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Crohn's disease successfully treated with the paleolithic ketogenic diet

Authors:
  • Nutrition intervention foundation
  • Paleomedicina Hungary

Abstract

Introduction: Crohn’s disease is regarded as having no curative treatment. Previous reports on dietary therapy of Crohn’s disease indicate no major success. Case Report: Here we report a severe case of Crohn’s disease where we successfully applied the paleolithic ketogenic diet. Dietary therapy resulted in resolution of symptoms, normalized laboratory parameters as well as gradual normalization of bowel inflammation as evidenced by imaging data and normalization of intestinal permeability as shown by the polyethylene glycol (PEG 400) challenge test. The patient was able to discontinue medication within two weeks. Currently, he is on the diet for 15 months and is free of symptoms as well as side effects. Conclusion: We conclude that the paleolithic ketogenic diet was feasible, effective and safe in the present case.
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Crohn’s disease successfully treated with the paleolithic
ketogenic diet
Csaba Tóth, Andrea Dabóczi, Mark Howard, Nicholas J. Miller,
Zsóa Clemens
ABSTRACT
Introduction: Crohn’s disease is regarded as having no curative treatment. Previous
reports on dietary therapy of Crohn’s disease indicate no major success.
Case Report: Here we report a severe case of Crohn’s disease where we successfully
applied the paleolithic ketogenic diet. Dietary therapy resulted in resolution of symptoms,
normalized laboratory parameters as well as gradual normalization of bowel inammation
as evidenced by imaging data and normalization of intestinal permeability as shown by the
polyethylene glycol (PEG 400) challenge test. The patient was able to discontinue medication
within two weeks. Currently, he is on the diet for 15 months and is free of symptoms as well
as side effects.
Conclusion: We conclude that the paleolithic ketogenic diet was feasible, effective and safe
in the present case.
(This page in not part of the published article.)
International Journal of Case Reports and Images, Vol. 7 No. 9, September 2016. ISSN – [0976-3198]
Int J Case Rep Images 2016;7(9):570–578.
www.ijcasereportsandimages.com
Tóth et al. 570
CASE REPORT OPEN ACCESS
Crohn’s disease successfully treated with the paleolithic
ketogenic diet
Csaba Tóth, Andrea Dabóczi, Mark Howard, Nicholas J. Miller,
Zsófia Clemens
ABSTRACT
Introduction: Crohn’s disease is regarded as
having no curative treatment. Previous reports
on dietary therapy of Crohn’s disease indicate
no major success. Case Report: Here we report
a severe case of Crohn’s disease where we
successfully applied the paleolithic ketogenic
diet. Dietary therapy resulted in resolution of
symptoms, normalized laboratory parameters
as well as gradual normalization of bowel
inflammation as evidenced by imaging data
and normalization of intestinal permeability
as shown by the polyethylene glycol (PEG 400)
challenge test. The patient was able to discontinue
medication within two weeks. Currently, he is on
the diet for 15 months and is free of symptoms
as well as side effects. Conclusion: We conclude
that the paleolithic ketogenic diet was feasible,
effective and safe in the present case.
Keywords: Crohn’s disease, Dietary therapy, In-
flammatory bowel disease, Ketogenic diet, Paleo-
lithic diet
Csaba Tóth1, Andrea Dabóczi1, Mark Howard2, Nicholas J.
Miller2, Zsófia Clemens1,3
Affiliations: 1Paleomedicina Hungary Ltd., Evolutionary
Medicine Working Group, Budapest, Hungary; 2Biolab Medical
Unit, London, United Kingdom; 3Neurological Department,
University of Pécs, Pécs, Hungary.
Corresponding Author: Zsófia Clemens, PhD, Paleomedicina
Hungary Ltd., Evolutionary Medicine Working Group, Hidász
u. 3. H-1026, Budapest, Hungary; Department of Neurology,
University of Pécs, Rét u. 2, H-7623, Pécs, Hungary; Email:
clemenszsofia@gmail.com
Received: 17 April 2016
Accepted: 03 June 2016
Published: 01 September 2016
How to cite this article
Tóth C, Dabóczi A, Howard M, Miller NJ, Clemens
Z. Crohn’s disease successfully treated with the
paleolithic ketogenic diet. Int J Case Rep Images
2016;7(10):570–578.
Article ID: Z01201609CR10690CT
*********
doi:10.5348/ijcri-2016102-CR-10690
INTRODUCTION
Crohn’s disease, an inflammatory disease of the
bowel, is regarded as having no cure [1]. Standard
treatment which involves steroids, immunosuppressants
and biological therapy is aimed at reducing symptoms
[1]. Periods of flares and remissions typically alternate,
however, the overall course of the disease is progressive.
A set of ecological evidence, including a discrepancy
between westernized and non-westernized countries
in the occurrence of the disease, raises the possibility
of lifestyle and/or dietary factors in the etiology of the
disease [2]. There have been several attempts to use a
dietary intervention in Crohn’s disease such as the specific
carbohydrate diet [3] and the anti-inflammatory diet [4]
as well as elimination-reintroduction diets [5]. Although
clinical improvements and reduction of medicines have
been reported being associated with these diets we are
not aware of any diet inducing complete remission and
long-term freedom of medicines at the same time.
