the potential role of dietary fiber in the control of
diabetes. The ‘glycemic index’ is essentially a quanti-
tative expression of the quantity of glucose appearing
in the bloodstream after ingestion of a carbohydrate-
rich food. To calculate the index, fasted subjects are
given a test meal of the experimental food containing
a standardized quantity of carbohydrate. The change
in concentration of glucose in the blood is then meas-
ured over a period of time. The ratio of the area under
the blood-glucose curve in response to the test meal to
that produced by an equal quantity of a standard
reference food is then calculated and expressed as a
percentage. When glucose is used as the standard,
complex starchy foods often have glycemic indices
lower than 100%.
0005 The physical resistance of plant cell walls during
their passage through the gut varies considerably
from one food to another, and any cell walls that
remain intact in the small intestine will impede the
access of pancreatic amylase to starch. Even when
enzymes and their substrates do come into contact,
the presence of cell wall polysaccharides may slow the
diffusion of hydrolytic products through the partially
digested matrix in the gut lumen. Pulses tend to give
particularly low glycemic index values, probably
because legume seeds have relatively thick cell
walls, which resist destruction during processing
and cooking. This effect of fiber on carbohydrate
metabolism cannot be predicted from simple analyt-
ical values for total fiber because it reflects the struc-
ture, as opposed to the absolute quantity, of cell wall
polysaccharides within the food.
0006 Many studies on postprandial glycemia have been
conducted using isolated fiber supplements added to
glucose test-meals or to low-fiber sources of starch.
They demonstrate that, contrary to Trowell’s original
hypothesis, wheat bran and other insoluble cell wall
materials have little effect on glucose metabolism.
However certain polysaccharides, such as guar gum,
pectin, and oat beta-glucan, which form viscous solu-
tions in the stomach and small intestine, do slow the
absorption of glucose. Highly viscous food compon-
ents may delay gastric emptying and inhibit the dis-
persion of the digesta along the small intestine, but
the primary mechanism of action appears to be sup-
pression of convective stirring in the fluid layer adja-
cent to the mucosal surface. The rapid uptake of
monosaccharides by the epithelial cells tends to
reduce the concentration of glucose in this boundary
layer, so that absorption from the gut lumen becomes
rate-limited by the relatively slow process of diffu-
sion. The overall effect is to delay the assimilation of
glucose and hence suppress the glycemic response to
glucose or starchy foods in both healthy volunteers
and diabetics. A similar mechanism probably inhibits
the reabsorption of cholesterol and bile salts in the
distal ileum, and this may account for the ability
of some viscous polysaccharides to reduce plasma
cholesterol levels in humans. (See Carbohydrates:
Metabolism of Sugars.)
Mineral Metabolism
0007Polysaccharides and phenolic components of cell
walls often contain polar groups that can interact
with ionized solutes in the gastrointestinal contents.
Such molecular binding effects do occur in vitro and
might, in principle, restrict the availability of nutri-
ents and other substances for absorption in the small
intestine. Iron, zinc, and calcium are absorbed rela-
tively poorly from the human diet, and there is a long
tradition that high intakes of dietary fiber have an
adverse effect on human mineral nutrition. Studies
with subjects who, for clinical reasons, have had the
colon removed and the small bowel brought to
the abdominal surface (ileostomists) suggest that al-
though neutral polysaccharides do not bind minerals,
charged polysaccharides such as pectin can displace
cations into the colon. However, fermentation of cell
walls probably releases iron and calcium into the
lumen, whence they may be salvaged by colonic ab-
sorption, and there is little objective evidence that
dietary fiber per se has much of an adverse effect
on mineral metabolism. Indeed, highly fermentable
oligo- and polysaccharides have been reported to pro-
mote mineral absorption in some studies, presumably
by stimulating active transfer in the colon.
0008The effect of phytate (myoinositol hexaphosphate)
is generally considered to be more significant than
that of fiber. Phytate is often present in close associ-
ation with cell wall polysaccharides in unprocessed
legume seeds, oats, and other cereals. Phytate does
exert a potent binding effect on minerals and has been
shown to reduce the availability of magnesium, zinc,
and calcium for absorption in trials with human vol-
unteers. Phytate levels in foods can be reduced by the
activity of endogenous phytase, by hydrolysis with
exogenous enzymes, or by fermentation. Dephyti-
nized products may be of benefit to individuals at
risk of suboptimal mineral status. (See Phytic Acid:
Nutritional Impact.)
Large Intestine
0009The large intestine, which is located distal to the small
bowel, salvages energy from food residues and from
endogenous proteins and carbohydrates that have
escaped digestion and absorption. Its other main
role is to form and store feces. Fecal microorganisms
degrade undigested starch, and many of the poly-
saccharides that comprise dietary fiber, to yield the
DIETARY FIBER/Physiological Effects 1835