II. Indications
III. Physiology
- Dietary Fiber improves stool bulk and transit time
- Dietary Fiber lowers serum Cholesterol
IV. Precaution
- Fiber content listed below is approximate
- Various texts list different fiber per serving
V. Adverse Effects
- Use with 64 oz/day (>1.8 Liters/day) non-caffeinated fluid
- Poorly tolerated in atonic colon (e.g. Megacolon)
- Gas (bloating, Abdominal Distention, Flatulence)
- More common if started too quickly with high dosing
- Reduced by gradually increasing fiber intake to 225-30 grams per day
- Side effects more likely with dyssynergic Defecation
- Side effects are more common with insoluble fiber
- Insoluble fiber examples include (Methylcellulose, Citrucel, wheat bran)
- In contrast, soluble fiber (psyillium, Metamucil, oat bran) is associated with less gas
VI. Drug Interactions
- May interfere with absorption of medications
- Do not take medications at the same time as Psyllium
- Space Psyllium several hours apart from medications
- Agents known to be affected
VII. Preparations: Dietary Fiber Sources
- Whole grain cereals or breads
- All-Bran or 100% Bran Cereal (>8 grams per serving)
- Wheaties (2.6 grams per serving)
- Shredded Wheat (6 grams per serving)
- Grits (5 grams per serving)
- Grape-nuts (5 grams per serving)
- Fresh fruits
- Raspberries (4.5 grams per serving)
- Fruits with 1-3 grams fiber per serving
- Apple with peal
- Orange
- Peach
- Pear
- Strawberries
- Fruits with negligible fiber
- Grape-fruit has only 0.6 grams fiber per serving
- Apple juice has no fiber content
- Vegetables (raw better than cooked)
- Beans (>8 grams per serving)
- Kidney beans
- Lima beans
- Navy beans
- Baked beans
- Peas (6 grams per serving)
- Corn on the cob (6 grams per serving)
- Parsnips (6 grams per serving)
- Lentils (4 grams per serving)
- Broccoli (3 grams per serving)
- Baked Potato with skin (3 grams per serving)
- Other vegetables with 1-2 grams fiber per serving
- Beets
- Cabbage
- Carrots
- Celery
- Corn
- Squash
- Green beans
- Turnips
- Beans (>8 grams per serving)
- Other sources
- Whole wheat bread (1.3 grams per serving)
VIII. Bulk-Forming agents
- Psyllium (Metamucil): 10 grams per day
- Dose: 1-2 tsp in 8 ounces of water or juice PO tid
- Methylcellulose (Citrucel): 6 grams per day
- Dose: 2 grams in 8 ounces liquid PO tid
- Calcium Polycarbophil (Fibercon)
- Dose: Two 625 mg tablets PO tid
- Synthetic bulk agent containing polyacrylic acid
- Dietary sources with as much fiber at 10% of cost
- Wheat bran, oat bran or all-bran cereal
- Lima, Navy, Kidney and baked beans
IX. References
- Brody (1981) Nutrition Book, p. 147
- Cheskin in Barker (1995) Ambulatory Medicine, p. 479
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Related Studies
| fiber (on 5/17/2017 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| FIBER LAXATIVE 625 MG CAPLET | Generic OTC | $0.06 each |
| FIBER LAXATIVE 625 MG TABLET | Generic OTC | $0.06 each |
| FIBER LAXATIVE CAPSULE | Generic OTC | $0.05 each |
| FIBER TABLET | Generic OTC | $0.06 each |
| FIBER TABS | Generic OTC | $0.06 each |
| FIBER THERAPY 500 MG CAPLET | Generic OTC | $0.05 each |
| FIBER THERAPY POWDER | Generic OTC | $0.01 per gram |
| FIBER-CAPS 625 MG CAPLET | Generic OTC | $0.06 each |
| FIBER-LAX CAPTABS | Generic OTC | $0.06 each |
