I have ulcerative colitis. Do you have any dietary suggestions for me?

Ulcerative colitis is a chronic inflammatory disease that affects the lining of colon and rectum. It is characterized by tiny ulcers (small abscesses) in the colon/rectum that flare up periodically, causing bloody stools and diarrhea. Unlike Crohn's disease, ulcerative colitis doesn’t affect the esophagus, stomach, or small intestine. However, both conditions are considered Inflammatory Bowel Diseases (IBD).

What causes ulcerative colitis?

The cause of ulcerative colitis is unknown. It’s likely that it occurs because of an abnormal immune system response in the gastrointestinal tract to something in the gut (such as food or bacteria from the small intestines), which causes uncontrolled inflammation. The main symptom is bloody diarrhea, which can be accompanied by:

• Abdominal pain
• Anemia (deficiency in red blood cells)
• Canker sores
• Dehydration
• Fever
• Joint pain
• Skin lesions
• Weight loss.

Treatment of ulcerative colitis

Treatment options include drug therapy, dietary modifications, and surgery.

Those with ulcerative colitis are at a greater risk for nutritional deficiencies, and must get enough protein, calories, vitamins and minerals from their diet. Consume more protein-rich foods such as meat, chicken, fish, and eggs; and get additional calories by eating smaller meals frequently throughout the day.

Interestingly, the omega-3 fatty acids in fish oil have been shown to reduce inflammation in people with ulcerative colitis. One experimental therapy uses a drink containing fish oil fatty acids, soluble fiber, and antioxidants. In studies, the supplement significantly reduced the need for corticosteroid therapy. Adding a multivitamin and/or other dietary supplement, such as calcium or iron to counter the affects of anemia and to round out your diet may be recommended. Be sure to consult with your gastroenterologist before taking any supplements.

Diarrhea and intestinal inflammation can cause fluid loss, so drink enough fluids to keep your body well hydrated. Try drinking small amounts throughout the day. The goal is to drink ½ ounce of liquid (preferably water) for every pound of body weight.

Some people with ulcerative colitis find that eating foods such as citrus fruits and popcorn makes symptoms worse. Others foods that commonly cause symptom flare-ups include:

• Milk products. These foods can lead to bloating, gas, and diarrhea. If you are lactose intolerant, eat dairy foods with lower lactose levels (e.g. yogurt and hard cheeses) or take a lactose enzyme capsule when you eat dairy.

• Fatty foods. These foods may trigger abdominal symptoms. If you develop gas and diarrhea after eating fatty or greasy foods, you may be suffering from malabsorption, a condition in which fat is not easily absorbed and passes quickly through the intestine.
• Fiber. Insoluble fiber (roughage) may make abdominal symptoms worse while soluble fiber (Metameucil® is often recommended) can help form stools. In general, fiber-rich cereals and foods in the cabbage family may cause gas and other problems.

• Alcohol/caffeine. Alcohol and caffeine stimulate the intestines and intensifies diarrhea. Avoid them when your symptoms act up.

One last tip: Learn stress management techniques.

If you begin to lose weight or if your diet has become too limited, make an appointment with a registered dietitian who will design a custom meal plan for your individual needs.

 

 

References:

Fletcher PC and MA Schneider. “Is there any food I can eat?” Living with inflammatory bowel disease and/or irritable bowel syndrome. Clin Nurse Spec. 2006 Sep-Oct;20(5):241-7.

O’Sullivan M and C O’Morain. “Nutrition in inflammatory bowel disease.” Best Pract Res Clin Gastroenterol. 2006;20(3):561-73. Review.

Michèle Turcotte, MS, RD/LDN Contributing Expert

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