I was recently interviewed and featured in IHCAN (Integrative Healthcare and Nutrition) magazine. It’s the UK’s only monthly magazine for practitioners of integrative medicine and, as you can imagine, is highly regarded in the integrative health industry.
You can read the article in full, where I talk about my work and the services I offer, below. Subscriptions to the magazine are available on their website, at https://www.ihcan-mag.com/
We all know that sugar is the root
of all evil right? Too much of the white
stuff has been linked to a range of health issues such as obesity, heart
disease, diabetes and mental health, to name a few. Tax on sugary drinks is a hot topic, with the
UK poised to add 6-8p on a can of fizzy pop in April next year and Ireland
recently announcing to add 27p per litre.
But the ‘can the tax’ campaigners in America have recently dumped the 1
cent per ounce levy on fizzy drinks in Chicago. (1) Lobbyists from the drinks
industry are piling on the pressure to scrap the tax, and campaigners from the
health industry to increase it. It’s
uncertain which way it will go in the UK at the next budget. What is clear, is that the debate has
highlighted the dangers of high sugar products such as fizzy drinks and
confectionary. We all know that we
shouldn’t be filling ourselves or our kids up with this stuff.
Because of the backlash against
sugar, many manufacturers are seeking alternatives to sweeten food. Products and recipes use artificial
sweeteners, natural sugar substitutes, fruit syrups, dried fruits and other
agents in an attempt to claim ‘low sugar’.
More recently the buzzword is ‘refined sugar’ and we are told that we should
avoid this at all costs. So, if a
products states on the packet that it has no or low refined sugar, but it still
contains 20g sugar per 100g on the ingredients list, is this OK? Confused?
Greater clarity is needed beyond the obvious ‘poor choices’ that we all
know to avoid. To make an informed
choice you need to know the facts and hopefully I can help.
WHAT IS SUGAR?
First you need to understand the
basics. This is the science bit, but
I’ll keep it short. Sugar is
a carbohydrate that is present naturally in fruit and vegetables and in dairy
products as lactose. The two main types
are simple carbohydrates (monosaccharides and disaccharides), and complex
carbohydrates (polysaccharides). Mono
means one and saccharides means sugar, so essentially, these are single sugar molecules:
glucose, fructose and galactose. Di
means two, so these are two of the single sugar molecules joined together,
making maltose, sucrose or lactose. Poly
means many, so as you would expect these are a string of sugar molecules
(starch, glycogen and cellulose).
Following so far? The picture
below should help. (2)
HOW DOES THE BODY USE IT?
In order to understand this
further, you need to know how the body uses it.
All foods falling into the carbohydrate category, either natural (e.g.
potatoes) or processed (e.g. bread) are broken down in the body to a single
sugar. So, bread, pasta, rice, vegetables,
chocolate, pastries and biscuits ALL turn into glucose eventually, which is the
primary fuel for the brain. The rest is used immediately for energy or stored
in muscle cells or the liver for later use.
When circulating in the blood, glucose is known as ‘blood sugar’ and
insulin is secreted from the pancreas when levels rise, to take glucose into
our cells. This prevents blood sugar
from getting too high, which is dangerous for health.
The speed which your body absorbs
sugar is partly determined by the amount of fibre in food, which slows the
process down. That’s why it’s better to
eat whole, unprocessed foods. Eating the
whole fruit, rather than just the juice is a good example and I am a big fan of
blending smoothies rather than juicing, for this reason. The other foods on your plate will also have
an impact on blood sugar in your body.
If you have a balance of proteins and good fats on your plate, this will
further slow the absorption of sugar.
So, it is definitely better to include something from each food group
with all your meals and snacks.
WHAT ABOUT FRUCTOSE?
Fructose is a sugar found naturally
in many fruits, some vegetables and honey. However, it is unlike other sugars
because it is not the preferred energy source for muscles or the brain and it’s
only processed in the liver. It also has
minimal impact on blood sugar levels and does not cause insulin to be released. In the past, this has led to the thinking
that we can eat as much fruit as we like, because it doesn’t cause blood sugar spikes,
or pose health issues.
