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Alyssa Luck

Alyssa Luck

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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.

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

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Hi! I’m Alyssa. I like thunderstorms and cats, hate wearing shoes, and enjoy devising extensive research projects for myself in my free time. This is me in Bali with a monkey on my shoulder. And this is my blog, where I muse about health-related topics and document my relentless self-guinea pigging. If you want to know more about me, click here!

alyssa.luck

alyssa.luck
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
I first stumbled upon polyvagal theory during the I first stumbled upon polyvagal theory during the course of my heart rate variability research. I was surprised to encounter it again "in the wild" shortly after, in the book "Accessing the Healing Power of the Vagus Nerve." Before long, I saw it popping up everywhere, (Baader-Meinhof, anyone?) 
 
Digging deeper, I discovered scientific controversy bubbling just beneath the smooth surface of polyvagal theory's popular presentation. Three months later, I posted a 13k word analysis of the topic. 
 
The technical details are far below the level of practicality for the average person, but the way polyvagal theory has propagated outside of academia has some important ramifications for clinical and scientific progress. 
 
In the wake of a wave of health complaints that our current medical model is poorly equipped to treat, it's clearer than ever that a new paradigm is needed. The grassroots push to emphasize diet and lifestyle factors has been a huge step in the right direction, but it's becoming more and more common to see people who have done everything "right" and are still struggling with persistent health complaints that could range anywhere from mildly annoying to debilitating. 
 
What we need is a genuine integration of mind and body in medicine – not the weak lip service that our current paradigm pays to "stress reduction," like the vague suggestion to relax more and maybe try meditation. And if we're going to develop a sophisticated mind-body medicine, we need a sophisticated mind-body science. And if we want a sophisticated mind-body science, we must subject such topics to the same standards of inquiry as we expect from molecular biomedicine. And that means rejecting pseudoscience like polyvagal theory. 
 
Full analysis and references at alyssaluck.com/polyvagal-theory-a-critical-appraisal
To continue my recounting of the health things I'm To continue my recounting of the health things I'm experimenting with, let me tell you about DNRS: the slightly cheesy, arguably outdated “brain rewiring” program that has changed my life. 

I found it because I was looking for ways to “retrain” my nervous system. I watched some success stories. None of the “target” health conditions matched mine, but I went for it anyway. Probably the best decision I’ve ever made for my health. 

The core of DNRS is built on the principles of neuroplasticity. They call it "brain rewiring" because you intentionally take triggers that would normally stimulate a negative response in your body or mind, and associate them repeatedly with neural signals of safety. If that sounds pseudosciencey, I hear ya – one of my goals with future posts is to bring some concreteness and specificity to the topic. I imagine there are lots of people who could benefit from this type of thing who are turned off by the overly abstract or touchy-feely language. 

There are tons of "brain rewiring" programs like DNRS, but they're all built on similar ideas. Most bring in elements of other popular approaches, ranging from the scientifically validated (cognitive behavioral therapy, mindfulness, acceptance and commitment therapy) to the type of new-agey stuff I always scoffed at (shadow work, inner child work, parts work). 

For me, DNRS has provided the perfect framework to finally achieve what meditation experts and therapists and mystics alike are always advocating – the ability to step into the role of “curious observer.” It's given me everything therapy and meditation promised but could never deliver, helping me recognize my own patterns of thought and behavior and consciously redirect unhelpful ones. If this sounds vague, that's because there isn't a single area of my life that hasn't been improved by using this framework. 

I spend far more time in states of joy and peace and gratitude, and less time in states of anxiety or depression or frenzy. Many chronic worries that used to occupy my mind or keep me up at night – whether related to health, relationships, or my future – have disappeared, and the others are on their way out. (Cont. in comments)
Isn’t it crazy how something can be so easy and Isn’t it crazy how something can be so easy and natural for one person, but so hard for another? 

Me doing food: I can totally cook everything I eat from scratch, no prob

Me doing mental health: just doing my hour of daily mindful cognitive gratitudinal journalization

Me doing physical therapy: I can’t do it I don’t have that muscle

I’ve done many hard things in the name of health, but I think they’ve all been the types of hard things that come naturally to me. And frankly, that hasn’t gotten me where I want to be. 

So I’ve decided to finally tackle something that feels very unnatural: developing a real relationship with my muscles and bones, and learning - through experience, not from a book - how they coordinate with each other and how to use them. 

I never really considered my musculoskeletal system a key player in autoimmune or digestive woes, but now I realize it’s naïve to think dysfunction in one part of the body doesn’t affect another. And since this is so obviously my weakest link, it’s high time to make it a priority!

