In pursuing the role of health education, nurses are well placed to help clarify the issues that arise about fibre in day-to-day eating. Patients who find that there is so much information to take in at an outpatient appointment with the physician, surgeon or dietician can leave feeling confused and aware that they have not asked the questions that they wanted to, not heard everything that they have been told or felt that they would be wasting time if they asked for things to be repeated. Often nurses are so busy that they do not have time to sit down with patients in the middle of a clinic to go over what they have been told, so they find it easier to resort to a 'diet sheet' and send the patient on his or her way. Is a high-fibre diet sheet the answer? Lambert and Dickerson (1989) surveyed 45 high-fibre diet sheets and found that there were inconsistencies in the importance of consumption of specific fibre-rich foods and that daily meal plans were open to wide interpretation. Eleven recommended bran for everybody, fifteen recommended using it if necessary and nine recommended its use if advised by a doctor and dietician. The use of large quantities of unprocessed bran is not advised because bran renders the minerals zinc, iron and calcium unavailable to the body as a result of its mineral-binding action. If large amounts of fibre are not available for consumption or cannot be consumed, NSPs can be ingested in the form of sterculia, isphagula or methylcellulose, which are bulking agents that give the stool weight; however, advice must always be given to drink adequate water with these products to avoid obstruction or impaction.
Work by Hardinge and colleagues in 1958, studying crude fibre intake in vegans, omnivores and vegetarians, was confirmed by Burkitt et al. in 1972. It showed that a vegan consumed 23.9 g of fibre a day, a vegetarian 16.3 g and an omnivore 10.7 g. Further studies by Davies and Dickerson (1994) suggested that not only is fibre intake in vegans and vegetarians higher, but also these groups have an improved bowel habit. Although there is an alteration in obtaining energy in vegetarian diets - from carbohydrate because fat is decreased within the diet - those who are vegans need to plan diets carefully so that nutritional status is not compromised.
In balancing good health, dietary fibre should include products that are wholegrain, with five to eleven servings of starchy foods that are wholemeal or wholegrain. NSPs should be from a mixed source such as wholegrain cereals and vegetables with at least five portions of fruit and vegetables per day and two portions of high-fibre cereal per day.
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