For citation purposes: Brotherton CS, Taylor AG. Clashing paradigms: low fibre or high fibre diets for non-infectious gut inflammation? OA Alternative Medicine 2014 Apr 18;2(1):8.

Review

 
Diet Therapy

Clashing paradigms: low fibre or high fibre diets for non-infectious gut inflammation?

C Brotherton, A Taylor
 

Authors affiliations

(1) George Mason University, Fairfax VA, United States

(2) University of Virginia, Charlottesville VA, United States

* Corresponding author Email: csb8b@virginia.edu

Abstract

Introduction

Crohn’s disease and ulcerative colitis, the two primary types of inflammatory bowel disease (IBD), are characterized by lengthy episodes of life-altering gastrointestinal symptoms that include incapacitating abdominal pain, diarrhoea, and bleeding. Progressively sophisticated microbiome research methods have inspired a fresh perspective among IBD researchers regarding the potential for dietary fibre to improve non-infectious gut inflammation outcomes. The purposes of this review are to (a) present some of the published rationale upon which IBD researchers justify their studies testing various dietary fibres of interest, (b) explain the reasons that low fibre recommendations continue to be generalized for persons diagnosed with IBD undergoing conventional care, and (c) encourage dissemination of updated dietary fibre/IBD information that is based upon present day science.

Discussion

Rationale published in peer-reviewed journals to support the testing of dietary fibre for IBD is based upon mechanisms related to the beneficial effects of fibre on the microbiome, upon beneficial mechanisms not related to the microbiome, and upon epidemiological observations. Low fibre recommendations for IBD were introduced approximately a century ago based upon an assumption that the word ‘indigestible’ equates to ‘irritating.’ Emphasis on low dietary fibre recommendations persist, perhaps because low fibre intake decreases diarrhoea. However, emerging research demonstrates that patients who have been carefully screened for contraindications to fibre can be safely taught to explore the gastrointestinal health-promoting effects of dietary fibre by consuming foods containing intact dietary fibre.

Conclusion

Conclusive evidence is lacking for the effectiveness of either a low or a high fibre diet to improve outcomes in persons being treated for IBD. However, rationale for testing dietary fibre as a therapeutic agent in IBD is multifaceted, and 21st century mechanistic and clinical findings are encouraging. Additional mechanistic studies and rigorous clinical trials are needed to determine effectiveness and generalizability of previous findings.

Licensee OA Publishing London 2014. Creative Commons Attribution License (CC-BY)
Keywords