GI Permeability Change in Response to Aquamin®

This is a sub-study to the ongoing clinical trial entitled: Aquamin®, a multi-mineral natural product from red marine algae, as an adjuvant intervention for mild ulcerative colitis and ulcerative colitis in remission (HUM00156676) NCT# NCT03869905.

• Aquamin (Drug), also known as Nutritional: Participants will take a 90-day supply of Aquamin®, 4 capsules per day; 2 to be taken in the morning and 2 in the evening (containing approximately 800 mg calcium/day).

Primary outcomes

• Change in the Lactulose:Mannitol Ratio in Urine by Comparing Values at 90-days (Post-intervention) to Baseline (Pre-intervention) Levels. [Baseline (pre-intervention), 90 days (post-intervention)]
• Mannitol Levels in Urine Samples [90 days]: Though lactulose measurements could not be taken from urine samples, the study team was able to measure mannitol levels in those samples. Higher mannitol levels in urine indicate higher levels of permeability. Participants provided baseline urine samples before drinking a mixture of lactulose/mannitol powder and water. Additional samples were then provided within 0-2 hour window, within a 2-8 hour window, and within an 8-24 hour window of drinking the lactulose/mannitol solution. This test was performed on "day 0" (prior to the participant beginning Aquamin treatment) and day 90 (after the participant had been taking Aquamin for 90 days).

Sex: All, ages: 18 Years to 80 Years, accepts healthy volunteers

Inclusion Criteria for UC participants:

* Must be able to give written informed consent
* Age 18 to 80 years old.
* Must have: Ulcerative colitis with confirmed diagnosis by histology and endoscopy; and be in stable remission for 3 months or more without therapy or with maintenance therapy (except steroids and antibiotics for 3 months) or have mild ulcerative colitis. Note: Corticosteroids (a type of steroid drug such as prednisone or cortisol that helps the body to regulate stress response, immune response and inflammation) and antibiotics can be used during a flare-up once the study has begun and the subject enrolled.
* A negative pregnancy test for pre-menopausal women with intact female reproductive organs. Must agree to use appropriate birth control over the study period (if applicable).

If cessation of menses is within 12 months, then the participant will be treated as pre-menopausal and a pregnancy test will be performed.

Inclusion Criteria for Healthy participants:

* Must be able to give written informed consent
* Be generally healthy, male or female, ages 18 to 80 years old.
* Pre-menopausal women with intact female reproductive organs must have a negative pregnancy test within 2 weeks of the Baseline Visit.
* Subject must agree to use appropriate birth control over the study period. (Post-menopausal is defined as no menses for the previous 12 months. If cessation of menses is within 12 months, then the participant will be treated as pre-menopausal and a pregnancy test will be performed.

Inclusion Criteria for participants with IBS-D:

* Patients with ages 18-80 years old.
* Must meet the IBS-D Diagnostic Rome IV (four) Criteria as noted in the protocol
* A negative pregnancy test for pre-menopausal cis-women with intact vagina, uterus, and/or ovaries. The negative pregnancy test must be within 2 weeks of the baseline visit and the subject must agree to use appropriate birth control over the study period.

Exclusion Criteria For UC participants:

* Must not be pregnant or lactating
* Must not be participating in any other interventional trial using an investigational drug.
* Subjects likely to be uncooperative or unable to comply with study procedures
* Participants must not be felt to have active ulcerative colitis for 3 months before study enrollment (with an exception of mild ulcerative colitis).
* Participants must not have a history or diagnosis of any of the following conditions:

Crohn's disease, Any stomach or intestinal bleeding disorders (gastrointestinal bleeding from gastric or duodenal ulcers, or gastrin secreting tumors) or active gastric/duodenal ulcers - peptic ulcer disease (without bleeding in last 3 months).

