Lactifibre Use in Inflammatory Bowel Disease
Lactifibre (lactulose fiber) is not recommended for patients with inflammatory bowel disease based on current evidence, as lactulose has been specifically studied and found ineffective for inducing remission in both ulcerative colitis and Crohn's disease. 1
Evidence Against Lactifibre in IBD
The most recent systematic review and meta-analysis examining prebiotics (including lactulose) for IBD treatment found:
- Lactulose showed no benefit for induction of remission in ulcerative colitis compared to controls 1
- Lactulose was no different than controls for induction of remission in Crohn's disease 1
- The overall certainty of evidence for prebiotics in IBD remains very low 1
Why Fiber Recommendations Are Complex in IBD
The relationship between fiber and IBD is nuanced and depends heavily on disease activity and type of fiber:
Soluble vs. Insoluble Fiber Distinction
- Soluble fiber (like ispaghula/psyllium) is effective for IBS symptoms and may be considered in IBD patients with functional overlay, starting at 3-4 g/day and building gradually to avoid bloating 2
- Insoluble fiber (like wheat bran) should be avoided as it may exacerbate symptoms 2
- Lactulose, while technically a soluble fiber, has not demonstrated clinical benefit in IBD 1
Disease Activity Matters
- During active inflammation or flares: Fiber restriction has traditionally been recommended, though newer guidelines suggest texture-modified fiber may be safe when feasible 3
- During remission: Patients should have little to no dietary restrictions and can include both soluble and insoluble fibers 3
- With strictures or ileostomy: Continued fiber intake with softer textures and mechanical modification should be prioritized when feasible 3
Alternative Fiber Options with Evidence
If fiber supplementation is desired for an IBD patient, consider these options with actual supporting data:
For Ulcerative Colitis
- Fructooligosaccharide (FOS) kestose showed effectiveness for induction of remission (RR 2.75) 1
- Germinated barley foodstuff trended toward preventing clinical relapse and lowered pro-inflammatory cytokines 4, 1
- Psyllium has limited evidence but some studies report symptom reduction 4
For Crohn's Disease
- High-dose mesalazine (4 g/daily) is appropriate first-line therapy for mild ileocolonic disease, not fiber supplementation 2, 5
- No fiber supplement has demonstrated clear benefit for Crohn's disease specifically 1
Important Caveats
- Oligofructose-enriched inulin (OF-IN) was associated with increased flatulence and bloating, and actually lowered IBD Questionnaire scores (indicating worse well-being) in some studies 4, 1
- Individual fiber types have vastly different effects - recommendations cannot be generalized across all fiber supplements 4
- Low-fiber diets in IBD patients result in greater dysbiosis, intestinal permeability, and mucosal inflammation 3
Clinical Bottom Line
Do not prescribe Lactifibre for IBD patients. If fiber supplementation is clinically indicated (such as for concurrent IBS-like symptoms in remission), consider psyllium starting at low doses, or discuss germinated barley foodstuff for ulcerative colitis patients. 2, 4, 1 For active IBD requiring treatment, focus on evidence-based anti-inflammatory therapies (mesalazine, corticosteroids, biologics) rather than fiber supplementation. 2, 6, 5