What to Eat to Beat Ulcerative Colitis
If you're dealing with ulcerative colitis, you don't need anyone to tell you how painful it is. Inflamed walls of the large intestine riddled with raw sores known as ulcers is no one's idea of a picnic. It’s no wonder that 70% of people suffering from UC, a type of inflammatory bowel disease (IBD), have tried elimination diets in an attempt to figure out how to ease the discomfort during flares. In fact, research suggests that the removal of certain foods from your daily repertoire, combined with the addition of beneficial ones, can play a big role in helping combat symptoms.
That approach is likely your best one, since the actual cause of UC remains elusive. "It is believed that a combination of factors may precipitate the onset, including genes, environmental factors like diet, stress, and smoking, immune system dysfunction, and imbalances in the gut microbiota," says Ryan Warren, R.D.N. a clinical nutritionist at the Jill Roberts Center for Inflammatory Bowel Disease at Weill Cornell Medicine and New York-Presbyterian. "Diet can play an important role in managing symptoms as well as maintaining adequate nutrition." Here’s what to eat to stay one step ahead of this painful disease.
Go Mediterranean During Remission
With UC, you'll likely eat differently depending on whether you're in remission or having a flare. During remission, the Mediterranean diet is ideal because of its focus on low-fat, anti-inflammatory foods. "People who follow a Mediterranean diet are less likely to experience flare ups," says Mary Wirtz, R.D.N., a clinical dietician at the Mayo Clinic in Rochester, MN. One reason: "The diet avoids foods high in sugar and added fat, which we know can lead to inflammation." Choose fish like salmon and tuna, rich in omega-3 fatty acids, as well as olive oil, whole grains, and fresh fruits and vegetables.
Choose Low FODMAP During a Flare
The Med diet is super healthy, but during a flare, the low Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols (just say FODMAP!) diet is your friend. Low-FODMAP plans reduce short-chain carbohydrates (like wheat and beans) and sugar alcohols (used as sweeteners) that spell trouble for UC sufferers. "This diet limits carbohydrates that are poorly absorbed and highly fermentable by the gut microbiota," says Warren. (Get some examples next!)
Even More on Low FODMAP
Foods to avoid include regular milk, wheat-based cereal and anything made with high- fructose corn syrup. "It can be a useful approach for dealing with gas, bloating or diarrhea." In a study at Australia's Monash University, 50% of UC patients following a low-FODMAP diet for three months improved their symptoms. Low FODMAP foods include kiwi fruit, cooked spinach, carrots, and peanut butter.
Make It a Decaf
Caffeine is a stimulant: It speeds up your internal systems. That's far from ideal when you’re dealing with loose stools from UC. "If you're having to go to the bathroom 8 to 12 times a day, you don't want caffeine—it will rev up your bowels," says Wirtz. In fact, a Nutrition Journal study found 38% of UC sufferers believe coffee worsens their symptoms. To avoid dehydration during a flare, keep your fluid intake up with chamomile tea, plain water, or low-sugar sports drinks. You'll know you’re drinking enough when your urine is a pale yellow color.
Curcumin, a compound found in the spice turmeric, may be beneficial to the treatment of ulcerative colitis due to its anti-inflammatory properties, according to a review of several small studies in the American Journal of the Medical Sciences. Research suggests the compound is most effective when taken as a supplement in conjunction with UC medication, but there's little downside to adding some zing to your cooking tonight. "Many of my patients take a curcumin supplement to help decrease inflammation," says Warren. Just be aware: "In some people, it can cause an increase in bowel movements, so it's not for everyone!"
Skip the Cheese
Life with UC means dealing with stomach pain, gas, and diarrhea. Lactose intolerance, when your body is unable to break down the sugar in milk known as lactose, means the same. Put them together and you've got a whole lot of miserable trips to the bathroom in your future. Although research is mixed on whether dairy directly contributes to flares, many UC sufferers are also lactose intolerant, making dairy and ulcerative colitis a tenuous pairing at best. To see whether dairy might be making your symptoms worse, try topping your breakfast flakes with almond or oat milk for a week or two instead and see if you feel a little better.