| citrucel (on 2/22/2017 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| CITRUCEL 500 MG CAPLET | Generic OTC | $0.05 each |
| CITRUCEL POWDER | OTC | $0.02 per gram |
| CITRUCEL POWDER S-F | OTC | $0.03 per gram |
Ontology: Metamucil (C0025559)
| Concepts | Pharmacologic Substance (T121) , Organic Chemical (T109) |
| MSH | D011620 |
| English | metamucil, Metamucil |
Ontology: Methylcellulose (C0025729)
| Definition (NCI) | The methyl ether of cellulose with laxative activity. Methylcellulose is not absorbed by the intestines and attracts large amounts of water into the colon, thereby increasing viscosity, producing a softer and bulkier stool and stimulating the constriction of intestinal smooth muscles. |
| Definition (MSH) | Methylester of cellulose. Methylcellulose is used as an emulsifying and suspending agent in cosmetics, pharmaceutics and the chemical industry. It is used therapeutically as a bulk laxative. |
| Definition (CSP) | methylester of cellulose; used as an emulsifying and suspending agent in cosmetics, pharmaceutics and the chemical industry and is used therapeutically as a bulk laxative. |
| Concepts | Pharmacologic Substance (T121) , Indicator, Reagent, or Diagnostic Aid (T130) , Carbohydrate (T118) |
| MSH | D008747 |
| SnomedCT | 317492003, 317350009, 322018001, 24504000, 387131008 |
| English | Cellulose, Methyl, Methyl Cellulose, Cellulose, methyl ether, Methylcellulose [GI bulk lax], Methylcellulose [antidiarrh], Methylcellulose [appet suppres, Methylcellulose [antidiarrheal], Methylcellulose [antidiarrhoeal], Methylcellulose [appetite suppressants], Methylcellulose [gastro-intestinal bulk laxative], methylcellulose (medication), ophthalmologicals artificial tears methylcellulose, Methylcellulose [Chemical/Ingredient], methyl cellulose, Methylcellulose, methylcellulose, Methylcellulose [gastro-intestinal bulk laxative] (product), Methylcellulose [antidiarrheal] (product), Methylcellulose [appetite suppressants] (product), Methylcellulose (product), Methylcellulose (substance), Methylcellulose [antidiarrheal] (substance), Methylcellulose [appetite suppressants] (substance), Methylcellulose [gastro-intestinal bulk laxative] (substance), METHYLCELLULOSE |
| Swedish | Metylcellulosa |
| Czech | methylcelulosa, hydroxypropylmethylcelulosa |
| Finnish | Metyyliselluloosa |
| Russian | METILTSELLIULOZA, МЕТИЛЦЕЛЛЮЛОЗА |
| Japanese | メチルセルロース, セルロースメチルエーテル, セルロチル, コロゲル |
| Croatian | METILCELULOZA |
| Polish | Metyloceluloza |
| Spanish | metilcelulosa (laxante expansor de volumen gastrointestinal) (producto), metilcelulosa [supresores del apetito], metilcelulosa [supresores del apetito] (producto), metilcelulosa [antidiarreico] (producto), metilcelulosa (laxante expansor de volumen gastrointestinal), metilcelulosa (laxante de volumen gastrointestinal), metilcelulosa [antidiarreico], metilcelulosa (producto), metilcelulosa (sustancia), metilcelulosa, Metilcelulosa |
| French | Méthylcellulose |
| German | Methylcellulose |
| Italian | Metilcellulosa |
| Portuguese | Metilcelulose |
Ontology: Psyllium (C0033979)
| Definition (MSH) | Dried, ripe seeds of Plantago psyllium, P. indica, and P. ovata (Plantaginaceae). Plantain seeds swell in water and are used as demulcents and bulk laxatives. |
| Concepts | Pharmacologic Substance (T121) , Biologically Active Substance (T123) , Organic Chemical (T109) |
| MSH | D011620 |
