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Ulcerative Colitis Diet: Foods, Supplements and Natural Remedies
June 28, 2018
Ulcerative colitis is an inflammatory bowel disease that causes long-lasting inflammation and ulcer symptoms, or sores in the digestive tract. Ulcerative colitis affects the innermost lining of the large intestine and rectum.
This inflammatory disease can be debilitating, and sometimes it can even lead to life-threatening complications. Ulcerative colitis may lead to a narrowed area of the intestines, making it harder to pass stool. It may also lead to swelling in the colon, intense diarrhea, joint pain, and scarring of the bile ducts and pancreas.
Ulcerative colitis most often begins gradually and can become worse over time. The symptoms of this inflammatory disease can be mild to severe, and most people have periods of remission, times when the symptoms disappear, which can last for weeks or years. While there is no known cure for ulcerative colitis, there are natural treatments that can greatly reduce signs and symptoms of the disease and result in long-term remission.
New research continues to come out with hope for a more permanent treatment for ulcerative colitis and other inflammatory bowel diseases. A 2017 study found that the protein NLRP12 regulates inflammation in the body. Analysis found low levels of NLRP12 in twins with ulcerative colitis, but not in twins without the disease. When NLRP12 was low, there were lower levels of friendly bacteria as well as high levels of harmful bacteria and inflammation. Researchers believe they could add back more of the friendly bacteria in people with inflammatory bowel diseases with reduced NLRP12 expression to reduce inflammation and restore healthy bacteria, ending the cycle and offering treatment to those with ulcerative colitis. (1)
Symptoms of Ulcerative Colitis
Ulcerative colitis symptoms can vary, depending on the severity of inflammation and where it occurs; they typically develop over time. Most people experience mild to moderate symptoms, but the course of ulcerative colitis may vary and some people have long periods of remission. The symptoms depend on the location of the disease-causing inflammation. If you have ulcerative colitis, you may have the following signs and symptoms:
- Diarrhea, often with blood or pus
- Abdominal pain and cramping
- Rectal pain
- Rectal bleeding
- Urgency to discharge stool
- Inability to discharge stool, despite the urgency
- Weight loss
- Fatigue or chronic fatigue syndrome
- Failure to grow (in children)
Living with ulcerative colitis can lead to some serious health conditions and complications. These occurrences include:
- Severe bleeding
- A hole in the colon
- Severe dehydration
- Liver disease
- Bone loss
- Inflammation of the skin, joints and eyes
- Sores in the lining of the mouth
- An increased risk of colon cancer
- A rapidly swelling colon
- An increased risk of blood clots in veins and arteries
Diet and stress were always known to be the root causes of ulcerative colitis, but recently doctors have concluded that these factors may aggravate the inflammatory condition but do not cause it, according to the Mayo Clinic. (1b) One possible cause is an immune system malfunction. When the immune system tries to fight off an invading virus or bacterium, an abnormal immune response causes the immune system to attack the cells in the digestive tract.
Ulcerative colitis usually begins before the age of 30, but there are some cases when people did not develop the disease until after age 60. You are at a higher risk of developing ulcerative colitis if you have a close relative with the disease, such as a parent or sibling. Another major risk factor is a certain medication used to treat scarring cystic acne, called isotretinoin. In studies published in the American Journal of Gastroenterology, a link between the development of ulcerative colitis and isotretinoin was established. (2)
Stress can also cause a flare-up. It’s important to avoid stress, particularly chronic stress, by exercising, stretching, and practicing relaxation techniques and breathing exercises.
Conventional ulcerative colitis treatment usually involves either drug therapy or surgery, and according to a review done at Harvard Medical School, anti-inflammatory drugs are typically the first step in treatment. (3) Two common anti-inflammatory medications that are prescribed for ulcerative colitis include aminosalicylates and corticosteroids. Although these medications can be effective in reducing symptoms of ulcerative colitis, they come with a number of side effects.
