Fish diet helps patients with Crohn's disease
OTSU, JAPAN. Crohn's disease is an inflammatory disease involving intestinal pain, diarrhea, and
malabsorption of nutrients. The disease is characterized by periods of active disease interspersed with
periods of remission. Elemental diet (ED) therapy is the preferred treatment in Japan. Conventional
treatment with prednisone and salycylates has been only marginally successful in extending the periods
of remission. The ED therapy involves tube feeding (enteral nutrition) a mixture of free amino acids,
short-chain maltodextrins, and low levels of fat in the form of soybean oil. Not surprisingly, compliance
with this diet is poor resulting in shorter periods of remission.
Medical researchers at the Shiga University of Medical Science now report that one of the three daily
enteral meals can be replaced by a special meal eaten normally. This new CD (Crohn's disease) diet
consists of rice, cooked fish, and soup. It is rich in polyunsaturated fatty acids and has an omega-3 to
omega-6 ratio of only 0.5. The researchers tried out the new diet regimen on 20 patients with Crohn's
disease who had been using enteral ED therapy for over a month. The patients were allowed to eat the
CD diet for lunch or dinner and continued with the ED regimen for the other 2 meals. They were also
given nutritional education to emphasize the importance of following the diets. The results were very
encouraging. Prior to the introduction of the CD diet 9 out of 10 patients experiences a relapse within one
year; on the new regimen only 4 out of the 10 had a flare-up within one year. The researchers conclude
that the combination ED and CD diet along with nutritional education is effective in extending the
remission periods in Crohn's disease. They also point out that the inclusion of the CD diet prevents the
development of nutritional deficiencies often seen in patients on the elemental diet alone.
Tsujikawa, Tomoyuki, et al. Clinical importance of n-3 fatty acid-rich diet and nutritional education for the
maintenance of remission in Crohn's disease. Journal of Gastroenterology, Vol. 35, 2000, pp. 99-104
Fish oils give hope to patients with Crohn's disease
BOLOGNA, ITALY. Crohn's disease is characterized by periods of active disease interspersed with
periods of remission. Now researchers at the University of Bologna report that fish oils prevent relapses.
Their experiment involved 78 patients with Crohn's disease who had been classified as having a high risk
of relapse. Half the patients were randomized to receive nine fish oil capsules daily, the other half
received nine placebo capsules daily. The fish oil capsules contained 500 mg of a marine lipid
concentrate each (40 per cent eicosapentaenoic acid and 20 per cent docosahexaenoic acid) and
provided a total of 2.7 grams of n-3 fatty acids per day. The capsules were enteric-coated so as to
ensure that they dissolved in the small intestine instead of in the stomach and to minimize unpleasant
side effects such as flatulence, heartburn, belching, and diarrhea. The results of the fish oil therapy were
spectacular. While 69 per cent of the patients in the control group had a relapse during the one-year
study period, only 28 per cent in the therapy group did. At the end of the one-year period 59 per cent of
the patients in the fish oil group were still in remission as compared to only 26 per cent in the placebo
group. The researchers conclude that fish oil therapy (with enteric-coated capsules) is effective in
preventing relapses in patients with Crohn's disease in remission. (NOTE: This study was supported in
part by Tillotts Pharma of Switzerland, the manufacturer of the enteric-coated fish oil capsules).
Belluzzi, Andrea, et al. Effect of an enteric-coated fish-oil preparation on relapses in Crohn's disease.
The New England Journal of Medicine, Vol. 334, No. 24, June 13, 1996, pp. 1557-60
Essential fatty acid deficiency and gastrointestinal disorders
BOSTON, MASSACHUSETTS. Researchers at the Boston University Medical Center report that patients
with chronic gastrointestinal disorders have abnormal essential fatty acid profiles. Their study involved 25
patients with Crohn's disease, 11 with ulcerative colitis, 4 with celiac sprue, and 7 with short bowel
syndrome. The patients and 56 non-obese healthy controls all provided fasting blood samples which
were used to determine the fatty acid content of whole plasma. The researchers found that the patients
tended to have significantly lower overall levels of saturated fat, monounsaturated fat, and
polyunsaturated fat than did the controls. Their fatty acid profile was also shifted so that the percentage
of polyunsaturated fat was lower than in the controls.
