Treating Ulcerative Colitis with Diet

Treating Ulcerative Colitis with Diet
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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?

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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.

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.

Images thanks to MichaelFrancisco via Flickr.

Doctor'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:                                                             

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.

If you haven’t yet, you can subscribe to my videos for free by clicking here.

43 responses to “Treating Ulcerative Colitis with Diet

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  1. I’ve had UC for 20 years. It was always well managed until I provided in essence assisted living for my elderly mother, and it was completely out of control after 2 years. Other arrangements were made for my mother and I returned to my normal lifestyle, but the damage already done was so severe, it looked too late. I reviewed popular websites on UC, such as UC.gov and UC.net, along with medical for-profit websites. Nothing worked that was suggested. It was always more drugs, different drugs, surgery, and they listed specific foods to avoid, mostly fruits and vegetables. So with that completely failed and unwilling to do the conventional route of more powerful drugs and/or surgery, by trial and error I found that the more vegetables I ate, the better my system responded. Then I began to actively search out websites on nutritional medicine and to put into practice what these people suggested. It worked. January 2015, I made the final major changes and am today almost entirely whole food plant based. UC has been in complete remission since April and I now take half the prescribed dosage of a generic anti-inflammatory drug, and continue to gradually phase it out. I hope to be at zero drugs by next year. Dr Greger is now my go to guy for nutritional science.




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    1. I’m so glad to hear of the positive change your diet had. Was it the stress of helping your mother that brought on your flare up? I have crohn’s disease, and I find stress can make this worse. I’ve been in remission for about 5-6 years now (I wasn’t on any special diet, just lucky I guess) and medication free for 2 years. However, I have changed my diet on my own while in remission to hopefully prevent any future attacks. My diet isn’t perfectly whole foods, but vegetarian with very little dairy and eggs, I hope to “clean it up” more as I get better at it. I hope your health stays up.




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      1. Thanks for encouraging comments. I’m certain stress was a contributing factor, but I think diet was the primary cause. Prior to this stay I ate little meat. Staying with her meat was the main portion of the meal. This is consistent with multiple instructional videos from Dr G. Now I am completely meat free and almost entirely dairy free (a little skim milk with cheerios is about all that’s left). So diet is the make or break factor for me. And I also continue to study to further “clean it up”. I am also focusing much more on quality of items on menu, not just that it’s vegetarian. For example, I used to eat beans out of a can regularly. Today it is almost entirely from dry made in a nutrition-packed soup including spices proven to have health benefit, like turmeric and piperine because of this:

        https://www.youtube.com/watch?v=5N3iLhjLF5s




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    2. Good luck to you. About 20 years ago my daughter had a serious case of c-dif and UC. Eventually her colon was removed and had a j-pouch.She has done ok, is now 50 has 2 children and watches her diet. I don’t know if it could have been different in the 20 years since the surgery but she has to watch she doesn’t eat to much fiber. At dinner last week she couldn’t have broccoli.




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  2. If sulfur containing amino acids are bad – what about the sulfur containing supplements that many people take for joint pain, like glucosamine, chondroitin and MSM?




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    1. I thought MSM was very good for you. Hydrogen Sulfide in the wrong place in the body can be bad, but it might be a pseudo-hormone and might be responsible for lowering blood pressure. It is possible to develop a sulfur deficiency given that it is the third most abundant mineral in the body. Magnesium sulfate is or was the hospital-based drug of choice for lowering blood pressure. Is it the Magnesium or the Sulfur that lowers blood pressure so quickly? It might be both.




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    2. My UC was pretty much half healed for ten yrs .still bleeds and flair ups then I started the eatright4yourtype and within 3days all bleeding stopped and has been under control for 16 yrs. Even with my vegan diet.it was giving up the bananas tomato potato capsicum chickpeas. These are no good for A blood type. I know the diet was poopooed but it saved me.




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    3. Check this?

      http://www.anti-agingfirewalls.com/2014/06/09/glucosamine-for-longevity/

      “This time the hazard ratio for mortality reduction is .82: 18% fewer deaths per unit of time for those consuming the supplement.

      Both of these papers were done on the same group of 77,719 people. We note that this is as great an effect as combining vegan diet and fish consumption! We find this quite surprising. Glucosamine appears to have a comparable or greater effect on mortality reduction and lifespan extension than Meformin, Rapamycin, 2DG, Veganism, and Resveratrol in nematodes and rodents.”




