Fibre & IBD - Friend or Foe? What you've been lead to believe may be wrong
What is fibre?
Dietary fibre is a type of carbohydrate and the part of plants that is not digested by us in our small intestine, unlike other carbohydrates like starch and sugars, so reaches the large intestine (colon).
Where is fibre found?
Fruit and vegetables
Wholegrains – brown rice, oats, buckwheat, millet, amaranth, quinoa, teff, barley, rye, wholewheat pasta, wholegrain bread.
Legumes (beans, peas, pulses, lentils)
Nuts and seeds
Fibre & IBD
For many years, the advice given to patients with IBD has been to follow a low fibre diet to help reduce symptoms during flares. As such diets like the LOFFLEX Diet (LOw Fat/ Fibre Limited EXclusion), which were designed based on reports from some patients that some high fibre foods exacerbated symptoms. Low fibre diets like these reduce wholegrains, nuts, seeds and certain fruits and vegetables, limiting fibre intake to less than 10-15g fibre a day which is around half what is usually recommended for a healthy balanced diet. In addition, many people end up following these low fibre diets for much longer than is recommended (2-4 weeks).
Whilst a low fibre diet is important for people with a higher risk of bowel obstruction (i.e. with strictures and stomas), the evidence now suggests that people with IBD do well or better with higher fibre intakes than in those following a low-fibre diet, even with active inflammation. But despite this, a low-fibre diet is still too often recommended by some gastroenterologists and dieticians.
In fact, some research has observed that people with IBD who restrict fibre could be more likely to relapse. There is also emerging evidence that suggests high fibre diets like a plant-based diet could be effective in IBD. Some research has also shown that supplementing with some specific fibres could reduce relapses in UC. The research in the area of gut health and the microbiome in recent years has revealed how important the microbes that live within our intestine, and the compounds they produce, are in helping to keep us healthy. If we do not eat enough fibre we deprive these microbes of the food they need to thrive and this can impact the lining of our digestive tract. Things get a little more complicated when we look at types of fibres. There are certain types of fibres that may cause symptoms in some people with IBD and the removal of these for a short period of time (4-8 weeks) followed by a strategic reintroduction has been shown to help in some people but these restrictive diets should never be followed long term – reducing these fibres can help symptoms in the short term but have a negative impact on the balance of bacteria in the intestine long term which could lead to problems.
Dietary recommendations for IBD are constantly evolving and it seems there is a real shift in the thinking around fibre and IBD. A low-fibre diet seems to have had its time (unless in specific cases as mentioned above) and research is now showing that long-term restriction of dietary fibre to control symptoms is actually more likely to be have a negative impact on digestive health, particularly colon health, long term.
What to do
Get help – if you experience lots of symptoms or if you are not sure what you should be doing then it’s vital you seek help from a qualified nutrition professional. They will be able to help to guide you through this journey and help you work out what is the best way forward for you specifically. It may be that you need to reduce certain fibres for a short time and then reintroduce them but this should only be done under the guidance of a professional.
Take is slowly – if you want to try and go it alone, take it slow. If you follow a low fibre diet now or have for a while and you suddenly start eating loads you might experience unwanted side effects like bloating so take it very slowly. Gradually start introducing different fibres into your diet, starting with very small amounts (half a tablespoon or less) and work up over a period of a few weeks or even months. Start with foods containing fibre that you know you can tolerate OK first then work out from there to include other foods. Doing it this way will help your system adapt and increase your tolerance over time.
Fibre is probably only one piece of the puzzle – I’m often talking about ‘pieces of the puzzle’ because its never one thing that’s going to be the magic pill that solves your problems when it comes to IBD and nutrition. We need to look at all the pieces of the puzzle, including foods, nutrients, deficiencies, gut health, sleep, stress, movement and how all these interlink to help or hinder your progress. Its also important we are not always focused on what we need to remove from our diets but rather what we can be including that may be supportive. Ultimately my aim with all my clients is to improve their quality of life and help them achieve nutritional balance through the least restrictive diet possible.
I have written a free e-book to help you find a way forward for your everyday life with Inflammatory Bowel Disease. Whether you are right at the beginning of your journey with IBD or have been living with your condition for years and feel like you have tried almost everything, there are things you can do everyday, beyond the medication you are taking, to help you take back control.
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We are all wonderfully unique and what works for one person may not work for another so please seek help and advice before changing your diet to work out the right way forward for you.