Therapeutic Diets for IBD

Vitamin A Detox Diet for Ulcerative Colitis and Crohn’s Disease

Alyssa Luck · Jul 9, 2022 · 2 Comments

I have not yet had time to delve as deeply into this theory as I’d like, so in a moment I’ll be directing you to other sources for your own exploration, but I wanted to give a brief introduction to the topic and a few of my own thoughts.

Back in 2014, a man named Grant Genereux (an engineer, unassociated with the science or medical fields) introduced a radical new hypothesis about the underlying cause of eczema, which he later expanded to include all autoimmune diseases and most other “diseases of Western civilization” as well: vitamin A toxicity. He even goes so far as to argue that vitamin A is not a vitamin at all, but a toxin.

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Ketogenic Diet for Ulcerative Colitis and Crohn’s Disease

Alyssa Luck · Mar 22, 2022 · Leave a Comment

Summary: Ketogenic diets have exploded in popularity for weight loss and overall health optimization. While we are still sorely lacking in clinical research on ketogenic diets for IBD, there are a few compelling mechanisms – particularly modulating intestinal immunity and overcoming energy starvation in colonocytes – indicating that ketosis could be a helpful therapeutic strategy for some people. However, there are also some risks, with a potential increase in hydrogen sulfide production being a particular concern since hydrogen sulfide is often already elevated in people with IBD. Therapeutic effects of the diet are likely mediated both metabolically (by emulating fasting) and via the microbiome, but both of these mechanisms appear to be highly context-dependent, contributing to significant disparity in results across the existing literature on ketogenic diets in health and disease. In the context of IBD, my current assessment is that a strict ketogenic diet could be helpful as a short-term strategy for certain people, but is unlikely to be an optimal long-term strategy.

This article is part of the IBD Index. Last updated on April 27, 2022.

As the name would suggest, a ketogenic diet is a diet that promotes the metabolic state of ketosis. This is generally accomplished by consuming very few carbohydrates, a moderate amount of protein, and getting most calories from fat.

Note that I discuss the carnivore diet separately, because while a carnivore diet is necessarily ketogenic, its defining feature is the elimination of all plant foods, which is not necessary on a non-carnivore ketogenic diet.

For information about exogenous ketones (including brands), MCT oil, and some comments about breath vs. urine vs. blood testing for ketosis, check out my article on ketone supplementation.

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Carnivore Diet for Ulcerative Colitis and Crohn’s Disease

Alyssa Luck · Mar 22, 2022 · Leave a Comment

Summary: The carnivore diet has become increasingly popular for everything from weight loss to general health, and many with IBD have reported miraculous results, including one written up and published as a case report. However, a strict carnivore diet (especially with our modern tastes) is not a tried and true strategy for humans: populations that have traditionally subsisted on mostly animal foods do still eat some plant foods, and usually have very specific dietary patterns that most modern carnivores don’t come close to replicating. A carnivore diet could absolutely still be worth trying for IBD, especially if nothing else has worked, but care should be taken to monitor for any issues related to hydrogen sulfide overproduction or metabolism and general health. Certain strategies, such as keeping the fat-to-protein ratio supportive of ketosis and including specific microbiome-supporting foods like cranberries, could help minimize risk and maximize chances of success.

This article is part of the IBD Index. Last updated on April 15, 2022.

The carnivore diet is like the sexier, more exciting cousin of the ketogenic diet (which I covered in the linked post). Rather than hewing to a certain macronutrient ratio, a carnivore diet simply eliminates any food that comes from a plant, only including foods that come from animals. This makes it far simpler to follow, and also more fun (if you’re the type of person who enjoys all the connotations of being a “carnivore” and feeling superior for eschewing lame plant foods).

Many people with IBD have reported miraculous results from adopting a carnivore diet, but many also claim that a stint of carnivore dieting ruined their health. So what are the considerations surrounding a carnivore diet in the context of IBD?

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Autoimmune Protocol (AIP) for Ulcerative Colitis and Crohn’s Disease

Alyssa Luck · Mar 22, 2022 · Leave a Comment

Summary: As the name implies, the Autoimmune Protocol, or AIP, is a therapeutic dietary strategy designed to address autoimmune diseases of all types – including IBD. The AIP addresses both gut and immune health by eliminating all foods that could be immune-activating or disruptive to the gut, and focusing on foods with high nutrient density. The dietary guidelines (including avoidance of grains, legumes, dairy, eggs, nuts and seeds, and nightshades) were already supported by extensive research, but now the AIP as a holistic strategy for IBD is also supported by one uncontrolled clinical trial. Most of my concerns with the diet (specifically surrounding carbohydrate and associated prebiotic content) are being actively addressed by prominent members of the community. As with any strict elimination diet, care should be taken to avoid triggering or exacerbating an unhealthy relationship with food, but overall the AIP is a nutritionally sound diet that has demonstrated success in treating IBD, both anecdotally and clinically.

