Studying a Culturally Tailored, Anti-inflammatory Diet’s Impact on Hispanic/LatinX Patients with Ulcerative Colitis
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Article Summary
- Dr. Oriana Damas will use an R01 grant to test a culturally tailored diet for Hispanic/LatinX patients with ulcerative colitis.
- The study diet will cater to South Florida dietary tendencies, making sure to involve foods with anti-inflammatory properties.
- Ulcerative colitis has been primarily a disease affecting people of white European descent, but its rates are rising in Hispanic/LatinX people.
Studies suggest that diet plays a significant role in modulating inflammation in gastrointestinal conditions, such as inflammatory bowel disease (IBD). Despite greater recognition of the role of diet in IBD, few studies have rigorously tested its effects on ulcerative colitis, a type of IBD, in a controlled trial setting. The primary dietary guidance available to patients with ulcerative colitis is centered around following a Mediterranean diet.
But the Mediterranean diet isn’t for everyone. Other culturally based diets may be just as effective as the Mediterranean diet in managing digestive conditions, but they haven’t been thoroughly studied.
Oriana Damas, M.D., associate professor of digestive health and liver diseases and director of translational studies for the Crohn’s and Colitis Center at the University of Miami Miller School of Medicine, identified this research gap as she treated patients of diverse backgrounds living with inflammatory bowel disease.
“It is hard to tell patients who have their own customs and grew up eating their own native foods to adapt their diet to one from a different region of the world,” she said.
Studying a Culturally Tailored, Anti-inflammatory Diet
Dr. Damas will use a new, five-year National Institutes of Health (NIH) R01 grant to develop and test a culturally tailored, anti-inflammatory diet for Hispanic/LatinX patients with ulcerative colitis, the first initiative of its kind. Historically a disease afflicting European and American white populations, ulcerative colitis is on the rise in Hispanic/LatinX patients.
R01 grants are highly competitive. Only 8% to 10% of proposals are typically funded, compared to a 20% funding rate for all NIH submissions.
“Diet can play an important role in reducing symptoms and inflammation of ulcerative colitis,” said Dr. Damas. “The big problem is that controlled dietary studies for ulcerative colitis are limited and lack ethnic diversity.”
Dr. Damas’ study will make an important contribution by examining the effects of a culturally tailored diet on the understudied Hispanic/LatinX population.
Ulcerative Colitis and Diet
Ulcerative colitis causes inflammation and ulcers in the lining of the colon. Symptoms include abdominal cramping, weight loss, diarrhea and bloody stools. In the United States, approximately 900,000 people are affected. The total rises to 5 million globally.
As many as one in four are admitted to the hospital when symptoms can’t be controlled by medication. In especially troublesome cases, surgery to remove the colon may be needed. But most people can manage their condition with anti-inflammatory drugs.
Diet can reduce inflammation of the colon associated with ulcerative colitis, as well, although more studies are needed. This is where Dr. Damas’s trial comes in.
Dr. Damas will recruit 122 Hispanic/LatinX participants from South Florida for her eight-week trial. Participants will be randomized to receive a special anti-inflammatory diet or their usual food. As a crossover study, everyone will receive the intervention diet at its conclusion. Participants will be engaged throughout and provide feedback on the recipes used, including through focus groups.
The study will adapt a Mediterranean diet for a South Florida population of Caribbean and South American heritage. Foods will include rice dishes, yams, plantains, yuca (also known as cassava), Latin soups and tropical fruits such as papaya, guava and mango. Dr. Damas’s goal is to assess the effects of traditional recipes on ulcerative colitis but transform them in a way that meets patients’ nutritional needs.
The diet arose out of an earlier, five-year observational study by Dr. Damas examining the dietary patterns of Hispanic/LatinX patients with inflammatory bowel disease and pinpointing foods likely to cause flare-ups or keep symptoms in remission. She found that certain foods in the Hispanic/LatinX diet are inherently healthy. Patients felt better when they ate these staples. So Dr. Damas and her team developed a clinical trial centered on a Latin-based diet with anti-inflammatory properties.
“We are dissecting the food components of each recipe we create to ensure that there is enough fiber and antioxidants, it’s low in fat and it has an appropriate ratio of polyunsaturated fatty acids,” said Dr Damas.
Antioxidants and polyunsaturated fatty acid compounds found in fruits, vegetables and other foods can reduce inflammation, which contributes to many chronic illnesses, including ulcerative colitis.
“This grant award will allow us to create and test dietary recipes with ingredients that are known to our patients and which mirror the properties of certain anti-inflammatory diets, such as the Mediterranean diet,” Dr. Damas said.
Assessing the Diet’s Effect
To determine the effects of the special diet, Dr. Damas will administer the Simple Clinical Colitis Activity Index, a questionnaire that assesses severity of symptoms in people with ulcerative colitis. The score is determined by answers to questions regarding rectal bleeding, urgency and other symptoms.
Dr. Damas will compare the scores of participants on the special diet and those maintaining their normal diets and measure markers of inflammation in the blood and stool before and after the diet intervention to obtain objective measures that indicate improvement of inflammation.
Additionally, Dr. Damas will examine stool microbiota — the microorganisms in the gastrointestinal system, such as bacteria, fungi and viruses — as predictors of dietary response in ulcerative colitis.
Our findings may get us closer toward personalizing medicine and making dietary recommendations for the Hispanic/LatinX population that patients like and can adhere to.
—Dr. Oriana Damas
“Growing evidence suggests that the gut microbiome may mediate the effect of diet on ulcerative colitis and similar diseases,” said Dr. Damas. “We will be looking for the baseline presence of certain bacteria before participants begin the special diet and see if those with these bacteria are more likely to have positive responses to the diet in terms of symptoms and inflammation.”
Few studies—none of which have focused on Hispanic/LatinX populations—have investigated stool microbiota composition as a predictor of dietary response in ulcerative colitis.
By examining specific genes as well as fatty acids in the blood, Dr. Damas will evaluate whether patients are more likely to respond to the diet based on their capacity to metabolize certain fats. Specifically, evidence indicates omega-3 polyunsaturated fatty acids play an important, anti-inflammatory role. Diets high in omega-6 polyunsaturated fatty acids, however, exert pro-inflammatory effects. Similar to the case with stool microbiota, Dr. Damas and her team will be looking to predict whether a person is likely to respond to their diet based on their genetic and fatty acid profile.
“Our findings may get us closer toward personalizing medicine and making dietary recommendations for the Hispanic/LatinX population that patients like and can adhere to, long term, while also allowing us to control their disease inflammation,” said Dr. Damas.
Dr. Damas’s future clinical trials will build on these findings by developing algorithms to personalize dietary recommendations based on factors such as ethnicity, genetic background and an individual’s gut microbiota composition. She also plans to create culturally tailored dietary interventions for other populations affected by ulcerative colitis and other inflammatory bowel diseases.
Tags: Crohn’s and Colitis Center, Division of Digestive Health and Liver Diseases, Dr. Oriana Damas, gastroenterology, inflammation, ulcerative colitis, USNWR Gastro
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