Evidence is now emerging which raises
concerns about high intakes of dietary fructose, because it can be converted to
fat in the liver. Much of this research
stems from the prevalence of high fructose corn syrup (HFCS) in the food
industry. In America, the per capita
consumption of HFCS in 2016 was 41.4 pounds. (3) The consumption in the UK is currently lower,
as both sugar and HFCS have been subject to export quotas and production
restrictions. Worryingly these limits
were lifted by the EU on 1st October this year. (4) This gives food manufacturers free reign to
switch to fructose corn syrup, should they choose.
Childhood obesity expert, Dr Robert
Lustig explains that as there isn’t a hormone to remove fructose from the
blood, it’s stored in the liver as glucose, or turned into a fatty acid
molecule called a triglyceride. These
fats are returned to the blood and deposited around the body. Once the fat stores are full, they can travel
to the heart or liver posing serious health risks. (5)
Recent evidence also links fructose
to gut health, revealing that it can cause damage to the intestinal lining and
imbalance our gut bacteria. (6)
Excessive amounts could therefore contribute to a range of health
disorders and can also cause bloating and digestive discomfort. We mustn’t forget that there are a host of fibre,
vitamins, minerals and antioxidants in fruit, so it shouldn’t be
demonised. However, intake should not be
unlimited, more on that later.
REFINED VS UNREFINED
We all know that it’s better to eat
whole fruit (in moderation) and vegetables, rather than a chocolate bar. We’ve learned that natural carbohydrate
sources will give more sustained energy and stable blood sugar. But what exactly is a refined sugar?
Refined sugar comes from sugar cane
or sugar beets, which are processed to extract the sugar. It is typically found
as sucrose (commonly known as table sugar), which is the combination of glucose
and fructose. During the refining
process, all the vitamins, minerals, fibre and antioxidants are stripped away.
Food manufacturers add refined or chemically
produced sugar (HFCS) to many foods and drinks to make them more palatable. A lot of these are not things you might typically
expect to find sugar in and low-fat foods are often the worst offenders. Get in the habit of checking labels to see
what the sugar content is, you might be surprised as you can see! (7)
Unrefined sugar on the other hand,
retains all the natural nutrients.
These are raw, unrefined sugar products such as honey, maple syrup,
brown rice syrup, date syrup and molasses.
But, here is where you must be careful, because these unrefined
‘healthy’ sugars can also have refined versions.
The processed golden honey found in
supermarkets is completely different from ‘raw’ unpasteurized honey which still
contains beneficial enzymes, vitamins, minerals and antioxidants. It also has a GI of about 75, compared to raw
honey at around 30. Processed maple
syrup that is commonly used on pancakes is often flavoured with maple and
loaded with sugar or high fructose corn syrup.
Choosing a ‘pure’ maple syrup ensures that it is not as refined and
still contains beneficial nutrients. You
will pay a premium for these products; however, you need to use a fraction of
the amount of the cheaper more processed versions. Supermarkets won’t always stock these, so
head to your health food store, or shop online.
WHAT ABOUT DRIED FRUIT?
recipes are now suggesting that we substitute refined sugar for dried fruits
such as raisins, prunes, apricots and dates.
Dried fruit has had all the water content removed and with this, the
vitamin C content is also dramatically reduced.
The fibre and antioxidant content, however are increased. (8,9) But if
we look at the fructose content of a range of fruits, it is dried varieties
that top the chart. (10)
So, as with everything in life, it
is all about balance. If you are going
to ditch refined sugar and start eating 20 medjool dates every day, this is
probably not the best idea! However, if
like me you are going to use dates in recipes to replace sugary snacks and use
these sparing, then it’s better than using the refined sugar. Healthy snacks such as energy balls usually
use dates (incidentally I use deglet noir as they are not only cheaper but
lower in fructose) and I would have one ball a day as a ‘sweet treat’. I find this chart really useful to moderate
the amount of high fructose fruit that is consumed. It does shed light on the downside of giving
kids boxes of raisins daily, versus say a tangerine.
