The minute you’ve been diagnosed with ulcerative colitis, you may find yourself swamped with information about foods you should avoid and how to eat the “right” things to keep your symptoms in check.
It’s true that anyone with inflammatory bowel disease (IBD) has different triggers that can make the condition feel so much worse, some of them being specific foods, per the National Center for Biotechnology Information. Ulcerative colitis, one form of IBD, is no different. Getting a handle on what those personal trigger foods are can help you to achieve and stay in ulcerative colitis remission, meaning you can actually be free of your symptoms with the right plan.
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Eating certain foods and avoiding others may help you avoid ulcerative colitis flares. sonyakamoz - stock.adobe.com. When you have ulcerative colitis (UC), just figuring out what to eat for lunch— to avoid a mad dash to the bathroom — can be downright confusing. While there is not an official
Those who are diagnosed with ulcerative colitis can experience ulcers in the large intestine, which may lead to diarrhea, bloody stool, and abdominal pain. But, ultimately, ulcerative colitis can manifest differently for different people. “I have some patients who have terrible diarrhea in UC flares, others
Since you have ulcerative colitis (UC), it's worth your while to pay attention to what you eat. Foods don't cause the disease, but some can set off your flares. How can you keep away from those triggers but still get the nutrients you need?
This is another “good” fat that blocks certain chemicals in your body called leukotrienes. Fish oil is a good source of EPA. In some studies, folks with UC saw some benefits when they took high doses. Many people, though, didn't like the fishy taste. There is also some evidence that adding fish oil to aminosalicylates (meds called 5-ASA) may be helpful, but this isn’t
But that doesn’t mean that restrictive eating is going to stop the progression of your ulcerative colitis, and in fact, it can be harmful, Simon Hong, M.D., a board-certified gastroenterologist specializing in inflammatory bowel disease and clinical assistant professor at NYU Grossman School of Medicine, tells SELF. “One of the big issues with IBD is appropriate nutrition,” he explains. “We don’t want people to start cutting out all of these things and end up being malnourished.”
It’s important to remember that diet is just one aspect of the condition. “For most patients with ulcerative colitis, when their inflammation is gone—which is achievable for many patients now with medicines—they generally can eat what they want unless it’s something that they’re intolerant to,” Russell Cohen, M.D., professor of medicine and director of the University of Chicago’s Inflammatory Bowel Disease Center, tells SELF.
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Ulcerative colitis is a major form of inflammatory bowel disease that affects millions of people worldwide
There are certain foods which may worsen a person’s ulcerative colitis symptoms.
Pro-inflammatory foods to avoid are refined sugars, processed foods , refined vegetable oils, meat
Information on ulcerative colitis (inflammatory bowel disease, UC), an inflammation of the lining of the colon. Symptoms of ulcerative colitis are generally frequent bowel movement and weight loss. An ulcerative diet that eliminates foods that trigger, and foods that help cure ulcerative colitis symptoms.
Proper nutrition is important for a person with ulcerative colitis . Foods do not cause ulcerative colitis , but certain food groups can cause symptoms to flare. Often it is a process of trial and error to find what foods need to be avoided . Although specific foods do not cause the disease
With that in mind, let’s dive into all things nutrition when it comes to ulcerative colitis, including the most common trigger foods you’ll want to be aware of during a flare-up.
What is ulcerative colitis? | Inflammatory foods | Foods to avoid | Ulcerative colitis flare-ups | When to see a doctor
Back up: What is ulcerative colitis, exactly?
Ulcerative colitis is a type of inflammatory bowel disease that causes ulcers and sores in the lower quarter to third of your digestive tract. Typically, these ulcers are found in your rectum (the last several inches of your colon right before your anus) or in the inner lining of your lower intestine (which is your large intestine). This can cause (sorry) bloody diarrhea, the most common symptom of ulcerative colitis, but you might also experience things like abdominal cramping, constipation, and a general sense of fatigue. Weight loss and a loss of appetite can also crop up, per the U.S. National Library of Medicine.
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Individuals with certain food intolerance may need to avoid whole groups of foods . Those with lactose intolerance should not eat foods containing dairy products including milk, cheese, yogurt and ice cream.
In ulcerative colitis , removal of the colon cures the disease, but the trend is now to try to control inflammation and minimize the need for surgery. Screening colonoscopy is required for patients with ulcerative colitis , since there is an increased potential for developing colon cancer.
Diana Whitehead, M.D., director of the Inflammatory Bowel Disease Center at the Greater Baltimore Medical Center, explains that though ulcerative colitis has a strong genetic component, symptoms are often set off by a triggering event that activates inflammation in the lower intestine. “Basically, your immune system is not doing what it should do, which is to protect you, but it’s gone kind of into overdrive,” Dr. Whitehead says. In other words, even though the exact causes of ulcerative colitis aren’t fully understood, experts consider it to be an autoimmune condition that’s set off by this overreaction in the gut.
