• Skip to primary navigation
  • Skip to main content
  • Skip to primary sidebar
Alyssa Luck

Alyssa Luck

  • About Me
  • Deep Dives
  • The IBD Index
  • Functional Orthodontics
  • YouTube
  • Instagram
  • Contact Me
  • Show Search
Hide Search

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.

Table of Contents
What is a semi-vegetarian/plant-based diet?
Is there evidence to support a semi-vegetarian/plant-based diet for IBD?
Why is treatment of IBD so much better in Japan?
Review of the literature

What is a Semi-Vegetarian/Plant-Based Diet?

This paper gives a great overview of the diet in the “History and concept of PBD in IBD” section, but to summarize here, Nakadori General Hospital in Japan has been providing a semi-vegetarian diet to ulcerative colitis patients since 2003. It appeared in the literature for the first time in a 2005 case report, and was fleshed out in more detail in a 2010 paper. (Of note, the researchers transitioned to using the term “plant-based diet” (PBD) rather than “semi-vegetarian diet” (SVD) for their more recent publications, but the diet is the same, and is depicted in the food pyramid below.)

Semi-vegetarian/plant-based diet food pyramid, as designed by Japanese researchers specifically for IBD patients. Chiba et al. Lifestyle-related disease in Crohn’s disease: Relapse prevention by a semi-vegetarian diet. 2010. World J Gastroenterol.

Is There Evidence to Support a Semi-Vegetarian/Plant-Based Diet for IBD?

Yes! The research group led by Mitsuro Chiba in Japan, first at Nakadori General Hospital and later at Akita City Hospital, has published several papers detailing the success of SVD/PBD in treating IBD.

This group has achieved remarkable results with Crohn’s patients: using a combination of infliximab (Remicade) and SVD/PBD, they’ve achieved a remission rate of 96% in 46 consecutive cases. (Source)

The UC results (76% remission) are less impressive, but still significantly better than those achieved with conventional treatment. (See Chiba et al. 2020 in the References section below.)

Note that these are not randomized controlled trials, and therefore the quality of the evidence would be considered low. But as far as I’m concerned, that is to their credit; it’s obvious that their priority is helping patients heal rather than producing “good” science. And when the intervention is as low-risk and holistic as this (ie a nutritionally complete and balanced diet), I think that approach is perfectly valid.

Why is Treatment of IBD So Much Better in Japan?

Glad you asked, I’ve been wondering the same thing.

All kidding aside, there’s a stark difference in how IBD treatment is discussed and implemented in these papers compared with the standard of care I’m familiar with in the US. Below are a few quotes I found particularly noteworthy.

In our practice, hospitalization plays a critical role in replacement of an omnivorous diet with PBD. It is obvious that the majority of diseases we face are chronic diseases (lifestyle diseases) due to an unhealthy lifestyle. Therefore, incorporation of a healthy lifestyle in medicine, namely lifestyle medicine, is fundamental for prevention and treatment of chronic diseases. Changes in lifestyle including dietary habits are not easy. Hospitalization helps limit risk factors for IBD and our health such as smoking, alcohol, sweets, and animal foods, while patients benefit from preventive factors every day such as intake of vegetables and fruits. Hospitalization seemed to enhance their self-management skills, which contributed greatly to prevention of relapse.

Chiba et al. Recommendation of plant-based diets for inflammatory bowel disease. 2019. Transl Pediatr.

Although medication is needed in the active phase of IBD, diet is generally more important than medication to maintain remission in the quiescent phase. If a suitable diet is established as part of a changing lifestyle, medication ultimately may not be needed to maintain remission.

Chiba et al. Relapse Prevention in Ulcerative Colitis by Plant-Based Diet Through Educational Hospitalization: A Single-Group Trial. (2018). Perm J.

It is suggested that patients can stop medication when they feel confident after a few years of remission using the PBD. This may go some way to relieving a patient’s fear about the disease, especially compared with being told that they may need to receive medication for life.

Chiba et al. Relapse Prevention in Ulcerative Colitis by Plant-Based Diet Through Educational Hospitalization: A Single-Group Trial. (2018). Perm J.

Review of the Literature

Note: These are in an order that makes sense from the standpoint of information conveyance; not in chronological or alphabetical order.

Chiba et al. Recommendation of plant-based diets for inflammatory bowel disease. 2019. Transl Pediatr.

