Ulcerative Colitis TreatmentIntroduction:
Resveratrol is a plant compound similar to flavonoids. It is found in the low levels of the skin of red grapes, red wine, cocoa powder, baking chocolate, dark chocolate, peanuts and mulberry skin. Red wine is perhaps the most recognized source of resveratrol, however, red wine contains only one milligram per glass. Most resveratrol supplements use Japanese knotweed (Polygonum cuspidatum) as the source.

There has been a great deal of hype regarding resveratrol as a dietary supplement and recent human clinical studies are showing tremendous promise in a variety of applications. A study published in the May issue of the Archives of Medical Research indicates that it can help patients with ulcerative colitis.

Background Data:
Inflammatory bowel disease (IBD) is a general term for a group of chronic inflammatory disorders of the intestines. It is divided into two major categories: Crohn’s disease (CD) and ulcerative colitis (UC). Clinically, IBD is characterized by recurrent inflammation of specific intestinal segments resulting in diverse symptoms. In the United States, about 1.4 million people have IBD with the number equally split between CD and UC. IBD may occur at any age, but it most often occurs between the ages of 15 and 35 years. Females are affected slightly more frequently than males. Caucasians have the disease two to five times more often than African or Asian Americans, and those with a Jewish heritage have a three-fold to six-fold higher incidence than non Jewish people.

One of the thoughts is that UC develops by a defect in the regulation of the immune response to intestinal flora in genetically susceptible individuals. Of course, the gut flora and intestinal environment is greatly influenced by dietary factors including low-fiber intake, reduced intake of dietary anti-inflammatory compounds such as flavonoids and omega-3 fatty acids, and increased intake of refined carbohydrates. Several studies that analyzed the pre-illness diet of patients with IBD have found that they habitually ate more refined sugar, chemically modified fats, processed and fast foods, and meat, while consuming less raw fruit, vegetables, omega-3 fatty acids and dietary fiber than healthy people.

The main drug approach in UC is the use of anti-inflammatory agents, corticosteroids like Prednisone, immune system modulators and antibiotics. These drugs are only palliative and offer no real path to complete resolution.

Resveratrol exerts a wide range of anti-inflammatory effects indicating a possible benefit in UC. In animal models of UC, resveratrol improved the disease activity index and decreased oxidative stress and inflammatory biomarkers.

New Data:
In a study sponsored by the National Nutrition and Food Technology of Iran, researchers sought to evaluate the effects of supplementation with resveratrol on inflammation and quality of life in patients with active UC in a double-blind, placebo-controlled format. The 50 eligible patients with active mild to moderate UC were given either 500 mg of resveratrol or a placebo capsule for 6 weeks. Serum inflammatory markers and quality of life assessments were conducted at baseline and at the end of the study.

Results showed that resveratrol supplementation led to a significant reduction in plasma levels of key inflammatory markers. Specifically, in the resveratrol group, the level of tumor necrosis factor-alpha (TNF-α), highly sensitive C-reactive protein (hs-CRP) and nuclear factor kappa-B (NF-κB) all showed statistically significant reductions. In contrast, no change was seen in the placebo group. Clinical evaluation also indicated a significant drop in the Clinical Colitis Activity Index Score decreased significantly in the resveratrol group, when compared with the placebo group.

The researchers concluded, “6 weeks supplementation with 500 mg resveratrol can improve quality of life and disease clinical colitis activity at least partially through inflammation reduction in patients with UC.”

Commentary:
Based upon the use of resveratrol for other applications, I question if a higher dosage (e.g., 500 mg two to three times daily) might have brought about even better results.

In addition to general measures to improve inflammatory bowel disease (IBD), I think the first step is an allergy elimination diet to address possible food allergies. In regards to nutritional supplementation, a broad-based nutritional supplementation plan is necessary for all patients with IBD. Particularly important are the nutrients zinc, folic acid, vitamin B12, magnesium, vitamin A, and vitamin D. Nutritional supplements are used as appropriate to correct deficiencies, normalize the inflammatory process, and promote healing of the damaged mucosa. Botanical medicines, including flavonoid-rich extracts or resveratrol, can be used to promote healing and normalize the intestinal flora.

Here are the key supplements that I recommend for IBD:
• High potency multivitamin and mineral supplement.
• Zinc picolinate: 15 mg/day in addition to the 15 to 30 mg in a high potency multiple
• Vitamin C: 500 to 1,000 mg daily
• Vitamin D: 2,000 to 5,000 IU daily
• Fish oil: 3,000 mg EPA+DHA daily
• Choose one of the following:
o Grape seed extract (>95% procyanidolic oligomers): 150 to 300 mg daily (or 1-2 mg per kg [2.2 pounds] body weight)
o Pine bark extract (>90% procyanidolic oligomers): 150 to 300 mg daily (or 1-2 mg per kg [2.2 pounds] body weight)
o Green tea extract (>90 polyphenol content): 300 to 450 mg daily
o Resveratrol: 500 mg two to three times daily.
• Probiotic supplement (providing various Lactobacillus and Bifidobacter sp.): minimum of 5 to 12 billion colony forming units daily
• Prebiotics (PGX®, inulin, fructose oligosaccharides, etc.): 5 g per day

Reference:
Samsami-Kor M, Daryani NE, Asl PR, Hekmatdoost A. Anti-Inflammatory Effects of Resveratrol in Patients with Ulcerative Colitis: A Randomized, Double-Blind, Placebo-controlled Pilot Study. Arch Med Res. 2015 May;46(4):280-5.

Dr. Michael Murray
11/10/15

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