This article is part of the IBD Index. Last updated on March 22, 2022.

As per my determination to avoid reinventing the wheel, this article primarily consists of links to other resources. The AIP has an extremely robust and scientifically-grounded online community, so while I do hope to one day spend some time comparing/contrasting the various IBD diets (including the AIP), I don’t have much to contribute to the AIP-specific body of knowledge that has not already been contributed by others!

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The Bean Protocol for Ulcerative Colitis and Crohn’s Disease

Alyssa Luck · Mar 17, 2022 · Leave a Comment

Summary: The bean protocol is a nutritional approach that has exploded in popularity as a cure-all for everything from acne to severe Crohn’s disease. The theoretical mechanism of success centers around soluble fiber and its ability to improve detoxification by interrupting enterohepatic circulation. While there are many scientifically sound mechanisms by which this protocol could be beneficial for those with IBD – including support for the liver, nervous system, and microbiome – certain claims are dubious and verge on the pseudoscientific (to be explored in a future post). Overall, the protocol provides an excellent framework for a health-supporting diet and lifestyle for those with IBD, but care should be taken to avoid getting so caught up in the particulars that individual needs or relationship with food are disregarded.

Note: this article is part of the IBD Index. Last updated on July 9, 2022 (added bullet point about vitamin A detox as a potential mechanism).

I’ve personally been experimenting with a bean-protocol-esque diet recently, and I plan to start delving into the science (or pseudoscience) behind it in the near future. Follow me on Instagram for personal content related to the bean protocol, as well as snippets of research as I work on an in-depth “Science Behind the Bean Protocol” blog post.

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Vegan Diets for Ulcerative Colitis and Crohn’s Disease

Alyssa Luck · Mar 16, 2022 · Leave a Comment

Summary: Vegan diets are one popular intervention for IBD, and for good reason – a well-designed vegan diet may confer beneficial effects on intestinal health via modulation of the microbiome, increased nutrient density, and elimination of food irritants. However, diets completely devoid of animal products are not viable long-term for the vast majority of people, and nutritional deficiencies are a serious risk. All the potential health benefits of a vegan diet can still be leveraged within an omnivorous diet, but for those who are vegan for ethical or sustainability reasons, careful supplementation or strategic inclusion of certain nutrient-dense animal foods (such as bivalves) are potential options for avoiding some of the pitfalls.

This article is part of the IBD Index. Last updated on March 16, 2022.

It is well known that high intakes of meat have been associated with IBD (example source; there are many!). And while yes, these are epidemiological studies and no, correlation does not equal causation, I’d consider it a bit disingenuous to brush off these results as a mere artifact of the “healthy user bias” (as many in the keto, carnivore, and paleo communities are wont to do).

I’ll say right at the outset that, on the basis of anthropological, biological, and other scientific knowledge and data, I don’t believe a strict vegan diet to be viable for the vast majority of humans. That said, many people have anecdotally had astonishing success managing their IBD with a vegan diet, and considering those experiences in light of the epidemiological evidence I mentioned above, I think it would behoove us to pay attention to what this information could teach us about the disease processes involved in IBD, and how to best address them.

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Semi-Vegetarian/Plant-Based Diet for Ulcerative Colitis and Crohn’s Disease

Alyssa Luck · Mar 14, 2022 · Leave a Comment

Summary: Hospitals in Japan routinely implement a specific diet in the treatment of IBD patients that they call a “semi-vegetarian diet” (SVD), or, in later publications, a “plant-based diet” (PBD), which consists mostly of brown rice, miso soup, vegetables, fruits, potatoes, legumes, eggs, plain yogurt, pickled vegetables, and green tea, with fish once per week and meat every two weeks. This group of doctors and researchers has achieved impressive results in both Crohn’s disease and ulcerative colitis using the diet alone or in combination with medical intervention. Of note is the markedly different mindset surrounding treatment of IBD in Japan compared with the US and other Western countries.

This article is part of the IBD Index. Last updated April 22, 2022.

“Semi-vegetarian diet? What a dumb and nonspecific name, Alyssa. Are you going to write an article about a “semi-carnivore” diet too? Ever heard the word omnivore?”

Yeah, I know. But believe it or not, the “semi-vegetarian diet” is a diet with fairly specific parameters that is used to treat IBD in Japan.

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Nutrition for IBD

Alyssa Luck · Mar 14, 2022 · Leave a Comment

This post is part of the IBD Index. I plan to flesh out the topic of nutrition for IBD (arguably the only topic I’m technically qualified to speak on, on the basis of formal education) in far greater detail as soon as I’m able, but for now, this page will serve as a placeholder and a gentle reminder that ensuring adequate nutrition is of the utmost importance when dealing with chronic illness.