The researchers conclude that patients with inflammatory bowel diseases, sprue, and short bowel
syndrome suffer from a deficiency of essential fatty acids. They believe this deficiency is not only a
consequence of the disorder, but also contributes to it by interfering with the renewal and formation of
new cells in the gut. They suggest that this deficiency needs to be corrected by adding omega-3 and/or
omega-6 oils to the diet in the ratio required to eliminate the abnormalities. The researchers caution that
some patients may not be able to metabolize the precursor omega-3 (alpha-linolenic acid) and omega-6
(linoleic acid) fatty acids and may need to be supplemented directly with the metabolites,
eicosapentaenoic acid (EPA) and gamma-linolenic acid if needed, in the form of periodic intravenous
infusions. [58 references]
Siguel, Edward N. and Lerman, Robert H. Prevalence of essential fatty acid deficiency in patients with
chronic gastrointestinal disorders. Metabolism, Vol. 45, January 1996, pp. 12-23
Fish oils ameliorate ulcerative colitis
SAN FRANCISCO, CALIFORNIA. Ulcerative colitis, a common form of inflammatory bowel disease, is
accompanied by an increased level of leukotriene B4 in the lining of the colon. Fish oils are known to
inhibit the synthesis of leukotrienes and it has therefore been postulated that they might be beneficial in
the treatment of ulcerative colitis. Researchers at the Veterans Affairs Medical Center have just released
the results of a study aimed at testing this hypothesis.
The study involved 11 male patients aged 31 to 74 years who had been diagnosed with ulcerative colitis.
The patients were randomized into two groups with one group receiving 15 fish oil capsules (providing 2.7
grams of eicosapentaenoic acid (EPA) and 1.8 grams of docosahexaenoic acid (DHA) daily); the other
group received placebo capsules (olive oil). After 3 months on the supplements all participants
underwent a 2-month wash-out period and were then assigned to the opposite treatment to what they had
received during the first stage for another 3 months. Clinical evaluations of all patients were performed at
the start of the study and every month thereafter.
Evaluation of the patients' clinical data at the end of the treatment periods showed a significant beneficial
effect of fish oil supplementation. The mean disease severity score for the patients on fish oil declined by
56% as compared to 4% for the placebo group. Eight of the 11 patients (72%) were able to markedly
reduce or totally eliminate their use of anti-inflammatory medication and steroids while taking the fish oils.
The researchers conclude that fish oil supplementation results in a marked clinical improvement of active
mild to moderate ulcerative colitis.
Aslan, Alex and Triadafilopoulos, George. Fish oil fatty acid supplementation in active ulcerative colitis: A
double-blind, placebo-controlled, crossover study. American Journal of Gastroenterology, Vol. 87,
April 1992, pp. 432-37
Fish oils benefit patients with ulcerative colitis
NEW YORK, NY. Researchers at the Mount Sinai School of Medicine report that fish oil supplementation
is highly effective in alleviating ulcerative colitis. Their small pilot study involved 10 patients with mild to
moderate ulcerative colitis who had not been helped by conventional medical therapy. The patients were
given 15 capsules of fish oil daily containing a total of 2.7 grams of eicosapentaenoic acid (EPA) and 1.8
grams of docosahexaenoic acid (DHA). The capsules were taken in 3 divided doses for an 8-week
period. All patients underwent rigid sigmoidoscopy at entry to the study, at 4 weeks, and at the
completion of the study. They also kept a daily log of the number of bowel movements, stool consistency,
and any side effects. At the end of the 8 weeks 7 out of the 10 patients showed marked to moderate
improvement and 4 out of 5 patients on prednisone were able to reduce their daily dose by 20 to 66%.
The researchers speculate that the EPA in the fish oil interferes with the synthesis of the highly
inflammatory leukotriene B4 in the lining of the colon and that this effect accounts for the improvement.
They recommend a large, randomized, placebo-controlled, double-blind trial to confirm the beneficial
effects of fish oil supplementation in ulcerative colitis patients.
Salomon, Peter, et al. Treatment of ulcerative colitis with fish oil n-3-omega fatty acid: an open trial.
Journal of Clinical Gastroenterology, Vol. 12, No. 2, 1990, pp. 157-61