For instance, some aminosalicylates, including mesalamine, balsalazide and olsalazine, have been associated with kidney and pancreas problems. Corticosteroids, which are given to patients with moderate to severe symptoms, have numerous side effects, including a puffy face, excessive facial hair, night sweats, insomnia and hyperactivity. More serious side effects of this type of medication includes high blood pressure, diabetes, osteoporosis, bone fractures, cataracts, glaucoma and increased chance of infection. This is why these conventional medicines and treatments are not utilized for long periods of time.
Immunosuppressant drugs are also used to treat ulcerative colitis. These medications suppress the immune system response that starts the process of inflammation in the first place. According to a study published in Digestive Diseases, the standard treatment of ulcerative colitis is directed towards inducing and maintaining remission of symptoms and mucosal inflammation. (4)
The key factor that is used by doctors to access the most appropriate treatment is the severity and extent of inflammation. Some other conventional treatment medications include antibiotics, which are given when a patient has a fever, anti-diarrheal medications, pain relievers and iron supplements, which are needed by patients who experience chronic intestinal bleeding and may develop iron deficiency anemia. Of course, relying too much on antibiotics can lead to antibiotic resistance.
In severe cases, surgery can eliminate ulcerative colitis, but it usually involves removing the entire colon and rectum. (5) According to a scientific review published in Surgical Treatment, the underlying rationale for surgical treatment of ulcerative colitis is that the disease is confined to the colon and rectum, and therefore proctocolectomy (rectum and colon removal) is curative.
In most cases, this involves a procedure called ileoanal anastomosis that eliminates the need to wear a bag to collect stool. In this case, a pouch is constructed at the end of the small intestine and then attached directly to the anus, allowing for the discharge of waste. In some cases, the surgeon is able to create a permanent opening in the abdomen so stool can pass through into a small bag that is attached.
To treat ulcerative colitis naturally, it’s important to understand that a healing diet is the foundation. Certain foods trigger an aggressive immune response and inflammation in the digestive tract, and these foods need to be pin-pointed and removed from your diet. Some problematic foods include dairy products, spicy foods and refined sugar. There are also beneficial foods that reduce inflammation and help with nutrient absorption, like omega-3 foods and probiotic foods.
Exercise is also an important factor in treating ulcerative colitis, since the benefits of exercise are so wide-ranging. Moderate-intensity exercise reduces stress, which is a root cause of this inflammatory disease. Exercise (especially yoga and swimming) also stimulates digestion, boosts the immune system and aids relaxation.
Relaxation is a vital element in combating ulcerative colitis because it calms the body and allows it to digest food more easily. Meditation, stretching and breathing practices can help improve circulation, regulate the digestive system, and keep the body out of fight or flight mode.
Foods to Avoid
The foods that make ulcerative colitis worse typically depend on the person and the location of inflammation. For some people, fiber is bothersome during flare-ups because high-fiber foods are harder to digest. Removing fibrous foods like nuts, seeds, whole grains, and raw fruits and vegetables from the diet is sometimes called a low-residue diet. Although this can help people with ulcerative colitis to ease pain, cramps and other symptoms, it does not get rid of inflammation.
If raw fruits and vegetables lead to discomfort, it may help to steam, bake or stew them. This makes foods in the cabbage family, such as nutrient-dense broccoli and cauliflower, easier to digest. Some other problematic products include spicy and fatty foods and caffeinated, carbonated drinks.
People with ulcerative colitis may have trouble with these foods and drinks:
- carbonated drinks
- dairy products (for people who are lactose intolerant or sensitive)
- raw fruits and vegetables
- dried beans, peas and legumes
- dried fruits
- foods that have sulfur or sulfate
- high-fiber foods
- nuts and crunchy nut butters
- products that have sorbitol (like sugar-free gum and candies)
- refined sugar
- spicy foods
The Ulcerative Colitis Diet
1. Omega-3 Fatty Acids
Studies have found that an omega-3 fatty acid called eicosapentaenoic acid (known as EPA) has the power to fight inflammation. It blocks certain chemicals in your body called leukotrienes. A benefit of fish oil is it’s a good source of EPA, and in some tests, people benefited from very high doses of it.
A 2010 case report published in the Journal of the Royal Society of Medicine evaluated a 38-year-old woman who had ulcerative colitis and used omega-3 fatty acids as part of her treatment. (6) In 1998, at the age of 27, she went to the emergency department after 10 days of bloody diarrhea and lower abdominal cramping pain. She described up to 15 bowel motions daily with urgency, and she lost approximately six pounds. She was also clinically dehydrated.