  • This is a good introduction to and review of the SVD/PBD that this research group has used in their hospital to treat IBD patients since 2003, providing background and rationale for diet design, etc.
  • As of the writing of this paper, the research group has treated more than 159 UC patients and 70 CD patients with the SVD/PBD.

Chiba et al. Lifestyle-related disease in Crohn’s disease: Relapse prevention by a semi-vegetarian diet. 2010. World J Gastroenterol.

  • This paper details the composition and nutrient breakdown of the semi-vegetarian diet (SVD) used at the hospital, including meal pictures and food pyramid.
  • Based on a 2-year analysis of Crohn’s disease relapse rates, a SVD was highly effective in preventing relapse.
  • Note: All 22 patients were advised to continue a SVD, so the two groups compared were those who chose to continue vs. those who did not. I probably don’t have to tell you that this leaves lots of room for confounding variables, since essentially you’re comparing a group that follows their doctor’s advice to a group that doesn’t.

Chiba et al. High Remission Rate with Infliximab and Plant-Based Diet as First-Line (IPF) Therapy for Severe Ulcerative Colitis: Single-Group Trial. (2020). Perm J.

  • 17 patients with severe UC were treated with infliximab (Remicade) and SVD/PBD
  • 13/17 (76%) achieved remission during the induction phase, and one patient had to undergo colectomy; these rates are better than those seen with conventional treatment
  • Cumulative relapse rate at one year was 25% with no additional colectomy cases

Chiba et al. Relapse Prevention in Ulcerative Colitis by Plant-Based Diet Through Educational Hospitalization: A Single-Group Trial. (2018). Perm J.

  • Patients included in the study included both initial cases and relapses who did not need immediate treatment
  • Patients were hospitalized and fed SVD/PBD for two weeks; they were also educated about the disease and lifestyle factors to consider when taking care of themselves moving forward
  • 77% of patients experienced improvements in symptoms and/or laboratory values during the hospitalization
  • Overall relapse rates were far lower than typical relapse rates with conventional therapy: cumulative relapse rates at 1, 2, 3, 4, and 5 years of follow-up were 2%, 4%, 7%, 19%, and 19%, respectively

Chiba et al. Relapse Prevention by Plant-Based Diet Incorporated into Induction Therapy for Ulcerative Colitis: A Single-Group Trial. (2019). Perm J.

  • As opposed to the previous study, which only included patients who didn’t need immediate treatment and received educational hospitalization only, this study looked at relapse prevention among typical UC patients when SVD/PBD was used as part of induction therapy
  • 92 cases were included in the analysis, and the overall cumulative relapse rates at 1, 2, 3, 4, and 5 years of follow-up were 24%, 30%, 36%, 37%, and 39%, respectively, which are lower than those reported with conventional therapy

Chiba et al. Onset of Ulcerative Colitis in the Second Trimester after Emesis Gravidarum: Treatment with Plant-based Diet. (2018). Inflamm Bowel Dis.

  • Comment/letter to the editor re: a case of a 36-year-old woman who developed UC in her second trimester. She was admitted to the hospital, fed a SVD/PBD for 10 days (no medication), then discharged with a negative stool occult blood test

Chiba et al. Onset of Ulcerative Colitis during a Low-Carbohydrate Weight-Loss Diet and Treatment with a Plant-Based Diet: A Case Report. (2016). Perm J.

  • Case study of a man who developed UC while following a low-carb weight loss diet (note that as discussed in the IBD Index article about ketogenic diets, I question to what extent this man’s diet could’ve possibly been “low-carb”)
  • Was hospitalized and fed SVD/PBD for 11 days, then discharged with a negative stool occult blood test
  • Interestingly, the patient had heard that this particular style of plant-based diet was effective for treating UC, so he started his own version after being diagnosed. According to the plant-based scoring system, his original low-carb diet had a score of −13; his attempt at a semivegetarian diet had a score of 18; and the hospital’s semivegetarian diet (which put him into remission) had a score of 35
  • Of note, he had reverted to a diet with a lower plant-based score (2) at 10 months post-discharge, and once again had UC symptoms

A couple selected Crohn’s Disease studies

Chiba et al. Lifestyle-related disease in Crohn’s disease: relapse prevention by a semi-vegetarian diet. 2010. World J Gastroenterol.

  • First study in Japan on SVD in CD showing 100% remission at 1 year and 92% remission at 2 years. Prevention in time to relapse in SVD to omnivores was p=0.0003.

Chiba et al. Induction with Infliximab and a Plant-Based Diet as First-Line (IPF) Therapy for Crohn Disease: A Single-Group Trial. 2017. Perm J.

