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== Rationale for fibre supplement Use ==
== Rationale for fibre supplement Use ==


The American Dietetic Association recommends that the average adult consume 25 to 38&nbsp;grams of [[dietary fiber|dietary fibre]] per day.<ref name=ADA2008>{{Cite journal
⚫
The American Dietetic Association recommends that the average adult consume 25 to 35&nbsp;grams of [[dietary fiber|dietary fibre]] per day. However, research has shown that the average American only consumes 14 to 15&nbsp;grams per day. To reach the recommended amount of fibre, consumption of [[dietary fiber|dietary fibre]] from foods (e.g. plants, vegetables, legumes, and grains) instead of supplements is preferred because they contain additional beneficial nutrients and non-nutritive components (e.g. [[antioxidant]]s and [[phytoestrogens]]). Nevertheless, a fibre supplement may be needed to prevent [[constipation]] when food intake is low, which is the case among inactive elderly. A cereal bran such as [[psyllium seed husks|psyllium seed husk]], or [[methyl cellulose|methylcellulose]] is often used in this case.<ref>Marlett, J. A., McBurney M.I., & Slavin, J.L. (2002). Position of the American Dietetic Association: Health implications of dietary fiber. Journal of the American Dietetic Association, 102, 993-1000. doi: 10.1016/S0002-8223(02)90228-2</ref>
| last1 = Slavin | first1 = J.
| title = Position of the American Dietetic Association: health implications of dietary fiber
| journal = J Am Diet Assoc
| volume = 108
| issue = 10
| pages = 1716–31
| year = 2008
| month = October
| pmid = 18953766
| doi = 10.1016/j.jada.2008.08.007
⚫
}}</ref> However, research has shown that the average American only consumes 14 to 15&nbsp;grams per day.<ref name=ADA2008/> To reach the recommended amount of fibre, consumption of [[dietary fiber|dietary fibre]] from foods (e.g. plants, vegetables, legumes, and grains) instead of supplements is preferred because they contain additional beneficial nutrients and non-nutritive components (e.g. [[antioxidant]]s and [[phytoestrogens]]). Nevertheless, a fibre supplement may be needed to prevent [[constipation]] when food intake is low, which is the case among inactive elderly. A cereal bran such as [[psyllium seed husks|psyllium seed husk]], or [[methyl cellulose|methylcellulose]] is often used in this case.<ref>{{Cite journal
| last1 = Marlett | first1 = JA
| last2 = McBurney | first2 = MI
| last3 = Slavin | first3 = JL
| last4 = American Dietetic | first4 = A.
| title = Position of the American Dietetic Association: health implications of dietary fiber
| journal = J Am Diet Assoc
| volume = 102
| issue = 7
| pages = 993–1000
| year = 2002
| month = July
| pmid = 12146567
| doi = 10.1016/S0002-8223(02)90228-2
}}</ref>


== Common fibre supplements in the market ==
== Common fibre supplements in the market ==
Line 39: Line 64:
In the second study, the total and [[Low-density lipoprotein|LDL-cholesterol]] levels of mildly [[hypercholesterolemia|hypercholesterolaemic]] men were lowered.<ref>Mee, K. A., & Gee, D. L. (1997). Apple fiber and gum arabic lowers total and LDL-cholesterol levels in men. Journal of the American Dietetic Association, 97(4), 422.</ref>
In the second study, the total and [[Low-density lipoprotein|LDL-cholesterol]] levels of mildly [[hypercholesterolemia|hypercholesterolaemic]] men were lowered.<ref>Mee, K. A., & Gee, D. L. (1997). Apple fiber and gum arabic lowers total and LDL-cholesterol levels in men. Journal of the American Dietetic Association, 97(4), 422.</ref>


