Let's Talk About Ulcerative Colitis and Diet
UC has a way of taking away your appetite (and not just because of what's going on in the bathroom). We'll help you understand the role food plays in your symptoms, and how to ensure it helps you heal instead of hurt.by Lara DeSanto Health Writer
When you have a condition like UC, which seems to turn your digestive system into fiery nightmare, food can feel like the bogeyman stoking the flames. While your diet didn’t cause you to develop ulcerative colitis, which affects the colon and rectum, certain foods may trigger your UC symptoms. Understanding exactly how nutrition and diet play into UC management can be tricky—but we’re here to help. Keep reading to learn what to avoid—and what to keep on enjoying.
Our Pro Panel
We went to some of the nation's top UC experts to bring you the most scientific and up-to-date information possible.
Kelly Issokson, R.D., C.N.S.C.
Clinical Nutrition Coordinator
Nutrition and Integrative IBD Program at Cedars-Sinai
Brittany Roman Green, R.D., C.P.T.
Dietitian Specializing in Digestive Disorders
San Mateo, CA
Aline Charabaty Pishvaian, M.D.
Director of the Inflammatory Bowel Disease Center
Sibley Memorial Hospital
There’s no such thing as a one-size-fits-all “ulcerative colitis diet.” That said, most experts recommend a plant-based, Mediterranean diet, along with working with a registered dietitian to develop a meal plan that works for you. Your R.D. may also recommend a low-residue diet (one limits high-fiber foods) or a low-FODMAP diet, which involves avoiding foods with certain types of sugars, to help reduce your symptoms.
It’s best to work with your doctor or registered dietitian to come up with a meal plan that tailors to your specific needs when you have active UC. Typically, however, foods prepared simply (e.g. grilled, steamed, or poached), low-fiber foods, lean proteins, and fully cooked, peeled, and seedless fruits and non-cruciferous veggies are well-tolerated.
Trigger foods vary from person to person. However, some common foods that may worsen UC symptoms include fatty foods, sugary foods, alcohol and caffeine, cruciferous vegetables, and lactose.
UC can’t be managed with just diet—but it is often an important piece of the puzzle. You’ll likely use a combination of medical therapies along with diet changes to help manage your UC effectively.
What Is UC Again and Why Does Diet Matter?
If you’re reading about UC and diet, you probably have some of the basics already down but just in case this is all new to you: Ulcerative colitis causes chronic inflammation in the colon and rectum, triggering frequent and urgent diarrhea, bloody stools, and abdominal pain and cramping.
It’s not just a poop problem though. It can lead to nutrient deficiencies, actual malnutrition, and weight loss along with body-wide inflammation, which can spur joint pain, fatigue, and more. And these are all issues that can be influenced for better or worse by what you eat (or don’t).
What’s tricky, though, is that there’s no specific “ulcerative colitis diet.”
In fact, there isn’t even a set list of trigger foods that applies to every single person with UC.
Just like everyone’s specific set of UC symptoms is unique, so too are their problem foods. So, what the heck are you supposed to do with that? Find yourself a guide, that’s what.
The best way to figure out how to make your diet work for your UC is to seek the advice of a registered dietitian. Ask your gastroenterologist (GI) if they can refer you to an R.D. they trust.
In the meantime, get up to speed on which foods do commonly worsen symptoms in people with UC, along with what goes into a healthy diet in general. While you can’t manage UC with diet alone, arming yourself with this knowledge can be a key piece of the puzzle.
Diet doesn’t cure the disease, but it can improve symptoms significantly. For example, the low FODMAPs diet, can improve bloating, gas and some types of abdominal pain/discomfort.
