Ulcerative colitis and weight gain

Your Best and Worst Foods

Everyone is different, so you are the best judge of what you can and can’t eat. Some foods may trigger flares for you, and some may not. No foods are proven to cause or worsen Crohn’s.

It may help to keep a diary of what you eat and how you react to it. Over time, the diary may allow you to pinpoint troublesome foods and drop them from your diet. A food diary will also help you and your dietitian check the quality of your diet.

Some foods you might want to steer clear of:

  • Fiber. It’s usually a good thing, but when you have Crohn’s, too much of it can lead to bloating and diarrhea.
  • High-fat foods. Butter, margarine, and cream can lead to gas and diarrhea.
  • Gluten. If you’re sensitive or have celiac disease, it can cause bloating and diarrhea.
  • FODMAPs. This stands for fermentable oligo-di-monosaccharides and polyols. They’re sugars found in carbs and sugar alcohols. They cause bloating, diarrhea, and cramps. They may play more of a role for people with irritable bowel syndrome than inflammatory bowel disease, though, and you should talk to your nutritionist before you drop then to make sure you don’t get undernourished. High-FODMAP foods include:
    • Fructose: A sugar found in fruits, honey, and high-fructose corn syrup
    • Lactose. This is a sugar found in milk and milk products. If your body can’t process it (this is called being lactose intolerant), it can give you cramps, belly pain, gas, diarrhea, and bloating.
    • Oligosaccharides: These are carbohydrates with a small number of simple sugars. They’re found in:
      • Onions
      • Garlic
      • Artichokes
      • Cereal grains like wheat and rye
      • Legumes
    • Polyols. Check the ingredients list of products like sugarless gum, ice cream, and candy for sorbitol, mannitol, and xylitol. These sugar alcohols can lead to bloating, gas, and diarrhea. They’re also in fruits like apples, pears, peaches, prunes, and their juices.

Maintaining a Healthy Weight With Crohn’s

Maintaining a healthy body weight can be a challenge when you have Crohn’s disease. Although food doesn’t cause the inflammation and tissue damage at the root of Crohn’s disease, people associate eating with flare-ups, and often avoid food to prevent further discomfort. Skipping meals may provide some relief, but the need for nourishment, especially adequate calories, can’t be ignored. Malnutrition and unexplained weight loss are very common in many Crohn’s patients. For these and other reasons, you should always work with a dietician to create a diet plan that works for you. Treatment should also include regular monitoring of body weight and other tests, as needed, to determine if you’re experiencing any nutritional deficiencies.

Even when your Crohn’s is in remission, you may have a low body weight because your body doesn’t properly absorb nutrients. You may require extra calories in your diet to counteract the body’s inefficient absorption of calories from food. You also may require a diet that’s free of specific components, for instance:

  • gluten
  • lactose
  • fructose
  • excess fiber

Every person’s needs are different, which is why it’s important to work closely with healthcare professionals to devise an individualized dietary plan.

General Guidelines for Weight Maintenance

The following guidelines, suggested by the Crohn’s and Colitis Foundation of America, may alleviate symptoms, help you maintain a healthy body weight, and help prolong disease remission.

  • Drink plenty of water throughout the day (in relatively small portions).
  • Eat small portions regularly throughout the day.
  • Minimize or eliminate foods that are high in fiber, including beans, nuts, seeds, raw vegetables, and popcorn.
  • Avoid fatty foods, including fried foods, and heavy cream or butter-laden sauces.
  • Lactose-intolerant people should avoid dairy or choose products which have relatively little lactose, such as hard cheeses.
  • Take supplements as directed to store up key nutrients, such as calcium, vitamin D, vitamin B-12, and folic acid.
  • If you know from experience that certain foods are likely to cause gas, put them on your “Foods to Avoid” list. Likely culprits include spicy foods, cabbage, broccoli, cauliflower, beans, and fruit juices. Citrus fruits may be especially problematic.

The Other End of the Spectrum

Low body weight is a common feature of Crohn’s disease and people with the condition often struggle to maintain a healthy body weight. However, there are also many people with Crohn’s disease who are overweight.

Being obese puts Crohn’s patients at increased risk for complications if they should need to undergo surgery to correct intestinal problems. A study on the wound-healing process published in the Journal of Dental Research showed that surgeries on obese patients often take longer to heal and are more likely to heal poorly, compared to individuals at a healthy weight.