In another study, a dietary supplement consisting of both [[dietary fiber|soluble fibre]] (guar gum, pectin) and [[dietary fiber|insoluble fibre]] (soy fibre, pea fibre, corn bran) was found to reduce [[Low-density lipoprotein|LDL-cholesterol]] for individuals that have mild to moderate [[hypercholesterolemia|hypercholesterolaemia]] without reducing [[high-density lipoprotein|HDL-cholesterol]] or increasing [[triglycerides]].<ref>Knopp, R.H., Superko, R., Davidson, M., Insull, W., Dujovne, C.A., Kwiterovich, P.O., Zavoral, J.H., Graham, K., O'Connor, R.R., & Edelman, D.A. (1999). Long-term blood cholesterol-lowering effects of a dietary fiber supplement. American Journal of Preventative Medicine, 17, 18-23. doi:10.1016/S0749-3797(99)00039-2</ref>
In another study, a dietary supplement consisting of both [[dietary fiber|soluble fibre]] (guar gum, pectin) and [[dietary fiber|insoluble fibre]] (soy fibre, pea fibre, corn bran) was found to reduce [[Low-density lipoprotein|LDL-cholesterol]] for individuals that have mild to moderate [[hypercholesterolemia|hypercholesterolaemia]] without reducing [[high-density lipoprotein|HDL-cholesterol]] or increasing [[triglycerides]].<ref>{{Cite journal
| last1 = Knopp | first1 = RH
| last2 = Superko | first2 = HR
| last3 = Davidson | first3 = M
| last4 = Insull | first4 = W
| last5 = Dujovne | first5 = CA
| last6 = Kwiterovich | first6 = PO
| last7 = Zavoral | first7 = JH
| last8 = Graham | first8 = K
| last9 = O'Connor | first9 = RR
| title = Long-term blood cholesterol–lowering effects of a dietary fiber supplement
| journal = Am J Prev Med
| volume = 17
| issue = 1
| pages = 18–23
| year = 1999
| month = July
| pmid = 10429748
| doi = 10.1016/S0749-3797(99)00039-2
}}</ref>


Supplements containing extracted [[dietary fiber|insoluble fibre]] may have an effect on [[blood lipids]] that most resembles the effects of [[dietary fibre]]. In a more recent randomized, double blind clinical study of 58 [[hypercholesterolemia|hypercholesterolaemic]] volunteers, an extruded [[carob tree|carob]] pulp preparation added to daily diet reduced total and [[Low-density lipoprotein|LDL-cholesterol]] and improved the ratio of [[high-density lipoprotein|HDL]]:[[Low-density lipoprotein|LDL cholesterol]] in all participants, and also showed a marked reduction in [[blood cholesterol|serum cholesterol]] in the women of the study.<ref>Zunft, H. J. F., Lüder, W., Harde, A., Haber, B., Graubaum, H. J., Koebnick, C., et al. (2003). Carob pulp preparation rich in insoluble fibre lowers total and LDL-cholesterol in hypercholesterolemic patients. European Journal of Nutrition, 42(5), 235-242.</ref>
Supplements containing extracted [[dietary fiber|insoluble fibre]] may have an effect on [[blood lipids]] that most resembles the effects of [[dietary fibre]]. In a more recent randomized, double blind clinical study of 58 [[hypercholesterolemia|hypercholesterolaemic]] volunteers, an extruded [[carob tree|carob]] pulp preparation added to daily diet reduced total and [[Low-density lipoprotein|LDL-cholesterol]] and improved the ratio of [[high-density lipoprotein|HDL]]:[[Low-density lipoprotein|LDL cholesterol]] in all participants, and also showed a marked reduction in [[blood cholesterol|serum cholesterol]] in the women of the study.<ref>Zunft, H. J. F., Lüder, W., Harde, A., Haber, B., Graubaum, H. J., Koebnick, C., et al. (2003). Carob pulp preparation rich in insoluble fibre lowers total and LDL-cholesterol in hypercholesterolemic patients. European Journal of Nutrition, 42(5), 235-242.</ref>
Line 61: Line 105:
It has been suggested that the refining of fibre-rich grains has contributed to the [[epidemiology of obesity|obesity epidemic]] of [[Western countries]]. Whole, [[dietary fiber|dietary forms of fibre]] are more difficult to ingest and absorb than milled and refined food products <ref>Heaton, K.W. (1973). Food fibre as an obstacle to energy intake. Lancet, 2, 1418–1421.</ref>. This is because [[dietary fibre]] may be able to displace available [[food energy|calories]] and [[nutrients]], requires more time for chewing (thereby slowing intake rate and inducing [[satiety]]), and reduces the efficiency of absorption in the [[small intestine]] <ref>Heaton, K.W. (1973). Food fibre as an obstacle to energy intake. Lancet, 2, 1418–1421</ref><ref>Slavin, J.L. (2005). Dietary fibre and body weight. Nutrition, 21, 411-418</ref>.
It has been suggested that the refining of fibre-rich grains has contributed to the [[epidemiology of obesity|obesity epidemic]] of [[Western countries]]. Whole, [[dietary fiber|dietary forms of fibre]] are more difficult to ingest and absorb than milled and refined food products <ref>Heaton, K.W. (1973). Food fibre as an obstacle to energy intake. Lancet, 2, 1418–1421.</ref>. This is because [[dietary fibre]] may be able to displace available [[food energy|calories]] and [[nutrients]], requires more time for chewing (thereby slowing intake rate and inducing [[satiety]]), and reduces the efficiency of absorption in the [[small intestine]] <ref>Heaton, K.W. (1973). Food fibre as an obstacle to energy intake. Lancet, 2, 1418–1421</ref><ref>Slavin, J.L. (2005). Dietary fibre and body weight. Nutrition, 21, 411-418</ref>.


