Epidemiological studies suggest that dietary fiber may decrease the risk for development of colorectal cancer. There appear to be four mechanisms by which fiber is protective in the colon and rectum: (a) increasing bulk of the stool; (b) binding to colorectal carcinogens; (c) decreasing transit time of waste through the bowel; and (d) altering the microbial composition of the colon leading to reduced risk for colon cancer (Kritchevsky, 1997; Zeng, 2014). Both (b) and (c) reduce the interaction of carcinogens with the lining of the colon and rectum. Dietary fiber may also play a role in reducing risk for the development of esophageal cancer, perhaps through mechanisms that differ from those in colorectal cancer. Epidemiological studies have identified protective effects of fiber against the precancerous lesion, Barrett's esophagus (BE), and its conversion to esophageal adenocarcinoma (EAC), presumably by reducing acid reflux from the stomach to the esophagus (Coleman et al., 2013). Similar associations were observed in studies of fiber intake and risk of conversion of esophageal dysplasia to esophageal squamous cell carcinoma (ESCC), but the results were not significant (Coleman et al., 2013). However, a recent cross-sectional study in China found that subjects were at increased risk for ESCC when they consumed diets low in vegetables and fruit and this was attributed in part to low fiber intake (Zang et al., 2022).
In any discussion of the role of fiber in disease occurrence, it is necessary to define what is meant by dietary “fiber.” Briefly, there are two types of dietary fiber, soluble and insoluble (Papandreou et al., 2015). Both types are carbohydrates found in most plant foods. Soluble fiber (largely pectin and inulin) dissolves in water and is digested by enteric bacteria in the large intestine. Dietary sources of soluble fiber include oats, legumes, and vegetables such as carrots, cabbage, Brussels sprouts, squash, and broccoli. Soluble fiber reduces low-density lipoprotein (LDL) cholesterol levels in blood and helps control blood sugar by preventing rapid rises in blood sugar levels after a meal (Kritchevsky, 1997). Insoluble fiber (cellulose, lignin) does not dissolve in water and passes directly through the gastrointestinal tract. Because it remains intact, it provides “bulk” with stool formation and speeds the movement of waste through the digestive system. Dietary sources of insoluble fiber include whole grains, rye, and fruits and vegetables. Bacterial degradation of fiber in the colon produces short-chain fatty acids (SCFA) such as butyric acid which may affect colonic and fecal pH. Butyric acid also exhibits both antiproliferative and proapoptotic activities (Vanamala et al., 2008). Given these various functions of soluble and insoluble fiber, it seems readily apparent how fiber might reduce risk for colon cancer but no
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