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?

Intro

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.

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 used 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 regard 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.

Sources

• Avoidance of Fiber Is Associated With Greater Risk of Crohn’s Disease Flare in a 6-Month Period
  Brotherton, Carol S. et al.
  Clinical Gastroenterology and Hepatology , Volume 0 , Issue 0 ,
• Aune Dagfinn, Chan Doris S M, Lau Rosa, Vieira Rui,Greenwood Darren C, Kampman Ellen et al. Dietary fibre, whole grains, and risk of colorectal cancer: systematic review and dose-response meta-analysis of prospective studies BMJ 2011; 343:d6617
• Frequently Asked Questions About Colorectal Cancer & IBD: Crohn’s & Colitis Foundation of America
• Ananthakrishnan AN, Khalili H, Konijeti GG, et al. A Prospective Study of Long-term Intake of Dietary Fiber and Risk of Crohn’s Disease and Ulcerative Colitis. Gastroenterology. 2013;145(5):970-977. doi:10.1053/j.gastro.2013.07.050.
• Chiba M, Tsuji T, Nakane K, Komatsu M. High amount of dietary fiber not harmful but favorable for Crohn disease. Perm J. 2015;19(1) 58-61. doi:10.7812/tpp/14-124. PMID: 25663207; PMCID: PMC4315379.