and dry beans, are the best sources of food fiber, for the nondigestible material they contain. Undigested material is essential to provide bulk to the mass of food residue moving through the intestines. Choosing Fiber Foods

Food scientists classify different fibers as soluble, found in fruits, beans, and oat bran, and insoluble, found in wheat bran and the skins of fruits and vegetables. This distinction is important for older adults who choose to increase their dietary fiber. The soluble fibers are thought to help lower blood cholesterol levels. They also help control blood sugar in Peggy Kloster Yen, RD, MPH, is a nutrition consultantat the PreventiveMedicineAdminis- patients with diabetes. Insoluble fiber helps relieve constitration, Maryland Department of Health and Mental Hygiene,Baltimore,MD. pation and may be involved in colon

cancer prevention. Thus, eating a variety of foods ensures older adults with an intake of both types of fiber. Read labels carefully when choosing foods for their fiber content. The number of whole grain, "lite," high fiber, and other categories of breads in the grocery store is so great, it's hard to know which is best. An excellent choice is whole grain bread made with whole grain flour. A whole grain is simply the original bran, germ, and endosperm of a grain, with nothing added or taken away. Whole grains provide additional nutrients, such as iron, not found in refined, unenriched grains. When shopping, look for whole wheat bread listing cracked wheat or 100% whole wheat flour as its first ingredient. Regular white bread is made with wheat (white) flour, a partial grain flour that is easy to confuse with whole wheat flour. Judging wheat bread by its color is equally difficult since caramel coloring is often added to make bread look brown and "healthier." This coloring will be noted on the label. Other names for whole grains are rolled oats, wheat germ, sprouted wheat, wheat berries, cornmeal, unprocessed bran, bulgur, barley, brown rice, and 100% rye flour. Unprocessed foods are easier to choose for fiber content. All fruits, vegetables, beans, nuts, and seeds contain fiber. Some of the best choices in the fruit and vegetable categories are oranges, grapefruits, apples, strawberties, pears, bananas, broccoli, beets, carrots, celery, corn, parsnips, peas, potatoes, zucchini, turnips, and green beans. Watermelon, grapes, lettuce, onions, and green peppers have somewhat less fiber per serving than these others. A 1/2cup serving of cooked dry beans or peas will provide at least 4 g of fiber. Kidney beans will provide over 7 g of GeriatricNursing November/December1988361

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fiber in the same size serving. Cereal is heavily advertised as a g o o d source o f fiber. M a n y new cereal products were developed solely for their fiber c o n t e n t a n d not necessarily as a g o o d source o f other nutrients. W h o l e grain cereals such as Shredded W h e a t c o n t a i n all the nutrients o f the whole grain, including iron and thiamin. All bran cereals c o n t a i n only the bran p o r t i o n o f t h e grain. A l t h o u g h they have the highest a m o u n t s o f fiber per cup, they m u s t be enriched or fortified with other nutrients they are lacking. It simply isn't necessary or advisable for older adults to get all or m o s t o f their fiber f r o m only one food source such as cereal. Fiber Supplements

As soon as a particular nutrient gains national attention as a disease preventer, it usually b e c o m e s available as a highly p r o m o t e d supplement. L o o k at omega-3 fatty acids a n d calcium, for example. W h e n scientists at the N a t i o n a l Research Council and U S D A r e c o m m e n d e d that A m e r i c a n s c o n s u m e m o r e fiber, fiber supplem e n t s began getting attention. Metamucil, a granular psyllium fiber s u p p l e m e n t has been a r o u n d for years. N o w , interest in fiber b r o u g h t Fiber-All, a similar product, o n t o the market. T h e newest p r o d u c t s are chewable supplements, such as Fiber-All chewable tablets, FiberMed, and Fiber-All wafers. T h e y cost twice as m u c h as the granular types. F i b e r M e d a n d FiberAll wafers are similar to cookies in appearance a n d texture. T w o S h r e d d e d W h e a t biscuits p r o v i d e m o r e fiber (6 g) in a b o u t the same a m o u n t o f calories (160) as two Fiber-All w a f e r s - - a t less than h a l f the cost! F i b e r in t h e Older Person's Diet

City/State/Zip State of Licensure

NUTRITION

GN

T h e average A m e r i c a n c o n s u m e s only a b o u t I0 g o f fiber daily, c o m pared with the 20 to 35 g r e c o m m e n d e d by health authorities. Elderly people should gradually increase their fiber i n t a k e - - w i t h fiber o f both types, s o l u b l e a n d i n s o l u b l e - - t o a v o i d flatulence a n d bloating. W h e n a d d i n g fiber to elders' diets, caregivers s h o u l d be aware that insoluble fibers, such as wheat bran, bind minerals a n d inhibit their absorption. GN