Supplemental forms of fibre have been shown to potentially assist weight management by increasing [[satiety]] <ref>Pasman, W.J., Saris, W.H.M., Wauters, M.A.J. & Westerterp-Plantenga, M.S. (1997). Effect of one week of fibre supplementation on hunger and satiety ratings and energy intake. Appetite, 29, 77-87.</ref><ref>Evans, E. & Millar, D.S. (1975). Bulking agents in the treatment of obesity. Nutrition and Metabolism, 18(4), 199-203. doi:10.1159/000175595</ref><ref>Slavin, J.L. (2005). Dietary fibre and body weight. Nutrition, 21, 411-418.</ref> ,decreasing the absorption rate of starches and sugars, and binding to lipids in the small intestine thereby reducing serum [[triglycerides]] and [[chylomicrons]].<ref>Khossousi, A. et al. (2005) The acute effects of a high fibre meal on postprandial blood lipids and satiety. Asia Pacific Journal of Clinical Nutrition; 2005 Supplement, Vol. 14, pS65-S65</ref>
Supplemental forms of fibre have been shown to potentially assist weight management by increasing [[satiety]] <ref>Pasman, W.J., Saris, W.H.M., Wauters, M.A.J. & Westerterp-Plantenga, M.S. (1997). Effect of one week of fibre supplementation on hunger and satiety ratings and energy intake. Appetite, 29, 77-87.</ref><ref>{{Cite journal
| last1 = Evans | first1 = E
| last2 = Miller | first2 = DS
| title = Bulking agents in the treatment of obesity
| journal = Nutr Metab
| volume = 18
| issue = 4
| pages = 199–203
| year = 1975
| pmid = 1196549
| doi = 10.1159/000175595
}}</ref><ref>Slavin, J.L. (2005). Dietary fibre and body weight. Nutrition, 21, 411-418. PMID 15797686</ref> ,decreasing the absorption rate of starches and sugars, and binding to lipids in the small intestine thereby reducing serum [[triglycerides]] and [[chylomicrons]].<ref>Khossousi, A. et al. (2005) The acute effects of a high fibre meal on postprandial blood lipids and satiety. Asia Pacific Journal of Clinical Nutrition; 2005 Supplement, Vol. 14, pS65-S65</ref>


Powdered [[guar gum]], a [[soluble fibre]], was shown to be associated with a significantly lower energy intake in [[obese]] subjects who ingested a non-restricted diet over one week, when the same participants did not consume the fibre supplement <ref>Pasman, W.J., Saris, W.H.M., Wauters, M.A.J. & Westerterp-Plantenga, M.S. (1997). Effect of one week of fibre supplementation on hunger and satiety ratings and energy intake. Appetite, 29, 77-87.</ref>.
Powdered [[guar gum]], a [[soluble fibre]], was shown to be associated with a significantly lower energy intake in [[obese]] subjects who ingested a non-restricted diet over one week, when the same participants did not consume the fibre supplement <ref>Pasman, W.J., Saris, W.H.M., Wauters, M.A.J. & Westerterp-Plantenga, M.S. (1997). Effect of one week of fibre supplementation on hunger and satiety ratings and energy intake. Appetite, 29, 77-87. PMID 9268427</ref>.


