Germinated barley foodstuff feeding. A novel neutraceutical therapeutic strategy for ulcerative colitis

A germinated barley foodstuff (GBF) contained glutamine-rich protein and the hemicellulose-rich fiber was made from brewer's spent grain by physical isolation (milling and sieving). Both in vivo and in vitro studies demonstrated that the fiber fraction of GBF supports maintenance of epithelial cell populations, facilitates epithelial repair, and suppresses epithelial nuclear factor kappa B-DNA binding activity through generating increased short-chain fatty acid (especially butyrate) production by luminal microflora which includes Bifidobacterium and Eubacterium, thereby preventing experimental colonic injury. The fiber fraction also modulates stool water content by its high water-holding capacity. The protein fraction which contains larger glutamine prevents experimental small bowel injury. Based on these observations, clinical studies were initiated in patients with mild to moderate active ulcerative colitis. The patients who had been unresponsive to or intolerant of standard treatment received 30 grams of GBF feeding daily in a nonrandomized, open-label fashion. At 4 weeks, this treatment resulted in a significant clinical and endoscopic improvement independent of disease extent. The improvement was associated with an increase in stool butyrate concentrations and in luminal Bifidobacterium and Eubacterium levels. After the end of GBF treatment the patients had an exacerbation of the disease. GBF was safe and well tolerated. These results indicate that GBF feeding is a potentially attractive treatment in patients with ulcerative colitis.