Do “inflammatory foods” play a role in ulcerative colitis?
If you’re searching for an ulcerative colitis treatment that starts with your diet, you are far from alone. David Schwimmer, M.D., a board-certified gastroenterologist at Florida Digestive Health Specialists in Sarasota, Florida, sees ulcerative colitis patients on a daily basis and has even lived with the condition himself since he was 18 years old. “I think every patient that has a GI illness certainly thinks that what they are consuming and what they’re eating has an impact on their disease,” he says.
Are There Foods to Eat and Avoid on an Ulcerative Colitis Diet?
It’s not a one-size-fits-all approach.Ulcerative colitis falls within the conditions considered to be inflammatory bowel disease (IBD). Experts aren’t sure of the exact mechanism that causes ulcerative colitis, but it is thought to be due to a combination of things, including an overreaction of the immune system, genetics, the gut microbiome, and environmental factors1.
Exclusion diets like the specific-carbohydrate diet, the semi-vegetarian diet, and the IBD-inflammatory diet continue to grow in popularity within the IBD community. But research to prove that these diets are helpful for ulcerative colitis lags behind the trend. As recently as 2019, a study published in the journal Nutrients concluded that “the mechanism by which dietary interventions impact inflammation in IBD remains unknown1.” Basically, there’s a lot more scientists need to learn before one type of diet (if ever) reigns supreme for people with IBD.
Since ulcerative colitis symptoms are aggravated by inflammation in your gut, it makes sense to assume that avoiding “inflammatory foods” would help you control your symptoms. Unfortunately, there’s just no concrete science that defines what an “inflammatory food” is or is not. Everyone’s body reacts differently to each food that they eat. “As far as a class of inflammatory food, I don’t think there is such a thing,” Dr. Whitehead says.
Dr. Schwimmer notes that in animal studies, researchers have been able to detect inflammatory biomarkers—proteins and other substances circulating in the blood that point to inflammation in the body—connected to specific food groups. But humans have much more complex diets that make it harder to nail down how certain foods might contribute to inflammation. “At this point, there’s a hypothesis that some foods are quote-unquote inflammatory, but I wouldn’t say it’s been nailed down yet by science,” he says.
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So, if you decide to just cut random foods out believing they are inflammatory, that might actually be a problem. Prolonged periods of time where you are on a restrictive diet can increase your chances of developing malnutrition2. The way that IBD affects your digestive system already puts you at risk for this complication, with a 2017 study showing that up to 62% of people with ulcerative colitis are lacking essential nutrients in some way2. To protect and nourish your body, any major dietary changes used to manage ulcerative colitis should be supervised by your doctor or a registered dietitian.
Are there common foods to avoid if you have ulcerative colitis?
Okay, so we’ve established that there are no surefire foods to avoid that will reduce or eliminate ulcerative colitis symptoms. But there are some foods that you could try to avoid during a flare-up until your bowels calm down. Those include:
1. High-fiber foods
Many people hail fiber as a magical nutrient that can lower your risk of developing heart disease, type 2 diabetes, and potentially offer some protection against Crohn’s disease flares—another type of IBD. And, well, loading up on fiber can aid in all of those things.
However, some people with ulcerative colitis may want to avoid a high-fiber diet, depending on their symptoms, according to the Crohn’s & Colitis Foundation. If diarrhea is a hallmark of your ulcerative colitis, you may want to eat less insoluble fiber because it moves food through the intestine quickly—which only makes the problem worse. To reduce your insoluble fiber intake, you may want to lay off beans (bye, chili) and other legumes like chickpeas or lentils, cruciferous vegetables like cauliflower or kale, nuts, and whole wheat flour in your diet to see if your symptoms improve3.
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Although high-fiber diets may affect some people with ulcerative colitis during a flare-up, experts generally recommend making sure to get enough fiber during remission. One 2017 review of studies found that it may help prolong periods without inflammation—except for in people who have strictures, or a narrowing of the intestine4. “In those patients, we do advise less fiber, because fibers can clump up and cause an obstruction or blockage,” Dr. Hong says.
2. Foods containing FODMAPs
FODMAP stands for fermentable oligosaccharides, disaccharides, monosaccharides, and polyols. These short-chain carbohydrates are difficult for our bodies to digest, can produce gas, and increase fluid in your colon—ultimately causing diarrhea and gastrointestinal distress in some people. They’re present in an abundance of foods, including onions, legumes, ice cream, apples, honey, and artificial sweeteners.
Experts commonly recommend a low-FODMAP plan to treat irritable bowel syndrome (IBS), a term that describes a collection of symptoms including abdominal pain, bloating, gas, and diarrhea or constipation. People with IBS by definition do not have inflammation in the digestive tract like people with IBD do. However, ulcerative colitis and IBS share some common symptoms5, so your doctor may recommend trying a low-FODMAP diet if you have ulcerative colitis, Dr. Hong says.
