The Role of Dietary Fiber in Gastrointestinal Health: Focus on Irritable Bowel Syndrome and Diverticular Disease
DOI:
https://doi.org/10.12775/QS.2024.18.53478Keywords
Irritable Bowel Syndrome, dietary fiber, Diverticular Disease, soluble fiber, insoluble fiberAbstract
Dietary fiber (DF) encompasses a variety of plant-derived carbohydrates resistant to human digestive enzymes, significantly influencing gastrointestinal health. This study examines the role of DF in managing Irritable Bowel Syndrome (IBS) and Diverticular Disease (DD), utilizing comprehensive analysis from PubMed, Google Scholar, and Embase. IBS, affecting 10-20% globally, involves complex brain-gut interactions, motility issues, and microbiota changes. Soluble fiber like psyllium reduces IBS symptoms by improving stool consistency and regulating bowel movements. However, the role of DF in DD is more nuanced. While the reports on the impact on diverticulosis prevalence are contradictory, numerous moderate-quality studies confirmed the protective effect against recurrent diverticulitis and hospitalization. The effect of different fiber types on this matter was not widely explored which might explain the discordances between the studies. Further research is essential to fully understand the diverse effects of different types of DF on gastrointestinal (GI) health. This way, exhaustive guidelines specific to each fiber type and disease phenotype could be developed, allowing to tailor the dietary recommendations to each patient, optimizing the management of symptoms of IBS and DD, and improving the quality of life.
References
Dai, F.-J., & Chau, C.-F. (2017). Classification and regulatory perspectives of dietary fiber. Journal of Food and Drug Analysis, 25(1), 37-42. doi: 10.1016/j.jfda.2016.09.006.
Definitions, regulations, and new frontiers for dietary fiber and whole grains. (2020). Nutrition Reviews, 78(Supplement_1), 6-12. doi: 10.1093/nutrit/nuz085.
Evolution of a Definition for Dietary Fiber and Methodology to Service This Definition. (2017). FAO/WHO Codex Alimentarius. Available from: FAO.
Stephen, A. M., Champ, M. M., Cloran, S. J., Fleith, M., van Lieshout, L., Mejborn, H., & Burley, V. J. (2017). Dietary fibre in Europe: current state of knowledge on definitions, sources, recommendations, intakes and relationships to health. Nutrition Research Reviews, 30(2), 149-190. doi: 10.1017/S095442241700004X.
Jones, J. M. (2014). CODEX-aligned dietary fiber definitions help to bridge the ‘fiber gap’. Nutrition Journal, 13(34). doi: 10.1186/1475-2891-13-34.
Holesh, J. E., Aslam, S., & Martin, A. (2021). Carbohydrates. In StatPearls. StatPearls Publishing. Available from: StatPearls.
Li, Y. O., & Komarek, A. R. (2017). Dietary fibre basics: Health, nutrition, analysis, and applications. Food Quality and Safety, 1(1), 47-59. doi: 10.1093/fqsafe/fyx007.
Fuentes-Zaragoza, E., Riquelme-Navarrete, M. J., Sánchez-Zapata, E., & Pérez-Álvarez, J. A. (2010). Resistant starch as functional ingredient: A review. Food Research International, 43(4), 931–942. doi:10.1016/j.foodres.2010.02.004
Chawla, R., & Patil, G. R. (2010). Soluble dietary fiber. Comprehensive Reviews in Food Science and Food Safety, 9(2), 178-196. doi: 10.1111/j.1541-4337.2009.00099.x.
Qin YQ, Wang LY, Yang XY, Xu YJ, Fan G, Fan YG, Ren JN, An Q, Li X. Inulin: properties and health benefits. Food Funct. 2023 Apr 3;14(7):2948-2968. doi: 10.1039/d2fo01096h.
Blackwood AD, Salter J, Dettmar PW, Chaplin MF. Dietary fibre, physicochemical properties and their relationship to health. J R Soc Promot Health. 2000 Dec;120(4):242-7. doi: 10.1177/146642400012000412.
Brownlee, I. A. (2011). The impact of dietary fibre intake on the physiology and health of the gut. Food Hydrocolloids, 25(2), 238-250. doi: 10.1016/j.foodhyd.2009.11.013.
DeVries, J. W. (2003). On defining dietary fibre. Proceedings of the Nutrition Society, 62(01), 37–43. doi:10.1079/pns2002234
Trumbo, P., Schlicker, S., Yates, A. A., & Poos, M. (2002). Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein and Amino Acids. Journal of the American Dietetic Association, 102(11), 1621–1630. doi:10.1016/s0002-8223(02)90346-9
Bijkerk CJ, de Wit NJ, Stalman WA, Knottnerus JA, Hoes AW, Muris JW. Irritable bowel syndrome in primary care: the patients' and doctors' views on symptoms, etiology and management. Can J Gastroenterol. 2003 Jun;17(6):363-8; quiz 405-6. doi: 10.1155/2003/532138.
