Fiber‘s role in disease:
A lifelong demolition derby
If you consume minor quantities of fiber from
natural, unprocessed food, there isn‘t anything wrong with it,
because (a) small amounts of natural fiber (which is mostly
soluble) will not obstruct your intestines or cause diarrhea,
(b) most of it will get fermented in the large intestine, and
(c) the remainder will not bulk up the volume of stool high
enough to cause any damage from “roughage.” But that‘s not what
most Americans do or are urged to do:
Average recommended fiber intake (grams per day)
These are the standing recommendations from the Food and
Nutrition Board, a division of the Institute of Medicine
of the National Academies, which is the body that
establishes the nutritional policy guidelines of the U.S.
Government. Let‘s analyze these recommendations:
Children from one to
eight: The recommended amount is sky-high even by the
standards of the American Dietetic Association. It isn‘t
based on the actual need, but on the fact that up to 25% of
children in this age group suffer from constipation related to
the abuse of antibiotics, lack of breastfeeding, poor toilet
training, inadequate nutrition, frequent diarrhea, and other
factors. In this case, fiber is used as a hard laxative instead
of correcting the primary causes of constipation. The large
intestine of a one-year-old is about one-tenth the size of a
fully-grown adult‘s, but the recommended dose is half of the
adult‘s (19 g vs. 38 g or 0.7 vs. 1.3 oz). With that much fiber
in the diet, the child will be irritable from abdominal pain,
bloated from the large volume of stools, flatulent from gases,
prickly with food because eating causes cramps, and prone to
frequent bouts of diarrhea alternating with constipation from
all of the above. That‘s a direct path to malnutrition, stunted
growth, poor development, and academic mediocrity.
Teenagers and adults:
Similar amounts of fiber are recommended for teenagers and
adults—from 26 to 38 g (0.9–1.3 oz) daily. If you consume that
much fiber, it means large stools, inevitable anorectal damage,
and eventual dependence on fiber to move the bowels.
As people get older, less fiber is recommended (not more, as one
may think) because the digestive organs are no longer as agile
and healthy. Unfortunately, this is not what most constipated
elderly patients hear from medical professionals. The majority
urge seniors to increase fiber consumption in order to relieve
constipation. Even so, 20 to 30 g (0.7–1.0 oz) of fiber for
people over 50, half of whom already suffer from hemorrhoidal
disease (and from diverticular disease by the age of 60) is a
prescription for trouble.
As the dynamics of
a “broken telephone” transform already bad advice, it gets
worse, much worse. Here are the “enhanced” recommendations from
what is considered one of the best medical and research
institutions in the nation, The Mayo Clinic. The article
is entitled “Fiber—A Good Carb”:
The June issue of Mayo Clinic Women's
HealthSource suggests ways to increase fiber in your diet:
— Eat a high-fiber cereal or add a few
spoonfuls of unprocessed wheat bran to your cereal.
- Add bran cereal or unprocessed bran
when making foods such as meatloaf, breads, muffins, cakes,
— Choose whole-grain bread instead of
white bread. Look for breads made with 100 percent
— Substitute whole-wheat flour for half
or all of the white flour when baking.
— Experiment with whole grains and
whole-grain products such as brown rice, barley, whole-wheat
pasta, and bulgur.
— Try adding canned kidney beans,
garbanzos and other beans to canned soups or salads.
— Eat snacks that are high in fiber,
such as fresh and dried fruits, raw vegetables, low-fat
popcorn, and whole-grain crackers.
— Add barley to soups and stews.
— Eat generous quantities of vegetables
Mayo Clinic Women‘s HealthSource
If you follow this
advice, just one cup (60 g/2 oz) of
All-Bran® With Extra Fiber
cereal gives you 30 g of fiber, already the daily amount
recommended for adults, and many more times for children. And
that‘s just for breakfast, before adding in the recommended
breads, salads, soups, stews, and “generous quantities of
vegetables and fruits” throughout the rest of the day.
Think about it—just one cup of fiber-fortified cereal contains
three times more fiber than the maximum recommended daily
dose for fiber laxatives, such as Metamucil® (3.4 g up to three
times daily). Even that little, just under 12 g of fiber in
Metamucil, may cause severe side effects:
Bloating, gas, and a feeling of fullness
may occur. If these effects continue or become bothersome,
inform your doctor. Notify your doctor if you experience:
stomach cramps, nausea, vomiting, rectal bleeding,
unrelieved constipation. If you notice other effects not
listed above, contact your doctor or pharmacist.
Patient Counseling at www.RiteAid.com
To all intents and
purposes, the indigestible fiber in cereals isn‘t any different
from the fiber in Metamucil‘s psyllium—fiber is fiber regardless
of the source. People who aren‘t accustomed to a high-fiber diet
may have identical side effects whether it is Metamucil or
Shocked? Puzzled? Surprised? Bewildered? Here
is a brief Q&A which explains why the side effects of various
kinds of fiber consumption are identical:
Q. Why does fiber cause bloating?
A. Because (a) fiber fermentation inside the
intestines produces gases, and (b) because the acidity from
fermentation causes intestinal inflammation. Since the
absorption of gases is the primary function of the intestine,
the combined impact of (a) and (b) blocks their absorption, and
causes the intestines to expand just like an air balloon.
Q. Why does fiber cause gas?
A. The intestines are colonized with symbiotic
bacteria (normal intestinal flora), which are essential for many
health-sustaining functions. Normally, mucin—a component of
mucus—provides bacteria with the nutrients they need. But when
fiber—soluble as well as insoluble—reaches the lower intestine,
the bacteria go wild, ferment everything in sight, and multiply
prodigiously. The fermentation is accompanied by lots of gases,
just as with yeast-rising dough or aging champagne. If you don‘t
experience gas after ingesting fiber, it means that your
intestines lack normal bacteria, and you are affected by
disbacteriosis, a serious pathology which is explained in
Chapter 4, Disbacteriosis.
Q. Why does fiber cause “stomach cramps”?
A. Actually, not stomach cramps, but abdominal
cramps. The cramping is a pain sensation in the abdominal region
that results from gases, inflammation, acidity, intestinal
obstruction, and large stools, or that stems from regular
contractions of affected sections of the small and large
Q. Why does fiber cause nausea and vomiting?
A. Once inside the stomach, fiber lumps
together and may cause mechanical stimulation of the receptors
that activate the vomiting center in the brain. The lumped fiber
may also temporarily obstruct the path between the stomach and
duodenum, and cause vomiting related to the stomach‘s overload
or delayed emptying. If you have gastritis (inflammatory stomach
disease) or ulcers, the likelihood of fiber-related nausea and
vomiting is even higher because of the fiber‘s contact with
extra-sensitive impaired tissues.
Q. Why does fiber cause “rectal bleeding?
A. Doctors, nutritionists, and dietitians refer
to fiber as “bulk” or “roughage,” because it makes stools rough
and bulky. When large stools pass through the narrow anal canal,
they may lacerate its delicate lining, and cause bleeding. Large
stools and the straining needed to expel them are also behind
hemorrhoidal disease and anal fissures—lacerations inside the
anal canal that won‘t heal. Far more dangerous bleeding may
result from ulcerative colitis, caused by the prolonged contact
of undigested fiber and large stools with the colorectal mucosal
membrane. Ulcerative colitis raises the risk of colorectal
cancer by 3,200%. The mechanical and chemical properties of
fiber and large stools are also the most likely causes of
Q. Why does fiber cause “unrelieved
A. For the same reason it causes anorectal
bleeding. When stools become large from excess fiber, many
people, particularly children, seniors, and those affected by
hemorrhoidal disease or anal fissures, simply can‘t pass them.
If this condition isn‘t quickly resolved, it may lead to fecal
impaction. The continuous accumulation of impacted stools may
cause diverticular disease (the bulging of the colorectal wall),
megacolon (permanent stretching of the colorectal walls), and
colorectal perforation (the spilling of intestinal content into
the abdominal cavity), which is usually lethal.
