Ulcerative Colitis: Supportive Nutrition for Treatment

Understanding Ulcerative Colitis and Nutrition

Ulcerative colitis is a chronic inflammatory disease affecting the mucous lining of the colon and rectum, characterized by periods of active disease (flares) and remission. While nutrition is not the cause of the disease, it is a fundamental factor in managing symptoms, reducing inflammation, and supporting healing.

Every patient with ulcerative colitis is unique, and what works for one person may not work for another. Therefore, individualized, personalized nutrition is the key to success.

Nutrition During Acute Flares

During periods of inflammatory activity, the primary goal is to reduce the burden on inflamed intestines, prevent malnutrition, and provide rest for the digestive system.

Basic Principles of Nutrition During Flares

Low-Fiber Diet: Reducing insoluble fiber helps decrease stool volume and bowel movement frequency. Focus on well-cooked, peeled foods.
Easily Digestible Foods: White rice, boiled potatoes, ripe bananas, white toast, and boiled chicken are safe options.
Avoid Trigger Foods: Rough fiber, seeds, nuts, corn, raw vegetables, dairy products (if lactose intolerant), caffeine, and alcohol.
Small Frequent Meals: 5-6 small meals are better than 3 large meals to reduce the burden on the digestive system.
Adequate Hydration: Drink 8-10 glasses of water daily to replace lost fluids, especially with diarrhea.

Recommended Foods During Flares

Proteins: Boiled or grilled chicken, turkey, white fish, boiled eggs, and soft tofu.

Starches: White rice, white pasta, boiled or mashed potatoes, toasted white bread.

Fruits: Very ripe bananas, cooked and peeled apples, cantaloupe, strained fruit juices.

Vegetables: Well-cooked carrots, peeled and cooked zucchini, mashed pumpkin, cooked sweet potatoes.

Specialized Medical Nutrition

In severe cases, the patient may need:

Liquid Nutritional Supplements: High-calorie, high-protein liquid supplements to prevent malnutrition.
Elemental Diet: Liquid formulations containing pre-digested nutrients that are easily absorbed.
Total Parenteral Nutrition (TPN): In very severe cases when the digestive system needs complete rest.

Nutrition During Remission

During remission, the goal is to maintain health, improve nutrition, support intestinal healing, and prolong the remission period as much as possible.

Nutrition Strategies for Remission

Gradual Dietary Diversity: Reintroduce foods slowly and systematically, one new food every 3-4 days to monitor tolerance.
Gradual Fiber Increase: Start with soluble fiber (oats, sweet potatoes, cooked apples) before moving to insoluble fiber.
Anti-Inflammatory Foods: Focus on foods rich in omega-3s, antioxidants, and polyphenols.
Microbiome Support: Introduce probiotics and prebiotics to improve gut bacteria health.

Anti-Inflammatory Foods

Fatty Fish: Salmon, mackerel, sardines - rich in omega-3 EPA and DHA that reduce inflammation.

Extra Virgin Olive Oil: Contains anti-inflammatory oleocanthal, use it cold on salads.

Turmeric: Curcumin has powerful anti-inflammatory properties, preferably taken with black pepper for improved absorption.

Berries: Blueberries, strawberries, raspberries - rich in anti-inflammatory anthocyanins.

Leafy Greens: Spinach, kale, arugula - rich in vitamins and antioxidants.

Nuts and Seeds: Almonds, walnuts, chia seeds, flaxseeds - rich in omega-3s and fiber.

Specialized Diets for Ulcerative Colitis

Specific Carbohydrate Diet (SCD)

The SCD diet excludes complex carbohydrates and disaccharides, focusing on simple, easily absorbed carbohydrates. The theory is that this diet reduces the fermentation of undigested carbohydrates in the colon, thereby reducing inflammation.

Allowed: Meats and fish, most vegetables, fruits, nuts, honey, 24-hour fermented yogurt.

Prohibited: All grains, refined sugar, regular dairy products, potatoes, corn, canned legumes.

Scientific Evidence: Small studies have shown promising results, but there is no conclusive evidence. Some benefit greatly, while others notice no difference.

Low FODMAP Diet

Excludes short-chain fermentable carbohydrates that may cause digestive symptoms. Particularly useful for ulcerative colitis patients who suffer from accompanying IBS symptoms.

Phase One: Complete elimination of high FODMAPs for 4-6 weeks.

