Treating Ulcerative Colitis with Diet

“Treating Ulcerative Colitis with Diet” The rotten egg gas, hydrogen sulfide, is
one of the main malodorous compounds in human flatus; in other words one of
the main reasons farts can smell so bad, but the larger concern is
that it may be responsible for relapses of ulcerative colitis. Previously I’ve talked about
the role animal protein may play in the development
of inflammatory bowel disease, thought to be because of the
putrefying animal protein gas. But what if you already
have ulcerative colitis? Can cutting down on sulfur-
containing amino acids help? Before this study was published,
the only thing shown really to help was the withdrawal of milk. Case reports going back
decades described patients with ulcerative colitis
whose flares appeared to be triggered by cow’s milk,
and the elimination of all dairy products from the diet was reported
to frequently result in a dramatic improvements in symptoms. But when milk was reintroduced
back into their diets, it could trigger an attack. It wasn’t formally studied,
though, until 1965. Was it just a small group of patients
who were maybe allergic or something, or could a milk-free diet help
with the disease in general? So they randomized patients
presenting with an attack of ulcerative colitis into a milk-free diet,
or a control placebo “dummy” diet where they told people just not
to eat a bunch of random things to make it seem like they
were getting special treatment. The milk-free diet worked better: twice as
many were symptom free off of all dairy, and fewer patients
suffered relapses. So there seems to be a certain proportion
of ulcerative colitis patients that would benefit from
eliminating all dairy. They estimate that milk is a
trigger in about one in every five, so certainly sufferers should
try a dairy-free diet trial to see if they’re one of the lucky
ones that can be controlled with such a simple
dietary intervention. OK, but what about cutting back on
sulfur-containing amino acids in general? This study of four ulcerative colitis
sufferers found that their daily bouts of bloody diarrhea
significantly lessened. So reduced intake of sulfur-containing
amino acids, or sulfur-containing amino acid rich foods, produced
an improvement in moderately severe ulcerative colitis. What happened when they
added these foods back? The researchers felt the effect was
so dramatic that challenging back with foods like meat, dairy, eggs, and
sulfited wine was considered unethical. This was just a pilot study, though. Researchers then set up a study
in which 191 ulcerative colitis patients, in remission, were
followed for a year along with their diets, to determine which foods
were associated with a relapse, and it turned out to
be meat and alcohol. This makes sense because they’re
both rich sources of sulfur, which may increase the concentration of hydrogen
sulfide, which, if you remember, is toxic because it interferes
with our body’s utilization of fiber, which our good bacteria turn into
this beneficial compound called butyrate. So, how can we increase fecal
butyrate levels to counteract any hydrogen sulfide? Well, butyrate enemas have
been shown to be of benefit, but if it’s formed from fiber, can’t we
just get it coming in the regular way? Yes. Ulcerative colitis sufferers
were given oat bran for three months, making their good bacteria happy. None of them relapsed,
and their symptoms appeared to be under better control. One of the common questions
we physicians treating patients with IBD, inflammatory bowel
disease, are often asked is whether changing diet could positively
affect the course of their disease? So far our answer, especially
for ulcerative colitis, has been, “We don’t know; no
special recommendations.” This may now change, though,
with this study that suggests that the consumption
of meat may aggravate the course of inflammatory
bowel disease. So folks may want
to cut down on meat, meaning like no more
than once a week. We don’t have confirmation
from interventional studies to support the specifics, but
that could be considered like the best available evidence
we have right now.

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