Written by Diana Gnat, DC. In 275 patients with irritable bowel syndrome, 57% had relief with psyllium, 40% with bran, and 35% with rice flour (control).
Irritable bowel syndrome (IBS) is a common disorder that affects the large intestine. It can cause abdominal cramping, bloating and a change in bowel habits. Some people with IBS have constipation, some have diarrhea, and some go back and forth between constipation and diarrhea. Although IBS can cause a great deal of discomfort, it does not harm the intestines. It affects more women than men and no one knows the exact cause. (1).
IBS imposes a substantial economic burden in direct medical costs and in indirect social costs such as absenteeism from work and school and lost productivity, along with the less-measurable costs of a decreased quality of life. The annual cost of IBS treatment in the United States has been estimated to be between $1.7 billion and $10 billion in direct medical costs (excluding prescription and over-the-counter [OTC] drug costs) and $20 billion for indirect costs. (2)
A randomized controlled trial (3) was performed to study the effectiveness of increasing dietary soluble fiber (psyllium) or insoluble fiber (bran) in patients with irritable bowel syndrome. The trial involved 275 patients, aged 18-65 years old, who were randomly assigned to one of three groups for 12 weeks:
- Group 1: 10g psyllium per day
- Group 2: 10g bran per day
- Group 3: 10g rice flour per day (control)
Out of the 275 patients, 85 patients completed the psyllium treatment, 97 patients completed the bran treatment, and 93 patients completed the rice flour treatment (control). The researchers measured for adequate symptom relief of at least two weeks at the end of each month during the 12-week treatment period. They also measured the symptom severity score, severity of abdominal pain, and quality of life. (3)
During the first month of treatment, 57% (45 of 79) of the patients in the psyllium group had adequate relief of abdominal pain for at least two weeks, compared to 40% (31 of 77) in the bran group and 35% (27 of 78) in the control group. During the second month of treatment, 59% (39 of 66) of the patients in the psyllium group had adequate relief of abdominal pain, compared to 51% (32 of 63) in the bran group and 41% (27 of 66) in the control group.
Symptom severity was assessed by points, from 0 points (no symptoms) to 500 points (greatest symptoms). At the beginning of the trial the treatment severity scores for the three groups were Psyllium group: 262, Bran group: 270, and Control group: 279. After three months of treatment, symptom severity in the psyllium treatment group was reduced by 90 points (P*=.03), compared to 58 points in the bran group and 49 points in the control group.
There were no differences among the three groups in quality of life. (3).
The results of this trial support the addition of soluble fiber, such as psyllium, as an effective first treatment approach in the clinical management of patients with irritable bowel syndrome. (3). Further studies of soluble fiber are needed to help examine their role in the treatment of IBS.
Source: Bijkerk, C. J., et al. “Soluble or insoluble fibre in irritable bowel syndrome in primary care? Randomised placebo controlled trial.” Bmj 339 (2009): b3154.
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Posted October 16, 2009
Posted on the Medline Plus. (2009).
- The Burden of Illness of Irritable Bowel Syndrome: Current Challenges and Hope for the Future, J Manag Care Pharm, 2004 Jul-Aug; 10 (4): 356-7.
- Bijkerk, C.J. et al. Soluble of insoluble fiber in irritable bowel syndrome in primary care? Randomized placebo controlled trial. British Medical Journal 2009; 339:b3154.