This isn’t “diets for IBD.” IBD diets are, more often than not, more about what you don’t eat than what you do. This page is about nutrition: making sure your body has all the nutrients – both macro and micro – that it needs in order to function, grow, and repair. This is, after all, the entire reason we eat food to begin with, but that fact is often forgotten amidst frantic attempts to quell symptoms by eliminating foods.

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The Specific Carbohydrate Diet (SCD) for IBD: Everything You Need to Know

Alyssa Luck · Mar 14, 2022 · Leave a Comment

Summary: The Specific Carbohydrate Diet is an increasingly popular dietary intervention for IBD patients that involves limiting dietary carbohydrate to monosaccharides, or simple sugars. In practical terms, this involves eliminating all sources of starch, as well as sugar (sucrose) and lactose. It has anecdotally been extremely helpful for a variety of digestive issues, and some published clinical research is beginning to accumulate suggesting benefit for IBD patients, although the best-designed trial thus far does not demonstrate any benefit over a “Mediterranean” diet. Further, the scientific theory underlying the SCD principles does not stand up to our current understanding of the role of intestinal bacteria in IBD, and more importantly, does not support the “fanatical adherence” called for. Ultimately, the diet has helped a great number of IBD sufferers and may be right for some people, but there are likely other dietary and lifestyle approaches that could deliver similar or greater benefit with less restrictiveness and easier-to-follow guidelines.

This article is part of the IBD Index. Last updated on March 14, 2022.

This article aims to give a high-level overview of the Specific Carbohydrate Diet, as well as practical guidance. For a deep (deep, deep) dive into the science, check out The Science Behind the Specific Carbohydrate Diet (SCD): Brilliant or Bunk?.

Ah, the Specific Carbohydrate Diet. I’ll save my experience with it for another time and keep this page as objective as possible, but as a disclaimer: this is the diet I stuck to religiously for the vast majority of the ~3 years between being diagnosed with UC in 2008 and having my colon removed in 2011. (So at the very least, I’m writing from a place of experience!)

From the looks of it, the diet has only grown in popularity since that time. Even giant online health websites like WebMD, VeryWellFit, and Healthline are chiming in about it. (You don’t need to go read those pages. Just keep reading this one; it’s better.)

This post will give you an overview of the SCD, where it came from, the rationale behind it, pros/cons, and things to watch out for. I also link some relevant resources, and at the bottom of the post (as usual) you’ll find a literature review of sorts. An annotated bibliography, if you will.

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The Science Behind the Specific Carbohydrate Diet (SCD): Brilliant or Bunk?

Alyssa Luck · Mar 14, 2022 · Leave a Comment

Summary: In her 1987 book Breaking the Vicious Cycle, Elaine Gotschall proposed the hypothesis that digestive diseases – including IBD – are perpetuated by a vicious cycle of carbohydrate malabsorption, bacterial overgrowth, and intestinal injury, and can therefore be resolved by removing specific carbohydrates from the diet to break the cycle. Much of her research was quite prescient, but key claims fail to stand up to scrutiny, and the science does not support adherence to SCD principles. A modern look at Gottschall’s hypotheses reveal that modulating the intestinal bacteria through diet is indeed as important as she suspected, but that strategies other than the SCD are better able to accomplish that goal.

This article is part of the IBD Index. Last updated April 20, 2022.

This article is a deep dive into the science behind the Specific Carbohydrate Diet, and is a companion post to the high-level summary post: The Specific Carbohydrate Diet (SCD) for IBD: Everything You Need to Know.

The Specific Carbohydrate Diet as laid out in the 1987 book Breaking the Vicious Cycle (BTVC) by Elaine Gotschall is respectably science-driven. She lists dozens of references in the back of the book to support her recommendations (which is impressive considering she was conducting this research in the pre-internet era), and the book itself has been cited in the literature over 100 times. The SCD is also increasingly showing up as an intervention in clinical research, first in case studies and more recently in a large randomized controlled trial.

I said this in my main post on the SCD, but in many ways, Gottschall was truly ahead of her time with the theories she lays out in her book, although of course she leaned heavily on the work of Dr. Haas. In researching this post, I was struck by how relevant her work still is, and how many modern lines of inquiry flow naturally from her hypotheses.

That said, the big wheel of science keeps on turning, and there’s much to be critiqued in BTVC, with quite a few issues that are – in my view, at least – highly relevant to patients. When you have a dietary protocol with rules that are as specific as those of the SCD – and when the diet originator claims they must be followed with “fanatical adherence” – you gotta make sure they stand up to scrutiny, right?

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