Enteral Nutrition Therapy

Doctors have numerous weapons in their arsenal to fight Crohn’s disease. Powerful drugs to decrease inflammation may allow some people to go into remission. Examples include aminosalicylates and corticosteroids. Others may benefit from drugs such as immunomodulators, antibiotics, or the newest class of drugs called biologic therapies.

Another approach is enteral nutrition. Enteral nutrition involves introducing a liquid nutrient formula directly into the stomach or intestines using a tube that is threaded through a nostril. Some studies have shown that people respond as well to enteral nutrition therapy as they do to drug therapy with corticosteroids. This is especially true among children with Crohn’s.

Talk to your doctor if you’re concerned about your weight, or if you feel like your diet is too limited. They can recommend a nutritionist that will help you create a personalized diet plan.

Q:

How is maintaining a healthy weight different in children with Crohn’s?

A:

Growth and development is extremely important in all children, and it can be specifically challenging when that child has Crohn’s disease. Malnutrition in children can lead to long-term issues including short stature, delay in puberty, and bone disease. All children with Crohn’s disease should have regular measurements of weight, height, BMI, and growth velocity by their pediatrician. Many children are picky eaters even without the symptoms of a chronic disease, so nutritional counseling and incentivizing should be a part of every child’s care plan. Supplemental nutrition by a nasogastric tube may be necessary for children to reach their growth goals.

Healthline Medical TeamAnswers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.

How to GAIN weight with IBD’s, Crohns, Colitis, and IBS

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Do you feel skinny? Embarrassed of your appearance? Wish you could gain some weight to look normal? You’re not alone as so many people who suffer with IBD’s feel scrawny and embarrassed. Are you wondering how to gain weight with IBD’s, Crohns, Colitis, and IBS?

I remember being a walking skeleton that could not stand my own reflection, from a fit dude to a skinny unattractive bone rack. I avoided looking at myself in the mirror so I didn’t have to think about my appearance. My self-esteem was too low to post pictures on dating sites, or to talk to women in person. When I was out with my friends people would make comments about how much weight I had lost. It got to the point that I simply just avoided being in social situations as I could avoid thinking about my appearance.

I was able to heal my IBD and this period did not last more than 12-18 months. As I healed, tweaked my way forward, the weight came back and my confidence was restored.

HOW can you GAIN weight?

There is no 1 pill magic cure, or 1 food that miraculously makes you gain your weight back. Gaining weight will be gradual and will increase as you heal your gut. To keep this simple weight gain ultimately comes down to these 2 things:

  • Healing the Gut lining (wall)
  • Balance and Optimize Hormone levels

Heal the Gut Lining (Wall)

If you currently have an IBD then you have a compromised gut wall or what other people may call a Leaky Gut. To gain weight you need to heal your gut lining first as you can only absorb what you digest. You can eat all you want but if it’s not getting absorbed efficiently then your not going to get the nutrients to put on extra body weight.

Balance and Optimize Hormone Levels

What do hormone levels have to do with gaining weight? Think of a teenager going through rapid growth spurts during puberty, or a pregnant woman who gains weight during pregnancy. The increase in growth is not merely due to caloric increase. It’s the body’s way of using hormones to increase body weight when the conditions apply. Early in my healing journey I thought I could simply double or triple my calories and I would gain weight. This approach was mostly unsuccessful as it put lots of stress on my already compromised gut. I ended up feeling worse, and my symptoms usually flared up.

Eventually my gut healed and my weight normalized. I noticed that I would gain weight quickly when I ate nuts, yogurt, and olive oil. I experienced more energy, and felt happier. This video made me understand why these foods helped me gain weight.

Cholesterol, a major player in your health

  • Is the precursor to the creation of every hormone in your body
  • It’s used to create your cell membranes, without it you would be a tub of goo!
  • 20% of Myelin (the insulation layer around nerves) is made of cholesterol . Get in the way of this process and you threaten the brain and nervous system (memory loss and MS)
  • Synapses in the brain are created via cholesterol
  • Is a healing agent in the body
  • Bile is made out of cholesterol and is essential for absorbing fat soluble vitamins A, D, K, and E

Cholesterol is one of the most vital substances in your body. You can not overcome your Autoimmune disease without it. If you are interested in more info about cholesterol please see this article.

The easiest way to to optimize cholesterol in your body is to consume these foods:

  • Cod liver oil
  • Cold water fish
  • Eggs
  • Butter & Ghee

Give these suggestions a try and make sure to let me know how they are working out. This is a healing collaboration and we’re working together to make the best simple resources for people to overcome their IBD’s and other Autoimmune Diseases.

