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Inflammatory bowel disease (IBD), a spectrum of chronic inflammatory diseases of the intestinal tract that includes Crohn's disease (CD) and ulcerative colitis (UC), is increasing in incidence and prevalence worldwide. These diseases can significantly impact the quality of life of those affected, and also have marked effects on societies and healthcare systems as a whole.

Dietary fiber is an important component of diet for IBD patients. Often, IBD patients do not tolerate fiber in the diet and express concerns that fiber may worsen inflammation. A recent study published in explored the role of fiber in promoting and preventing inflammation.

Armstrong et al. demonstrated that while select fibers may be detrimental in IBD patients lacking fermentative microbes, the same fibers can also be beneficial in those with high fermentative potential. Utilizing colonic biopsies cultured ex vivo, whole unfermented beta-fructan induced pro-inflammatory cytokine secretion in a specific subset of IBD patients. Fermentation of beta-fructan prevented pro-inflammatory effects. These results were validated in an adult IBD randomized controlled trial examining beta-fructan supplementation.

Despite the robust methods, there were some important limitations to the study. The authors confirmed the purity of the fibers, but microbial contamination may have co-purified with the beta-fructans. Additionally, samples were collected after colonoscopy preparation, which is known to alter microbiota.

Clinically, this study provides important information regarding the role of fiber in promoting or preventing inflammation. Dietary fibers are typically beneficial in individuals with normal fermentative potential. Certain dietary fibers have detrimental effects in a subset of IBD patients who lack fermentative microbe activities. Further studies are warranted to determine if beta-fructan should be avoided by IBD patients.

Abhishek Bhurwal, MD, is a gastroenterologist at Southeast Georgia Health System.

You can read an interview with the lead study author here, and the abstract of the study here.