The authors of the present report are using a diet
referred to as the paleolithic ketogenic diet in the
treatment of chronic conditions. So far we have published
CASE REPORT PEER REVIEWED | OPEN ACCESS
International Journal of Case Reports and Images, Vol. 7 No. 9, September 2016. ISSN – [0976-3198]
Int J Case Rep Images 2016;7(9):570–578.
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Tóth et al. 571
cases of successful treatment of diabetes type 1 [6, 7] and
type 2 [8], epilepsy [9, 10] as well as other conditions [11].
CASE REPORT
Diagnosis
The 14-year-old boy presented with fatigue, low grade
fever, iron deficiency anemia, lower abdominal tenderness
and perianal dermatitis. He was of short stature for his
age. On 30 September 2013 upper and lower endoscopy
was performed. The latter showed ulcerative lesion in
the terminal ileum. Biopsy was taken from multiple sites
and histopathology showed severe inflammation of the
terminal ileum and the Bauhin’s valve. Signs of mild-
to-moderate degree aspecific inflammation were seen in
the colon. On laboratory workup inflammatory marker C
reactive protein (CRP) was elevated (58 mg/L). He was
diagnosed with Crohn’s disease.
Standard treatment
At the time of diagnosis onset (on 07 October 2013)
the patient was started on mesalazine, metronidazole
and pantoprazole. Within ten days, ciprofloxacin and
probiotics were added. Given that no improvement
was seen immunosuppressant therapy was initiated
on 13 November 2013 with azathioprine together with
methylprednisolone, potassium citrate, calcium and
vitamin D. Given that disease progressed, a year after
diagnosis onset (on 25 September 2014), biological
therapy was initiated: five cycles of adalimumab were
given each two weeks apart. The condition of the patient
further deteriorated and therefore on 07 November 2014
exclusive formula feeding was initiated. At this time
mesalazine, multivitamin, vitamin D3 and calcium were
discontinued. Pantoprazole was discontinued within two
weeks. Formula-based nutrition resulted in the resolution
of abdominal pain but other symptoms persisted (Table 1,
Figures 1 and 2).
Laboratory data
As the disease progressed iron deficiency anemia of
the patient worsened. Thrombocyte number showed a
decreasing tendency across the course of the standard
treatment. Level of inflammatory markers CRP and
erythrocyte sedimentation rate (ESR) dropped when
initiating the immunosuppressant therapy and steroid
but increased thereafter (Table 1, Figure 2).
Imaging
At the time of the diagnosis ultrasound examination
performed on 07 October 2013 showed thickening of
the terminal ileum and that of the small intestine at
multiple sites. No thickening of the colon was seen. Three
further follow-up ultrasound examinations were carried
out during the next year. This showed progression of
the disease as reflected by increasing diameter of the
thickened bowel wall and an increasing intensity of
hypervascularization. The last ultrasound out of the four
(on 7 November 2014) already indicated the thickening of
nearly all bowel segments including the colon ascendens
and the colon transversum. Figure 3 shows as the largest
diameter of the terminal ileum changed between 7
October 2013 and 7 November 2014.
Magnetic Resonance Enterography
Magnetic resonance enterography performed five
weeks after diagnosis onset (on 12 November 2013)
indicated thickening of the small intestinal wall at
multiple locations. A follow-up magnetic resonance
enterography 13 months later, on 16 December 2014,
showed an increase in the variability in the diameter of
the bowel lumen and narrowing of the lumen (Figure 4).
Due to the narrowing the patient was offered surgery in
December 2014 which he refused.
Symptoms
Abdominal cramps as well as episodes of low grade
fever lessened when initiating the immunosuppressant
therapy together with steroid. However, within three
months the patient developed bilateral knee pain as a
new symptom. Later on his appetite deteriorated. At
12 months after diagnosis onset abdominal cramps
increased and episodes of low grade fever returned. The
patient reported fatigue along with a deterioration in his
school performance. Following the onset of the biological
therapy all symptoms persisted. Following the fourth cycle
of adalimumab strong abdominal pain emerged abruptly
which persisted for several hours. Given this experience
and the overall ineffectiveness of the biological therapy
the patient decided to stop it. He was put on exclusive
enteral nutrition which resulted in a lessening of his
abdominal cramps but other symptoms persisted.
Dietary advices while on the standard
therapy
The patient was advised to follow a diet free of lactose
and low in fat and fibers. Analysis of his diet-symptom
diary did not show any consistent association between
symptoms and food items.
Intervention with the paleolithic
ketogenic diet
Given the ineffectiveness of standard therapies the
parents of the child were seeking for alternative options.
