Updated on February 2, 2023
- Patients with autoimmune digestive disorders often struggle to find adequate symptom relief using pharmaceutical therapies and are increasingly seeking out dietary interventions for better results.
- Recent research suggests that the Autoimmune Protocol Diet is a particularly promising management strategy.
- Nutritional supplements, such as butyric acid and curcumin, can be used in concert with elimination diets like the Autoimmune Protocol Diet or as standalone therapies to help patients achieve symptom relief.
When it comes to addressing 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 adverse functional consequences. Common pharmacological therapies include anti-inflammatory drugs, immunosuppressants, and steroids, all of which work by dampening the immune response. Unfortunately, the reported patient response rates to these therapies are less than optimal. Additionally, many standard therapies are associated with debilitating side-effects that compromise quality of life. As a result of the shortcomings of pharmacological therapy, many researchers, clinicians, and patients are turning to dietary interventions to find more satisfactory 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 targeted supplementation, can be an effective approach for dealing with autoimmune digestive disorders.
Evidence that the Autoimmune Protocol Diet Is Effective for Patients with Autoimmune Digestive Disorders
In 2017, 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 Autoimmune Protocol Diet as a possible therapy for patients with Crohn’s disease and ulcerative colitis. Although earlier research had implicated diet in the pathogenesis of IBD and served as the impetus for the study, relatively few studies on nutritional interventions had 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 believed to trigger intestinal inflammation and/or symptoms of food intolerance. Essentially, it is an extension of the Paleolithic diet, adding several 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 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 six weeks, the patients were coached to gradually eliminate from their diet dairy, eggs, grains, legumes, nightshades, nuts and seeds, coffee, alcohol, refined and processed sugars, oils, and food additives. 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 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 6-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 better 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 the Autoimmune Protocol Diet can be equally effective for addressing both autoimmune digestive disorders.
Of course, it is important to recognize these findings are only preliminary. An open-label, uncontrolled study like this serves only as a basis for future randomized, controlled trials. However, it does offer an option for patients considering dietary interventions, and it offers another piece of strong evidence that diet does play a role in the pathology of autoimmune digestive disorders.
Nutritional Supplements as a Dietary Intervention for Gastrointestinal Autoimmune Disorders
From a broad perspective, the findings of this study suggest that dietary interventions that target the immune system might help patients with Crohn’s disease and ulcerative colitis achieve remission. Therefore, alongside elimination diets like the Autoimmune Protocol Diet, patients might also want to consider nutritional supplements that help maintain a normal inflammatory response 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 down-regulating the inflammatory response under conditions when an immune response is unwarranted. Curcumin also plays an important role in immune system regulation and supports the body’s natural inflammatory response, 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 beneficial effects as the Autoimmune Protocol Diet because they have the same essential goal: targeting dysfunction in the immune system.
Another issue 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 deficient in vitamin D and iron at the start of the study—and without an effective nutritional repletion strategy, these problems are likely to 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 are associated with positive outcomes in patients with inflammatory bowel disorders. Therefore, for patients who are choosing nutritional supplements to address nutritional deficiencies and/or address 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 Autoimmune Digestive Disorders
Overall, a universally effective therapy for autoimmune digestive disorders remains elusive. However, based on the latest research, it is clear that elimination diets like the Autoimmune Protocol Diet offer a promising alternative to traditional pharmacological options. Although more randomized, controlled trials are needed to verify the efficacy of these alternatives, some physicians and patients today are already considering them as possible therapeutic options. At the same time, while elimination diets may be useful, nutritional supplements designed to support gastrointestinal health, such as those from Tesseract Medical Research, can be a less overwhelming option for some individuals and therefore more attractive. As such, they can either replace or complement an elimination diet depending on the response of the patient. Patients and physicians should work closely to find the optimal therapy to meet individual needs.
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Works Cited
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Konijeti GG, Kim NM, Lewis JD, et al. 2017. Inflammatory Bowel Diseases. 23(11):2054-60.
Lewis JD, Abreu MT. 2017. Gastroenterology. 152(2):398-414.
Reich KM, Fedorak RN, Madsen K, Kroeker KI. 2014. World Journal of Gastroenterology. 20(17):4934-47.
Rios-Covian D, Ruas-Madiedo P, Margolles A, et al. Frontiers in Microbiology. 7:185.