Q. Why are there no fiber warnings printed on
the boxes of fiber-fortified cereals?
A. Cigarettes didn‘t have any warnings either
for a long, long time. It takes a while to change a belief
Q. I am young, fit, and healthy, and I consume
lots of fiber. And it causes me no harm. Why?
A. Fiber is very much like a bomb with a time-delay fuse. For a
while, it will not visibly affect you, because young people are
still active enough to burn off all excess carbs, their
intestines are still supple enough to process fiber, and young
anorectal organs are still strong enough to handle large stools.
Alas, if you keep consuming lots of fiber, your youthful bliss
may soon be over. Just ask your parents and grandparents.
Avoiding dietary fiber in food isn‘t an easy
task. It is often hidden behind obscure names such as cellulose,
β-glucans, pectin, guar gum, cellulose gum, carrageen,
agar-agar, hemicellulose, inulin, lignin, oligofructose,
fructooligosaccharides, polydextrose, polylos, psyllium,
resistant dextrin, resistant starch, and others.
These ingredients are factory-made from wood
pulp, cotton, seaweed, husks, skins, seeds, tubers, and selected
high-yield plants that aren‘t suitable for human consumption
without extra processing. They are widely used to add texture
and volume to ersatz food. For example, guar gum or cellulose
gum are added to water and dry milk in order to fake yogurt or
sour cream consistency, carrageen gives texture to cheap ice
cream, and pectin thickens fruit preserves.
The only reliable way of avoiding hidden
sources of fiber is this: read the labels! if you didn‘t learn
the name of the ingredient on the product‘s label by the first
grade, it doesn‘t belong on your plate or inside your gut.
So let‘s stroll along the mouth-to-anus pathway
and check out the damage from this fiber orgy.
Fiber‘s affect on the oral cavity: As sticky as
The human mouth is primarily intended to cut
and chop flesh, not grind indigestible fibers. Unlike humans,
cows have so-called hypsodont teeth, which extend very far above
the gum line and grow continuously to accommodate a lifetime of
wear-and-tear from grinding fibrous grasses.
We aren‘t as lucky—our teeth are brachydont,
and aren‘t intended for chewing fiber, otherwise, after a decade
or so, you simply wouldn‘t have any teeth left to argue this
point with clarity. That‘s why the fiber for human
consumption is crushed, milled, or ground first, and requires
little or no chewing. But even after processing, it affects the
oral cavity with a menacing vengeance:
of the salivary glands. Fiber, especially in dry-roasted
cereals, has a tendency to obstruct the salivary glands. When
that happens, the tongue senses a polyp-like protrusion. Though
unpleasant, this benign problem may, in some instances, cause
acute inflammation and require treatment with antibiotics.
caries. Powdered (well-milled) fiber of any kind has a
natural tendency to lodge itself inside the abrasions both on
the chewing surfaces and between the teeth. Once there, it
provides perfect feed for normal oral flora. The bacterial
fermentation in the mouth produces lactic acids that bind with
the minerals that form the enamel mineral matrix. In turn, the
weakening of the matrix causes dental caries. That‘s why all
kinds of fiber-rich products, especially cereals, are
exceptionally destructive for dental health. Not surprisingly,
tooth decay is the second most common disease in the United
States. The common cold is the first. Weak immunity related to
disbacteriosis happens to be one of the leading causes of most
colds as well.
disease (gingivitis, necrotizing ulcerative gingivitis,
periodontitis). Pulverized fiber lodges easily inside the
gingival sulcus, a pocket that exists between the teeth and the
gums (gingiva). The bacterial fermentation inside the sulcus
causes inflammation of gingiva, the periodontal ligament, and
alveolar bone, and eventual tooth loss. Gingivitis—the initial
stage of periodontal disease—is easily recognized by bleeding
gums. A receding gum line, even without bleeding, indicates the
progression of periodontal disease.
Fiber‘s affect on the esophagus: If not plugged,
The esophagus is the narrow muscular tube that
transports chewed food and water from the mouth to the stomach.
A chewed mass is called a bolus. The bolus travels the entire
length of the esophagus in just a few seconds. This unassuming
organ is quite vulnerable to the vagaries of indigestible fiber.
The impact is indirect, through the digestive disorders of the
stomach, such as heartburn, but the suffering is real—millions
of people suffer from dysphagia, the difficulty or inability to
swallow food. The other prominent fiber-related complications
obstruction. Supplemental fiber may rapidly expand and
cause an obstruction when not accompanied by a lot of liquid. It
isn‘t likely to happen in healthy adults, but is probable in
small children, people with a narrowed esophagus or affected by
dysphagia (difficulty swallowing), as well as the mentally
disabled, old, and infirm.
is the most common symptom of gastroesophageal reflux disease
(GERD)—a spilling over (reflux) of the stomach‘s content back
into the esophagus. The burning sensation emanates from the
esophageal mucosa, unprotected from digestive juices and
esophagus (change of mucosa, precursor to cancer),
dysphagia (difficulty swallowing),
ulceration, bleeding, and esophageal cancer. Indirectly through
the GERD, indigestible fiber is a primary causative factor
behind these conditions.
Fiber‘s affect on the stomach: The luck stops
The digestion of protein is the exclusive
provenance of the stomach. When gastric digestion commences, the
contents of the stomach are churned inside, until it‘s
completed (i.e. solid particles of food larger than 2
millimeters, or 0.08,” are no longer detected).
Fiber‘s specific properties—water absorbency,
expansion, stickiness (congregation)—interfere with digestion
and may cause an array of gastric disorders. Fiber-related
problems become more pronounced with age because of the
inevitable wear-and-tear on the internal organs. Insoluble fiber
affects the stomach particularly hard because it tends to
congregate and form lumps, and its rapid expansion fills the
stomach with idle bulk.
You don‘t even need to consume that much fiber
to feel its punch. For example, TV commercials for antacids are
commonly shot inside Mexican restaurants because beans—a main
staple of Mexican cuisine—commonly cause heartburn, even though
a 100 g (0.22 lb) serving of beans contains a paltry 4 to 5 g of
fiber. Just imagine the cumulative impact on the aging stomach
of 30 to 40 grams of fiber consumed daily. Here are the most
and vomiting. The congregated lumps of fiber may cause
mechanical stimulation of the receptors that activate the
vomiting center in the brain. That much, as you recall, is
stated in the side effect section of common fiber supplements.
Duodenal obstruction). The lumps of expanded fiber,
primarily from supplements, may temporarily obstruct the path
between the stomach and duodenum. If there are no other
pathologies, the situation resolves itself with nausea and
(delayed stomach emptying). The stomach‘s peristalsis and
digestion are completed when specialized receptors no longer
detect undigested components over 2 mm. The undigested lumps of
fiber may considerably extend the duration of the gastric phase
of digestion because the stomach can‘t distinguish between an
undigested chunk of meat and a lump of fiber. This problem is
particularly acute among older individuals, who may have weak
peristaltic contractions of the stomach. The digestion can
extend from the customary 4–6 hours to 10, 12, and beyond. The
extended exposure of the stomach lining to digestive juices and
enzymes, particularly while laying down, may cause inflammation
and ulceration of the esophagus and upper stomach regions
(cardia and fundus), that aren‘t as well-protected as its lower
regions (antrum and pylorus). [The original meaning of
gastroparesis is the paralysis (paresis) of the
stomach‘s peristalsis related to nerve damage from trauma,
diabetes, surgery, medication, and other causes. Today this term
is broadly used as delayed stomach emptying irrespective
of nerve damage – ed.]
Reflux Disease (GERD). Simply speaking,
GERD results from two primary factors: overloading the stomach
with food and liquids, and delayed digestion (indigestion).
Because indigestible fiber expands four to five times its size,
it is the largest contributor to the stomach‘s overload. Absence
of indigestion, heartburn, and reflux is one of the most
immediate and pronounced benefits of low- or fiber-free diets.
