Living with a digestive condition can be a real challenge. You’re biologically required to eat every day, multiples times a day—and food can also be an important source of pleasure, socialization, and culture. If you have ulcerative colitis (UC)—a condition that causes inflammation in the colon—your food choices might require a bit more planning and consideration.
No certain food “causes” ulcerative colitis, as far as researchers know so far, but a healthy and balanced diet can help manage UC symptoms, prevent dehydration and malnutrition from diarrhea, and maintain a healthy weight and nutrition despite potential loss of appetite.
In terms of eating for UC, most “successes” are anecdotal and not yet consistently proven by research. “People come in all the time with all sorts of things: I’ve tried this diet, I’ve tried this supplement, I’ve tried this probiotic, and they feel that it’s working for them,” says Todd B. Linden, MD, gastroenterologist.
Nutritional Concerns with Ulcerative Colitis
Compared to Crohn’s disease, UC may have fewer malnutrition concerns due to the fact that UC doesn’t affect the small intestines, which is where most nutrients are absorbed. (Learn more about the difference between Crohn’s and UC here.)
That said, UC can still lead to nutrition complications. The frequent diarrhea associated with UC can lead to excessive fluid and nutrient loss, resulting in dehydration. Blood loss from ulcers can also result in iron-deficiency anemia.
Plus, people with UC who experience a loss of appetite may struggle to eat enough calories (and thus adequate nutrients). “That’s a problem because we need people to be having good nutrition in order to heal well,” says Dr. Linden.
Loss of appetite may be especially harmful because chronic inflammation requires extra energy, and thus extra calories. Those who are struggling with UC symptoms may also develop an anxiety about food and eating, resulting in malnutrition or unintended weight loss.
Malnutrition can have added risks for children with UC, who need sufficient nutrition to grow and develop. Low bone mineral density is a common concern for children (and adults) with UC, which could increase the risk of osteoporosis later on.
How to Eat During UC Flares
To keep UC symptoms at bay while still getting a well-balanced diet, here are tips to manage your diet with UC:
1. Keep a food journal to track symptoms and identify trigger foods. This can also help you learn to distinguish between common digestive issues and a UC flare, which is a common mistake among many people with UC, according to Dr. Linden. Here are tips for keeping a helpful food journal.
2. Seek a balance of macronutrients (i.e. carbohydrates, proteins, and fats).
3. Choose nutrient-dense foods, meaning foods that are rich in micronutrients (e.g. vitamins and minerals). That generally translates to fresh fruits and vegetables, whole grains, and lean proteins—with a few exceptions for UC (see #6).
4. Avoid or limit common trigger foods, such as insoluble fiber (e.g. beans, leafy vegetables, wheat bran), lactose (a sugar in dairy), high-fat foods, gluten, sugar alcohols (like sorbitol and mannitol), and FODMAPs. These components are all known for being difficult to digest and may cause bloating, gas, and diarrhea, which worsens UC symptoms.
5. Increase calorie intake if necessary. If you notice your weight dropping unintentionally, add 250 to 500 calories daily.
6. Pick foods that are easier to digest during flare-ups. That means choosing soluble fiber instead of insoluble fiber, cooked vegetables instead of raw, minimal use of oil when cooking, and soft or cooked fruits (e.g. applesauce instead of a fresh apple).
7. Eat smaller, frequent meals in a relaxed environment if you are experiencing a lack of appetite. This might help you increase calorie intake.
8. Ask your doctor about probiotics. Although some studies have shown that probiotic supplements may help the immune system to reduce inflammation, probiotics are incredibly complex and not all types can help UC, according to the American College of Gastroenterology. Learn more about the role of probiotics for gut health.
9. Parents should monitor children with UC carefully to look for appropriate growth or signs of weight loss.
For more tips for UC, find out how to prevent UC complications.