Preventing IBD with Diet

Did you know that eating a diet filled with animal products can disrupt your microbiome faster than taking an antibiotic? Here’s our first story.

If you go online and search for Crohn’s disease and diet, or ulcerative colitis and diet, the top results are a hodgepodge of conflicting advice. What does the science say? If you do a systematic review of the medical literature on dietary intake and the risk of developing inflammatory bowel disease, Crohn’s disease is associated with the intake of fat and meat, whereas dietary fiber and fruits appear protective. The same foods are associated with the other major inflammatory bowel disease, ulcerative colitis: fat and meat, with a protective association found for vegetable intake.

Why, according to this meta-analysis of nine separate studies, do meat consumers have about a 50 percent greater risk for inflammatory bowel disease? One possibility is that meat may be a vehicle for bacteria that play a role in the development of such diseases. Meat contains huge amounts of Yersinia, for example. Yes, maybe antibiotic residues in the meat could be theoretically mucking with our microbiome, but Yersinia are so-called psychotropic bacteria, meaning they’re able to grow at fridge temperatures. It has been found to be significantly associated with inflammatory bowel disease, supporting this concept that Yersinia infection may be a trigger for chronic inflammatory bowel disease.

One reason why specifically animal protein was associated with triple the risk of inflammatory bowel disease, but plant protein was not, is because it can lead to the formation of toxic bacterial end products, such as the rotten egg gas, hydrogen sulfide. Hydrogen sulfide is not just one of the main “malodorous compounds in human flatus;” it’s a poison that has been implicated in ulcerative colitis. So, go on some meat-heavy, low-carb diet, and we’re not just talking about some “malodorous rectal flatus,” but increased risk of irritable bowel, inflammatory bowel syndrome, and eventually, colorectal cancer.

Hydrogen sulfide in the colon comes from sulphur-containing amino acids like methionine that are concentrated in animal proteins, though there are also sulfites added as preservatives to some nonorganic wine and nonorganic dried fruit. It’s the sulphur-containing amino acids that may be the more important of the two. Give people increasing quantities of meat, and you can get an exponential rise in fecal sulfides.

Specific bacteria, like Biophilia wadsworthia, can take this sulfur that ends up in our colon and produce hydrogen sulfide. And give people an animal product-based diet packed with meat, eggs, and dairy, and you can specifically increase the growth of this bacteria. People underestimate the dramatic effect diet can have on our gut bacteria. Give people a fecal transplant, and it can take three days to shift your microbiome. Take a powerful antibiotic like Cipro, and it can take a week. But start packin’ in the meat and eggs, and within a single day you can change your microbiome—and not for the better. You can more than double the bad bacterial machinery that churns out hydrogen sulfide, consistent with the thinking that diet-

induced changes to the gut flora may contribute to the development of inflammatory bowel disease. In other words, the increase in sulfur compounds in the colon when you eat meat is “not only of interest in the field of flatology,” the study of human farts.

In our next story, we look at how different plant-based diets can be up to 98 percent effective in keeping ulcerative colitis patients in remission, blowing away other treatments.

One of the most common questions physicians treating patients with inflammatory bowel disease (IBD) are asked is whether changing one’s diet can positively affect the course of their disease. Traditionally, our answer had been we have no clue, but this may now be changing, given the evidence that hydrogen sulfide may be playing a role in ulcerative colitis. And since the sulfur-containing amino acids concentrated in meat cause an increase in colonic levels of this rotten egg gas, maybe we should take off the meat. See, animal protein isn’t just associated with an increased risk of getting inflammatory bowel disease in the first place, but also IBD relapses once you have the disease.

This is a recent development. Because the concept of IBD as a lifestyle disease mediated mainly by a Westernized diet is not widely appreciated, an analysis of diet in the follow-up period after diagnosis in relation to a relapse of inflammatory bowel disease had been ignored. But not any longer. Ulcerative colitis patients in remission and their diets were followed for a year to see which foods were linked to the bloody diarrhea coming raging back. And the strongest relationship between a dietary factor and an increased risk of relapse observed in this study was for a high intake of meat.

