Exploring Diet’s Role in Managing Ulcerative Colitis, with Oriana Damas, MD

Although it is generally understood that diet plays an important role in inflammatory bowel disease (IBD), studies exploring the role of diet as adjunctive therapy to medicine in ulcerative colitis (UC) are limited.

Oriana Damas, MD, assistant professor of gastroenterology and associate professor of clinical medicine at the University of Miami Miller School of Medicine, sought to address this gap in research with a study exploring the impact of a pair of 5-day intervals of a low-calorie plant-based diet on clinical response to medication in patients with active UC. Findings were presented at Digestive Disease Week (DDW) 2024 in Washington, DC, this weekend.

“We have population-based data that really implicates the role of diet and IBD and UC risk, but we lack data that really can help us understand how we can change the diet of patients with UC to help with their inflammation,” Damas explained. “We do have some data, though they are not large, robust clinical trials, but they do suggest that diets low in animal protein and higher in fiber tend to have improvement in things like quality of life and improvement of some inflammatory markers, but the data is not large. That's one of the things that inspired the current proposal.”

Thus, she and a team of investigators conducted a study among adult patients with active UC starting a new advanced therapy, excluding those with diet restrictions or comorbidities. Participants were randomly assigned in a 1:1 ratio to arm 1 with 2 intervals of the plant-based diet and standard medical therapy for 8 weeks or arm 2 with a low residue control diet and standard medical therapy for 8 weeks. The primary outcome was decrease in simple clinical colitis activity index (SCCAI) at week 8.

Among the 24 patients who completed the study, 19 were on tofacitinib, 2 on upadacitinib, 2 on infliximab, and 1 on risankizumab. In total, 10 patients were randomized to the plant-based diet and 14 were randomized to the control diet.

Results showed 50% of those in the plant-based diet group had a clinical response (defined as a decrease in SCCAI by 3) by week 8 compared to 30.7% in the placebo arm (P <.05). The mean decrease in SCCAI for the plant-based diet was 4.4 (SD, 3.32) compared to 1.61 (SD, 2.43) for the control arm (P = .037). Similarly, when examining differences in response among patients treated only with JAK inhibitors, a similar trend in SCCAI between the PB diet and control arm was observed (P = .06).

“I do a lot of diversity research, and I'm always trying to understand understudied populations and I feel like patients with ulcerative colitis are an understudied population in a way when it comes to dietary research,” Damas said. “So, this is why I wanted to offer this kind of trial and also to measure whether diet could help augment response to medical therapy.”

Reference:

Damas OM, Mengarelli CA, Garces LC, et al. INTERVALS OF A PLANT-BASED, LOW-CALORIE DIET IMPROVE CLINICAL SYMPTOMS COMPARED WITH USUAL DIET IN PATIENTS INITIATING ADVANCED THERAPIES FOR MODERATE-TO-SEVERE ULCERATIVE COLITIS. Abstract presented at Digestive Disease Week (DDW) 2024 Annual Meeting. Washington, DC. May 17-21, 2024.