Recent research suggests that habitual dietary may play an important part in the treatment of inflammatory bowel disease (IBD), but this has not been systematically explored. Habitual intake of a diet that is rich in "anti-inflammatory" nutrients (e.g. n-3 fatty acids, polyphenols), soluble fiber and other prebiotics (e.g. inulin), and probiotics (that improve gut microbiota) may lead to major improvements in IBD disease. Ultimately, the investigators are interested in studying the extent to which habitually eating foods, sources of these important nutrients and dietary components, might help people with IBD living in Alberta. Thus, the information about nutrients and dietary components must be translated to foods and dietary patterns that are acceptable and accessible to people in Alberta. This study will compare the effectiveness of 2 different approaches, either a structured, personalized menu plan constructed with a dietitian (intervention group) vs. general advice to follow Canada's Food Guide by a dietitian (control group), to promoting uptake and adherence to an appropriate diet. The control group will receive the same care as the intervention group as far as access to a registered dietitian. In the intervention group, the nutritional advice offered will be to follow a structured four-week menu plan that includes recipes and nutrition tips. The menu plan emphasizes specific foods that have been shown in the literature to improve IBD symptoms. In the control group, the nutritional advice will be general and will emphasize the principles outlined in Canada's Food Guide. Each control participant will be provided with their daily serving size allowance for each of the four food groups. Each participant will have sole responsibility in deciding which foods are selected from each food group; specific foods will not be highlighted.
Objectives: To evaluate if the proposed Alberta anti-inflammatory diet is effective for the prevention of relapses in ulcerative colitis as well as to determine their protective mechanisms
Study Design: Randomized controlled clinical trial Study Population and Number of Subjects: 70 patients with ulcerative colitis in clinical remission Duration of Treatment: 6 months Primary Endpoint: Patient relapse rate over 6 months Secondary Endpoints: Changes in: 1) Time to relapse; 2) Patients' quality of life during the study period; 3) Mucosal inflammation, measured by fecal calprotectin at baseline, months 1, 3, 6 or at relapse; 4) Partial Mayo score at the baseline and monthly, or at a relapse; 5) Laboratory markers of inflammation
Subject visits:
1. Screening Visit
* Assessment of inclusion of exclusion criteria
* Obtainment of Informed Consent
* Medical History
* Pregnancy Test
* Partial Mayo score
2. Visit Month 0 (baseline), 1, 3, 6 (or at relapse)
* Focused Physical Exam and Medical History
* Partial Mayo score
* Fecal samples for Calprotectin and luminal microflora analysis
* Blood and urine samples for metabolomic analysis, inflammatory markers and other tests specified in the appendix 2.
* Dietary counseling
* Questionnaires specified in the appendix 2.
* Sigmoidoscopy (only at relapse)
3. Visit at Month 2, 4, 5
* Telephone interview by the dietician
* Partial mayo score
* Questionnaires specified in the appendix 2
Studies to Evaluate Mechanisms of Action of the Alberta anti-inflammatory diet:
* Compositional changes of the intestinal microbiota in fecal samples, using pyrosequencing
* Host and microbial metabolomics in serum and urine samples using gas chromatography and nuclear magnetic resonance
* Evaluations of inflammatory markers (fecal calprotectin, serum interleukin (IL) -6, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and lipopolysaccharide (LPS).