Schmulson, M. J., & Drossman, D. A. (2017). What Is New in Rome IV. Journal of Neurogastroenterology and Motility, 23(2), 151–163. doi: 10.5056/jnm16214.
Lovell, R. M., & Ford, A. C. (2012). Global prevalence of and risk factors for irritable bowel syndrome: a meta-analysis. Clinical Gastroenterology and Hepatology, 10(7), 712-721. doi: 10.1016/j.cgh.2012.02.029.
Camilleri, M., et al. (2012). Intestinal barrier function in health and gastrointestinal disease. Neurogastroenterology & Motility, 24(6), 503-512. doi: 10.1111/j.1365-2982.2012.01921.x.
Blackwood AD, Salter J, Dettmar PW, Chaplin MF. Dietary fibre, physicochemical properties and their relationship to health. J R Soc Promot Health. 2000 Dec;120(4):242-7. doi: 10.1177/146642400012000412.
Lovell, R. M., & Ford, A. C. (2012). Prevalence of and risk factors for irritable bowel syndrome. Clinical Gastroenterology and Hepatology, 10(7), 712-721. doi: 10.1016/j.cgh.2012.02.029.
Eswaran, S., Muir, J., & Chey, W. D. (2013). Fiber and Functional Gastrointestinal Disorders. The American Journal of Gastroenterology, 108(5), 718–727. doi: 10.1038/ajg.2013.63.
Mehmood MH, Aziz N, Ghayur MN, Gilani AH. Pharmacological basis for the medicinal use of psyllium husk (Ispaghula) in constipation and diarrhea. Dig Dis Sci. 2011 May;56(5):1460-71. doi: 10.1007/s10620-010-1466-0. Epub 2010 Nov 17.
Anderson JW, Baird P, Davis RH Jr, Ferreri S, Knudtson M, Koraym A, Waters V, Williams CL. Health benefits of dietary fiber. Nutr Rev. 2009 Apr;67(4):188-205. doi: 10.1111/j.1753-4887.2009.00189.x.
Bijkerk, C. J., et al. (2009). Soluble or insoluble fibre in irritable bowel syndrome in primary care? Randomised placebo controlled trial. BMJ, 339, b3154. doi: 10.1136/bmj.b3154.
Prior A, Whorwell PJ. Double blind study of ispaghula in irritable bowel syndrome. Gut. 1987 Nov;28(11):1510-3. doi: 10.1136/gut.28.11.1510.
Moayyedi, P., et al. (2014). The efficacy of fiber in the treatment of irritable bowel syndrome: a systematic review and meta-analysis. American Journal of Gastroenterology, 109(9), 1365-1374. doi: 10.1038/ajg.2014.195.
Francis CY, Whorwell PJ. Bran and irritable bowel syndrome: time for reappraisal. Lancet. 1994 Jul 2;344(8914):39-40. doi: 10.1016/s0140-6736(94)91055-3.
Whelan K. Probiotics and prebiotics in the management of irritable bowel syndrome: a review of recent clinical trials and systematic reviews. Curr Opin Clin Nutr Metab Care. 2011 Nov;14(6):581-7. doi: 10.1097/MCO.0b013e32834b8082.
Peery, A. F., et al. (2013). Burden of gastrointestinal disease in the United States: 2012 update. Gastroenterology, 143(5), 1179-1187.e3. doi: 10.1053/j.gastro.2012.08.002.
Everhart, J. E., & Ruhl, C. E. (2009). Burden of Digestive Diseases in the United States Part II: Lower Gastrointestinal Diseases. Gastroenterology, 136(3), 741–754. doi:10.1053/j.gastro.2009.01.015
Piscopo N, Ellul P. Diverticular Disease: A Review on Pathophysiology and Recent Evidence. Ulster Med J. 2020 Sep;89(2):83-88. Epub 2020 Oct 21.
Tursi, A. (2016). Diverticulosis today: unfashionable and still under-researched. Therapeutic Advances in Gastroenterology, 9(1), 213-228. doi: 10.1177/1756283X15621228.
Rezapour M, Ali S, Stollman N. Diverticular Disease: An Update on Pathogenesis and Management. Gut Liver. 2018 Mar 15;12(2):125-132. doi: 10.5009/gnl16552.
Strate LL. Lifestyle factors and the course of diverticular disease. Dig Dis. 2012;30(1):35-45. doi: 10.1159/000335707. Epub 2012 May 3.
Wlodarczyk JR, Yoon D, Owens J, Ershadi S, Lee SW, Cologne KG, Koller SE. Prevalence of and Risk Factors for Incidental Colonic Diverticulosis. J Surg Res. 2022 Dec;280:348-354. doi: 10.1016/j.jss.2022.07.021. Epub 2022 Aug 26.