A general term that describes non-specific pain and discomfort
that emanates from the stomach (upper middle abdominal region).
The sensation of pain may result from conditions described above
and below. The pain may become more pronounced after a meal.
Meals heavy in all kinds of fiber cause more pain because of the
volume and the extended duration of digestion. Some medical
writers refer to dyspepsia as “indigestion.” Well, guess what
substance doesn‘t digest in the stomach?
All of the above conditions, related to fiber interfering with
or extending gastric digestion, are the primary causes of
gastritis—an inflammation of the stomach‘s mucosa, caused by the
inability of the stomach‘s lining to withstand its own
aggressive environment. The risk of gastritis goes up
exponentially if you‘re under a great deal of stress (it
inhibits digestion); consume alcohol (in small amounts it
stimulates digestion, but inhibits in large); drink coffee, chew
gum, or smoke (all three stimulate digestion); regularly take
aspirin and other NSAIDs drugs; or are infected with H.pylori
bacteria. The fiber adds to this mix far more than the
proverbial two cents. Please note that there is nothing wrong
with stimulating digestion when appropriate. The problems
develop when the digestion is stimulated inappropriately—between
meals, before going to bed, while experiencing reflux,
dyspepsia, and similar circumstances.
Gastric Ulcer (Peptic
ulcer disease). A perforation of the stomach‘s mucosa
causes ulcers. Gastritis commonly precedes ulceration and
bleeding. All of the causative factors behind gastritis apply to
ulcers as well. Fiber extends digestion. The longer the
digestion lasts, the more difficult, if not outright impossible,
for the ulcers to heal. That‘s why people who are admitted to a
hospital with a bleeding ulcer are placed on a liquids-only
diet. If a zero-fiber diet helps ulcers to heal, a low-fiber one
isn‘t as likely to cause them.
(Hiatus) Hernia. The diaphragm (midriff) is a muscular
membrane that separates the heart and lungs (thoracic cavity)
from the digestive organs (abdominal cavity). The esophagus
connects with the stomach through the esophageal hiatus—an
opening in the diaphragm. A pathological protrusion (herniation)
of the stomach‘s upper wall above the diaphragm through that
opening is called hiatal hernia. This condition affects over 40%
of the population in the United States. When the stomach
capacity is exceeded by food and fluids, the upward pressure
created by peristalsis (at the bottom of the stomach) causes its
upper walls to prolapse into the opening. Fiber is the only food
that expands four to five times its original size once inside
the stomach. This expansion creates strong volumetric pressure
long after the meal has already been consumed. Neither proteins,
nor fats, nor soluble carbohydrates can expand beyond their
initial volume. A horizontal position (i.e. while lying down) is
likely to contribute to herniation. You may have heard that
herniation contributes to heartburn, dyspepsia, gastritis, and
peptic ulcers. It isn‘t so—the hiatal hernia simply mirrors the
state of the affected stomach, and these conditions are already
present there, regardless of the hernia. Unless patients stop
recklessly stuffing their stomachs with fiber, the majority of
surgeries to remove hiatal hernias are also useless.
As you can see, the relationship between the
stomach and the fiber is awkward at best, ruinous at worse.
Well, what else would you expect when matching a primary
digestive organ with an indigestible substance?
Fiber‘s affect on the small intestine: Not
welcome at any price
The journey of food from the plate to the large
intestine—that is, through the mouth, esophagus, stomach, and
small intestine—normally takes about 24 hours, depending on what
was on that plate.
The small intestine is long and thin—about 7
meters (23‘) of coiled tubing laid out in a tight serpentine
shape (3.5 to 4 cm wide in adults), which is about the width of
a half-a-dollar coin.
The more insoluble fiber there is in the meal,
the longer the trip, because of the bottlenecks in the small
intestine, which is an organ nature intended for moving along
liquid chyme, not lumps of heavy fiber. If you doubt this, just
visualize the following experiment:
To replicate the chewing
action, use a fork to crush a serving of high-fiber cereal in a
To reproduce the
stomach‘s churning, add water or milk to the bowl, mix
thoroughly, and let the crushed cereal soak in the liquid;
To imitate the small
intestine, cut a piece of garden hose, about 7 meters long, and
lay it down into a serpentine shape—a good approximation of the
small intestine‘s architecture;
To simulate the
propulsion of food through the small intestine, keep adding the
“digested” cereals through a funnel on top until it appears at
the other end of the hose. Or will it appear?
It‘s highly unlikely. The more fiber in the
cereal, the faster this dense, thick, semi-liquid mass will clog
the hose (intestine) at the bottom of its very first bend, and
there are quite a few more bends left to go. To propel the
cereal to the end of the hose, you‘d need to keep adding more of
the mixture from the top, in order to push out the jam in the
middle—a process strikingly similar to pressure-stuffing
homemade sausages with ground meat.
Unlike the clumps of cereal, any liquid poured
through the funnel, no matter how thick, will soon reach the end
thanks to the inscape-able laws of gravitation. As long as the
exit is located below the en-trance, no clogging occurs, even if
the hose is old and worn out.
If you chew your food thoroughly, and your
stomach digests it well, it‘s transformed to chyme—a thick
liquid without any solids. And the first organ to greet chyme is
Duodenum. Literally twelve fingers‘
breadths, the duodenum is the first and the shortest (18–25 cm)
section of the small intestine. The pyloric valve (sphincter)
separates the stomach from the duodenum. When the gastric phase
of digestion is completed, this valve controls the transfer of
chyme into the duodenum. Once inside, the chyme is neutralized
with bicarbonate, mixed with bile and pancreatic juices, and the
intestinal phase of digestion begins.
Fiber is particularly hard on the duodenum,
because, unlike the stomach, the duodenum isn‘t expandable, but
a small, narrow, and easy-to-clog circular tube shaped like the
letter C. That‘s why duodenitis (a condition identical to
gastritis) and duodenal ulcer (a condition identical to gastric
ulcer) strike their victims in their early twenties, twenty to
thirty years ahead of the peak occurrences of gastritis and
It‘s a well-known fact among military doctors
that duodenitis and duodenal ulcers are quite common among
recent recruits. No surprise there—beans, legumes, whole grain
cereals, whole wheat pasta, and bread make up the largest share
of military rations, and young soldiers are particularly
prodigious eaters after the daily grind of military life.
The duodenum possesses a few specifics that
make it particularly vulnerable to obstruction with fiber. The
ducts from the liver, gallbladder, and pancreas congregate into
the common bile duct and terminate inside the duodenum. They
supply a prodigious amount of bile (400 to 800 ml daily) and
pancreatic juice (up to 1500 to 3000 ml daily). It doesn‘t take
long to cause considerable damage to the liver, gallbladder, and
pancreas by blocking, even partially, a considerable outflow of
The blockage of biliary and pancreatic ducts
can be purely mechanical or caused by duodenitis, an
inflammation that affects the lining of the duodenum and the
common duct itself. Again, the prolonged contact of a fibrous,
acidified mass with the duodenal mucosa is the most likely cause
of both inflammation and blockage. The conditions that follow
are quite common:
(inflammation of the pancreas).
Besides fiber there isn‘t any other substance in human nutrition
that enters the duodenum not only as is, but also expanded many
times its original size. Lo and behold, the recent (17th
edition) of The Merck Manual of Diagnosis and Therapy confirms
this fact: “recent data indicate that obstruction of the
pancreatic duct in the absence of billiary reflux can produce
pancreatitis.” Acute pancreatitis is quite common in
toddlers, who are placed on solid food, which means loads of
fiber from cereals, bread, pasta, fruits, and vegetables. The
condition itself often remains undiagnosed, while its most
prominent symptom—the onset of juvenile diabetes (type I), a
failure to produce insulin because of acute
inflammation—manifests itself almost immediately. Here is yet
another ruinous aspect of fiber that strikes so early in life.