| SnomedCT | 52370008, 398702001 |
| English | Psyllium gum, Psyllium Gum, Psyllium, Ispaghula, psyllium, Psyllium preparation, psyllium preparations (medication), stool softeners psyllium preparations psyllium, psyllium preparations, psyllium (medication), Psyllium [Chemical/Ingredient], Psyllium (product), Psyllium (substance), Psyllium preparation (substance), PSYLLIUM |
| Spanish | psilio, psilio (sustancia), ispágula, preparado de psilium, preparado de psilio (sustancia), preparado de psilio, Psilio, psyllium (producto), psyllium, Psillium |
| Swedish | Psyllium |
| Czech | psyllium |
| Finnish | Psyllium |
| Russian | ISPAGULA, PSILLIUM, ИСПАГУЛА, ПСИЛЛИУМ |
| Japanese | プシリウム種子, プランタゴ･プシリウム(車前子), プシリウム, シャゼンシ, プシリウム子, ヘラオオバコ(車前子), オオバコ(車前子), 車前子 |
| Polish | Wyciąg z babki, Ispaghula, Psyllium |
| Korean | 차전자 |
| Portuguese | Psílio, Psyllium |
| French | Plantago arenaria, Plantago psyllium, Psyllium |
| German | Psyllium |
| Italian | Psillio |
Ontology: calcium polycarbophil (C0054480)
| Definition (NCI) | A loosely cross-linked synthetic polycarboxylic-type hydrophilic polymer resin, laxative and anti-diarrheal Calcium Polycarbophil increases stool frequency, fecal water content, and fecal weight in a dose-dependent manner. It is used for idiopathic constipation, secretory diarrhea, and irritable bowel syndrome. (NCI04) |
| Concepts | Pharmacologic Substance (T121) , Organic Chemical (T109) |
| MSH | C030312 |
| SnomedCT | 326660003, 37433002, 400848002, 412106006, 412105005 |
| English | calcium polycarbophil, polycarbofil, laxatives calcium polycarbophil, calcium polycarbophil (medication), polycarbophil (as calcium carbophil), calcium polycarbophil [Chemical/Ingredient], CALCIUM POLYCARBOPHIL, polycarbophil, POLYCARBOPHIL, Polyacrylic Acid Cross-Linked With Divinyl Glycol, polycarbophil calcium, Polycarbophil, Polycarbophil (product), Polycarbophil (substance), Polycarbophil [dup] (substance), Calcium polycarbophil (product), Calcium polycarbophil (substance), Calcium polycarbophil, POLYCARBOPHIL CALCIUM, Calcium Polycarbophil |
| Spanish | policarbofilo de calcio, policarbófilo de calcio, policarbofilo de calcio (producto), policarbofilo de calcio (sustancia), policarbófilo de calcio (producto), policarbófilo de calcio (sustancia), policarbofil (producto), policarbofilo (sustancia), policarbofilo, policarbofil |
Ontology: Roughage (C0086941)
| Concepts | Food (T168) |
| MSH | D004043 |
| English | Roughages, roughage, Roughage |
| Portuguese | Substâncias não Digeríveis da Alimentação |
| Spanish | Alimento o Forraje Indigestible |
| German | Ballaststoffe |
| French | Aliment de lest |
| Italian | Crusca di cereali |
| Czech | vláknina, nestravitelné látky |
| Norwegian | Fiberrik kost |
| Dutch | Ruwe vezels |
Ontology: Citrucel (C0305648)
| Concepts | Pharmacologic Substance (T121) , Carbohydrate (T118) |
| MSH | D008747 |
| English | citrucel, Citrucel, SmithKline Beecham Brand of Methylcellulose |
Ontology: FiberCon (C0720432)
| Concepts | Pharmacologic Substance (T121) , Organic Chemical (T109) |
| English | FiberCon, fibercon, Fibercon |
Ontology: Bulk Laxatives (C1955900)
| Concepts | Pharmacologic Substance (T121) |
| MSH | D054368 |
| English | Laxatives, Bulk, Bulk Laxatives |
| French | Laxatifs de lest |
| Italian | Lassativi di volume |
| Czech | objemová projímadla, objemová laxativa |
