The Best Diet For Ulcerative Colitis: Splitting Fact From Fiction

Ulcerative colitis and diet feature

[Last updated: 13th June 2017]

Many people claim to have “cured” their ulcerative colitis with diet or supplements.

Unfortunately, there is no diet or pill that can cure the disease.

However, certain diet changes have shown promise in reducing symptoms and easing discomfort.

This article explains what we currently know about the role of diet in ulcerative colitis.

What is Ulcerative Colitis?

Ulcerative colitis is a chronic type of inflammatory bowel disease (IBD), like Crohn’s disease, that affects the colon (large intestine).

Recent studies estimate that IBD affects 2 million people worldwide (1).

 ulcerative colitis in large intestineUlcerative colitis causes inflammation and sores in the inner lining of the colon. Inflammation often begins in the rectum, but it can spread throughout the large intestine.

This brief video gives a more detailed look at the disease:

Summary: Ulcerative colitis is a type of inflammatory bowel disease that causes inflammation and sores in the colon.

Ulcerative Colitis Symptoms and Causes

Ulcerative Colitis Symptoms and CausesUlcerative colitis is thought to develop when a person at genetic risk is exposed to certain environmental stressors.

These environmental stressors either change the ratios of gut bacteria or alter the way the immune system responds to bacteria (2, 3).

As a result, the immune system attacks the intestinal lining causing inflammation and other symptoms including:

  • Abdominal pain
  • Diarrhea (often with blood, pus or mucus)
  • Nausea
  • Poor appetite
  • Fatigue
  • Frequent bowel movements or urgent need to go
  • Weight loss
  • Fever
  • Anemia (low red blood cell count)
  • Leaky gut (3).

The same environmental factors that contribute to disease onset can also cause flares.

Certain medications and stress are known to increase disease risk. And recent studies have looked at the relationship between diet and IBD (4, 5).

Research has linked excessive use of sugar and artificial sweeteners to IBD, but other studies have shown no connection (2, 6).

Other research has shown a strong link between animal protein and IBD risk.

In an observational study of more than 67,000 middle-aged French women, those who frequently ate meat and fish were significantly more likely to develop IBD. Eggs and dairy were not linked to increased risk (7).




Summary: A combination of genetic, environmental and immunological factors contribute to ulcerative colitis risk. Symptoms occur in flares and include digestive complaints, as well as fatigue and fever.

What to Eat During Flares

An Ulcerative Colitis Diet During FlaresMedications are used to manage flares and induce remission as quickly as possible.

In addition, certain diet changes may help shorten flares. Some tips to keep in mind:

  • Keep a food and symptom journal during flares to identify bothersome foods. This also ensures that foods are not avoided without cause.
  • Eat small, frequent meals (8).
  • Avoid fatty foods, caffeine and alcohol, as they may increase diarrhea (6, 9, 10).
  • Ask your doctor whether to limit fiber until symptoms pass. Eating a maximum of 10 grams of fiber per day may reduce irritation and lower the risk of intestinal blockage. Once you are in remission, gradually increase your fiber intake, depending on how much you can tolerate, until you reach the recommended daily intake of 25–30 grams.
  • Keep an eating dairy if you can. Those with IBD are at higher risk of osteoporosis due to low calcium intake and difficulty absorbing minerals (11, 12).
  • Drink plenty of fluids to avoid dehydration.

Summary: Diet changes during flares can support medications to bring on remission faster. Some find it helpful to avoid fatty foods, caffeine, alcohol and high-fiber foods.

Can Elimination Diets Cure It?

Up to 60% of IBD patients have tried an elimination diet to relieve ulcerative colitis symptoms (12).

Unfortunately, the only known cure is total surgical removal of the colon and rectum (13).

There is no scientific proof that any diet can cause remission on its own. Limited evidence suggests, however, that certain diets can greatly improve comfort and quality of life.

impact of diet on ulcerative colitis and IBD

The impact of diet on inflammatory bowel disease. Click to enlarge. Image source.

