With new evidence emerging on the human gut microbiome every day, researchers are more convinced than ever that diet plays an important role in the pathogenesis of inflammatory bowel diseases. The hypothesis is further supported by increasing rates of IBD in regions with previously few incidences, as the Western diet permeates the globe.
This is especially exciting, as the more we understand the inner workings of the microbiome and its role in chronic inflammation, the closer we are to safer and more natural treatments for Crohn’s and colitis. There is currently much research to support diet and nutrition as a therapeutic treatment for Crohn’s disease, especially for children. Ulcerative colitis, on the other hand, is slightly more challenging.
Dietary Support vs Therapeutic Treatment for UC
Nutritional support is vital in the treatment and management of IBD, as these patients often suffer extreme deficiencies in vitamins and minerals. But we have yet to confirm a specific diet or nutritional treatment that adequately targets inflammation to the point of induction of remission in ulcerative colitis.
That said, there are clinically proven, natural anti-inflammatory therapies dieticians can utilize to help patients achieve remission. These compounds can be used as medical foods along with dietary support so your patients get their nutritional needs met as well as a thorough treatment for the inflammation itself.
But first, here’s a quick look at the research on dietary treatment for UC, as it stands now:
The Low FODMAP Diet
In 2008, Australian researchers conducted a pilot study in which 20 quiescent UC patients adhered to the Low FODMAP diet. The three-step elimination diet appeared to relieve “functional gut symptoms”, such as abdominal pain, bloating, wind, and diarrhea. Basically, it was effective in reducing the IBS-style symptoms of quiescent ulcerative colitis.
More recently, a 2019 UK study tracked 52 quiescent IBD patients on low FODMAP, measuring gut symptoms, inflammatory markers, and fecal microbiome. After 4 weeks, 52% of the patients reported relief in gut symptoms and scored higher in quality-of-life assessments.
The Low FODMAP diet reduced the fecal abundance of microbes believed to regulate the immune response, compared with the control diet, but had no significant effect on markers of inflammation.
The IBD Anti-inflammatory Diet
A 2014 case report series on the IBD-AID found that all IBD patients on the diet experienced a reduction in symptoms, including bowel movement frequency. All patients were also able to discontinue at least one of their medications, but it must be noted that only three of the participants had ulcerative colitis, and more research is definitely required.
Further studies from the researchers at the University of Massachusetts who initially developed the regimen showed a similar reduction of symptoms and a decrease in disease severity in patients, but it is not clear how many of these patients suffered from UC. There is also little evidence that the IBD-AID can adequately reduce inflammatory markers to the point of remission induction.
Exclusive Enteral Nutrition
Exclusive enteral nutrition (EEN) can be used as a therapeutic treatment for patients with Crohn’s disease, but there is not currently enough data to support its use for UC patients.
The studies are limited, but one prospective study investigated the safety and “nutritional efficiency” of the diet on UC patients with severe disease activity. The study found EEN to be well tolerated, with 11 of the 17 patients attaining over 80% of their caloric requirements after 4 days. Still, as it stands, EEN cannot be considered an effective therapeutic treatment for adult UC patients.
Fiber Supplements
In 2003, a pilot study showed that oat bran helped quiescent UC patients maintain remission by increasing the fecal butyrate level, which has been shown to be effective in UC treatment. 22 patients were given 60g of oat bran for 3 months. After 4 weeks, fecal butyrate level was increased by 36% and no disease flare-up was reported.
Another study in 2014 treated mild-to-moderate UC patients with water-insoluble dietary fibers and glutamine-rich proteins along with conventional medication. At the end of two months, patients showed lower levels of CRP, less abdominal pain, and less cramping compared to the control group. In 2015, researchers confirmed that dietary fiber is useful in prolonging remission.
Nutraceuticals as Medical Food for UC
As you can see, there is scant research on diet as a sole therapy for UC, and even less evidence. Although diet and nutrition are vital aspects of treatment, only an anti-inflammatory therapy will sufficiently target and reduce chronic intestinal inflammation.
If your UC patients are looking for a natural induction therapy, treatment with curcumin and qing dai (QD) are currently the most effective medical foods for IBD. Both are purely natural herbal compounds that have passed rigorous testing and are clinically proven to induce remission in UC.
Qing Dai & Curcumin for UC therapy
Qing dai, from the indigo naturalis plants, is a potent anti-inflammatory and antioxidant best used in short periods of time to relieve severe inflammation and flare-ups in UC. Curcumin contains both anti-inflammatory and antioxidant properties but is more suitable for mild-to-moderate conditions and long-term use.
These nutraceuticals, when used in combination with medical foods with the correct dosages and ratios, have helped thousands of IBD patients achieve remission and maintain remission for years. Many of these patients had previously failed pharmaceutical treatment or suffered from loss of response. We’ve found that induction generally occurs within 4-6 weeks, with some patients even achieving complete mucosal healing within that time frame.
For the best results, we carefully adjust the ratio of curcumin and qing dai according to our patient’s condition and their response to treatment. For a tailored plan that takes your needs into account, simply take our free online assessment.
Rotem Sigall-Boneh