Related

Therapeutic Diets for IBD plant based, ulcerative colitis, vegetarian

Reader Interactions

Leave a Reply Cancel reply

Your email address will not be published. Required fields are marked *

This site uses Akismet to reduce spam. Learn how your comment data is processed.

Primary Sidebar

 

Hi! I’m Alyssa. This website is where I house all of my musings and investigations and pet research projects – topics ranging from autoimmune disease to nutrition to adult palate expansion to psychology and nervous system therapy. I hope you enjoy this awkwardly cropped poor resolution photo of me playing mini golf. If you want to know more about me, click here!

Recent Comments

  • Alyssa Luck on The DNA Appliance Has Arrived! (APE Diary #6)
  • Jorge González on The DNA Appliance Has Arrived! (APE Diary #6)
  • Alyssa Luck on Can L-Glutamine Cause Brain Fog? {Monday Musings}
  • Cam on Can L-Glutamine Cause Brain Fog? {Monday Musings}
  • Alyssa Luck on Can L-Glutamine Cause Brain Fog? {Monday Musings}

alyssa.luck

alyssa.luck
Photo dump from the last year. Thanks to everyone Photo dump from the last year. Thanks to everyone who made 28 the best yet - excited for 29🥰

(PS. In case anyone wants to know what it’s like in my head, I was going to write something like “year 28” or “my 28th year” but then I realized that the year between your 28th and 29th birthdays is not your 28th year of life, it’s your 29th year. I am turning 29 because I have been alive for 29 years. So then I had a whole thing about how to word it without being inaccurate and ended up going with what you see above which is vague and weird but the point is it was a good year and I love all the people in my life dearly)
Biology of Belief (2005) was written by Bruce Lipt Biology of Belief (2005) was written by Bruce Lipton, who earned a PhD in developmental biology in 1971 and was an anatomy professor and academic researcher in the 70s and 80s. Despite the book's presentation and Lipton's background, this is not a science book. It is an exposition of an ideology, supported by haphazard and poorly contextualized nuggets of evidence, rhetorical leaps, and a mind-boggling overuse of analogies. 

The book largely failed to deliver on its promised content. What it does is argue for the primacy of the environment over DNA in controlling life; propose that the cell membrane rather than the nucleus is the "brain" of the cell; invoke quantum physics to explain why modern medicine fails; explain that our behavior is largely controlled by our subconscious mind; inform parents that they therefore have a great deal of control over the destiny of their children; and conclude that humans must become nonviolent protectors of the environment and of humanity because Everything Is Connected.

It’s not that these points aren’t relevant to the topic at hand - they are. But they were not connected in a coherent way that would explain how “belief” actually works (like…biologically), and the treatment of scientific concepts throughout was careless, or perhaps disingenuous.

I think he's correct about many things, some of them being common knowledge. For instance, the "new" science of epigenetics is now old news, as is the critical role of parenting and early environment in shaping a child’s future. But however important these and attendant concepts may be, the book did not do a good job explaining, supporting, or connecting them. 

As far as practical guidance, he refers the reader to a list of resources on his website, which is fine, but I expected some scientific insight into how/why those modalities work. None was given. 

On the plus side, the book was quite thought-provoking, and I came away with loads of references and topics to follow up on. My favorite line? "There cannot be exceptions to a theory; exceptions simply mean that a theory is not fully correct."
Friedrich Nietzsche, The Gay Science (section 382) Friedrich Nietzsche, The Gay Science (section 382), as quoted in the introduction to Thus Spoke Zarathustra because I like the translation better.
This paper totally changed the way I think about e This paper totally changed the way I think about early nervous system development and the relationship between physiology and sociality. 

The authors propose that newborn babies are not inherently social, and have just one goal in life: physiological homeostasis. I.e. staying alive. This means nutrients, warmth, and regulation of breath and heart rate, i.e. autonomic arousal (it’s well-accepted that newborns sync their breathing and heart rate with caregivers through skin to skin contact). 

All these things are traditionally provided by a loving caregiver. So what the baby experiences during the first weeks of life, over and over, is a shift from physiological perturbation to homeostasis (a highly rewarding event inherently) REPEATEDLY PAIRED with things like the sound of a caregiver’s voice and seeing their face. Thus, over time, the face/voice stimuli become rewarding as well. 

The authors argue that THIS is the beginning of humans’ wiring for sociality, and may explain why loving social interactions can have such a profound regulating effect on physiology throughout life: because the brain was trained for it at an early age. 

