A few months ago I was delighted to announce the publication of my case studies in the American Journal of Lifestyle Medicine with the support of Shireen Kassam, a physician and honorary lecturer at Kings College. It was about 3 patients with ulcerative colitis that managed to achieve symptom remission and even discontinuation of medication with a specific plant-based protocol designed by me, based on each individual’s condition. You can imagine how much of an honor that was for me as a dietitian-nutritionist specializing in autoimmunity and clinical nutrition, educated in plant-based nutrition, not only to be published in such an important journal, but to prove once again the benefits of plant-based nutrition in our health.
Recognition from the other side of the Atlantic came once again, with publication by the Physicians Committee for Responsible Medicine, a very important Washington-based non-profit organization of 17,000 physicians and nearly 1 million members and supporters worldwide, that aims to change the way doctors treat chronic conditions such as diabetes, heart disease, obesity and cancer, with alternative ways and scientific methods, with an emphasis on disease prevention and the benefits of a plant-based diet.
It is a great pleasure for me both to be able to help ulcerative colitis patients take life back into their hands, but also to see that all this effort with positive results has travelled to America, with publications that can motivate many people and scientists to see the benefits of a plant-based diet more seriously and to change their own as well as other people’s lives.
But how has plant-based diet helped? Let’s take a brief look at the effects of a plant-based choices in 3 different cases.
Case 1
In the first case, the 35-year-old patient visited me after the birth of her second child with a diagnosis of ulcerative colitis. Her symptoms included bloody stools with mucus, excessive gas and severe constipation, which had also occurred during her first pregnancy at the age of 31. Treatment with mesalazine under medical supervision worsened the symptoms with bloody diarrhea and abdominal pain. It was therefore discontinued and the patient opted for a nutritional approach. Her basic diet up to that point included a variety of plant foods, but also included meat or fish most days, processed grains and processed foods. The dietary recommendations were based on a whole-food plant-based diet. After one week, there was severe bloating and constipation that got worse. Therefore, we restricted high FODMAPS foods for 6 weeks and increased fibre intake gradually, along with hydration by adding soup. Within 3 weeks, there was an improvement in symptoms, with further improvement and subsequent remissionof all symptoms over the following months. New colonoscopy in September 2021 showed no inflammation in the sigmoid colon and significant improvement in the rectum, with evidence of healing. After the initial response to this nutritional approach, the patient relapsed during her third pregnancy, which may have been due to changes in diet (reintroduction of some animal foods), but also to other factors such as pregnancy, stress of moving, to which the bowel is highly sensitive. Ultimately, the patient returned to a plant-based diet with occasional fish and chicken consumption and was symptom-free in the last follow-up in June.
Case 2
In April 2021, a 35-year-old man came to see me with a diagnosis of ulcerative colitis and symptoms of bloody stools with mucus, excessive gas and diarrhea. His medical history included a diagnosis of irritable bowel syndrome in 2017, when he received antibiotics to treat his diarrhea and was also receiving oral mesalazine therapy. The patient had a very active lifestyle with regular exercise, including bodybuilding, and had taken multiple nutritional supplements including branched-chain amino acids, creatine, protein and high-dose multivitamins. Prior to his diagnosis, the patient had quit smoking cigarettes and was now smoking e-cigarettes. His basic diet was rich in animal protein, processed carbohydrates and frequent delivery meals. He started a plant-based diet under dietary supervision. During the first 3 months, he lost some weight (3kg), which he didn’t want, so we increased the calories in meals with avocado, banana and peanut butter smoothies and servings of quinoa, grains, legumes and sweet potatoes. A new colonoscopy in November 2021 was normal and his clinical team recommended he stopped taking mesalazine. In the last follow-up in June 2023, the patient continued to follow a 100% whole food plant-based diet with no relapses and also reported improvement in his athletic performance.
Case 3
In October 2020, a 41-year-old man visited me with a diagnosis of ulcerative colitis, with recurrent relapses every 6 months, persistent inflammation on annual colonoscopies and elevated calprotectin levels (206 ug/g). He was initially diagnosed in 2017, with symptoms of bloody diarrhea, mucus and excessive gas. He was taking oral mesalazine along with daily enemas. His past medical history included severe migraines since childhood which led to his daily use of non-steroidal anti-inflammatory drugs. He was a non-smoker but reported that his job as a truck driver was stressful. His usual diet was rich in meat (lamb and pork). His doctor had recommended a low fibre diet but this had not helped his symptoms and he had therefore decided to seek further dietary support. He adopted a fully plant-based diet with my guidance and support and within a few weeks he reported an improvement in symptoms, a reduction in his mesalazine dose from 6 times a day to 4 and no further need for enemas. New colonoscopy in April 2021 showed complete remission for the first time in 3 years. On re-examination in February 2022, the patient reported a recurrence of symptoms with blood diarrhea and an increase in calprotectin levels to 345 ug/g. He reported that he was going through a stressful life event related to his family situation and had also reintroduced meat into his diet. Following the review, he reverted to a mostly plant-based diet with occasional fish (once a month) and chicken (once or twice a month), introduced exercise into his routine and had further remission of symptoms, which remained at his last follow-up in June 2023.
General recommendations that applied in all 3 cases
Since each case is different, I created personalized dietary plans based on the patients’ baseline diet, symptom severity and medical history. They all received general advice on meal selection when eating out and a timeline of meals, such as finishing the last meal of the day at least 3 hours before bedtime. I discussed with them the benefits of good sleep, along with tips for improving sleep hygiene and the importance of guided meditation in their daily routine. I recommended vitamin B12 supplementation to all patients, while vitamin D supplementation was only given to those who had low blood levels. Due to the fact that nuts are not well tolerated in cases of ulcerative colitis, based on my experience, I suggested nut butters instead of whole nuts. Emphasis was given on daily consumption of seeds (flaxseeds, chia, hemp seeds, pumpkin seeds), for adequate short-chain omega-3 fats.
Extra virgin olive oil is included as part of the dietary plan, and I asked patients to avoid food additives and emulsifiers such as carboxymethyl cellulose, polysorbate 80 (P80), propylene glycol alginate, carrageenan, guar, xanthan gum, maltodextrin, glycerol monolaurate, locust bean gum, magnesium stearate, titanium dioxide, artificial coloring, hydrogenated oil (in supplements). I also recommended that patients should avoid drinking alcohol while presenting symptoms and consider it (if they wish) in low quantities only when symptoms have subsided. Since physical activity can be difficult for people with gastrointestinal symptoms, I recommended at least 15 minutes of walking.
The three cases, with more than 2 years of follow-up, highlight the potential role of a plant-based diet with whole foods as therapeutic approach for people with ulcerative colitis. Given the crucial role of dietary risk factors in the development of the disease, it makes sense to eliminate or significantly reduce meat and over-processed foods, as well as food additives and emulsifiers. A plant-based diet in such cases was first introduced by Japanese researchers, who used it in clinical practice for over 15 years, with remarkable results.
Check out the publications here and here.