Researchers are studying whether low-FODMAP diets can relieve ulcerative colitis flare-ups, but so far studies have been small. A 2016 retrospective study in the journal Inflammatory Bowel Diseases found that a low-FODMAP diet reduced symptoms in 38 ulcerative colitis patients6. More research studying larger numbers of people is necessary to determine whether FODMAPs are a critical factor in ulcerative colitis symptoms. However, anecdotally, some people with ulcerative colitis report that curbing their FODMAP intake seems to help their gut symptoms7.
Everything You Need to Know About a Low-FODMAP Diet
It could be the solution to your IBS troubles.A low-FODMAP diet has been shown to improve digestive symptoms of IBS for up to 86%1 (but typically closer to 70%2) of those living with this condition, Kate Scarlata, M.P.H., R.D.N., digestive health and FODMAP diet expert and author of The Low-FODMAP Diet Step by Step, tells SELF. (IBS is a condition in which people experience abdominal pain and changes in bowel movements, including diarrhea and constipation.
Initially, the low-FODMAP diet is very restrictive: The idea is to cut out all FODMAPs before slowly reintroducing some to determine which you can tolerate. So, it’s important to work with your health team when making any dietary change to avoid nutritional deficiencies.
3. Cheese, milk, and dairy products
Dairy is tricky, Dr. Hong says, because lactose intolerance—or even a full-blown dairy allergy—can sometimes be mistaken for an ulcerative colitis flare-up. “One of the things we recommend is if you’re feeling unwell with things you’re eating, try cutting out the dairy. If that does help, then maybe get tested for lactose intolerance, which is an easy test to do and is warranted.”
Lactose intolerance and a dairy allergy are very different, even though some of the symptoms are similar, like abdominal cramping and diarrhea. With lactose intolerance, your body doesn’t produce enough lactase, which is an enzyme that allows you to digest lactose, the main sugar found in dairy. Lactose intolerance isn’t an emergency situation, even if it feels like a bathroom emergency. If you have a dairy allergy, you are actually allergic to specific proteins found in dairy products, and your immune system springs into action when you consume them. This can lead to a severe allergic reaction, which can turn life-threatening. No matter which you might be dealing with, you’ll want to rule out a sensitivity to dairy as a cause for your GI discomfort.
4. Foods containing gluten
Ulcerative colitis is not the same as celiac disease, in which gluten triggers the immune system to attack the small intestine. However, 2020 research indicates that people with ulcerative colitis are more likely to also have celiac disease3. Alternatively, you might have gluten sensitivity, meaning you don’t have an immune response to gluten but find it causes symptoms including bloating, abdominal pain, diarrhea, and fatigue, all of which can also be symptoms of ulcerative colitis.
A 2014 Inflammatory Bowel Diseases study surveyed 314 people with an IBD—including 122 people with ulcerative colitis—and found that 56.5% reported less bloating while on a gluten-free diet. In addition, 42.6% reported less diarrhea, 41.5% reported less abdominal pain, and 38.3% reported that they had fewer and less severe flare-ups9.
But don’t start tossing out your favorite cereal just yet. A high-FODMAP carbohydrate called fructan is in many of the same foods as gluten. So cutting out gluten means you’re eliminating many FODMAP foods too, which can be too much of a change to just take on by yourself.
As with all of these foods, it’s a matter of trial and error, and working with a professional can help you figure out what’s going on as safely as possible. “We don’t recommend gluten avoidance per se, and there’s no evidence that gluten worsens IBD,” Dr. Hong says. “If someone’s having symptoms, we’ll go down the list and try avoiding gluten, try avoiding FODMAPs, and if they seem to respond, then we’ll go down that path.”
5. Wine, beer, and other alcoholic beverages
Maybe you’ve already noticed, but alcohol has a tendency to stimulate your intestines, which can make diarrhea worse, according to the Mayo Clinic. But don’t raise your fist to the sky and curse the alcohol gods, researchers believe the additive sulfite (read: not put there by the gods), found in beer, wine, and lager, may worsen symptoms, rather than the alcohol itself—which brings us to the last item on this list. (Note that sulfite sensitivity is thought to be rare, and is not yet well understood).
6. Sulfites and other additives
It’s important to mention that research on the impacts of additives in people with ulcerative colitis is preliminary—most of it has been conducted on animals and the results in mice wouldn’t necessarily replicate in humans. “It’s a big area of study because additives are so prevalent in modern foods,” Dr. Hong says. “But there isn’t some strong evidence saying, ‘These are absolutely out-and-out bad for you.’ But there are thoughts that they could be bad.”
