Last month we learnt that:

1. Ulcerative colitis (UC) is generally considered incurable,
2. regular medical approaches can involve pharmacotherapy including antibiotics, anti-inflammatory, and/or immunosuppressive drugs, and surgical intervention (sometimes extensive).
3. These interventions are supportive not curative, many have side effects.
4. Human UC patients have alterations in gut microbial composition.
5. Inappropriate gut flora may be a contributor to UC disease.
6. Faecal microbial transplantation (FMT) tries to treat UC by correcting gut microbial composition.
7. donor SD-FMT was able to maintain steroid free remission in
   1. 32% of UC patients at 8weeks
   2. 13% at 12 months

And patients maintained their standard medications through this study (Costello et al., 2019).

One of the issues with this study is that patient diet, ‘a key modifiable factor influencing the composition of the’ microbiota resident in the gastrointestinal tract (Leeming et al., 2019) was not addressed. Thus, while transplanting someone else’s gut bacteria to patients may be a good start, failure to appropriately modify patient diet, in order to maintain transplanted bacteria, represents a physiologically naive intervention when viewed from this broader perspective.

More recently another research team (Kedia et al., 2022), randomised 66 patients:

1. 35 receiving FMT plus a specific autoimmune dietary regimen (FMT-AID) and standard care;
2. 31 receiving standard care alone.

In this study FMT-AID was found significantly superior in all measures when compared to standard medical care as an intervention for UC.

If we compare the results (at the end of 1 year) from this study with those of the FMT only intervention we looked at last month:

UC Intervention	% Patients in deep remission
Standard care only	0%
FMT only	13%
FMT-AID + standard care:	25%

 

We see that the intervention that addresses diet has by far the best results. This might be expected given that:

1. ‘Diet is one of the major determinants of the gut microbiome, and has been associated with risk as well as disease course of IBD’ (Khalili et al., 2018).
2. diet provides nutritional elements that improve intestinal health, from our previous articles it will be clear that intestinal cells aren’t healthy in UC patients.

A review of dietary instructions given to patients in the FMT-AID group shows that although the prescribed diet provides some good nutritional advice, this diet often focuses on exclusion of certain foods and misses some foods providing key nutritional elements likely helpful for UC. For example:

1. there were no probiotics or probiotic foods prescribed for FMT-AID patients. Remember that at least one probiotc ‘E coli Nissle 1917’ (Kruis et al 2004) was found as effective as mesalazine for UC. A multi-strain probiotic, ‘VSL#3’ was also found efficacious (Lee et al, 2012; Miele et al., 2009; Sood et al., 2009)
2. FMT-AID patients were asked to avoid some high Zinc foods, yet higher zinc intake has been shown to ‘reduce inflammation and disease activity’ in UC patients (de Moura et al, 2020).
3. FMT-AID patients were not specifically provided with high nitrate foods sources which can activate a cascade of events that eventually help to increase intestinal melatonin production (My personal work). Intestinal melatonin has been shown to:
   1. aid regeneration and regulation of function of intestinal lining cells (epithelium),
   2. modulate intestinal immune responses,
   3. act as a potent antioxidant, anti-inflammatory and antigenotoxic agent in all organs including the intestine (Jena & Trivedi, 2014)

suggesting that such foods and their melatonin effects would likely benefit UC patients.

UC is a complex condition that probably requires a sophisticated solution, and a magic bullet is unlikely.

Article Written + Submitted by:

Andreas Klein Nutritionist + Remedial Therapist from Beautiful Health + Wellness
P: 0418 166 269