When we first met the patient he reported bilateral pain
and swelling of the knee, frequent episodes of fever
and night sweats as well as fatigue. He looked pale. We
offered the paleolithic ketogenic diet along with close
monitoring of the patient. The patient started the diet
on 4 January 2015. The diet is consisting of animal fat,
meat, offal and eggs with an approximate 2:1 fat : protein
International Journal of Case Reports and Images, Vol. 7 No. 9, September 2016. ISSN – [0976-3198]
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Tóth et al. 572
ratio. Red and fat meats instead of poultry as well as
regular intake of organ meats from pork and cattle were
encouraged. Grains, milk, dairy, refined sugars, vegetable
oils, oilseeds, nightshades and artificial sweeteners
were excluded. Small amount of honey was allowed for
sweetening. The patient was not taking any supplements.
Regular home monitoring of urinary ketones indicated
sustained ketosis. Regular laboratory follow-up was used
to monitor the course of the disease as well as for giving
feedback how to fine tune the diet. The patient was under
our close control and gave frequent feedbacks and so we
could assess the level of dietary compliance. The patient
maintained a high level dietary adherence on the long-
term, yet on his birthday, he made a mistake: he has
eaten two pieces of commercially available “paleo” cake
which contained coconut oil, flour from oilseeds as well
as sugar alcohol. Clinical consequences are discussed
later. From July 2015 onwards he also consumed small
amounts of vegetables and fruits. Given the persistence of
certain alterations in laboratory values (mild anemia) on
10 November 2015, despite 10 months on the paleolithic
ketogenic diet, we suggested to tighten the diet again.
From this time on he did neither consume vegetables and
fruits nor vegetable oil containing spices such as cumin
and cinnamon.
We obtained written informed consent from the
patient for the publication of his case.
RESULTS
Discontinuing medication
Within two weeks after diet onset the patient
discontinued azathioprine, the only medicine he was
taking at this time. Currently, he is without medicines for
15 months.
Symptoms
The frequent night sweats of the patient disappeared
within three weeks after diet onset and thus his sleep
improved significantly. The knee pains of the patient
began to lessen at 4th week on the diet and completely
disappeared by the third month. From this time onwords
he regularly went to school by bike (20 km daily). He
reported restored energy and increased physical and
mental fitness. Although during the eight months before
diet onset his weight was declining, following diet onset he
began to gain weight. At diet onset his weight was 41 kg and
was 152 cm tall (BMI = 17.7). At 12 months after diet onset,
his height was 160 cm and weighted 50 kg (BMI: 19.5).
The change in his height and weight is depicted in Figure
5. At the time of writing the article he is on the diet for 15
months and is free of symptoms as well as side effects.
Laboratory workup
Laboratory workup including blood and urinary
analysis was performed seven times during follow-up.
Urinary ketones were positive on each occasion. Blood
glucose was between 5 and 5.4 mmol/l. Renal and liver
function as well as ions were normal. His severe iron
deficiency anemia was reversed already on the fourth
week of the diet: iron level increased from 3.6 μmol/L
to 12.1 μmol/L. Inflammatory markers including ESR
and CRP decreased significantly: at four weeks CRP
was 3.75 mg/L while ESR was 3 mm/h (Figure 2).
Thereafter inflammatory markers elevated to some
extent. Thrombocyte number was already low before diet
onset but decreased further following diet onset. The last
laboratory follow-up, however, on 14 December 2015,
indicated an increase in thrombocyte number (Table 2.).
Imaging
Ultrasound examination of the abdomen was carried
out five times during follow-up and was performed
by the same investigator. The first examination
following the onset of the paleolithic ketogenic diet,
on 29 January 2015, showed significant improvement.
Although wall of the terminal ileum was still thickened
hypervascularization was no longer present. Thickening
was still seen in the coecum and the ileum but not in the
other regions which were described as being affected
on the preceding ultrasound examination. A follow-up
exam on 09 April 2015 showed further improvement:
thickening of the wall of the terminal ileum decreased
and no abnormal was seen in any other regions. A next
ultrasound which was made following eating the “paleo
cakes” showed thickening of the wall of the terminal
ileum to as much as 6 mm. On the next examination, on
19 Jun 2015, thickening of the terminal ileum decreased
to 4.5 cm. Three months later, on 17 September 2015, the
examination showed no abnormality (Figures 2 and 3).
Intestinal permeability test
Intestinal permeability was assessed using a
polyethylene glycol (PEG 400) challenge test based on
the method of Chadwick et al. [12]. PEG 400 contains a
mixture of inert water soluble molecules of 11 different
sizes that are absorbed independently of dose, but which
display decreasing mucosal transport with increasing
molecular size. PEG 400 is also nontoxic, not degraded
by intestinal bacteria, not metabolized by tissues, and
rapidly excreted in urine. After a 3.0-gram oral dose of
PEG, the subject makes a six-hour urine collection. The
PEG fractions are acetylated with acetic anhydride, using
pyridine as a catalyst, and then quantitated by capillary
gas-liquid chromatography. The percentage of each
fraction of PEG excreted over 6 hours is calculated.
