The prevalence of chronic conditions of all kinds are continuing to rise across the globe, impacting the lives of many. Some examples of chronic diseases are diabetes, cancer, cardiovascular disease (CVD), gastrointestinal diseases, chronic obstructive pulmonary disease (COPD), and chronic kidney disease (CKD) [i]. The CDC reports that in 2018, “more than half (51.8%) of adults had at least 1 of 10 selected diagnosed chronic conditions…and 27.2% of US adults had multiple chronic conditions” [ii].
Fortunately, there are several ways that people can reduce their risk of chronic disease as many of the disease-contributing factors are modifiable lifestyle choices, such as diet. There may be certain foods or food groups that contribute to or reduce the risk of chronic disease development, so it can be useful to take a deeper look at diet. For example, the 2020-2025 Dietary Guidelines for Americans states that dietary fiber is “…one of several ‘dietary components of public health concern’ due to underconsumption” [iii]. Thus, it has been advised that individuals increase their daily consumption of dietary fiber to meet the recommendation of 21-38 grams per day of fiber [iv]. Recent research has highlighted dietary fiber’s various benefits, one of which is its impact on chronic disease risk.
In general, dietary fiber is found in unrefined carbohydrates or plants that are edible but non-digestible, meaning that fiber particles travel through the gastrointestinal (GI) tract unabsorbed and exit the body through fecal excretion. Undigested fiber in the GI tract is left to be fermented by the bacteria that live within the large intestine; and the byproduct of this fermentation is short chain fatty acids (SCFAs). It is these SCFAs that are thought to be partially responsible for fiber’s role in promoting bowel movements, decreasing blood sugar levels, and decreasing blood cholesterol levels [v]. Although fiber is most often known for its constipation-relieving effects, it is also crucial in the prevention and management of nutrition-related chronic diseases.
There are two types of fiber, soluble and insoluble, that are categorized based on the physiological effects fiber has on the body. For example, soluble fiber dissolves in water, forming a gel-like material in the GI tract. Soluble fiber helps to soften stool and bind with excess substances within the body such as cholesterol and estrogen. Unlike soluble fiber, insoluble fiber cannot dissolve in water and instead adds bulk to the stool. Insoluble fiber helps with increasing bowel movements and is responsible for increasing overall GI health [iii]. Therefore, the role that dietary fiber plays within the body may depend upon which type of fiber is consumed. Examples of each type can be found here.
Let’s take a look at some of the data that support fiber’s role in decreasing the risk of chronic disease.
- Diabetes and CVD: As we know, dietary fiber is a key component in controlling blood sugar levels and lowering blood cholesterol, thus not surprisingly, it has been researched in connection to diabetes and cardiovascular disease. In a study conducted in 2020 by Partula et al., the consumption of different types of dietary fiber in relation to risk of general chronic disease, high total dietary fiber consumption of greater than 27.9 grams per day for men and more than 23.4 grams per day for women, soluble fiber intake of at least 8.73 grams per day for men and 7.17 grams per day for women, and insoluble fiber consumption of more than 19.6 grams per day for men and 16.6 grams per day for women, were all associated with a decreased risk of type 2 diabetes. Whereas, only soluble fiber intake was associated with decreased CVD risk. Additionally, this study found that soluble fiber and total dietary fiber, specifically from fruit sources, were associated with a decreased risk of general chronic disease and mortality [vi].
- Chronic Obstructive Pulmonary Disease (COPD): The long-term effects of dietary fiber intake on COPD risk were studied in 2020 by Szmidt et al. with conclusive findings. This study showed that long-term high dietary fiber intake, defined as consuming more than 26.5 grams of fiber per day, decreased COPD risk by 30%, with fiber in cereal and fruit having the greatest effects [vii].
- Chronic Kidney Disease (CKD): A 2018 study by Mirmiran et al. investigating the relationship between dietary fiber and CKD risk found that, “…for every 5 g/d increase in total fiber intake, the risk of incident of CKD decreased by 11%.” When looking at the sources of dietary fiber that were associated with decreased CKD risk, participants that consumed more than 4.6 grams of vegetable fiber per day and greater than 1.3 grams of legume fiber per day were 37% and 32% less likely to develop CKD, respectively [viii]. Across each of these studies, the findings were that dietary fiber intake is associated with a decreased risk of some chronic diseases. However, it should be noted that each study found that certain diseases responded better to specific types of fiber and fiber sources, which could be useful in disease prevention and management strategies.
