What is ulcerative colitis?
Ulcerative colitis (UC) is a chronic condition that causes inflammation of the large intestine (colon) and the rectum and sores (ulcers) on the inner lining of the large intestine. Ulcerative colitis is thought to be an autoimmune disease, that is, one where the body attacks itself. It is a type of inflammatory bowel disease (IBD). It is not the same as Crohn's disease, another type of IBD, which can affect any part of the gastrointestinal tract, whereas ulcerative colitis only affects the colon and rectum. It is also not the same as irritable bowel syndrome (IBS), which affects how the colon functions and does not cause inflammation.
Ulcerative colitis is estimated to affect nearly 907,000 Americans, and it affects males slightly more often than females. The disease is most commonly diagnosed between the ages of 15 and 40.
What causes ulcerative colitis?
The cause of ulcerative colitis is unknown but it is believed to be caused by
a combination of several factors including an overactive immune system,
genetics, and the environment.
- Overactive immune system: It is believed that in ulcerative colitis, the
immune system is triggered to mistakenly attack the inner lining of the large
intestine, causing inflammation and symptoms of ulcerative colitis.
- Genetics: Ulcerative colitis
can run in families. The genetic link is not entirely clear but studies show
that up to 20% of people with ulcerative colitis have a close family member with the disease.
- Environment: Certain environmental factors including taking certain medications
(nonsteroidal anti-inflammatory drugs or NSAIDs, antibiotics, and oral
contraceptives), and eating a high fat diet may slightly increase the risk of
developing ulcerative colitis.
Physical or emotional stress, and certain foods do not cause ulcerative
colitis, however, they may trigger symptoms in a person who has ulcerative
Ulcerative Colitis Treatment Medications
Treatments for ulcerative colitis includes both medications and surgery;
however, there is no medication that can cure ulcerative colitis. Medications
that treat ulcerative colitis are
- anti-inflammatory agents, for example, 5-ASA compounds like sulfasalazine
(Azulfidine), and olsalazine (Dipentum), and topical and systemic
- immunomodulators, for example, 6-mercaptopurine (6-MP), azathioprine (Imuran), methotrexate (Rheumatrex, Trexall), cyclosporine (Gengraf, Neoral).
Treatment of ulcerative colitis with medications is similar, though not always identical, to treatment of Crohn's disease.
What is an ulcerative colitis diet?
A person with ulcerative colitis may find they need to modify their diet to
help manage their symptoms. There is not a single diet or meal plan that fits
everyone with ulcerative colitis, and diets are individualized for each patient. Depending on
symptoms different types of diets may be recommended, such as:
- A high-calorie diet: Many people with ulcerative colitis lose weight and can
develop signs of malnutrition. A high calorie diet may prevent these problems.
lactose-free diet: People with ulcerative colitis may also have lactose intolerance.
- A low-fat
diet: Ulcerative colitis may interfere with fat absorption and eating fatty
foods may trigger symptoms. This is often recommended during an ulcerative
low-fiber diet (low-residue
diet): This can help reduce the frequency of bowel movements and
- A low-salt diet: This diet is used when patients are on
corticosteroid therapy to help reduce water retention.
- A low FODMAP diet: FODMAP
stands for Fermentable Oligo-Di-Monosaccha-rides and Polyols, which are types of
sugars found in certain carbohydrates and sugar alcohols. This diet is used in
people who have intolerance to FODMAPS.
- A gluten-free diet:
People with ulcerative colitis may
also be sensitive to gluten.
Attention to nutrition is important for patients with ulcerative colitis, as
the symptoms of diarrhea and bleeding can lead to dehydration, electrolyte
imbalance, and loss of nutrients. It may be necessary to take
nutritional supplements if your symptoms do not allow you to eat a nutritionally balanced
diet. Talk to your health-care professional about what supplements to take. Many people with
ulcerative colitis find it easiest to eat smaller, more frequent meals rather
than a few large ones. This can also help increase the nutrition absorbed from
the foods you eat.