PEG 400 challenge test performed at four months on
the diet (on 18 May 2015) showed increased permeability
to PEG between 242 and 418 molecular weight. A
follow-up test performed at 10 months on the diet (on
26 November 2015) showed no abnormal intestinal
permeability (Figure 6).
International Journal of Case Reports and Images, Vol. 7 No. 9, September 2016. ISSN – [0976-3198]
Int J Case Rep Images 2016;7(9):570–578.
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Tóth et al. 573
Table 1: Laboratory data while on a standard diet and corresponding medications, Dashes indicate that a given parameter was not
measured
04 Oct
2013
17 Oct
2013
25 Nov
2013
17 Dec
2013
27 Mar
2014
04 Sep
2014
10 Nov
2014
normal
value
WBC 9.6 7.5 23.2 13.8 6.3 7.6 7.7 4.5-11.5 G/L
RBC 5.5 5.3 5.6 5.5 4.2 4.4 4.7 4.5-5.9 T/L
Hgb 117 113 130 133 110 119 132 135-170 g/L
Hct 0.38 0.36 0.41 0.41 0.33 0.35 0.39 0.41-0.51 L/L
Thrombocyte 252 285 311 168 128 240 166 150-400 G/L
CRP 23.1 21.1 2.6 2.4 12.3 46.7 19.6 0-5 mg/L
ESR 12 8 1 1 14 25 15 0-15 mm/h
T. protein 59 53.9 57.9 54.4 58.3 61.6 57.3 57-80 g/L
Carbamide 0.8 1.7 4.2 5 3.5 2.7 2.8 2.8-7.2 mmol/L
Creatinine 49 47 44 58 41 45 56 53-100 μmol/L
Sodium 140 142 140 136 - - 143 135-145 mmol/L
Potassium citrate 4.5 4.1 3.9 4.1 - - 4.5 3.2-5.1 mmol/L
GOT 11 18 11 10 17 15 15 0-50 U/L
GPT 6 11 12 8 7 7 7 0-50 U/L
GGT 13 23 23 15 11 15 9 0-55 U/L
Iron - - - - 6.9 3.6 - 12.5-32 μmol/L
formula feeding x
adalimumab x
multivitamin x x
calcium x x x x
vitamin D3 x x x x
potassium citrate x x
methylprednisolone x x
azathioprine x x x x x
probiotics x x
ciprofloxacin x
pantoprazole x x x x x x
metronidazole x
mesalazine x x x x x
Abbreviations: WBC: white blood cell count, RBC: red blood cell count, Hgb: hemoglobin, Hct: hematocrit, CRP: C-reactive protein,
ESR: erythrocyte sedimentation rate, T. protein: total protein, GOT: glutamate-oxaloacetate transaminase, GPT: glutamate-pyruvate
transaminase, GGT: gamma-glutamyl transferase
International Journal of Case Reports and Images, Vol. 7 No. 9, September 2016. ISSN – [0976-3198]
Int J Case Rep Images 2016;7(9):570–578.
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Tóth et al. 574
Figure 1: Timeline encompassing the medication of the patient,
timing and the result of the MR enterography as well as that of
the ultrasound examination.
Abbreviations: ti: thickness of the terminal ileum, *: moderate
hypervascularization, **: strong hypervascularization, IPT:
intestinal permeability test
Figure 2: Timeline encompassing medication and the change
in the inflammatory markers ESR (erythrocyte sedimentation
rate) and CRP (C reactive protein).
Figure 3: Thickness of the terminal ileum (largest diameter is
indicated) seen on ultrasound. Onset of the paleolithic ketogenic
diet as well as the occurrence of a dietary failure is indicated with
arrows. Note the improvement during the paleolithic ketogenic
diet, the relapse following the single episode of dietary failure
and the normal results on the last examination.
* indicate mild degree hypervascularization while ** high degree
hypervascularization.
Figure 4: Magnetic resonance enterography on 16 December
2014 showed thickening of the terminal ileum (arrows).
Figure 5: Weight and height of the patient during the 14 months
on the standard treatment and following the onset of the dietary
therapy.
Figure 6: PEG 400 challenge test showing increased intestinal
permeability to PEG from molecular weight 242 to molecular
weight 418 at four months on the diet (A) while no abnormal at
10 months (B).
DISCUSSION
Here we report a case where Crohn’s disease was
reversed by the paleolithic ketogenic diet.
Disease symptoms began to improve a few weeks
after diet onset. Within 10 months the patient achieved
full remission from symptoms as well as normalization
of intestinal inflammation as evidenced by imaging data,
normalization of laboratory parameters and that of the
International Journal of Case Reports and Images, Vol. 7 No. 9, September 2016. ISSN – [0976-3198]
Int J Case Rep Images 2016;7(9):570–578.
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Tóth et al. 575
intestinal permeability. Aside from a single dietary fault
the patient strictly adhered to the diet as assessed by
frequent patient feedback, laboratory data and home
monitoring of urinary ketones. Given the patient’s severe
condition upon the first visit the paleolithic ketogenic
diet was started in the strictest form thus containing no
vegetables and fruits at all. Such a diet may first sound
restrictive but our previous experience indicate that a
full fat-meat diet is needed in the most severe cases of
Crohn’s disease. In addition, our experience shows that
even a single occasion of deviation from diet rules may
result in lasting relapse. This was the case in the present
patient too where breaking the strict rules (eating the
”paleo cakes”) resulted in a thickening of the bowel wall.
