Ulcerative colitis (UC), which affects the colon (large intestine) and rectum, is a type of inflammatory bowel disease (IBD). Its incidence and prevalence is rising worldwide. Although there is no known cure for UC, medical treatment and/or lifestyle changes can help manage symptoms and achieve disease remission. In this article we’ll unpack how following an ulcerative colitis diet can help influence development and management of UC. (Source)
What Is Ulcerative Colitis?
Ulcerative colitis is an IBD consisting of chronic inflammation of the lining of the colon and rectum. Common symptoms include but are not limited to:
abdominal pain and cramping
blood in the stool
irregular bowel movements
As disease severity progresses, symptoms may also include:
Ulcerative colitis is often characterized by its repeating pattern of flares, when the disease is active, and remission, when symptoms are alleviated. The treatment of UC often involves using medications to manage symptoms and achieve remission, although diet and other lifestyle factors are increasingly recommended. (Source, Source)
Who Is at Risk for Ulcerative Colitis?
The cause of UC is unknown, but there appears to be a genetic component. Onset is most commonly between the ages of 30 and 40, and men and women are affected equally.
Because incidence is rising worldwide, especially in developed nations, environmental risk factors are also suspected.
Known and suspected risk factors include:
history of gastroenteritis
use of oral contraceptives, hormone replacement therapy, or non-steroidal anti-inflammatory medications
Although the exact way in which diet influences development of UC is unknown, possibilities include alterations to the gut microbiome (the population of microorganisms in the gastrointestinal tract), intestinal barrier function, and gut immunity. It is thought that changes in gut microbiota due to diet may cause intestinal inflammation in patients with IBD. Additionally, it is possible that a diet high in saturated fats and refined sugars can increase inflammatory gut bacteria and decrease healthy bacteria.
Short chain fatty acids in the gut are also important for maintaining intestinal barrier function and immunity. These molecules are synthesized from bacterial fermentation of dietary fibers, and diets low in fiber are associated with increased risk of developing UC. (Source)
Diet in the Prevention of Ulcerative Colitis
Diet is an important factor influencing the development of UC. Consumption of fruits, vegetables, and foods high in omega-3 fatty acids (e.g., salmon) has been correlated with decreased risk of UC onset.
Conversely, dietary components such as the sucrose found in soft drinks, omega-6 fatty acids (high in foods such as red meat and corn oil), and trans-unsaturated fatty acids have been shown to increase the risk of developing UC. These dietary components may cause changes in intestinal barrier function and, consequently, immune function and inflammation. (Source, Source)
Diet in the Management of Ulcerative Colitis
Dietary changes can be important for the management of ulcerative colitis symptoms, but it’s crucial to work with your health care provider to understand and follow an evidence-based ulcerative colitis diet. Make sure you’re getting the nutrition you need by sticking with the science and avoiding unnecessarily restrictive diets.
Keep in mind that although there are overall recommendations in the management of UC, your dietary recommendations should be based on your own specific dietary triggers. (Source)
Practical Ulcerative Colitis Diet Changes
There are several practical, evidence-based dietary changes that have been shown to be beneficial in achieving and maintaining UC remission.
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Decreasing intake of omega-6 fatty acids found in red meat and vegetable oils may help to maintain UC remission.
Processed carbohydrates, such as sweetened drinks, are a risk factor for the onset of UC symptoms.
Alcohol is thought to potentially be a trigger for IBD flares as it can promote pro-inflammatory molecules and disrupt the gut barrier, which can alter intestinal content. However, there is mixed evidence as to whether alcohol is truly a risk factor in the development of UC and whether it contributes to ulcerative colitis flares.
A number of popular diets show promise in reducing IBD symptoms, but in many cases their efficacy is still under study. These diets are often highly restrictive and the balance between their benefits and drawbacks is unclear.
Low FODMAP Diet
This diet eliminates foods high in fermentable and poorly absorbed carbohydrates.
The low FODMAP diet is often used to manage symptoms of irritable bowel syndrome (IBS) such as bloating, cramping, and diarrhea, and may also reduce these symptoms in people with IBD.
Specific Carbohydrate Diet
Eliminates complex carbohydrates, which include starches, grains, and sugars, as these substances can be poorly absorbed in the digestive tract and cause bacterial fermentation and inflammation.
Low Residue Diet
Eliminates whole grains, legumes, fruits and vegetables, dairy, and fibrous meats to reduce the frequency and volume of stools.
The food you consume on a daily basis is linked to UC prevention and management. Best dietary practices may vary, but there are general practices that are strongly encouraged to prevent ulcerative colitis flares. It’s important to be well informed about the nutritional guidelines you are following to ensure these practices increase your quality of life without causing nutritional deficiencies.
If you are considering making changes to your diet plan to achieve a reduction in UC symptoms, the WellTheory 1-1 coaching membership can help take the guesswork out of a personalized dietary and activity approach. Working with a Nutritional Therapy Practitioner can provide hands-on guidance to help you identify a personalized nutrition and lifestyle plan to support your body and mind while living with UC.
Give yourself the time and space to find out what your ideal routine looks like to support your autoimmunity. Over 75 days, you’ll incorporate new routines focused on diet, sleep, movement, stress management, and lifestyle to make steady, sustainable progress towards reducing your symptoms.”