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Gut 53:1399-1401 doi:10.1136/gut.2003.035287
  • Commentary

Diet and relapsing ulcerative colitis: take off the meat?

  1. H Tilg1,
  2. A Kaser2
  1. 1Department of Medicine, Division of Gastroenterology and Hepatology, University Hospital Innsbruck, Innsbruck, Austria
  2. 2Brigham and Women’s Hospital, Department of Gastroenterology, Harvard Medical School, Boston, MA, USA
  1. Correspondence to:
    Dr H Tilg
    Department of Medicine, Division of Gastroenterology and Hepatology, University Hospital Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria; Herbert.Tilguibk.ac.at

    Dietary factors such as red meat, high protein intake, and alcohol are associated with relapse in ulcerative colitis, probably mediated via hydrogen sulphide production.

    Major advances in the understanding of the aetiopathogenesis and genetics of inflammatory bowel disease (IBD) have been accompanied by an increase in the therapeutic armamentarium, including immunosuppressants and anticytokine drugs. Whereas patients are in many cases highly motivated to use prescribed drugs in those chronic disorders, they would be even more willing to change lifestyle and dietary habits so they could actively influence the course of their disease. Therefore, one of the most common questions physicians treating patients with IBD are asked is whether changing diet could positively affect the course of their disease. So far, and this has been especially true for patients with ulcerative colitis (UC), our answer had been “we do not know and there are no special recommendations”.

    This may now change as Jowett and colleagues1 in this issue of Gut present interesting and clinically novel data studying the role of dietary factors on the clinical course of UC (see page 1479). In this prospective cohort study, they investigated the effects of habitual diet on relapses of disease. Impressively, 96% of patients (n = 191) completed the study. Dietary factors such as red and processed meat, protein, and alcohol, as well as sulphur and sulphate intake were positively associated with relapses. Even though dietary factors in this study were less important than measures of prior disease activity in determining the risk of relapse,2 clinically this information is extremely valuable as it may open the perspective of lifestyle modification in the treatment of UC. As discussed in detail by the authors, these effects may be related to sulphur and sulphate contents of food. Most importantly, to continue to prove this important …