HOW MUCH DO WE NEED?
The NHS states that we shouldn’t
have more than 5% of our calorie intake as sugar, which is 30g of sugar (7.5
teaspoons) a day for anyone aged 11 or over. Children aged 7-10 should not have
more than 24g a day (6 teaspoons) and aged 4-6, no more than 19g a day (just
under 5 teaspoons). (11) So, you start the kids’ day with a bowl of
cheerios and a glass of orange juice, pack them off to school with a carton of
fruit juice in their packed lunch and
then a kids yogurt later. This, without
any ‘sweet’ treats gives them about 12 teaspoons of sugar!
The Government supports the UK
Eatwell Guide which shows you their version of a healthy plate and what should
come from each food group. (12) On this,
they do not include sugary foods at all, but show them separately, saying ‘eat
less often and in small amounts’. Their
advice is still to eat 5 portions of fruit and vegetables daily, which I
believe is now outdated. We should not
be eating to prevent disease, rather we should eat to optimise health. From this perspective I much prefer the
Alliance for Natural Health ‘Food4Health Plate’ which state that we should eat
from 6 groups each day; vegetables (40%), Fruits (10%), Grains (10%), Healthy
Fats (10%), Protein (25%) and concentrated nutrients (5%). (13) This could be
developed further to include fermented foods, which are beneficial for gut
health and are thankfully becoming more readily accessible.
In my opinion we should strive to
include 6-8 vegetables a day and minimise fruit to 2-3 portions. Using the fructose guide, it would be smart
to try and ensure that you aren’t picking all the high fructose varieties. Dried fruits should be minimised and used
sparingly as treats. People with blood
sugar and digestive issues could benefit from minimising further, or even
removing fruits completely. There should
always be room for a treat, so try to pick a day or evening that is your treat
time and think about minimising the quantity of the treat, so it’s not a binge! When choosing packaged products, try to pick
the lowest percentage of sugar per 100g that you can (under 5% would be a good
start) and eat whole foods as much as possible. Remember that if you enjoy a drink on the
weekend you should also consider the sugar content. A large glass of dry white, prosecco or red
wine is a quarter of a teaspoon, a pint of ale 1 tsp, a pint of lager is 2 tsp,
and a pint of sweet cider such is up to 5 tsp! If chocolate is your weakness, treat yourself
to a bar of raw chocolate which is made by roasting the cocoa beans to much
lower temperatures. This retains
nutrients and antioxidants that are usually destroyed. It’s also dairy and
refined sugar free.
So, what about the myriad of sugar
alternatives on offer? Well here’s an
overview and my advice on the ones to buy and avoid:
Artificial sweeteners such as saccharine, sucralose
and aspartame (brand names Nutrasweet, Equal, Splenda) are best avoided
altogether. Research indicates that these can disrupt appetite regulation and
promote weight gain, as well as negatively impact gut health. (14,15,16)
Agave nectar was considered a healthy sweetener a few
years ago. Recent evidence however shows
that whilst it is low in GI, it has an extremely high fructose level (over
70%). From this perspective I would not
recommend using this product at all.
Coconut sugar is from the sap of the coconut tree and
has a sweet caramel flavour. It is a low
GI option at only 35, low in fructose and contains trace amounts of vitamins
and minerals. It also contains inulin,
which is a fibre which can help to slow glucose absorption and is beneficial
for our gut bacteria. (17) Whilst it
isn’t refined, it should be used sparingly as it does contain the same calories
as sugar. I have found this works well
in small quantities in baking and desserts.
