Fiber in the treatment and maintenance of inflammatory bowel disease.

[DustyKat]

Fiber in the treatment and maintenance of inflammatory bowel disease: a systematic review of randomized controlled trials.

Abstract
BACKGROUND:
Dietary fiber may favorably influence fermentation, gastrointestinal inflammation, and disease progression in Crohn's disease, ulcerative colitis (UC), and pouchitis and offer an attractive therapeutic addition to pharmacological treatment. This systematic review appraised data from randomized controlled trials of fiber in the management of inflammatory bowel disease.

METHODS:
The review followed Cochrane and PRISMA recommendations. Seven electronic databases were searched along with hand searching and contacting experts. Inclusion criteria were randomized controlled trials of the effects of fiber on clinical endpoints (primarily disease activity for treatment or maintenance) or physiological outcomes in patients with inflammatory bowel disease.

RESULTS:
In total, 23 randomized controlled trials fulfilled the inclusion criteria (UC, 10; Crohn's disease, 12; and pouchitis, 1) recruiting 1296 patients. In UC, 3/10 studies reported fiber supplementation to benefit disease outcomes. In Crohn's disease, 0/12 studies and in pouchitis 1/1 study reported a benefit on disease activity. Despite this, a number of studies reported favorable intragroup effects on physiological outcomes including fecal butyrate, fecal calprotectin, inflammatory cytokines, microbiota, and gastrointestinal symptom indices. Meta-analysis was not possible.

CONCLUSIONS:
There is limited weak evidence for the efficacy of fiber in improving disease outcomes in UC and pouchitis. The potential antiinflammatory role of fiber is intriguing and merits further investigation in adequately powered clinical trials. Excluding overt gastrointestinal obstruction, there was no evidence that fiber intake should be restricted in patients with inflammatory bowel disease.

http://www.ncbi.nlm.nih.gov/pubmed/24445775

 

[DustyKat]

Re Crohn’s:

I do wonder how much of a role psyllium plays in maintaining remission for my children due to the butyrate it contains. Thank you David for pointing this out to me in the first place.

I have lifted this from the wiki:

In patients with Crohn's Disease with NOD2 / CARD15 Gene mutation causing impaired NOD2 function. Butyrate (possibly in combination with Vitamin D) may upregulate NOD2.[4]

Having two children with Crohn’s the possibility of this gene mutation is certainly a consideration.

They both use psyllium due to bile salt malabsorption and take Vit D.

 

[David]

Thank you for sharing this study Dusty. Interesting stuff!

 

[VeganOstomy]

"Excluding overt gastrointestinal obstruction, there was no evidence that fiber intake should be restricted in patients with inflammatory bowel disease."

There's the key point. So often I see IBDer's restricting healthy foods from their diet out of the fear of fiber.