Psyllium reduces dietary fiber-induced gas production in IBS-D, IBS-C
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Psyllium reduced inulin-induced colonic gas production among patients with Rome IV criteria irritable bowel syndrome, according to research published in Gut.
“The connection between intestinal gas and gut symptoms is complex as signaling from gut to brain is influenced by many factors in patients with IBS. Although cross-sectional studies of unselected patients with IBS have not shown excessive intestinal gas compared with healthy controls, increases in gas have been related to symptom induction,” David Gunn, Nottingham Research Center, and colleagues wrote. “Inulin-type fructans worsen some symptoms in IBS particularly when given at higher doses. ... Alternative approaches to control of colonic fermentation in IBS are therefore being actively pursued.”
To investigate colonic gas production. researchers analyzed 19 patients (78% women, median age 39 years) with Rome IV criteria IBS-diarrhea (10) or IBS-constipation (nine) who ingested a 500 mL test beverage that contained 20 g of either inulin, psyllium, combined inulin and psyllium or dextrose. They measured breath hydrogen every 30 minutes for 6 hours and an in vitro fermentation model evaluated fecal samples from a subset of patients.
“Inulin caused the greatest rise in colonic gas (AUC 3,145 mL/min), which was significantly reduced by the coadministration of inulin and psyllium (AUC 618 mL/min), the latter not being significantly different from dextrose” Gunn and colleagues added.
Further analysis of MRI data demonstrated increased levels of breath hydrogen 120 minutes after inulin ingestion but not after psyllium ingestion (AUC 7,230 ppm per hour vs. AUC 555 ppm per hour). Combined inulin and psyllium reduced the maximum increase to 1,035 ppm per hour. Researchers noted although fermentation in vitro produced more gas following inulin ingestion vs. psyllium ingestion, combined inulin and psyllium did not reduce colonic gas production.
“Adding psyllium to inulin reduces gas production in patients with IBS and suggests that by choosing diets with adequate amounts of viscous fiber, patients may be able to obtain the prebiotic health benefits of high-fiber diets without exacerbating their IBS symptoms, particularly flatulence,” Gunn and colleagues concluded. “Larger clinical trials are now indicated to confirm the clinical value of such mechanistic insights.”
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