Xylitol and Erythritol are sugar alcohols or polyols
and have low GI and calories. They are
naturally derived and can be used in recipes to substitute sugar, in lower
quantities. They do not stimulate an
insulin response and therefore can be useful for diabetics. People with digestive complaints such as IBS
should be cautious as they can cause digestive disturbance. I don’t tend to use these products as I am
cautious of their highly processed nature and lack of evidence of safety.
Maple syrup as discussed should only be used in it’s
raw unprocessed form as it contains more nutrients. Its strong taste means you won’t need to use
much and I would advise to use it sparingly as it has a GI of 54. I do use maple in some of my recipes and to
drizzle it on gluten free pancakes.
Honey should also be unrefined and raw, or you could
splash out on manuka honey which has antimicrobial properties. Not only is raw honey lower GI than
processed, it also contains beneficial enzymes and nutrients. Remember though to use in moderation as it is
still high in fructose.
Date syrup is extracted from dates using a soaking and
squeezing process. It has a GI of around
50 and is also high in fructose. It is
OK to use in moderation, but I prefer to use whole dates in my recipes, which
retain the fibre and vitamins and minerals.
Brown rice syrup is a natural sweetener also called
rice malt syrup. Cheaper versions are
made from cooked brown rice cultured with enzymes. Better versions use sprouted grains that
release the enzymes to break the rice down into maltose and other sugars. Brown rice syrup does not contain any
fructose and I think in moderation it is a good sweetener, but it doesn’t work
so well in baking.
Blackstrap molasses is a by-product of sugar, but it
is unrefined as it still contains a variety of vitamins and minerals. It has a GI of about 55 and contains high
levels of vitamin B6, manganese, magnesium, potassium, iron and selenium. It also contains high levels of antioxidants,
compared to other sugar substitutes. (18)
I think it’s an underrated sweetener and has more uses than people
Stevia is a low calorie natural sweetener which comes
from the stevia plant in South America. It
is much sweeter than sugar, so you only need to use a little. There are some highly processed varieties on
the market (such as Truvia) which often add in other chemicals, or come from
GMO plants. These products should be
totally avoided and really don’t taste good at all. If using stevia, make sure that you only buy
full green leaf stevia which is the least processed.
Chicory root fibre (or inulin) is what gives TROO
granola it’s sweetness. It is a soluble
fibre, with many health benefits and it has no impact on blood sugar
levels. Best of all, inulin is a
prebiotic meaning that it feeds the good bacteria in our guts. It isn’t widely available for home use.
For the best choice of all these products, you should head to a health food store, as you won’t find them all in the supermarket.
THE 28 DAY CHALLENGE
So, it all sounds a bit gloomy, right? Basically, there is sugar everywhere. But honestly, it’s not as hard as you think to cut down. By making a positive change you are not only taking control of your health, but you will most likely shed a few pounds at the same time. As an experiment, I cut all refined sugar and alcohol from my diet for 28 days about a year ago and did not find it nearly as hard as I imagined. Although during this time I did include fruit (2 a day) and used dried fruit (dates) to provide me with healthy ‘treats’ (again 1 small treat per day). I used sugar alternatives sparingly for baking and increased my protein and vegetable intake. I found myself way less hungry, my energy levels improved, my hormones balanced and I lost 1.5 inches from my waistline. I found that the alternatives I used were more than enough to satisfy any cravings (which by the way also reduced dramatically). I now have very little sugar in my diet at all and really don’t miss it.
Try the 28-day challenge, it might just step change your diet (and health) for good!
We only became interested in the role of
dietary fibre in humans towards the end of the nineteenth century. Building on the work of other scientists, a
surgeon called Denis Burkitt proposed what is now known as ‘The Dietary Fibre Hypothesis’
in 1972. (1) At the time, this somewhat
radical view identified that diets low in fibre increased the risk of many
degenerative disorders such as cardiovascular disease, obesity, diabetes,
cancer and bowel conditions, to name a few.
So, public interest in fibre was put firmly on the map and the food
industry went on an all-out fibre assault.
Cereals were an obvious win for food manufacturers and subsequently
‘high fibre’ claims were established.
