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Remicade + Plant Based Diet led to high remission in severe UC

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Ulcerative Colitis
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Posted 12/4/2020 3:04 PM (GMT -7)
Research study just published showing that Remicade combined with a Plant Based Diet had incredible outcomes for severe UC. Only one pt needed a colectomy even after follow up. Remission was over 70% with combination of Remicade and diet (plant based here). This is a great alternative to high doses of pred. or colectomy. I don't know what the plant based diet was exactly.

Quoted from the article: hiba M, Tsuji T, Nakane K, et al. High remission rate with infliximab and plant-based diet as first-line (ipf) therapy for severe ulcerative colitis: Single-group trial. Perm J 2020;24:19.166. DOI: https://doi.org/10.7812/TPP/19.166:
Results: Infliximab and PBD as first-line therapy was administered in 17 cases. The remission rate was 76% (13/17), and the colectomy rate was 6% (1/17) in the induction phase. At 1-year follow-up, the cumulative relapse rate was 25%, and there were no additional colectomy cases.

Conclusion: This new first-line therapy for severe UC demonstrated a higher remission rate and lower colectomy rate than with the current modality.

Post Edited (Jane974) : 12/4/2020 3:11:13 PM (GMT-7)

Posted 12/8/2020 11:37 PM (GMT -7)
plantbase diet has very high succesrate much higher than any other medicine...check them there are more. Recently not too much (2-4) but there is some ...we need more studies regerding PBD.
Posted 12/9/2020 2:04 PM (GMT -7)
I would love to live on a plant based diet but it’s hard to digest so many veggies. I eat only fish and chicken as my protein at this point .
Posted 12/9/2020 2:13 PM (GMT -7)
What's the difference between a plant-based diet and a healthy, balanced diet?
Posted 12/9/2020 11:17 PM (GMT -7)

poopydoop said...
What's the difference between a plant-based diet and a healthy, balanced diet?

Good question. A plant based diet is not very different from the recommended mediterranean diet that prevents many chronic diseases. In a plant based diet the emphasis is on veggies, fruits, yogurt, legumes and you only eat meat about once/week and fish once/weekly.

Taken from the study:
8 items considered to be preventive factors for IBD (vegetables, fruits, pulses [beans, soybeans, peas, etc], potatoes, rice, miso soup, green tea, and plain yogurt) contributed to a positive score (PBDS+), whereas 8 items considered to be IBD risk factors (meat, minced or processed meat, cheese/butter/margarine, sweets, soft drinks, alcohol, bread, and fish) contributed to a negative score (PBDS−).
Posted 12/10/2020 5:53 AM (GMT -7)
The funniest part of all these studies do not include the subjects that are/have been on plant-based diets ONLY and compare it with their 'findings'.

I gave up meat a LONG time ago and strictly on a plant-based diet. While it has definitely helped me, along with other interventions, to keep myself in remission. Occasional, small flare-ups are still way too common.
Posted 12/10/2020 8:34 AM (GMT -7)
I notice the study says Remicade AND the diet. How do they know most of the effects weren’t mainly due to remicade? (Caveat — I didn’t read the study - maybe it explains?)

while I agree in theory and am not a big meat eater or breads either, I’d hate to lose cheese and butter! I know sugar is a problem for me so I try to limit it but I do love my sweets.
Posted 12/11/2020 8:46 AM (GMT -7)

countess18 said...
I would love to live on a plant based diet but it’s hard to digest so many veggies. I eat only fish and chicken as my protein at this point .

here is the link you can find here a food list with three stage. (stage 1 is no symtoms an so on)
you have to eat difgerent vegies according to your colitis condition...
Posted 12/11/2020 11:00 AM (GMT -7)

FlowersGal said...
I notice the study says Remicade AND the diet. How do they know most of the effects weren’t mainly due to remicade? (Caveat — I didn’t read the study - maybe it explains?)

Typical remission rates for remicade are 30-40% in clinical trials, and those have ties to pharma companies. Remission rate when you incorporate diet was 75% for severe UC. No biologic has ever shown this much promise, so diet is essential here. They didn't have a control group, but there are many clinical trials on biologics that show way lower remission rates. There is also a large body of research showing that mesalamine remission rates are way, way higher with probiotics, curcumin and other supplements than mesalamine alone.