A similar reduction of energy intake through fibre supplementation was observed in another study. A dose of [[guar gum]] was administered to normal-weight and [[obese]] participants. A 10% reduction of energy was observed in the normal subjects, and a 30% reduction of energy for obese subjects <ref>Evans, E. & Millar, D.S. (1975). Bulking agents in the treatment of obesity. Nutrition and Metabolism, 18(4), 199-203. doi:10.1159/000175595</ref>.
A similar reduction of energy intake through fibre supplementation was observed in another study. A dose of [[guar gum]] was administered to normal-weight and [[obese]] participants. A 10% reduction of energy was observed in the normal subjects, and a 30% reduction of energy for obese subjects <ref>Evans, E. & Millar, D.S. (1975). Bulking agents in the treatment of obesity. Nutrition and Metabolism, 18(4), 199-203. doi:10.1159/000175595</ref>.

Revision as of 06:20, 27 December 2010

Template:Globalize/USA

Fibre supplements (or fiber supplements) are considered to be a form of a subgroup of functional dietary fibre, and in the United States are defined by the Institute of Medicine (IOM). According to the IOM, functional fibre "consists of isolated, non-digestible carbohydrates that have beneficial physiological effects in humans" [1].

Fibre supplements are widely available, and can be found in forms such as powders, tablets and capsules. Consumption of fibre supplements may be for: improving dietary intake, lowering blood cholesterol, alleviating irritable bowel syndrome, reducing the risk of colon cancer, and increasing feelings of satiety.

Excessive fibre intake can lead to fluid imbalance, dehydration, mineral deficiencies, nutrient and drug interactions and other medical problems.

Rationale for fibre supplement Use

The American Dietetic Association recommends that the average adult consume 25 to 38 grams of dietary fibre per day.[2] However, research has shown that the average American only consumes 14 to 15 grams per day.[2] To reach the recommended amount of fibre, consumption of dietary fibre from foods (e.g. plants, vegetables, legumes, and grains) instead of supplements is preferred because they contain additional beneficial nutrients and non-nutritive components (e.g. antioxidants and phytoestrogens). Nevertheless, a fibre supplement may be needed to prevent constipation when food intake is low, which is the case among inactive elderly. A cereal bran such as psyllium seed husk, or methylcellulose is often used in this case.[3]

Common fibre supplements in the market

Capsule/Chewable Tablet Forms Soluble/Insoluble Powder Forms Soluble/Insoluble
PGX S Colon Pure S
Benefiber S Benefiber S
FibreSmart S/I FiberSmart S/I
Fiber Choice S Organic Clear Fiber S
Natural Brand Psyllium seed husk S ReCleanse Fibre Powder S/I

S=Soluble, I=Insoluble

Fibre supplement claims

Blood cholesterol reduction

Foods that are high in viscous fibres have been found to lower blood cholesterol by binding with bile acids. In order to compensate for this, cholesterol from the liver may be used to make more bile acids. The products of bacterial fermentation in the colon may also decrease the rate of cholesterol synthesis in the liver.[4]

However, research has produced mixed results with respect to whether fibre supplements are as effective as dietary fibre in reducing blood cholesterol. Two recent studies show nearly opposing results, using fibre-supplemented apple juice containing both the soluble pectin from apples and gum arabic. In the first study, the supplement-enriched juice had no discernible effect on the blood cholesterol levels of 110 hypercholesterolaemic men and women.[5] In the second study, the total and LDL-cholesterol levels of mildly hypercholesterolaemic men were lowered.[6]

In another study, a dietary supplement consisting of both soluble fibre (guar gum, pectin) and insoluble fibre (soy fibre, pea fibre, corn bran) was found to reduce LDL-cholesterol for individuals that have mild to moderate hypercholesterolaemia without reducing HDL-cholesterol or increasing triglycerides.[7]

Supplements containing extracted insoluble fibre may have an effect on blood lipids that most resembles the effects of dietary fibre. In a more recent randomized, double blind clinical study of 58 hypercholesterolaemic volunteers, an extruded carob pulp preparation added to daily diet reduced total and LDL-cholesterol and improved the ratio of HDL:LDL cholesterol in all participants, and also showed a marked reduction in serum cholesterol in the women of the study.[8]

Gastrointestinal health

Colorectal cancer

The protective properties of dietary fibre against colorectal cancer are undisputed. However, fibre supplements do not seem to provide the same defensive effect. A study of 1429 men and women over six months showed that a high-fibre cereal (wheat bran) supplement had no protective effect on recurring colorectal adenomas. In addition, no significant improvement in the proportion or features of existing colorectal adenomas was observed[9].