Specific Carbohydrate Diet, GAPS Diet and IBD Anti-Inflammatory Diet

The Specific Carbohydrate DietSpecific Carbohydrate Diet, GAPS Diet and IBD Anti-Inflammatory Diet (SCD) has long been reported to relieve symptoms of ulcerative colitis.

It limits complex carbohydrates and eliminates refined sugar and lactose. It’s believed that these foods travel to the bowel undigested, where they alter gut bacteria and cause discomfort (2).

Foods permitted on the diet include most fruits and vegetables (except canned produce and starchy vegetables), meats, certain legumes, honey and lactose-free dairy products.

The GAPS (Gut and Psychology Syndrome) Diet, the IBD Anti-Inflammatory Diet (IBD-AID), and the Paleo Diet are all similar in that they exclude most grains. The Paleo Diet eliminates all dairy products too (14).

The IBD-AID includes prebiotic and probiotic foods and a specific ratio of healthy fats. It also permits oats.

Small studies have shown the SCD and the IBD-AID to improve IBD symptoms. Larger, well-designed studies are needed to better determine if there is a role for these diets in IBD treatment (14, 15, 16).

Conversely, the Paleo Diet and the GAPS Diet have not been proven to be beneficial in ulcerative colitis.

The removal of grains in particular is questionable for IBD. Several studies have shown cereal grains to be helpful in reducing ulcerative colitis symptoms and protecting against flares.

In one study, 22 ulcerative colitis patients in remission ate 60 g of oat bran per day for 3 months. Fecal studies after treatment showed a significant increase in butyrate, a short-chain fatty acid that is known to heal the intestinal wall (17).

Another study of 18 patients showed that 20–30 g per day of germinated barley foodstuff increased beneficial gut bacteria and butyrate, and reduced symptoms (18).

Patients in both studies ate grains without discomfort.

Low FODMAP Diet

What is low FODMAP and who is it for?The low FODMAP diet is an elimination diet that’s shown promise in managing irritable bowel syndrome (IBS) (19).

It restricts short-chain carbohydrates for several weeks then reintroduces them to see which foods cause digestive problems.

In one study of 72 IBD patients who’d received low FODMAP diet education, those who successfully followed the diet for 3 months reported significant reduction in abdominal pain, bloating and diarrhea (20).

Other studies have shown mixed results for ulcerative colitis.

It’s believed the disease doesn’t cause FODMAP sensitivity but that there is an overlap between the two conditions. Any benefit seen in IBD may be from a reduction in functional digestive symptoms (20, 21).

One concern with the low FODMAP diet is that it limits vegetables and prebiotic foods, both of which are thought to protect against IBD (12, 23).

Keeping the elimination period to a few weeks and working with a registered dietitian can help maximize the benefits of a low FODMAP diet while reducing the risk of nutrient deficiencies.

Semi-Vegetarian

A semi-vegetarian diet limits meat, fish and poultry intake and includes fruits, vegetables, grains, eggs, dairy and legumes.

In one study, 22 patients in remission from Crohn’s disease were given educational materials about a plant-based diet that allowed fish once per week and meat every two weeks.

Sixteen patients were able to follow the semi-vegetarian diet for 2 years. The treatment group was significantly more successful in maintaining remission than those who resumed eating meat (24).

semi vegetarian diet for ulcerative colotis and IBD

Comparison of remission rates over time for the semi-vegetarian group and those who returned to a standard diet. The top line represents the semi-vegetarian diet, with 100% of semi-vegetarians maintaining remission for more than 600 days. Click to enlarge. Image source.

The semi-vegetarian diet has not been studied in ulcerative colitis patients. Clinical trials are needed to determine if it may be beneficial.

However, given newer research linking high meat intake with ulcerative colitis, it’s likely to become a research focus.

Maker’s Diet

The Maker’s Diet (also called the Bible Diet) allows only unprocessed and organic foods and specific supplements.

It’s become a popular topic in online IBD support forums because its creator claims the diet cured his Crohn’s disease.

There have been no studies on the diet to date. The United States Food and Drug Administration issued a warning about the supplements, which are sold through the diet creator’s website.