After weeks of various treatments that only led to short-term results, the patient turned to omega-3 fatty acid treatments. The EPA and DHA doses were well-tolerated and had no side effects. Her bowel frequency slowly decreased, and within a week all rectal bleeding had resolved. The woman continued to take one gram of omega-3s and 2.4 grams of mesalazine, an anti-inflammatory medication that did not have the same reactions when given alone. The patient went into remission after adding omega-3s into her diet.
Probiotics are bacteria that line your digestive tract and support your body’s ability to absorb nutrients and fight infection. Probiotics crowd out bad bacteria, yeast and fungi. They also create enzymes that destroy bad bacteria that can lead to inflammation and infections. Probiotics have the power to boost the immune system and improve digestive function.
Digestive experts agree that the balance of gut flora should be approximately 85 percent good bacteria and 15 percent bad bacteria. If this ratio gets out of balance, the condition is known as dysbiosis, which means there is an imbalance of too much of a certain type of fungus, yeast or bacteria that affects the body in a negative way. By consuming certain types of probiotics foods and supplements, you can help bring these ratios back into balance.
Probiotics work by acting as a barrier; they line the intestinal tract and prevent bacteria from stimulating an immune response. They also enhance mucus production, which protects the body from invasive bacteria. Probiotics alter the function of the mucosal immune system and make it more anti-inflammatory and less pro-inflammatory, which makes probiotic foods also excellent anti-inflammatory foods. They have the power to stimulate dendritic cells to make them slightly less responsive and slightly less reactive to bacteria, thereby reducing the inflammation that leads to ulcerative colitis symptoms.
According to a peer-review published in Gastroenterology and Hepatolgy, when probiotic treatment was compared to mesalamine treatment, a medication used to reduce inflammation in ulcerative colitis patients, the two were found to be equally effective. (7) In clinical trials, probiotic benefits have proven to be effective in treating ulcerative colitis because of its ability to stimulate mucus and alter the mucosal immune system that triggers inflammation.
Top probiotic and fermented foods include kefir, sauerkraut, kimchi, natto, probiotic yogurt, miso, kombucha and raw cheese. Another food that helps with ulcerative colitis is Manuka honey. In fact, Manuka honey ulcerative colitis research on rats showed it “possesses a potent antiulcer activity, which may be due to its antioxidants abilities which result in reducing lipid peroxidation and interfering with the inflammatory process.”
3. Iron-Rich Foods
A major symptom of ulcerative colitis is anemia, which occurs when the body doesn’t have enough healthy red blood cells. Bleeding ulcers and bloody diarrhea can cause anemia, and to fight it you need to boost your blood iron levels.
Aside from preventing anemia, iron is a nutrient needed to maintain general well-being, energy and a healthy metabolism because it helps support overall cellular health and is involved in many enzyme functions. An iron deficiency can mean that you aren’t able to produce enough oxygen-carrying red blood cells; therefore, your body struggles to transport oxygen to your brain, tissues, muscles and cells, leaving you feeling exhausted and weak. Iron-rich foods include liver, beef, navy beans, black beans, spinach, Swiss chard and egg yolks.
4. Folate-Rich Foods
Folate is another important vitamin for people with ulcerative colitis because it helps the body make new cells, specifically by playing a role in copying and synthesizing DNA. A folate deficiency causes anemia, poor immune function and poor digestion.
According to a publication for the American Association for Cancer Research, folate supplementation may even reduce the risk of colorectal dysplasia and cancer in patients with chronic ulcerative colitis. (8) The top folate foods include chickpeas, lentils, asparagus, avocado, beets and broccoli. Keep in mind that these foods can be difficult to digest when eaten raw, so if you notice an increase in symptoms when eating these foods, try to steam or bake them.
One of the most powerful aspects of turmeric, or curcumin, is its ability to control inflammation; it’s actually one of the most effective anti-inflammatory compounds in the world! Oftentimes, people with digestive and stomach complaints become intolerant to medical interventions because the stomach flora is already compromised and drugs can literally tear up the mucosal lining.
