Supplement fibers or not in patients with inflammatory bowel disease?
Come on: evidence-based dietary guidance on dietary fibers in inflammatory bowel disease (IDI) has been limited due to insufficient reproducibility in intervention trials. However, there is a great understanding of the importance of fibers in maintaining the health-associated microbiome. Preliminary evidence suggests that dietary fiber can alter the microbiome, improve IDI symptoms, balance inflammation, and improve health-related quality.
Fibers and inflammatory bowel disease
Although fiber is generally considered beneficial for the intestinal microbiome in healthy individuals, there is very little understanding of how fiber affects the microbiome of individuals with IDI. There is limited evidence from intervention studies that IDI-associated dysbiosis can be modified in inactive and moderately active people. However, tolerability varies greatly, depending on the current activity of the disease and the source of fiber. Interestingly, there is a suggestion that fermentation patterns are altered in IDI compared to healthy controls due to the altered functional capacity of the microbiome.
Particularly worrisome, a recent study using colonic biopsies of IDI patients found that unfermented inulin and FOS induce pro-inflammatory cytokines in a group of patients, promoting inflammation. This highlights that fiber supplementation may not be as benign as previously thought. Individual microbiomes play a strong role in determining results and require a more personalized nutritional approach to implement dietary changes, including fiber supplementation.
Personalized nutrition, which aims to develop nutritional recommendations based on intrinsic and extrinsic factors of an individual, is a great promise in managing diseases such as IDI. The responsiveness of the intestinal microbiota (including responders and host response raters) appears to be largely dependent on the diversity of the baseline microbiota and specific microbes present or absent at baseline. Therefore, fiber supplementation in patients with IDI depends on the individuality of the patient and should be prescribed in a personalized way.
Relationship between the gastrointestinal tract and fiber consumption
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Microbiota on weight management
– Haskey N, Gold SL, Faith JJ, Raman M. To Fiber or Not to Fiber: The Swinging Pendulum of Fiber Supplementation in Patients with Inflammatory Bowel Disease. Nutrients
. 2023; 15(5):1080. https://doi.org/10.3390/nu15051080