Diverticular disease

Diverticulitis is mainly attributed to the low fibre intake typical of the Western diet for which gradual increase dietary fibre over several weeks is common clinical solution. Fibre supplements are again much less effective. One study of 58 men and women with uncomplicated diverticulitis in a double-blind controlled trial concluded that common doses of wheat bran and a psyllium-derived supplement provided relief of constipation only, with no other observable effects.[10]

Irritable Bowel Syndrome

Irritable Bowel Syndrome (IBS) is a common gastrointestinal ailment for which dietary fibre is often prescribed as part of a therapeutic solution. As a supplement, partially hydrolysed guar gum (PHGG - completely soluble, fully fermentable[11]) has been shown to be quite effective in clinical trials for decreasing IBS symptoms such as abdominal pain and generally improving quality of life for sufferers well beyond treatment. In addition, PHGG has been shown to have prebiotic properties by acidifying bowel contents and increasing gut microflora.[12]

Weight management

It has been suggested that the refining of fibre-rich grains has contributed to the obesity epidemic of Western countries. Whole, dietary forms of fibre are more difficult to ingest and absorb than milled and refined food products [13]. This is because dietary fibre may be able to displace available calories and nutrients, requires more time for chewing (thereby slowing intake rate and inducing satiety), and reduces the efficiency of absorption in the small intestine [14][15].

Supplemental forms of fibre have been shown to potentially assist weight management by increasing satiety [16][17][18] ,decreasing the absorption rate of starches and sugars, and binding to lipids in the small intestine thereby reducing serum triglycerides and chylomicrons.[19]

Powdered guar gum, a soluble fibre, was shown to be associated with a significantly lower energy intake in obese subjects who ingested a non-restricted diet over one week, when the same participants did not consume the fibre supplement [20].

A similar reduction of energy intake through fibre supplementation was observed in another study. A dose of guar gum was administered to normal-weight and obese participants. A 10% reduction of energy was observed in the normal subjects, and a 30% reduction of energy for obese subjects [21].

Fibre supplementation has also been indicated to assist compliance to low-calorie diets, as indicated through decreased feelings of hunger and increased ratings of satiety [22].

Safety considerations

Abruptly adding elevated amounts of fibre to the diet too quickly can lead to intestinal gas, diarrhoea, abdominal bloating, cramping and constipation. It is therefore better to regulate and moderate daily fibre intake. If increased fibre intake is desired, gradually increasing the amount over a few days allows the natural bacteria in the gastrointestinal tract to adjust to the change. Drinking 6 to 8 glasses of water everyday can prevent some uncomfortable symptoms by making the stool soft and bulky.

Excessive fibre intake not only contributes to all of the abovementioned symptoms, but may also lead to toxicity. The risk of Intestinal obstruction in susceptible individuals[23], fluid imbalance leading to dehydration and mineral deficiencies may increase if we ingest more than 50g of fibre per day. For this reason, individuals who decide to suddenly double or triple their fibre intake are often advised to double or triple their water intake. In addition, excessive intake of non-fermentable fibre, (typically in supplemental form) may lead to mineral deficiencies by reducing the absorption or increasing the excretion of minerals, especially when mineral intake is too low or when mineral needs are increased such as during pregnancy, lactation, or adolescence.

Excessive fibre intake can also contribute to nutrient and drug interactions. For example, antidepressant medications, diabetes medications, Carbamazepine [24], cholesterol-lowering medications and Penicillin.