Based on our experience this is due to the components
of the popular paleolithic diet including coconut oil, oil
seeds and sugar alcohols which may trigger inflammation.
In contrast, honey, consumed in limited amounts is
tolerable and does not cause such symptoms. The
significant improvement seen in the last laboratory exam
also indicates that the paleolithic ketogenic diet is most
effective when containing no plant components at all.
Crohn’s disease is known to be characterized by a
progressive worsening of symptoms. Standard therapies
may result in a temporary symptom relief but are
accompanied by significant side effects [1]. Surgical
resection is thought to be inevitable on the long-term [13].
Our patient also failed to respond to immunosuppressive
therapies, steroid, biological agents and exclusive formula
feeding. Within 14 months after diagnosis onset, he was
offered surgery due to the narrowing of the bowel. The
paleolithic ketogenic diet reversed the disease from this
Table 2: Laboratory data while on the paleolithic ketogenic diet with no medications. Dashes indicate that a given parameter was not
measured
02 Feb
2015
09 Apr
2015
29 Apr
2015
19 Jun
2015
17 Sep
2015
10 Nov
2015
14 Dec
2015
normal value
WBC 7.1 8.5 5.7 7.1 7.1 7.8 8 4.5–11.5 G/L
RBC 5 4.8 4.8 5.2 4.8 5.3 5.4 4.5–5.9 T/L
Hgb 145 135 137 147 135 146 151 135–170 g/L
Hct 0.42 0.39 0.4 0.42 0.39 0.43 0.44 0.41–0.51 L/L
Thrombocyte 71 75 68 82 95 65 100 150–400 G/L
CRP 3.75 9.9 9.3 1.8 14.3 4.4 7.1 0–5 mg/L
ESR 3 8 8 5 10 6 5 0–15 mm/h
Total protein 60 62 - - 63 65 66 57–80 g/L
Carbamid 5.3 6.2 - - 5.8 6.3 6.9 2.8–7.2 mmol/L
Creatinine 53 63 - - 48 66 7.3 53–100 μmol/L
Sodium 141 138 - - 139 140 139 135–145 mmol/L
Potassium 4.3 3.9 - - 4.1 4.1 4.2 3.2–5.1 mmol/L
GOT 18 20 - - 21 24 24 0–50 U/L
GPT 12 14 - - 18 18 18 0–50 U/L
GGT 12 13 - - 13 13 12 0–55 U/L
Iron 12.1 10.3 - - 10.6 11 13.7 12.5–32 μmol/L
Uric acid 258 264 - - 332 329 329 208–428 μmol/L
Glucose 5 5 - - 5.3 5.2 5.4 3.5–6.1 mmol/L
Magnesium 0.76 0.86 - - 0.81 0.87 0.89 0.73–1.06 mmol/L
Cholesterol 4.6 4.9 4.7 4.8 4.3 4.1 4.3 <5.2 mmol/L
Trigliceride 0.9 1.46 - - 0.56 0.93 1.34 <1.7 mmol/L
Fibrinogen - - 2.5 2.3 - - - 2-4 g/L
Urinary ketones ++ ++++ ++ +++ +++ ++ +
Abbreviations: WBC: white blood cell count, RBC: red blood cell count, Hgb: hemoglobin, Hct: hematocrit, CRP: C-reactive protein,
ESR: erythrocyte sedimentation rate, T. protein: total protein, GOT: glutamate-oxaloacetate transaminase, GPT: glutamate-pyruvate
transaminase, GGT: gamma-glutamyl transferase.
International Journal of Case Reports and Images, Vol. 7 No. 9, September 2016. ISSN – [0976-3198]
Int J Case Rep Images 2016;7(9):570–578.
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Tóth et al. 576
very advanced stage. Although Crohn’s disease is known
to be characterized by an alternation of better and worse
periods, a complete remission from a very advanced stage
is highly unlikely to be the part of the normal course of
the disease.
While on the biological therapy thrombocyte number
dropped and continued to decrease while on the diet. Our
previous experience does not indicate thrombocytopenia
on the paleolithic ketogenic diet. However, low
thrombocyte number is a well-known side effect of
the use of adalimumab in Crohn’s disease [14, 15]. It
is also noteworthy that a return to the strictest form of
the paleolithic ketogenic diet resulted in an increase in
thrombocyte number.
Crohn’s disease is regarded as an autoimmune disease.
Autoimmune diseases and Crohn’s disease specifically
have been linked to increased intestinal permeability
[16]. Yet currently there is no known means to reverse
pathological intestinal permeability [17]. A previous study
with the paleolithic diet found no change in intestinal
permeability as assessed by the lactulose-mannitol test
[18]. As far as we know this is the first documented case
where pathological intestinal permeability was reversed
as assessed by a diagnostic test.
