Two failsafers have completed a full dietitian-supervised RPAH elimination diet with challenges to show exactly which foods exacerbate their colitis. In addition, one woman working with a dietitian reported a four year full remission of her diagnosed “moderate UC” due to diet.

Some scientists now agree that commonly used food additives and other components of the Western diet appear to be associated with the increase of colitis in developing countries.

Our first report:

“I had ulcerative colitis with associated liver problems and spontaneous bruising, I was a mess. The doctors were talking about a possible liver transplant in ten years. My job meant I travelled and ate out frequently. I kept telling the doctors I thought it was something to do with food but I couldn't pinpoint what it was. Then I quit my job, stopped eating out, ate very simple food and got better. My last liver function test was quite good. I asked my doctors ’Don't you want to hear about this because it could help someone else?’ They weren't interested.” – [883]

When this woman did the then-popular Liver Cleansing Diet, she spent three weeks in bed, feeling dreadful. She then did the RPAH Elimination diet and found she was sensitive to salicylates and amines that are especially high in the Liver Cleansing Diet.  She also found that dairy foods, gluten and food additives could cause problems. Sulphite preservatives (220) in dried fruit were the worst.

British scientists from the MRC Dunn Clinical Nutrition Centre in Cambridge suspect that high levels of sulphur in the Western diet from the most commonly used group of preservatives, sulphites (220-227, in fast foods, dried fruit, drinks, sausages, fast food, salads and many others) may be somehow implicated in ulcerative colitis, see more in The Science: Sulphites below.

Our second report:

“I am a 43 mother and have done the RPA elim diet at Royal Prince Alfred Hospital. I have colitis that was triggered by a single episode of food poisoning ten years ago. It took a long time to get a diagnosis of microscopic colitis. For a long time I was told that it was irritable bowel. Finally a colonoscopy and biopsy showed it - a very under-diagnosed condition. My big 3 "no-no's" are: annatto 160b, synthetic antioxidants such as BHA 320, and sorbates. All of those cause cramping and diarrhoea. “– Kate [800]

American scientists led by Professor Andrew Gewirtz at the Centre for Inflammation, Immunity and Infection at Georgia State University suspect that components of the Western diet - including use of antibiotics and increasing consumption of food additives - can change the microbiome and thus may be contributing factors to the increased incidence of colitis, obesity and associated diseases.  In a 2015 study, they found that widely used emulsifiers in processed food can alter the microbiome. Re-establishing the microbiome has proven to be more difficult. Since the Western diet, high in fats and sugars but low in fibre, has been linked to an increased risk of inflammatory bowel diseases, in a new study published last week they examined whether use of inulin fibre supplements in mice could re-establish an altered microbiome. The inulin restored some number and diversity to the gut bacteria, but could not completely return the mouse gut bacteria to its original bacterial diversity. It also had the potential to exacerbate acute colitis.

A third woman reports a full remission of diagnosed ulcerative colitis, confirmed after four years:

I’m 58 with a severe salicylate intolerance and thankfully, my avoidance of sals over the last 7 months has "cured", or put me in remission, for ulcerative colitis. My ulcerative colitis developed from my Paleo diet (to lose weight – juicing tons of spinach and eating almond breads, I thought it would cure my years of issues) and a natural practitioner who gave me high doses of Chinese herbs, thinking she was helping.

My GI doc said my recovery was remarkable. She also said I don't have to come back for 10 years. I think that is as close to a cure as anyone could get. I truly believe the salicylates crashed me and caused it. The stats I have discovered are that 7-10% of patients with UC or Crohn's have salicylate issues - if more docs knew this - they wouldn't give them meds which are...duh....salicylates. Thankfully, my doc listened to me and was willing to read my research - combined with real results - Kathy in 2014.

FOLLOWUP four years later: Yes, my ulcerative colitis is still fully in remission (I was diagnosed with moderate UC).  The GI doc gave me a 10 year return visit and was impressed at my healing – saying it should never have happened. I think salicylates are connected to other things like oxalates and histamines - it is not a stand alone. My roseacea is also cleared after 3 years of a dermatologist trying to fix it. My fibromyalgia is gone, as well. I'm in pretty good shape considering I thought I was a goner 4 years ago. Had I not been a persistent person and researched on my own, I’m not sure I would be as well today as I am.  But I believe I will always have to manage this issue.  My genetics say so and the epigenetic influences I have been exposed to say so as well - Kathy in 2018 [1473]

Conclusion: There is some evidence of sulphites, annatto and salicylates exacerbating symptoms of ulcerative colitis, and of salicylates interacting with sulphites to produce this effect. A trial of the RPAH elimination diet and challenges, preferably with an experienced and supportive dietitian, is worth considering. Avoidance of emulsifier food additives carboxymethylcellulose (E466) and polysorbate-80 (E433) during the trial might be useful.

The science

1. Sulphites

In a rather quirky study, volunteers were locked in a small airtight room for 36 hours while researchers measured the types of gases they gave off through farting or belching.

