Second Line Induction Therapy and Healthy Diet for Patients With Ulcerative Colitis

Advanced therapies included will be:

JAK inhibitors (tofacitinib or upadacitinib) IL-23 inhibitors (ustekinumab or risankizumab) Anti-TNF (infliximab)

Patients will be provided these medications as part of their standard of care, as decided by their treating physician.

Inclusion criteria

• Patients with ulcerative colitis who are beginning tofacitinib therapy.
• Patients with ulcerative colitis who are initiating second line biologic therapy with ustekinumab
• Patients with ulcerative colitis who are initiating second line biologic therapy with infliximab
• Patients aged 18 years or older.
• Patients with active disease defined as simple clinical colitis activity index (SCCAI) >2
• Patients who have not been on antibiotics for 2 weeks or probiotics.

Exclusion criteria

• Patients younger than 18 years.
• Patients that do not meet the inclusion criteria specified above.
• Patients with clinical signs of fulminant colitis, toxic megacolon, ischemic colitis or impending hospitalization for severe ulcerative colitis.
• Patients with concomitant infectious colitis.
• Patients allergic nuts/soy/sesame/oats.
• Patients who do not like the food items that form part of the kits for the fasting mimicking diet (see below).
• Patients that are diabetics on a glucose lowering drug.
• Individuals with a history of syncope/presyncope with fasting or from medical conditions.
• Women who are pregnant or nursing.
• Individuals with very low BMI< or equal to 18.
• Patients with the following comorbidities: chronic kidney disease, diabetes, active cancer.
• Prohibited concomitant therapies will include TNF antagonists, azathioprine, methotrexate, and mercaptopurine.
• Patients who routinely have fasting eating habits