This framework holds all kinds of fascinating implications for what happens if that initial “training” isn’t so ideal. What if the return to nutritional homeostasis via feeding is paired with negative expressions and vocalizations rather than loving ones, perhaps as could occur with PPD? What happens if the caregiver has poor autonomic regulation, such that social stimuli become paired with cardiorespiratory overexcitement in the baby? Could that have potential for influencing later introversion vs extroversion? (Because if social interaction is paired with autonomic overexcitement, that could lead to social interaction literally being more energetically draining, which is what introverts experience. Thoughts?)

For my energy metabolism enthusiasts: Table 1 in the paper draws a link between metabolic rate and sociality across species. Swipe for a screenshot. 

Anyway, check out the paper! It’s free, just google “growing a social brain pdf.”
I’ll be under general anesthesia in a couple day I’ll be under general anesthesia in a couple days to have two tooth implants placed, and I think I’ll take the opportunity to have a little heart-to-heart with my subconscious mind. A bit of medically-assisted self-hypnosis, if you will. 

I randomly stumbled upon these papers a couple months ago - an RCT showing reduced post-op pain in patients who listened to recorded positive messages while under general anesthesia, plus a post-hoc analysis of the same data that found reduced post-op nausea and vomiting in a subset of high-risk patients. 

The full review paper from the first slide is unfortunately in German, but it has long been recognized that even when unconscious, the patient is listening (for better or for worse). 

It boggles my mind that it isn’t standard of care to have patients listen to recordings like this while under sedation, considering that almost nothing could be easier, safer, or cheaper, and we have at least some evidence of significant efficacy. I mean c’mon, what more could you want from an intervention? 

(Yeah, I know. Profit. If anyone still thinks that our medical system operates with patient well-being as the foremost goal, you’re deluding yourself.)

“There should be a fundamental change in the way patients are treated in the operating room and intensive care unit, and background noise and careless conversations should be eliminated.”

“Perhaps it is now time to finally heed this call and to use communication with unconscious patients that goes beyond the most necessary announcement of interventions and is therapeutically effective through positive suggestions. When in doubt, assume that the patient is listening.”
If you've seen "vagus nerve exercises" that have y If you've seen "vagus nerve exercises" that have you moving your eyes or tilting your head, you've probably encountered the work of Stanley Rosenberg. The exercises he created and introduced in his 2017 book now appear in instructional videos all over the internet. 
 
The book itself has much to recommend it: it's accessible, it's practical, it's inspiring. But it has one major flaw: the solid practical and informational content regarding the cranial nerves is framed in terms of the scientifically dubious polyvagal theory. 
 
I particularly enjoyed the book as an introduction to the therapeutic arena of bodywork, of which Rosenberg is a skilled practitioner. His book is full of case reports that demonstrate how immensely powerful extremely subtle movements and physical manipulations can be. These do need to be kept in perspective: it's a small sample size of the most remarkable cases, and the results were achieved within the supportive clinical environment of a skilled practitioner. You can tell from his descriptions how refined his technique is. But nevertheless, it was a paradigm-shifting read for me, and the exercises give you something concrete to play around with. 
 
The book also brought the cranial nerves and the concept of “social engagement” to the fore as arbiters of health. Rosenberg has a solid background in cranial nerve anatomy and shares many interesting tidbits and considerations that you don’t typically hear; for instance, the potential impact of dental and orthodontic work on cranial nerve function.
 
So, is it worth reading? If any of the above piques your interest, go for it! Just read my post on polyvagal theory first – you can use the book to practice separating the wheat (solid informational content) from the chaff (pseudoscientific framing). If nothing else, the book is a nice reminder that genuine healers who get lasting results for their patients do exist.

But if you just want to try the exercises, you can easily find them all on YouTube. 

“You learn techniques to understand principles. When you understand the principles, you will create your own techniques.” -Stanley Rosenberg
Load More Follow on Instagram

Recent Posts

  • Polyvagal Theory: A Critical Appraisal
  • Lymphatic Support for Ulcerative Colitis and Crohn’s Disease
  • Heart Rate Variability 101: What It Is, How It’s Measured, and Controversies in the Literature
  • Autonomic Nervous System 101: Anatomy and Physiology
  • Vitamin A Detox Diet for Ulcerative Colitis and Crohn’s Disease

Categories

Archives

Copyright © 2023 · Monochrome Pro on Genesis Framework · WordPress · Log in