The results of this study led scientists to suspect the high levels of sulphur in the Western diet may be somehow implicated. Sulphur in the human gut comes from the most commonly used group of preservatives, sulphites (220-227, in fast foods, processed fruit, drinks, sausages, fast food, salads and many others) as well as large quantities of meat. Several studies have now linked a high number of sulphate-eating bacteria in the gut of ulcerative colitis sufferers and an Australian abdominal surgeon has shown that exposure to sulphides inhibits the ability of colon cells to use a vital fatty acid. These bacteria might only contribute to the maintenance of the disease rather than causing it, and there may be other factors, but researchers at the Dunn Nutrition Institute in Britain are now looking at the amount of sulphates and sulphites ingested with an average Western diet. Although reactions to food additives are known to be related to dose and there is an Acceptable Daily Intake, never before has there been any systematic monitoring of the quantity of additives we actually eat.

Further reading:

Hydrogen sulphide: a bacterial toxin in ulcerative colitis? Pitcher MC, Cummings JH. Gut. 1996 Jul;39(1):1-4.  QUOTE: “Much of the sulphate present in the British diet is added as a preservative … principally as sulphur dioxide (E220) and the sulphites (E221-227), and to a lesser extent as carrageenan (E407) and is consumed by 98.6% of the population ... a typical rural African diet only contains 2.7 mmol sulphate/day whereas in Western diets there may be in excess of 16.6 mmol/day [over 6 times higher – and anything more than 7 mmol/day spills over into the colon]. Sulphate intake … may explain the changing prevalence of UC in developing countries”.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1383219/?page=2

New Scientist, 8 Aug 98, p26-30. Thanks to Marion Leggo and Damien Howard for sending copies of this article. https://www.newscientist.com/article/mg15921465-400-a-gut-feeling/

2. Emulsifiers: common food additives that can contribute to inflammatory bowel disorders and obesity

An international team of researchers from the US and Israel have shown that in mice, relatively low concentrations of two commonly used emulsifiers, carboxymethylcellulose and polysorbate-80 (Code numbers E466 and E433; both regarded as safe by RPAH researchers in terms of triggering food intolerance reactions or altering children's behaviour), can induce low-grade inflammation, obesity/metabolic syndrome and promote colitis in mice predisposed to the disorder, due to disturbance of beneficial gut bugs called the microbiota.

Further reading:

Chassaing B and others, Dietary emulsifiers impact the mouse gut microbiota promoting colitis and metabolic syndrome. Nature. 2015 Mar 5;519(7541):92-6. http://www.ncbi.nlm.nih.gov/pubmed/25731162 and Widely used food additives promotes colitis, obesity and metabolic syndrome, shows study of emulsifiers, Science Daily, http://www.sciencedaily.com/releases/2015/02/150225132105.htm

Zou J and others, Fiber-Mediated Nourishment of Gut Microbiota Protects against Diet-Induced Obesity by Restoring IL-22-Mediated Colonic Health, Cell Host Microbe. 2017 Dec 12. pii: S1931-3128(17)30497-3 https://www.ncbi.nlm.nih.gov/pubmed/29276170 and https://www.sciencedaily.com/releases/2017/12/171221122558.htm

Miles JP and others, Supplementation of Low- and High-fat Diets with Fermentable Fiber Exacerbates Severity of DSS-induced Acute Colitis, Inflamm Bowel Dis. 2017 Jul;23(7):1133-1143. https://www.ncbi.nlm.nih.gov/pubmed/28590342

Chassaing B1, Gewirtz AT1. Has provoking microbiota aggression driven the obesity epidemic? Bioessays. 2016 Feb;38(2):122-8. QUOTE: “ Alterations in the gut microbiome have increasingly been implicated in driving obesity and its associated diseases …, we hypothesize that  … a range of societal changes, including use of antibiotics and increasing consumption of food additives, have provoked such microbiota aggression and, consequently, may be contributing factors to the increased incidence of obesity and its associated diseases.” https://www.ncbi.nlm.nih.gov/pubmed/26749135

3. Salicylates

One paper suggest that salicylate drugs (and hence salicylates in foods, which are rarely considered) exacerbate colitis symptoms, and others point out that salicylate drugs affect sulphide production (sulphites are commonly used food preservatives that can give rise to sulphides) which can exacerbate colitis symptoms.

Further reading:

The oral administration of mesalazine (5-aminosalicylic acid) resulted in the exacerbation of ulcerative colitis in two patients intolerant to sulphasalazine whose colitis had previously been quiescent. Although sulphasalazine intolerance is usually attributable to the sulphapyridine moiety, the possibility of salicylate sensitivity should be considered in colitic patients who fail to respond appropriately to sulphasalazine or who experience abdominal pain or diarrhoea while taking the drug.

Chakraborty TK, Bhatia D, Heading RC, Ford MJ. Salicylate induced exacerbation of ulcerative colitis. Gut 1987;28(5):613-5. https://www.ncbi.nlm.nih.gov/pubmed/3596343

The effect of 5-aminosalicylic acid-containing drugs on sulfide production by sulfate-reducing and amino acid-fermenting bacteria. Edmond LM, Hopkins MJ, Magee EA, Cummings JH. Inflamm Bowel Dis. 2003 Jan;9(1):10-7. https://www.ncbi.nlm.nih.gov/pubmed/12656132

The contribution of sulphate reducing bacteria and 5-aminosalicylic acid to faecal sulphide in patients with ulcerative colitis. Pitcher MC, Beatty ER, Cummings JH. Gut. 2000 Jan;46(1):64-72. https://www.ncbi.nlm.nih.gov/pubmed/10601057