Common Foods to Avoid With UC
Just so we’re crystal: The foods that exacerbate UC symptoms really do vary from person to person. But there are some choices that experts find commonly make UC folks feel craptacular. They include:
Anything with lactose. Many people lose the ability to digest lactose, a sugar found in dairy products, as they get older, and you may notice that your UC symptoms flare up when you consume it as well. For that reason, you may want to limit your intake of milk and cheeses. If you prefer cow’s milk, opt for a lactose-free version. Otherwise, give almond or oat milk a try. And remember, Greek yogurt is low in lactose. Incorporating it into your diet may be a wise move because the probiotics it contains can be beneficial to the gut by helping maintain a healthy bacteria balance—and it can be a good source of protein, too. Dairy is a pro-inflammatory food and that’s another reason to avoid dairy.
Sugary foods. Foods and drinks high in sugar may make your UC symptoms worse by increasing the body’s inflammatory response and by altering your belly's balance of healthy bacteria. Try to limit your intake of soda, juice, candy, pastries, and other foods high in the sweet stuff. Besides, as you know, it’s not good for your overall health, either!
Alcohol. Add this to the list of reasons to limit how much you drink—alcohol can seriously irritate the GI tract, according to a study in Alcohol Research. And when you have UC, your GI tract is already irritated—and alcohol just makes it even angrier. Plus, many alcoholic drinks are super sugary, compounding the problem. It can be helpful to try to avoid alcohol altogether or to only drink on special occasions. Even then, stick to just one drink per day for women and two for men, and rather than ordering the sugared-up cocktails and mixed drinks, go for a glass of wine or beer instead.
Caffeine. In some people with UC, the caffeine in coffee, soda, and other drinks can aggravate your already inflamed intestinal lining. Plus, it can speed up your entire digestive system and make you go even more.
High-fat foods. Super fatty foods can wreak havoc on UC symptoms in some people by increasing inflammation in the digestive tract. Watch out for foods with butter, cream, margarine, and coconut, and limit your intake of fatty, greasy, and fried foods.
Insoluble fiber foods. Some people with UC may find that foods with insoluble fibers can be hard to digest and trigger symptoms like diarrhea. These foods may include fruits with skin and seeds, whole grains, whole nuts, and raw green and cruciferous vegetables like broccoli and cauliflower. You may hear people say they follow a “low-residue diet” to reduce UC symptoms. Basically, it’s another way of saying they’re limiting high-fiber foods. These foods should also be avoided if you have been diagnosed with a stricture, or have had a recent surgery.
Spicy foods. Step away from the hot sauce! You may also find that foods with “hot” spices don’t sit well in your digestive tract. Why? Because they contain capsaicin, which acts as a stimulant and legit heats up the lining of your intestines. And since UC already leads to damage in your colon, more irritation from that heat is the last thing your body needs.
What About FODMAP Foods?
You also may have heard of something called the low-FODMAP diet (here’s the ridiculous full name: Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols). FODMAPs are carbohydrates that are poorly absorbed by the small intestine and when they land in the colon where the colonic bacteria ferment the undigested sugars resulting in gas production. Some research shows that following this diet can help reduce symptoms in people with UC. According to researchers at Monash University in Australia:
High FODMAP foods include:
wheat, rye, and barley
foods with fructose like honey, apples, and pears
foods containing polyols, like stone fruits, mushrooms, and cauliflower
Low FODMAP foods include:
cucumber, potato, zucchini
cantaloupe, grapes, kiwi
almond and soy milk
eggs, tofu, plain lean meats
You may want to stick to low FODMAP foods during a flare, but before you try it, hit up your R.D. for advice on getting started.
How to Identify Your Trigger Foods
There’s no way around this one: You’ve got to track everything you eat and what, if any, symptoms result. Even if you work with an R.D. (and we hope you do), this will be an important part of that process. For example, maybe you realize that every time you eat dairy, diarrhea follows a few hours later. Or maybe a night of drinking really sparked a flare-up. Watch for patterns like this and make note. And don’t forget to take your food diary with you to your doctor’s appointments—it can be a useful tool to help you and your health care team figure out how best to manage your UC. You can go the old-fashioned route and use a paper format or try an app like GI Monitor.
