Can Bilberry Extract Be the Next Big Thing in Ulcerative Colitis Management?

A recent study explored the potential benefits of anthocyanin-rich extract, derived from bilberries, in treating moderate-to-severe ulcerative colitis. This multi-center, randomized, placebo-controlled, double-blind study aimed to evaluate anthocyanin-rich extract’s efficacy in improving clinical, endoscopic, and biochemical markers in ulcerative colitis patients.

The study, originally planned for 100 participants, was prematurely concluded due to the COVID-19 pandemic. Patients with moderate-to-severe active ulcerative colitis, as determined by a Mayo score of 6-12 and an endoscopic sub-score ≥ 2, were randomly assigned to either anthocyanin-rich extract or placebo groups at baseline.

The primary endpoint was defined as a clinical response at week 8, indicated by a reduction of at least 3 points in the total Mayo score. Secondary endpoints included changes in fecal calprotectin levels and a centrally evaluated endoscopic response.

Out of 48 patients from six Swiss centers, 34 were randomized. The per-protocol analysis included 18 patients in the anthocyanin-rich extract group and 8 in the placebo group. Half of the anthocyanin-rich extract patients (9/18) showed a clinical response, compared to 3/8 in the placebo group (p = 0.278). The anthocyanin-rich extract group demonstrated a higher rate of Mayo score improvement (77.8%) compared to the placebo group (62.5%).

Notably, the anthocyanin-rich extract group experienced a significant decrease in fecal calprotectin levels, from 1049 ± 1139 to 557 ± 756 μg/g, while the placebo group showed no improvement (947 ± 1039 to 1040 ± 1179 μg/g; p = 0.035). Serious adverse events were infrequent throughout the study.

Although anthocyanin-rich extract treatment did not demonstrate significant superiority over placebo in terms of clinical response, the study revealed a marked reduction in FC levels in the anthocyanin-rich extract group, suggesting potential efficacy in managing ulcerative colitis. The researchers noted an unusually high placebo response, which may have influenced the overall results.

Commentary by YourDailyFit columnist Alice Winters:

The exploration of anthocyanin-rich extract (ACRE) from bilberries as a potential treatment for ulcerative colitis represents an intriguing avenue in the realm of natural supplements for inflammatory bowel diseases. This study, while hampered by the unforeseen challenges of the COVID-19 pandemic, offers some valuable insights and raises important questions for future research.

First and foremost, the reduction in fecal calprotectin (FC) levels in the ACRE group is particularly noteworthy. FC is a well-established biomarker for intestinal inflammation, and its significant decrease in the treatment group suggests that ACRE may indeed have anti-inflammatory properties beneficial for ulcerative colitis patients. This finding aligns with previous research on the anti-inflammatory effects of anthocyanins, the potent antioxidants found in bilberries and other dark-colored fruits.

However, the study’s limitations cannot be overlooked. The small sample size, a consequence of the pandemic-induced early termination, significantly reduces the statistical power of the results. This is evident in the lack of statistical significance in the primary endpoint of clinical response, despite the numerically higher response rate in the ACRE group.

The unusually high placebo response rate is another point of interest. This phenomenon is not uncommon in ulcerative colitis trials and highlights the complex nature of this condition, where psychological factors and the natural course of the disease can significantly influence outcomes. It underscores the need for larger, more robust studies to truly elucidate the efficacy of ACRE in ulcerative colitis management.

From a supplement perspective, ACRE shows promise as a natural adjunct therapy for ulcerative colitis. Its safety profile appears favorable, with few serious adverse events reported. This is crucial for ulcerative colitis patients, who often contend with the side effects of conventional treatments. However, more extensive safety data would be necessary before widespread recommendation.

The formulation and dosage of ACRE used in this study warrant further investigation. Standardization of anthocyanin content and optimal dosing regimens need to be established to ensure consistent results across different patient populations. Additionally, the bioavailability and metabolism of anthocyanins in the gut should be explored to better understand their mechanism of action in ulcerative colitis.

While the results are encouraging, they also highlight the challenges in developing natural supplements for complex conditions like ulcerative colitis. The interplay between diet, gut microbiome, and inflammation is intricate, and isolating the effects of a single compound or extract is challenging. Future studies might benefit from a more holistic approach, perhaps combining ACRE with other anti-inflammatory nutrients or probiotics.

In conclusion, this study on ACRE opens up an exciting avenue for natural ulcerative colitis management, but it’s clear that we’re just scratching the surface. The promising FC results juxtaposed with the inconclusive clinical outcomes underscore the need for larger, more comprehensive trials. As we continue to unravel the potential of natural compounds in managing inflammatory conditions, ACRE from bilberries remains a compelling candidate worthy of further scientific scrutiny and cautious optimism.