If you have a condition such as Ulcerative Colitis, it’s important to understand the etiology of your disease to be able to treat it properly. A question we are frequently asked about UC is if it is an autoimmune condition. The short answer is yes, but it’s most important to understand what that means for your treatment plan. First, let’s review what exactly an autoimmune disease is.
Autoimmune Disease Overview
An autoimmune disease is defined as a condition in which the body’s immune system mistakes its own healthy tissues as foreign and attacks them. With Ulcerative Colitis, the body recognizes harmless gut bacteria as an enemy and attacks the tissues in the colon. In a typical immune response, the body will send white blood cells to the area of illness or infection to help protect the body. After the body has combated the illness or infection, the inflammation will resolve.
However, in a colon affected by UC, the body continues to send white blood cells (specifically called T cells) to the inner layer of the large intestine, which accumulate and continue to attack. This process causes a buildup of inflammation and can lead to sores, or ulcers, in the affected area. Because UC is recognized as an autoimmune condition, the treatment methods generally target the immune response within your body.
While the exact cause of UC is unclear, experts hypothesize about a few potential triggers. The first is genetics. There is some evidence that UC can run in families, and that individuals with UC have some abnormal genes. The second is the immune system. As discussed above, a healthy immune system will turn off after an infection has been resolved. Some evidence shows that an infection may trigger the immune system, but fail to turn it off, resulting in inflammation and UC symptoms. The third is the environment. This includes triggers such as a virus you may have encountered. It also includes factors such as using anti-inflammatory drugs, antibiotics, or birth control pills regularly. Additionally, a high fat diet may be related.
Immune-targeted treatments attempt to modify the body’s response to perceived “enemies” and reduce the immune system’s attack on healthy tissue. The most common immune-targeted treatments for UC are biologics and Immunomodulators.
Biologic medications are made from a wide variety of products derived from animal or human compounds. They are designed to block specific steps in the immune response and prevent subsequent inflammation. The most common biologics for UC are anti-TNF agents. Some examples are listed below.
- Adalimumab (Humira)
- Adalimumab-atto (Amjevita)
- Adalimumab-adbm (Cyltezo)
- Golimumab (Simponi)
- Infliximab (Remicade)
Immunomodulators are designed to modify the immune response and decrease inflammation in the gut. These medications are typically used as a long-term treatment option as it may take 3-6 months or longer to see improvement. Some examples of Immunomodulators are listed below.
- Methotrexate (Otrexup, Rasuvo, Rheumatrex, Trexall)
- Azathioprine (Azasan, Imuran)
- Mercaptopurine (Purinethol, Purixan)
- Cyclosporine (Gengraf, Neoral, Sandimmune)
- Tacrolimus (Prograf)
Biologics and Immunomodulators work in similar ways to suppress the immune response in the gut. Suppressing the immune response helps to prevent inflammation buildup and, therefore, decrease your UC symptoms. However, these medications typically work best in conjunction with diet therapy for UC. Now that the connection between UC and the immune system is clear, you may be wondering how this affects your long-term health.
Medical Nutrition Therapy for Ulcerative Colitis
While your doctor may prescribe medical management for UC, focusing on certain aspects of your diet can help to improve the impact of this autoimmune condition and improve your symptoms. Certain foods can help to decrease inflammation in your body. Fruits and vegetables are dense sources of nutrients, which your body needs to manage inflammation, repair the damage to your large intestine, and support overall health.
Remember that your body may need a lower fiber diet because of UC, so opt for fruits like bananas or cooked/canned fruits and non-cruciferous vegetables like asparagus, potatoes, cucumbers, and carrots. Healthy fats, specifically omega-3 fatty acids, can also support your body’s efforts to reduce inflammation. Including fish in your diet can be a great way to get these healthy fats.
Conversely, there are foods that increase inflammation within the body, and can be avoided to help alleviate symptoms. These foods include foods with added refined sugars. Limit juice, candy, pastries, and soft drinks to cut back on sugar. High fat foods, specifically those containing saturated and trans fats can also increase inflammation. Avoid fried foods, butter, cream, high fat meats, and baked goods to reduce your intake of these fats.
Does Ulcerative Colitis weaken your immune system?
Although Ulcerative Colitis is an auto-immune condition, research shows that having UC does not make you immunocompromised. However, if UC is not managed properly, it may lower the immune system’s overall function. Additionally, some UC medications may influence your immune system since they work to alter the way your immune system responds to perceived “enemies”.
The following medications are known immunosuppressants used to treat UC:
- JAK inhibitor
The following medications do not suppress the immune system:
It is important to know that each medication affects your immune system differently, so be sure to check with your doctor to know your risks and benefits.
The bottom line
Knowing UC is an autoimmune condition is helpful in deciding the correct treatment plan for you. It’s important to know that the inflammation in your body is not directly caused by your actions, but instead your body’s unwarranted response to those actions. However, a combination of medication and nutrition therapy should deter the immune response and tame inflammation enough to allow periods of long-term remission.
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.