(Inflammation of the gallbladder).
Gallstones are the primary (90%) cause of acute (sudden, severe)
and chronic cholecystitis. Gallstones are formed from
concentrated bile salts when the outflow of bile from the
gallbladder is blocked. The gallstones cause inflammation either
by irritating the gallbladder mucosa or by obstructing the duct
that connects it to the duodenum. The gallstones are the
secondary factor, because before they can form, something else
must first obstruct the biliary ducts. Just like with
pancreatitis, that “something” is either inflammatory disease or
obstruction caused by fiber.
Women are affected by gallstones far more than
men, because they are more likely to maintain a “healthy” diet,
which nowadays means a diet that is low in fat and high in
fiber. Since the gallbladder concentrates bile pending a fatty
meal, no fat in the meal means no release of bile. The longer
concentrated bile remains in the gallbladder, the higher the
chance for gallstones to form.
Upper (jejunum) and lower (ileum) small
intestine. The duodenum transitions into the jejunum, which
comprises the upper two-fifths of the small intestine. It‘s
distinguished from the ileum by its larger width and thickness,
slightly more pronounced mucosa structure, and deeper color,
because it embodies more blood vessels.
It‘s somewhat ironic that the name jejunum is
derived from the Latin fasting, because during dissection this
particular segment of the small intestine was always found
empty. Apparently, the fathers of anatomy, who named the
internal organs, hadn‘t yet been confronted with the scourge of
indigestible fiber; otherwise this particular section of the
small intestine would be called intestinum repletus
The final three-fifths of the small intestine
are called the ileum (from Latin‘s groin, meaning near groin).
The ileum is narrower (3.5–3.75 cm), has thinner walls, and is
not as vascular. At the very end, the ileocal valve terminates
the small intestine and prevents the content of cecum (the first
section of large intestine) from spilling back into the small
One look at the small intestine, laid out
inside the abdominal cavity like a tangled, convoluted garden
hose, makes it apparent that this organ was designed to move
fluids only, and that it‘s remarkably easy to jam with solid,
undigested stuff. There is only one substance that can get down
there undigested and expanded many times its size—indigestible
fiber. And when that happens, here are the possible outcomes (a
obstruction. The medical term for an undigested mass
that forms inside the stomach or intestines and gets stuck there
is bezoar (pronounced bee-zawr). Indigestible fiber is the only
consumable substance that doesn‘t digest, and has the potential
to form bezoars, which cause mechanical obstruction of the small
intestine. When bezoars are lodged beyond the reach of the
endoscope, abdominal surgery is the only option available to
remove the obstruction. Bezoars are rare among healthy adults,
but more common among children (whose intestines are
comparatively tiny and underdeveloped). Old and infirm
individuals, whose intestines lack the muscular tone needed to
propel anything but fluids, are also vulnerable. That‘s why
indigestible fiber should be taboo for children, or very old,
infirm, and bed-ridden patients.
(inflammation of the small intestine).
The insides of the small intestine are covered with a pinkish
mucosal membrane, superficially similar to the insides of one‘s
mouth or vagina. The assimilation of digested nutrients into the
bloodstream is the sole function of the intestinal mucosa. It
can only assimilate nutrients dissolved in liquid chyme. It
isn‘t intended to transport anything other than mildly acidic
chyme (pH 6.0 to 6.5). Once inside the stomach, undigested fiber
soaks up acid and enzymes like a sponge. When expanded fiber
enters the small intestine, the permanent contact with the
delicate mucosa causes mechanical and chemical damage, which in
turn causes mucosal inflammation (enteritis). Once inflamed, the
mucosa can no longer absorb the nutrients and gases formed
during digestion, and the intestines expand, causing bloating
and cramping, which is often accompanied by severe pain.
disease. If left unchecked long enough, enteritis
progresses into Crohn‘s disease. The mucosal inflammation gets
so severe that it may cause
intestinal obstruction—a condition similar to a stuffy nose
during a cold, flu, or allergy attack, all of which cause acute
inflammation of the nasal mucosa. The inflammation may happen at
any point along the length of the small and large intestines,
but it‘s most commonly localized in the bottom section of the
ileum—the place where clogging with undigested fiber, bacterial
fermentation, and fecal reflux is likeliest to occur. According
to The Merck Manual of Diagnosis and Therapy: “Over the past few
decades, the incidence of Crohn‘s disease has increased in the
Western populations of Northern European and Anglo-Saxon ethnic
derivation, third-world populations, blacks, and Latin
Americans.” What else happened during “the past few
decades?” A substantial increase in the consumption of
indigestible fiber, of course.
When intestines protrude through the abdominal wall or inside
the scrotum, they cause hernias. About 5 million Americans
suffer from this unpleasant, potentially lethal condition.
Coughing, straining, or lifting weights isn‘t generally enough
to push the intestines so hard that they pierce the abdominal
muscles or squeeze down into the scrotum (inguinal hernia).
Intestinal bloating from inflammatory diseases caused by
indigestible fiber is the primary force capable of expanding the
intestines so much that they don‘t have enough room inside the
abdominal cavity, and may ripple through the abdominal wall. The
physical exertion that causes the actual herniation is a
secondary force. Straining to move large stools (caused by
fiber) is one of the major causes of hernia as well.
and vitamin and mineral deficiencies. All the hard work that
the body did breaking food down into basic nutrients—simple
sugars, amino acids, fatty acids, vitamins, and minerals—is
wasted unless they get assimilated into the blood-stream to
become energy, electrolytes, hormones, enzymes,
neurotransmitters, tissues, and other substances that keep our
bodies functional and healthy. This final act of digestion takes
place throughout the entire length of the small intestine,
unless it‘s affected by inflammation. In this case, the
essential nutrients will not digest, even if your diet contains
plenty of them. Since indigestible fiber is the major source of
intestinal inflammation, it is also a major cause of
malnutrition and mineral and vitamin deficiencies. Pernicious
anemia, which is a chronic shortage of dietary iron, folic acid,
and vitamin B12, related to gastric and intestinal inflammation,
is one of the most common forms of such a deficiency. It‘s also
the most difficult to overcome, because regular oral supplements
won‘t digest, no matter what the dose, unless the fiber is
completely withdrawn and the stomach and intestines permitted to
Fiber‘s affect on the large intestine:
The large intestine (a.k.a. gut, colon, bowel,
entrails, and viscera) is a bona fide digestive organ. Its time
is primarily taken up with the fermentation of undigested
carbohydrates and assimilation of nutrients, water, and
electrolytes. In the process, the large intestine converts the
remnants of liquid chyme into stools and expels them. The more
undigested fiber there is in the chyme, the larger and harder
the stools become.
The adjective “large” next to the word
“intestine” is misleading—the large intestine isn‘t that large
vis-à-vis the small intestine, but wide. In Russian, for
example, the intestines aren‘t small or large, but, respectively
(and correctly), thin for small and thick for large.
Length-wise, the large intestine is under 1.5 meters (5‘);
width-wise, it‘s 6 to 9 cm (2.3–3.5”) at the base, narrowing
down at the end.
The large intestine is made up of four
functional sections that encircle the small intestine. It starts
with a sac at the bottom that metamorphoses into a tube that
looks like the letter “U” upside down. At the opposite end of
the tube, another sac, terminated by a tight sphincter,
completes the U-turn. Respectively, these are the cecum, colon,
rectum, and anal canal.
Cecum. The cecum is a large pouch at the
bottom of the ascending colon, also known as the blind gut. It
is called blind because it only has one exit, just like a blind
alley. The cecum is located at the lower-right-hand side of the
abdomen. It collects chyme from the ileum, which is the final
segment of the small intestine.
The cecum can hold up to 1.5 liters (1.58
quarts) of chyme. A sphincter (ileocecal valve) prevents chyme
from spilling back into the small intestine whenever you lie
down, bend down, or stand on your head.