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    1. Lucy, I would bet this applies to both Crohns and UC because both are considered inflammatory bowel diseases. Personally my UC went in remission when I completely omitted fish and meat. I’m completely vegan now. Totally worth it to have my UC not bother me anymore!




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    2. Lucy,

      The way I look at it is, there are only two types of food on the planet…Plant, and Animal.

      Last time I checked, ‘fish’ was not considered a ‘plant’. ALL animal products pretty much have the same response in our bodies.




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    3. Lucy kindly check other videos about fish to add more perspective about fish, coz it seems although fish doesnt give us bad effect for UC or even Crohns, avoiding both meat and fish provide the best interest in terms of health.

      u might want to check other vid in this web. it might help you understand my opinion.thx

      and u also can find the video about crohns… am sure the solution is pretty similar.




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    4. Clicking through to the abstract of the review article Dr. Greger shows in the video (link under Sources Cited) suggests that the low-meat diet recommendation may be specifically for UC, but that “[i]ndirect evidence supports recommendation of a low intake of animal fat, insoluble fibre and processed fatty foods containing emulsifiers” for both UC/Crohn’s (IBD).




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  3. I’ve had UC since 1995 and once I went completely WFPB no SOS, my UC went into remission. I’d like to know the dose of oat bran used in the study mentioned in regards to butyrate.




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      1. Thanks Angela,
        That’s great information. Certainly, if one doesn’t already have UC, there doesn’t seem to be a need to decrease fermented vegetables until such a problem should result.
        JOhn




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  4. Ask the doctor
    I’ve been hearing a lot about fasting intermittently. Seems you are missing a bet by not talking about if. What are the benefits of skipping breakfast? Should we only eat dinner? While fasting should we drink coffee? Water? Should we not really fast but just under-eat? How is human growth hormone affected? What about autophagy? Is intermittent fasting a good way to lose weight and add muscle?




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    1. I’d also be interested in this topic. I’ve been eating only within an eight hour time period each day for the last couple of year after reading that the practice promotes a healthy live including brain health and might even result in a longer and .




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  5. Meat ones per week , is that You call the best recomendation? But why You not recomend, like a best one: diet with no animal products ?To my position or mind it is the best diet : with no animal products . Animal products are harm to all our cells . Am I right ? We have the right to know the best of the best . Thanks .




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  6. Good day Doctor Greger. I really admirer your work, congratulations for living your true passion and thank you so much, because it is very helpful for so many people and for me and my family! My question is: If I understood the video on Ulcerative Colitis correctly, Sulfur intakes are not something we should aim at. Though I do not have this condition (Ulcerative Colitis), I have been interested in MSM (methylsulfonylmethane). I Read a lot of information on this considered to be “Miraculous” substance (http://www.msm-info.com/). What is your opinion on this supplement? Thank you!




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  7. I was ovo lacto vegetarian for about thirty five years until about two years ago when i stopped drinking milk and started reducing my dairy intake. I stopped eating eggs about six months ago, in the midst of a previous diagnosis of c-diff (clostridium dificile) which my doctors think I may have gotten during several bouts of illness requiring me to take antibiotics during the Fall of 2014. I think they’re wrong because ever since the 1970s I’ve taken probiotics each time I’m on an antibiotic. Anyway, the c-diff ended up causing a flareup of my ulcerative colitis with which I haven’t suffered since the 1980s. Doctors always want to put us on medication and some of it can cause symptoms almost as bad as the ailment. Most of the meds include an element of medication to which I’m allergic and I’ve refused. It bothers me that pharmaceutical companies provide incentives to medical professionals for them to purchase the medications. This is a personal prejudice I have difficulty dealing with. Anyway, back in 2012 following my colonoscopy my GI doctor told me there was no evidence of my ever having had colitis, that I was pretty much completely cured of it. I had no symptoms of it at all until the time I was suffering with c-dif at the beginning of 2015. My May 2015 colonoscopy diagnosed me with c-dif and ulcerative colitis. I attribute it all to the increased stress I suffered with during the last year. Since suffering with the c-diff I increased my probiotic intake to 500-750 billion mgs and started including a prebiotic called Boulardis Saccharides and after many months feel the c-dif is gone. Anyway, last year I significantly changed my diet so that I’m practically vegan….no eggs, no milk, mostly plant based although I can’t resist an occasional dish of eggplant parmesan (I ask the wait staff for very little cheese). I feel as if my c-diff is finally gone but I’ve had a bad flareup with ulcerative colitis this past week and a half so I’ve drastically reduced my food intake. I don’t fit the normal profile of some suffering with ulcerative colitis, except for the stress, which as we all know we literally and figuratively feel in our gut. I’m trying to deal with it by returning to some yoga and exercise….I’ll see how that goes. In the meantime I’m practically starving and not yet able to leave my house for any length of time beyond an hour or two (that’s a great improvement over last week!) I hope to meet with a nutritionist who can assist me in developing a menu plan. I need protein and without the nuts I love (so happy about smooth peanut butter) and raw fruits and veggies which I adore and apparently now have to cook (which I hate!), I need to understand what foods I can incorporate. I’m also type 2 diabetic but not on medication for it.