Experts in the field of evolutionary medicine has
long been suggesting that chronic diseases of civilization
emerge from a mismatch between our ancient genome and
current lifestyles [19, 20]. In recent years an increasing
number of studies showed that the metabolic syndrome
and associated conditions can be reversed or improved by
applying a diet denoted as ”paleolithic” (for a review see:
[21]). In the paleolithic diet, as described in the implied
papers, macronutrient ratios are undefined or variable,
as well as that of the ratio of animal/plant foods including
the ratio of animal/plant fats. Our clinical experience,
however, indicate that the most severe chronic conditions,
including the Crohn’s disease, can only be reversed by
the paleolithic ketogenic diet based on animal fat, meat
and offal. A same conclusion was drawn in our previous
case study showing that the paleolithic ketogenic diet was
more effective than the popular form of the paleolithic
diet in the case of Gilbert’s syndrome [11]. The paleolithic
ketogenic diet we use in the treatment of chronic diseases
is close to the evolutionary diet originally proposed by
gastroenterologist Voegtlin [22]. With regard to the main
principals, background, sustainability and further issues
such as vitamin supply while on a meat-fat based diet we
refer to the excellent book of Voegtlin [22].
As regards the underlying mechanism, we put forward
that normalizing pathological intestinal permeability
is crucial in tackling autoimmune diseases, including
Crohn’s disease. Accordingly, increased intestinal
permeability has been shown to predict relapses in
Crohn’s disease [23]. It is known that under physiological
conditions, dietary macromolecules are not transported
paracellularly from the intestinal lumen to the blood or
the lymph. It has been suggested that certain components
of the Western-type diet are able to destroy cell junctions
and thereby compromise the intestinal barrier function
[24, 25]. As a result, large molecules including protein
fragments and glycoproteins, possessing antigenic
properties, may appear in the circulation and promote
chronic inflammation [26]. Given their specific structure,
these macromolecules may bind to and form complexes
with the surface molecules of certain cell types. Such
a complex is then destroyed by the immune system
through apoptosis [27, 28]. We assume that a continued
exposition to these macromolecules may maintain the
autoimmune destruction of tissues. We put forward that
the animal fat-meat based diet, the only diet humans
are evolutionary adapted to, is lacking substances that
are destroying the intestinal barrier. A shift toward
the paleolithic ketogenic diet may normalize intestinal
permeability (as also seen in our patient) and thereby
may halt the autoimmune destruction of the affected
tissues, in our case the intestine. With the attenuation of
the autoimmune process the intestine may regenerate.
CONCLUSION
We conclude that the paleolithic ketogenic diet was
effective while producing no side effects in this case of
Crohn’s disease. In contrast to standard therapeutic
approaches which are aimed to control certain
components of the disease only, the paleolithic ketogenic
diet was able to reverse the cluster of symptoms and
abnormalities associated with the disease. Assuming a
long term dietary compliance, we believe that the patient
would remain disease-free in the future.
*********
Author Contributions
Csaba Tóth – Substantial contributions to conception and
design, Acquisition of data, Analysis and interpretation
of data, Drafting the article, Revising it critically for
important intellectual content, Final approval of the
version to be published
Andrea Dabóczi – Acquisition of data, Analysis and
interpretation of data, Revising it critically for important
intellectual content, Final approval of the version to be
published
Mark Howard – Acquisition of data, Analysis and
interpretation of data, Revising it critically for important
intellectual content, Final approval of the version to be
published
Nicholas J. Miller – Acquisition of data, Analysis and
interpretation of data, Drafting the article, Revising
it critically for important intellectual content, Final
approval of the version to be published
Zsófia Clemens – Substantial contributions to
conception and design, Acquisition of data, Analysis
and interpretation of data, Drafting the article, Revising
it critically for important intellectual content, Final
approval of the version to be published
International Journal of Case Reports and Images, Vol. 7 No. 9, September 2016. ISSN – [0976-3198]
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International Journal of Case Reports and Images, Vol. 7 No. 9, September 2016. ISSN – [0976-3198]
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Introduction: Currently, type 1 diabetes mellitus (T1DM) is treated with insulin and a high carbohydrate diet. In literature, there are studies indicating that low carbohydrate diets may be beneficial in reducing hypoglycemic episodes as well as the need for insulin. Previously, we reported a case of a 19-year-old T1DM patient who was successfully treated with a modified version of the ketogenic diet we refer to as the Paleolithic ketogenic diet. Case Report: A nine-year-old child with T1DM who initially was on an insulin regime with high carbohydrate diet then was put on the Paleolithic ketogenic diet. Following dietary shift glucose levels normalized and he was able to discontinue insulin. No hypoglycemic episodes occurred on the diet and several other benefits were achieved including improved physical fitness, reduction of upper respiratory tract infections and eczema. Currently, he is on the diet for 19 months. Conclusion: Adopting the Paleolithic ketogenic diet ensured normoglycemia without the use of external insulin. The diet was sustainable on the long-term. Neither complications nor side effects emerged on the diet. Keywords: C peptide, Ketogenic diet, Ketosis, Low carbohydrate diet, Paleolithic diet, Paleolithic ketogenic diet, Type 1 diabetes mellitus
