Can a Mediterranean and Low-FODMAP Diet Improve Outcomes for Patients With Ulcerative Colitis?

The results from a recent randomized clinical trial showed a significant reduction in disease activity and an improvement in quality of life for patients with active mild-to-moderate ulcerative colitis (UC) who followed a combined Mediterranean, low-FODMAP diet with partial enteral nutrition (PEN) compared with those on a regular diet. FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides and polyols) are short-chain carbohydrates that the small intestine fails to adequately absorb.

Dietary management plays a crucial role in the treatment of UC, but specific dietary approaches are not well-established. This study was conducted to explore whether a diet combining the anti-inflammatory properties of the Mediterranean diet with the gut-symptom management benefits of a low-FODMAP diet could improve clinical outcomes for patients with UC. The researchers aimed to determine whether this combined diet could help manage the inflammatory and oxidative stress markers associated with the disease.

A total of 50 patients with active mild-to-moderate UC were enrolled in this 6-week study. Participants were randomized into two groups: one group received the combined Mediterranean, low-FODMAP diet with PEN, while the control group maintained their regular diet. Before and after the intervention, disease activity was assessed using validated questionnaires, and quality of life was evaluated. Blood samples were also collected to measure inflammatory markers such as high-sensitivity C-reactive protein (hs-CRP) and oxidative stress markers, including total antioxidant capacity (TAC).

The results showed that patients on the combined diet experienced a significant reduction in their disease activity index (P = 0.043 compared with the control group, P < 0.001 and compared with baseline). Quality of life scores also improved markedly in the combined diet group compared to both the control group and baseline values (P < 0.001 for both comparisons). Serum hs-CRP levels, a marker of inflammation, significantly decreased in the combined diet group (P < 0.01), whereas they increased nonsignificantly in the control group. Changes in TAC were not statistically significant in either group, suggesting that the combined diet's impact on oxidative stress markers was minimal.

One limitation of this study is its short duration, which may not be long enough to fully capture the long-term effects of dietary interventions on UC. Additionally, the study sample size was relatively small, and the control group was on a regular diet, which may not be reflective of specific dietary habits known to affect UC symptoms. Further clinical trials with longer intervention periods and larger sample sizes are needed to validate these findings.

"This study indicates that this combination diet has the potential to be used as a safe and highly effective approach in patients with significant intestinal symptoms," the authors concluded.

Reference

Narimani B, Sadeghi A, Daryani NE, et al. Effectiveness of a novel diet in attenuation of clinical activity of disease in patients with ulcerative colitis. Sci Rep. 2024;14(1):13791. doi:10.1038/s41598-024-64512-8.