Introduction:
Ulcerative colitis is a type of inflammatory bowel disease that affects the large intestine (the colon) and the rectum. This disease causes inflammation of the colon’s inner lining and the rectal wall, which becomes red, swollen, and ulcerated. Symptoms of ulcerative colitis include cramping, abdominal pain, and diarrhea. Conventional treatment for ulcerative colitis includes anti-inflammatory drugs (including immune system suppressors), antibiotics, anti-diarrheals, and pain relievers. Options for treatment of ulcerative colitis may also include the use of various natural treatments with evidence of benefit. Ulcerative colitis has been known in research to improve with natural treatments including the anti-inflammatory ulcerative colitis diet, probiotics, resveratrol, Andrographis, and turmeric.
Probiotic Treatment for Ulcerative Colitis:
Lactic acid bacteria, balsalazide, and melsalazine for ulcerative colitis: In individuals with mild to moderate ulcerative colitis (UC), inflammation that affects the large intestine and rectum, balsalazide plus VSL#3 (a probiotic treatment with 8 strains of live, freeze dried, high-concentration, lactic acid bacteria available over the counter) was found to be an effective treatment for UC. For 8 weeks, 90 patients received either balsalazide (2.25 g/day) plus 3 g/day VLS#3 (group A, n=30) or balsalazide alone (group B, n=30) or mesalazine (group C, n=30). At the end of the study, remission rates were 80%, 77%, and 53.3% for balsalazide/VSL#3, balsalazide alone, and melsalazine, respectively. The balsalazide/VSL#3 combination was also faster in obtaining remission (4 days) than either of the other two treatments (7.5 and 13 days in groups B and C, respectively). In terms of safety, balsalazide with or without VSL#3 was better tolerated than mesalazine. (1)
Lactic acid bacteria and ulcerative colitis: A study of 32 individuals with mild to moderate ulcerative colitis (UC) unresponsive to conventional medication were given VSL#3. VSL#3 is a (a probiotic treatment with 8 strains of live, freeze dried, high-concentration, lactic acid bacteria. The probiotic contained 3,600 billion bacteria and was given twice per day. VSL#3 was found to be associated with improved remission and response rates. After 6 weeks of daily of VSL#3, remission was reported in 53% (n = 18) of patients; response in 24% (n = 8); no response in 9% (n = 3); and worsening in 9% (n = 3). Two patients did not complete the study. No side effects were reported. (2)
Bifidobacteria and ulcerative colitis: Treatment with bifidobacteria (a probiotic)-fermented milk product was shown to be more effective than standard treatment alone in patients with ulcerative colitis (UC), a type of inflammatory bowel disease. Participants (n=21) with mild to moderate UC randomly received wither 100 mL/day of bifidobacteria-fermented milk or placebo for 12 weeks with standard treatment. While improvement reported in both groups were significant, participants on bifidobacteria treatment had significantly lower clinical activity index compared to placebo. Endoscopic activity index and histological score (used to test severity) were significantly reduced in the treatment group, but not the placebo group. No side-effects were reported. (3)
Bilberry Supplement for Ulcerative Colitis:
In addition to an ulcerative colitis diet, probiotics, resveratrol, Andrographis, and turmeric, patients may benefit from anthocyanin rich fruit intake. Individuals suffering from mild to moderate ulcerative colitis (UC, ulcers in the lining of the rectum and colon) may benefit from anthocyanin-rich bilberry supplementation. After 6 weeks of patients (n=13) taking a daily anthocyanin-rich bilberry preparation, 63.4% and 90.9% of patients reported remission and showed a response, respectively. The Mayo score, which is used to assess UC activity such as stool frequency, rectal bleeding etc), also improved. Additionally, fecal calprotectin levels, which become elevated with UC, significantly decreased by an average of 473 μg/g from the start of the study to the end of treatment. The study was done on a small number of patients. The response of the UC to the bilberry supplement was measurable by fecal calprotectin levels. No serious side-effects were reported. The study did not report the amount of bilberry ingestion. (4)
Andrographis paniculata for Ulcerative Colitis:
An herbal extract of Andrographis paniculata, (HPML-004) at a dose of 1200 mg/day may be an effective alternative treatment to the drug mesalazine (4500 mg/day). A study included patients with mild-to-moderate active ulcerative colitis (UC), a form of inflammatory bowel disease that causes ulcers in the lining of the rectum and colon. At the end of an 8-week study, 21% of HPML-004 treated participants had clinical remission of UC and 76% had a clinical response. Corresponding values in the mesalazine group were 16% and 82%, respectively. Colonoscopy results showed a 28% remission and 74% response rate for HMPL-004, compared to 24% and 71% for the mesalamine group. No significant difference was reported between the two groups. (5)
Curcumin for Ulcerative Colitis:
A randomized, double blind placebo controlled trial was conducted to test the effectiveness of curcumin, a spice also known as turmeric, as a treatment for patients with quiescent ulcerative colitis (UC), a type of chronic, recurring inflammatory bowel disease. In this 6-month study, patients with UC received either curcumin (n=45), 1 gram after breakfast and 1 gram after the evening meal, plus sulfasalazine or mesalamine, or placebo (n=44) plus sulfasalazine or mesalamine. Results were significantly different between treatment and placebo groups. Of 43 patients who received curcumin, 2 relapsed during the 6 months of treatment (4.65%), while 8 of 39 patients (20.51%) receiving placebo relapsed. (6)
Resveratrol Supplementation for Ulcerative Colitis
Samsamikor M et al studied 56 subjects with mild to moderate ulcerative colitis. The authors randomized the group to either resveratrol at a dose of 500 mg by mouth daily, or placebo then used a standard inflammatory disease questionaire to assess the response. The resveratrol group showed a reduction in the oxidative stress, lowered the disease activity and improved the quality of life in ulcerative colitis patients (7).