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Paleolithic nutrition, which has attracted substantial public attention lately because of its putative health benefits, differs radically from dietary patterns currently recommended in guidelines, particularly in terms of its recommendation to exclude grains, dairy, and nutritional products of industry. We evaluated whether a Paleolithic nutritional pattern improves risk factors for chronic disease more than do other dietary interventions. We conducted a systematic review of randomized controlled trials (RCTs) that compared the Paleolithic nutritional pattern with any other dietary pattern in participants with one or more of the 5 components of metabolic syndrome. Two reviewers independently extracted study data and assessed risk of bias. Outcome data were extracted from the first measurement time point (≤6 mo). A random-effects model was used to estimate the average intervention effect. The quality of the evidence was rated with the use of the Grading of Recommendations Assessment, Development and Evaluation approach. Four RCTs that involved 159 participants were included. The 4 control diets were based on distinct national nutrition guidelines but were broadly similar. Paleolithic nutrition resulted in greater short-term improvements than did the control diets (random-effects model) for waist circumference (mean difference: -2.38 cm; 95% CI: -4.73, -0.04 cm), triglycerides (-0.40 mmol/L; 95% CI: -0.76, -0.04 mmol/L), systolic blood pressure (-3.64 mm Hg; 95% CI: -7.36, 0.08 mm Hg), diastolic blood pressure (-2.48 mm Hg; 95% CI: -4.98, 0.02 mm Hg), HDL cholesterol (0.12 mmol/L; 95% CI: -0.03, 0.28 mmol/L), and fasting blood sugar (-0.16 mmol/L; 95% CI: -0.44, 0.11 mmol/L). The quality of the evidence for each of the 5 metabolic components was moderate. The home-delivery (n = 1) and dietary recommendation (n = 3) RCTs showed similar effects with the exception of greater improvements in triglycerides relative to the control with the home delivery. None of the RCTs evaluated an improvement in quality of life. The Paleolithic diet resulted in greater short-term improvements on metabolic syndrome components than did guideline-based control diets. The available data warrant additional evaluations of the health benefits of Paleolithic nutrition. This trial was registered at PROSPERO (www.crd.york.ac.uk/PROSPERO) as CRD42014015119. © 2015 American Society for Nutrition.
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Purpose: Although the classical ketogenic diet is an effective treatment in childhood epilepsy, it is difficult to maintain on the long term due to side-effects and dislike. Methods: Here we report a case of a child with frequent epileptiform discharges confined to non-rapid-eye-movement (NREM) sleep and extensive cortical malformation. The child was started on a modified version of the classical ketogenic diet we refer to as the paleolithic ketogenic diet. Results: Subsequent follow-up electroencephalograms showed complete normalization of brain electric activity along with cognitive improvement. Neither antiepileptic medication nor vitamin supplements were used. The child strongly adhered to the diet as assessed by regular urinary ketone tests and laboratory work ups. Currently she is on the diet for 17 months. Neither side effects nor clinical signs of nutrient deficiency were observed. Conclusion: We conclude that the paleolithic ketogenic diet was effective, safe and feasible in this case.
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Gilbert’s syndrome (GS) is a common hyperbilirubinaemia syndrome caused by reduced conjugation of serum bilirubin by the liver. Although it is considered as a common and harmless condition not requiring treatment symptoms associated with GS may be unfavorable. Here we present a case of GS where high level of total and direct bilirubin, yellowish discoloration of the sclera as well as associated symptoms including migraine, fatigue and granulomatosus dermatitis were reversed following a shift toward the popular paleolithic and then toward the paleolithic ketogenic diet.
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Introduction: Metabolic syndrome is a major public health problem affecting at least 20% of the world’s adult population. Components of the metabolic syndrome include obesity, impaired glucose metabolism, hypertension and altered lipid profile. Currently, medical treatment relies on drugs. A major problem is that patients with long-standing disease are excessively medicated because of an increase in the number of symptoms over time. A few clinical studies indicate that low-carbohydrate diets, including the paleolithic as well as the ketogenic diet, may be beneficial in the treatment of conditions associated with the metabolic syndrome. Case Report: Herein, we present a case of patient with metabolic syndrome successfully treated with the paleolithic ketogenic diet. While on the diet the patient was able to discontinue eight medicines, lost weight, showed a continuous improvement in glucose parameters and her blood pressure normalized. Currently, the patient is on the paleolithic ketogenic diet for 22 months, free of symptoms and side effects. Conclusion: We conclude that the paleolithic ketogenic diet was safe, feasible and effective in the treatment of this patient with metabolic syndrome.