Ulcerative Colitis Symptoms, Causes, and Treatment
19 trigger foods to avoid with an ulcerative colitis diet plan
Dietary choices do not cause ulcerative colitis, but certain foods can
trigger and worsen symptoms. Learning to identify trigger foods can help reduce
the frequency and severity of ulcerative colitis symptoms. Not all people with ulcerative
colitis have the same
triggers, but a list of some of the most common include:
- Alcohol can stimulate the intestine, triggering
diarrhea. Some people
tolerate alcohol better than others.
Caffeine, found in coffee, tea,
and energy drinks, is a stimulant and can speed up the transit time in the
colon, leading to more frequent trips to the bathroom.
beverages including sodas and beer contain carbonation that can irritate the
digestive tract, and cause
gas. Many contain
caffeine, or artificial
sweeteners, which can also be ulcerative colitis triggers.
- Dairy products should be avoided if
you are lactose intolerant, as they can cause symptoms similar to ulcerative
colitis. Not everyone with ulcerative colitis is lactose intolerant.
- Dried beans, peas, and
legumes are all high in fiber and can increase bowel movements, abdominal
cramping, and gas. If you are a
vegetarian or vegan, you can try these foods in
small amounts, or pureed to see if they do not trigger symptoms.
- Dried fruits,
berries, fruits with pulp or seeds are other foods high in fiber that can
trigger ulcerative colitis symptoms.
- Foods containing sulfur or sulfate can cause excess gas
production. Sulfate may be found in many foods, including beer, wine, some
juices, dairy milk, eggs, cheese, dates, dried apples and apricots, almonds,
wheat pasta, breads, peanuts, cruciferous vegetables, raisins, prunes, red meat,
and some supplements.
- High fiber foods, including whole-grains, can increase
bowel movements, abdominal cramping, and gas.
- Meats, especially fatty meats, can
trigger ulcerative colitis symptoms. Excess fat may not be properly absorbed during a flare, and
this can make symptoms worse. Red meat can be high in sulfate, which triggers
- Nuts and crunchy nut butters, and seeds that are not ground up (such as in
smooth peanut butter or tahini) can cause worsening abdominal cramping, bloating, and diarrhea. During a flare, even tiny fruit seeds (such as those in
strawberries or in jams) may trigger symptoms.
- Popcorn is another high fiber,
bulky food that is not completely digested by the small intestine and can
trigger diarrhea and bowel movement urgency.
- Sugar alcohols (such as
and mannitol) are found in sugar-free gum and candies, some ice creams, and some
fruits and fruit juices (apples, pears, peaches, and prunes) and can cause
diarrhea, bloating, and gas in some people.
- Chocolate contains caffeine and
sugar, both of which can irritate the digestive tract and cause cramping and
more frequent bowel movements.
- Vegetables, especially raw vegetables, are high
in fiber and can be difficult to digest, causing bloating, gas, and abdominal
cramps. This is particularly true for stringy vegetables such as broccoli,
celery, cabbage, onions, and Brussels sprouts. Many people with ulcerative
colitis also find it
hard to digest corn and mushrooms because they are hard to digest to begin with.
- Refined sugar can pull more water into the gut and cause diarrhea.
- Spicy foods,
hot sauces, and pepper can cause diarrhea in many people, and in someone with
ulcerative colitis experiencing a flare spicy hot foods may trigger or worsen
- Gluten, found in wheat, rye, barley, and some oats, can trigger
symptoms similar to ulcerative colitis in people who have gluten sensitivity.
What foods help manage and soothe ulcerative colitis flares?
Avoiding foods that trigger ulcerative colitis symptoms is one way to help
manage symptoms through diet. Another is knowing what foods to eat that may help
relieve flares. Following is a list of foods that may help soothe ulcerative
- Salmon and albacore tuna contain
omega-3 fatty acids, which can help reduce inflammation during a flare and may
help you to stay in remission. Other sources of omega-3s include mackerel,
herring, sardines, flaxseed oil, ground flaxseed, and walnuts. Some people may
be unable to eat whole nuts and flaxseeds during a flare, but they may be
tolerated if ground up.
- Lean meats and poultry are recommended
following flares of ulcerative because proteins are often lost. Increasing your
protein intake can help replenish the nutrients lost during a flare.
- Eggs are another great source of
protein, and are often well-tolerated even during flares. Some eggs are
fortified with omega-3 fatty acids, which can help
Soy-based protein can be substituted
for animal protein in vegetarians and vegans. Other good sources of non-animal
proteins include legumes and whole grains.