Fast forward to now and it’s not in dispute
that fibre is beneficial, in fact research into fibre and digestive health
particularly has evolved considerably (more on that later). There is a big market for products rich in
fibre and a trend to find new sources. But
what exactly is ‘high fibre’, where should we get it from and what does it do
for us? I’ve written the fibre file to
hopefully arm you with the facts, so that you can make an informed decision on
your food choices.
Its definition has been
subject to a great deal of debate over the years. The most recent definition seems to be
globally agreed as: ‘dietary ﬁbre is made
up of carbohydrate polymers with three or more monomeric units (MU), which are
neither digested nor absorbed in the human intestine’. (2)
In simple terms, fibre is
the indigestible portion of food derived from plants. It is often described as soluble fibre (e.g.
in oats and fruit) and insoluble fibre (e.g. in wholegrains and nuts), simply
meaning that can or can’t be dissolved in water. Insoluble fiber is found in the cell walls of
plants and is beneficial as it adds bulk to stools to assist in moving them out
of the digestive tract. Soluble fiber on the other hand dissolves in water and
helps to slow the passage of food through the digestive tract, lower blood
sugar levels, and reduce cholesterol.
For the science brains
amongst you, dietary fibre is technically a non-digestible polysaccharide. If you read my previous article on sugar ‘The
Sweet Truth’, you may remember the diagram below. (3) Within the polysaccharide category, there are
some types that are not digested or absorbed in the stomach or small intestine
and therefore can’t be broken down into single sugar molecules. Cellulose is just one example, however there
are now around 16 different types, as identified by a 2017 review of dietary
fibre in Europe. (2) It’s way too
confusing to talk about them all, however the following table gives a good
summary of some of the main types along with their sources and health benefits.
(4) Note that the fibre used to give
TROO granola its sweet taste is inulin, derived from the chicory root and has
benefits for both gut and immune function.
WHY DO WE NEED IT?
We know that fibre is not
digested or absorbed in the stomach and small intestine, so how is it useful? It’s probably best known for its role to
alleviate constipation; however, we now know that it has many more important
functions. These range from the reduction
of glucose and cholesterol absorption in the small intestine, providing bulk
for our stools (which minimises toxicity and aids hormone balance), influencing
metabolic activity in the gut and the production of energy resources for the
body. As a result, clinical studies
suggest fibre exerts a wide range of benefits in areas such as bowel function,
immunity, blood glucose control, cholesterol levels and gut health and hormone
We know that dietary
fibre decreases the risk of bowel cancer, likely because of the effect it has
in bulking our stools and moving waste through the colon quickly. As our stools contain carcinogens and toxins,
we really don’t want them hanging around in there for too long! Did you know that up to 80% of our immune
system is in the gut? This is because
the digestive tract is lined with active immune tissue. The immune enhancing effect of dietary fibre
and the link between the gut and our immune systems is an exciting and growing
area of research.
In terms of regulating
blood sugar levels, foods which contain fibre take longer to digest and
therefore slow the absorption of glucose, in particular the soluble mucilage
and beta glucan varieties from the previous table found in oats, nuts, seeds
and beans. The body does not produce
insulin in response to fibre, so inclusion of adequate levels can lead to lower
blood glucose and decrease subsequent risk of diabetes and cardiovascular
disease. Soluble fibre has also been shown
to lower LDL blood cholesterol (the bad type) in a number of different ways. An all-round win for heart health.
And as if those reasons
weren’t enough, eating fibre can also help with weight loss. Blood sugar balance is key this, however fibre
also fills you up as it absorbs liquid in your stomach and this fullness
stimulates receptors to tell your brain to stop eating. Fibre helps to eliminate excess hormones in
our stools which can also aid weight loss.
