Inflammatory bowel diseases include two main types of colitis- Ulcerative and Microscopic Colitis. Microscopic colitis can include a sub-type of either lymphocytic or collagenous colitis. Ulcerative colitis (UC) is an inflammatory disorder of the colon or large intestines that results in deterioration of the colon walls, often associated with bleeding. Microscopic colitis is also inflammatory and usually presents with watery diarrhea rather than bleeding.
Along with Crohn’s disease, colitis (ulcerative or microscopic) is another condition that people with inflammatory bowel disease (IBD) suffer from. Even so, partnering with a licensed dietitian is an excellent means of adopting an effective nutritional therapy plan to help you identify food for ulcerative colitis that alleviate inflammation flare-ups following a remission.
A 2015 surveillance report by the Centers for Disease Control and Prevention (CDC) determined that approximately three million (1.3%) American adults reported having been diagnosed with IBD (mostly either Crohn’s disease or ulcerative colitis). Meanwhile, a 2018 health surveillance report by the National Center for Biotechnology Information (NCBI) determined that the number of individuals with ulcerative colitis increased from 9 to 20 per 100,000 persons per year. Compared to Crohn’s disease, ulcerative colitis has a higher prevalence rate in adults than children.
This article provides critical insights into the foods that people with ulcerative colitis and microscopic colitis can benefit from, why they are the best foods for you, and some foods you might want to avoid. Although each type of colitis is different, the nutrition treatment paths are similar with regards to diet. For the purpose of this article, we will talk specifically about ulcerative colitis nutrition. But before we delve into that, it would be best to know the signs and symptoms of ulcerative colitis.
Risk factors, signs and symptoms of ulcerative colitis
Ulcerative colitis occurs due to an immune system dysfunction. Normally, the immune system safeguards the body against disease-causing bacteria by sending fighter cells to counter-attack pathogens. However, people develop UC when the immune system mistakes food, beneficial bacteria, and cells lining the colon for intruders. As a result, the white blood cells meant to protect you attack the colonic walls, resulting in inflammation and ulcers.
Ulcerative colitis is an idiopathic inflammatory condition because doctors don’t know why people experience on and off UC symptoms. Nonetheless, UC is associated with various risk factors that include:
- Age – UC prevalence rate is high among individuals of 15-30 years and those older than 65.
- Ethnicity – The risk of developing UC is highest among people of Ashkenazi Jewish descent.
- Family history – If you have a close relative with UC, your chances of developing the condition are 30% and above.
Signs and symptoms of ulcerative colitis
The most common UC symptom is bloody diarrhea or pus in the stool. Besides, other symptoms include:
- Sudden and frequent need to poop
- Cramping bowel pain
- Weight loss
- Joint pains
- Skin sores
- Feeling like your colon is full even after using the washroom
- Inability to hold your stool in
- Canker sores
- Pain or bleeding with bowel movements
Although ulcerative has no cure, knowing what to eat with colitis (through a prescribed nutritional plan) can effectively mitigate the on-and-off cycle of these symptoms, and can aid in the reduction of inflammation and risk of flare.
What to eat with ulcerative colitis
Although there is no universal standard dietary plan for people with UC, there are some things we know about IBD and the microbiome that can help guide food recommendations. In our practice we focus on two areas when it comes to dietary recommendations:
- Choosing things to reduce inflammation & risk of flare
- Choosing things that will improve quality of life & reduce symptoms
Before we delve into the guidance- if you aren’t familiar with the 4 types of remission be sure to check out our previous article. As you navigate nutrition for UC, it’s important to note that what triggers symptoms- doesn’t always trigger inflammation. Also, the opposite is also true- an inflammatory diet pattern doesn’t always lead to immediate symptoms.
Typically, the best type of diet for UC is a plant-based diet that’s rich in omega 3-fatty acids. Discussed below are some foods that are helpful for people with ulcerative colitis:
Omega 3 Rich Foods
If you have ulcerative colitis, increasing omega 3 fatty acids in the diet can be helpful for dialing back inflammation. Ground flax, hempseed, chia seed, walnuts and omega-3 rich fatty fish are excellent sources. High consumption of omega-3’s has been shown to decrease disease activity, improve antioxidant status and tone down inflammatory agents like leukotriene B4 (1, 2, 3).
The Journal of Gastrointestinal and Liver Disease (JGLD) discovered that over 50% of people with IBD suffer weight loss and malnutrition before diagnosis. Including avocados in an ulcerative colitis dietary plan is an excellent means of fighting UC-induced malnourishment as the fruit contains high content of healthful monounsaturated fats. Eating mashed, blended, or spread avocado can restore your fat deposits healthily if you lose weight due to UC.
Oatmeal is relatively easy to digest for individuals with UC and is a higher insoluble fiber which helps to soak up excess moisture in the colon if diarrhea is a concern. Soluble fibers also help increase butyrate production which can reduce inflammation. In a study ½ cup of oat bran was given to UC patients over 4 weeks and it increased butyrate by 36% (4).
