Top Questions to Ask Your Doc About UC Treatment

Advances in medicine are making it easier than ever to stay ahead of this condition.

by Megan McMorris Health Writer

Picture this: You’re sitting in your doctor’s office, minutes after receiving news that you have ulcerative colitis (UC), two words you never heard before today. “Do you have any questions for me?” Your doctor asks. Questions? Yeah, a lot… but what are they? It’s easy for your mind to go blank after a UC diagnosis. No worries, we’ve circled back and knocked on your gastro’s door after visiting hours to ask your top questions about UC treatment.

What’s the Most Common Treatment?

Once you have a Dx, your doc will usually start you off with cortiscosteroids—short-term, fast-acting medications designed to ease inflammation in the digestive tract. “If those don’t work, your doctor will likely prescribe immunosuppressants like biologics, which work well to control inflammation,” says Niket Sonpal, M.D., gastroenterologist at Touro College of Osteopathic Medicine in New York. How effective are they? “If a treatment works, it’s possible to go into complete remission from your symptoms,” he says.

What New Medications Are Available?

Several medications have either recently been approved by the FDA or are in clinical trials. In 2019, the FDA approved the use of the biologic drug ustekinumab for people with moderate to severe UC. The approval was based on a trial which included 961 subjects who hadn’t had success with steroids and showed improvement of the intestinal lining with the new treatment. At eight weeks, 19% reached clinical remission, and 45% did so within a year.

Are Other Medications Coming?

Yes! For several years, researchers have been focusing on the role of sphingolipids in UC. Clinical trials for Zeposia (ozanimod), an oral sphingosine1‐phosphate (S1P) for patients with moderate-to-severe UC, found the drug successfully induced remission for a significant percent of people. Sphingolipids act as transit police for your immune cells going to and from in your body, and it’s believed that overly active transit is linked to inflammation, hence the connection.

What About Supplements?

In addition to your doctor’s Rx, certain supplements may help your symptoms. “There are several supplements that have been shown to have anti-inflammatory properties, and taking them can help give you more control over the disease,” says Andrew Dupont, M.D., associate professor of gastroenterology at McGovern Medical School at The University of Texas Health Science Center in Houston. Aloe vera is an anti-inflammatory (supplements are preferable as the juice can cause diarrhea) and wheatgrass and omega-3 fatty acids also have anti-inflammatory properties. (Always check with your doc before taking anything.)

Should I Consider CBD?

In recent years, CBD has separated itself from its trippy sister THC to bring marijuana into the medicine forefront. While there is no scientific evidence that the oil derived from cannabis can reduce inflammation, word on the street is promising. “Patients tell me that CBD helps with appetite and nausea, and improves symptoms like diarrhea,” says Sunitha D. Posina, M.D., an internal medicine specialist in Stony Brook, NY. It’s also becoming more accessible, with 47 states now selling CBD-containing products legally.

Can I Use Off-Label Meds?

With more research, scientists are gaining a deeper understanding of the mechanisms at play behind the curtain of this challenging condition. That has led to some crossover medications, where some treatments originally designed for entirely different conditions are showing success for UC, too. Zeposia, for example, is a medication originally designed for multiple sclerosis. While the exact mechanism isn’t yet known—it may help limit the number of lymphocytes in your intestine tissue—Zeposia helped 37% of patients maintain remission a year into the clinical trial.

Will I Need Surgery?

Perhaps the most worrisome thought when you hear a UC diagnosis is the idea of going under the knife. That’s unlikely, says Dr. Sonpal. “Surgery is primarily reserved for very severe cases, or for when medical treatments are no longer working,” he says. While in severe cases, the most common surgery is a proctocolectomy—which includes removal of a portion of the colon and rectum—this is becoming less common thanks to increased awareness, early diagnosis, and better treatments.

Should I Change My Diet?

“There is no one best diet for UC, but any food that decreases inflammation is good,” Gabriela Gardner, R.D., clinical dietician with Memorial Hermann-Texas Medical Center's Ertan Digestive Disease Center in Houston. Still, there are some superstar ingredients when it comes to UC. “You can’t go wrong with the spice turmeric,” says Dr. Sonpal. Used in curry, turmeric not only reduces inflammation but may increase effectiveness of certain UC medications. And don’t forget about probiotics: “The gut flora changes significantly with UC,” he says. “Foods like kimchi, kafir, yogurt, and kombucha help with a healthy gut.”

There’s Reason for Hope

It’s not like there’s any “good time” to have a condition, but when it comes to UC, there really is reason to be optimistic. Between new meds, current studies, and a growing acceptance of useful complementary therapies, it can make the difference between UC being the star of your show or relegating it to the backstage. “Finding the right treatment may take some time,” says Dr. Sonpal. “But the good news is that there are more treatments than ever that are proving successful for managing UC, so it doesn’t take over your life.”

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Megan McMorris