Digestive Diseases and Sciences

, Volume 47, Issue 8, pp 1697–1704 | Cite as

High-Fiber Diet Supplementation in Patients with Irritable Bowel Syndrome (IBS): A Multicenter, Randomized, Open Trial Comparison Between Wheat Bran Diet and Partially Hydrolyzed Guar Gum (PHGG)

  • G.C. Parisi
  • M. Zilli
  • M.P. Miani
  • M. Carrara
  • E. Bottona
  • G. Verdianelli
  • G. Battaglia
  • S. Desideri
  • A. Faedo
  • C. Marzolino
  • A. Tonon
  • M. Ermani
  • G. Leandro


High-fiber diet supplementation is commonly used in IBS, although it poses several management problems. Partially hydrolyzed guar gum (PHGG) has shown beneficial effects in animal and human studies, but its potential role in IBS symptom relief has not been evaluated yet. We investigated PHGG in IBS patients and compared it to a wheat bran diet. Abdominal pain, bowel habits, and subjective overall rating were longitudinally evaluated in 188 adult IBS patients (139 women and 49 men) for 12 weeks. Patients were classified as having diarrhea-predominant, constipation-predominant, or changeable bowel habits and were randomly assigned to groups receiving fiber (30 g/day of wheat bran) or PHGG (5 g/day). After four weeks, patients were allowed to switch group, depending on their subjective evaluation of their symptoms. Significantly more patients switched from fiber to PHGG (49.9%) than from PHGG to fiber (10.9%) at four weeks. Per protocol analysis showed that both fiber and PHGG were effective in improving pain and bowel habits, but no difference was found between the two groups. Conversely, intention-to-treat analysis showed a significantly greater success in the PHGG group (60%) than in the fiber group (40%). Moreover, significantly more patients in the PHGG group reported a greater subjective improvement than those in the Fiber group. In conclusion, improvements in core IBS symptoms (abdominal pain and bowel habits) were observed with both bran and PHGG, but the latter was better tolerated and preferred by patients, revealing a higher probability of success than bran and a lower probability of patients abandoning the prescribed regimen, suggesting that it can increase the benefits deriving from fiber intake in IBS, making it a valid option to consider for high-fiber diet supplementation.