What if you have people lower their sulfur-containing amino acid intake by decreasing their consumption of animal products? They tried it on four ulcerative colitis patients, and without any change in meds, they experienced like a four-fold improvement in their loose stools. In fact, they felt so much better that they didn’t think it ethical to try switching them back. Since sulfur-containing amino acids are the primary source of dietary sulfur, a “low sulfur” diet essentially means a shift from a typical diet high in animal protein and fat, and low in fiber, to more of a plant-based diet. Westernized diets are pro-inflammatory, and plant-based diets are anti-inflammatory.

Let’s see what treatment with a plant-based diet can do, after the onset of ulcerative colitis during a low-carbohydrate weight-loss diet. A 36-year-old man lost 13 pounds on a low-carb diet, but also lost his health, diagnosed with ulcerative colitis. Put him on a diet centered around whole plant foods, though, and poof—symptoms resolved without medication. Okay, but this is just one case. Case reports are just like glorified anecdotes. The value of case reports lies in their ability to inspire researchers to put it to the test, and that’s exactly what they did.

There had never been a study published focusing on using plant-based diets for the treatment of ulcerative colitis, until now. Considering the lack of a suitable diet to be the biggest issue faced in the current treatment of inflammatory bowel disease, and regarding it as a lifestyle disease caused mainly by our omnivorous diet, a group of Japanese gastroenterologists have been providing a plant-based diet to all patients with IBD for over a decade and publishing extraordinary results—far better than have to date been reported in the medical literature elsewhere. I profiled some of their early work in one of my first videos that went up on NutritionFacts.org, found to be effective in the maintenance of remission in Crohn’s disease by 100 percent at one year and 90 percent at two years. So, how about a plant-based diet for relapse prevention in ulcerative colitis?

Educational hospitalization meant bringing patients into the hospital to control their diet and educate them about the benefits of plant-based eating, so they’d be more motivated to continue it at home. Most patients—about three-quarters—experienced improvements such as disappearance or decrease of bloody stool during hospitalization. Fantastic!

Okay, but here’s the really exciting part. Then, they followed the patients for five years, and 81 percent were able to remain in remission the whole time, and 98 percent were able to keep the disease at bay for at least a year. That blows other treatments away. Those relapse rates are far lower than those reported with medication. Under conventional treatment, other studies found that about half relapse, compared to only 2 percent among those taught to eat healthier.

A plant-based diet was previously shown to be effective in both the active and quiescent stages of Crohn’s disease. The current study has shown that a plant-based diet is effective in both the active and quiescent stages of ulcerative colitis as well. And so, they did another study on even more severely-affected cases with active disease and found the same thing, far beating out conventional drug therapy. People felt so much better that they were still eating more plant-based even six years later. The researchers conclude that a plant-based diet is effective for treating ulcerative colitis to prevent a relapse.

Why? Well, plant-based diets are rich in fiber, which feeds our good gut bugs. That might partly explain why a plant-based diet prevents a variety of chronic diseases. And so, that’s what we may be seeing with inflammatory bowel disease, suggesting that replacing an omnivorous diet with a plant-based diet is the right approach.

It’s like using plant-based diets to treat the cause of heart disease, our #1 killer. It’s not just safer and cheaper, but it works better. No adverse side effects noted for plant-based eating.

Let’s compare that to the side effects of immunosuppressants used for ulcerative colitis, like cyclosporine.

And now, we have even fancier drugs that cost about $60,000 a year (that’s $5,000 a month), and they don’t even work very well, with clinical remission at one year of only like 17 to 34 percent. And instead of no adverse side effects, they can give you a stroke. They can give you heart failure. They can even give you cancer, including a rare type of cancer that often results in death. Or how about a serious brain disease known as progressive multifocal leukoencephalopathy, which can kill you, and for which there is no known treatment or cure? Yeah, yeah increased risk of death, but did we mention how nice and small the pill was and the easy-to-open bottle?

Finally today, we look at how switching to a plant-based can lead to far better outcomes than those reported on conventional treatments in both active and quiescent stages in both Crohn’s disease and ulcerative colitis.