- Probiotics, usually found in yogurt,
kefir, sauerkraut, and miso, are good bacteria that can aid in digestion. Choose
yogurts that are low in added sugars, as sugar can aggravate ulcerative colitis
- Avocados are an excellent source of
healthy fats. They are calorie dense, but because they are about 70%
water, they are easily digested.
- Unsweetened applesauce is bland and may
be tolerated after an ulcerative colitis flare, though some people may find it
difficult to tolerate during a flare-up.
- Instant oatmeal contains refined grains
and is often easier than steel cut or old-fashioned oatmeal because it has a
little less fiber.
- Squash is a healthy choice that is
usually well-tolerated during an ulcerative colitis flare. It's full of fiber,
vitamin C, and beta carotene. Any variety of squash (butternut, zucchini,
spaghetti, acorn, winter, and summer) are best tolerated cooked. Raw squash may
aggravate ulcerative colitis symptoms during a flare.
- Juice and smoothies can be tolerated by
some during a flare, and can help you maintain good nutrition. Carrot juice is
chock full of vitamin A and antioxidants and many
people with ulcerative colitis find it easy to
- Plantains, which are a variety of
banana, can help aid digestion.
Ulcerative colitis affects the colon. The colon is also referred to as the...
How can I track foods that cause flare-ups and trigger symptoms of my
The Crohn's and Colitis Foundation of America recommends people with
ulcerative colitis to keep a food journal to keep track of what they eat. Note
what you eat and drink, and how you feel afterwards, noting any symptoms that
arise. Start to keep a list of any foods you suspect may trigger or aggravate
your ulcerative colitis symptoms. A food diary will also help you figure out if
you are getting adequate nutrition, and can help your doctor or dietician
determine the right diet for you to manage your symptoms and prevent flares.
The Crohn's and Colitis Foundation of America also has an interactive food
tracking tool. It is available online or as a mobile app.
What other things trigger ulcerative colitis symptoms and flare-ups?
In addition to foods that trigger ulcerative colitis flare-ups, there are
certain environmental risk factors that may also trigger flares.
- Nonsteroidal anti-inflammatory drugs, or NSAIDs (aspirin, ibuprofen
[Advil, Motrin, Nuprin],
[Naproxen]) may cause colitis or worsen the condition. NSAIDs increase the
occurrence of bloody diarrhea, weight loss, iron deficiency anemia, and
- Where you live may predispose you to a higher incidence of
ulcerative colitis. Ulcerative colitis is found more commonly in developed countries, urban
areas, and northern climates. The highest rates for ulcerative colitis are reported in the
United States, Denmark, and Iceland.
- Stress does not cause ulcerative colitis
but it can make symptoms worse. Stress management techniques can be important in
managing your ulcerative colitis symptoms.
- Not taking medications or improper dosing of
medications that are used to treat ulcerative colitis can bring on a flare.
Medications for ulcerative colitis must be taken regularly, even when you feel well. Take
medications as prescribed. Do not skip doses, cut doses, or increase doses.
- Antibiotics may cause diarrhea in some people. If you have an infection, tell
your doctor to figure out the right antibiotic for you. You may also take a
probiotic along with the antibiotic to help prevent diarrhea.
Which specialties of health-care professionals prescribe an ulcerative
A gastroenterologist is a specialist in disorders of the digestive tract and
can prescribe a diet for ulcerative colitis. In addition, dietitians and
nutritionists who are familiar with the disorder may also help create a diet and
meal plan to manage ulcerative colitis.
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Medically Reviewed on 8/13/2018
Medically reviewed by Venkatachala Mohan, MD; Board Certified Internal Medicine with subspecialty in Gastroenterology
Langan, R. C., MD., et al. "Ulcerative Colitis: Diagnosis and Treatment." Am Fam Physician. 2007 Nov 1;76(9):1323-1330.
Crohn's & Colitis Foundation of America. "Facts about Inflammatory Bowel Diseases. Published May 1, 2011.
Crohn's & Colitis Foundation of America. "Diet, Nutrition, and Inflammatory Bowel Disease."
Crohn's & Colitis Foundation of America. "Living with Ulcerative Colitis."