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  8. I’ve been vegan (whole foods, no soy wheat or gluten) for 6 months now. Although my overall health has improved and I’m not going back, my colitis is still terrible. What am I doing wrong? Am I eating too many fruits? can someone please help me? I’m at my wits end.




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  9. A plant based diet has defiantly helped my Ulcerative Colitis. I have been in remission for 10 years by not drinking alcohol and eating a strict non dairy plant based diet. In addition to this I have smoked cannabis daily and practiced yoga, all of which I believe have helped me to remain in remission. I just recently became pregnant and I am having my first flare up in 10 years. Dr. Greger do you know of any correlation between pregnancy and a ulcerative colitis flare up? I also have not been on any medication for my UC for 10 years, I was able to stop my meds after I made lifestyle changes.




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  10. I have had uc for the last seven years, been on an experimental drug called vedolezumab (entyvio) taken intravenously. It seemed to work quite well for me in the beginning, but has not for the past six months. My symptoms have been worse than ever. I have been a vegetarian most of my life. Up until three years ago I was eating fish and chicken occasionally and cheese (no milk). Three years ago I became vegan with a totally whole food plant based diet. I don’t know where to go next. Do you have any suggestions?
    BTW I have ‘How Not To Die’, just starting it. I’m hoping to be able to pass it around my family and share the knowledge. Thank you for writing the book.




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  11. I’ve had celiac disease and collagene (microscopic) colitis for about 15 years. I’ve been on a glutenfree diet for about 10 years. Would it make sense for me to also follow Dr. Greger’s diet recommendations on inflammatory bowel disease? He mainly mentions UC and Crohn’s disease in his videos. Is this because there are no/fewer studies on microscopic colitis or because it doesn’t really count as an inflammatory bowel disease? Due to the collagenous colitis I’ve also been diagnosed with osteoporosis at the age of 40. I can hardly eat anything without having to go to the bathroom within 20 minutes. I often have problems sleeping because I have to run to the bathroom. I really don’t feel like taking the medications recommended, as they also have osteoporosis as a side effect…… On the other hand I’m really exhausted from going to the bathroom up to 15 times/day. Would you follow the same recommendations as for UC?




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    1. Hello Sanna, I am a volunteer and I help Dr Greger with questions that come into NutritionFacts. I am a plant based dietitian located in Scottsdale, Arizona. In a search of the website, I cannot find anything regarding Celiac and diet from NutritionFacts. Celiac disease is technically an autoimmune disorder, as opposed to an inflammatory disorder as is UC and Chron’s. What I don’t understand is why you have difficulty eating things other than gluten. With Celiac, it should be just avoiding gluten and you will be better. With microscopic colitis, you also have an inflammatory bowel disease, so yes, I would follow the same recommendations as for UC. Please let me know how you’re doing after you make the changes in your diet!

      –Lisa




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  12. I would like to recommend a WFPB diet to a friend with an ileostomy. She also has other diet related diseases including diabetes and obesity. Is there any special advice ?




