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Alyssa Luck

Alyssa Luck

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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.

Table of Contents
What is a vegan diet?
How might a vegan diet help with IBD?
Is there any clinical evidence to support a vegan diet for IBD?
Are there any risks to a vegan diet?
The bottom line
Bonus content! A blast from the past

What is a Vegan Diet?

The term “vegan” refers to any diet that excludes all products of animal origin, including dairy, eggs, and honey. You may also see people use the term “plant-based,” although that one is more ambiguous; some people use it to mean strict vegan, while others use it to mean an omnivorous diet that is mostly based on plants. Of particular note in the context of this website, one group of Japanese researchers has devised a semi-vegetarian diet for the treatment of IBD that they refer to as a “plant-based diet.”

There are a couple of popular sub-classifications of vegan diet as well, including raw vegan (only eats uncooked plant food) and fruitarian (only eats fruit). There may be others I’m unaware of as well. If I had unlimited time, I would do a thorough analysis of raw vegan and fruitarian health claims, but I don’t, and I’m sure the topic has been dealt with extensively elsewhere. For the purposes of this post, suffice it to say that neither of these dietary approaches are supported by science, and both are risky long-term. For a short period of time (on the order of a month or less), they’re probably harmless.

How Might a Vegan Diet Help with IBD?

The commonly cited rationale for going on a vegan diet to treat IBD is that all foods of animal origin are in some way unhealthy, toxic, etc. There’s nuance here that could be explored, but for all practical purposes, that is simply untrue.

However, there’s a lot to recommend a well-designed vegan diet, and the below are some of the likely contributing factors for those who do find relief on such a diet:

  • Improved microbiome health: The average vegan diet will likely be higher in fiber than the average omnivorous diet, including prebiotic fibers that feed beneficial bacteria in the gut. It’s fairly well established that generally, diets high in prebiotic fibers improve the health of the microbiome and increase production of butyrate and other SCFAs, which feed colonocytes and support healthy gut function.
  • Elimination of many food irritants: Although dairy is not an intrinsically unhealthy or toxic food, many people with IBD have difficulty digesting lactose and/or are sensitive to casein or other components of dairy, so removing it from the diet could provide relief. And assuming someone is following a whole-foods-based vegan diet (ie, not eating a bunch of processed junk), they’ve probably also removed many other potential irritants, such as food additives, gums, etc.
  • Improved nutrition: Although a well-designed vegan diet is less nutritionally complete than a well-designed omnivorous diet, switching from a Standard American Diet (or similarly unhealthy diet) to a vegan diet may improve certain aspects of nutritional status, although nutrients found primarily in animal foods may quickly become a concern.
  • Higher concentration of beneficial polyphenols: A fair bit of evidence (review article here) indicates that polyphenols (such as quercetin, resveratrol, caffeic acid, etc) have beneficial effects on health in general, and gut health in the context of IBD specifically.
  • Reduction of protein fermentation in the colon: Animal studies and other preliminary evidence indicates that the byproducts of protein fermentation (such as hydrogen sulfide, which I’ve discussed a bit here) can compromise the structure and function of colonic epithelial cells, lead to thinning of the mucus barrier, and increase intestinal permeability (two review articles here and here). Much of the research thus far on this topic makes it difficult to parse out effects related to availability of fermentable carbohydrates/fiber vs. effects related to availability of protein in the large intestine, but either way, a vegan diet is likely to reduce bacterial fermentation of proteins.

All of these factors will be magnified if someone switches to a vegan diet straight from an extremely processed and nutrient-poor diet, so in those cases especially, it’s not a surprise at all if a vegan diet confers significant health improvements.

However, all of these potential mechanisms can easily be leveraged without eliminating animal products from the diet.

Is There Any Clinical Evidence to Support a Vegan Diet for IBD?

No; I haven’t been able to find any clinical trials that have tested a vegan diet as an intervention for IBD. The mechanisms I mention in the previous section are certainly evidence-based though, and I’ll discuss them in greater detail in future articles.

But again, there’s no evidence (aside from anecdotal) that a strict avoidance of all animal products is more beneficial for IBD patients than a similar diet that contains some nutrient-dense animal products. In fact, the opposite is true – there’s plenty of evidence that including animal products is more beneficial.

For an example of a plant-based (but still omnivorous) diet for IBD that is supported by clinical evidence, check out this post: Semi-Vegetarian/Plant-Based Diet for Ulcerative Colitis.

Are There Any Risks to a Vegan Diet?

Yes. Specifically, the risk of nutrient deficiencies. And when I say “risk” – for the average person, it’s not a matter of “if,” but a matter of “when” (for a vegan diet with no supplements, that is).

An extensive review of why a strict vegan diet is not suitable for most people is outside the scope of this post, but if you’re interested in 19-year-old Alyssa’s take, check out the links at the bottom of this page.

But if you’re committed to a vegan diet, I recommend reading this post from Denise Minger, where she gives advice on how to avoid some of the common pitfalls that strict vegans face. Her own health suffered terribly on a vegan diet, but she’s long since recovered and still feels best eating mostly plants, so she brings an excellent perspective to the topic. Strategies she discusses include supplementation, food preparation methods, and thoughtful incorporation of certain animal foods that may have fewer sustainability and/or ethical concerns.

The Bottom Line

I would not recommend a vegan diet long-term due to the risks associated with nutrient deficiencies. All of the above-mentioned beneficial mechanisms (improved microbiome health, improved nutrient density, elimination of food irritants, high concentration of beneficial phytonutrients, and reduced microbial protein fermentation) can be leveraged in a diet that includes animal foods.

If someone has tried and failed other approaches and/or is particularly drawn to a vegan approach, then it could be worth experimenting with temporarily. But even then, I would urge you to consider whether there are any nutrient-dense animal products you could strategically include in your diet to improve nutritional completeness (bivalves in particular might be worth considering, from nutritional, ethical, and environmental standpoints; Denise Minger discusses this in the article mentioned above).

Bonus Content! A Blast From the Past

Almost a decade ago, back when I first thought it would be nifty to blog regularly, I wrote a series of posts about veganism. My knowledge of health and nutrition has grown tremendously since then, and my overall philosophy of health has evolved considerably, but upon re-reading the posts today (almost a decade later), much of what I had to say back then still rings true. So if you’re interested in 19-year-old Alyssa’s take on veganism – well, here you go!

  • Veg*n is Not a Curse Word
  • Plant-Based Diet or Plant-Based Diet?
  • Are Humans Herbivores?
  • Is it Possible to be Healthy on a Vegan Diet? [Part One]
  • Is it Possible to be Healthy on a Vegan Diet? [Part Two]
  • A word on raw meat, carnivory, and compassion towards animals

Related

Therapeutic Diets for IBD Crohn's disease, fiber, IBD, plant based, ulcerative colitis, vegan

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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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