As water, electrolytes, and micronutrients get
absorbed into the bloodstream, the chyme is slowly propelled up
the ascending colon. By this stage, it begins transformation
into what we call stools or feces.
The cecum‘s most famous sibling—the appendix—is
attached to the cecum‘s inside wall, further to the left, just
under the intersection with the small intestine. Despite what
you may have seen in pictures, the appendix is pointed upwards,
not downwards, and its orifice faces sideways, not down.
Colon. The terms colon and large
intestine are often used interchangeably, although technically
this isn‘t correct. Actually, the colon is the tubing between
the cecum and rectum, and it is divided into four parts: the
first three are named for their direction: ascending,
transverse, descending, and the fourth—sigmoid—for its
This is why medical professionals use the term
colorectal in connection with such words as cancer, exam,
surgery, x-ray, etc., because saying “an exam of the large
intestine” is cumbersome, while “colon exam” is incorrect:
doctors must pass and examine the rectum before reaching the
colon, hence the term “colorectal exam.”
The word colon gave birth to numerous related
terms, none of them particularly pleasant, such as colic
(abdominal pain emanating from the colon), colitis (inflammation
of the large intestine), colonoscopy (examination with an
optical scope), colonics (a type of generous two-way enema), and
colonic (specific to the large intestine, as in colonic
The fecal mass goes up through the ascending
colon, makes a sharp left, passes the transverse colon, turns
down into the descending colon, and then makes a slight right
into the sigmoid colon—the ramp leading into the rectum, and the
last stop before being dumped. The mucus secretion (binding
factor), water removal (drying factor), and bacterial action
(volumetric factor) solidify the remnants of liquid chyme into
solid stools before they reach the descending colon. The
descending and sigmoid colon essentially perform a storage
function for ready-to-be eliminated stools.
Rectum. The rectum is a stretchable,
muscular sac, 10 to 15 cm (4”–6”) long, situated at the end of
the sigmoid colon. It‘s right above the anus, and it shares a
central space inside one‘s pelvis with the reproductive organs.
Not romantic, but it works. The term rectal ampoule is often
applied to the rectum‘s shape, because it‘s narrow at the bottom
and dilates further up to form an ampoule-like appearance.
Anal Canal. This is the least
appreciated organ, and usually the first to get into trouble
because it‘s so tiny. The anal canal‘s maximum aperture is tight
and narrow—3.5 cm (1.37”). The anal canal itself is about 3 cm
(1.18”) long, and is encircled with two taut muscular
sphincters—internal and external. Both sphincters perform in
concert to keep the stools safely inside the rectum. We can
consciously control only the external sphincter, while the
internal is controlled autonomously, by the body itself.
The elimination of stools is the final act of
digestion. Technically, it should be as easy as eating—the first
act of digestion. When everything works just right, it is, but
when it doesn‘t, it becomes a long and awful ordeal, first
because of large stools caused by undigested fiber, second
because of all the damage caused by large stools.
As with everything else in life, timing is
everything with digestion: the mouth is busy chewing an average
meal for 15–20 minutes; the healthy stomach digests an average
mixed meal in 5 to 7 hours; the small intestine takes about 24
hours to transport chyme down to the large intestine; and the
large intestine processes stools in about 72 hours.
In young, healthy people, indigestible fiber
slows down stomach digestion and the transport time in the small
intestine, but considerably speeds up the transport time
(motility) in the large intestine, sometimes down to 24 hours.
When this happens, the person may experiences diarrhea and
cramping, which are usually “diagnosed” as irritable bowel
syndrome. The word “diagnosed” is in parenthesis, because what‘s
happening isn‘t a disease, but the natural reaction of a healthy
colon to an unhealthy content. If caught early, the “syndrome”
disappears a few days after the fiber is removed from the diet.
When a person is no longer young, or the digestive organs
aren‘t in perfect shape, everything takes longer—the digestion
in the stomach, the transport of chyme through the small
intestine, and colonic motility. And when fiber is added, it
takes even longer:
Those with defecation disorders or slow transit respond [to
fiber] much less favorably. Those with severe colonic
inertia may not be helped by fiber, since there is decreased
smooth muscle contractile activity.
Rome II: The Functional
Gastrointestinal Disorders, C3: p. 389;
by Douglas A. Drossman (editor); [link]
That‘s why fiber
affects the large intestine the most, earlier than any other
organ, why its impact becomes much greater and more obvious, and
why the list of associated diseases is so much longer. Here are
the conditions that one may get, or have already, from consuming
too much fiber:
Appendicitis is the sudden swelling
and inflammation of the appendix. It generally follows the
obstruction of the appendix by undigested food or a large
accumulation of hardened stools (fecal impaction). There is only
one type of food that reaches the cecum undigested, and that‘s
plant fiber, including seeds and husks. The swelling occurs
because the bacteria trapped inside the appendix continues to
divide, grow in volume, and generate refuse that has nowhere to
go. Inflammation follows the swelling, and then sharp pain and
other symptoms ensue. Without prompt surgical removal, the
swollen appendix may burst and spill the cecum‘s “dirty”
contents into the sterile peritoneal cavity, and cause
peritonitis—an infectious inflammation of the membrane
(peritoneum) that lines the insides of the abdomen. Without
rapid and competent surgical treatment, the chances of
recovering from acute peritonitis are slim.
Appendicitis is more prevalent among children
precisely because their tiny ceca (plural of cecum) and
appendixes are so much easier to clog with undigested fiber and
large stools. When infected appendixes are removed in children,
in many cases the source of obstruction and infection are
undigested seeds, nuts, and grains.
Think twice before force-feeding your child
fiber-rich food or supplements. Most children dislike raw,
cooked, or pureed fibrous vegetables, such as broccoli,
cauliflower, carrots, cabbage, and spinach, because their
reaction to fiber, literally and figuratively, is visceral (by
the gut): discomfort, flatulence, cramps, and sharp pain. And
these “veggies” aren‘t even that fiber-rich (just one or two
grams per serving) until you recognize that just five grams of
fiber for a three-year old is about the same as thirty to forty
grams for an adult, which is almost twice the amount of the
average daily fiber intake for people in the U.S.
The combination of fecal impaction and fiber
laxatives may also cause appendicitis in adults. It just takes
longer to “stuff” a much larger adult‘s bowel with fibrous
stool, until the cecum is completely clogged with undigested
fiber. It takes about two to four weeks to fill the large
intestine to capacity, depending on the amount of fiber in the
diet and the degree of distention.
(The overviews that follow are shorter than
those above because these conditions are discussed in greater
depth in Part II of this book.)
(dysbiosis). The fermentation of undigested fiber causes
acidity inside the large intestine great enough to damage
intestinal flora. The damage isn‘t likely to occur with minor
amounts of fiber, but is highly probable when fiber is consumed
in excess. This and other causes of disbacteriosis are discussed
in depth in Chapter 4, Disbacteriosis.
and flatulence. The fermentation of fiber by colonic
bacteria creates gases. The gases in excess of normal vital
activity cause abdominal distention (bloating). Gases are normal
in human digestion, excess gases aren‘t.
cramps. A high volume of chyme, large stools, and gases
(all related to fiber action) cause mechanical pressure on the
intestinal walls, which is especially pronounced after meals,
when peristalsis commences.
Soluble fiber is a known causative factor of osmotic diarrhea
and is commonly used as a laxative. The laxative/diarrhea effect
depends on the amount of fiber taken and the status of
intestinal flora. The absence of normal intestinal flora
(disbacteriosis) contributes to diarrhea.
Indigestible fiber has a pronounced laxative effect in healthy
people because it increases stool size and stimulates
motility—the propulsion of stools through the large intestine.