When you’re planning your meals, forget about sticking to three squares. Eating large portions can overwhelm your already-sensitive digestive system. Instead, aim for smaller portions spread throughout the day instead of a few big meals. Downing your food too fast can also lead to discomfort, so eat slowly and mindfully and really concentrate on chewing your food thoroughly—that gives your gut a little extra help!
What Are the Basics of a Healthy Diet for People With UC?
This whole UC situation would be a lot easier if it came with an instruction manual for eating. But even though we’re not quite as lucky as that, there are plenty of nutrition guideposts to help you along the way.
Case in point: Doctors and dietitians generally discourage people with UC from adopting fad diets like Keto or Paleo, which may do more harm than good because you may not get the nutrients you need—or you may get too much of what you don’t need. On the what-you-can-eat side, they generally recommend following a plant-based, Mediterranean diet (which is pretty much the advice for every pretty much human on earth). But what you eat during a flare and what you eat the rest of the time likely won’t be exactly the same. Here are some things to keep in mind:
Tips for Eating During a UC Flare
Prepare foods simply. Yes, that is code for plain. Instead of frying up foods or dousing them in lots of oil, opt for steaming, poaching, grilling, or boiling foods instead.
Hydrate, hydrate, hydrate. Hydration is extra important for people with IBD, who may already be dehydrated thanks to all the diarrhea, which can deplete your body of electrolytes. Make sure to drink plenty of water throughout the day, and choose hydrating foods in general, like soups. A good way to tell if you’re getting enough fluids is to check the color of your urine—it should range from light yellow to clear, and darker yellow is a sign that you need to hydrate even more.
Choose low-fiber fruits. While some fruits, like apples, oranges, and peaches, can be difficult for people with UC to tolerate because of their insoluble fiber content, low-fiber options like cantaloupe, honeydew, and bananas can be gentler on the stomach. Cooking fruits can also make them easier to digest. Fruits that are made into smoothies are ok to eat as well.
Pick your veggies wisely. Vegetables are a key part of any diet, but when you have UC, you want to be careful about which ones you eat—and how you eat them. Go for non-cruciferous veggies (usually a healthy option, but they’re notorious gas-producers, which is exactly what you don’t want during a flare) as well as skinless and seedless options, like asparagus tips, potatoes, and squash. Fully cooking veggies can also help you digest them more easily.
Go for refined grains. Foods like white rice, white pasta, and oatmeal can be easier on the digestive system during a flare. Whole grains and whole nuts, on the other hand, contain a large amount of insoluble fiber, which can be difficult to digest.
Incorporate lean proteins. Lean cuts of poultry and other meats, along with fish, soy, eggs, and tofu, can be great additions to your diet with UC and help you get the protein your body needs. That’s important, especially if you’ve been losing weight.
Stick to your “safe” foods. If you can find a meal or two that you’ve been able to successfully tolerate during a flare-up, keep that knowledge in your back pocket. (Hopefully you’ll know what it is because you’ve been tracking!) Sometimes it helps to have some go-to meals and snack ideas that you already know work for you.
Eating During Remission From UC
During remission—that blissful time when your insides aren’t rioting against you—you may wonder if you can “relax” a little bit more about the foods you eat. In general, move slowly when adding new foods to your diet during remission. In fact, it’s best to do it one at a time so you can monitor any reaction. Otherwise, aim to hit the main points of a Mediterranean diet (as tolerated!) to get the nutrients you need. Your doctor or R.D. can offer more advice too. In the meantime:
Prioritize whole grains, non-cruciferous vegetables and low-fiber fruits, and healthy fats
Incorporate poultry, fish, beans, and eggs weekly
Add moderate portions of dairy if you can tolerate lactose
Limit your consumption of red meat
Limit processed foods
What if You’ve Had Surgery for UC?
If you’ve had surgery for UC, such as an ileostomy (where part of your colon is re-routed to an opening in your abdomen), your GI may give you specific guidelines regarding your diet and nutrition. For example, they may recommend you eat extra foods with vitamin B12 or take a supplement since removal of the ileum can make it hard for you to absorb the B12 you need. A lack of this vitamin can affect the health of your nerve and blood cells.