Summary: No elimination diet has been proven to cure ulcerative colitis. Many popular diets limit foods that may in fact be beneficial. Low FODMAP and semi-vegetarian diets show some promise, but larger studies are needed on these meal plans.

Probiotics and Other Supplements for Ulcerative Colitis

Many supplements are advertised to help with ulcerative colitis symptoms.

However, strong evidence is lacking for most supplements, with the exception of probiotics.

Always check with your doctor before beginning any new supplement.

Probiotics

ProbioticsProbiotics and Other Supplements for Ulcerative Colitis are bacteria that offer health benefits by helping to restore the balance of microflora in the gut. They’re found in dairy and fermented foods and are also available in supplement form.

Fecal studies have shown that the composition of gut bacteria in those with ulcerative colitis is very different to that in healthy people, so probiotics may be helpful for correcting the imbalance.

The bacteria strains Escherichia coli (E. coli) Nissle 1917 and Lactobacillus rhamnosus GG have been shown in small studies to be as effective as aminosalicylate medications in maintaining remission in ulcerative colitis (25, 26, 27).

Also promising is the probiotic blend VSL#3. Studies have shown VSL#3 to be as effective as standard medications in bringing about and maintaining remission and reducing symptoms (28, 29, 30).

In a double-blind study, one group of 65 symptomatic ulcerative colitis patients took VSL#3 at a dose of 3600 billion colony-forming units (CFU) per day for 8 weeks. A second group of 66 ulcerative colitis patients received a placebo. All participants received standard ulcerative colitis medications during the study.

Participants recorded their symptoms in a diary, and researchers assigned each participant a score on the Ulcerative Colitis Disease Activity Index (UCDAI) at the beginning and end of the study.

Disease activity score was reduced by a much greater margin for the VSL#3 group compared to the placebo group at 8 weeks. They also showed significant improvements in rectal bleeding and were more successful in maintaining remission at 8 weeks (30).

VSL #3 probiotics for ulcerative colitis and IBD

Comparisons of VSL#3 and placebo in reduction of Ulcerative Colitis Disease Activity Index (UCDAI) score and remission rates. The first chart shows the difference between VSL#3 and placebo in those with a 50% or greater reduction in UCDAI score, while the second shows the difference between VSL#3 and placebo in improving UCDAI score by at least 3 points. Higher percentage is better for all charts. Click to enlarge. Image source.

However, ongoing treatment may be key with VSL#3, as one study found that beneficial bacteria returned to pre-treatment levels within 15 days of discontinuing use (2).

Probiotics are safe for most people but can be very expensive. Ask your doctor for a recommended strain and dose if you wish to try them.

Prebiotics

PrebioticsPrebiotics are fibers that feed the good bacteria in the gut.

Food sources include leeks, Jerusalem artichokes, garlic, chicory root, onions, bananas, apples, barley and oats.

Germinated barley foodstuff and psyllium husk are both known to increase butyrate production. Butyrate helps to repair the intestinal wall and reduce inflammation (18, 31, 32, 33).

In one study of 105 ulcerative colitis patients in remission, psyllium was nearly as effective as aminosalicylate medications at maintaining remission for 12 months. Remission rates in the study were highest when psyllium and medications were taken together (33).

And the prebiotics inulin and oligofructose have been shown to increase two types of beneficial bacteria (Lactobacilli and Bifidobacteria) in the gut. One small study showed that oral inulin supplements that were enriched with oligofructose decreased concentrations of inflammatory proteins in the feces (34).

Both the psyllium and inulin studies reported good patient tolerance.

More research is needed to determine if prebiotics are safe and effective for ulcerative colitis.

L-Arginine and L-Glutamine

L-arginineL-Arginine and L-Glutamine and L-glutamine are amino acids that are used to build proteins.

They are made in the body, although sometimes not in sufficient amounts. They can also be found in meat, dairy and certain grains.

Both of these amino acids are known for their anti-inflammatory properties. Glutamine is said to be helpful in healing leaky gut syndrome, although this is questionable.

Arginine has been shown in rodent studies to heal wounds and reduce inflammatory chemicals in the blood (cytokines) (35, 36, 37).

However, results from human studies are less clear.