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The incidence of autoimmune diseases is increasing along with the expansion of industrial food processing and food additive consumption. The intestinal epithelial barrier, with its intercellular tight junction, controls the equilibrium between tolerance and immunity to non-self-antigens. As a result, particular attention is being placed on the role of tight junction dysfunction in the pathogenesis of AD. Tight junction leakage is enhanced by many luminal components, commonly used industrial food additives being some of them. Glucose, salt, emulsifiers, organic solvents, gluten, microbial transglutaminase, and nanoparticles are extensively and increasingly used by the food industry , claim the manufacturers, to improve the qualities of food. However, all of the aforementioned additives increase intestinal permeability by breaching the integrity of tight junction paracellular transfer. In fact, tight junction dysfunction is common in multiple autoimmune diseases and the central part played by the tight junction in autoimmune diseases pathogenesis is extensively described. It is hypothesized that commonly used industrial food additives abrogate human epithelial barrier function, thus, increasing intestinal permeability through the opened tight junction, resulting in entry of foreign immunogenic antigens and activation of the autoimmune cascade. Future research on food additives exposure-intestinal permeability-autoimmunity interplay will enhance our knowledge of the common mechanisms associated with autoimmune progression. Copyright © 2015. Published by Elsevier B.V.
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Herein we will review the role of glycans in the immune system. Specific topics covered include: the glycosylation sites of IgE, IgM, IgD, IgE, IgA, and IgG; how glycans can encode “self” identity by functioning as either danger associated molecular patterns (DAMPs) or self-associated molecular patterns (SAMPs); the role of glycans as markers of protein integrity and age; how the glycocalyx can dictate the migration pattern of immune cells; and how the combination of Fc N-glycans and Ig isotype dictate the effector function of immunoglobulins. We speculate that the latter may be responsible for the well-documented association between alterations of the serum glycome and autoimmunity. Due to technological limitations, the extent of these autoimmune-associated glycan alterations and their role in disease pathophysiology has not been fully elucidated. Thus, we also review the current technologies available for glycan analysis, placing an emphasis on Multiple Reaction Monitoring (MRM), a rapid high-throughput technology that has great potential for glycan biomarker research. Finally, we put forth The Altered Glycan Theory of Autoimmunity, which states that each autoimmune disease will have a unique glycan signature characterized by the site-specific relative abundances of individual glycan structures on immune cells and extracellular proteins, especially the site-specific glycosylation patterns of the different immunoglobulin(Ig) classes and subclasses.
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Introduction: Type 1 diabetes mellitus (T1DM) patients are usually instructed to follow a low fat/high carbohydrate diet. A few studies in literature, however, reported metabolic benefits and sustainability of carbohydrate restricted diets. Case Report: Herein, we present a case of a 19-year-old male with newly diagnosed T1DM. The patient was first put on an insulin regime. Twenty days later, he shifted towards the paleolithic ketogenic diet and was able to discontinue insulin. Strict adherence to the diet resulted in normal glucose levels and a more than three-fold elevation of C-peptide level indicating restored insulin production. Currently, the patient is on the paleolithic ketogenic diet for 6.5 months. He is free of complaints, and no side effects emerged. Conclusion: We conclude that the paleolithic ketogenic diet was effective and safe in the management of this case of newly diagnosed T1DM. Marked increase in C peptide level within two months indicates that the paleolithic ketogenic diet may halt or reverse autoimmune processes destructing pancreatic beta cell function in T1DM.
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Nutrition science is a highly fractionated, contentious field with rapidly changing viewpoints on both minor and major issues impacting on public health. With an evolutionary perspective as its basis, this exciting book provides a framework by which the discipline can finally be coherently explored. By looking at what we know of human evolution and disease in relation to the diets that humans enjoy now and prehistorically, the book allows the reader to begin to truly understand the link between diet and disease in the Western world and move towards a greater knowledge of what can be defined as the optimal human diet. Written by a leading expert Covers all major diseases, including cancer, heart disease, obesity, stroke and dementia Details the benefits and risks associated with the Palaeolithic diet Draws conclusions on key topics including sustainable nutrition and the question of healthy eating This important book provides an exciting and useful insight into this fascinating subject area and will be of great interest to nutritionists, dietitians and other members of the health professions. Evolutionary biologists and anthropologists will also find much of interest within the book. All university and research establishments where nutritional sciences, medicine, food science and biological sciences are studied and taught should have copies of this title.
Article
Background Anti-TNF-α therapies interact with the tolerogenic response in patients with Crohn’s disease, modulating inflammation. However, drug levels and the genetic background may affect this interaction. Methods Patients with Crohn’s disease in remission on biologic monotherapy were enrolled in this study. FoxP3+ lymphocytes, NOD2 genotype, serum cytokine, anti-TNF-α levels, and anti-drug antibodies were evaluated. Regulatory T cell response to infliximab was evaluated in vitro. Results Fifty-seven patients were included. Thirty-nine patients (68.4 %) were receiving non-intensified biologic therapy whereas 18 patients (31.6 %) were under an intensified biologic schedule due to loss of response. Eleven intensified patients (61.1 %) showed a variant NOD2 genotype vs 9 on non-intensified biologics (23 %, p