See also

References

  1. ^ Institute of Medicine of the National Academies. (2005). "Dietary Reference Intakes for energy, carbohydrates, fiber, fat, fatty acids, cholesterol, protein and animo acids". Washington, DC: National Academies Press. Retrieved from http://books.nap.edu/openbook.php?record_id=10490&page=R1
  2. ^ a b Slavin, J. (2008). "Position of the American Dietetic Association: health implications of dietary fiber". J Am Diet Assoc. 108 (10): 1716–31. doi:10.1016/j.jada.2008.08.007. PMID 18953766. {{cite journal}}: Unknown parameter |month= ignored (help)
  3. ^ Marlett, JA; McBurney, MI; Slavin, JL; American Dietetic, A. (2002). "Position of the American Dietetic Association: health implications of dietary fiber". J Am Diet Assoc. 102 (7): 993–1000. doi:10.1016/S0002-8223(02)90228-2. PMID 12146567. {{cite journal}}: Unknown parameter |month= ignored (help)
  4. ^ Whitney, E., & Rolfes, S. R. (2005). Understanding Nutrition. Belmont, CA: Thomson Wadsworth.
  5. ^ Davidson, M. H., & Dugan, L. D. (1998). A low-viscosity soluble-fiber fruit juice supplement fails to lower cholesterol. Journal of Nutrition, 128(11).
  6. ^ Mee, K. A., & Gee, D. L. (1997). Apple fiber and gum arabic lowers total and LDL-cholesterol levels in men. Journal of the American Dietetic Association, 97(4), 422.
  7. ^ Knopp, RH; Superko, HR; Davidson, M; Insull, W; Dujovne, CA; Kwiterovich, PO; Zavoral, JH; Graham, K; O'Connor, RR (1999). "Long-term blood cholesterol–lowering effects of a dietary fiber supplement". Am J Prev Med. 17 (1): 18–23. doi:10.1016/S0749-3797(99)00039-2. PMID 10429748. {{cite journal}}: Unknown parameter |month= ignored (help)
  8. ^ Zunft, H. J. F., Lüder, W., Harde, A., Haber, B., Graubaum, H. J., Koebnick, C., et al. (2003). Carob pulp preparation rich in insoluble fibre lowers total and LDL-cholesterol in hypercholesterolemic patients. European Journal of Nutrition, 42(5), 235-242.
  9. ^ Vitanzo Jr., P. C., & Hong, E. S. (2000). Does a high-fiber dietary supplement of wheat bran reduce the recurrence rate of colorectal adenomas? Journal of Family Practice, 49(7), 656-656.
  10. ^ Ornstein, M. H., Littlewood, E. R., Baird, I. M., Fowler, J., North, W. R. S., & Cox, A. G. (1981). Are fibre supplements really necessary in diverticular disease of the colon? A controlled clinical trial. British Medical Journal (Clin Res Ed), 282(6273), 1353.
  11. ^ American Association of Cereal Chemists http://www.aaccnet.org/meetings/2000/Abstracts/a00ma043.htm
  12. ^ Giannini, E. G., Mansi, C., Dulbecco, P., & Savarino, V. (2006). Role of partially hydrolyzed guar gum in the treatment of irritable bowel syndrome. Nutrition, 22(3), 334-342.
  13. ^ Heaton, K.W. (1973). Food fibre as an obstacle to energy intake. Lancet, 2, 1418–1421.
  14. ^ Heaton, K.W. (1973). Food fibre as an obstacle to energy intake. Lancet, 2, 1418–1421
  15. ^ Slavin, J.L. (2005). Dietary fibre and body weight. Nutrition, 21, 411-418
  16. ^ Pasman, W.J., Saris, W.H.M., Wauters, M.A.J. & Westerterp-Plantenga, M.S. (1997). Effect of one week of fibre supplementation on hunger and satiety ratings and energy intake. Appetite, 29, 77-87.
  17. ^ Evans, E; Miller, DS (1975). "Bulking agents in the treatment of obesity". Nutr Metab. 18 (4): 199–203. doi:10.1159/000175595. PMID 1196549.
  18. ^ Slavin, J.L. (2005). Dietary fibre and body weight. Nutrition, 21, 411-418. PMID 15797686
  19. ^ Khossousi, A. et al. (2005) The acute effects of a high fibre meal on postprandial blood lipids and satiety. Asia Pacific Journal of Clinical Nutrition; 2005 Supplement, Vol. 14, pS65-S65
  20. ^ Pasman, W.J., Saris, W.H.M., Wauters, M.A.J. & Westerterp-Plantenga, M.S. (1997). Effect of one week of fibre supplementation on hunger and satiety ratings and energy intake. Appetite, 29, 77-87. PMID 9268427
  21. ^ Evans, E. & Millar, D.S. (1975). Bulking agents in the treatment of obesity. Nutrition and Metabolism, 18(4), 199-203. doi:10.1159/000175595
  22. ^ Pasman, W.J., Saris, W.H.M., Wauters, M.A.J. & Westerterp-Plantenga, M.S. (1997). Effect of one week of fibre supplementation on hunger and satiety ratings and energy intake. Appetite, 29, 77-87.
  23. ^ Hillemeier C. An overview of the effects of dietary fibre on gastrointestinal transit. Pediatr. 1995:997-999.
  24. ^ Ettinger AB, Shinnar S, Sinnett MJ, Moshe SL. Carbamazepine-induced constipation. J Epilepsy. 1992;5(3):191-193.
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