- Cancer: In addition to fiber’s effect on blood sugar and cholesterol levels, its effect on bowel movement promotion is another mechanism of action associated with decreased risk for some chronic diseases. It is theorized that because dietary fiber intake can increase fecal excretion, waste and toxins are eliminated from the body along with the excess estrogen and cholesterol bound to the fiber. This mechanism of fiber may decrease the risk of certain chronic conditions such as colorectal cancer and breast cancer. In a 2022 study conducted by Qi et al., participants with the highest total dietary fiber intake had a 31.4% lower risk of all-cause mortality and a 39.4% reduced risk of cancer mortality compared to those with the lowest dietary fiber intake. More specifically, high total fiber intake of more than 28.12 grams of fiber per day was associated with a reduced risk for breast cancer; and high soluble fiber intake was associated with a decreased risk for colorectal cancer [v]. Thus, this study supports the conclusion that dietary fiber intake may decrease the risk of chronic disease and enhances the argument that specific types of fiber have different roles in disease pathology.
Overall, soluble or insoluble dietary fiber has been shown to be inversely related to chronic disease risk. Therefore, it is important to promote dietary fiber and ways to increase its intake to the public. One way to increase fiber intake is to consume a variety of whole, plant-based foods. A diet that includes a variety of fruits and vegetables, whole grains, legumes, nuts, and seeds will guarantee adequate intake of soluble and insoluble fiber. Along with the benefits of fiber, these plant foods are packed with an abundance of vitamins, minerals, and antioxidants, which may have an additional beneficial impact on chronic disease risk. Meeting the recommendation stated in the very beginning of consuming, on average, 21-38 grams of fiber per day from the sources listed above can be a simple, yet effective way to help to reduce the risk of a variety of chronic conditions.
References:
[i] Centers for Disease Control and Prevention (2022, July 21). About chronic diseases. CDC.gov. https://www.cdc.gov/chronicdisease/about/index.htm Accessed October 5, 2022.
[ii] Boersma, P., Black, L.I., & Ward, B.W. (2020). Prevalence of multiple chronic conditions among US adults, 2018. Centers for Disease Control and Prevention, 17. http://dx.doi.org/10.5888/pcd17.200130external icon.
[iii] Academy of Nutrition and Dietetics (2022, January). Dietary Fiber. EatRightPro.org. https://www.eatrightpro.org/news-center/nutrition-trends/foods-and-supplements/functional-fiber Accessed October 5, 2022.
[iv] Mayo Clinic (2021, January 6). Dietary fiber: essential for a healthy diet. MayoClinic.org. https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/fiber/art-20043983 Accessed October 5, 2022.
[v] Qi J, Gao J, Zhang Y, Hou W, Han T, & Sun C (2022). The association of dietary fiber intake in three meals with all-cause and disease-specific mortality among adults: the U.S. National Health and Nutrition Examination Survey, 2003-2014. Nutrients, 14(12):2521. doi: 10.3390/nu14122521. PMID: 35745250; PMCID: PMC9228910.
[vi] Partula, V., Deschasaux, M., Druesne-Pecollo, N., Latino-Martel, P., Desmetz, E., Chazelas, E., Kesse-Guyot, E., Julia, C., Fezeu, L.K., Galan, P., Hercberg, S., Mondot, S., Lantz, O., Quintana-Murci, L., Albert, M.L., Duffy, D., Consortium, T.M.I, Srour, B., & Touyier, M. (2020). Associations between consumption of dietary fibers and the risk of cardiovascular diseases, cancers, type 2 diabetes, and mortality in the prospective NutriNet-Sante cohort. American Journal of Clinical Nutrition, 112(1), 195-207. https://doi.org/10.1093/ajcn/nqaa063
[vii] Szmidt, M.K., Kaluza, J., Harris, H.R., Linden, A., & Wolk, A. (2020). Long-term dietary fiber intake and risk of chronic obstructive pulmonary disease: a prospective cohort study of women. European Journal of Nutrition, 59(5), 1869-1879. https://doi.org/10.1007/s00394-019-02038-w
[viii] Mirmiran, P., Yuzbashian, E., Asghari, G., Sarverzadeh, S., & Azizi, F. (2018). Dietary fibre intake in relation to the risk of incident chronic kidney disease. British Journal of Nutrition, 119(5), 479-485. doi:10.1017/S0007114517003671
Susan started Savor Health after losing a close friend to a brain tumor and, through that experience, becoming aware of the significant unmet nutritional needs of people with cancer. Struck by the fact that her friend was told “nutrition doesn’t matter” and “eat whatever you want,” Susan read the evidence-based literature on the subject, interviewed oncologists, oncology nurses and oncology dietitians, as well as patients and caregivers, and found that, in fact, nutrition does matter in oncology. Armed with solid scientific evidence supporting the clinical and quality of life benefits of proper nutrition, Susan left Wall Street and created Savor Health, an AI-based provider of personalized and clinically appropriate nutrition solutions for cancer patients, their caregivers and health enterprises. Susan brings to Savor Health over 25 years of industry experience in healthcare and business as well as expertise in strategy, finance and management.