FIBRE AND GUT HEALTH
The emerging research in
this area is fascinating. A recent
research paper identified 188 relevant studies in the area of the human gut
‘microbiota’ (or gut bacteria) and the consumption of dietary fibre. (6) It seems that the amount and type of fibre
consumed can have a huge effect on the number of beneficial bacteria in our
gut. We used to think that fibre did not
provide any energy to the body, however it is now known that some types can be
fermented in the large intestine by our gut bacteria. This process feeds the good bacteria and
helps them to grow.
It also produces short
chain fatty acids (SCFAs) which can be absorbed into the blood stream and used
as energy, as well as providing food for the cells of the colon. In the last few decades, it became apparent
that SCFAs may play a key role in the prevention and treatment of metabolic
syndrome, bowel disorders, and certain types of cancer. (7) When bacteria in the lower intestine break down fiber, a substance called
butyrate is produced which may inhibit the growth of tumors of the colon and
leading to beneficial changes in gut bacteria comes from fibre termed as
‘prebiotic’. Prebiotics are defined as
“a selectively fermented ingredient that allows specific changes, both in the
composition and/or activity of the gastrointestinal microbiota that confers
benefits.” (9) Prebiotics fall into the
oligosaccharide and inulin category and sources include raw leeks, onions
(cooked or raw), green bananas, chicory root, raw asparagus, raw garlic,
jerusalem artichoke and dandelion greens. (10)
Before you all start
loading up on the foods above, there should be a word of caution for anyone suffering
from digestive issues such as IBS. There
has been research to suggest that these fermentable fibre sources can aggravate
the symptoms of IBS such as bloating, discomfort and flatulence. (11) It is not the fibre itself that is causing
the issue, but rather the fermentation process, as sufferers from IBS usually have
abnormal bacterial balance and therefore undesirable, or ‘bad’ bacteria may be
feeding from the fibre. (12)
A specific dietary
approach has been identified in helping symptoms of those with IBS, called
FODMAP, which stands for Fermentable Oligosaccharides, Disaccharides,
Monosaccharides and Polyols (bit of a mouthful hence the need for an
acronym!) It relates to the dietary restriction
of poorly digestible carbohydrates that are easily fermented in the gut and
includes some of the fibre sources we have been discussing. Although this approach can be successful in
relieving symptoms, it is important to note that it may not be addressing the
underlying causes of IBS. The
hypersensitivity of the gut in IBS sufferers is something that should firstly
be assessed by a trained nutritional professional, as this dietary regime is
restrictive and excludes many beneficial foods. (13)
HOW MUCH IS ENOUGH?
So, hopefully you now
have a better understanding of fibre, how much do we need to eat? In 2015 the Government announced new
guidelines, following the SACN Report on Carbohydrates and Health stating that intake
should be as follows: (14)
intake of fibre
15g per day
20g per day
25g per day
17 and over
30g per day
The new level represents
an increase of 7g per day for adults and the report suggests that to meet this,
it would be necessary to consume around 3-5 servings of fibrous vegetables (for
example peas, broccoli and carrots), 2-4 servings of fruit (for example an
apple with skin, a portion of strawberries and an orange) plus 3 servings of
wholegrain bread/pasta/beans/pulses (for example, 2 slices of wholemeal bread,
lentils and wholemeal spaghetti). (14)
The link between higher consumption of dietary fibre and a reduced
incidence of the health issues already discussed was the driver for this
It is estimated that the
current adult intake in the UK is 12g below the new recommendation, at only 18g
of fibre daily. The sources are
estimated to come from cereals (39%), vegetables and potatoes (31%), fruit (9%)
and meat products (11%). (15) I have to say that I found it shocking that
meat products, which contain little, to no fibre showed a higher consumption
percentage than fruit! One can only
assume that this figure is driven by processed meats which have fibre added for
both technological reasons and for benefits to health. (16)
For a manufacturer to claim
that a food is high in fibre, the product must contain at least 6g of fibre per
100g or at least 3g of fibre per 100 kcal. (17)
But is 6g per 100g really a ‘high’ level? I would urge you to check out any packaged
goods you buy to make the comparisons.
