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HIGH-FIBER DIETS

Dietary fiber is a diverse group of plant constituents that is resistant to digestion by the human digestive tract. Guidelines suggest that adult men should eat 30–38 g of fiber per day and adult women 21–25 g/day (eTable 29–2). Typical US diets, however, contain about half of that amount. Epidemiologic evidence suggests that populations consuming greater quantities of fiber have a lower incidence of certain GI disorders, including diverticulitis and, in some studies, colon cancer as well as a lower risk of CVD. A meta-analysis of 22 studies suggested that each 7 g of dietary fiber was associated with a 9% decrease in first cardiovascular event.

Diets high in dietary fiber (21–38 g/day) are commonly used in the management of a variety of GI disorders such as irritable bowel syndrome and recurrent diverticulitis. Diets high in fiber, particularly soluble fiber, may also be useful to reduce blood sugar in patients with diabetes and to reduce cholesterol levels in patients with hypercholesterolemia. Good sources of soluble fiber are oats, nuts, seeds, legumes, and most fruits. Foods with insoluble fiber include whole wheat, brown rice, other whole grains, and most vegetables. For some patients, the addition of psyllium or methylcellulose may be a useful adjunct to increase dietary fiber.

HIGH-POTASSIUM DIETS

Potassium-supplemented diets are used most commonly to compensate for potassium losses caused by diuretics. Although potassium losses can be partially prevented by using lower doses of diuretics, concurrent sodium restriction, and potassium-sparing diuretics, some patients require additional potassium to prevent hypokalemia. High-potassium diets may also have a direct antihypertensive effect. Typical American diets contain about 3 g (80 mEq) of potassium per day. High-potassium diets commonly contain 4.5–7 g (120–180 mEq) of potassium per day.

Most fruits, vegetables, and their juices contain high concentrations of potassium. Supplemental potassium can also be provided with potassium-containing salt substitutes or as potassium chloride in solution, capsules, or effervescent tablets.

HIGH-CALCIUM DIETS

Adequate intake of dietary calcium has been recommended for the prevention of postmenopausal osteoporosis, the prevention and treatment of hypertension, and the prevention of colon cancer. The Women’s Health Initiative, however, suggested that calcium and vitamin D supplementation did not prevent fractures or colon cancer. Observational studies have also suggested that calcium supplements, especially when taken without vitamin D, may be associated with an increased risk of CHD. The recommended dietary allowance for the total calcium intake (from food and supplements) in adults ranges from 1000 mg/day to 1200 mg/day. Average American daily intakes are approximately 700 mg/day.

Dairy products are the primary dietary sources of calcium in the United States. An 8-ounce glass of milk, for example, contains approximately 300 mg of calcium. Patients with lactose intolerance who cannot tolerate liquid dairy products may be able to drink lactose-free milk, take supplemental lactase enzyme supplements, ...

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