Background
Inflammatory Bowel Disease (IBD) is a chronic immune-mediated disorder which consists of two main forms; Crohn’s disease (CD) and ulcerative colitis (UC). It is a global disease, with an accelerating incidence in newly industrialised countries whose societies have become more westernised. Commonly, mesalazine drugs are positioned as first line treatment for patients with mild-moderate UC, however, only approximately 40%–70% achieve symptomatic response. Specialised dieticians are key members of an integrated approach to modern IBD management, delivering dietary therapies that can reduce symptoms and inflammation. An ultra-processed dietary pattern (UPD) has been shown to correlate with higher circulating inflammatory cytokines and markers of oxidative stress. Characteristic of an UPD is the regular consumption of food additives such as artificial sweeteners, emulsifiers and carrageenan gum. In previous work our team have developed a low food additive diet (LFAD) and demonstrated a reduction in food additives was correlated with significant improvements in faecal calprotectin, disease activity scores and quality of life after 8 weeks in adults with mild to moderate IBD. A growing body of evidence from in vitro and animal models suggests that food additive exposure damages the mucous layer of the gut wall and perturbs the microbial ecosystem.9 However, whether these findings translate to individuals with IBD is unknown.
Aim
The primary aim of this pilot study is to determine whether a low food additive diet can improve symptomatic response as compared with a standard diet in patients with mild-moderate ulcerative colitis taking oral mesalazine treatment. Secondary aims include: validation of a purposely developed food additive assessment tool through targeted metabolomic analysis of urine, stool and blood samples.