Important to our understanding and prevention of the global increase of inflammatory bowel disease, we know that dietary fiber appears to reduce risk, whereas dietary fat, animal protein, and sugar may increase risk. “Despite the recognition of the Westernization of lifestyle as a major driver of the growing incidence of inflammatory bowel disease, no countermeasures against such lifestyle changes have been recommended, except that patients with Crohn’s disease should not smoke.” Look, we know consuming whole, plant-based foods is synonymous with an anti-inflammatory diet. So, how about putting a plant-based diet to the test?

Just cutting down on red and processed meat didn’t work, but what about cutting down on all meat? A 25-year-old guy diagnosed with Crohn’s disease, but failed to enter clinical remission despite standard medical therapy. But after switching to a diet based exclusively on grains, legumes (like beans, split peas, chickpeas, and lentils), vegetables, and fruits, he entered clinical remission, without the need for medication and showed no signs of Crohn’s disease on follow-up colonoscopy.

It’s worth delving into some of the details. The conventional treatment they started him on is infliximab, sold as REMICADE^®, which can cause a stroke, and may increase your chances of getting lymphoma or other cancers—but it’s a bargain for only $35,000 a year. And it may not even work in 35 to 40 percent of patients. And that seemed to be the case here. So, they upped the dose, after 37 weeks and still suffering after two years on the drug—until he tried completely eliminating animal products and processed foods from his diet, finally experiencing a complete resolution of his symptoms.

Prior to this, his diet had been a typical American diet. But having experienced complete clinical remission for the first time since his diagnosis, he decided to switch to a whole-food, plant-based diet permanently, severely reducing his intake of processed food and limiting animal products to one serving, or less, per week. And whenever his diet started to slip, symptoms started coming back. But he could always wipe them out by eating healthier. After six months of implementing these changes in diet and lifestyle, including stress relief and exercise, a follow-up demonstrated complete mucosal healing of the gut lining with no visible evidence of Crohn’s disease.

We know “[a] diet consisting of whole grains, legumes, fruits, and vegetables has been shown to be helpful in the prevention and treatment of heart disease, obesity, diabetes, hypertension, gallbladder disease, rheumatoid arthritis, and many cancers. Although further research is required…, this case report suggests that Crohn’s disease might be added to this list of conditions.” But that further research has already been done! About 20 patients with Crohn’s disease were placed on a semi-vegetarian diet, meaning no more than a half-serving of fish once a week and a half-serving of meat once every two weeks, and achieved 100 percent remission rate at one year and 90 percent at two years.

Some strayed from the diet though. Let’s see what happened to them. After a year, half had relapsed, and at year two, only 20 percent remained in remission. But those that stuck with it had remarkable success. It was a small study with no formal control group, but represents the best reported result in Crohn’s relapse prevention published in the medical literature to date.

Nowadays, Crohn’s patients are often treated with so-called biologic drugs, expensive injected antibodies that suppress your immune system and have effectively induced and maintained remission in Crohn’s disease, but not in everybody. The current remission rate in Crohn’s with early use of REMICADE^® is 64 percent. So, 30 to 40 percent of patients are likely to experience a disabling disease course even after treatment. What about adding a plant-based diet?

Remission rates jumped up to 100 percent for those who didn’t have to drop out due to drug side effects. Even if you exclude the milder cases, 100 percent of those with serious—even severe—fulminant disease achieved remission.

But if you look at gold standard systematic reviews, they conclude that the effects of dietary interventions on inflammatory bowel diseases, Crohn’s disease and ulcerative colitis, are uncertain. This is because only randomized controlled trials were considered. Totally understandable, as that’s the most rigorous study design. “Nevertheless, people with inflammatory bowel disease deserve advice based on the ‘best available evidence’ rather than no advice at all….” And switching to a plant-based diet has been shown to achieve far better outcomes than those reported on conventional treatments in both active and quiescent stages in both Crohn’s and ulcerative colitis. Maybe we should recommend plant-based diets for inflammatory bowel disease.

It would seem clear that treatment based on treating the cause of the disease is optimal. Spreading the word about healthier diets could help halt the scourge of inflammatory bowel, but how are people going to hear about this amazing research without some kind of public education campaign? That’s what NutritionFacts.org is all about.