Fibre/FODMAP and CFS/IBS/FM

In researching my last post on Psyllium fiber, I was surprised to find no known positive effects. Some of my readers asked about other fiber. Rather than piecemeal a series of post — I thought I should research the area and find what is actually demonstrated and not what has evolved in alternative health beliefs.

“In an attempt to bridge this “fiber gap,” many consumers are turning to fiber supplements, which are typically isolated from a single source. Fiber supplements cannot be presumed to provide the health benefits that are associated with dietary fiber from whole foods. Of the fiber supplements on the market today, only a minority possess the physical characteristics that underlie the mechanisms driving clinically meaningful health benefits…. This emphasizes the importance of recognizing that not all marketed fiber supplements will provide the clinical efficacy of the original raw fiber“[2015]

Conditions Related Studies

NOTE: I view FM/IBS/CFS to be very similar dysfunction of the microbiome with results for one being applicable to all.

  • “What increases inflammation are hypercaloric Western-style diets, characterized by high salt, animal fat, red meat, sugar-sweetened drinks, fried food, low fiber, and lack of physical exercise.” [2015] –
    • This is likely the root of recommending fiber supplements — but there is a major difference between pure fiber and high fiber food (which contains many other things — like complex sugars (not the white sugar we add to tea).
    • “Conversely, exercise and low-calorie diets based on the assumption of vegetables, fruit, legumes, fish, prebiotics, and probiotics act on nuclear receptors and enzymes that upregulate oxidative metabolism, downregulate the synthesis of proinflammatory molecules, and restore or maintain a healthy symbiotic gut microbiota.”
  • “Of the CFS patients, 23% smoked, 32% had an unhealthy BMI, and none had an unhealthy alcohol intake. A majority had an unhealthy food intake: 70% had unhealthy fat, fruit and vegetable intake, and 95% had unhealthy fibre intake.” [2009]
  • On Fibromyalgia [2016]
    • “A daily or almost-daily consumption of fruit and vegetables and a moderate consumption of fish (2 to 5 servings per week) were associated with higher scores in mental health (P<0.001, P<0.05, and P<0.001, respectively) and lower levels of depression (P<0.001, P<0.01, and P<0.01, respectively).”
    • “A daily or almost-daily consumption of vegetables and a moderate consumption of dairy products and fish were associated with higher levels of optimism (P<0.05, P<0.05, and P<0.001, respectively).”
    • “A daily or almost-daily consumption of cured meats and sweetened beverages were associated with higher levels of depression and lower levels of optimism, respectively (both P<0.05).”
    • “However, intake of foods rich in polyphenols was associated with lower numbers of tender points (coffee, r = – 0.346; pear, r = – 0.331) and better quality of life (red fruits, r = – 0.342; dark chocolate, r = – 0.404) in the fibromyalgic group.” [2016]
  • “Dietary fiber that is intrinsic and intact in fiber-rich foods (eg, fruits, vegetables, legumes, whole grains) is widely recognized to have beneficial effects on health when consumed at recommended levels (25 g/d for adult women, 38 g/d for adult men). Most (90%) of the US population does not consume this level of dietary fiber, averaging only 15 g/d.” [2015]  Refined items with NO CLINICALLY demonstrated health benefits:
    • Wheat Bran (wheat)
    • Wheat Dextrin (treated wheat)
    • Inulin (Chicory root)
    • Methylcellulose (wood pulp)
    • Partially Hydrolyzed Guar Gum (Guarn beans)
    • Beta-Glucan (Oats, Barley)
  • “A high fibre intake (> 25-30 g/day) based on a variety of food sources (fruit, vegetable, legumes, cereals) is the only way to avoid many of the disorders mentioned.” [2002]
  • FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides and polyols) have been shown to trigger gastrointestinal symptoms in patients with IBS.” [2014] – whether this is good (microbiome change) or bad (uncomfortable), seem unclear. Digging further…
    • “Certain food items trigger the symptoms experienced by IBS patients, including those rich in fermentable oligo-, di- and monosaccharides, and polyols (FODMAPs). ” [2014]
    • “a diet low in FODMAPs effectively reduced functional gastrointestinal symptoms[ in IBS]. [2014]
    • “Perceived intolerance to high FODMAP foods and low FODMAP foods were both statistically significantly associated with exposure to Giardia infection [resulting in IBS].” [2015]
    • Managing irritable bowel syndrome: The low-FODMAP diet [2016].
    • Efficacy of the low FODMAP diet for treating irritable bowel syndrome: the evidence to date [2016].
    • “Histamine, a measure of immune activation, was reduced eightfold in the low FODMAP [IBS] group (p<0.05).” [2016]
    • “The daily total consumption (mean±s.e.m. values) of fruits and vegetables rich in FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides and polyols) decreased significantly from 16.2±5.3 g before receiving dietary guidance to 9.2±3.2 g after receiving dietary guidance (P=0.02)…The densities of the large intestinal endocrine cells tend to normalize following dietary guidance that may have contributed to the improvement of the patients with IBS symptoms.” [2016] – going FODMAP appears to be a poor decision.

Microbiome Studies

  • ” Low FODMAP diet increased Actinobacteria richness and diversity, and high FODMAP diet decreased the relative abundance of bacteria involved in gas consumption.”[2016]
  • ” The low FODMAP diet was associated with higher faecal pH (7.37 vs. 7.16 ), similar short-chain fatty acid concentrations, greater microbial diversity and reduced total bacterial abundance (9.63 vs. 9.83 ) compared with the Australian diet.” [2015]

Bottom Line

  • You may wish to print off this list. or try this iphone application or android app
    • Remember — we do NOT know if all of fermentable oligosaccharides, disaccharides, monosaccharides and polyols are to be avoided. This is a direction — not a detailed route.
  • Do not bother spending money on fibre supplements — their only effect is shrinking your wallet.
  • Less (ideally no) refined and prepared food — fruit, legumes and vegetables — especially raw!

Filtered Table

The following table was created from two lists I found on the web – high fiber foods excluding high FODMAP items. This is to help the brain fogged.