Blood arginine levels in one small study were linked to more severe ulcerative colitis. But researchers suspect that ulcerative colitis patients may not be able to take up arginine into the cells effectively. In other words, some patients have high arginine levels overall but not enough usable arginine (38).

More human studies are needed.

Herbal Therapies

Herbal TherapiesStudies have linked several herbal supplements to reduction of ulcerative colitis symptoms.

Some show promise at inducing remission and improving symptoms. However, few studies have established safe and effective doses.

  • Aloe vera gel is taken from the leaves of the aloe plant. It’s known for its strong anti-inflammatory properties.
    In a trial of 44 patients with active ulcerative colitis, 200 milliliters (mL) per day of aloe vera gel for 4 weeks reduced symptoms more significantly than placebo.
    Aloe vera is considered safe for most people (39).
  • Wheatgrass (Triticum aestivum) is a form of grass that is available fresh or as a powder, juice or tablet.
    In one study of ulcerative colitis patients, a group of 11 patients drank 100 mL of wheatgrass juice daily for 1 month. A second group of 12 patients received a placebo drink.
    The wheatgrass group had significantly less rectal bleeding and greater improvements in disease activity than the placebo group.
    Wheatgrass is generally safe but may cause mild nausea (40).
  • Andrographis paniculata is an Asian herb that is available as a capsule.
    Studies have found it brings about remission faster than placebo and at a comparable rate to aminosalicylates.
    The doses in these studies ranged from 1200 milligrams (mg) to 1800 mg per day for 8 weeks (41).
  • Xilei-san is an anti-inflammatory Chinese herbal blend that’s given as a suppository or enema.
    It’s believed to be comparable to standard topical medications and significantly better than placebo in reducing inflammation and bringing about remission (42, 43).
    Because it’s delivered in enema or suppository form, it’s most effective for lesions and inflammation in the rectum.
  • Curcumin is reported to have anti-inflammatory, wound-healing and antispasmodic properties. It’s the active ingredient in the spice turmeric.
    In one study of 99 ulcerative colitis patients in remission, curcumin was much more effective than placebo in reducing inflammation and lesions and in maintaining remission (44).
    But a large review of curcumin released recently showed that its effects may be overstated. The authors reviewed more than 120 clinical trials and found no strong evidence to support its use. In fact, they believe that the herb may mask inflammation rather than heal it (45). The authors acknowledge that the herb may be found to be beneficial down the road. But more research is certainly needed in light of this new study.

Summary: Many supplements claim to bring about or maintain remission. But specific probiotic strains are the only supplements that have strong scientific support at this time.

Specific Foods and Nutrients

Just as some foods are known to increase risk for ulcerative colitis, others are thought to have protective effects.

Fruits and Vegetables

Fruits and VegetablesHigh fruit and vegetable intake appears to protect against ulcerative colitis. Certain types may even reduce symptoms during flares.

Fruits and vegetables are high in fiber, which is thought to lower risk for IBD. Many are also high in antioxidants, which help to repair and protect the body’s cells (46).

High vegetable intake was linked to lower risk in a review of 19 studies that included 1340 ulcerative colitis patients. A second review of 14 studies found lower rates of the disease in people who ate large quantities of fruits and vegetables (47, 48).

It’s been suggested that citrus fruits and black raspberries may be especially helpful.

One study of 398 ulcerative colitis patients and 616 controls found higher disease rates in those with low intake of citrus fruits. It was not clear whether citrus fruits alone protect against the disease, or if those who eat more citrus simply have higher quality diets. More research is needed (49).

And a study of mice with experimental colitis found that a diet consisting of 5% of calories from black raspberries protected against ulcers (50).

Many fruits and vegetables contain FODMAPs, and some people with ulcerative colitis may find that certain types cause digestive symptoms.

Patients with pain, gas or bloating during remission may wish to work with a dietitian to identify any FODMAP sensitivities. And some may find it helpful to avoid higher-fiber fruits and vegetables during flares.

Dietary Fats

Research on dietary fats and ulcerative colitis is murky, with results from different studies seeming to contradict each other.