Marissa Buchan is a registered dietitian, with advanced practice certifications in Oncology Nutrition (CSO) and Clinical Research (CCRP). She received her Bachelor’s degree in Psychology from Duke University, and Master’s of Science degree in Clinical Nutrition from New York University. Marissa worked for 10 years at Memorial Sloan Kettering Cancer Center in both the clinical research and nutrition departments. In addition to counseling patients before, during, and after cancer therapy, she spearheaded nutrition-research efforts for the bone marrow transplant service. She has co-authored over 20 articles and has a particular interest in the role of nutrition on the intestinal microbiota and its impact on patient outcomes. When Marissa’s not wearing her lab coat, she’s in her apron whipping up healthy and delicious recipes that you can find on her blog, Get Off Your Tush and Cook.
Dr. DeFrance has a unique background including clinical interventional cardiologist, chief medical officer, educator, outcomes researcher and entrepreneur. He has expertise in Lifestyle medicine in which he was board certified in 2020 and is highly interested in the prevention and reversal of chronic disease. Dr. DeFrance also has expertise in appropriate utilization of technology in medicine, healthcare economics, value-based metrics, and educational design and delivery. He worked as Chief Medical Officer for HealthHelp, one of the largest specialty benefit managers in the US, and led large teams of healthcare professionals in writing evidence based appropriate care guidelines and rule sets which improve the quality and safety of medicine for over 20 million people in the US while also creating sustained savings in healthcare. He has also designed clinical decision support systems that are currently in use helping to improve patient care.
Alyson is a registered nurse and is certified in oncology nursing (OCN) through the Oncology Nursing Society (ONS). She also has her certification as an ONS Biotherapy and Chemotherapy Provider. Alyson studied nursing at Thomas Jefferson University where she obtained her Bachelor’s of Science in Nursing (BSN). Since starting her nursing career in 2004, Alyson has had a strong dedication and commitment to oncology patients. She has worked inpatient specializing in Bone Marrow and Peripheral Blood Stem Cell Transplantation. Alyson currently works in outpatient oncology at the North Shore-LIJ Monter Cancer Center. Alyson is part of the clinical team at Savor Health where she counsels patients on oncology and oncology nutrition issues and contributes to website and other Savor Health content.
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Michelle is a Registered Dietitian specializing in oncology. She works as a clinical dietitian at an ambulatory cancer center in New York City and is a consultant for Savor Health. She is passionate about educating oncology patients on the importance of nutrition during their fight against cancer and helping them to optimize their nutrition through all phases of treatment. Michelle received her Bachelor of Science degree in dietetics from the University of Wisconsin-Madison and her Master of Science degree in Clinical Nutrition from New York University.
Denise Sievering is a Registered Dietitian who is board certified in Oncology Nutrition as well as Nutrition Support. A fluent Spanish speaker, Denise joined the Savor Health team to support Spanish speaking cancer patients and to continue to expand the Platform’s nutritional strategies and recommendations in Spanish. Denise holds a Bachelor of Science degree from Rutgers University, and completed her internship at New York Presbyterian Hospital (NYP). Denise started her career as a registered dietitian at NYP-Columbia University Medical Center, primarily covering inpatient Oncology units. Denise also holds a Master of Arts degree in Mental Health Counseling from New York University, and incorporates her advanced training in motivational interviewing and empathic listening in her patient encounters, particularly those whose lives have been forever changed by a cancer diagnosis. A New Jersey native, Denise now resides in sunny San Diego, CA where she works as a part-time outpatient Oncology dietitian at Scripps Health-MD Anderson Cancer Center, and also works as an inpatient dietitian at Kaiser Permanente. In her spare time, Denise can be found at a mom-and-pop taco shop, one of the many local craft breweries, and exploring her new city of San Diego with her husband and her rescue pup, Ripley.
Karen is a Registered Dietitian, Board Certified Specialist in Oncology Nutrition and registered in New York as a Certified Dietitian Nutritionist. Fluent in Spanish, Karen joined the Savor Health team to support Spanish speaking cancer patients and to continue to expand the Platform’s nutritional strategies and recommendations in Spanish. Karen received her Bachelor of Science degree from Ithaca College and her Master of Science degree from Hunter College. She works as an outpatient oncology dietitian in New York. Karen often works with local community centers to host nutrition programs for cancer survivors and their families, leading classes on how to live healthier lifestyles throughout their continuum of care. The American Institute of Cancer Research selected to showcase one of her many programs at their conference in 2019. Karen has written for and lent commentary to various publications and truly enjoys teaching people how to eat better. She loves to cook and strongly feels that healthy food doesn’t have to taste bad.