Phase Two: Systematic gradual reintroduction to identify individual triggers.

Phase Three: Long-term personalized diet avoiding only triggers.

Modified Mediterranean Diet

A balanced diet rich in anti-inflammatory foods, with modifications to suit the needs of ulcerative colitis patients.

Principles: Olive oil as the main fat source, fatty fish 2-3 times weekly, abundance of vegetables and fruits, moderate whole grains (as tolerated), well-cooked legumes, nuts and seeds in moderation.

Supportive Dietary Supplements

Essential Supplements

Omega-3 (EPA/DHA): 2-4 grams daily of high-quality fish oil. Has a direct anti-inflammatory effect on the intestines.

Vitamin D: Most ulcerative colitis patients suffer from deficiency. Optimal level is 40-60 ng/mL. Dosage according to blood level.

Iron: Only if there is deficiency proven by analysis. Iron bisglycinate is preferred as it's gentler on the stomach.

Vitamin B12: Especially if there is inflammation in the terminal ileum. Some patients may need injections.

Folic Acid: Especially for patients taking sulfasalazine or methotrexate.

Zinc: Helps with tissue healing and immune support. 15-30 mg daily.

Promising Supplements

Curcumin: 1-3 grams daily of enhanced-absorption curcumin extract. Studies have shown benefit in maintaining remission.

Probiotics: Specific strains such as VSL#3 and E. coli Nissle 1917 have shown benefits in some studies.

Glutamine: An amino acid that supports healing of the intestinal lining. 5-15 grams daily.

Aloe Vera: Some small studies have shown benefit, but evidence is still limited.

Common Trigger Foods

Each patient has their own triggers, but these foods are common in causing symptoms:

Dairy Products: About 60% of ulcerative colitis patients have lactose intolerance.
Spicy Foods: May irritate inflamed intestines.
Alcohol and Caffeine: Intestinal stimulants and can increase diarrhea.
Processed Foods: Additives and emulsifiers may negatively affect the microbiome.
Gluten: Some notice improvement by avoiding it despite not having celiac disease.
Legumes: May cause gas and bloating, but proper cooking and soaking improve tolerance.
Cruciferous Vegetables: Broccoli, cauliflower, cabbage - may cause gas.

How to Identify Personal Triggers

Keep a detailed food diary for 4-6 weeks, record everything you eat and the symptoms that appear. Look for recurring patterns. Try an elimination and reintroduction system: exclude the suspected food for 2-3 weeks, then reintroduce it and observe symptoms.

Practical Tips for Daily Life

Planning and Preparation

Prepare your meals in advance to avoid unhealthy choices when hungry.
Carry safe snacks with you when leaving home.
Cook larger quantities and freeze individual portions for difficult days.
Keep a list of your safe and favorite meals.

Eating Out

Review the menu in advance online.
Don't hesitate to request modifications to the dish (without hot sauce, grilled instead of fried, etc.).
Start with simple options: grilled chicken, white rice, cooked vegetables.
Avoid open buffets where it's difficult to know the ingredients.

Managing Stress and Nutrition

Psychological stress may affect the digestive system and trigger flares. Practice relaxation techniques before meals, eat in a calm environment, chew slowly and mindfully, and avoid eating while working or under pressure.

When to Consult a Dietitian

Consulting a dietitian specialized in inflammatory bowel diseases is important in these cases:

Immediately after diagnosis to develop a personalized nutrition plan
During acute flares to prevent malnutrition
If you're considering following a special diet like SCD or Low FODMAP
When there is proven nutritional deficiency
Difficulty gaining weight or unintended weight loss
Children and adolescents who need nutrition that supports growth

Conclusion

Nutrition is an essential, integral part of managing ulcerative colitis. An individualized, personalized approach that considers the disease stage, symptom severity, and personal triggers is the foundation for success. Working with a specialized medical team including a gastroenterologist and dietitian provides the best results.

Remember that nutrition alone does not cure ulcerative colitis, but it is a powerful tool for managing symptoms, improving quality of life, and supporting medical treatment. Patience and systematic experimentation are necessary to find the optimal diet for you.

Suffering from Ulcerative Colitis and Need Specialized Nutritional Support?

Dr. Mai Obeid, clinical dietitian, provides personalized consultations for inflammatory bowel disease patients.

For Appointments and Inquiries:

WhatsApp: +961 81 337 132