Fiber enriched protein-free pasta and bread: Is it a useful tool in chronic kidney disease in type 2 diabetes?

Fibre Intake in Chronic Kidney Disease: What Fibre Should We Recommend?

Chronic kidney disease (CKD) is a major global health problem that challenges all patients' healthcare needs. Fibre consumption benefits kidney patients by acting preventively on associated risk factors, improving intestinal microbiota composition or reducing metabolic acidosis and inflammation. In this review, we focus on increasing fibre consumption and the quality of fibre to recommend, in addition to increasing the consumption of foods that naturally have it in their design, that can resort to fortified foods or fibre supplements. The Western nutritional practice, which is low in fibre and rich in animal proteins, saturated fats, sodium, and sugar, increases the risk of mortality in these patients. On the contrary, patterns with higher consumption of fibre and vegetable proteins, such as the Mediterranean, vegetarian, or Plant dominant low protein diet (PLADO), seem to have a preventive effect on the associated risk factors and influence CKD progression. Until now, the use of fibre supplements has not achieved an evident impact on clinical results. Fibre-rich foods contain other nutrients that reduce cardiovascular risk. Promoting diets richer in vegetables and guaranteeing adequate energy and protein intake is a challenge for the multidisciplinary teams involved in the standard of care for CKD.

Psyllium: a useful functional ingredient in food systems

Psyllium gum is a hydrocolloid found in the husk of seeds from Plantago ovata. Psyllium husk has been used in traditional medicine in areas of India and China. Its consumption has been shown to provide nutritional benefits, such as the capacity to reduce the glycaemic index, to minimize the risk of cardiovascular diseases, to decrease cholesterol and constipation problems and others. Thus, interest in the incorporation of psyllium in food products is twofold. First, it can be a natural alternative to the use of other gums and hydrocolloids considered additives. Second, it can be used to improve the nutritional properties of products in which it is incorporated. However, for this purpose, it is necessary to add great quantities of psyllium. This review analyses the potential use of psyllium in distinct food products, considering its advantages and inconveniences as well as possible solutions for undesired effects. Among the analyzed products there are bakery products and, in particular, gluten-free breads where psyllium has been used as a gluten substitute. The incorporation of psyllium into dairy products such as yogurts and those derived from fruits, among others, is also addressed.