We’ve already mentioned sulfites, which manufacturers often use to lengthen the shelf life of products, including burgers, soft drinks made from concentrate, sausages, canned goods, meats, fish, and dried fruit. Experts theorize sulfites damage bacteria that promote gut health10. That’s a big deal since diverse gut bacteria—which play a key role in digestion, regulating the immune system, and so many other critical functions in the body11—is already thought to be lacking in people with ulcerative colitis12.
Researchers have also looked into potential ulcerative colitis impacts from carrageenan, which is derived from seaweed and works as a thickening agent in dairy products, milk alternatives such as almond milk, processed meats, and soy-based products. According to a 2017 study, carrageenan causes inflammation and ulcerations in animals that are similar to those seen in patients with ulcerative colitis13. But again, there’s no solid evidence that this causes inflammation in people.
Are food triggers the only cause of an ulcerative colitis flare-up?
Regardless of your diet, there may be times when your ulcerative colitis symptoms seem to disappear completely for months at a time before making a dramatic reappearance. When this happens, it’s called a flare.
But the foods you’re eating aren’t the only possible culprit. Emotional stress, not taking medications as prescribed, and use of certain medications, like steroids and antibiotics, can also trigger ulcerative colitis flares, according to the Cleveland Clinic.
Flares take different forms for different people, and there’s no formula that predicts what will bring them on. “Different people will claim a medicine or anxiety will set their symptoms off. But some people just seem to have had flares when they have flares, and you can drive yourself crazy trying to find the cause,” Dr. Schwimmer says.
When should you see a doctor about ulcerative colitis food triggers?
According to Dr. Schwimmer, seeing a doctor at the first sign of ulcerative colitis symptoms is your safest bet, especially if you’ve never been formally diagnosed. Concerning, unexplained symptoms like bloody stool, diarrhea, and abdominal cramping shouldn’t be ignored, because even if it’s not ulcerative colitis, you might be dealing with something else that needs proper treatment.
After you’ve been diagnosed, your doctor might recommend making diet adjustments as a part of your ulcerative colitis treatment plan. But ultimately, FDA-approved medications, which help control the inflammation that sets off GI pain, are going to be the main course of treatment that your doctor suggests for the long haul of this chronic condition.
“There is no secret treatment for inflammatory bowel disease. Everybody’s looking for the secret pills. What diet can I follow? What supplement can I take? What probiotic can I take? Unfortunately, it just doesn't exist,” Dr. Schwimmer says. “But the medicines we have work and they work better than anything else.”
That’s why doctors who specialize in IBD caution that self-treatment with diet is not enough. If you aren’t working within the framework of a plan that includes proven, FDA-approved medication, you are at a higher risk of complications from your ulcerative colitis, including malnutrition.
“Let us control inflammation, let us heal the intestine objectively,” Dr. Hong says. “And then we’ll talk about ways to tweak your diet so that you can still enjoy all the foods you like while cutting out the ones that may be causing the symptoms.”
- Nutrients, A Review of Dietary Therapy for IBD and a Vision for the Future
- Gastroenterol Res Pract., Nutrition and IBD: Malnutrition and/or Sarcopenia? A Practical Guide
- Gastroenterology, Association Between Inflammatory Bowel Diseases and Celiac Disease: A Systematic Review and Meta-Analysis
- Nutrients, An Examination of Diet for the Maintenance of Remission in Inflammatory Bowel Disease
- Journal of Crohn’s and Colitis, Reduction of dietary poorly absorbed short-chain carbohydrates (https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC5372922/FODMAPs) improves abdominal symptoms in patients with inflammatory bowel disease—a pilot study
- Inflammatory Bowel Diseases, Fermentable Carbohydrate Restriction (Low FODMAP Diet) in Clinical Practice Improves Functional Gastrointestinal Symptoms in Patients with Inflammatory Bowel Disease
- Gastroenterology, Effects of Low FODMAP Diet on Symptoms, Fecal Microbiome, and Markers of Inflammation in Patients With Quiescent Inflammatory Bowel Disease in a Randomized Trial
- Nutrients, Implications of the Westernized Diet in the Onset and Progression of IBD
- Inflammatory Bowel Diseases, Prevalence of a gluten free diet and improvement of clinical symptoms in patients with inflammatory bowel diseases
- PLoS One, Sulfites inhibit the growth of four species of beneficial gut bacteria at concentrations regarded as safe for food
- Integr Med, Part 1: The Human Gut Microbiome in Health and Disease
- Cell Host & Microbe, Dysbiosis-Induced Secondary Bile Acid Deficiency Promotes Intestinal Inflammation
- Front Pediatr., The Role of Carrageenan and Carboxymethylcellulose in the Development of Intestinal Inflammation
- 7 Questions People With Ulcerative Colitis May Have About Biologics
- Here’s What No One Tells You About Life With Ulcerative Colitis
- 7 Ways You Could Accidentally Be Making Your IBS Worse