Did you know that two of the leading ‘healthy’ granola brands on the
market contain only 6.9g and 10.6g of fibre per 100g, compared to TROO granola
at a massive 16.7g-18.3g, depending on which variety you choose.
WHAT SHOULD I EAT?
There’s a sensible
approach to fibre intake in my opinion, in fact, it’s an approach to healthy
eating more than anything. Think about
food sources being the least processed and as close to the ‘whole’ food as possible. The advice to consume 8-10 portions of fruit
and veg (with only 2-3 as fruit) is a good one.
I prefer blending to juicing, as the fibre is retained and soup with
added vegetables and grains is another way to boost fibre levels. Vegetables as crudités make a quick high
fibre snack option too.
In terms of grains, stick with wholemeal
varieties and steer clear of white refined foods. Be experimental with the wide range of fibre
rich grains on the market that are also high in protein, vitamins and minerals,
such as quinoa, buckwheat, millet and amaranth.
Include some of the fermentable fibre sources that are known to be
beneficial for gut health (assuming that you do not have any digestive
issues). Eat your bananas green, or chop
and freeze them green to add to smoothies.
Be mindful of being seduced by ‘high’ fibre
claims when there are alternatives with higher levels. If these foods are also high in sugar, then
it’s a no-no. Cereal brands and snack
bars are the worst offenders here. For example,
a popular brand of cereal bar that I looked at, had high fibre (at 7.7g) but included
a whopping 32.5g of sugar per 100g! There
are countless cereals on the market that have incredibly high levels of sugar,
so always check the pack before you buy.
Oats and oat bran are heart healthy fibre rich options if you like to
alternate your TROO granola with porridge or overnight oats.
Do include legumes – that’s beans and pulses,
which are high in fibre and don’t forget that nuts and seeds make a great snack
with added fibre too. Flax or linseed
which you can buy milled as a powder is really versatile for adding to baking
and cereals and has 27g of fibre per 100g.
Chia seeds have become popular and can be included in lots of different
recipes too and have 34g of fibre per 100g.
Eat as wide a range of food from as many
different good sources as you can. And
remember that not all fibre is created equal, so a couple of slices of toast
each day isn’t going to suffice!
Cummings, JH & Engineer, A: Denis Burkitt
and the origins of the dietary fibre hypothesis. Nutr Res Rev.
Stephen, A et al: Dietary fibre in Europe: current
state of knowledge on definitions, sources, recommendations, intakes and
relationships to health. Nutr Res Rev.
2017; 30 (2) 149-190
Klosterbuer A, Roughead ZF, Slavin J: Benefits
of dietary fiber in clinical nutrition. Nutr Clin Pract 2011;26:625-635
Caleigh M. Sawicki, et al: Dietary Fiber and the Human Gut Microbiota:
Application of Evidence Mapping Methodology. Nutrients. 2017 Feb; 9(2): 125.
Besten, G et al: The role of short-chain fatty
acids in the interplay between diet, gut microbiota, and host energy
metabolism. J Lipid Res. 2013;54(9): 2325–2340.
Polak-Charcon S, Madar Z, et al. Apoptosis cascade proteins are regulated in
vivo by high intracolonic butyrate concentration: correlation with colon cancer
inhibition. Oncol Res. 2000;12:83-95
Gibson GR, et al: Dietary prebiotics: current status and new
definition. Food Sci Technol
Bull Funct Foods 2010; 7:1-19;
Bijkerk CJ1, Muris JW, Knottnerus JA, Hoes AW,
de Wit NJ. Systematic review: the role of different types of fibre in the
treatment of irritable bowel syndrome. Aliment
Pharmacol Ther. 2004 Feb 1;19(3):245-51.
King TS1, Elia M, Hunter JO. Abnormal colonic fermentation in irritable
bowel syndrome. Lancet. 1998 Oct
2015. The Digestive Health
Solution, edn 2. Exisle Publishing,