* Must not have any gastrointestinal or colonic malignancy.
* Must not have Kidney disease, including kidney "stones" or hypercalcemia.
* Must not have Coagulopathy/hereditary hemorrhagic disorders
* Participants will be excluded if they have taken certain medications (per protocol), within the last 30 days or are unwilling to forgo the following for 30 days prior to entry into the study.

Exclusion Criteria For Healthy participants:

* Must not be pregnant or lactating.
* Must not be participating in any other interventional trial using an investigational drug.
* Participants must not have a history or diagnosis of any of the following conditions:

Kidney disease, including kidney "stones" or hypercalcemia, Crohn's disease, Neurologic disease, other inflammatory bowel disease, any stomach or intestinal bleeding disorders (gastrointestinal bleeding from gastric or duodenal ulcers, or gastrin secreting tumors) or active gastric/duodenal ulcers - peptic ulcer disease (without bleeding in last 3 months).

* Not have Coagulopathy/hereditary hemorrhagic disorders
* Any gastrointestinal or colonic malignancy.
* Participants will be excluded if they have taken certain medications (per protocol), within the last 30 days or are unwilling to forgo the following for 30 days prior to entry into the study.

Exclusion Criteria for participants with IBS-D:

* Must not be pregnant or lactating
* Must not be participating in any other interventional trial using an investigational drug.
* Participants must not have a history or diagnosis of Crohn's disease or Inflammatory bowel disease, any stomach or intestinal bleeding disorders (gastrointestinal bleeding from gastric or duodenal ulcers, or gastrin secreting tumors) or active gastric / duodenal ulcers - peptic ulcer disease (without bleeding in last 3 months).
* Must not have any gastrointestinal or colonic malignancy.
* Must not have kidney disease, including kidney "stones" or hypercalcemia, Coagulopathy/hereditary hemorrhagic disorders, neurologic disease
* Participants will be excluded if they have taken certain medications (per protocol), within the last 30 days or are unwilling to forgo the following for 30 days prior to entry into the study.

Participant flow

Outcome results

• Change in the Lactulose:Mannitol Ratio in Urine by Comparing Values at 90-days (Post-intervention) to Baseline (Pre-intervention) Levels. (Primary)
• Mannitol Levels in Urine Samples (Primary), Mean, mgs: Aquamin® - Healthy Subjects 68.54 +/- 85.03; Aquamin® - Subjects With Ulcerative Colitis 110.35 +/- 92.70 (p 0.322)

Adverse events

Time frame: Up to 95 days

Other adverse events by term

• Results publication: Aslam MN, Turgeon DK, Appelman HD, Stidham R, McClintock S, Allen R, Moraga G, Harber I, Jencks KJ, McNeely MM, Sen A, Jepsen KJ, Varani J. A multi-mineral intervention to improve disease-related and mechanistic biomarkers in ulcerative colitis patients: Results from a randomized trial. PLoS One. 2025 Dec 8;20(12):e0337408. doi: 10.1371/journal.pone.0337408. eCollection 2025. PMID 41359652
• Results publication: Aslam MN, Turgeon DK, McClintock S, Allen R, Sen A, Varani J. A Multi-Mineral Intervention Improves Intestinal Permeability in Patients with Ulcerative Colitis: Results from a 90-Day Pilot Trial. medRxiv [Preprint]. 2026 Jan 30:2026.01.28.26345064. doi: 10.64898/2026.01.28.26345064. PMID 41646788
• Results publication: Aslam MN, Turgeon DK, McClintock S, Allen R, Sen A, Varani J. A multi-mineral intervention is associated with improved intestinal permeability in patients with ulcerative colitis: results from a pilot trial. Front Med (Lausanne). 2026 Jun 22;13:1805900. doi: 10.3389/fmed.2026.1805900. eCollection 2026. PMID 42440705

• Study Protocol and Statistical Analysis Plan (PDF, 2024-02-23)
• Informed Consent Form (PDF, 2026-03-05)

• James Varani, Principal investigator, University of Michigan
• Muhammad N Aslam, Study director, University of Michigan