Coconut Water Induces Clinical Remission in Mild to Moderate Ulcerative Colitis: Double-blind Placebo-controlled Trial

Saurabh Kedia; Shubi Virmani; Aditya Bajaj; Manasvini Markandey; Neha Singh; Divya Madan; Kanav Kaushal; Pabitra Sahu; Sudheer Kumar Vuyyuru; Bhaskar Kante; Peeyush Kumar; David Mathew Thomas; Sandeep Kumar Mundhra; Mukesh Kumar Singh; Mahak Verma; Raju Sharma; Prasenjit Das; Nihar Ranjan Dash; Nitika Monga; Amit Awasthi; Govind Makharia; Vineet Ahuja

doi:10.1016/j.cgh.2024.01.013

Coconut Water Induces Clinical Remission in Mild to Moderate Ulcerative Colitis: Double-blind Placebo-controlled Trial

Clin Gastroenterol Hepatol. 2024 Jan 24:S1542-3565(24)00088-0. doi: 10.1016/j.cgh.2024.01.013. Online ahead of print.

Authors

Saurabh Kedia¹, Shubi Virmani¹, Aditya Bajaj¹, Manasvini Markandey¹, Neha Singh¹, Divya Madan¹, Kanav Kaushal¹, Pabitra Sahu¹, Sudheer Kumar Vuyyuru¹, Bhaskar Kante¹, Peeyush Kumar¹, David Mathew Thomas¹, Sandeep Kumar Mundhra¹, Mukesh Kumar Singh¹, Mahak Verma¹, Raju Sharma², Prasenjit Das³, Nihar Ranjan Dash⁴, Nitika Monga⁵, Amit Awasthi⁶, Govind Makharia¹, Vineet Ahuja⁷

Affiliations

¹ Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India.
² Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India.
³ Department of Pathology, All India Institute of Medical Sciences, New Delhi, India.
⁴ Department of GI Surgery, All India Institute of Medical Sciences, New Delhi, India.
⁵ Non-communicable Disease Division, Indian Council of Medical Research, New Delhi, India.
⁶ Department of Infection and Immunology, Translational Health Science and Technology Institute, Faridabad, Haryana, India.
⁷ Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India. Electronic address: vineet.aiims@gmail.com.

PMID: 38278200
DOI: 10.1016/j.cgh.2024.01.013

Abstract

Background & aims: Coconut water (CW) is anti-inflammatory, can manipulate the gut microbiome, and is a rich source of potassium. Gut microbiome modulation improves outcomes in ulcerative colitis (UC), and potassium possesses in vitro anti-inflammatory property. We evaluated the effect of CW as an adjunct therapy for patients with mild-moderate UC.

Methods: This single-center, double-blind, placebo-controlled trial randomized patients with mild to moderate (Simple Clinical Colitis Activity Index [SCCAI]: 3-9) endoscopically active UC (Ulcerative Colitis Endoscopic Index of Severity [UCEIS] >1) in 1:1 ratio to CW + standard medical therapy (SMT) vs placebo + SMT. Four hundred mL of CW was administered for 8 weeks. Primary outcome measure was clinical remission (SCCAI ≤2), and secondary outcome measures were clinical response (SCCAI decline ≥3) and adverse events at 8 weeks. Microbiome was analyzed at baseline and 8 weeks.

Results: Of 121 patients screened, 95 were included for modified intention to treat analysis (CW, n = 49; placebo, n = 46) (mean age, 37.2 ± 11.2 years; males, 54.1%; disease duration, 48 months [interquartile range (IQR), 24-90 months]; pancolitis, 26.1%; SCCAI, 5 [IQR, 4-6]; UCEIS, 4 [IQR, 3-5]). Clinical response (57.1% vs 28.3%; odds ratio [OR], 3.4; 95% confidence interval [CI], 1.4-7.9; P = .01), remission (53.1% vs 28.3%; OR, 2.9; 95% CI, 1.2-6.7; P = .02), and proportion of patients with fecal calprotectin (FCP) <150 μg/g (30.6% vs 6.5%; OR, 6.3; 95% CI, 1.7-23.6; P = .003) were significantly higher in CW. The relative abundance of bacterial taxa that had a significant or trend towards negative correlation with SCCAI, UCEIS, or FCP increased at 8 weeks in CW, and this effect was independent of disease activity and dietary fiber. Adverse events were comparable, and no patient developed hyperkalemia.

Conclusions: CW was more effective than placebo for induction of clinical remission in patients with mild to moderate UC. The trial was prospectively registered on Clinical Trials Registry of India (ctri.nic.in, Number: CTRI/2019/03/01827).

Keywords: Diet; Inflammation; Inflammatory Bowel Disease; Minerals; Sodium.