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: 

• diarrhea
• abdominal pain and cramping
• blood in the stool
• irregular bowel movements
• fatigue

As disease severity progresses, symptoms may also include: 

• fever
• decreased appetite
• weight loss

(Source) 

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
• being a former smoker 
• family history of IBD
• Jewish heritage

(Source, Source)

How Is Diet Related to Ulcerative Colitis?

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    

Strong Recommendations 

There are several practical, evidence-based dietary changes that have been shown to be beneficial in achieving and maintaining UC remission. 

Consume More of These 

Fruits and Vegetables

• These complex carbohydrates can help manage UC symptoms and decrease the risk of relapse.

Fiber

• Adequate intake of dietary fiber, especially fiber from fruits, has been associated with reduced risk of developing Crohn’s disease, but not UC.
• Beneficial bacteria in the gut ferment fiber to produce short chain fatty acids, which are important for maintaining the gut barrier and immune function.
• While important for health in the long run, fiber intake should be reduced during an active UC flare.

Vitamin D Supplement 

• Vitamin D strengthens the immune system and reduces inflammation.
• Vitamin D deficiency is associated with more severe IBD.

Omega-3 Fatty Acids

• Omega-3 fatty acids, found in many foods including nuts and seeds but especially high in fish such as salmon and mackerel, have anti-inflammatory properties.
• Omega-3 fatty acids in the form of fish oil supplements have not been found to be as beneficial in treating UC. 

 Dairy and Lactose Products

• Although it’s often recommended that people with UC avoid dairy products, there’s no good evidence dairy increases IBD symptoms in those who are not allergic or lactose intolerant.
• Restricted consumption of dairy can lead to calcium deficiency if it isn’t made up elsewhere in the diet. 
• Fermented dairy products, such as yogurt and kefir, are lower in lactose than non-fermented products and may be easier to digest.

(Source, Source, Source, Source)

Consume Less of These 

Omega-6 Fatty Acids 

• Decreasing intake of omega-6 fatty acids found in red meat and vegetable oils may help to maintain UC remission. 

Refined Carbohydrates

• Processed carbohydrates, such as sweetened drinks, are a risk factor for the onset of UC symptoms.

Alcohol

• 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.

(Source, Source, Source, Source)

Optional Recommendations

These dietary practices may be advantageous to those with UC, but it is unclear if the benefits outweigh the risks; more thorough research is needed. 

Mediterranean Diet

• This diet focuses on fiber-rich plant-based foods.
• It includes olive oil as the main fat; moderate nut, fish, egg, poultry, and dairy intake (yogurt and cheese); and low red meat intake.
• This diet has been shown to decrease biomarkers of inflammation in patients with IBD. 

Paleo Diet

• Eliminates processed food, refined sugars, legumes, dairy, and grains. 
• Includes grass fed meat, wild fish, vegetables, and healthy saturated fat. 

Anti-Inflammatory Diet 

• Restricts refined and complex carbohydrates, total fat, and saturated fat.
• Eliminates hydrogenated oils.
• Includes pre- and probiotic foods and encourages intake of omega-3 fatty acids.

Curcumin 

• Curcumin is a natural spice derived from turmeric, which is purported to have anti-inflammatory properties. 

(Source, Source)

Recommended on a Case-by-Case Basis  

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. 

(Source)

The Bottom Line

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.