Should High-fiber Diets Be Recommended for Patients With Inflammatory Bowel Disease?

Rebecca Kuang; David G. Binion

Disclosures

Curr Opin Gastroenterol. 2022;38(2):168-172. 

In This Article

Abstract and Introduction

Abstract

Purpose of Review: Dietary fiber intake in IBD patients has oftentimes generated conflicting data and clinical recommendations. This review aims to unify apparently conflicting lines of evidence regarding dietary fiber intake in IBD patients by highlighting new information from natural history studies and prospective clinical trials.

Recent Findings: IBD patients have lower dietary fiber intake than the general population as well as national guideline recommendations. Patients report short-term benefits from fiber avoidance. Low fiber and low FODMAP diets are associated with lower fecal microbiota abundance and essential nutrient intake. There is emerging evidence suggesting that IBD patients may be able to increase dietary fiber intake with short-term benefit and good tolerability, particularly when fiber is introduced during clinical remission. Current societal recommendations do not favor withholding dietary fiber during long-term IBD management. The long-term impact of increased dietary fiber on IBD clinical outcomes remains unanswered.

Summary: Dietary fiber intake is not necessarily contraindicated in IBD patients.

Introduction

Inflammatory bowel diseases (IBD), which include Crohn's disease and ulcerative colitis, are chronic inflammatory diseases of the gastrointestinal tract with increasing incidence globally, affecting up to 1% of the American population and an equal number of additional individuals worldwide. Although exact etiopathogenesis of IBD is not defined, environmental factors, including diet and dietary components, have been implicated. A key dietary component which has oftentimes generated conflicting data and clinical recommendations is dietary fiber. IBD patients were historically advised to avoid dietary fiber as a strategy for symptom relief, particularly during disease flares, which would often extend into lifetime fiber avoidance. New insights into the impact of diet on overall health and health of the microbiome have recently drawn attention to the potential importance of increasing dietary fiber. This review attempts to unify these apparently conflicting lines of evidence in IBD by highlighting new information from natural history studies, prospective clinical trials and studies assessing both short-term and long-term outcomes.

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