In Europe and Japan, they are much more willing to study diet in clinical trials and take a more holistic, do less harm approach. In the US, diet does not make any money and biologics are billed at 100K per patient/year or so, so of course there are more studies. Follow the money is relevant here.

For the 20-30% of UCers with very mild inflammation, many researchers outside the US feel that diet should be tried as a first line treatment before trying medications.
Posted 12/11/2020 4:07 PM (GMT -7)
I found this study & it was done in Japan. the patients had severe UC that had not responded to traditional medications. They were started on Remicade & a plant based diet. They started with I think 20 people & ended losing several, this was small scale. Most had improved after the loading doses of Remicade which is typical for it. Since the participants all ate a plant based diet, there really isn't a way to be 100% sure the diet played a roll. Perhaps they should have split it up, half on the diet & the other half not.

At the bottom of their paper it stated; Our study was limited, not a controlled group, sample size small. We hope that other large controlled studies can be done to validate our results. Whether this will get anyone interested or not remains to be seen. Small studies like this are done all the time hoping to attract people with a lot of money & influence.

@ Jane, you really cannot compare the US to Europe or Japan when it comes to their holistic approach. Our culture, lifestyle & way of living are not the same by any stretch.

Diets are a toss up, some people believe in them & some do not because they didn't help them. Diets & supplements are a very lucrative business here.

While biologics are expensive there are millions of people thankful to have them. They enjoy being in remission & living their life, instead of being sick & miserable.
Posted 12/11/2020 4:59 PM (GMT -7)
I'm in Europe and don't find the healthcare particularly holistic. They're a little slower to start with biologics for UC because of the cost - will generally try imuran first - but I've never heard of someone who is flaring being left unmedicated (assuming they have a diagnosis and under care of a gastroenterologist). With very mild cases they will give 5-ASAs on an as-needed basis.
Posted 12/13/2020 2:06 PM (GMT -7)
In clinical trials of mild to moderate UC, 20% of people go into remission without any intervention, even after LT follow up and still have endoscopic remissions. Based on this, 1 in 5 may not need meds and it's reasonable for them to try without meds for a few weeks if they choose and have very mild symptoms or only when they flare. I think many people would prefer using diet modification, probiotics or light supplements over lifetime meds if they can get away with it (key part here).

I had a 12 year period where I rarely needed medications (only once to manage a flare really and some intermittent use for mild symptoms), and managed it entirely with diet and probiotics. This was pretty amazing and way more preferable to side effects I get from medication. I'm so glad I didn't take meds most of those years during that time and was able to try without meds. Some GI docs are fine with people using intermittent meds if flare hx is mild and they don't like side effects. These days i have to combine 5-ASA meds + supplements and diet to stay in remission. I'm happy to do diet modification and if anything it's led to low blood pressure, great cholesterol, no nutritional deficits, inflammatory markers in blood are practically zero and will help reduce risk of cancer and other autoimmune issues.

The only way to think about diet modification is that it helps with long-term health and reducing risk of all chronic disease (plant based diets as well as anti-inflammatory diets such as AID-IBD) as opposed to seeing it as an annoying sacrifice. You also may not have to go as restrictive as 100% SCD.

Post Edited (Jane974) : 12/13/2020 2:18:51 PM (GMT-7)

Posted 12/13/2020 3:00 PM (GMT -7)
Honesty I would never say it’s a nuisance to try a diet, but Some of the diets are hard because of the high fiber. I cannot eat oats and that’s a big staple in the IBD diet. Also other diets include loads of veggies which I would love to live on, but if I eat too many it hurts. On the other hand, I could live on rice and white flour and body loves it. I hate this because I’d rather eat lots of fruit and veggies and higher fiber type grains. So I doubt eating all plants can help everyone . In fact I upped my veggie intake considerably last year and then flared. It’s awful.
Posted 12/13/2020 4:43 PM (GMT -7)
Yeah, some people cannot tolerate fiber and many veggies. During a flare, it makes sense to reduce fiber, as needed, depending on the flare. Some people benefit from fiber during a flare to bulk up stool and reduce constipation (some inflammation presents this way).