Even though I’ve done strength training in the past, I never dedicated the time and focus to figure out what my body actually needed to function better, and workouts often felt awkward or led to injury. 

I’ve always dreaded PT-type exercises because they felt simultaneously like “not enough” and also SO HARD, especially when there’s no way to confirm whether I’m doing them “right” (my nightmare). 

But I’m pretty sure the fact that targeted “mind-muscle” work is so hard for me means it’s what I need the most. (That’s how that works, right?)

Anyway, I’m happy to report that I’m finally through both the initial phase of being a giant baby because I have to do something I’m bad at, AND the second phase of neurotically worrying about doing it “wrong.” And hopefully I’m on my way to better posture, improved breathing, and greater strength! 

Super thankful to have people in my life who remind me to have fun and stay curious, when my natural disposition is to write a 27-step plan to “fixing” everything “wrong” with me. And to remind me that it is, in fact, a JOY to be a novice at something (as @_john_the_savage_ would say).
"If your nervous system is balanced, your heart is "If your nervous system is balanced, your heart is constantly being told to beat slower by your parasympathetic system, and beat faster by your sympathetic system. This causes a fluctuation in your heart rate: HRV." (whoop.com) 
 
This statement is a formidable example of one of the biggest misconceptions about heart rate variability (HRV). 
 
HRV is highest during rest or sleep, when sympathetic input is lowest. If HRV was the result of an autonomic “tug-of-war,” why would it be greatest when one of the contenders has entirely dropped the rope? 
 
Part of the misunderstanding may stem from failure to recognize that the heart has an intrinsic rate, well above the resting heart rate maintained by the vagus nerve. Varying vagal impulses create HRV without any sympathetic input at all. 
 
There are many other common misconceptions, such as the notion that HRV metrics measure autonomic tone, or that HRV itself is a metric with one interpretation. 
 
Such misconceptions aren’t only found in layscience – they also pervade academic and clinical literature. For instance, you’ll see LF used as a measurement of “sympathetic tone” and LF/HF as a measurement of “sympathovagal balance,” even though it’s been clear for decades that those interpretations are not physiologically accurate.
 
This post (and the associated article at alyssaluck.com/hrv101) can be thought of as “foundations for understanding HRV research.” And it provides a good example not only of the insufficiency of “sound-byte” science, but also of real science in action. 
 
The unfortunate reality is that we can’t always take researchers’ conclusions at face value. Few have the time to adequately assess a field before adopting one of their metrics, and once a misinterpretation has taken root it can easily become an accepted fact that propagates through repetition, becoming more entrenched with each published paper.
 
Thankfully the ramifications in this case are not very serious - misdirection of experimental design and analysis, and many false statements, but no dire consequences. Nevertheless, it’s a good reminder that science is a human institution, and it never hurts to question oft-repeated “facts.”
My latest diet experiment: the bean protocol! This My latest diet experiment: the bean protocol! This was one of the changes I made immediately prior to my drastic increase in HRV. 

Brief background: the bean protocol entails eating lots of soluble fiber (particularly beans) as a way to support detox. It rests on the assumption that most chronic health issues are the result of fat-soluble environmental toxins, excess hormones, and other fat-soluble things being recirculated in the body rather than eliminated. 

There is some scientific merit to this: the liver does eliminate many toxins and other compounds through the bile, these things can be subject to reabsorption via enterohepatic recirculation, and certain types of fibers do interrupt this process by binding bile, preventing reabsorption and allowing excretion in the feces.

That said, there are many unanswered questions that would need to be answered for me to be on board with that as the sole or even primary explanation for the anecdotal success of those on the protocol. I think there are almost certainly other mechanisms at play, and I doubt things work exactly as proponents of the protocol describe. 

But at the end of the day, what matters is not mechanisms, but practical outcome. And whatever the reason, it works for many! It seems especially popular and effective for hormonal issues and acne, but the preeminent bean spokesperson @uniquehammond cured her severe Crohn’s with it. 

For me, I experienced better digestion and clearer skin, among other benefits (like not having to wear deodorant). On the less-good side, I lost weight I didn't need to lose, had cold hands and feet, and developed some dry patches on my skin. 

(The dry patches [and perhaps weight loss] were probably because I kept fat too low – mostly because their favored fat source, nuts, is a no-go for me.)

I'm continuing to experiment, hoping to find a balance that lets me reclaim the benefits (which I lost after returning to my normal eating pattern) while avoiding the pitfalls. I’ll share any exciting developments, and will eventually dig into the science behind it too. 

For info about what the protocol entails, you can visit alyssaluck.com/the-bean-protocol-for-ibd!
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