Colitis Crohn's Gastrointestinal

The Future of Treatment for Autoimmune Digestive Disorders: Considering the Autoimmune Protocol Diet

autoimmune digestive disorder

When it comes to treating autoimmune digestive disorders, finding an effective solution can be a major challenge. In patients with these disorders—which include inflammatory bowel diseases like Crohn’s disease and ulcerative colitis—the immune system attacks healthy cells in the gastrointestinal tract, which can have a wide range of functional consequences. Common pharmacological therapies include anti-inflammatory drugs, immunosuppressants, and steroids, all of which work by dampening the immune response. However, the reported patient response rates to these treatments are suboptimal. Additionally, many standard therapies are associated with debilitating side-effects that compromise quality of life. As a result of the shortcomings of pharmacological treatment, many researchers, clinicians, and patients turn to dietary interventions in the hope of finding more complete symptom relief while avoiding unwanted side-effects.

One emerging possibility for patients with inflammatory bowel disease is the Autoimmune Protocol Diet. According to a recently published prospective study, this diet has the potential to help patients with Crohn’s disease and ulcerative colitis achieve remission. More broadly, the researchers’ findings indicate that nutritional intervention, including supplementation, can be an effective approach for treating autoimmune digestive disorders.

Evidence that the Autoimmune Protocol Diet Can Work for Patients with Autoimmune Digestive Disorders

In November 2017, a group of researchers from the Division of Gastroenterology at the Scripps Research Institute in La Jolla, California, published a study in the journal Inflammatory Bowel Diseases on the possibility of the Autoimmune Protocol Diet as a treatment for patients with Crohn’s disease and ulcerative colitis. Earlier research had implicated diet in the pathogenesis of IBD and served as the impetus for the study, but relatively few studies on the use of nutritional interventions have been conducted. The researchers set out to address the gap in the literature by conducting a prospective study on one of the diets they considered to be the most promising: the Autoimmune Protocol Diet. This diet specifically restricts consumption of foods that are believed to trigger intestinal inflammation and/or symptoms of food intolerance. Essentially, it is an extension of the Paleolithic diet, adding on some additional food restrictions that had previously been associated with IBD symptom alleviation, including avoidances of gluten and refined sugar. Due to the comprehensive, combinatorial nature of the diet, the researchers hypothesized that it could potentially promote remission in patients with autoimmune digestive disorders.

For their open-labeled, uncontrolled pilot study, the researchers recruited 15 adults (9 with active Crohn’s disease, 6 with active ulcerative colitis) to participate in an 11-week program, which included a 6-week staged elimination phase and a 5-week maintenance phase. Over the course of the first 6 weeks, the patients were coached to gradually eliminate dairy, eggs, grains, legumes, nightshades, nuts and seeds, coffee, alcohol, refined and processed sugars, oils, and food additives from their diets. Then, during the 5-week maintenance phase, they were instructed not to reintroduce any of these food groups. They were also instructed to avoid non-steroidal anti-inflammatory drugs and other medications as part of the Autoimmune Protocol Diet. At the same time, they were instructed to consume fresh, nutrient-dense foods, bone broth, and fermented foods.

Office visits were conducted at baseline, at week 6, and at week 11. The primary outcome that the researchers measured was the achievement of clinical remission, as determined by scores on the established Harvey-Bradshaw Index for active IBD. In addition, the subjects underwent endoscopy, radiology, and biomarker assessment to evaluate the extent of mucosal healing. By the six-week mark, 11 of the 15 patients in the study had achieved remission, which continued throughout the 5-week maintenance period. The researchers also noticed statistically significant improvements in scores on the Harvey-Bradshaw Index among all patients, as well as statistically significant improvements on indices measuring damage to gastrointestinal mucosa. Notably, there was no statistically significant difference in the outcomes of patients with Crohn’s disease and those with ulcerative colitis, which suggests that the Autoimmune Protocol Diet could be equally effective for the treatment of both autoimmune digestive disorders.

Of course, it is important to recognize that these findings are only preliminary. An open-label, uncontrolled study like this serves only as a basis for randomized, controlled trials in the future. However, it does offer an option for patients who are considering dietary interventions, and it also offers another piece of strong evidence that diet plays a role in the pathology of autoimmune digestive disorders.

Nutritional Supplements as Dietary Interventions for Gastrointestinal Autoimmune Disorders

From a broad perspective, the findings of this study suggest that dietary interventions targeting the immune system may help patients with Crohn’s disease and ulcerative colitis achieve remission. Therefore, alongside elimination diets like the Autoimmune Protocol Diet, patients may also want to consider nutritional supplements that combat inflammation in the gut, which could have similar functional effects. For instance, butyric acid induces T regulatory cell differentiation in the gut, and these cells are essential for suppressing the inflammatory response under conditions when an immune response is unwarranted. Curcumin also plays an important role in immune system regulation and has well-demonstrated anti-inflammatory and antioxidant activities, such as the modulation of transcription factors that regulate the production of key proteins involved in the immune response. Adding supplements like these could have similar effects as the Autoimmune Protocol Diet because they have the same essential goal: targeting dysfunction in the immune system.

Another issue that the researchers at Scripps highlighted in their study was the potential for nutrient deficiency in patients with Crohn’s disease and ulcerative colitis. They found that several of the patients were already deficient in vitamin D and iron at the start of the study—and without an effective nutritional repletion strategy, these problems may only be exacerbated by a highly restrictive diet like the Autoimmune Protocol Diet. This can be a serious problem not only because of the general importance of these nutrients for body functioning, but also because nutrients like vitamin D have been associated with symptom reduction and improved outcomes in patients with inflammatory bowel disorders. Therefore, for patients who are choosing dietary supplements to address nutritional deficiencies and/or treat symptoms related to autoimmune digestive disorders, choosing a supplement with high bioavailability is essential. This will ensure optimal absorption of the supplement in the gut and maximize its effectiveness.

Future Approaches to Treating Autoimmune Digestive Disorders

Overall, a universally effective treatment for autoimmune digestive disorders remains elusive. However, based on the latest research, it is clear that elimination diets like the Autoimmune Protocol Diet offers a promising alternative to traditional pharmacological options. While more randomized, controlled trials are needed to verify the efficacy of these alternatives, some physicians and patients today are already considering them as possible treatment options. At the same time, while elimination diets may be useful, supplements may be a less overwhelming option for some and therefore more attractive. As such, they may either replace or complement elimination diets depending on the response of the patient. Patients and physicians can work closely to find the optimal treatment to meet individual needs.

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Works Cited

Gautam SC, Gao X, Dulcavsky S. 2007. Immunomodulation by curcumin. Advances in Experimental Medicine and Biology. 595:321-41.

Konijeti GG, Kim NM, Lewis JD, Groven S, Chandrasekaran A et al. 2017. Efficacy of the Autoimmune Protocol Diet for inflammatory bowel disease. Inflammatory Bowel Diseases. 23(11):2054-60.

Lewis JD, Abreu MT. 2017. Diet as a trigger or therapy for inflammatory bowel diseases. Gastroenterology. 152(2):398-414.

Reich KM, Fedorak RN, Madsen K, Kroeker KI. 2014. Vitamin D improves inflammatory bowel disease outcomes: Basic science and clinical review. World Journal of Gastroenterology. 20(17):4934-47.

Rios-Covian D, Ruas-Madiedo P, Margolles A, Guiemonde M, Reyes-Gavilan CG, et al. Intestinal short chain fatty acids and their link with diet and human health. Frontiers in Microbiology. 7:185.

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