My experience is that you have to add fiber/veggies in slow stages and start with peeled, well cooked and even pureed. Soups really help in the beginning with squash and carrots. You can follow the staging in the IBD-AID diet (phase 1-4). You have to start with very easily digestible veggies and often peeled/overcooked like green beans and squash, and then progress from there. You can check out the IBD-AID diet stages if that helps. There is enough data showing that fiber, fruits and veggies reduce inflammation long-term so if you haven't tried it already, it's worth a shot outside of a flare.

I've also often seen posts on this forum (not yours countess) with people eating a ton of kale and berries and then stating that they can't tolerate it. Kale/cabbage family would be very advanced and most cannot tolerate it without a solid remission.
Posted 12/13/2020 5:13 PM (GMT -7)
I could not tolerate veggies or legumes for years because of the fibre, it was only after I'd been in remission for over a year that I could finally eat whatever I want.
Now that I'm in remission I hope that my dietary choices are helping, but I never could have got out of my flare using diet (I tried and I remember the abdominal pain and emotional exhaustion of doing so). Some people need medication and no shame in that.
Posted 12/14/2020 12:13 AM (GMT -7)
Definitely no shame in using meds or in trying other options before meds smile
Posted 12/14/2020 3:56 AM (GMT -7)
I still believe that diet solves only food intolerance part of the equation. The inflammation part stays intact.

Regarding clinical studies about diets and UC there is no clear "signal". Yes, they claim that microbiome plays important role in the pathogenesis of UC. And yes, the microbiome can be altered with a diet. But we do not know whether the altered microbiome is cause or consequence of UC. Many of these studies have their limitations. They are usually very small and without a placebo group.

People report success with totally opposite diets:

1. vegan X carnivores
2. low carb X high carbs
3. low fibre X high fibre

Personally, I follow this diet approach:

1. fresh food
2. minimally processed
3. as diverse as possible

A. avoid generally unhealthy food
B. avoid artificial additives
C. avoid food I do not tolerate

For me, it does not make sense to exclude big food categories like carbs or meat.
Our bodies are adapted to it pretty well. For example, our ancestors ate meat and wild wheat already 30 000 years ago. The human body is able to adapt to a new food category within a few thousand years. For example, we probably acquired cow milk tolerance during a period of 3000 years.

Regarding additives, I think that majority of them are safe. But we do not have long term studies about their safety. Maybe it is OK to ingest some additive for 1 or 2 years. But nobody knows what it will do to our bodies after 10 years. I do not want to risk it.

For me, it really does not make sense to consume food I do not tolerate. This food can be super healthy but if I do not tolerate it - I exclude it or lower amount.
Posted 12/20/2020 6:38 PM (GMT -7)

Oligodar said...
I still believe that diet solves only food intolerance part of the equation. The inflammation part stays intact.

Regarding clinical studies about diets and UC there is no clear "signal". Yes, they claim that microbiome plays important role in the pathogenesis of UC. And yes, the microbiome can be altered with a diet. But we do not know whether the altered microbiome is cause or consequence of UC. Many of these studies have their limitations. They are usually very small and without a placebo group.

People report success with totally opposite diets:

1. vegan X carnivores
2. low carb X high carbs
3. low fibre X high fibre

Personally, I follow this diet approach:

1. fresh food
2. minimally processed
3. as diverse as possible

A. avoid generally unhealthy food
B. avoid artificial additives
C. avoid food I do not tolerate

For me, it does not make sense to exclude big food categories like carbs or meat.
Our bodies are adapted to it pretty well. For example, our ancestors ate meat and wild wheat already 30 000 years ago. The human body is able to adapt to a new food category within a few thousand years. For example, we probably acquired cow milk tolerance during a period of 3000 years.

Regarding additives, I think that majority of them are safe. But we do not have long term studies about their safety. Maybe it is OK to ingest some additive for 1 or 2 years. But nobody knows what it will do to our bodies after 10 years. I do not want to risk it.

For me, it really does not make sense to consume food I do not tolerate. This food can be super healthy but if I do not tolerate it - I exclude it or lower amount.

high carb diet? i did not hear about it and socces because of it.
however i heard many succes with high fibre diet. Ok not the first but i think we have to change gradually, firstly you have to eat carefully. When you have symtoms you dont have to eat very irritatable fruit and vegetables .
Eat bananas and so on.

othervise you are right. there are few study regarding the plant based diet. But these succesrate are very very promising.
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