Question explored with the scientific record
Search for natural solutions to proctitis
The short version: the evidence for natural interventions in proctitis is thin, mostly from animal models and small pilot studies, and no trial has compared a natural approach to standard care in a head-to-head design.
The retrieved evidence contains almost nothing that directly tests a natural intervention for proctitis in humans. The closest studies are a pilot trial of curcumin in inflammatory bowel disease [17], a rat study of the flavonoid combination diosmin + hesperidin for radiation proctitis [18], and a case report of stem-cell therapy [16]. None of these were funded by a manufacturer, but all are small, early-stage, and unconfirmed. The curcumin study [17] showed symptom improvement in 5 patients with ulcerative proctitis or Crohn's, but it had no control group and no blinding. The rat study [18] found that diosmin + hesperidin reduced mucosal inflammation after radiation, but rats are not humans and the dose (100 mg/kg/day) is far above what a person would take from a supplement. The stem-cell case report [16] is a single patient.
The rest of the evidence is about drug therapies (5-ASA, tacrolimus, biologics) [15, 19, 24, 26, 29], the natural history of proctitis [28, 31], or dietary fiber's effects on glucose metabolism [1-12], which is a different question entirely. No study compared a natural intervention to a placebo or to standard drug therapy in a randomized, blinded trial with hard clinical endpoints. The absence of such a trial is not proof that natural interventions do not work, but it means the burden of proof has not been met.
My call: the evidence for any natural intervention in proctitis is too weak to recommend one over standard care or over watchful waiting. Confidence: low.
Sources used 22
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The Effect of Dietary Fiber on Glucose and Hormone Responses to a Mixed Meal in Normal Subjects and in Diabetic Subjects With and Without Autonomie Neuropathy
This study investigates the effects of dietary fiber on glucose and hormone responses to a mixed meal in both normal and diabetic subjects, revealing that fiber improves glucose tolerance without altering insulin or GIP levels, particularly in those without autonomic neuropathy.
DOI: 10.2337/diacare.3.4.515 -
Arabinoxylan Fibre Consumption Improved Glucose Metabolism, but did not Affect Serum Adipokines in Subjects with Impaired Glucose Tolerance
The study investigates the effects of arabinoxylan, a soluble dietary fiber, on serum glucose, insulin, lipids, and adipokines in adults with impaired glucose tolerance, finding significant reductions in fasting serum glucose and triglycerides without changes in adipokine levels.
DOI: 10.1055/s-2006-955089 -
Male grower pigs fed cereal soluble dietary fibres display biphasic glucose response and delayed glycaemic response after an oral glucose tolerance test
This study investigates the effects of cereal soluble dietary fibers, specifically wheat arabinoxylan and oat β-glucan, on glucose tolerance and postprandial hormone responses in male grower pigs, revealing no significant dietary effects on glycaemic control despite a biphasic g…
DOI: 10.1371/journal.pone.0193137 -
Fiber or No Fiber in Tube‐Fed Patients
A physician letter disputing a 1990 JPEN study that claimed dietary fiber in tube-feeding formulas improves gastrointestinal tolerance, arguing that the data do not support the conclusion and highlighting methodological flaws.
DOI: 10.1177/014860719201600191 -
Effect of dietary oat and soy fiber on bowel function and clinical tolerance in a tube feeding dependent population.
This study investigates the effects of a dietary fiber combination of oat and soy on bowel function and clinical tolerance in tube-fed patients, finding that fiber significantly increases bowel movements and fecal weight without adverse effects.
DOI: 10.1080/07315724.1994.10718448 -
Arabinoxylan consumption decreases postprandial serum glucose, serum insulin and plasma total ghrelin response in subjects with impaired glucose tolerance
This study investigates the effects of arabinoxylan consumption on postprandial serum glucose, insulin, and ghrelin responses in subjects with impaired glucose tolerance, finding that arabinoxylan significantly reduces serum glucose, insulin, and total ghrelin levels after a liq…
DOI: 10.1038/sj.ejcn.1602525 -
Inappropriate Use of Parenteral Nutrition in the Intensive Care Unit
This study evaluates the effectiveness of two fiber-containing enteral products in preventing gastrointestinal intolerance in critically ill patients, finding no significant difference between them.
DOI: 10.1016/j.jada.2008.06.093 -
Could dyslipidemic children benefit from glucomannan intake?
In a double-blind, randomized, cross-over trial in 36 dyslipidemic children, glucomannan supplementation modestly lowered total cholesterol, LDL-C, and non-HDL-C (with sex-specific effects favoring girls for TC/LDL-C) and was well tolerated, suggesting glucomannan as a feasible …
DOI: 10.1016/j.nut.2013.02.010 -
Effects of Higher Dietary Protein and Fiber Intakes at Breakfast on Postprandial Glucose, Insulin, and 24-h Interstitial Glucose in Overweight Adults
In overweight adults, breakfast with higher protein and higher fiber did not change postprandial glucose or 24-h interstitial glucose, but higher fiber attenuated postprandial insulin, suggesting fiber may improve insulin efficiency without lowering glucose acutely.
