Fiber Mania

On the day that I came back from a conference, I got a consult from a nurse practitioner. He said patient AB was status post allogenic stem cell transplant but with poor food intake, therefore he was newly initiated on enteral nutrition (tube feed) but experiencing diarrhea. The nurse practitioner asked me if there was any other formula that we could switch to to improve AB's diarrhea. During our conversation, I found out AB was ordered on a fiber-containing enteral nutrition formula. Instead of recommending a much more expensive semi-elemental enteral nutrition formula, I recommended that the nurse practitioner switch AB to a fiber-free formula and AB's diarrhea was resolved overnight.

The question is: Is fiber good you?

The answer is: It depends.

According to the Institute of Medicine's Dietary Reference Intake (DRI), an average adult needs about 25 to 38 grams of dietary fiber a day. But most Americans struggle to eat an adequate amount of fiber which is only an average of 15 grams a day, about half of the recommended intake.

Dietary fiber normalizes bowel movement, helps maintain bowel health, lowers cholesterol levels, helps control blood sugar levels and aids in achieving healthy weight.

However, in the case of AB, in addition to the intestinal toxicity of chemotherapy, AB had not been eating well for a prolonged period of time, AB's intestinal villus were shortened during the period of starvation, and when AB was fed with a fiber-containing enteral nutrition, his shortened gut villus were not able to tolerate the dietary fiber provided to his body and therefore caused all those uncomfortable signs and symptoms.

Therefore, dietary fiber is another example of one size does not fit all.