Fiber: Influential prebiotic for gut health
We’ve heard countless stories from our clients about how their doctors tell them diet doesn’t make a difference for their inflammatory bowel disease (IBD). But with recent scientific advances in our understanding of both IBD etiology and the role of the microbiome, it is becoming clear that this view is outdated: what we eat and what we feed our gut microbes plays a crucial role in healing and preventing flares. In this blog, we discuss why exactly fiber is so significant for people with IBD. At IBDCoach, we believe that reaching remission is based on three biological mechanisms:
- Stopping inflammation
- Rebalancing the microbiome
- Repairing the intestinal barrier.
Fiber addresses all of these.
What is fiber, and why do I need it?
The term “fiber”, in its broadest nutritional sense, refers to indigestible carbohydrates and lignins found intact in whole plants. There are various types of fiber, all with varying characteristics like solubility, fermentability, and even viscosity (we’ll cover more on viscosity in a future post). Each of these characteristics determines the biological function of the fiber critical for our health.
- Soluble fiber absorbs water in the stomach and small intestine to form a gel that slows digestion. As a result, it can prevent erratic blood sugar spikes and keep you feeling full for longer.
- Examples of soluble fiber include pectins, gums, and inulin which are found in foods like citrus fruits, oats, legumes, and some vegetables.
- Insoluble fiber (also referred to as roughage) does not break down in the small intestine, and instead draws in water to add bulk to stool to aid its passage through the large intestine.
- Examples of insoluble fiber include cellulose, hemicellulose, and lignin which are found in foods like leafy greens, seeds, whole grains, and vegetable skins.
Beyond the benefits of stool formation and gut transit, the fermentability of fiber has powerful implications for our health. Our stomach enzymes do not digest fiber directly; instead, fiber in foods is passed along undigested to the colon where our bacteria is then able to metabolize it through fermentation, conferring beneficial effects for gut health. For example, Bifidobacteria, a commensal bacteria in our colon, produces enzymes that break down a type of fiber called inulin (found in onions). Reports have shown a correlation between inulin consumption, Bifidobacteria activity, and a subsequent increase in the production of butyrate, an essential metabolite for gut health.(1) Since different fiber types have varying degrees of fermentability, they are not equally capable of stimulating metabolite production. Nonetheless, we are now learning that this fermentation of fiber is imperative for gut health.
How fermentation of fiber addresses IBD mechanisms
Additionally, consuming fiber has huge implications for our resident gut microbes themselves. Studies have associated a decrease in fiber intake with a reduction in bacterial diversity and dysbiosis, an altered microbial environment seen in people with GI disorders.(5,6) In fact, without fiber to feed on, bacteria in our gut can begin eating the protective mucus layer, causing more GI distress.(7) Conversely, research shows diets rich in fiber increase the beneficial bacteria in our gut, out-competing pathogenic bacteria.(8) Overall, by the means of fermentation, we see how fiber addresses all three mechanisms of IBD: the intestinal barrier, inflammation, and our microbiota.
Applying the evidence to our diet
Traditionally, people with IBD have been recommended to avoid all fiber. Now, we are seeing that train of thought may be more detrimental to gut health in the long run. Nonetheless, the texture of fiber is important to consider. During active flares, it is still encouraged to stay away from the “roughage” found in insoluble fiber as it can exacerbate symptoms.(9) In order to still feed your microbiota and prevent issues with texture, you can blend or purée soluble fiber to form a gel-like substance. Because tolerances to fiber-rich foods vary, it’s usually suggested to introduce fiber consumption slowly as everyone’s digestive system responds uniquely.
Barbara Olendski, RD associate professor at the University Massachusetts has implemented this new evidence to create the IBD Anti-Inflammatory Diet (IBD-AID) which prioritizes foods that feed beneficial bacteria and avoids foods thought to have adverse effects on the microbiome such as gluten, corn, lactose, etc. She believes adjustments to the texture of soluble fiber for different disease states is the best way to feed the gut microbiota and avoid further tissue damage until inflammation subsides. For some of her patients, she suggests the addition of digestive enzymes to aid in the digestion of fiber. Ultimately, because IBD-AID targets each IBD mechanism by the use of fiber, it has shown in practice to help many people achieve remission.
