Coconut water was more effective than placebo for induction of clinical remission in patients with mild to moderate ulcerative colitis.

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

Sameer Kedia, Shubi Virmani, Aditya Bajaj, Manasvini Markandey, Nasib Singh, Divya Madan, Kanav Kaushal, P K Sahu, Sudheer Kumar Vuyyuru, Bhaskar Kante, Pasupulati Anil Kumar, D Paul Thomas, Sandeep Kumar Mundhra, Meenakshi Singh, Myank Verma, Radha Sharma, Partha Das, Nihar Ranjan Dash, Nitika Monga, Anupam Awasthi, Govind Makharia, Vineet Ahuja

Clin Gastroenterol Hepatol

May 31, 2024

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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)