In people who already have colorectal disorders related to age,
medication, disbacteriosis, or other causes, the enlargement of
stools has the opposite effect: it causes anorectal damage and
even more severe constipation. In healthy people, anorectal
damage caused by large stools is gradual, and the onset of
constipation is delayed.
disease. By some accounts, over 50% of Americans suffer
from hemorrhoidal disease by the age of 50, and by other
accounts, over two-thirds do. Large stools related to fiber are
the primary cause of this self-perpetuating condition. As it
develops, enlarged internal hemorrhoids permanently constrict
the anal canal. The narrowing of the anal canal requires more
straining to move the bowels. The more the person strains, the
more the hemorrhoids become enlarged, and the need for straining
Normal defecation requires no more effort than urination. Large
stools caused by fiber (and resulting constipation) require
additional external force to move them because they exceed the
width of the anal canal. This action is accomplished with the
help of the abdominal and pelvic muscles. The applied force and
pressure on the intestinal lining and walls from large stools
causes inevitable damage to the rectum and anal canal. The
resulting conditions are extremely painful, because the anus has
the highest degree of innervation among all of the alimentary
- Anal abscess. An injury of
the anal canal mucosal lining may cause small ulcerations. The
spontaneous healing of the ulcer may leave encapsulated pus
inside the wound. This condition is extremely painful, because
of the continuous pressure of the pus on the upper skin layer.
This condition may require treatment with antibiotics and/or
- Anal fissures—a tear in the
skin lining the anus. Fissures are particularly hard to heal,
because each consecutive hard stool damages newly grown tissues
and breaks the wound apart.
- Anal fistulas (non-congenital)—permanent
ducts (passages) from the anal canal into the perianal (around
anus) region or vagina. Fistulas form as a result of
ulcerations, fissures, or abscesses inside the anal canal. The
fistulas cause the continuous spillage of stools, which is
particularly unsafe when the fistula terminates inside the
vagina. In almost all cases, the elimination of fistulas
- Rectal prolapse. This
condition is likely to affect older people, and is characterized
by the protrusion of the rectal wall or just the rectal mucosa
through the anus (to the outside). Rectal prolapse requires
urgent medical intervention.
- Withdrawal of stools.
This problem is particularly acute among children, and it
happens in response to pain and discomfort related to the above
complications. The withdrawal of stools causes fecal impaction,
which usually requires manual disimpaction, because laxatives
are no longer effective. The most dangerous thing one can do
(and often does) in this case is to give a child more fiber. In
this case, there is a high probability of stools spilling into
the small intestine, and fiber causing obstructions.
There is just one solution to straining-related
complications—elimination of fiber from the diet, resulting in
the semisoft or even watery stools that will allow healing, and
soft, small stools thereafter. (See Chapter 11, Avoiding the
Perils of Transition.)
(diverticulosis). When fiber
increases stool size beyond the normal confinements of the large
intestine, it causes the outward protrusion of the intestinal
wall. The pouches that are formed are called diverticula
(plural). When the diverticulum (singular) gets inflamed, the
condition is called diverticulitis. The diverticulitis is
localized to specific diverticula because they may retain a
fibrous fecal mass indefinitely. The eventual inflammations
inside the diverticula are caused by the same mechanical,
chemical, and bacteriological factors that are behind IBS,
ulcerative colitis, and Crohn‘s disease. (See Chapter 9,
Ulcerative Colitis and Crohn‘s Disease.)
syndrome (IBS): Along with undigested
fiber‘s mechanical properties, increased acidity causes
irritation of the mucosal lining inside the colon, hence the
term irritable bowel. In most cases, before the onset of
ulcerative colitis, the removal of fiber from the diet reverses
IBS within a few days. A reintroduction of fiber into the diet
brings this condition back as soon as it reaches the large
colitis. Disbacteriosis and fermentation-related acidity
strips the intestinal mucosa of its protective properties and
leads to ulcerations of the intestinal walls. The healing of
these ulcers is further complicated by a pronounced deficiency
of vitamin K (blood-clotting factor), which is caused by
disbacteriosis. The removal of fiber and reinoculation of the
large intestine with bacteria is often all that is needed to
reverse both conditions.
The stretching of the large intestine by expanded, impacted
fiber compromises colonic motility (the normal peristaltic
transport of stools inside the large intestine), resulting in a
condition known as colonic inertia, which is a precursor to
fecal impaction (an abnormal accumulation of compressed stools,
which stretch the colon and rectum even further); hence,
nerve damage. The irreversible stretching (distention)
of the rectum, and anorectal nerve damage (both caused by large
stools from fiber) diminishes defecation reflexes, and in turn
requires even more stool volume (obtained from fiber and/or
laxatives, of course) to stimulate defecation. At some point the
reflexes may disappear altogether, which is a problem that can
be alleviated only with even more fiber and/or laxatives.
Incontinence. The loss of anal sphincter control causes
an uncontrolled escape of stools. The condition is further
exacerbated with excess gas, because the sphincter tone isn‘t
sufficient to contain it, and the release of gas provokes
spillage. Both problems—anal sphincter damage and excess gas—are
caused by, respectively, large stools comprised mainly from
fiber and bacterial fiber fermentation. Obviously, the exclusion
of all types of fiber is the first step in combating this
polyps. The normal bacteria that reside in the
intestinal mucosa (epithelium) provide a non-specific immune
defense against external pathogens and internal cellular
pathologies. Disbacteriosis strips the epithelium of its
protective properties. Mechanical abrasion from large stools
(caused by fiber) and chemical damage from fermentation-related
acidity (from too much fiber) contribute to cellular damage, and
the formation of polyps—neoplasms (new growth of tissues) that
protrude from the epithelium, and have a high risk of becoming
cancer. A single polyp increases the risk of colon
cancer by 2.5% at 5 years, 8% at 10 years, and 24% at 20 years.
Ulcerative colitis alone increases the risk of colon cancer
3,200% (32 times). Both conditions—polyps and ulcerative
colitis—are connected by the same common denominators, fiber and
Fiber‘s affect on the
genitourinary organs: Unlucky neighbors
The bladder and reproductive organs
(collectively, genitourinary organs) share common space at the
bottom of the abdominal cavity with the small and large
intestines. The sigmoid colon bend is situated right next to the
bladder; a thin wall separates the female rectum from the
vagina; the uterus and ovaries are enveloped by intestines; the
male prostate gland is located in the immediate proximity of the
rectum. You get the picture.
This layout may offend your sense of sexual
aesthetics, but it has been working quite well for millennia,
except when the intestines are expanded by large stools and
gases “courtesy” of fiber. The resulting outward pressure of the
distended intestines on the reproductive organs, even slight
pressure, causes symptoms identical to genitourinary disorders,
such as prostatitis, endometritis, cystitis, and
urethritis—respectively, an inflammation of the prostate gland,
endometrium, bladder, and urinary canal.
Unfortunately, modern day gynecologists and
urologists aren‘t trained to recognize the impact of intestinal
disorders and large stools on the genitourinary organs, and may
prescribe potent pain relievers, antibiotics, diuretics, or
antidepressants to treat these phantom conditions instead of
advising patients to eliminate fiber, large stools, or treat
constipation. Here are some of the results:
Premenstrual Syndrome (PMS).
The impact of fiber‘s side effects is particularly profound
prior to menstruation. The physical metamorphosis that precedes
menstruation—water and sodium retention, enlargement of the
endometrium and ovaries, egg movement through the fallopian
tube(s)—predisposes women to premenstrual syndrome. The ensuing
symptoms, such as Mittelschmerz (middle pain, a condition
related to the enlargement of ovaries during ovulation),
cramping (primary dysmenorrhea, a condition not related to
physical anomaly), abdominal pain, and backache, are often
related to undue pressure by the distended intestines on the
uterus, fallopian tubes, and ovaries, which become
hypersensitive during ovulation.
Correspondingly, the emotional aspect of PMS
isn‘t related to hormonal changes so much, but to the constant
presence of pain and discomfort, which trigger the continuous
release of stress hormones. In turn, stress hormones cause
migraine headaches and patterns of social interaction typical
for PMS sufferers.