Antioxidant support is a crucial component of nutrition therapy for UC. In UC patients, an excessive amount of something called damage-causing reactive oxidative metabolites (ROM’s) are produced in the gut. Trying to consume as many brightly colored antioxidant-rich foods throughout the day can be helpful in correcting damage in the digestive tract from ROM’s. Smoothies can be an excellent way to consume fruits and vegetables if you struggle to tolerate these foods.
Spaghetti, acorn, and butternut are varieties of squash with high fiber content, antioxidants, and vitamin C. While you might be tempted to avoid fiber during a flare-up, research shows fiber is pretty crucial for inflammation reduction so changing the type of fiber is typically preferred to eliminating it entirely. Plus many people with UC tolerate squash. Apart from that, squash is a versatile food and can be consumed as soup puree or mashed as a side dish.
Green Banana & Applesauce
Both green bananas and cooked and cooled apples are high in soluble fibers and resistant starches which help to slow down transit and soak up excess moisture which can be helpful if diarrhea is a concern. According to the University of Wisconsin Health, applesauce is helpful for ulcerative colitis and are a rich source of vitamins and minerals like potassium.
Food patterns that trigger ulcerative colitis symptoms or flare-ups
Consistent consumption of foods in the list below have been shown to either increase risk of flare or symptoms. This doesn’t mean that consuming food once will cause a flare, but more so that consistent consumption of the food may increase the risk of flare in IBD.
Foods rich in sulfur and sulfites
Foods like beer, wine, shellfish, some dried fruits, white bread, and cured meats contain sulfur, producing excess gas in the colon. Even without these foods, UC patients produce more hydrogen sulfide than usual, and they have difficulty breaking the gas down due to inflammation of the colonic wall. Hence, ingesting more foods with sulfur causes more damage to the colon.
Fructose & High Fructose Corn Syrup
A scientific study that examined the effect of fructose among people with ulcerative colitis concluded that high amounts of fructose causes can be inflammatory in UC. Fructose can be found in several foods, including corn syrup, honey, fruit juice, and molasses. Fructose also depletes the layer of mucus lining the colonic wall, exposing it to bacteria that “eat up” the colonic lining. That results in inflammation.
In 2020, the IOIBD guidelines suggested reducing myristic acids in the diet like coconut oil, palm oil and dairy fats (6). This guidance is consistent with what we know about gut bacteria that we don’t like to be high in IBD such as biophyla wadsworthia which increases when these types of fat are present in larger amounts in the diet (7).
Milk, cheese, and other dairy products are not problematic for all people with ulcerative colitis. However, a high amount of dairy fats in the diet was identified as an inflammatory diet pattern. As far back as 1965, a study looked at the elimination of dairy in UC patients and found that a dairy free diet was better for helping keep UC patients in remission (link). In 2020, the IOIBD guidelines added dairy (especially dairy fats) to the list of inflammatory foods to minimize in the diet (6).
Red and Processed Meats
High amounts of red and processed meats in the diet and low amounts of fiber is a risk factor for the development of IBD and risk of flare (8). In addition, the IOIBD guidelines have also recommended reduced or limited amounts in the diet in UC (6).
We know that alcohol even in moderate intakes of 1-3 glasses per week can increase intestinal permeability (or leakiness) which can increase risk of flares over the long term (9, 10, 11). Not to mention, wine especially is often higher in sulfites- another IBD trigger mentioned above.
Spicy foods (symptom trigger only)
Although more data is required to determine the effect of spicy foods among people with ulcerative colitis, most people with UC report pain in the gastrointestinal tract or bloating, stomach cramps, and diarrhea after consuming these foods. Researchers found out that 41% of persons with IBD say that spicy foods trigger symptoms (5). Although spicy food can trigger symptoms in those with IBD, there is no data showing that it is an inflammatory trigger.
Want to Learn More?
If you’d like to understand more about what to eat with IBD without triggering symptoms, I’ve got a free e-book on this topic! The e-book is a deeper dive into not just what to avoid, but also what to eat and the importance of eating a diverse diet. We also go over common questions you might have about fiber. Check it out here.
Partner with a licensed IBD dietitian for a healthy nutritional diet plan to reduce UC flare-ups
Do you have IBD but are confused when choosing the best food for ulcerative colitis? Or do you find yourself restricted to just a few foods? It doesn’t have to be this way. Working one on one can be a great way to get to symptom reduction faster and reduce the stress of figuring it out on your own.
Partner with Crohn’s and Colitis Dietitians today and get professional help creating a nutritional therapy plan to help reduce the symptoms of ulcerative colitis. Contact us today at (661) 306-7517 or get started on your nutritional plan by booking a consultation.
