Inflammatory bowel disease affects an estimated 1.5 million individuals in the United States alone. Approximately 2.2 million individuals experience inflammatory bowel disease in Europe, with a comparable number of estimated cases in the rest of the world. There are many different diseases that fall under the term inflammatory bowel disease, including Crohn’s disease and ulcerative colitis. These diseases are classified by chronic inflammation of the digestive tract, and can vary in severity over time.
Diet is not thought to cause inflammatory bowel disease, but it can aggravate symptoms. Depending on the type and severity of the disease, it can be difficult for the body to receive or process the proper nutrients to keep the body healthy. Foods interact with a complex system of microbes that live inside the gastrointestinal tract, and how the interaction with the bacteria occurs can affect the outcome of a person’s symptoms.
In some cases, symptoms can spread beyond the digestive tract, or even progress into cancerous bodies. Having inflammatory bowel disease increases a person’s risk of developing colon cancer, and because the symptoms of cancer can be the same as the symptoms of inflammatory bowel disease, it is important to test for cancer frequently. Maintaining a beneficial and low-impact diet can help reduce the symptoms of inflammatory bowel disease, and help reduce the risk of developing cancerous ulcers or tumors.
Recent studies have focused on a group of foods that seem to have a positive impact on inflammatory bowel disease: fruits. Certain fruits break down into secondary plant compounds that metabolize and interact positively with bacteria in the intestine. Most prevalent among these is mango. Dr. Susanne Talcott of Texas A&M AgriLife Research recently led an investigation into the use of mango as a supplement to conventional therapy in cases of mild or moderate inflammatory bowel disease.
Conducting the Study on Mango Consumption
Dr. Talcott and her team, which included her husband, Dr. Stephen Alcott, sought to investigate the impact that mango have on humans. They were specifically observing a group of compounds called mango polyphenolics. Polyphenols are made up of chains of phenols, which can be found naturally in both plants and microorganisms. As part of the study, participants ate mango as part of their regular treatments, and closely reported their daily intake.
The study was designed as a controlled clinical pilot trial by Dr. Talcott while studying inflammatory bowel disease at Texas A&M. Participants were recruited from College Station and the Ertan Digestive Disease Center at the Memorial Hermann Hospital in Houston. Both males and females were enrolled in the study, and their ages ranged from 18 to 79. All had been diagnosed with mild or moderate cases of either Crohn’s disease or ulcerative colitis.
Those who participated in the study were required to have been on a treatment program within the six months leading up to the study. Talcott and her team wanted to ensure that the participants were on stable drug programs, and that the results of the study would show improvement from mango, not from efficacy of other treatments. Those who had not been on a stable drug regimen for at least three weeks were not able to participate in the study.
In order to keep the results of the study within a defined region, several other groups of people were excluded from the study. Smokers were excluded, as well as those who had liver or renal dysfunction. Those with dietary issues such as gluten sensitivity, lactose intolerance, and celiac disease were excluded. Women who were pregnant or lactating were also excluded. Finally, those who had an upcoming surgery related to inflammatory bowel disease, or who had developed a complication from inflammatory bowel disease, were excluded from the study.
After more than 300 subjects were evaluated, 20 were found eligible and able to participate. Of those selected to participate, 14 were able to successfully complete the study. While the sample size was relatively small, Dr. Talcott claims that “the study yielded significant findings” and that “several biomarkers would have been significantly reduced with a higher number of subjects.”
Adding Mango to the Diet
The subjects who participated in the study were provided with 200-400 grams of Keitt frozen mango, and were asked to add these mango into their daily diet. This variety of mango is available commercially. Participants began with smaller portions of mango, and were asked to steadily increase their mango intake after the first week of the study. Dr. Talcott allowed subjects to skip days or reduce the intake to accommodate digestive issues, which can be common for those suffering from an inflammatory bowel disease, provided that they documented mango intake every day.
Every person’s body processes food in slightly different ways, and Dr. Talcott anticipated this in her study. In order to better study the effects, Dr. Talcott had patients increase their mango intake after a period of building tolerance to mango. She said that “since the tolerability of large amounts of fiber-rich fruit varies between subjects and for each patient over time, this study allowed subjects to consume mango within a range rather than a fixed amount.”
For eight weeks, participants recorded their daily intake of mango. They increased the amount of mango consumed on average from approximately 200 grams of mango twice a day, to 400 grams of mango three times a day. Talcott was hopeful that mango and other polyphenolic-rich fruits would have a significant enough impact on inflammatory bowel disease that it would be included in conventional treatment options.
Results of the Study
In the 14 patients who completed the study, symptoms of ulcerative colitis were significantly reduced. Upon checking certain biomarkers, Talcott discovered that those associated with inflammation had also been significantly decreased. Perhaps most surprising and exciting was the discovery that GRO, a molecule that is thought to cause the growth of colon cancer, was significantly less present after the regular consumption of mango.
Talcott and her team examined the gut flora of the participants after the study, seeking answers in the complex system of bacteria that live within the gastrointestinal tract. They discovered that several beneficial probiotic bacteria had been significantly increased, which led to an increase in certain fatty acids that are essential to healthy GI tracts. Improving the composition of the gut flora has other benefits outside of inflammatory disease, and opened the door for more studies on how the diet affects the body and mind.
Another key area of success in the study was in serum endotoxin levels. Endotoxins are associated with intestinal inflammation, and have been identified as key factors in other chronic inflammatory diseases. After the eight weeks of mango consumption, the participants were found to have significantly lower endotoxin levels in their blood plasma. This may lead directly to shorter and less frequent episodes of symptoms, and an overall reduction in their severity.
All of these results proved positive for the study, and may lead to future therapies involving polyphenolics. "Taken together, our results indicate mango intake exerted beneficial effects in the progression and severity of the IBD after eight weeks of nutritional intervention," she said. Those who participated in the study indicated that they would continue to keep mango as an essential part of their diet, going insofar as to recommend mango as a treatment to others who suffer from inflammatory bowel disease.