Snack on Cucumber, Not Broccoli
Hey, if you're looking for your excuse to never, ever eat broccoli again, here's a legit one: People with UC may have a harder time digesting the veggie (as well as cauliflower) due to its high fiber content and level of sulfur compounds. Better options include carrots, green beans, squash and bok choy. If you absolutely must get your cruciferous fix, try steaming or boiling the broccoli first—cooked vegetables tend to be gentler on your gut.
Know When to Go Low-Fi
There are a lot of good things about fiber, including a possible protective effect in IBD patients. "It feeds beneficial gut bacteria, which helps to maintain a healthy intestinal lining," says Warren. But during a flare, steer clear of high-fiber foods, which can exacerbate an already-irritated colon. Your better bet: "Choose very low-fiber vegetables like iceberg lettuce and go for white rice instead of brown," says Wirtz. Avocados, bananas, and melons are also lower in roughage. To increase the ease of digesting vegetables, peel and cook them first, then blend them into soups or smoothies.
It's a tale of two cities: During a flare, you don't want nuts. The fiber is hard to digest and bitty pieces can irritate your gut. But as a preventative measure, nuts—particularly walnuts—have been given the green light. According to a study in the journal Nutrients, lab mice who ate a diet of 14% walnuts for two weeks before a UC flare had less damage from inflammation and were able to repair their colons faster than those without nuts. In humans, that's equivalent to 20 to 25 walnuts a day. Add them to cereal, salad, or munch on them whole.
Eat Less, More Often
Along with what you eat, how you eat can make a big difference in your comfort level during a flare. The less you put into your system at one time, the less work your intestines have to do—and that's good. "Generally speaking, people will tolerate smaller, more frequent meals better during a flare," says Wirtz. Rather than three square ones a day, split each meal in half: Eat the first half at your normal mealtime, then the second half about 90 minutes later, so that you are eating six mini-meals spread evenly throughout the day.
Ban the Burger
There's nothing better than a thick, juicy hamburger. Except if you have ulcerative colitis, and then just about anything else is preferable. That’s because fatty red meat doesn't just exacerbate the condition, it's an actual trigger, according to researchers at the University of Newcastle in the UK, who found that among 191 study participants, those who ate the most red meat were five times as likely to have a flare as those who ate less. Researchers believe the sulfates in red meat may be partially to blame. Stick with the new vegan burgers instead—we promise, they're nearly as good.
Elimination diet: World Journal of Gastroenterology. (2016). "Diet and Nutritional Factors in Inflammatory Bowel Diseases." ncbi.nlm.nih.gov/pmc/articles/PMC4716043/
Low FODMAP diet relieves UC symptoms: Gastroenterology. (2017). "A Diet Low in FODMAPs Reduces Symptoms in Patients With Irritable Bowel Syndrome and A Probiotic Restores Bifidobacterium Species: A Randomized Controlled Trial." gastrojournal.org/article/S0016-5085(17)35744-X/pdf
Low FODMAP improves symptoms. Journal of Crohn's and Colitis. (2009). "Reduction of dietary poorly absorbed short-chain carbohydrates (FODMAPs) improves abdominal symptoms in patients with inflammatory bowel disease—a pilot study." academic.oup.com/ecco-jcc/article/3/1/8/2393150
Caffeine worsens symptoms. Nutrition Journal. (2015). "Patients’ perceptions on the impact of coffee consumption in inflammatory bowel disease: friend or foe? – a patient survey." nutritionj.biomedcentral.com/articles/10.1186/s12937-015-0070-8
Benefits of curcumin: The American Journal of the Medical Sciences. (2018). "Use of Curcumin in Achieving Clinical and Endoscopic Remission in Ulcerative Colitis: A Systematic Review and Meta-analysis." amjmedsci.org/article/S0002-9629(18)30252-0/fulltext
Walnuts: Nutrients. (2019). "Dietary Walnut Supplementation Alters Mucosal Metabolite Profiles During DSS-Induced Colonic Ulceration." mdpi.com/2072-6643/11/5/1118/htm
Red meat: British Medical Journal: Gut. (2004). "Diet and relapsing ulcerative colitis: take off the meat?" gut.bmj.com/content/53/10/1399