Have you ever told a patient to eat more fibre only to find they complain of bloating, wind, pain in the stomach and worsening constipation or diarrhoea? The guidelines for fibre intake are around 25-30 grams per day according to the Australian Healthy Eating Guide. But there are some bowel conditions where this intake causes extreme gastric upset for some patients. There are journal articles that suggest we should be eating up to 50 grams of fibre per day to avoid modern lifestyle disease, such as diabetes and heart disease. There is evidence for and against this claim.

In practice I talk to many patients who suffer from inflammatory bowel diseases such as Crohn’s disease, ulcerative colitis, acute diverticulitis, colorectal cancer with or without an ostomy, where a high fibre diet simply made patients symptoms worse.

A low fibre diet is not a ‘forever’ diet, but it is very successful in the inflammatory stages of acute presentations of the above diseases and conditions.

The evidence is lacking for exactly how much, and when a low fibre diet should be advised as we only have interventional studies to go by. From an anecdotal and experiential perspective most of my patients state they have some form of benefit from adopting a low fibre diet when in an acute or ‘flare up’ state or post-surgery when the bowel is inflamed.

Resistant starch can still be safely used in the low fibre diet to feed colonocytes and make short chain fatty acid butyrate for a healthy bowel, such as cooked and cooled rice, skinned potatoes and greenish bananas.

Here are a few tips on how you can help you patients:

• Rule out any sinister reasons for diarrhea or constipation by ensuring a diagnosis has been made.
• Rule out all other potential irritants, FODMAPs, food allergy, intolerances, by taking a good food frequency questionnaire to see when the symptoms occur, what makes the bowel feel more or less comfortable, or what helps with daily Bristol Stool 4 type defecation.
• Utilise functional testing facilities.
• Ensure all nutrients are covered during the flare up period – this can last for up to a month, by using nutritional powders or supplements containing B group vitamins as these are usually found in the highest fibre foods – wholegrains.
• Aim for 10 grams of fibre or under, in the first few days and gradually titrate back up to 25-30 grams over a period of weeks in increments of 5 additional grams per week, monitor patient symptoms.
• Ensure all fruit and vegetables are peeled, have no pips, seeds or hard skins and are low fibre.
• Find out how much fibre is in foods at Food Standards Australia and New Zealand, Australian Food Composition Database, Searchable database, Nutrient – Fibre, Dietary Fibre https://www.foodstandards.gov.au/science/monitoringnutrients/afcd/pages/default.aspx
• Keep the bowel moving, if the patient has constipation whilst healing you can use bitter herb stimulants and relaxants, stool softeners or aloe vera whole leaf extract.
• Slow the bowel down in diarrhoeal states with SB probiotics in addition to the low fibre diet.
• Don’t forget the usual anti-inflammatory herbs, foods, nutrients and supplements to address the underlying cause of the disease.