It's also extra important to stay hydrated if you’ve had surgery for UC, so make sure you’re drinking lots of water and eating foods with a high-water content. Talk with your health care team and registered dietitian to understand how your surgery may affect your dietary needs.
Should You Take Nutritional Supplements With UC?
In some cases, you may not be able to get all your nutritional needs directly from food; your intestines just can’t do their best nutrient-absorbing job when its dealing with ulceration. That’s where supplements come in. Again, it’s important to understand that there’s not a set list of supplements that everyone with UC should take—it really varies from person to person.
Your GI or registered dietitian will recommend supplements based on your specific situation after looking at your symptoms and test results. And always get the green light from your doctor before adding a supplement to your routine—some may actually contain sugar alcohols, lactose, and preservatives that can actually aggravate your symptoms.
That said, here are some supplements that are commonly recommended for people with UC—don’t forget to take them on a full stomach, or else they could irritate your GI tract:
Iron. People living with UC can lose a fair amount of blood via their stool due to the bleeding ulcers in their colon, increasing their risk for iron-deficiency anemia. In fact, this is the most common complication of IBD and affects about 45% of patients, according to a study in Therapeutic Advances in Gastroenterology. Having a low red-blood cell count not only makes it harder for your cells to get the oxygen they need, but it literally leaves you feeling depleted as well. If you become anemic, your doctor will likely recommend an iron supplement, either as a pill or possibly as an infusion.
Methotrexate. If you’re taking certain medications for UC, including the 5-aminosalicylate-acid drug sulfasalazine, your body may have trouble absorbing folic acid as a side effect. That’s not ideal since folic acid helps promote healthy cell growth in the body, among other important functions. If you’re taking one of those medications, or if you’re pregnant or planning to become pregnant, your doctor will likely recommend you supplement with folic acid.
Vitamin D and calcium. Vitamin D is recommended for all people with UC—and IBD in general—because there’s some evidence that it can help with inflammation in the intestines. In fact, one study in Clinical Gastrolenterology and Hepatology found that being vitamin D deficient during UC remission may up your risk of relapse. This is a vitamin that can be hard for anyone to get from food alone. If you’re low in vitamin D, your doctor may recommend you take a supplement. Make sure to ask them how much you should take per day, and pair it with calcium to help support your bone health, as well. Calcium is especially if you’re on steroids, which can increase your risk of weakened bones (osteoporosis).
Keep in mind, this isn’t an exhaustive list of possibilities—your doctor may recommend other vitamin or mineral supplements, including potentially a multivitamin, depending on your specific nutritional needs.
- UC and Diet Background:
- UpToDate. (2019). “Patient education: Ulcerative colitis (Beyond the Basics).” uptodate.com/contents/ulcerative-colitis-beyond-the-basics
- Crohn’s & Colitis Foundation. (2019). "Diet and Nutrition." crohnscolitisfoundation.org/diet-and-nutrition/
- Low-FODMAP Diet: Michigan Medicine, University of Michigan. (2015). “Low-FODMAP Diet Introduction.” med.umich.edu/1libr/Gastro/LowFODMAPDietIntroduction.pdf
- Mediterranean Diet and UC: The Mayo Clinic. (2019). “Mediterranean Diet: A Heart-healthy Eating Plan.” mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/mediterranean-diet/art-20047801
- Clinical Nutrition in IBD: ESPEN. (2016). “Clinical Nutrition in Inflammatory Bowel Disease.” espen.org/files/ESPEN-guideline_Clinical-nutrition-in-inflammatory-bowel-disease.pdf
- UC Nutrition Advice: University of California San Francisco. (2019). “Nutrition Tips for Inflammatory Bowel Disease.” ucsfhealth.org/education/nutrition_tips_for_inflammatory_bowel_disease/