Fibre and IBD - Mythbuster

Myth: Avoiding fibre will cure your IBD

Truth: May be helpful to reduce or modify fibre during flares to help symptoms but long term could have a negative impact on gut health. Read more below……

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 our large intestine (colon) where it acts as food for the trillions of microbes that live there and help to keep us healthy.

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) and low residue diet, which were designed based on reports from some patients that some high fibre foods exacerbated symptoms, have become common.

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 (30g/day).

Although a low fibre diet may help to reduce symptoms during flares in some people, a low fibre diet is by no means a cure and does not reduce inflammation. If followed long term, could have a negative impact on our gut health (1), and many people with Crohn’s and Colitis end up sticking to these low fibre diets for much longer than the 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 may help reduce symptoms in some people during flares, 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 and there is no need to restrict fibre in people with IBD (2, 3). But despite this, a low-fibre diet is still often recommended by some gastroenterologists and dieticians (this is not unusual – statistics show that it takes an average of 17 years for research evidence to reach clinical practice! (4)).

Some research has observed that people with IBD who restrict fibre longer term could be more likely to relapse (5). There is also emerging evidence that suggests high fibre diets like a plant-based diet (semi-vegetarian diet) could be effective in CD (6). Some research has also shown that supplementing with some specific fibres could reduce relapses in UC (7). 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 health of the lining of our digestive tract (8).

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 who still experience symptoms despite being in remission. 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 (9). 

Dietary recommendations for IBD are constantly evolving and it seems there is a real shift in the thinking around fibre and IBD with the research we now have around the role of the microbiome in gut and overall health. 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 (10).

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 and feel better.

Disclaimer: All content found on the nalmclinic.com website, including: text, video, or other formats have been created for informational purposes only. The Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your doctor, consultant or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.

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.

References

  1. Makki, K., Deehan, E., Walter, J., Bäckhed, F. (2018) The Impact of Dietary Fiber on Gut Microbiota in Host Health and Disease. Cell Host & Microbe. 23(6): 705-715. https://doi.org/10.1016/j.chom.2018.05.012.

  2. Linda Wedlake, MSc, RD, Natalie Slack, MSc, RD, H. Jervoise N. Andreyev, PhD, Kevin Whelan, PhD, RD, Fiber in the Treatment and Maintenance of Inflammatory Bowel Disease: A Systematic Review of Randomized Controlled Trials, Inflammatory Bowel Diseases, Volume 20, Issue 3, 1 March 2014, Pages 576–586, https://doi.org/10.1097/01.MIB.0000437984.92565.31

  3. Ananthakrishnan, AN, Khalili, H, Konijeti, GG, et al. A prospective study of long-term intake of dietary fiber and risk of Crohn’s disease and ulcerative colitis. Gastroenterology 2013; 145: 970–977.

  4. Morris ZS, Wooding S, Grant J. (2011) The answer is 17 years, what is the question: understanding time lags in translational research. J R Soc Med. 104(12):510-520. doi:10.1258/jrsm.2011.110180

  5. Brotherton CS, Martin CA, Long MD, Kappelman MD, Sandler RS. Avoidance of fiber is associated with greater risk of crohn’s disease flare in a 6-month period. Clin Gastroenterol Hepatol. 2016 Aug;14(8):1130–6.

  6. Chiba, M., Abe, T., Tsuda, H., Sugawara, T., Tsuda, S., Tozawa, H., Fujiwara, K., & Imai, H. (2010). Lifestyle-related disease in Crohn's disease: relapse prevention by a semi-vegetarian diet. World journal of gastroenterology, 16(20), 2484–2495.

  7. Claes Hallert, Inger Björck, Margareta Nyman, Anneli Pousette, Christer Grännö, Hans Svensson, Increasing Fecal Butyrate in Ulcerative Colitis Patients by Diet: Controlled Pilot Study, Inflammatory Bowel Diseases, Volume 9, Issue 2, 1 March 2003, Pages 116–121, https://doi.org/10.1097/00054725-200303000-00005

  8. Pigneur B, Ruemmele FM. Nutritional interventions for the treatment of IBD: current evidence and controversies. Therapeutic Advances in Gastroenterology. January 2019. doi:10.1177/1756284819890534

  9. Gibson PR. Use of the low-FODMAP diet in inflammatory bowel disease. J Gastroenterol Hepatol. 2017 Mar;32 Suppl 1:40-42. doi: 10.1111/jgh.13695. PMID: 28244679.

  10. Yao, C., Staudacher. H. (2019) The low-fibre diet: contender in IBD, or has it had its time? The Lancet Gastroenterology & Hepatology. 4(5): 339. https://doi.org/10.1016/S2468-1253(19)30096-2.

Clemmie Macpherson