PMS is often accompanied by intermittent
constipation and diarrhea. Evidently, both conditions are
usually already present before menstruation. They simply become
more pronounced and noticeable during this period.
Nausea and Vomiting during Pregnancy (NVP).
If fiber causes so many problems during menstruation, imagine
its impact during pregnancy, especially the last two trimesters,
when NVP can no longer be written off to hormonal changes.
That‘s why many pregnant women unconsciously switch to
liquid-only diets, in most cases with deleterious effects for
both themselves and the fetus, as these diets lack essential
proteins, fats, and micronutrients.
NVP is easy to understand: the metamorphosis
that is taking place in the abdominal cavity to accommodate the
expanding uterus affects the stomach‘s ability to expand and
accommodate fiber; the outward pressure on the small intestines
increases the chances for intestinal obstructions by fiber. A
pattern of diarrhea and vomiting caused by all of the above
causes a predisposition to constipation.
If you‘re planning to become pregnant, study
this book and wean yourself off fiber in advance of your
pregnancy. If you‘re already pregnant, and suffer from NVP, just
follow the guidelines in later chapters to restore the normal
physiological functioning of the large intestine, so you can get
off fiber without incurring the wrath of constipation, that
comes with sudden fiber withdrawal. It will not only reduce or
eliminate NVP altogether, but will also prevent you from
developing numerous gastric disorders, related to persistent
vomiting, diarrhea, and constipation.
Restoring normal intestinal flora in advance of
pregnancy and maintaining adequate nutrition will improve the
quality of your breast milk and enhance your ability to
breastfeed. And, of course, all of the above will have a
positive impact on fetal development, and the health, growth,
intellect, and future life of your child.
prolapse (herniation) of the rectal wall into the vagina is
another common affliction related to fiber consumption (around
an 18.4% prevalence in the general population). Rectocele
is most likely related to large stools and severe straining.
Most, if not all, medical texts on this topic don‘t mention the
rectal connection, and write off rectocele to abnormal
childbirth, weakness of the pelvic support system, and
unspecified congenital conditions. These are doubtful
assertions, because rectocele affects women who have never been
pregnant, the incidence of rectocele increases with age—which
means the condition wasn‘t congenital, and the rectum wall can‘t
simply prolapse into the vagina unless some external force
pushes it down there. In most women, fiber-laden stools and
straining are most likely these forces. To avoid corrective
surgery and enjoy sex into the wee years, cutting out fiber, and
avoiding constipation and straining, is the best prescription to
An inflammation of the vagina‘s mucosal lining related to
vaginal yeast infection (vulvovaginal candidiasis), which is
characterized by an enlargement of the labia, inflammation of
the external opening of the urethra, itching, vaginal discharge,
odor, and pain during intercourse and urination. Candidiasis is
directly related to disbacteriosis, that may be caused,
contributed to, or sustained by excess fiber. The absence of
normal flora causes an overgrowth of yeast bacteria (Candida
albicans) and a reduction of non-specific immunity.
affects up to 75% of American women during their
lifetimes—a number which accurately mirrors societal dietary
dogma. Fiber reduction by itself isn‘t sufficient to eliminate
candidiasis. An affected person and her sexual partner must
restore normal intestinal flora as described in Chapter 11,
Avoiding the Perils of Transition (see page 211 or
Candidiasis infects men via sexual intercourse
with an infected partner or from contamination of the urethral
opening with his own fecal matter. In this case, the condition
is likely to be diagnosed as urinary tract infection (UTI) or
prostatitis, and a harsh treatment with antibiotics may follow,
which will only exacerbate disbacteriosis and its side effects.
obstruction. The male urethra, the canal that discharges
urine from the bladder, passes through the prostate gland. An
accumulation of large stools in the rectum (typical for organic
constipation and fecal impaction) causes strong pressure on the
prostate gland which in turn squeezes the urethra and blocks
urine flow. This blockage of the urethra interferes with normal
urination, may stimulate frequent urination, and cause pain
typical of prostatitis and benign prostate enlargement.
dysfunction. Finally, keep in mind that just a thin wall
separates the rectum from the vagina, and an equally thin wall
separates the rectum from the prostate gland. That‘s why even
the mildest intercourse is capable of stimulating the defecation
urge or the release of gas in the least desirable moment. The
fear of such an occurrence tenses the anal muscles in both men
and women, inhibits erection and arousal, and precludes orgasms,
particularly among affected women. Good sex 'ain‘t' a laxative,
though it often works that way. If you wish to enjoy relaxing,
worry-free sex, cut out the fiber and finish reading this book.
Fiber‘s affect on
heart disease: A bargain with the devil
Dietary fiber represents from 5 to 10% of the
total content of consumed carbohydrates. For example, to get
just the 30 grams of recommended daily fiber in natural form,
you need to consume 300 to 600 grams of carbohydrates. But
excessive carbohydrate consumption is the primary cause of
diabetes, obesity, hypertension, elevated triglycerides, and
hyperinsulinemia—the best researched and most obvious precursors
of heart disease.
In this context, the idea of protecting
yourself from heart disease with a high-carb, high-fiber diet is
as preposterous as the suggestion to treat high blood pressure
with bloodletting (less blood being equated with less blood
pressure). That the patient would soon die from anemia or
cardiac arrest caused by acute hypotension (extremely low blood
pressure)—well, that‘s a problem for the undertaker.
Nonetheless, the idea of using dietary fiber against heart
disease received some traction, because certain types of fiber
in combination with a low-fat diet slightly reduce LDL (“bad”)
To avoid the
onslaught of natural carbs, you may try to fool the system, and
replace these carbs with just fiber supplements. Well here,
courtesy of the American Heart Association‘s research, is a
description of the probable outcome:
...a fiber supplement containing a mixture of guar gum,
pectin, soy fiber, pea fiber, and corn bran lowered LDL
cholesterol by 7% to 8% in hypercholesterolemic participants
after 15 weeks compared with those taking a placebo. These
reductions persisted throughout the 51-week follow-up period
with continued use of supplements. Potential risks of
excessive use of fiber supplements include reduced mineral
absorption and a myriad of gastrointestinal disturbances.
Linda Van Horn, PhD, RD;
From the Nutrition Committee; American Heart Association
“Impressive,” isn‘t it? “Reduced mineral absorption,” meaning
more hypertension, more arthritis, more osteoporosis, and a
“myriad of gastrointestinal disturbances.” Well, “myriad” is an
understatement, a euphemism for gastritis, gastric and duodenal
ulcers, enteritis, Crohn‘s disease, irritable bowel syndrome,
colitis, diarrhea, bloating, flatulence, and, of course,
constipation and its side effects. Besides, according to the
same research by the American Heart Association, the fiber-heart
disease theory is a fluke anyway. It appears to work on paper,
but not in real life:
“The rate of CHD [cardio-vascular
disease] mortality was reported to be inversely associated
with fiber intake across 20 industrialized nations, but
adjustment for fat intake removed the association.
Similarly, a 20-year cohort study of 1,001 middle-aged men
in Ireland and Boston reported significant inverse
association between fiber intake and risk of CHD, but the
association diminished when other risk factors were
(Same as above)
Well, well, well.
Since heart disease isn‘t a topic covered in this book, it‘s up
to you to decide who‘s the devil‘s advocate, and who‘s not.
This entire chapter in itself is a summary of
the most prominent problems caused by fiber. Hence, the list of
key points is brief:
Fiber from plants wasn‘t
consumed by humans during most of evolution because until very
recently there was no means to process fiber.
Sugars and starches are
broken down in the small intestine, but the small intestine
can‘t break down fiber because the human body lacks the
There are two types of
fiber—soluble and insoluble. Soluble fiber causes osmotic
diarrhea, because it retains water inside the large intestine.
Insoluble fiber absorbs digestive juices and expands four to
five times its original size. The expansion of insoluble fiber
may cause esophageal, gastric, and intestinal obstruction.
