For people with ulcerative colitis, the simple question of “what’s for dinner?” isn’t always such a straightforward question. Ulcerative colitis is a form of inflammatory bowel disease. So is Crohn’s disease and two conditions that are unrelated to ulcerative colitis but can cause similar symptoms, microscopic colitis and ischemic colitis.
Inflammatory bowel disease, or IBD, conditions can cause a variety of symptoms, including diarrhea, cramping, bloating and bloody stools. And depending on where you are in your disease cycle, you may need to be following different diets.
“Ulcerative colitis is an autoimmune process where the body attacks the colon or large intestine,” says Dr. Jacob Skeans, a gastroenterologist at the Ohio State University Wexner Medical Center. This process causes inflammation and ulcers in the lining of the colon.
Because ulcerative colitis is an autoimmune disorder, it’s likely caused by a combination of genetics and environmental triggers. As such, “the foods you eat don’t cause you to develop ulcerative colitis. But food definitely plays a role in your symptoms,” Skeans says.
Dr. Andrew Ho, associate chief of gastroenterology with Santa Clara Valley Medical Center in San Jose, California, agrees that diet doesn’t cause the problem, but it can help you feel better – or worse. “While I do not specifically restrict certain foods in my IBD patients, some patients may have increased gastrointestinal symptoms with certain foods. Some foods may cause cramping, bloating and/or diarrhea.”
[ See: 9 Most Common Food Allergies. ]
What Are the Best Foods for Ulcerative Colitis?
During colitis flare-ups, your gastroenterologist may recommend that you change your diet to help your digestive system heal. Dr. Hardeep Singh, a gastroenterologist with Providence St. Joseph Hospital in Orange, California, says, “For the most part, it does not appear that diet causes ulcerative colitis to flare.” But certain foods may help you feel better faster or, at a minimum, cause less discomfort.
If you’re experiencing a flare-up, the following foods might make a better diet for ulcerative colitis:
— Salmon and other fish containing omega-3 fatty acids. These polyunsaturated fatty acids can help reduce inflammation, which may help soothe inflammation and ulcers in the lining of the colon.
— Lean meat and poultry. During a flare, many people have difficulty extracting the nutrients they need from food and may deplete stored reserves. Consuming enough protein can help you keep from losing weight and muscle mass.
— Peanut butter, tahini and flaxseed oil. Seeds and nuts are a good source of protein, but for people having a flare-up, they can be hard to digest and cause additional inflammation. However, if they’re ground into a paste or refined into an oil, this jump-starts the digestion process and makes them gentler on an inflamed gut than their whole or raw counterparts.
— Eggs. High in protein, eggs are easy to digest and usually well tolerated by people experiencing ulcerative colitis flare-ups.
— Low-fiber foods. Most doctors encourage people to consume high-fiber foods such as leafy greens, raw vegetables and whole grains for general health. But for people experiencing an ulcerative colitis flare, lots of fiber can make you feel worse. “If you have a lot of inflammation in the colon, that increases symptoms,” Skeans says. Therefore, when your colon is inflamed, eat easy-to-digest, low-fiber foods like white rice, white bread, plain pasta, bananas and applesauce.
— Protein shakes. Ho recommends protein shakes or oral nutritional supplements if you need additional calories. However, Candace Pumper, a staff dietitian with the Ohio State University Wexner Medical Center in Columbus, notes that there’s a limit to what the body can absorb. For example, if you consume more than about 20 to 30 grams of protein in a single sitting, “undigested protein will either move to the colon where it ferments and leads to the production of potentially toxic substances, such as ammonia, or it will be excreted.”
She adds that most individuals should be encouraged to “meet their required daily protein needs from predominately food sources and resort to protein supplementation only if sufficient protein is not available in their normal diet.” Your doctor can help you determine whether a protein shake makes sense in your situation.
[ SEE: 6 Worst Foods for Gut Health. ]
Foods to Avoid During an Ulcerative Colitis Flare
People with ulcerative colitis are more likely to have other food sensitivities and intolerances, such as being lactose intolerant (unable to digest the sugars in dairy products) or having celiac disease (unable to digest gluten, a compound found in wheat).
“Sometimes, patients may feel that when they eat a certain food, that is causing their colitis to flare,” Singh says. “But usually in my experience, they may just have a simple dietary intolerance that may be causing gas or cramps or intermittent diarrhea.” Nevertheless, if there are foods that you know make you uncomfortable, it’s best to avoid those.
Other foods that can be challenging for people in ulcerative colitis flare to digest include:
— High-fiber foods. “When there is a flare of colitis, you want to try to avoid high-fiber foods, especially what we call insoluble fibers,” Singh says. “Examples would be fruits with skin. High-fiber foods can cause gas or cramps when the colon is inflamed.”
— Seeds, nuts and popcorn. Small, hard-to-digest foods such as seeds and nuts can cause increased bowel urgency, and cramping or bloating. This includes fresh strawberries, because the tiny seeds that dot their flesh can be problematic for people with an inflamed digestive system.
