Clinical guidelines in the use of fibre supplementation for patients with IBS provide one-size-fits-all advice, which has limited value. This narrative review addresses data and concepts around the functional characteristics of fibre and subsequent physiological responses induced in patients with IBS with a view to exploring the application of such knowledge to the precision use of fibre supplements. The key findings are that first, individual fibres elicit highly distinct physiological responses that are associated with their functional characteristics rather than solubility. Second, the current evidence has focused on the use of fibres as a monotherapy for IBS symptoms overall without attempting to exploit these functional characteristics to elicit specific, symptom-targeted effects, or to use fibre types as adjunctive therapies. Personalisation of fibre therapies can therefore target several therapeutic goals. Proposed goals include achieving normalisation of bowel habit, modulation of gut microbiota function towards health and correction of microbial effects of other dietary therapies. To put into perspective, bulking fibres that are minimally fermented can offer utility in modulating indices of bowel habit; slowly fermented fibres may enhance the activities of the gut microbiota; and the combination of both fibres may potentially offer both benefits while optimising the activities of the microbiota throughout the different regions of the colon. In conclusion, understanding the GI responses to specific fibres, particularly in relation to the physiology of the individual, will be the future for personalising fibre therapy for enhancing the personalised management of patients with IBS.
- irritable bowel syndrome
- dietary fibre
- colonic fermentation
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Contributors DS and CKY conceived the concepts and wrote the manuscript. PRG and JGM critically revised the manuscript. All authors approved the final version of the manuscript.
Funding DS was supported by a scholarship from Monash University through the Graduate Research Industry Partnership program. JGM was supported by a Research Fellowship from the National Health and Medical Research Foundation of Australia. CKY has received support for investigator-initiated grants from Atmo Biosciences and Crohn’s and Colitis Australia.
Competing interests All authors also work in a department that financially benefits from the sales of a digital application and booklets on the low fermentable oligosaccharides, disaccharides, monosaccharides and polyols diet. Funds raised contribute to research of the Department of Gastroenterology and to the University. No author receives personal remuneration.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Provenance and peer review Not commissioned; externally peer reviewed.