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Case report
peer-reviewed

Effect of the Specific Carbohydrate Diet on the Microbiome of a Primary Sclerosing Cholangitis and Ulcerative Colitis Patient



Abstract

A 20-year-old female was diagnosed with ulcerative colitis (UC) at age 14 and primary sclerosing cholangitis (PSC) at age 16. The PSC was successfully treated with high doses of oral vancomycin; however, the UC was more difficult to manage. After many drug treatments failed to treat the UC, the patient began following the specific carbohydrate diet (SCD). This report documents fecal microbiome changes resulting from following the SCD for two weeks. The DNA extracted from fecal samples was subjected to 16S rRNA gene sequencing to quantify bacterial species abundance. Not only were substantial changes in the fecal bacterial composition detectable within two weeks, but all UC symptoms were also controlled as early as one week following the start of the diet. The patient's fecal microbiota was dramatically different from those of three healthy control subjects and showed remarkable loss of bacterial diversity in terms of species richness, evenness, and overall diversity measures. Other specific changes in bacterial composition included an increase in Enterobacteriaceae, including Escherichia and Enterobacter species. A two- to three-fold decrease was observed in the prevalence of the most dominant fecal bacterial species, Fusobacterium ulcerans, after two weeks on the SCD. Overall species diversity and evenness increased to levels near the controls, although species richness remained low. These findings provide information on the fecal bacteria from a patient with PSC and UC, following prolonged oral vancomycin treatment, and identifies a potentially specific microbial effect for the SCD.



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Case report
peer-reviewed

Effect of the Specific Carbohydrate Diet on the Microbiome of a Primary Sclerosing Cholangitis and Ulcerative Colitis Patient


Author Information

Alanna Dubrovsky

School of Medicine, UC Davis School of Medicine

Christopher L. Kitts Corresponding Author

Biological Sciences, California Polytechnic State University, San Luis Obispo

Office of Research and Economic Development, California Polytechnic State University, San Luis Obispo


Ethics Statement and Conflict of Interest Disclosures

Human subjects: Consent was obtained by all participants in this study. California Polytechnic State University, San Luis Obispo issued approval N/A. The Cal Poly Institutional Review Board (IRB) has conducted a minimal review of the project “Effects of the Specific Carbohydrate Diet on the Microbiome of a Primary Sclerosing Cholangitis and Ulcerative Colitis Patient” and finds the project to be in compliance with U.S. Public Health Service guidelines for the use of human subjects in research and exempt under 45 CFR 46.101(b)(4).

Please be aware that it is your responsibility as the persons in charge of this research project to ensure that, with respect to human subjects, the work is carried out as described in the proposal and the rights of the subjects are fully protected. We wish you success in your research efforts.

Debbie A. Hart, CIP
Compliance/Information Officer
Office of Research and Economic Development, 38-154
Cal Poly State University, San Luis Obispo
San Luis Obispo, CA 93407
(805) 756-1508
dahart@calpoly.edu. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: DNA sequencing was performed at published rates by MR-DNA labs in Shallowater TX. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Acknowledgements

This research was funded by the College Based Fee program at California Polytechnic State University, a student-approved allocation of student fees directed to support undergraduate student research.


Case report
peer-reviewed

Effect of the Specific Carbohydrate Diet on the Microbiome of a Primary Sclerosing Cholangitis and Ulcerative Colitis Patient


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Case report
peer-reviewed

Effect of the Specific Carbohydrate Diet on the Microbiome of a Primary Sclerosing Cholangitis and Ulcerative Colitis Patient

  • Author Information
    Alanna Dubrovsky

    School of Medicine, UC Davis School of Medicine

    Christopher L. Kitts Corresponding Author

    Biological Sciences, California Polytechnic State University, San Luis Obispo

    Office of Research and Economic Development, California Polytechnic State University, San Luis Obispo


    Ethics Statement and Conflict of Interest Disclosures

    Human subjects: Consent was obtained by all participants in this study. California Polytechnic State University, San Luis Obispo issued approval N/A. The Cal Poly Institutional Review Board (IRB) has conducted a minimal review of the project “Effects of the Specific Carbohydrate Diet on the Microbiome of a Primary Sclerosing Cholangitis and Ulcerative Colitis Patient” and finds the project to be in compliance with U.S. Public Health Service guidelines for the use of human subjects in research and exempt under 45 CFR 46.101(b)(4).

    Please be aware that it is your responsibility as the persons in charge of this research project to ensure that, with respect to human subjects, the work is carried out as described in the proposal and the rights of the subjects are fully protected. We wish you success in your research efforts.

    Debbie A. Hart, CIP
    Compliance/Information Officer
    Office of Research and Economic Development, 38-154
    Cal Poly State University, San Luis Obispo
    San Luis Obispo, CA 93407
    (805) 756-1508
    dahart@calpoly.edu. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: DNA sequencing was performed at published rates by MR-DNA labs in Shallowater TX. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

    Acknowledgements

    This research was funded by the College Based Fee program at California Polytechnic State University, a student-approved allocation of student fees directed to support undergraduate student research.


    Article Information

    Published: February 09, 2018

    DOI

    10.7759/cureus.2177

    Cite this article as:

    Dubrovsky A, Kitts C L (February 09, 2018) Effect of the Specific Carbohydrate Diet on the Microbiome of a Primary Sclerosing Cholangitis and Ulcerative Colitis Patient. Cureus 10(2): e2177. doi:10.7759/cureus.2177

    Publication history

    Received by Cureus: August 25, 2017
    Peer review began: September 22, 2017
    Peer review concluded: February 05, 2018
    Published: February 09, 2018

    Copyright

    © Copyright 2018
    Dubrovsky et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 3.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

    License

    This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

A 20-year-old female was diagnosed with ulcerative colitis (UC) at age 14 and primary sclerosing cholangitis (PSC) at age 16. The PSC was successfully treated with high doses of oral vancomycin; however, the UC was more difficult to manage. After many drug treatments failed to treat the UC, the patient began following the specific carbohydrate diet (SCD). This report documents fecal microbiome changes resulting from following the SCD for two weeks. The DNA extracted from fecal samples was subjected to 16S rRNA gene sequencing to quantify bacterial species abundance. Not only were substantial changes in the fecal bacterial composition detectable within two weeks, but all UC symptoms were also controlled as early as one week following the start of the diet. The patient's fecal microbiota was dramatically different from those of three healthy control subjects and showed remarkable loss of bacterial diversity in terms of species richness, evenness, and overall diversity measures. Other specific changes in bacterial composition included an increase in Enterobacteriaceae, including Escherichia and Enterobacter species. A two- to three-fold decrease was observed in the prevalence of the most dominant fecal bacterial species, Fusobacterium ulcerans, after two weeks on the SCD. Overall species diversity and evenness increased to levels near the controls, although species richness remained low. These findings provide information on the fecal bacteria from a patient with PSC and UC, following prolonged oral vancomycin treatment, and identifies a potentially specific microbial effect for the SCD.



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