Soluble fibre best for irritable bowel

A recommended treatment for irritable bowel syndrome, which is thought to affect about 10% of the population, is to increase dietary fibre even though many sufferers experience an aggravation of their symptoms when they do. However, this may be to do with the type of fibre they are taking.

Dr René Bijkerk from University Medical Center Utrecht and colleagues studied 275 patients aged 18–65 all of whom suffered from irritable bowel syndrome. They received at random 10 grams of psyllium (soluble fibre), bran (insoluble fibre) or a placebo (rice flour) twice a day for 12 weeks. They were assessed after one, two and three months.

Results indicated that psyllium was the most efficient treatment as significantly more patients reported satisfactory symptom relief. After three months of treatment, symptom severity was reduced by 90 points in the psyllium group, 49 points in the placebo group and 58 points in the bran group but there was no report of differences between the groups in abdominal pain or quality of life. Many patients also seemed to be intolerant of bran and as a result the dropout rate was highest in this group.

The authors suggest that treatment with soluble fibre such as psyllium may be beneficial but that bran may worsen symptoms and should be advised only with caution.

Soluble or insoluble fibre in irritable bowel syndrome in primary care? Randomised placebo controlled trial C J Bijkerk et al BMJ 2009; 339:b3154

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Back in 2004....

A review of research on the effects of different kinds of fibre on IBS symptoms shows that extra fibre is helpful in most individuals studied, but the type of fibre matters a lot. Isphagula and calcium polycarbophil - two varieties of soluble fibre, the latter synthetic - seem the most likely to be helpful with overall symptoms, but evidence that extra fibre helps abdominal pain is at present unconvincing. Eating extra insoluble fibre, such as wheat bran, was much less likely to relieve general symptoms, and might be worse than a low fibre diet, except for patients with constipation.

The review team regret the scarcity of well designed trials needed to give more reliable information, especially as most sufferers rely on GP advice.

Bijkerk et al, Aliment Pharmacol Ther 19 (3): 245 - 251, 2004


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