The disease has been associated with high intake of all forms of dietary fat. But some studies suggest omega-6 fatty acids increase risk while omega-3 fatty acids are protective (48, 51).

Some of the richest dietary sources of omega-3 fats come from fish. But animal protein, including fish, is linked to higher rates of disease (7).

And studies have shown that omega-3 supplementation does not lengthen remission or decrease need for medications (52).

It’s not yet known if plant sources of omega-3 fatty acids increase risk. Non-meat sources include flax and chia seeds, walnuts, omega-3 enriched eggs, and leafy greens. Use caution with seeds, as they may irritate the colon during flares.

Vitamin D

Vitamin DVitamin D deficiency is common in IBD.

One study from the Netherlands found that 82% of IBD patients are low in vitamin D, compared to 31% of healthy adults (53).

It appears to be important in IBD prevention because it regulates the immune system and maintains the intestinal barrier (54, 55).

One study of Crohn’s disease patients found that 2000 international units (IU) per day of vitamin D is helpful in reducing intestinal permeability and inflammation (56).

But very high doses may cause more harm than good. One rodent study found that high doses of vitamin D during flares decreased bone density.

Mice in this study received up to 5000 IU/kg of vitamin D per day. The estimated human equivalent is 3648 IU/60 kg. So a person weighing 68 kg (150 pounds) may see the same effect at 4145 IU per day (57, 58).




Summary: Fruits and vegetables appear to protect against ulcerative colitis and should be eaten as tolerated. The role of omega-3 fatty acids and vitamin D is less clear. Safe upper limits for ulcerative colitis patients have not yet been established.

An Ulcerative Colitis Diet: Summarizing The Evidence

Despite many reports online that certain diets or supplements can cure ulcerative colitis, the only known cure is total removal of the colon and rectum.

Those with digestive symptoms during remission may find relief from a low FODMAP diet to identify trigger foods.

A semi-vegetarian diet has also shown promise in maintaining remission in Crohn’s disease and may be helpful for ulcerative colitis, but we cannot make firm conclusions.

Even without following elimination diets, certain patterns have been shown to reduce symptoms:

  • A diet that is rich in fruits and vegetables provides fiber and antioxidants, which are linked to lower disease risk. Reducing intake of high-fiber fruits and vegetables may increase comfort during flares.
  • Limiting dietary fat, especially fatty meats, may be beneficial.
  • Certain probiotics are helpful in bringing about and maintaining remission. Ask your doctor for a recommendation.
  • A few herbal supplements show promise but lack sufficient scientific evidence to support their use.
  • Avoid foods that irritate the gut during flares, including fatty foods, caffeine and alcohol.

A registered dietitian can help you identify foods that trigger your symptoms and design a well-balanced meal plan.



No one diet can cure ulcerative colitis. However, certain diet changes can greatly ease discomfort and symptoms. This article looks at the current research: https://www.dietvsdisease.org/ulcerative-colitis-diet/

Comments

  1. Michele says:

    I’ve had UC for over 20 years. I’m 40 now and it’s been under control for the most part. Once in a while I have a flare up but nothing bad and I’ve been on meds this whole time. I have gas pains everyday from something that I am eating so i decided to try Low FODMAP. It helped me immensely because I felt 100% better during the elimination phase, no gas pains! Introducing foods back into my diet is where I am having trouble. Its exhausting. I just never realized that the food I just ate is not the cause of my gas pains. It’s the food from yesterday or the day before, which here lies my difficulty in staying on this diet. But after trying low FODMAP I truly believe that it’s a sugar/food that’s causing my pain. The UC flare ups are a different kind of pain and symptoms. I’ve tried so many different diets. I realized, for the most part, if I am eating super healthy making my own foods instead of eating processed foods then I’m in A LOT LESS pain everyday.

    • Sarah Gray says:

      The low FODMAP diet should not be followed strictly long term by anyone, it is an elimination diet where foods should be gradually added back in, in specific amounts and only from one group at a time. I highly recommend you seek the advice of an accredited practicing dietitian who specialises in the low FODMAP diet to help you with the reintroduction phase.

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