Effects of Mediterranean Diet, Curcumin, and Resveratrol on Mild-to-Moderate Active Ulcerative Colitis: A Multicenter Randomized Clinical Trial.

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• The Mediterranean diet is a safe, effective strategy for improving inflammation, symptoms, and quality of life in mild-to-moderate UC.
• While curcumin and resveratrol may be used as optional adjuncts, they did not enhance outcomes beyond the diet alone in this small study.
• Further research is required.

Introduction

Ulcerative colitis (UC) is a chronic inflammatory condition with alternating periods of flare-ups and remission. UC can cause diarrhoea, rectal bleeding, pain, weight loss, and fever. This study aimed to investigate the effects of the Mediterranean diet (MD), combined with curcumin and resveratrol supplementation, on disease activity, serum inflammatory markers, and quality of life in patients with mild-to-moderate active UC.

Methods

• A prospective multi-centre three-arm RCT with MD, MD + curcumin, and MD + resveratrol groups.
• The control group (n=16) were provided with the MD intervention for 8 weeks.
• Curcumin participants (n=16) received 1600 mg/day of curcumin divided into two capsules twice daily.
• Resveratrol participants (n=16) received 500 mg/day of resveratrol divided into two capsules twice daily.
• All participants adhered to the same dietary protocol. Dietary intervention was tailored to each individual’s physical activity levels (PALs), resting metabolic rate, and individual requirements following the ESPEN guidelines.
• Anthropometric measurements, Truelove–Witts Index, Short Form-36, Inflammatory Bowel Disease Questionnaire (IBDQ), Mediterranean Diet Adherence Scale (MEDAS), and complete blood count, C-reactive protein (CRP) levels, and erythrocyte sedimentation rate (ESR) were taken at baseline and after 8 weeks of interventions.

Results

• Between-group comparisons revealed no significant difference in all parameters except for the lower levels of pain-related quality of life reported by the MD + R group (p < 0.05).
• Within-group comparisons showed that health-related quality of life improved across all groups (p < 0.05).
• Between-group analysis revealed no statistically significant differences in the hemogram and inflammatory biomarkers.
• Within-group comparisons showed that all groups had a significant decrease in CRP and ESR levels.
• The MD + C group achieved improved systemic symptoms scores (p < 0.05).

Conclusion

The MD was effective in decreasing CRP and ESR levels, and enhancing the quality of life of individuals with mild-to-moderate active UC. Adding curcumin or resveratrol did not lead to greater or additive benefits beyond the MD alone.

• The MD is an effective and safe intervention to be used in clinical practice in individuals with UC.
• Curcumin and resveratrol may be used as optional adjuncts but no summation of effects was observed in this study.
• Clinicians should emphasise MD adherence in UC and use tools like the MEDAS score to track and encourage compliance.

• Larger RCTs are required with more diverse participants and longer intervention periods.
• Further studies should include faecal calprotectin and proinflammatory cytokine measures and endoscopic imaging to enhance the comprehensiveness of results.
• This study was limited to individuals with mild-to-moderate active disease, further research could compare findings to individuals in remission or with severe active disease.