— High-fat foods. Ulcerative colitis can make it difficult for you to break down and absorb fat, which can lead to worsening symptoms. Coconuts, fried foods and salad dressings, especially those that contain poppy seeds, might be hard on your system during a flare-up.
— Sugary foods and sugar substitutes. This includes dairy products because lactose, a type of sugar found in milk, can exacerbate gas output, Singh says. Sugar substitutes, including sorbitol and aspartame, can also exacerbate symptoms.
— Alcohol, caffeine and carbonated beverages. “Both alcohol and caffeine can act as irritants to the intestinal lining,” Singh says. Caffeine is also a stimulant, which can make your digestive system work faster than usual, leading to diarrhea. Soda and other carbonated beverages can make you gassy and increase bloating.
— Beans. They’re known as the “musical fruit” for a reason – they can cause excess gas, which for some people can feel worse during a flare-up. They’re also very high in fiber, which can be difficult for an inflamed gut to handle.
— Corn. Notoriously difficult to digest, corn kernels often pass through the gut undigested. Therefore, if you’re having a flare-up, it’s probably best to skip corn on the cob.
— Raw vegetables. Because of their higher fiber content, raw vegetables are more difficult to digest than their cooked counterparts.
— Fatty cuts of meat. The fattier the cut of meat, the more difficult it will be for your system to digest.
— Chocolate. As delicious as it is, chocolate contains a lot of sugar and some caffeine, two ingredients that are common triggers for people with ulcerative colitis.
— Spicy foods. These foods can also be taxing on the digestive system and worsen your symptoms.
[ SEE: Best Mediterranean Diet Food List. ]
During Remission
Singh says he tells his patients with ulcerative colitis who are in remission that they should simply “focus on a healthy diet,” as you would if you didn’t have ulcerative colitis. He recommends eating lean proteins, limiting saturated fats and eating “a good dose of fiber every day. On average I would recommend 25 to 30 grams of fiber, either through diet or with fiber supplements.”
Add in rich sources of fiber including:
— Whole grains, such as oatmeal and brown rice.
— Cruciferous vegetables like broccoli.
— Leafy greens like spinach.
— Fruit with the skin on.
“If patients are in remission, then foods that are high in fiber, protein, fruits and vegetables and calcium-rich foods can help patients stay healthy,” Ho says.
Skeans adds that some studies have shown that people with ulcerative colitis who eat a high-fiber diet when not in a flare actually have a reduced risk of developing exacerbations. It seems those healthy foods may actually help you in the long run, once your condition has been stabilized and inflammation in the colon has been reduced.
Do Probiotics Help?
“I get a lot of questions about probiotics,” Skeans says. “It’s a huge market right now,” and these live bacteria are being touted as a solution for a range of digestive problems. There is some data showing that certain probiotics can “improve the remission rate and get ulcerative colitis patients to remission quicker and keep them from having relapses.” Or in the case of a 2019 study, some patients reported feeling improvements in symptoms when using probiotics.
However, not all probiotics are created equal, though, and the kind you buy over-the-counter at the supermarket or drugstore probably won’t make much of a difference if you’re using them to help ulcerative colitis, Skeans says. Instead, he will sometimes advise his patients to take a particular type of prescription-strength, over-the-counter probiotic called VSL#3.
“It’s a specific cocktail of probiotics that has the highest evidence for decreasing ulcerative colitis relapses and inducing remission,” Skeans says. Though the cost can be prohibitive for some patients, and insurance companies don’t typically cover it, he says it can be useful as a short-term therapeutic course in some cases.
Other Tips For Living Well With Ulcerative Colitis
Singh says that in addition to eating or avoiding specific foods, patients with colitis should try to make a number of other dietary changes including:
— Eating smaller, more frequent meals. Smaller meals put less stress on the digestive system.
— Hydrating as much as possible. Water helps the gut stay in balance and work the way it’s supposed to.
— Drinking slowly to avoid swallowing air, which produces more gas and cramps.
— Ditching the straw, which can also cause you to swallow more air.
— Managing your stress levels and exercising. Although stress doesn’t cause ulcerative colitis, it can exacerbate symptoms and could trigger flare-ups. Exercise can also help reduce stress and keep your bowels functioning normally.
Seek Assistance
Both Singh and Skeans recommend talking with your health care provider and/or a nutritionist to make sure your diet is healthy and will support your nutritional needs, even when your ulcerative colitis is in a flare. Your primary care provider is often the front-line for helping you manage ulcerative colitis, but you may also work with a gastroenterologist, especially initially to bring your disease under control.
Getting help planning your diet is important because “malnutrition is kind of under-recognized in ulcerative colitis and can lead to weight loss, muscle mass loss, osteoporosis (bone loss) and osteopenia (low bone density),” Skeans says. “We’ve gotten better at monitoring that over time, and it’s actually less common than it was 30 years ago. But it’s still something patients need to be aware of.”
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Foods for Ulcerative Colitis originally appeared on usnews.com
Update 06/13/22: This story was previously published at an earlier date and has been updated with new information.
