Hi Chepsy,

Since Gut GVHD look-and-feel and symptoms are very close to those of both Coeliac Disease and IBS I would suggest a gluten-free, low carbohydrate (50~100g/day) and low FODMAPs diet. As soon results would appear, try to identify pacient-specific FODMAPs aggressors and then return to the diet the non-aggressors foods so that diet becomes less restrictive.

For Low FODMAP Diet, try the Stanford approach:

https://stanfordhealthcare.org/content/dam/SHC/for-patients-component/programs-services/clinical-nutrition-services/docs/pdf-lowfodmapdiet.pdf

My thinking is that the diet would continue without changes as long Gut GVHD persists.

Thank you silvio. Are they following this approach at Stanford for gut GvHD?? would be helpful to know the experience.

Chepsy, they 're surely following this approach for IBS. I've just suggested it for applying to GvHD but there are several other approaches, such as Monash University approach (http://www.med.monash.edu/cecs/gastro/fodmap/). Maybe you could contact both and check it for sure.

I wonder if you are developing some research about GvHD or just trying to help a patient. I've found that deficiencies in the IL-2 pathway may cause reduced regulatory T cells (Tregs) function and an increased risk of autoimmunity and recent researches found out that IL-2 and IL-2RA are genetically associated with autoimmune diabetes (mainly T1DM) and the functional state of Tregs, aiming dramatic clinical success with IL-2 therapy in chronic GvHD.

What gives low FODMAPs diet? Somehow it may improve Tregs and thus improving IL-2 half-life. Consequently GvHD subjects get improvements in their heath.

If you apply such approach to your patient (a gluten-free, low carbohydrate (50~100g/day) and low FODMAPs diet) please keep in touch and report the results, I would be very happy to see them.

Thank You Silvio.

It is for a patient.

I was not sure what your question actually was, so was hesitant to answer earlier

Here at The Ottawa Hospital, we have a 4 step GVHD diet progression from a modified clear fluid up to a modified low fibre type.  Our dietitian in our BMT program could give you more details, if you wish.

Thank you Joseph.That will definitely be helpful.

How do i contact the dietician. Wanted to know how do you decide to go up on the phases or come down. Is there a criteria you use??