UC Cohort - The Influence of Diet on Gut Microbiotas

Mayo Clinic6 enrolled

Overview

The purpose of this research is to determine if different diets have different effects on the inflammation in the colon.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

SUPPORTIVE_CARE

Masking

DOUBLE

Enrollment

Conditions

Ulcerative Colitis

Interventions

High Protein and Low Fiber DietDIETARY_SUPPLEMENT

Protein intake will be increased to be \>40% calories from protein, and the fiber intake will remain \<15gm/day.

Low Protein and High Fiber DietDIETARY_SUPPLEMENT

Increase fiber intake up to 40gms of fiber with a requirement to increase at least 15gms above baseline fiber, with 50-75% of total fiber intake from psyllium husk. Subjects will be allowed to slowly increase fiber every two days to reach goal by end of week 1. The total protein will be reduced to \<10% total calories from protein.

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: 1. Adults ≥ 18 years old 2. Ability to give informed consent 3. Diagnosis of ulcerative colitis 4. Moderate UC disease activity defined by a Mayo Score of \>6 with endoscopic score of 2 5. On a baseline diet characterized by: * Fiber intake of \< 15g/day * \> 18% of daily calories from protein Exclusion Criteria: 1. Prior history of gastrointestinal surgeries (except appendectomy and cholecystectomy) 2. Use of tobacco products within the past 6 months (since nicotine may affect intestinal permeability) 3. Use of NSAIDs or aspirin and unable or unwilling to stop taking two weeks prior to permeability test and for the duration of the study 4. Use of osmotic laxatives and unable or unwilling to stop taking one week prior to permeability test and for the duration of the study 5. Use of oral corticosteroids and unable or unwilling to stop use of oral corticosteroids within the previous 2 weeks and for the duration of the study 6. Multiple dietary restrictions or unable/unwilling to alter dietary protein or dietary fiber. 7. Unwilling to stop ingestion of alcohol and artificial sweeteners such as Splenda™ (sucralose), Nutrasweet™ (aspartame), sorbitol, xylitol, lactulose, or mannitol 2 days before and during the permeability testing days, e.g. foods to be avoided are sugarless gums or mints and diet beverages 8. Unwilling to stop stenuous exercise (running \>5 miles or equivalent) one week prior to the permeability tests 9. Bowel preparation for colonoscopy less than one week prior to completion of the first stool kit and permeability test and flexible sigmoidoscopy and upper endoscopy 10. Pregnancy or plan to become pregnant during the study time frame 11. Vulnerable adult 12. Known bleeding disorders or takes medications that increase risk of bleeding from mucosal biopsies 13. Use of oral antibiotic(s) within the past 4 weeks (can be enrolled after 4-week washout period) 14. Use of commercial probiotic formulations and unwilling to stop for the duration of the study 15. Diagnosis of diabetes 16. Any other disease(s), condition(s) or habits(s) that would interfere with completion of study, or in the judgment of the investigator would potentially interfere with compliance to this study or would adversely affect study outcomes

Locations (1)

Mayo Clinic in Rochester

Rochester, Minnesota, United States

Outcomes

Primary Outcomes

Decrease in endoscopic Mayo score for ulcerative colitis inflammation

Measured from unprepped, non-sedated flexible sigmoidoscopy by decrease in Mayo score with a decrease of at least 1 point on the endoscopic subscore or absolute endoscopic subscore of 0-1).

Time frame: 8 weeks

Clinical remission derived from patient reported outcomes

Defined as a Mayo score ≤2 and no sub-scores with a value greater than 1 is a secondary endpoint. This what the patient reports for stool frequency and reporting of any blood in the stool

Time frame: 8 weeks

Secondary Outcomes

Intestinal inflammation determined from blood and stool samples

Measures C-reactive protein from blood samples and fecal calprotectin from stool samples

Time frame: 8 weeks

Urinary excretion of lactulose and 13C-Mannitol

Small Bowel and Colonic Permeability by Urinary Excretion of Lactulose and 13C-Mannitol after Oral Ingestion of lactulose and 13C mannitol (5:1 ratio by mass). The 0-2h urine most closely reflects small intestinal permeability and 8-24h urine reflects colonic permeability. HPLC-tandem mass spectrometry will be used for detection of the sugars. The results will be expressed as the ratio of percentage excretion of the ingested dose of lactulose and mannitol in urine.

Time frame: 8 weeks

Data from ClinicalTrials.gov

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