A randomized trial of the effects of the no-carrageenan diet on ulcerative colitis disease activity.

BACKGROUND: Carrageenan is a very common food additive in Western diets, but predictably causes inflammation in thousands of cell-based and animal experiments. OBJECTIVE: To assess the impact of carrageenan exposure on the interval to relapse in patients with ulcerative colitis in remission. METHODS: A randomized, double-blind, placebo-controlled, multicenter, clinical trial was conducted to assess if patients with ulcerative colitis in remission would have a longer interval to relapse if they followed a diet with no carrageenan. All participants were instructed in the no-carrageenan diet and were randomized to either placebo capsules or carrageenan-containing capsules. The carrageenan in the capsules was less than the average daily carrageenan intake from the diet. Relapse was defined as an increase of two or more points on the Simple Clinical Colitis Activity Index (SCCAI) and intensification of treatment for ulcerative colitis. Participants were followed by telephone calls every two weeks until relapse or one year of participation. The occurrence of relapse and inflammatory biomarkers were compared between the two groups. RESULTS: Twelve patients completed study questionnaires. Three patients who received carrageenan-containing capsules relapsed, and none of the patients who received placebo-containing capsules relapsed (p = 0.046, log-rank test). Laboratory tests showed increases in Interleukin-6 (p = 0.02, paired t-test, two-tailed) and fecal calprotectin (p = 0.06; paired t-test, two-tailed) between the beginning and the end of study participation in the carrageenan-exposed group, but not in the placebo-group. CONCLUSION: Carrageenan intake contributed to earlier relapse in patients with ulcerative colitis in remission. Restriction of dietary carrageenan may benefit patients with ulcerative colitis.

Health literacy: universal precautions needed.

Inadequate health literacy adversely affects health care outcomes and the quality of life of 90 million Americans and costs the health care system dollars 73 billion annually. Current strategies addressing inadequate health literacy primarily target physicians, nurses, and pharmacists but omit the allied health practitioners responsible for providing most patient services. The 2003 Coalition for Allied Health Leadership Health Literacy Project team undertook a survey of allied health professionals and educators to assess their awareness and needs concerning inadequate health literacy. Less than one third of all respondents were aware of the issues surrounding health literacy or that health literacy resources are available or had institutional policy or goals to address health literacy. Brochures and videos were identified most frequently as new resources needed to establish or increase the effectiveness of health literacy awareness programs. The results of this project indicated that there is substantial opportunity to increase awareness of the impact of health literacy, to develop and assess institutional policies toward health literacy, and to create new resources to promote health literacy within the allied health professions. Any approach to improving health literacy must be universal by involving all health care professionals and all patients in the intervention.