Lecture on Inflammatory Bowel Diseases and Dietary Interventions

Key Points:

• Inflammatory Bowel Diseases (IBDs):
  • Include ulcerative colitis and Crohn's disease.
  • Can significantly impact the lives of those diagnosed.
  • Personal anecdote: Diagnosed at 21, led to significant life changes.

Dietary Interventions:

• Experimental Ketogenic Diet:

  • Personally credited with achieving remission.
  • Lack of rigorous dietary trials for extreme diets such as ketogenic and carnivore diets.
  • Physicians are reluctant to recommend non-evidence-based diets.
  • Absence of evidence is not evidence of absence.

• Biological Plausibility:

  • Therapeutic effects of ketones noted in animal models.
  • Correlation between low colonic ketone levels and higher disease activity in humans.
  • Ketones stimulate anti-inflammatory pathways and promote stem cell renewal in the GI tract.
  • Elimination of certain dietary components can shift microbiome metabolism therapeutically.

Case Study:

• Study Details:

  • Case series of 10 patients with IBD (ulcerative colitis or Crohn's disease).
  • Patients adopted ketogenic, primarily animal-based diets (carnivore diet).
  • Duration of remission ranged from 5 months to 5 years.
  • 8 out of 10 patients in remission for at least a year.
  • Patients off all medications following dietary changes.

• Previous Treatments Attempted:

  • Various pharmaceuticals: corticosteroids, biologics, immunomodulators.
  • Lifestyle therapies and various diet plans (specific carbohydrate, low FODMAP, plant-based).

Results:

• Quality of Life Improvements:

  • Assessed using IBD Q32 questionnaire.
  • Pre-diet average score: 95 (poor quality of life).
  • Post-diet average increase of 121 points to 216 (clinical remission).

• Patient Diversity:

  • Included males and females, aged 20-60s.
  • Diverse dietary energy requirements, body shapes, and sizes.

• Diet Composition:

  • 67% to 82% calories from fat.
  • 21 grams or less of carbohydrates, many strictly carnivore.

Patient Stories:

• Patient 1:

  • 62-year-old male, diagnosed at age 30.
  • Disease-free after adopting a keto-carnivore diet.

• Patient 3:

  • 31-year-old female with a significant family history of IBD.
  • Experienced significant improvement in symptoms and energy.

Conclusion and Call to Action:

• Limitations:

  • Retrospective case series with selection bias, no control group.
  • Conducted without funding.

• Importance of Further Research:

  • Extreme diets not widely socially accepted.
  • Need for rigorous controlled trials.
  • Advocating for investment in research to explore potential therapeutic efficacy of ketogenic and carnivore diets for IBD and other autoimmune/inflammatory conditions.

• Final Note:

  • Not claiming superiority of any diet.
  • Focus on potential therapeutic effects and the need for investigation.