Fiber interferes with
gastric (stomach) digestion, and is the leading cause of
indigestion, GERD, heartburn, gastritis, and ulcers.
Fiber obstructs the
small intestines throughout their entire length, and is the
primary cause of intestinal disorders. Because the intestines
are responsible for the assimilation of nutrients, fiber-related
inflammatory disease causes malnutrition, and an acute
deficiency of vitamins and minerals.
particularly vulnerable to fiber, because their digestive organs
are smaller than adults.
Fiber is a primary cause
of flatulence. These gases are formed during fiber‘s
fermentation inside the large intestine.
Fiber increases stool's
weight and size, and causes mechanical damage to colorectal
organs. Even minor damage leads to constipation. When more fiber
is added to combat constipation, more damage is incurred.
Fiber‘s impact on the
small and large intestines affects male and female genitourinary
organs because of their proximity. Women are particularly
vulnerable because female reproductive organs occupy a large
space in the abdominal cavity, and because of the specifics of
Fiber has no measurable
affect on heart disease. If anything, it worsens the outcome
because of the excessive carbohydrate consumption that comes
Patients who try taking
supplemental fiber to reduce cholesterol levels develop a
“myriad” of digestive disorders.
Excerpted from Chapter 9,
Ulcerative Colitis and Crohn's Disease
Respect Thy Doctor
You may ask a reasonable question: why aren‘t
doctors denouncing fiber? The answer is really simple—they
simply may not know about its ill effects yet. Just like not
long ago doctors didn‘t know that smoking causes lung cancer; or
that calcium deficiency may cause kidney stones; or that hormone
replacement therapy increases the risk of breast cancer, heart
disease, and dementia; or that lack of sleep causes weight gain;
or that Vioxx may cause heart attacks, doctors don‘t yet know
that dietary fiber is not only detrimental in the treatment of
colorectal disorders, but may also be one of their primary
causes. [This paragraph was revised by the author—ed.]
And the question “You make it so obvious, why can‘t doctors
figure it out?” isn‘t fair, because of the following
The ability to express complex concepts and ideas in an
accessible format and language is the domain of professional
medical writers, not practicing doctors. It takes years to
master the art of writing, and, on top of that, a writer must
have a medical education, life experiences, analytical skills,
motivation, time, resources, and the guts to tackle these
complex and controversial subjects. That‘s simply not the domain
of [practicing -ed.] doctors, unless, of course, they become
medical writers and still possess all of the above.
Training and ethics.
Practicing doctors aren‘t scientists, researchers, or analysts
trained to analyze and investigate the causes of diseases. They
are confronted with preexisting medical conditions and are
trained to take care of them to the best of their abilities. For
the same reason you don‘t expect a policeman to write, or, even
worse, decide the 'law,' you shouldn‘t expect practicing doctors
to be know-it-all scientists or, even worse, conduct experiments
and research on unwitting patients.
Rules of engagement.
Medical doctors are in one of the most tightly regulated
professions. To avoid harm to patients and malpractice suits,
they rely on the generally accepted treatment protocols taught
in accredited medical schools, and described in blue-chip
medical books and references. In general, that‘s what we all
want them to do. And if all of these authoritative sources
recommend dietary fiber to treat digestive disorders, they too
will recommend this approach to their patients, and will apply
it to themselves, and to their family members without the
slightest hesitation or doubt in its safety and efficacy. That‘s
Personal experience. Doctors may not
suspect the connection between dietary fiber and IBD
[inflammatory bowel disease - ed.], because they may believe
that they themselves benefit from fiber, and, for a while, they
don‘t experience any of its side effects. Indeed, it takes
decades for fiber‘s impact to become apparent in healthy people.
But by the time it does, it‘s hard to determine what hit
you—age, bad luck, or fiber. Personal experience and subjective
judgment play an important role in medicine. If you don‘t feel
it, you don‘t pay as much attention to it.
Independent analysts (such as myself) aren‘t restricted or
limited to any dogma and leave no stone unturned while seeking
out better solutions. And, once they believe that they‘ve found
better ones, they publish their findings, and stake their
reputation and livelihood on the results. That‘s the kind of
risk that doctors don‘t take, and shouldn‘t be expected to take.
Theory of relativity.
The human body isn‘t as mysterious as it was once thought to be,
but it‘s still as unpredictable as the weather in early spring.
Hence, there is no absolute truth, but many 'truths.' And
reasonable people have the right and obligation to doubt
anything that isn‘t 'absolute.' And they will. It means that
even the best-intentioned doctors may not instantly accept this
or that method, regardless of its merits. That‘s human nature.
The field of colorectal disorders and inflammatory bowel
diseases isn‘t any different from any other field of science or
medicine. Not long ago, the top scientists of their day believed
that the world was flat. It takes time for old beliefs to wither
and die, and new ones to take hold.
When the idea of using fiber for constipation
relief was initially advanced in the first half of the 20th
century, the average lifespan of Americans was still too short
to observe its 'global' harm. Besides, it takes decades for
symptoms to develop, the diseases to take hold, the statistics
to get collected, and for someone to question conventional
Well, we know better now. Get on with
it, and don‘t blame the doctors for not being clairvoyants. For
all I know, doctors are victimized by the fiber scourge even
more than the general public, because they start taking ‘good‘
care of their bodies earlier than most of us. And, up to now,
that has meant eating more fiber, drinking more water,
and exercising the abdominal muscles. You already
know the results that all of these activities may cause, and
hopefully, because of this book, most doctors will also know
about them soon, and will declare a similar loud message:
FIBER ISN‘T THE SOLUTION, IT‘S THE PROBLEM!
Hence, respect thy doctor! When bloody diarrhea strikes, it
isn‘t the time to read a self-help book. You need a good doctor!
Most of us, myself included, treat their personal physicians
with a reverence reserved for Elvis, the Pope, or a head of
state. But unlike me, some people read Fiber Menace, drop
fiber in disgust, and, at some point, resume a high-fiber diet
again. When I ask them why, almost all reply: “Because my doctor
told me to take more fiber!”
That 'fluke' taught me several important
lessons: (1) not all human behavior is rational, and some is
outright self-destructive; (2) patients “respect thy doctor more
than thy spouse” and this relationship sometimes become
irrational too; (3) educating doctors is as important as
educating patients; (4) ignorance is even more dangerous than
ill intent, because, unlike ignorance, professional ill intent
is a rarity.
In fact, those four lessons are forcing me to
disown my own well-intentioned advice at the end of Fiber
Menace, which said: “Don‘t stick this book in front of
your doctor. Professionals don‘t study medicine from popular
books, no matter how relevant or well written they may be.”
It still remains correct advice, but,
unfortunately, it leaves most doctors uninformed —and you, the
patient, defenseless. So, go ahead, and 'stick' Fiber Menace
in front of your doctors. Professionals who refuse to consider
(not heed, just consider) the facts presented in it have no
business doctoring your body — simply because they may cause it
harm regardless of their best training and good intentions.
I also believe most doctors will be grateful to
you for this gift of knowledge, because they “doctor thyself,
thy parents, thy children, and thy spouses.” And good doctors
appreciate learning a new approach when they see one! Just as
important, the positive feedback these doctors will get from
their own guts (from switching to low-fiber diet) is more
immediate, informative, and transformative than any other
So, to heal yourself, heal your doctors first!
Ask them to read Fiber Menace, and sow a reasonable doubt
in their minds. This way you won‘t need to go “back on fiber” to
please your doctor, and your doctor won't have any doubts about
the safety and effectiveness of a low-fiber diet!
Finally, keep this in mind: medical doctors
practice “medical arts,” not science. They enjoy a substantial
discretion of judgment in order to protect their patients, their
professional reputations, and their livelihoods. If this were
otherwise, then bloodletting, lobotomies, mercury ointments, and
countless Vioxx-es would still be around. Fortunately, thanks to
good doctors, they aren't. Respect thy doctor!