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Efficacy of the Autoimmune Protocol Diet for Inflammatory Bowel Disease

Konijeti, Gauree G. MD, MPH*,†; Kim, NaMee MD; Lewis, James D. MD, MSCE§; Groven, Shauna BS; Chandrasekaran, Anita MD, MPH*; Grandhe, Sirisha MD*; Diamant, Caroline MD*; Singh, Emily MD*; Oliveira, Glenn BS†,¶; Wang, Xiaoyun MS; Molparia, Bhuvan MS¶,†; Torkamani, Ali PhD¶,†

doi: 10.1097/MIB.0000000000001221
Original Clinical Articles

Introduction: Data suggest dietary modification can improve clinical responses in inflammatory bowel disease (IBD). The goal of this study was to determine the efficacy of an autoimmune protocol diet in patients with Crohn's disease and ulcerative colitis.

Methods: We enrolled adults with active IBD (Harvey–Bradshaw index ≥ 5 or partial Mayo score ≥3 and erosions on endoscopy and/or elevated fecal calprotectin). For the autoimmune protocol, patients underwent 6-week elimination followed by 5-week maintenance phase. Clinical indices, laboratories, and biomarkers were assessed at baseline and weeks 6 and 11. Endoscopy was performed at study completion.

Results: The final cohort included 15 patients with IBD, with mean disease duration 19 years (SD 14.6) and active biological use in 7 (47%) patients. Nutrient repletion was initiated for deficiencies in vitamin D (n = 3) and iron (n = 6). From week 0 to weeks 6 and 11, mean partial Mayo score significantly improved from 5.8 (SD 1.2) to 1.2 (SD 2.0) and 1.0 (SD 2.0) for ulcerative colitis, and mean Harvey–Bradshaw index significantly improved from 7 (SD 1.5) to 3.6 (SD 2.1) and 3.4 (SD 2.6) for Crohn's disease. C-reactive protein did not significantly change during study. Mean fecal calprotectin improved from 471 (SD 562) to 112 (SD 104) at week 11 (P = 0.12). Among those with follow-up endoscopy at week 11 (n = 7), improvements were noted in simple endoscopic score for Crohn's disease (n = 1), Rutgeerts score (n = 1), and Mayo endoscopy subscore (n = 4).

Discussion: Dietary elimination can improve symptoms and endoscopic inflammation in patients with IBD. Randomized controlled trials are warranted.

Article first published online 29 September 2017.

*Division of Gastroenterology, Scripps Clinic, La Jolla, California;

Scripps Translational Science Institute, La Jolla, California;

Division of Cardiology, Scripps Clinic, La Jolla, California;

§Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania;

School of Exercise and Nutritional Sciences, San Diego State University, San Diego, California; and

Department of Integrative Structural and Computational Biology, The Scripps Research Institute, La Jolla, California.

Address correspondence to: Gauree G. Konijeti, MD, MPH, Division of Gastroenterology, Scripps Clinic, 10666 N. Torrey Pines Road, La Jolla, CA 92037 (e-mail: konijeti.gauree@scrippshealth.org).

Research reported in this publication was supported by the Scripps Clinic Medical Group Research & Education Award (G.G.K.) and the NIH/NCATS CTSA Award UL1 TR001114—Scripps Translational Science Institute (G.G.K.). This work is also supported by K24-DK078228 (J.D.L.) and an NIH-NCATS Clinical and Translational Science Award (CTSA; 5 UL1 RR025774) to STSI (A.T.). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

G. G. Konijeti: Previously received honoraria from AbbVie, Janssen, Pfizer, and Takeda. J. D. Lewis: Has received research support from, and previously consulted for, Nestle Health Science. The remaining authors have no conflict of interest to disclose.

This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

Received March 21, 2017

Accepted June 07, 2017

© Crohn's & Colitis Foundation