III. Physiology

  1. Dietary Fiber improves stool bulk and transit time
  2. Dietary Fiber lowers serum Cholesterol

IV. Precaution

  1. Fiber content listed below is approximate
  2. Various texts list different fiber per serving

V. Adverse Effects

  1. Use with >1.5 Liters/day non-caffeinated fluid
  2. Poorly tolerated in atonic colon (e.g. Megacolon)
  3. Bloating is common in larger doses initially
    1. Reduced by slowly increasing fiber intake

VI. Drug Interactions

  1. May interfere with absorption of medications
    1. Do not take medications at the same time as Psyllium
    2. Space Psyllium several hours apart from medications
  2. Agents known to be affected
    1. Carbamazepine (Tegretol)
      1. Etman (1995) Drug Dev Ind Pharm 21:1901-6 [PubMed]
    2. Lithium
      1. Perlman (1990) Lancet 335:416 [PubMed]

VII. Preparations: Dietary Fiber Sources

  1. Whole grain cereals or breads
    1. All-Bran or 100% Bran Cereal (>8 grams per serving)
    2. Wheaties (2.6 grams per serving)
    3. Shredded Wheat (6 grams per serving)
    4. Grits (5 grams per serving)
    5. Grape-nuts (5 grams per serving)
  2. Fresh fruits
    1. Raspberries (4.5 grams per serving)
    2. Fruits with 1-3 grams fiber per serving
      1. Apple with peal
      2. Orange
      3. Peach
      4. Pear
      5. Strawberries
    3. Fruits with negligible fiber
      1. Grape-fruit has only 0.6 grams fiber per serving
      2. Apple juice has no fiber content
  3. Vegetables (raw better than cooked)
    1. Beans (>8 grams per serving)
      1. Kidney beans
      2. Lima beans
      3. Navy beans
      4. Baked beans
    2. Peas (6 grams per serving)
    3. Corn on the cob (6 grams per serving)
    4. Parsnips (6 grams per serving)
    5. Lentils (4 grams per serving)
    6. Broccoli (3 grams per serving)
    7. Baked Potato with skin (3 grams per serving)
    8. Other vegetables with 1-2 grams fiber per serving
      1. Beets
      2. Cabbage
      3. Carrots
      4. Celery
      5. Corn
      6. Squash
      7. Green beans
      8. Turnips
  4. Other sources
    1. Whole wheat bread (1.3 grams per serving)

VIII. Bulk-Forming agents

  1. Psyllium (Metamucil): 10 grams per day
    1. Dose: 1-2 tsp in 8 ounces of water or juice PO tid
  2. Methylcellulose (Citrucel): 6 grams per day
    1. Dose: 2 grams in 8 ounces liquid PO tid
  3. Calcium Polycarbophil (Fibercon)
    1. Dose: Two 625 mg tablets PO tid
    2. Synthetic bulk agent containing polyacrylic acid
  4. Dietary sources with as much fiber at 10% of cost
    1. Wheat bran, oat bran or all-bran cereal
    2. Lima, Navy, Kidney and baked beans

IX. References

  1. Brody (1981) Nutrition Book, p. 147
  2. Cheskin in Barker (1995) Ambulatory Medicine, p. 479

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Cost: Medications

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