- Stenson WF, Cort D, Rodgers J, Burakoff R, DeSchryver-Kecskemeti K, Gramlich TL, Beeken W. Dietary supplementation with fish oil in ulcerative colitis. Ann Intern Med. 1992 Apr 15;116(8):609-14. doi: 10.7326/0003-4819-116-8-609. PMID: 1312317.
- Aslan A, Triadafilopoulos G. Fish oil fatty acid supplementation in active ulcerative colitis: a double-blind, placebo-controlled, crossover study. Am J Gastroenterol. 1992 Apr;87(4):432-7. PMID: 1553930.
- Barbosa DS, Cecchini R, El Kadri MZ, Rodríguez MA, Burini RC, Dichi I. Decreased oxidative stress in patients with ulcerative colitis supplemented with fish oil omega-3 fatty acids. Nutrition. 2003 Oct;19(10):837-42. doi: 10.1016/s0899-9007(03)00162-x. PMID: 14559317.
- Hallert C, Björck I, Nyman M, Pousette A, Grännö C, Svensson H. Increasing fecal butyrate in ulcerative colitis patients by diet: controlled pilot study. Inflamm Bowel Dis. 2003 Mar;9(2):116-21. doi: 10.1097/00054725-200303000-00005. PMID: 12769445.
- Vrdoljak, J., Vilović, M., Živković, P. M., Tadin Hadjina, I., Rušić, D., Bukić, J., Borovac, J. A., & Božić, J. (2020). Mediterranean Diet Adherence and Dietary Attitudes in Patients with Inflammatory Bowel Disease. Nutrients, 12(11), 3429. https://doi.org/10.3390/nu12113429
- Levine A, Rhodes JM, Lindsay JO, Abreu MT, Kamm MA, Gibson PR, Gasche C, Silverberg MS, Mahadevan U, Boneh RS, Wine E, Damas OM, Syme G, Trakman GL, Yao CK, Stockhamer S, Hammami MB, Garces LC, Rogler G, Koutroubakis IE, Ananthakrishnan AN, McKeever L, Lewis JD. Dietary Guidance From the International Organization for the Study of Inflammatory Bowel Diseases. Clin Gastroenterol Hepatol. 2020 May;18(6):1381-1392. doi: 10.1016/j.cgh.2020.01.046. Epub 2020 Feb 15. PMID: 32068150.
- Devkota, S., & Chang, E. B. (2013). Diet-induced expansion of pathobionts in experimental colitis: implications for tailored therapies. Gut microbes, 4(2), 172–174. https://doi.org/10.4161/gmic.23589
- Andersen V, Olsen A, Carbonnel F, Tjønneland A, Vogel U. Diet and risk of inflammatory bowel disease. Dig Liver Dis. 2012 Mar;44(3):185-94. doi: 10.1016/j.dld.2011.10.001. Epub 2011 Nov 3. PMID: 22055893.
- Bishehsari, F., Magno, E., Swanson, G., Desai, V., Voigt, R. M., Forsyth, C. B., & Keshavarzian, A. (2017). Alcohol and Gut-Derived Inflammation. Alcohol research : current reviews, 38(2), 163–171.
- Swanson GR, Sedghi S, Farhadi A, Keshavarzian A. Patterns of alcohol consumption and its effect on gastrointestinal symptoms in inflammatory bowel disease. Alcohol. 2010 May;44(3):223-8. doi: 10.1016/j.alcohol.2009.10.019. PMID: 20682190; PMCID: PMC3708696.
- Büning C, Geissler N, Prager M, Sturm A, Baumgart DC, Büttner J, Bühner S, Haas V, Lochs H. Increased small intestinal permeability in ulcerative colitis: rather genetic than environmental and a risk factor for extensive disease? Inflamm Bowel Dis. 2012 Oct;18(10):1932-9. doi: 10.1002/ibd.22909. Epub 2012 Feb 16. PMID: 22344959.
I’m just here to help one person from my family but he is overseas. He has Crohn.s and he been Sick a long time . I want to know what kind food is good for him please because is must time he told me he can’t eat anything. Need ur help if you can please
Hi Jasim – I’d suggest he check out our you tube as a starting point. You can have him reach out if he needs individualized support too! https://www.youtube.com/watch?v=-BnI2XZ0l04&t=173s
Thank you. I tried to download the what to eat e-book but the information was not available. Do you have a link to access the e-book?
What would you recommend to replace white bread and white pasta. We were told to eat white bread, white pasta and rice but there is no nutritional value in these
Whole grain or brown rice versions? White rice still has nutritional value- it’s just got less fiber. You can still get resistant starches and carbohydrates from white rices too.
What type of food we can eat
We have a good you tube video on this topic! https://www.youtube.com/watch?v=-BnI2XZ0l04&t=173s
Hi Kim! Yes actually it does… I know the title says colitis but we use a very similar approach for dietary strategies with Crohn’s too!
Does this same advice apply to those with Crohn’s? Is there a similar article on what to eat with Crohn’s? Thanks.