IBS high fiber diet, trial PHGG 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Drossman DA, Li Z, Andruzzi E, Temple RD, Talley NJ, Thompson WG, Whitehead WE, Janssens J, Funch-Jensen P, Corazziari E, Richter JE, Koch GG: US householder survey of functional gastrointestinal disorders: Prevalence, sociodemography and health impact. Dig Dis Sci 38:1569–1580, 1993PubMedGoogle Scholar
  2. 2.
    Heaton KW, O'Donnell LJD, Braddon FEM, Moutford RA, Hughes AO, Cripps PJ: Symptoms of irritable bowel syndrome in a British urban community: Consulters and nonconsulters. Gastroenterology 102:1962–1967, 1992PubMedGoogle Scholar
  3. 3.
    Zuckerman MJ, Guerra LG, Drossman DA, Foland JA, Gregory GG: Comparison of bowel patterns in Hispanic and non-Hispanic whites. Dig Dis Sci 40:1761–1769, 1995Google Scholar
  4. 4.
    Harvey RF, Salih SY, Read AE: Organic and functional disorders in 2000 gastroenterology outpatients. Lancet 1:632–634, 1983PubMedGoogle Scholar
  5. 5.
    Mitchell CM, Drossman DA: Survey of the AGA membership relating to patients with functional gastrointestinal disorders. Gastroenterology 92:1282–1284, 1987Google Scholar
  6. 6.
    Talley NJ: Irritable bowel syndrome: Definition, diagnosis and epidemiology. Ballière's Clin Gastroenterol 13:371–384, 1999Google Scholar
  7. 7.
    Talley NJ, Gabriel SE, Harmsen WS, Zinsmeister AR, Evans RW: Medical costs in community subjects with irritable bowel syndrome. Gastroenterology 109:1736–1741, 1995PubMedGoogle Scholar
  8. 8.
    Sperling MS, McQuaid KR: Rational medical therapy of functional GI disorders. In Handbook of Functional Gastrointestinal Disorders. KW Olden (ed). New York, Marcel Dekker, 1996, pp 269–328Google Scholar
  9. 9.
    Klein KB. Controlled treatment trials in the irritable bowel syndrome: A critique. Gastroenterology 95:232–241, 1988PubMedGoogle Scholar
  10. 10.
    Mangel AW, Hahn BA, Heath AT, Northcutt AR, Kong S, Dukes GE, McSorley D: Adequate relief as an endpoint in clinical trials in irritable bowel syndrome. J Intern Med Res 26:76–81, 1998Google Scholar
  11. 11.
    Connell AM: The effects of dietary fiber on gastrointestinal motor function. Am J Clin Nutr 31:S152–S156, 1978PubMedGoogle Scholar
  12. 12.
    Francis CY, Whorwell PJ: Bran and irritable bowel syndrome: Time for reappraisal. Lancet 344:39–40, 1994PubMedGoogle Scholar
  13. 13.
    Lewis MJ, Whorwell PJ: Bran: May irritate irritable bowel. Nutrition 14:470–471, 1998PubMedGoogle Scholar
  14. 14.
    Haderstofer B, Psycholgin D. Whitehead WE, Schuster MM: Intestinal gas production from bacterial fermentation of undigested carbohydrate in irritable bowel syndrome. Am J Gastroenterol 84:375–378, 1989PubMedGoogle Scholar
  15. 15.
    Jenkins DJA, Leeds AR, Slavin B, Mann J, Jepson EM: Dietary fiber and blood lipids: Reduction of serum cholesterol in type II hyperlipidemia by guar gum. Am J Clin Nutr 32:16–18, 1979PubMedGoogle Scholar
  16. 16.
    Jenkins DJA, Goff DV, Leeds, AR, Alberti KGMM, Wolever TMS, Gassull MA, Hockaday TDR: Unabsorbable carbohydrates and diabetes: Decreased post-prandial hyperglycemia. Lancer 2:172–174, 1976Google Scholar
  17. 17.
    Takahashi H, Yang SI, Hayashi C, Kim M, Yamanaka J, Yamamoto T: Effect of partially hydrolyzed guar gum on fecal output in human volunteers. Nutr Res 13:649–657, 1993Google Scholar
  18. 18.
    Takanishi H, Wako N, Okubo T, Ishihara N, Yamanaka J: Influence of partially hydrolyzed guar gum on constipation in women. J Nutr Sci Vitaminol 40:251–259, 1994PubMedGoogle Scholar
  19. 19.
    Yamatoya K, Kuwano K, Suzuki J, Mitamura T, Sekeiya K: Effect of hydrolyzed guar gum on frequency and feeling of defecation in humans. J Appl Glycosci 42:251–257, 1995Google Scholar
  20. 20.
    Drossman DA (ed): The Functional Gastrointestinal Disorders. Diagnosis, Pathophysiology, and Treatment. Boston, Little, Brown & Co, 1994Google Scholar
  21. 21.
    Farthing MJG. Irritable bowel syndrome: New pharmaceutical approaches to treatment. Ballière's Clin Gastroenterol 13:461–471, 1999Google Scholar
  22. 22.
    Drossman DA, Whitehead WE, Camilleri M. Irritable bowel syndrome: A technical review for practice guideline development. Gastroenterology 112:2120–2137, 1997PubMedGoogle Scholar
  23. 23.
    Distrutti E, Azpiroz F, Soldevilla A, Malagelada J-R: Gastric wall distension determines perception of gastric distension. Gastroenterology 116:1035–1042, 1999PubMedGoogle Scholar
  24. 24.
    Cann PA, Read NW, Holdsworth CD. What is the benefit of coarse wheat bran in patients with irritable bowel syndrome? Gut 25:168–173, 1984PubMedGoogle Scholar
