Fiber: Friend or Foe to someone with Inflammatory Bowel Disease?

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For the longest time, I remember fiber being the sworn enemy of someone who has Crohn’s Disease or Ulcerative Colitis. In fact, the suggestion to go on a low-fiber diet when you have IBD is often one of the first ones you’ll hear – but is that the best thing to do?

In this post, I’ll be discussing my thoughts on a very recent study that’s been published about fiber and how it impacts people with Crohn’s Disease. This topic interests me quite a bit, not only because I have Crohn’s Disease, but because plant-based (vegan) diets are known to be high in fiber and this new research can have an impact on how someone might eat.

Please note that I am not a researcher, doctor, or dietitian.  I have an interest in this subject, but my opinions are just that.

The study which piqued my interest this week was made possible through the CCFA Partners study. It consisted of compiling data from over 1600 people with IBD who completed a diet survey and were followed-up with another survey six months later.

The conclusion is an eye-opener:

CONCLUSIONS: Intake of dietary fiber is associated with reduced disease flares in patients with Crohn’s disease, but not UC. Recommendations to limit dietary fiber should be re-evaluated.From the study: Avoidance of Fiber Is Associated With Greater Risk of Crohn’s Disease Flare in a 6-Month Period

More fiber reduces flares in Crohn’s patients? What kind of sorcery is this?!!  Anyone with Crohn’s Disease will tell you that high-fiber food hurts them – or does it?  I know that when I use to flare, I started eating plain white rice and skinned white potatoes for weeks at a time to control it, but it could have simply been a coincidence that it worked. I mean, back then even drinking water hurt, and you can’t get lower fiber than that!

But it’s right there: People eating the most fiber are less likely to have flares than people who ate the lowest amounts.

Note that they found no difference for people who have Ulcerative Colitis, but I would still argue that people with UC should consume more fiber if only to help reduce the risk of colon cancer (SOURCE), which is still a concern for people with UC (SOURCE).

Interestingly enough, the “high” end of fiber intake in these groups was approx. 20g/day, which is below the minimum given by the Dietitians of Canada (25g/day or more).  This doesn’t surprise me since most people aren’t getting enough fiber anyway, but it does beg the question whether getting 30, 40 or 50+ grams per day would have benefited these patients even more (I eat a minimum of 40g per day).

I don’t have access to the full text of the study, but it left me with quite a few new questions:

  • I do not know if any of the Crohn’s patients suffered from strictures or chronic bowel obstructions, as I’m sure that would increase/decrease the likelihood of them eating more or less fiber.
  • It’s also not clear what type of fiber benefited patients more; both soluble and insoluble fiber affect us differently, so it would have been nice to know if one helped more than the other.
  • And it’s not clear if the source of fiber made a difference. In other studies I’ve seen, fiber from fruit, vegetables, legumes and whole grains can influence the outcome of a study considerably, so it would have been nice to know if these foods had any impact in this study.

Now, studies that look at fiber and IBD aren’t new.  A few years ago another study came out based on the extremely large Nurses’ Health Study (over 170,000 participants), and it found that fiber intake (particularly from fruit) reduced the risk of Crohn’s Disease (but not Ulcerative Colitis) by a considerable amount. (SOURCE)

More recently, a study out of Japan confirms the findings from the CCFA Partners Study data but takes it a step further by suggesting that a high fiber, plant-based diet (approx. 32g of fiber / day) provides a higher rate of long-term maintenance of remission vs those on a more omnivorous diet, citing that the gut bacteria in their patients were vastly different from patients eating the omnivorous diet. (SOURCE)

We believe a plant-based diet not only is effective for gut inflammation but also promotes the general health of IBD patients.From the study: High amount of dietary fiber not harmful but favorable for Crohn disease.

I have no intention of reducing my fiber intake anytime soon. In fact, I’m eating a lot of fiber each day even with an ileostomy, but I know that other ostomates may have to take it easy if they are newly out of surgery or have a history of blockages.

For the people with IBD, I wonder if information like this might change their mind in regards to fiber, or whether their GI will recommend not avoiding high-fiber foods.  I suspect that people with complications like strictures will likely continue to keep fiber intake low, but you should always consult with your doctor before upping your fiber intake by a considerable amount.

Question: Have you experimented with low/high-fiber foods? How does your body respond to it?
Sources/References
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4 thoughts on “Fiber: Friend or Foe to someone with Inflammatory Bowel Disease?

  1. I find this article very interesting as I have just switched to a vegetarian diet. I was diagnosed in Feb of 2014 I have avoided high fiber foods. Most of the protein sources I need are aso high fiber foods like nuts. I have found that I tolerate Quiona rather well but do find that when I eat foods that have more fiber I do use the restroom more frequently but I dont necessarily see that as a bad thing as long as its good poops that Im having LOL. I have a fear of trying food though because of how sick I was when first diagnosed I am still trying to work up the courage to venture out and try the new foods. Any advice on how to go about that?

    • Thanks for writing, Haley!

      It isn’t necessarily a bad thing to have more bowel movements (assuming we aren’t talking 10+ a day!): http://nutritionfacts.org/2011/09/29/bowel-movements-the-scoop-on-poop/

      I have written two guides on food options for ostomates, but they work fine for anyone who needs to watch their fiber/roughage intake due to surgery or illness (including IBD). I’d suggest having a look at this article first: https://www.veganostomy.ca/2015/02/ostomy-diet-what-to-eat-first-six-weeks.html

      If you feel more comfortable exploring more options, then this article will be helpful:
      https://www.veganostomy.ca/2015/06/ostomy-diet-beyond-recovery.html

      There’s also some great advice in this article, which was written by an Registered Dietitian who has Crohn’s: https://www.veganostomy.ca/2015/04/the-fear-of-food.html

      Good luck, and let me know how else I can help.

      Eric

      • Eric I know you have an ileostomy and I do not but did you find that when you would eat beans or nuts before that it would hurt your digestive system? I have been in remission and have never had issues with strictures but I did find that when I was sick it didnt matter what I ate as everything hurt. I know that when I see my GI he makes me rate my stools on the bristol stool scale and I have noticed since eating more fiber I dont typical fall into the normal scale anymore. I also am noticing undigested food like quinoa in my stool but dont notice any discomfort when consuming these foods. I have started a food journal today and will continue to keep track of everything.

        • Before my ostomy, but after my diagnosis, eating anything hurt – even water. But I don’t find that beans have ever been hard for me to digest, unless they are black beans and I haven’t chewed them well.

          It’s normal to see some undigested food bits in your stool as many plant foods contain indigestible matter. For me, I always see red kidney bean skins when I empty my ostomy bag, but I know they’ve still digested fine.

          Food journals are great! Good luck.

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