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Fermented Fiber Supplements Are No Better Than Placebo for a Laxative Effect.
Dig Dis Sci. 2016 11; 61(11):3140-3146.DD

Abstract

BACKGROUND

Misconceptions about the effects of dietary fiber and 'functional' fiber on stool parameters and constipation persist in the literature.

METHODS

A comprehensive literature review was conducted with the use of the Scopus and PubMed scientific databases to identify and objectively assess well-controlled clinical studies that evaluated the effects of fiber on stool parameters and constipation.

RESULTS

The totality of well-controlled randomized clinical studies show that, to exert a laxative effect, fiber must: (1) resist fermentation to remain intact throughout the large bowel and present in stool, and (2) significantly increase stool water content and stool output, resulting in soft/bulky/easy-to-pass stools. Poorly fermented insoluble fiber (e.g., wheat bran) remains as discreet particles which can mechanically irritate the gut mucosa, stimulating water & mucous secretion if the particles are sufficiently large/coarse. For soluble fibers, some have no effect on viscosity (e.g., inulin, wheat dextrin) while others form high viscosity gels (e.g., β-glucan, psyllium). If the soluble fiber is readily fermented, whether non-viscous or gel-forming, it has no effect on stool output or stool water content, and has no laxative effect. In contrast, a non-fermented, gel-forming soluble fiber (e.g., psyllium) retains its gelled nature and high water-holding capacity throughout the large bowel, resulting in soft/bulky/easy-to-pass stools.

CONCLUSION

When considering a recommendation for a fiber supplement regimen to treat and/or prevent constipation, it is important to consider which fibers have the physical characteristics to exert a laxative effect, and which fiber supplements have rigorous clinical evidence of a significant benefit in patients with constipation.

Authors+Show Affiliations

Global Clinical Sciences, Procter & Gamble, Mason Business Center, 8700 Mason-Montgomery Road, Mason, OH, 45040, USA. mcrorie.jw@pg.com.University of Michigan Health System, 1500 E Medical Center Dr, Ann Arbor, MI, 48109, USA.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

27680987

Citation

McRorie, Johnson W., and William D. Chey. "Fermented Fiber Supplements Are No Better Than Placebo for a Laxative Effect." Digestive Diseases and Sciences, vol. 61, no. 11, 2016, pp. 3140-3146.
McRorie JW, Chey WD. Fermented Fiber Supplements Are No Better Than Placebo for a Laxative Effect. Dig Dis Sci. 2016;61(11):3140-3146.
McRorie, J. W., & Chey, W. D. (2016). Fermented Fiber Supplements Are No Better Than Placebo for a Laxative Effect. Digestive Diseases and Sciences, 61(11), 3140-3146.
McRorie JW, Chey WD. Fermented Fiber Supplements Are No Better Than Placebo for a Laxative Effect. Dig Dis Sci. 2016;61(11):3140-3146. PubMed PMID: 27680987.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Fermented Fiber Supplements Are No Better Than Placebo for a Laxative Effect. AU - McRorie,Johnson W, AU - Chey,William D, Y1 - 2016/09/28/ PY - 2016/04/29/received PY - 2016/09/07/accepted PY - 2016/10/19/pubmed PY - 2017/7/8/medline PY - 2016/9/30/entrez KW - Ferment KW - Fiber KW - Laxative KW - Placebo KW - Stool KW - Supplement SP - 3140 EP - 3146 JF - Digestive diseases and sciences JO - Dig Dis Sci VL - 61 IS - 11 N2 - BACKGROUND: Misconceptions about the effects of dietary fiber and 'functional' fiber on stool parameters and constipation persist in the literature. METHODS: A comprehensive literature review was conducted with the use of the Scopus and PubMed scientific databases to identify and objectively assess well-controlled clinical studies that evaluated the effects of fiber on stool parameters and constipation. RESULTS: The totality of well-controlled randomized clinical studies show that, to exert a laxative effect, fiber must: (1) resist fermentation to remain intact throughout the large bowel and present in stool, and (2) significantly increase stool water content and stool output, resulting in soft/bulky/easy-to-pass stools. Poorly fermented insoluble fiber (e.g., wheat bran) remains as discreet particles which can mechanically irritate the gut mucosa, stimulating water & mucous secretion if the particles are sufficiently large/coarse. For soluble fibers, some have no effect on viscosity (e.g., inulin, wheat dextrin) while others form high viscosity gels (e.g., β-glucan, psyllium). If the soluble fiber is readily fermented, whether non-viscous or gel-forming, it has no effect on stool output or stool water content, and has no laxative effect. In contrast, a non-fermented, gel-forming soluble fiber (e.g., psyllium) retains its gelled nature and high water-holding capacity throughout the large bowel, resulting in soft/bulky/easy-to-pass stools. CONCLUSION: When considering a recommendation for a fiber supplement regimen to treat and/or prevent constipation, it is important to consider which fibers have the physical characteristics to exert a laxative effect, and which fiber supplements have rigorous clinical evidence of a significant benefit in patients with constipation. SN - 1573-2568 UR - https://www.unboundmedicine.com/medline/citation/27680987/Fermented_Fiber_Supplements_Are_No_Better_Than_Placebo_for_a_Laxative_Effect_ L2 - https://doi.org/10.1007/s10620-016-4304-1 DB - PRIME DP - Unbound Medicine ER -