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Gila Sasson, MD



Job Title

BWH Associate Physician

Academic Rank





Joshua Korzenik, MD, Gila Sasson, MD, MS, Demsina Babazadeh, MPH, RD, LDN, CNSC, Shelley Hurwitz, Maia Paul, MPH, Nadine Javier, BS, Christopher Bowlus, MD, Linda Gray, MPH, RD, CDE,Francene Steinberg, PhD, RD, Elaine Souza, MPH, RD, Alexandra Austin, BA

Principal Investigator

Dr. Joshua Korzenik

Research Category: Other


A Pilot Study Examining a Vegan/Low-Sulfur Diet Versus the Specific Carbohydrate Diet in Patients with Primary Sclerosing Cholangitis

Scientific Abstract

BACKGROUND: Little is known about the clinical implications of dietary modulation in PSC. An emerging dietary therapy may stem from ulcerative colitis studies that suggest high-sulfur/high-protein diet is associated with increased disease risk. This study compares the effects of SCD and low-sulfur diet on parameters in PSC. We propose that SCD, with high-protein content, would increase activity and low-sulfur diet would reduce activity, as assessed by alkaline-phosphatase (ALP).
METHODS: Twenty participants (ALP >1.5xULN) were randomized 1:1 to low-sulfur diet (group 1) and SCD (group 2). Trial was 8 weeks under dietitian supervision. Participants attended 7 video visits with dietitians. Diet was assessed using 3-day food diaries every 2 weeks and a baseline Food Frequency Questionnaire. Participants submitted Patient Report Outcome questionnaires every 2 weeks, and bloodwork and stool every 4 weeks.
RESULTS: Our preliminary analysis demonstrates that a low-sulfur diet is associated with improved liver biochemistry and that ALP response appears to be driven by protein consumption. We observed decreases in liver enzymes in group 1 as early as week 4 (ALP: P=0.01415, ALT: P=0.01721, AST: P=0.04105).

Lay Abstract

Dietary manipulation has gained interest as a potential therapeutic approach for Primary Sclerosing Cholangitis (PSC) given its presumed influence on the intestinal microbiome. This study seeks to explore the effects of dietary-intervention in PSC by comparing the Specific Carbohydrate Diet (SCD) and a low-protein(low-sulfur) diet.
Twenty participants were randomly assigned to the SCD or low-protein diet. Participants had 7 video-visits with a dietitian and submitted food diaries, symptom questionnaires and blood and stool samples regularly.
A preliminary analysis of dietary differences and liver enzymes was available at the time of abstract submission. The low-protein group documented low protein intake throughout the study and the SCD group documented low carbohydrate intake. . Liver enzymes (ALP, ALT and AST) were significantly improved (decreased) in the low-protein group as early as week 4, which was not seen in the SCD group.
In conclusion, our study so far demonstrates that a low-protein (low-sulfur) diet is associated with improved liver enzymes. ALP improvement appears to be driven by low protein intake. Our next steps include studying the effects of diet on the gut microbiome, metabolites and bile acids, and how this influences clinical parameters of PSC.

Clinical Implications

The pathogenesis of Primary Sclerosing Cholangitis (PSC) is poorly understood, however the composition/functional changes of gut-microbiome are highlighted. Little is known about the clinical-implications of dietary modulation in PSC given a lack of dietary-trials, which this study hopes to undo.