For more information on how to appropriately introduce fiber into your diet, check out the University of Massachusetts website on IBD-AID. Andrew also has some great recipes on his food blog containing soluble fiber (like his his blueberry, banana, avocado, cacao smoothie!).
- Rossi, M. et al. Fermentation of Fructooligosaccharides and Inulin by Bifidobacteria: a Comparative Study of Pure and Fecal Cultures. Appl. Environ. Microbiol. 71, 6150–6158 (2005).
- Parada Venegas, D. et al. Short Chain Fatty Acids (SCFAs)-Mediated Gut Epithelial and Immune Regulation and Its Relevance for Inflammatory Bowel Diseases. Front. Immunol. 10, 277 (2019).
- Cr, C. et al. Differential effects of short-chain fatty acids on proliferation and production of pro- and anti-inflammatory cytokines by cultured lymphocytes. Life Sci. 73, 1683–1690 (2003).
- Asarat, M., Apostolopoulos, V., Vasiljevic, T. & Donkor, O. Short-Chain Fatty Acids Regulate Cytokines and Th17/Treg Cells in Human Peripheral Blood Mononuclear Cells in vitro. Immunol. Invest. 45, 205–222 (2016).
- Holscher, H. D. Dietary fiber and prebiotics and the gastrointestinal microbiota. Gut Microbes 8, 172–184 (2017).
- A fiber-deprived diet disturbs the fine-scale spatial architecture of the murine colon microbiome | Nature Communications. https://www.nature.com/articles/s41467-019-12413-0.
- Sonnenburg, E. D. & Sonnenburg, J. L. Starving our microbial self: the deleterious consequences of a diet deficient in microbiota-accessible carbohydrates. Cell Metab. 20, 779–786 (2014).
- Makki, K., Deehan, E. C., Walter, J. & Bäckhed, F. The Impact of Dietary Fiber on Gut Microbiota in Host Health and Disease. Cell Host Microbe 23, 705–715 (2018).
- Levine, A. et al. Dietary Guidance From the International Organization for the Study of Inflammatory Bowel Diseases. Clin. Gastroenterol. Hepatol. Off. Clin. Pract. J. Am. Gastroenterol. Assoc. 18, 1381–1392 (2020).
Recent Posts from the IBDCoach Blog
Due to long-term steroid use and inflammation, half of all patients with IBD will show a significant reduction of their bone mass during the course of their disease. In this blog, we explain why that is and what you can do to monitor and improve your bone health. If...
Andrew's Food PostsApril 19, 2021 To continue our love of oats here at IBDCoach, I'm starting my week off with a bowl of creamy steel-cut oat porridge. Packed with beta-glucans (a soluble fiber) and a low glycemic index (digesting slowly), oat porridge is simple to...
“CRP, ESR, FCP, oh my!” There’s nothing like a bowl of three-letter alphabet soup to make it feel like we’re not in Kansas anymore. If you’ve been diagnosed with IBD, then you are no stranger to the range of lab work and tests physicians use to monitor IBD and its...
Gluten in our food is a topic that has grown in popularity for both individuals with IBD and the general population. We are living in the age of gluten-free products. Are these always better for IBDers? Considering many gluten-free products are still processed foods...
This Tuesday morning I’ve had the delight of musing about our incredible gut and how this organ exemplifies the old adage in biology that "structure defines function". Our bodies are full of other examples of this: our opposable thumbs allow us to grasp items large...
COVID-19 susceptibility for individuals with IBD With the rise of COVID-19 cases in the US, we wanted to shed some light on what this means for individuals with inflammatory bowel disease. Considering that IBD is a condition in which your immune system is...
Flavonoids aren’t a widely discussed topic in the IBD community nor in the doctor's office yet emerging research has discovered these substances to be powerful in regulating inflammation observed in IBD. One exciting area in nutrition research today is the study of...