An in-depth analysis of all the studies evaluating curcumin’s ability to manage inflammatory bowel disease found that many patients were able to stop taking their prescribed corticosteroids because their condition improved so dramatically by taking curcumin. For many patients with ulcerative colitis, taking corticosteroids reduces their pain symptoms but damages the intestinal lining over time, which actually makes the condition worse. However, supplementing with curcumin did not have these side effects, and because of its anti-inflammatory properties, actually helped heal the gut and supported the growth of good bacteria.
According to the University of Maryland Medical Center, powerful turmeric benefits may help people with ulcerative colitis stay in remission. In one double-blind, placebo-controlled study, people whose ulcerative colitis was in remission took either curcumin or placebo, along with conventional medical treatment, for six months. Those who took curcumin had a significantly lower relapse rate than those who took placebo. (9)
A great way to incorporate turmeric into your diet is by drinking my Turmeric Tea Recipe that I refer to as “liquid gold.” This tea recipe is sure to help heal your body from ulcerative colitis and a number of other inflammatory health conditions.
Supplements for Ulcerative Colitis
Because ulcerative colitis may interfere with your ability to absorb nutrients, it’s important that you use supplements to ensure that your body gets the vitamins and minerals that are necessary. Some supplements that may be helpful when combating the symptoms of ulcerative colitis include:
- Calcium — improves bone strength and hormone secretion
- Vitamin D — fights autoimmune diseases and contributes to bone health
- Multivitamin — ensures that you are getting the necessary vitamins and minerals
- Probiotics — provide good bacteria, reduce inflammation and minimize immune responses
- Fish oil — fights inflammation and blocks chemical reactions
1. Keep a Food Journal
Because ulcerative colitis is triggered by a variety of foods, it’s important to evaluate which foods are problematic for you. I suggest you keep a food journal for a few weeks or months, until you understand what foods aggregate your symptoms and what foods soothe them. Write down what you eat throughout the day and how your body reacted to those foods. This will give you some insight about your own specific sensitives and intolerances.
2. Drink Plenty of Liquids
It’s common that people with ulcerative colitis become dehydrated. It’s important that you drink plenty of water throughout the day in order to protect yourself from dehydration. It’s also essential that dehydrating liquids, like alcohol and caffeine, are avoided.
Acupuncture has traditionally been used in the treatment of inflammatory bowel disease in China and is increasingly applied in Western countries. A 2006 study done at the Friedrich-Alexander-University of Erlangen-Nuremberg in Germany evaluated the efficacy of acupuncture treatment on 29 patients with mild to moderately active ulcerative colitis. (10) As a result of 10 acupuncture sessions over a 10-week period, patients experienced a significant improvement in general well-being and quality of life.
4. Essential Oils
Using essential oils like peppermint, fennel and ginger essential oil may reduce ulcerative colitis symptoms because of their anti-inflammatory properties. Add one drop of these essential oils to water three times daily, or rub two to three drops over the abdomen two times daily.
5. Eat Small Meals and Drink Smoothies
Because cramping is a common ulcerative colitis problem, try eating five to see small meals throughout the day. It’s easier for the digestive system to deal with smaller amounts of food, and if the digestive system is able to work with these smaller batches of food, it’s also able to absorb the nutrients that are needed. Consuming smaller amounts of food reduces pain and provides the body with a stream of vitamins and minerals.
Smoothies and meal-replacement drinks can also be a good way to get nutrition when you can’t handle solids. If you are having trouble keeping on weight, smoothies provide nutrients and calories. They also lower your chances of dehydration, as they supply a good amount of fluid. For some smoothie ideas, check out these 20 Greatest Green Smoothie Recipes.
Cilantro Ginger Smoothie Recipe
This delicious smoothie includes beneficial cilantro, which helps your body detoxify, and ginger, which helps soothe inflammation.
- 1 bunch cilantro
- 1 cucumber, cut into pieces
- 1 lime, juiced
- ½ finger length ginger
- 5 little pieces pineapple
- 1 large tomato cut into slices
- Mix all ingredients in blender until smooth