DOI: 10.3390/nu9040352 -
Arabinoxylan fiber, a byproduct of wheat flour processing, reduces the postprandial glucose response in normoglycemic subjects
This study investigates the effects of arabinoxylan-rich fiber extracted from wheat flour byproducts on postprandial glucose and insulin responses in healthy individuals, demonstrating significant reductions in both metrics with increasing fiber content.
DOI: 10.1093/ajcn/71.5.1123 -
Supplementation of cassava fiber counteracts high sugar diet-induced metabolic syndromes by maintaining glucose and lipid homeostasis
Cassava fiber supplementation in high-sugar-fed mice reduces hyperphagia, improves glucose tolerance, and lowers LDL cholesterol, suggesting cassava fiber may counter diet-induced metabolic syndrome.
DOI: 10.5455/faa.41875 -
Safety Assessment of Cassava Pulp-Derived Dietary Fiber: Acute and Sub-Acute Toxicity Evaluation
This study rigorously evaluated the safety profile of dietary fiber extracted from cassava pulp through acute and sub-acute oral toxicity assessments in Wistar rats, finding it to be well tolerated with a high margin of safety, although some histopathological changes in the lung…
DOI: 10.3390/toxics13060473 -
Drug Therapies for Ulcerative Proctitis
This systematic review and meta-analysis evaluates the efficacy of drug therapies, particularly topical 5-aminosalicylic acid (5-ASA), for inducing and maintaining remission in patients with ulcerative proctitis, finding that 5-ASA is significantly more effective than placebo.
DOI: 10.1097/MIB.0000000000000141 -
Management of radiation-induced proctitis using submucosal endoscopic injections of autologous adipose-derived stromal vascular fraction: a case report
A case report describing endoscopic submucosal injections of autologous adipose-derived stromal vascular fraction (SVF) to treat radiation-induced proctitis in a 76-year-old patient, showing epithelial healing, reduced inflammation, and sustained remission of bleeding over 12 mo…
DOI: 10.1186/s13287-024-04017-3 -
Curcumin Therapy in Inflammatory Bowel Disease: A Pilot Study
This pilot study investigates the effects of curcumin therapy on patients with inflammatory bowel disease, showing improvements in symptoms and inflammatory markers in both ulcerative proctitis and Crohn's disease patients.
DOI: 10.1007/s10620-005-3032-8 -
The effect of a flavonoid fractions diosmin + hesperidin on radiation-induced acute proctitis in a rat model
An experimental rat study evaluating whether the flavonoid fraction Daflon (diosmin + hesperidin) can mitigate radiation-induced acute proctitis, showing reduced mucosal inflammation and glandular distortion with Daflon treatment compared to irradiation alone.
DOI: 10.4103/0973-1482.82927 -
Systematic review: the use of tacrolimus in steroid-refractory ulcerative colitis
Systematic review evaluating tacrolimus (systemic and topical) for steroid-refractory ulcerative colitis and ulcerative proctitis, showing potential short-term efficacy comparable to anti-TNFs in UC and promising topical therapy for proctitis, but with uncertain long-term outcom…
DOI: 10.1177/20406223251333570 -
Rectal tacrolimus in the treatment of resistant ulcerative proctitis
This pilot study demonstrates that topical rectal tacrolimus ointment can effectively induce remission in patients with resistant ulcerative proctitis, with a high tolerance and minimal adverse effects.
DOI: 10.1111/j.1365-2036.2008.03841.x -
The Role of Topical Tacrolimus in the Management of Inflammatory Bowel Disease: A Comprehensive Review
Comprehensive review of the efficacy and safety of topical tacrolimus for inflammatory bowel disease (including distal colitis and cutaneous manifestations), highlighting potential benefits in select patients but noting limited high-quality evidence and the need for further comp…
DOI: 10.3390/jcm13185518 -
Clinical Predictors and Natural History of Disease Extension in Patients with Ulcerative Proctitis
This study investigates the clinical predictors and natural history of disease extension in patients with ulcerative proctitis, finding that obesity, appendectomy, and endoscopic severity at diagnosis are associated with an increased risk of disease extension.
DOI: 10.1097/MIB.0000000000001214 -
Diagnosis and Treatment of Ulcerative Proctitis
A 2004 clinical review detailing the diagnosis and treatment of ulcerative proctitis, arguing that topical 5-aminosalicylic acid therapies are the primary first-line treatment, with various topical formulations offering rapid symptom control, and outlining maintenance strategies…
DOI: 10.1097/01.mcg.0000139178.33502.a3 -
Clinical pattern and progression of ulcerative proctitis in the Japanese population: a retrospective study of incidence and risk factors influencing progression
This retrospective study of 66 Japanese patients with ulcerative proctitis followed from 1979 to 2014 quantified disease extension rates (up to 20 years) and identified younger age at onset and corticosteroid use as independent risk factors for proximal extension, with a small n…
DOI: 10.1111/codi.13237