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  3. Ulcerative colitis: a randomized controlled trial highlights the positive effects of the Mediterranean diet
Gastroenterology

Ulcerative colitis: a randomized controlled trial highlights the positive effects of the Mediterranean diet

Colitis
Gastroenterology

A Canadian clinical study recommends taking advantage of the remission phases of ulcerative colitis to follow a Mediterranean diet in order to reduce the frequency of flare-ups and underlines the importance of adopting a healthier diet in addition to treatment.

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About this article

Created 29 August 2023
Updated 05 September 2023

The symptoms of ulcerative colitis, i.e., bloody diarrhea, abdominal pain, cramps, tenesmus and fatigue, have a major impact on the quality of life of patients. Altered gut microbiota may lie at the root of the problem. However, this same microbiota is influenced by diet. That is why this randomized controlled trial was set up by researchers and clinicians at the University of British Columbia, Canada. They assessed the effectiveness of the Mediterranean diet in treating symptoms, inflammation and gut microbiota. The adults recruited (65% women, median age 47) either adopted a Mediterranean diet for 12 weeks, with advice from a dietitian (15 patients), or continued with their usual diet (13 patients, control group).

Preventing ulcerative colitis relapses 

At the end of the 12-week study, the Mediterranean diet was well tolerated and reduced the frequency of attacks. Although all patients (except one experiencing a benign episode) were in remission at the start, slight activity was observed in one-third of the patients in the Mediterranean group while almost half of the patients in the control group suffered from a mild-moderate attack. The Mediterranean diet also helped to reduce fecal calprotectin levels which predict impending relapses and measure intestinal inflammation: 20% of patients on this diet had levels above 100 μg/g compared with 75% of those in the control group. 

Prevalence of ulcerative colitis

The prevalence of ulcerative colitis ranges from 114 cases/100,000 inhabitants in Asia and the Middle East to 505 cases/100,000 inhabitants in Europe.

Source : World Gastroenterology Organisation Global Guidelines, 2015

Improved gut microbiota

Microbiota analysis also showed the benefits of the Mediterranean diet, with an increased presence of protective bacteria, notably Firmicutes (Ruminococcus spp., Flavonifractor spp., Clostridium M, Blautia A, and Lactococcus spp.), as well as a decrease in potentially pathogenic bacteria such as Veillonella dispar, Veillonella obetsuensis, Prevotella copri, Streptococcus australis, and biofilm-forming species. The researchers also observed a significant increase in fecal secretory immunoglobulin A (sIgA) after 12 weeks on the Mediterranean diet. This sIgA plays an essential role in maintaining mucosal homeostasis as it binds to pathogenic bacteria and prevents them from gaining access to the intestinal epithelium. Fecal secretory immunoglobulin A could thus explain the negative association between opportunistic pathobionts and the Mediterranean diet.

More short-chain fatty acids

Lastly, the Mediterranean diet coincided with an increase in the production of short-chain fatty acids (SCFAs), known for their immunomodulatory properties and role in promoting intestinal homeostasis, with observed higher levels of total SCFAs as well as butyric, acetic and valeric acids.

As such, the well-tolerated Mediterranean diet appears to be a reasonable and healthy dietary model that can be an option for ulcerative colitis patients in remission to prevent relapses, in addition to their standard medical treatment.

Sources

Haskey N, Estaki M, Ye J, Shim RK et al. A Mediterranean Diet Pattern improves intestinal inflammation concomitant with reshaping of the bacteriome in ulcerative colitis: A randomized controlled trial. J Crohns Colitis. 2023 Apr 24:jjad073.

Tags
Ulcerative colitis Short-chain fatty acid Mediterranean diet Diet

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