If the avoidance of sulfur-rich proteins and food additives can help prevent inflammatory bowel disease, might similar dietary changes help prevent relapses of ulcerative colitis?
Treating Ulcerative Colitis with Diet
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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 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 to really 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 improvement 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 this 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 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 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.
That 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 they turned out to be meat and alcohol. And 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 inflammatory bowel disease, are 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; there are no special recommendations’’. This may now change, though, with this study that suggests that 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 the best available evidence we have right now.
To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video. This is just an approximation of the audio contributed by Katie Schloer.
Please consider volunteering to help out on the site.
- P Jantchou, S MOrois, F Clavel-Chapelon, M C Boutron-Ruault, F Carbonnel. Animal protein intake and risk of inflammatory bowel disease: The E3N prospective study. Am J Gastroenterol. 2010 Oct;105(10):2195-201.
- E Richman, J M Rhodes. Review article: evidence-based dietary advice for patients with inflammatory bowel disease. Aliment Pharmacol Ther. 2013 Nov;38(10):1156-71.
- E Magee. A nutritional component to inflammatory bowel disease: the contribution of meat to fecal sulfide excretion. Nutrition. 1999 Mar;15(3):244-6.
- R Wright, S C Truelove. A Controlled Therapeutic Trial of Various Diets in Ulcerative Colitis. Br Med J. 1965 Jul 17; 2(5454): 138–141.
- S C Trulove. Ulcerative Colitis Provoked by Milk. Br Med J. 1961 Jan 21; 1(5220): 154–160.
- A H Rowe, A Rowe Jr. Chronic ulcerative colitis--atopic allergy in its etiology. Am J Gastroenterol. 1960 Jul;34:49-66.
- A P R Andresen. Ulcerative colitis — an allergic phenomenon. The American Journal of Digestive Diseases March 1942, Volume 9, Issue 3, pp 91-98.
- W E Roediger. Decreased sulphur aminoacid intake in ulcerative colitis. Lancet. 1998 May 23;351(9115):1555.
- V Andersen, A Olsen, F Carbonnel, A Tjonneland, U Vogel. Diet and risk of inflammatory bowel disease. Dig Liver Dis. 2012 Mar;44(3):185-94.
- S L Jowett, C J Seal, M S Pearce, E Phillips, W Gregory, J R Barton, M R Welfare. Influence of dietary factors on the clinical course of ulcerative colitis: a prospective cohort study. Gut. 2004 Oct; 53(10): 1479–1484.
- F Beck. The role of Cdx genes in the mammalian gut. Gut. 2004 Oct; 53(10): 1394–1396.
- M C Pitcher, J H Cummings. Hydrogen sulphide: a bacterial toxin in ulcerative colitis? Gut. 1996 Jul; 39(1): 1–4.
- C Hallert, I Bjorck, M Nyman, A Pousette, C Granno, H Svensson. Increasing fecal butyrate in ulcerative colitis patients by diet: controlled pilot study. Inflamm Bowel Dis. 2003 Mar;9(2):116-21.
Images thanks to MichaelFrancisco via Flickr.
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 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 to really 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 improvement 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 this 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 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 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.
That 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 they turned out to be meat and alcohol. And 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 inflammatory bowel disease, are 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; there are no special recommendations’’. This may now change, though, with this study that suggests that 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 the best available evidence we have right now.
To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video. This is just an approximation of the audio contributed by Katie Schloer.
Please consider volunteering to help out on the site.
- P Jantchou, S MOrois, F Clavel-Chapelon, M C Boutron-Ruault, F Carbonnel. Animal protein intake and risk of inflammatory bowel disease: The E3N prospective study. Am J Gastroenterol. 2010 Oct;105(10):2195-201.
- E Richman, J M Rhodes. Review article: evidence-based dietary advice for patients with inflammatory bowel disease. Aliment Pharmacol Ther. 2013 Nov;38(10):1156-71.
- E Magee. A nutritional component to inflammatory bowel disease: the contribution of meat to fecal sulfide excretion. Nutrition. 1999 Mar;15(3):244-6.
- R Wright, S C Truelove. A Controlled Therapeutic Trial of Various Diets in Ulcerative Colitis. Br Med J. 1965 Jul 17; 2(5454): 138–141.
- S C Trulove. Ulcerative Colitis Provoked by Milk. Br Med J. 1961 Jan 21; 1(5220): 154–160.
- A H Rowe, A Rowe Jr. Chronic ulcerative colitis--atopic allergy in its etiology. Am J Gastroenterol. 1960 Jul;34:49-66.
- A P R Andresen. Ulcerative colitis — an allergic phenomenon. The American Journal of Digestive Diseases March 1942, Volume 9, Issue 3, pp 91-98.
- W E Roediger. Decreased sulphur aminoacid intake in ulcerative colitis. Lancet. 1998 May 23;351(9115):1555.
- V Andersen, A Olsen, F Carbonnel, A Tjonneland, U Vogel. Diet and risk of inflammatory bowel disease. Dig Liver Dis. 2012 Mar;44(3):185-94.
- S L Jowett, C J Seal, M S Pearce, E Phillips, W Gregory, J R Barton, M R Welfare. Influence of dietary factors on the clinical course of ulcerative colitis: a prospective cohort study. Gut. 2004 Oct; 53(10): 1479–1484.
- F Beck. The role of Cdx genes in the mammalian gut. Gut. 2004 Oct; 53(10): 1394–1396.
- M C Pitcher, J H Cummings. Hydrogen sulphide: a bacterial toxin in ulcerative colitis? Gut. 1996 Jul; 39(1): 1–4.
- C Hallert, I Bjorck, M Nyman, A Pousette, C Granno, H Svensson. Increasing fecal butyrate in ulcerative colitis patients by diet: controlled pilot study. Inflamm Bowel Dis. 2003 Mar;9(2):116-21.
Images thanks to MichaelFrancisco via Flickr.
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Treating Ulcerative Colitis with Diet
LicenseCreative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0)
Content URLDoctor's Note
I’ve previously covered ulcerative colitis in Preventing Ulcerative Colitis with Diet and Bowel Wars: Hydrogen Sulfide vs. Butyrate. More on this epic fermentation battle in our gut in Stool pH and Colon Cancer.
For more on inflammatory bowel, see:
- Titanium Dioxide & Inflammatory Bowel Disease
- Preventing Crohn’s Disease with Diet
- Dietary Treatment of Crohn’s Disease
Is the concept of sulfur-rich proteins new to you? Check out Starving Cancer with Methionine Restriction and Methionine Restriction as a Life Extension Strategy.
2021 Update: I’ve added some more videos on ulcerative colitis and Crohn’s disease. Click the links to see them all.
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