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    1. Hi Shireen, If your friend has an ileostomy then I’m assuming she has had a large portion if not all of her colon removed. That being the case she may face more unusual challenges with regard to absorption and assimilation of nutrients and water than the average person who switches to a WFPBD. For that reason I would recommend she work closely with a plant based doctor or dietician who has experience in working with patients who are missing large portions of their large bowel. She could try going to this site http://www.plantbaseddoctors.org/ for a listing of plant based docs and dietitians in her area.
      As far as how you might approach encouraging her, you might want to point her to some of Dr G’s videos on diet and inflammatory bowel disease.
      Here’s a few to start with
      http://nutritionfacts.org/video/wheatgrass-juice-ulcerative-colitis/
      http://nutritionfacts.org/video/striking-root-turmeric-curcumin-ulcerative-colitis/
      http://nutritionfacts.org/video/vitamin-d-for-inflammatory-bowel-disease/
      http://nutritionfacts.org/video/titanium-dioxide-inflammatory-bowel-disease/




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  13. Dear Dr. Greger and team,

    thank you for that video! Good one!

    I have a question though: I’m not aware of sulfur-rich foods that are plant-based. So things like nuts, certain dried fruits, and soya products like tofu or soya yoghurt.

    I would be happy if you could enlighten me on that issue.

    Kindest regards

    Michael




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    1. Hi Michael, It can be hard to determine which foods are high or low in certain vitamins and minerals. A website that is really good for this is called “cron-o-meter” Here is their website. https://cronometer.com/ Hopefully you can find all the information there regarding sulfur containing foods that you need.




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  14. Hi Dr Greger!

    My mother (73) was diagnosed with colitis 2yrs ago. since then has been taking 4800mg daily of Acecol. She has been vegan for a least 7 months now. Her Dr’s say “what you eat doesn’t matter” Do you think she should be at least tapering her dose? Her stools are usually runny..not really formed. Other than that no issues. She takes no other medications, is active and in good health other than colitis . I’ve read stories of people getting off their meds after turning to a vegan diet and report no issues or flare ups. Just hoping this would be possible for my mom :)

    Thanks
    Janice




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    1. Hi Janice: As you know, Asacol is used to help reduce the symptoms of ulcerative colitis and to also help prevent flare ups. There’s a chance your mother’s symptoms could worsen if this medication is decreased or discontinued. However, it would absolutely be worth discussing medication adjustments with her healthcare providers now that she’s following a WFPB diet. You can find additional information on ulcerative colitis here.




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  15. I was diagnosed last year with ulcerative colitis (UC). I recently read a study (it was small, pilot study https://www.sciencedaily.com/releases/2016/12/161228171130.htm ) that used the SCD (Specific Carbohydrate Diet) to help some children get their CD and UC under control and in remission. This diet contains meat and certain dairy products. With all the evidence on a plant-based whole food diet helping those with UC, and meat and dairy causing hydrogen sulfide, how is it that the diet seems to work for the study participants (and apparently a large number of other folks on SCD diet message boards/groups)?

    The reason I ask is that I am on a WFPBD as of a couple weeks ago in an attempt to get mine under control. Seems to be some contradicting information, and while I wish to stay on the vegan path, I am curious as to the thoughts/experiences of others who were on SCD and then went WFPBD.

    Many thanks :)




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  16. Has anyone here got any scientific knowledge on the impact of dairy products on someone with Cystic Fibrosis . My nephew is getting steadily worse from it. His doctors reommended a high fat dairy diet to get maximum calories without too much bulk because he has limited ezymes for breaking down food. As a vegan I struggle to see that dairy has any benefits and worry that we will look back on my nephew’s eventual death with frustration for this archaic diet advice. Any experience or knowledge would be greatly appreciated.




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  17. I’ve suffered from Ulcerative Colitis since I was 16. I’m now in my 50’s. I miraculously survived 5 major abdominal surgeries including a total Colectomy concluding in the late 80’s. My main problem now is surgical adhesions from these surgeries. Are there any dietary changes or other ideas (no one will operate as I only have about 12′ of small bowel left) that might help my condition? Both my parents also have UC which was discovered only after my condition manifested enough to require surgeries; this dual genetic component is enough to prevent me from having children, as I could never subject a child to the pain, stress and disfigurement I went through. I’m currently going plant based after seeing “WTH”, but am using Turmeric and Vitamin D per your advice. I also saw ‘payoung’s’ advice above. I’m also following up with a nutritionist, but would appreciate any other advice you might impart. I’ll never know now if early dietary intervention could have trumped both parents’ genetics in my case. Thanks to all who respond and thank you for your life-changing work.




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