Sugarcane Prebiotic Fibre can help IBS patients on a low FODMAP diet: Monash University research study shows

IV Nutrition Gut Health + Prebiotic dietary fiber is a double-edged sword for people with intestinal disorders. While fiber has been shown to alleviate constipation, certain high fiber foods may increase gas production and bloating that may induce symptoms in people with Irritable Bowel Syndrome (IBS). However, a study by Monash University has found that supplementing a specific fiber, sugarcane fiber, alongside a low FODMAP diet has been shown to be effective in providing improvement in both IBS type symptoms and stool satisfaction in patients with IBS.

IBS is the most prevalent functional gastrointestinal (GI) disorder, affecting 15% of the global population. The exact pathophysiology of IBS is still poorly understood as it varies from person to person and often has multiple contributing dynamics. Some of the factors that predispose individuals to IBS include genetics, dietary components, stress-related nervous and endocrine systems, and alterations in the gut microbiome. In people with these predispositions, food sensitivities and dysbiosis of the gut microbiome are among the triggers that can provoke symptoms.

The most common symptoms of IBS include constipation, diarrhea (alternating between the two), abdominal pain, bloating, and gas. Patients with IBS can be classified into four major subtypes depending on the predominant stool pattern, including IBS with constipation (IBS-C), IBS with diarrhea (IBS-D), IBS with mixed bowel habits (IBS-M), and unclassified IBS.

Food plays a role in symptom induction in many people, but the foods that trigger IBS symptoms will vary for each person. A low FODMAP diet – a diet low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs) has been proven effective in reducing IBS-related symptoms. But a diet low in FODMAPs restricts common sources of dietary fiber, subsequently starving the gut of valuable prebiotic benefits and microbiome support. Moreover, reduction in fiber intake can also have a negative impact on other aspects of gut health, especially bowel regularity and constipation.

Prebiotic dietary fiber for IBS may sound a bit like an oxymoron because many types of prebiotic fibers are high FODMAP fermentable fibers that can create havoc on the digestive system due to rapid gas production and symptom induction. Many common types of prebiotic fibers are poorly tolerated by individuals with IBS, and hence many IBS sufferers will avoid prebiotics as part of a temporary low FODMAP diet.

From a functional point of view, two of the most important attributes of prebiotic dietary fiber include:

1. Bulking – to help normalize regular bowel movements, regulate transit time, increase stool output, and normalize stool form.
2. Fermentation in the gut – to support gut microbiome that, in turn, can offer an array of health benefits that stretches even beyond the gut.

So how can people with IBS overcome the fiber gap without the risk of inducing GI symptoms? Well, the answer lies in the use of prebiotic dietary fibers with slow and uniform fermentation rates in the gut.

Fibers that ferment more quickly (e.g., oligosaccharides in FODMAPs) may exacerbate symptoms via sudden gas production. In contrast, fibers that resist fermentation (cellulose) or slowly ferment (e.g., psyllium) are less likely to induce symptoms via accumulation of gas.

Fibers capable of enhancing stool bulk through particulate stimulation of the mucosa and retention of water may assist with increasing stool mass while normalizing stool consistency and colonic transit.

Rapidly fermented fibers may not be suitable for this purpose because bulking effects tend to diminish upon fermentation, while subsequent increases in gas volume may induce symptoms in the presence of visceral hypersensitivity.

Researchers in the Department of Gastroenterology at Monash University have shown how strategic use of specific types of dietary fibers based on their fermentation functionality in the gut can help in IBS patients in their recent study.

What kind of dietary fibers did the study test? The study used sugarcane fiber – that is minimally fermented and has bulking properties. This means that it produces minimal gas and may offer laxative effects. The study also utilized resistant starch (RS) known to ferment more slowly than other prebiotics like inulin.

Who were the participants and how was the study conducted?

In this double-blind crossover trial, 26 patients with IBS were randomly assigned to 1 of 3 low FODMAP diets differing only in total fiber content:

• Control – 23 g/day
• Sugarcane fiber – 33 g/day
• Fiber combination (sugarcane fiber with resistant starch) – 45 g/day

Each diet lasted 14 days with most food provided and separated by a washout period of ≥ 21 days during which participants resumed habitual dietary habits, evaluated by direct questioning by a dietitian.

What did the study find? Overall, across all participants, the three dietary interventions led to improved GI symptoms (abdominal pain, bloating, gas) compared with before they took part in the study.

This confirmed the efficacy of a low FODMAP diet in improving the IBS-related GI symptoms. Also, more importantly, the concomitant fiber supplementation with a low FODMAP diet, as reported, did not diminish the therapeutic effects of reducing FODMAP intake.

The study found that supplementing sugarcane fiber with and without resistant starch with a low FODMAP diet was well tolerated by these patients and improved bowel habits by increasing stool output and normalizing low stool water content.

The study also noted that there were signals that the fiber combination (sugarcane fiber + resistant starch) tended to be less well tolerated compared with Sugarcane fiber only. The effects experienced, however, were small and did not lead to participant withdrawal. This may likely be due to the higher fermentability of RS than sugarcane fiber, thus, likely tending to increase bloating and passage of gas with resistant starch supplementation.

Stool output was noted to be 50% higher during the fiber-supplemented (both Sugarcane only & Sugarcane + resistant starch) vs. control diets.

It is interesting to note that despite the increase in overall total fiber intake by the participants on co-supplementation with resistant starch, the stool output was identical with that of sugarcane fiber only supplementation. This suggests that resistant starch may offer minimal bulking effect.

So, in conclusion, this study clearly confirmed the benefits experienced in IBS patients (although in small numbers) from inclusion of specific dietary fibers like sugarcane fiber during a low FODMAP diet, thus supporting the application to overcome the fiber gap.

What can you do with this information?

The Low FODMAP diet is well-recognised to improve IBS- related symptoms however, it can also starve the gut by reducing the abundance of prebiotic fibre needed for GI healing. However, it’s quite evident that not all prebiotics support bowel regularity or are well-tolerated by those with IBS due to their rapid fermentability in the gut.

If this new research has captured your interest in sugarcane for general gut health, there is only one source of “Virgin Sugarcane Prebiotic” in the world.

Health Food Symmetry harvests and produces Virgin Sugarcane Prebiotic in Queensland, Australia.

• Kfibre is Monash University Low FODMAP certified, is gluten free, high in prebiotic fibre with 95% sucrose reduced. Plus, in addition to the fibres with prebiotic benefits, Kfibre Virgin sugarcane is a complex fibre retaining other phytonutrients present in sugarcane plant. So, you can enjoy the excellent benefits of prebiotics & phytonutrients from sugarcane without the sugar.

Contrary to many prebiotic fibres, IV Nutrition Gut Health – Virgin Sugarcane prebiotic is fermented at a slow and uniform fermentation rate (link) in the entire colon (large intestine), influencing the beneficial gut microbiota and delivering SCFAs including butyrate to especially nourish the hindgut (link). This makes it not only well tolerated by those with IBS, but beneficial to the maintenance of intestinal health as well.

You too can enjoy the gut joy so many others have already found when they tried IV Nutrition Gut Health