The great thing about the internet is that you have constant access to information on any topic you want to learn about. The bad thing about the internet is that it can be difficult to determine a credible source from a phony one. When it comes to finding information on how to best manage GI conditions like Ulcerative Colitis (UC), online information can often be contradicting and confusing. Thankfully, we’re up to date on the current research and recommendations to help you best manage your Ulcerative Colitis symptoms.
The tough part about ulcerative colitis management is that our recommendations are specifically tailored to your stage of ulcerative colitis- active (flare) or dormant (remission).
Ulcerative Colitis Stages
Ulcerative Colitis is an Inflammatory Bowel Disease (IBD) that causes inflammation and ulcers in the large intestine and colon. There are two stages of Ulcerative Colitis, active flare and remission.
During an active flare, inflammation is worse and symptoms are active. Flares can last anywhere from a few days to a few weeks. Symptoms of a flare may include abdominal pain, abdominal cramping, rectal pain, rectal bleeding, urgent and/or painful bowel movements, fatigue, dehydration, fever, bloody stool, pus in stool, diarrhea, and weight loss. Symptoms persisting for more than 48 hours can signify a Ulcerative Colitis flare, not just a typical stomach bug. Some individuals with Ulcerative Colitis will also experience pain in their joints, ulcers in their mouth, and tender, red spots on their skin during a flare. Flares can be brought on by missing doses of medication, taking nonsteroidal anti-inflammatory drugs, taking antibiotics, smoking, stress, and eating foods that irritate the GI tract.
During remission, inflammation is resolved, or at least controlled, which causes symptoms to become dormant. The length of remission periods varies individually, but can last from weeks to months to years. Because UC isn’t curable, the goal of treatment and management is to achieve and maintain remission. Taking medications prescribed by your doctor is essential to preventing flare ups even years into remission. Continuing to stay hydrated, eat a nutrient-rich diet, manage stress, prioritize class, exercise regularly, and get regular checkups can help maintain remission. While there are many treatment methods, diet therapy plays a primary role in Ulcerative Colitis management. Read more about how to manage Ulcerative Colitis through diet below.
Dietary Recommendations for Ulcerative Colitis
There are different dietary recommendations for each stage of Ulcerative Colitis, active and remission. Recommendations mainly revolve around the amount of dietary fiber in your diet. During a flare it’s best to minimize the amount of fiber in your diet, whereas during remission fiber can be a beneficial part of your diet. Fiber is a tough nutrient for the gut to digest so during a flare, when the gut is already stressed, fiber can aggravate the symptoms of Ulcerative Colitis. Fiber also adds residue to stool, which should be avoided to allow the bowels to rest and heal. This is specifically true for insoluble fiber, which does not dissolve, and moves through your GI tract unchanged. Consuming fiber during a flare can increase bloating, gas, diarrhea, and abdominal pain, and may even lead to intestinal blockage.
- Foods to Eat:
- Low fiber fruit: bananas, cooked fruit, canned fruit
- Non-cruciferous vegetables: asparagus, potatoes, cucumbers, carrots
- Refined grain products: white pasta, white rice, white bread
- Lean protein: fish, chicken, lean pork, eggs, tofu
- Foods to Avoid:
- Fruits with seeds and skins
- Spicy food
- High-fat foods: fried food, red meat, fast food
When UC is in remission, it’s important to eat a varied, nutrient-dense diet. Maintaining a diet full of nutrients can help prevent future flares, as well as nutrient deficiencies, malnutrition, and other complications. Once symptoms have subsided, begin introducing new foods slowly to avoid irritation:
- Foods to Reintroduce during Remission
- Whole grains: oats, brown rice, whole wheat pasta, whole wheat bread
- Legumes/nuts: beans, nuts, seeds
- Fruits and vegetables: Reach for colorful, fresh fruits and vegetables. It can be helpful to remove the skin and seeds to avoid symptoms.
Whenever possible, eat a diet rich in fiber and nutrients. With Ulcerative Colitis there is an increased risk for malnutrition, specifically if you are not eating enough food. Meeting your nutrient needs may be challenging during a flare, which makes it even more crucial during remission. Additionally, when your large intestine is inflamed, your body loses some of the nutrients you are eating instead of absorbing all of them. When coming out of a flare and into remission, your body also needs energy and nutrients to help heal the damage in your body.
A well-balanced, nutrient-rich diet is the best way to care for your body. Eating a variety of foods from different food groups can help ensure you are getting all of the different nutrients you need. If you have Ulcerative Colitis, it’s best to avoid any type of restrictive diet (keto, paleo, etc.) because diets that eliminate many foods or entire food groups reduce your ability to get a wide variety of nutrients.
Some specific nutrients, including vitamin D, calcium, iron, and folate are especially important for individuals with UC:
Vitamin D can be found in fatty fish, eggs, and mushrooms
Calcium can be found in dark leafy greens, beans, nuts, and seeds
Iron can be found in fish, meat, poultry, beans, legumes, and dark leafy greens
Folate can also be found in beans, legumes, and leafy greens
Omega-3 fatty acids are another important nutrient. Omega-3s can help reduce inflammation within the body, and can be found in fish, nuts, and seeds.
However, when managing a condition like Ulcerative Colitis, you may need to make temporary dietary adjustments to relieve your symptoms. The key is to change your dietary intake based on your needs at the time.
Kaitlyn Willwerth is a Registered Dietitian at OnPoint Nutrition. Kaitlyn's work focuses on providing individualized health and lifestyle coaching and, most importantly, support. She is a Certified LEAP Therapist and has also completed the Monash University 'Low FODMAP Diet for IBS' online training course for health professionals.