  25. 25.
    Voderholzer WA, Schatke W, Muhldorfer BE, Klauser AG, Birkner B, Muller-Liesner SA: Clinical response to dietary fiber treatment of chronic constipation. Am J Gastroenterol 92:95–98, 1997PubMedGoogle Scholar
  26. 26.
    Cook IJ, Irvine EJ, Campbell D, Shannon S, Reddy SN, Collins SM: Effect of dietary fiber on symptoms and rectosigmoid motility in patients with irritable bowel syndrome. Gastroenterology 98:66–72, 1990PubMedGoogle Scholar
  27. 27.
    Lucey MR, Clark ML, Lowndes J, Dawson AM: Is bran efficacious in irritable bowel syndrome? A double-blind, placebocontrolled crossover study. Gut 28:221–225, 1987Google Scholar
  28. 28.
    Snook J, Shepard HA: Bran supplementation in the treatment of irritable bowel syndrome. Aliment Pharmacol Ther 8:511–514, 1994PubMedGoogle Scholar
  29. 29.
    Hillman LC, Stace NH, Pomare EW: Irritable bowel patients and their long-term response to a high fiber diet. Am J Gastroenterol 79:1–7, 1984PubMedGoogle Scholar
  30. 30.
    Muller-Liesner S: Effect of wheat bran on weight of stool and gastrointestinal transit time: A meta analysis. Br Med J 296:615, 1988Google Scholar
  31. 31.
    Camilleri M: Therapeutic approach to the patient with irritable bowel syndrome. Am J Med 107:27S–32S, 1999Google Scholar
  32. 32.
    Camilleri M: Management of the irritable bowel syndrome. Gastroenterology 120:652–668, 2001PubMedGoogle Scholar
  33. 33.
    American Gastroenterological Association: Medical position statement: Irritable bowel syndrome. Gastroenterology 112:2118–2119, 1997Google Scholar
  34. 34.
    Drossman DA: Psychosocial sound bites: Exercises in the doctor–patient relationship. Am J Gastroenterol 92:1418–1423, 1997PubMedGoogle Scholar
  35. 35.
    Ide T, Moriuchi H, Nihimoto K: Hypolipidemic effects of guar gum and its enzyme hydrolysate in rats fed highly saturated fat diets. Ann Nutr Metab 35:34–44, 1991PubMedGoogle Scholar
  36. 36.
    Takahashi H, Yang SI, Ueda Y, Kim M, Yamamoto T: Influence of intact and partially hydrolysed guar gum on iron utilization in rats fed on iron-deficient diets. Comp Biochem Physiol 109:75–82, 1994Google Scholar
  37. 37.
    Takahashi H, Yank SI, Kim M, Yamamoto T: Protein and energy utilization of growing rats fed on the diets containing intact or partially hydrolyzed guar gum. Comp Biochem Physiol 107:255–260, 1994Google Scholar
  38. 38.
    Takeno F, Yamada H, Sekiya K, Fujitani B, Ohtsu K: Effect of partially decomposed guar gum on high-cholesterol-fed rats and non-dietary fiber-fed rats. J Jpn Soc Nutr Food Sci 43:421–425, 1990Google Scholar
  39. 39.
    Yamatoya K, Sekiya K, Yamada H: Effects of partially hydrolyzed guar gum on postprandial plasma glucose and lipid levels in humans. J Jpn Soc Nutr Food Sci 46:199–203, 1993Google Scholar
  40. 40.
    Okubo T, Ishihara N, Takahashi H, Fujisawa T, Kim M, Yamamoto T, Mitsouka T: Effects of partially hydrolyzed guar gum intake on human intestinal microflora and its metabolism. Biosci Biotech Biochem 58:1364–1369, 1994Google Scholar
  41. 41.
    Cummings JH, Southgate DAT, Branch W, Houston H, Jenskins DJA, James WPT: Colonic response to dietary fiber from carrot, cabbage, apple, bran and guar gum. Lancet 1:5–9, 1978PubMedGoogle Scholar
  42. 42.
    Penagini R, Velio P, Vigorelli R, Bozzani A, Castagnone D, Ranzi T, Bianchi Porro A: The effect of dietary guar on serum cholesterol, intestinal transit and fecal output in man. Am J Gastroenterol 81:123–125, 1986PubMedGoogle Scholar
  43. 43.
    Homann HH, Kemen M, Fuessenich C, Senkal M, Zumtobel V: Reduction in diarrhea incidence by soluble fiber in patients receiving total or supplemental enteral nutrition. J Parent Ent Nutr 18:846–490, 1994Google Scholar

Copyright information

© Plenum Publishing Corporation 2002

Authors and Affiliations

  • G.C. Parisi
    • 1
  • M. Zilli
    • 2
  • M.P. Miani
    • 3
  • M. Carrara
    • 2
  • E. Bottona
    • 2
  • G. Verdianelli
    • 4
  • G. Battaglia
    • 5
  • S. Desideri
    • 2
  • A. Faedo
    • 2
  • C. Marzolino
    • 2
  • A. Tonon
    • 6
  • M. Ermani
    • 1
  • G. Leandro
    • 7
  1. 1.Servizio di GastroenterologiaPadovaItaly
  2. 2.U.O. di Gastroenterologia Azienda Ospedaliera S.M. MisericordiaUdineItaly
  3. 3.Clinica PediatricaUniversità di UdineItaly
  4. 4.Medicina Interna Ospedaliera, Arcispedale S. AnnaFerraraItaly
  5. 5.Medicina Interna Ospedaliera, Arcispedale S. AnnaFerraraItaly
  6. 6.Divisione di Gastroenterologia Ospedale MaggioreVeronaItaly
  7. 7.Ospedale “S. De Bellis” IRCCSCastellana GrotteItaly

Personalised recommendations