What is ulcerative colitis?
An ulcerative colitis diet may be high in calories, lactose- and gluten-free, and low in fat, fiber, and salt.
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 colitis.
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 corticosteroids), and
- 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.
- A 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 colitis flare.
- A low-fiber diet (low-residue diet): This can help reduce the frequency of bowel movements and abdominal cramps.
- 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 an 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 healthcare 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, Diet, Treatment, Causes
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 colitis flares:
- 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 reduce inflammation.
- 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 symptoms.
- Avocados are an excellent source of protein and 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) is 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 tolerate.
- Plantains, which are a variety of bananas, can help aid digestion.
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 includes:
- Alcohol can stimulate the intestine, triggering diarrhea. Some people tolerate alcohol better than others.
- Caffeine, found in coffee, tea, chocolate, and energy drinks, is a stimulant and can speed up the transit time in the colon, leading to more frequent trips to the bathroom.
- Carbonated beverages including sodas and beer contain carbonation that can irritate the digestive tract, and cause gas. Many contain sugar, 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, and 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, bread, 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 gas.
- Nuts and crunchy nut butter, 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 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 sorbitol 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 symptoms.
- Gluten, found in wheat, rye, barley, and some oats, can trigger symptoms similar to ulcerative colitis in people who have gluten sensitivity.
How can I track foods that cause flare-ups and trigger symptoms of my ulcerative colitis?
The Crohn's and Colitis Foundation of America recommends people with ulcerative colitis keep a food journal to keep track of what they eat. Note what you eat and drink, and how you feel afterward, 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. www.ccfa.org/gibuddy
Ulcerative colitis affects the colon. The colon is also referred to as the...
What other things trigger ulcerative colitis symptoms and flare-ups?
In addition to foods that trigger ulcerative colitis flare-ups, certain environmental risk factors may also trigger flares.
- Nonsteroidal anti-inflammatory drugs or NSAIDs (aspirin, ibuprofen [Advil, Motrin, Nuprin], naproxen [Naproxen]) may cause colitis or worsen the condition. NSAIDs increase the occurrence of bloody diarrhea, weight loss, iron deficiency anemia, and abdominal pain.
- 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 of 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 colitis diet?
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 8/31/2022
Medically reviewed by Venkatachala Mohan, MD; Board Certified Internal Medicine with subspecialty in Gastroenterology
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