Allie is a Registered Dietitian and a Certified Specialist in Oncology (CSO). She joins Savor in 2023, bringing years of experience from the John Theurer Cancer Center in New Jersey, where she worked with patients with a variety of cancers. Her goal is to help people feel their best, both mentally and physically, when physical health challenges arise. She believes in the power of nutrition ever since the impact it made on her athletic career as a volleyball player during college. Allie graduated with her Bachelor of Science degree from University of Maryland-Baltimore County and has her Master’s degree in Human Nutrition from the University of Wisconsin Stout. She enjoys travelling, enjoying different cuisines, cooking, and hiking and other outdoor activities with her family and dog.
Julia Penberg is a seasoned healthcare professional with more than 30 years of experience focusing on maximizing operational excellence, leading clinical program development and building strong cross-functional teams. Her previous roles include overseeing the performance of clinical managers and nurse practitioners across multiple markets within United Healthcare-Optum’s Medicare Advantage and dual-eligible special needs populations, payer outreach and program development at Mayo Clinic, ground level specialty hospital development and direct patient care as a family and dermatology nurse practitioner. Julia volunteered as an operating room nurse and nurse practitioner on several mission trips to Romania and was a support group leader for the Kansas City chapter of the International Myeloma Foundation. Her motivation throughout her career has been with wellness promotion, disease risk modification and ensuring the best patient experience across the health continuum. Ms. Penberg received an MBA from the University of Dallas; a MS in Nursing from the University of Kansas and a BS in Nursing from the University of Texas-Austin. She is board certified as a Family Nurse Practitioner.
Rachel is a Registered Dietitian and Board Certified Specialist in Oncology Nutrition (“CSO”). She joined NYP-Columbia as the outpatient oncology dietitian in 2020 after working at Jamaica Hospital Medical Center for two years. Rachel completed her dietetic internship through Keene State College in 2017. She is pursuing an MS in Integrative Nutrition at Stony Brook University and has a BS in Human Nutrition, Foods and Exercise from Virginia Tech. Rachel provides nutrition counseling to all types of oncology patients and helps them understand the mental and physical benefits of nutrition as an ally in their fight against cancer. In her free time she enjoys slow meals with family and friends, Pilates, and tending to her fire escape garden.
Allie Werner is a Registered Dietitian at Fresenius Kidney Care where she provides medical nutrition therapy diet counseling to patients on Dialysis. She received her Bachelor’s Degree in nutrition from Indiana University and completed her Master’s Degree and dietetic internship at Loyola University Chicago. In her free time she enjoys spending time with friends and family, checking out the amazing food scene in downtown Chicago, and exercising on her Peloton bike.
Immersed in the tech world for a decade, I've coded, led teams, and honed my skills in architecture and design. As a tech enthusiast, I've seamlessly woven through full-stack projects, fusing my love for code with the art of leadership.
Mohit is a full-stack developer with expertise in Python and JavaScript, known for his efficient coding and ability to deliver scalable software solutions. His technical contributions are highlighted on GitHub and Stack Overflow, demonstrating his commitment to the tech community and problem-solving skills. With a solid educational foundation and a diverse project portfolio, Mohit excels at navigating complex challenges and is well-equipped to contribute to dynamic software projects.
Rayna McCann is a Registered Dietitian and Board Certified Specialist in Oncology Nutrition. She is a Registered Yoga Teacher and yoga4cancer certified. She received her BS in Nutrition at Penn State University and her MS from Stony Brook University. For work, Rayna wears many hats in the world of nutrition and worked for years in clinical settings focusing on oncology nutrition. She is also an Adjunct Professor and passionate about inspiring the future of dietitians. Throughout her career, she has received awards recognizing her dedication to patient safety and her contributions to improving malnutrition awareness. In 2022, Rayna was proud to accept the ‘Dietitian of the Year’ award through the Long Island Academy of Nutrition and Dietetics. Rayna has co-authored abstracts for poster presentations within the American Institute for Cancer Research conference, as well as, the Nutrition and Dietetics Food and Nutrition Conference Expo and subsequent publication. She has enjoyed authoring articles, including an article for The Cure magazine regarding Multiple Myeloma and nutrition. When Rayna is not participating in nutrition related activities, she is dedicated to dog rescue.