Concerned about IBS or IBD? Know your fibre to help manage your symptoms
Know your fibre to help manage your IBS or IBD symptoms
19th May is World IBD Day – the annual date to raise awareness to improve life for people living with Inflammatory Bowel Disease. 10 million people Worldwide live with the debilitating symptoms of IBD. From pain and diarrhoea, to weight loss and fatigue, it is a serious condition usually managed by medications.
Whilst IBS (Irritable Bowel Syndrome) is not as serious as IBD, it can still make life extremely difficult for sufferers, affecting social life and work.
I find that few people understand about the roles and impact of different types of fibre. How some can irritate and aggravate pre-existing symptoms, whilst others can have a calming and soothing effect that support better gut and bowel health. Let’s explore here why there’s far more to fibre than just roughage!
Could I have IBD?
Inflammatory bowel disease (IBD) is a term characterized by chronic inflammation of the gastrointestinal (GI) tract that goes through periods of flare-ups and remission. There are two main types:
- Ulcerative colitis, whereby there is inflammation and sores (ulcers) in the large intestine (colon) starting from the rectum and travelling backwards.
- Crohn’s disease, whereby the inflammation can be anywhere along the digestive tract, (although often at the point where the small intestines joins the large intestines) which often can involve the deeper layers of the epithelial lining.
Whilst the exact cause of IBD is unknown, it is strongly linked to an impaired immune system that responds incorrectly to a trigger such as a virus or bacteria, causing the immune cells to attack the gut tissues. This results in chronic inflammation. There also appears to be a genetic component as it can run along family lines, particularly on the female side.
Key IBD Symptoms to watch out for (but don’t panic, as these may occur with IBS too):
- Prolonged diarrhoea with or without urgency
- Abdominal pain or cramping
- Blood in the stools
- Unexpected weight loss
- Unexplained fatigue
If you have any concerns, do consult your medical provider who will run a stool test for raised calprotectin (inflammation) and faecal blood and if considered necessary arrange for a colonoscopy.
Why Fibre plays an important role in both IBD and IBS
Most people consider fibre to be “roughage” and is necessary to encourage bowel movements and avoid constipation. But it’s more complex than that.
The two main types of fibre are soluble and insoluble fibre. Both have an important role to play in keeping the gut healthy. But one type can be extremely aggravating to the gut barrier if inflammation is present, whilst the other can provide a soothing effect and can help with situations like diarrhoea.
Otherwise, known as “roughage”. It’s the fibre that adds bulk to stools. It doesn’t dissolve in water, and it may seem to have almost an abrasive like effect on the gut wall as it passes through. Roughage is a good word to describe it. For a healthy gut, it’s necessary to keep bowel transit time regular and avoid constipation (when transit and bowel regularity is too slow). It is also an excellent fuel for beneficial gut bacteria to keep the microbiome in balance. So it’s necessary and excellent for the gut – when the gut is in balance and calm. But it’s a “no, no” if the gut is already inflamed during IBD flare-ups, as this fibre is abrasive and can really irritate the gut lining.
Sources of Insoluble Fibre:
It’s the rigid fibre found in certain plant foods. The outer cell walls of some plants are really tough, so can aggravate and irritate an already inflamed GI tract. It’s found in:
- Woody stems (like kale, broccoli, artichokes);
- Skins like tomatoes, grapes, potatoes, apples, pears;
- Whole nuts and seeds;
Pulses like chickpeas and kidney beans and in lentils;
- Pips and seeds found in tomatoes,
- Whole flaxseed and sesame seed, watermelon;
- Stringy fibres found in some beans and celery;
- Cabbage, onions and sweetcorn too.
Not surprisingly, wholegrains containing the tough outer husk (where the bran is found) such as bread, rice and pasta is another source of insoluble fibre.
This type of fibre is much softer. It absorbs water as it passes through, creating a gel like substance which is gentle on the digestive tract. It keeps stools soft which also helps with bowel regularity and constipation, yet it doesn’t cause stools to be too loose so has a positive effect on diarrhoea. It also provides fuel to support the growth of beneficial bacteria.
Soluble fibre may be tolerated during IBD flare-ups, whilst insoluble is not.
Sources of Soluble Fibre:
- Apple pectin (from stewed peeled apples in cinnamon but no sugar) can have an anti-inflammatory effect as well as being gentle on the gut wall. This is usually well tolerated during flare-ups.
- Skinless apricots
- Cooked rolled oats in water or nut milk (not dairy)
- Sweet potato (mashed, no skin)
- Milled ground flaxseed
Other Tips for eating Fibrous Foods during an IBD flare-up
Avoid raw vegetables and all salads. Only eat very well cooked vegetables that soften the tough cell walls and is easier on the digestive tract. Stew fruit-like apples and pears without sugar. Try tahini- a paste made from sesame seeds.
Natural supplements that can be very helpful for both IBD and IBS (professional advice is recommended):
- Psyllium Husk – A natural soluble fibre that is gentle on the gut wall, supports and regulates bowel movements and an anti-inflammatory effect too.
- Deglycyrrhizinated Liquorice – DGL has a powerful anti-inflammatory effect and is very soothing to the upper GI tract. It has been comprehensively researched and shown to be an effective approach for ulcers of the GI tract..
- Slippery Elm has a soothing, calming effect on an inflamed gut lining. This soothing action can be attributed to its antioxidant action and mucilage which coats, soothes and calms the intestinal lining.
For those living with IBD, do try to have a little soluble fibre during a flare-up from the list above (starting with stewed apple). When not in flare-up, very slowly increase your range and diversity of both types of fibre. Longer-term remission is linked to a more balanced microbiome, and this is fuelled by our dietary fibre.
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