Völkerer A, Wernly S, Semmler G, Flamm M, Aigner E, Datz C, Wernly B. Diverticulosis and cardiometabolic risk factors: a systematic literature review. Int J Colorectal Dis. 2023 Sep 19;38(1):236. doi: 10.1007/s00384-023-04532-4.
Everhart, J. E., & Ruhl, C. E. (2009). Burden of Digestive Diseases in the United States Part II: Lower Gastrointestinal Diseases. Gastroenterology, 136(3), 741–754. doi:10.1053/j.gastro.2009.01.015
Herrera AF. Medical therapy of colonic diverticular disease. Postgrad Med. 1976 Dec;60(6):107-9. doi: 10.1080/00325481.1976.11708409.
Carabotti, M., Annibale, B., Severi, C., & Lahner, E. (2017). Role of Fiber in Symptomatic Uncomplicated Diverticular Disease: A Systematic Review. Nutrients, 9(2), 161. doi:10.3390/nu9020161
Hawkins AT, Wise PE, Chan T, Lee JT, Glyn T, Wood V, Eglinton T, Frizelle F, Khan A, Hall J, Ilyas MIM, Michailidou M, Nfonsam VN, Cowan ML, Williams J, Steele SR, Alavi K, Ellis CT, Collins D, Winter DC, Zaghiyan K, Gallo G, Carvello M, Spinelli A, Lightner AL. Diverticulitis: An Update From the Age Old Paradigm. Curr Probl Surg. 2020 Oct;57(10):100862. doi: 10.1016/j.cpsurg.2020.100862. Epub 2020 Jul 18.
Crowe, F. L., Appleby, P. N., Allen, N. E., & Key, T. J. (2011). Diet and risk of diverticular disease in Oxford cohort of European Prospective Investigation into Cancer and Nutrition (EPIC): prospective study of British vegetarians and non-vegetarians. BMJ, 343(jul19 4), d4131–d4131. doi:10.1136/bmj.d4131
Ünlü, C., Daniels, L., Vrouenraets, B. C., & Boermeester, M. A. (2011). A systematic review of high-fibre dietary therapy in diverticular disease. International Journal of Colorectal Disease, 27(4), 419–427. doi:10.1007/s00384-011-1308-3
Carabotti M, Falangone F, Cuomo R, Annibale B. Role of Dietary Habits in the Prevention of Diverticular Disease Complications: A Systematic Review. Nutrients. 2021; 13(4):1288. https://doi.org/10.3390/nu13041288
Peery, A. F., Barrett, P. R., Park, D., Rogers, A. J., Galanko, J. A., Martin, C. F., & Sandler, R. S. (2012). A high-fiber diet does not protect against asymptomatic diverticulosis. Gastroenterology, 142(2), 266-272. doi: 10.1053/j.gastro.2011.10.035.
Ornstein, M. H., Littlewood, E. R., Baird, I. M., Fowler, J., North, W. R., & Cox, A. G. (1981). Are fibre supplements really necessary in diverticular disease of the colon? A controlled clinical trial. BMJ, 282(6273), 1353–1356. doi:10.1136/bmj.282.6273.1353
Wick, J. Y. (2012). Diverticular Disease: Eat Your Fiber! The Consultant Pharmacist, 27(9), 613–618. doi:10.4140/tcp.n.2012.613
Thorburn, H. A., Carter, K. B., Goldberg, J. A., & Finlay, I. G. (1992). Does ispaghula husk stimulate the entire colon in diverticular disease? Gut, 33(3), 352–356. doi:10.1136/gut.33.3.352
Slavin, J. (2013). Fiber and Prebiotics: Mechanisms and Health Benefits. Nutrients, 5(4), 1417–1435. doi:10.3390/nu5041417
Crowe, F. L., Balkwill, A., Cairns, B. J., Appleby, P. N., Green, J., Reeves, G. K., … Beral, V. (2014). Source of dietary fibre and diverticular disease incidence: a prospective study of UK women. Gut, 63(9), 1450–1456. doi:10.1136/gutjnl-2013-304644
Schechter S, Mulvey J, Eisenstat TE. Management of uncomplicated acute diverticulitis: results of a survey. Dis Colon Rectum. 1999 Apr;42(4):470-5; discussion 475-6. doi: 10.1007/BF02234169.
Strate LL, Liu YL, Syngal S, Aldoori WH, Giovannucci EL. Nut, corn, and popcorn consumption and the incidence of diverticular disease. JAMA. 2008 Aug 27;300(8):907-14. doi: 10.1001/jama.300.8.907.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 Marta Kapler, Jacek Kotula, Magdalena Natalia Mąsior, Karolina Zinkow, Łukasz Marek Gawlik
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Stats
Number of views and downloads: 149
Number of citations: 0
