Don't Forget Fiberin Today's Low-Carb World
by Kathryn Matthews

Let's face it: in the nutrition arena, fiber is not an easy--or sexy--sell. Most of us would rather not dwell on our internal plumbing, or being "regular." And, in an Atkins-Gone-Wild world where low-carb, high-protein diets reign, fiber-rich foods, like whole-grain cereals and breads, are that much easier to eschew. Legumes, fruits and vegetables are taking a back seat to "A"-List (a.k.a. Atkins-approved) foods, like -buttery-soft prime rib or juicy burgers smothered with fried onions (minus the bun, of course!).

Now, fiber, along with vitamin D, is having its day in the sun again. In a new study, one of the most comprehensive on colon cancer risk to date, a team led by the Veterans Administration (VA), the National Cancer Institute and Harvard researchers confirmed that a diet high in cereal fiber and vitamin D lowered the risk of developing serious colon polyps, or tumors, that may lead to the disease.

This study, conducted by lead investigator David Lieberman, MD, chief of gastroenterology at the Portland VA Medical Center, analyzed how various dietary, lifestyle and genetic factors affected the development of serious colon polyps. Study participants were mostly men, between 50 and 75 years old, and included 3,121 veterans at 13 VA medical centers across the country. None had colonic polyps. The results? Men who had consumed higher amounts of cereal fiber (more than 4 grams daily) and vitamin D (more than 645 international units--or "IUs"--per day, derived from food and supplements) were significantly less likely to develop pre-cancerous colon polyps. Interestingly, researchers noted a similar protective effect in men who took a daily aspirin or non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen.

It's welcome news to medical experts who have long touted the benefits of fiber--among them, reducing cholesterol count, stabilizing blood sugar and helping prevent constipation, obesity and colon cancer. This new research comes in the wake of two previous, recent studies, which had indicated that a high-fiber diet failed to prevent the recurrence of colorectal polyps in people who had previously had them. Experts have argued, however, that both these studies were relatively short-term and focused on subjects already predisposed to colon polyp formation.

In terms of vitamins, Vitamin D stood out for its strong protective effect, said Lieberman. Adequate amounts of vitamin D help regulate cell growth, preventing cell mutations that can lead to cancer. Food sources include vitamin D-fortified milk and orange juice, as well as oily fish, like herring, mackerel and salmon. A multivitamin or supplement typically contains 400 IUs of vitamin D. The body, however, can easily produce 90 to 95% of the vitamin D it needs through sun exposure.

But, be advised: getting "sun exposure" is not medical permission to sunbathe. For most of us, this means exposing bare skin--face (optional), arms and legs--to sunlight no more than five to ten minutes (between 10am and 3pm) three times a week, said Michael F. Holick, MD, Ph.d, director of the Vitamin D Research Lab at Boston University Medical Center and author of "The UV Advantage" (ibooks, 2003). Afterwards, put the sunblock on, he added.

Who is At Risk?
In the US, colorectal cancer is the third leading cause of cancer both in men and in women, after lung cancer (first for both), then prostate cancer (second for men) and breast cancer (second for women). This year, the American Cancer Society (ACS) estimates 146, 940 new cases, with projections nearly equal for men (73,620) and women (73,320)--surprising news for those who assume this is a "man's cancer."

Age is a primary risk factor--over 90% of those diagnosed with colorectal cancer are age 50 or older--as is a personal or family history of this disease. And Lieberman's study, in sync with previous research findings, found that being overweight, physically inactive, cigarette smoking and consuming alcohol (eight or more drinks per week), as well as frequent consumption of red meat--eating beef, pork or lamb five or more times a week--increases risk.

So, Atkins devotees, take note. "Red meat is high in saturated fat, and our study, which took place over a three year period, strongly suggest that those who consume it regularly are at higher risk for developing pre-cancerous colon polyps" said Lieberman.

But there's good news. "Colon cancer is largely preventable through diet, exercise and weight control," said registered dietician Colleen Doyle, Director of Nutrition and Physical Activity at the American Cancer Society. In addition to getting regular screenings, eating mostly plant-based foods and limiting saturated fat consumption are key in reducing risk. Since colorectal cancer can take up to ten years to develop, it's never too early to start being vigilant about diet and exercise, maintained Doyle.

Getting Regular
Most of us get less than half the recommended 25 to 35 grams of fiber in our daily diet. Doyle suggests the following tips to boost fiber intake:

• At breakfast, eat a whole-grain cereal, preferably 100% bran. Add one cup of berries or a banana for extra fiber.

• Choose beans, like black beans, kidney, lima and lentils. You don't have to slow cook them from scratch--canned is just fine. I especially like Eden Organic brand beans because they're low-salt and additive-free. Beans are a high-fiber food and an excellent protein source. Toss them into salads and soups. Or wrap them in a tortilla with grilled vegetables.

• Use whole-grain bread for sandwiches. Up the fiber ante by adding apple or banana slices to, say, peanut butter on whole wheat, or add cranberry sauce to a turkey (on whole wheat) sandwich.

• Snack on dried fruit. Just a few will do (no more than a handful), since dried fruit is higher in calories than fresh fruit.

• Eat whole foods, like apples (instead of applesauce) and oranges (instead of orange juice). Fruit skins are good sources of fiber.

• Contrary to popular belief, lettuce contains very little fiber. While it's rich in folate, lettuces, like romaine and iceberg, are mostly water. A fiber-friendly solution: add colorful vegetables, like grated carrots, tomato wedges and broccoli florets, a handful of dried or fresh fruit and a few nuts.

Fiber Counts!

Aim for 25-35 grams a day.
Getting enough fiber isn't as hard as you may think. Start the day with a bowl of hot or cold cereal, topped with fruit and/or ground flaxseed---and you're halfway there. Not to worry: if you've been lax about your fiber intake, fall is a great time to start anew. Nearby farmers' markets and farm stands are great sources of local inspiration, from Hudson Valley apples and pears, to spinach, carrots, parsnips and pumpkin.