Summary: Ulcerative Colitis Diet, Probiotics, Resveratrol, Andrographis, and Turmeric
- Tursi A et al found that balsalazide plus VSL#3 (a probiotic treatment with 8 strains of live, freeze dried, high-concentration, lactic acid bacteria available over the counter) was given to 90 patients for 8 weeks. The patients received balsalazide (2.25 g/day) plus 3 g/day VLS#3 (group A, n=30) or balsalazide alone (group B, n=30) or mesalazine (group C, n=30). Remission rates were 80%, 77%, and 53.3% for balsalazide/VSL#3, balsalazide alone, and melsalazine, respectively. Also, balsalazide was better tolerated than melsalazine in the study. (1)
- Bibiloni R et al performed a study of 32 individuals with mild to moderate ulcerative colitis (UC) who did not respond to other conventional therapy. After 6 weeks of daily VSL#3 (containing 3,600 billion bacteria twice a day), 53% achieved remission (n = 18) of patients; response in 24% (n = 8); no response in 9% (n = 3); worsening in 9% (n = 3). Two patients did not complete the study. No side effects were reported. (2)
- 100 mL/day of bifidobacteria-fermented milk or placebo for 12 weeks with standard treatment had significantly lower clinical activity index compared to placebo. Endoscopic activity index and histological score were significantly reduced in the treatment group, but not the placebo group. No side-effects were reported. (3)
- After 6 weeks, 13 patients taking a daily anthocyanin-rich bilberry preparation, 63.4% and 90.9% of patients reported remission of ulcerative colitis and showed a response, respectively. Response was measurable by fecal calprotectin levels. No serious side-effects were reported. However, the study did not report the amount of bilberry product ingested. (4)
- Andrographis paniculata extract in the form of (HPML-004) at a dose of 1200 mg/day resulted in 21% remission and 76% had clinical response after 8 weeks. Corresponding values in the mesalazine group were 16% and 82%, respectively. (5) Confirmatory studies are needed. Please the section on Andrographis paniculata (AP), AP is well tolerated but has been found to produce several adverse reactions and interactions.
- Samsamikor M et al found that Resveratrol supplementation at a dose of 500 mg by mouth daily reduced the oxidative stress, lowered the disease activity and improved the quality of life in ulcerative colitis patients (7).
References: Ulcerative Colitis Diet, Probiotics, Resveratrol, Andrographis, and Turmeric
1.Tursi A, Brandimarte G, Giorgetti GM, et al. Low-dose balsalazide plus a high-potency probiotic preparation is more effective than balsalazide alone or mesalazine in the treatment of acute mild-to-moderate ulcerative colitis. Med Sci Monit. 2004 Nov;10(11):PI126-31. http://www.ncbi.nlm.nih.gov/pubmed/15507864?dopt=Abstract
2.Bibiloni R, Fedorak RN, Tannock GW, Madsen KL, Gionchetti P, Campieri M, De Simone C, Sartor RB. VSL#3 probiotic-mixture induces remission in patients with active ulcerative colitis. Am J Gastroenterol. 2005 Jul;100(7):1539-46. http://www.ncbi.nlm.nih.gov/pubmed/15984978
3.Kato K, Mizuno S, Umesaki Y, et al. Randomized placebo-controlled trial assessing the effect of bifidobacteria-fermented milk on active ulcerative colitis. Aliment Pharmacol Ther. 2004;20:1133-1141. http://www.ncbi.nlm.nih.gov/pubmed/15569116
4.Biedermann L, Mwinyi J, Scharl M, et al. Bilberry ingestion improves disease activity in mild to moderate ulcerative colitis – an open pilot study. J Crohns Colitis. 2013 May;7(4):271-9. http://www.ncbi.nlm.nih.gov/pubmed/22883440
5.Tang T., Targan S.R., Li Z.-S., Xu C., Byers V.S., Sandborn W.J, Randomised clinical trial: Herbal extract HMPL-004 in active ulcerative colitis – A double-blind comparison with sustained release mesalazine. Alimentary Pharmacology and Therapeutics 2011 33:2(194-202). https://www.ncbi.nlm.nih.gov/pubmed/21114791
6.Hanai et al. Curcumin maintenance therapy for ulcerative colitis: randomized, multi-center, double-blind, placebo-controlled trial. Clin Gastroenterol Hepatol. 2006 Dec;4(12):1502-6. http://www.cghjournal.org/article/S1542-3565(06)00800-7/abstract
7.Samsamikor M, Daryani NE, Asl PR, Hekmatdoost A. Resveratrol Supplementation and Oxidative/Anti-Oxidative Status in Patients with Ulcerative Colitis: A Randomized, Double-Blind, Placebo-controlled Pilot Study. Arch Med Res. 2016 May;47(4):304-9. https://www.ncbi.nlm.nih.gov/pubmed/27664491
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