If your looking to improve your IBD and change your life, check out my free healing guide.

9 tips for GAINING weight with IBD

March 21, 2018

One of my biggest health missions is always to gain weight. Yes, you might think that’s strange being a ‘health blogger’ but having IBD can make it much more difficult to stay at a healthy weight. In fairness, I’ve always been ‘slim’, but I can definitely get an idea about my condition based on the weight I’ve gained (or more often than not- lost)

Not everyone with IBD struggles to gain weight- it’s a bit of a myth that all of us are super-skinny too! If you’re looking to lose weight, I actually write a blog post on safely losing weight with IBD last year so give that a read. However, if you’re looking some practical tips on gaining weight safely and healthily with IBD then keep reading.

1.Seek professional help

The most obvious I know but if you’re underweight or losing weight rapidly; no blog post can transform that! So definitely do ask to see a dietician.

I’ve not had the greatest experiences with dieticians myself but completely recognise the work they do and they may also be able to prescribe an elemental drink; which would at least help you get plenty of fats and calories whilst experimenting with your diet. If you’re losing weight, do not attempt to restrict your diet-e.g. giving up dairy-without proper medical help.

2. Traditional ‘high fat’ choices might not work

A dietician might prescribe full-fat foods but the problem with this is that many traditional fatty foods can worsen symptoms. Full example full-fat milk might cause a problem if you have problems with dairy (more on Crohn’s and dairy here) whilst high-fat foods can increase gut motility and cause you to rush to the loo. So although these items do contain lots of fat; they’re likely to worsen your symptoms (especially if they contain other potential triggers such as preservatives, sweeteners and MSG) and if you can’t keep the food down, you’re not going to see the benefit!

3.Exercise can help

You might think the opposite would be true, but the proper exercise can help you bulk up! Fellow IBD blogger Alex from Girl in Healing explains that getting more exercise and strength training helped her the most!

4.Eat healthy fats at EVERY meal

Instead of a huge, fatty meal; try to focus on smaller doses of healthy fats; but spreading them out across the day with each meal (so your gut doesn’t have a huge amount of fat to handle at once). Examples might be:

  • 1/2 an avocado
  • 1 tablespoon of nut butter
  • 1 tablespoon of coconut oil or hemp oil
  • 1 portion of oily fish
  • A few squares of dark chocolate
  • A few tablespoons of coconut cream
  • 1 teaspoon of ground flax seed
  • Leaving the skin on chicken

Note that the portions here are really small so they should be ok for your body in small doses. Omega 3 fats in particular (from fish and flaxseed) is also thought to help inflammation. Try my sweet potato, fish and avocado recipe for an example. One thing I’ve also been doing is keeping the skin on the chicken when making my gut rest and repair soup-it tastes yummy and is a good source of fats.

5.Eat more often

When I used to do nutrition consultations, I was really surprised how long people went between eating (or perhaps how often I ate!). Breakfast really is an important meal as your body has been ‘fasting’ overnight and needs the energy to get on with the day ahead! Yet so many people would perhaps finish eating at 6pm one day and not eat until 11 am the next.! That’s a huge amount of time your body is running on empty and if trying to gain weight; I would definitely advocate a ‘little (or large!) and often approach. Keep a log of what you eat-you might be surprised!

6.Liquid Nutrition

Having higher fat drinks can help as it’s an easy to digest state. For example, if you don’t feel like eating of a morning; try a smoothie-adding 1/2 an avocado and nut butter instead. Another example of this is things like bone broth.

Add healthy fats to your morning smoothie-including this Pumpkin and Turmeric smoothie recipe.

Juicing doesn’t contain fat but it can still help you with nutrients when feeling low;

7.Elemental Drinks can help

Now I’ll be honest, when I first heard about elemental drinks, I wasn’t a huge fan there’s a lot of milk and sugar (both of which can be triggers). However if you can tolerate them, you should absolutely give them a try. The focus should always be on getting enough fat and calories rather than ‘worrying’ ingredients aren’t healthy enough (and to be honest, if your body has been on long-term medication, it can handle a bit of sugar). A lot of you have asked about healthier alternatives to Elemental Drinks-and the closest I’ve come across is Huel– I haven’t tried this myself but it does look nutritionally balanced (however, it does contain more fibre than some of us might be able to handle and they state on their website this might be a problem if not in IBD remission-which seems very responsible of them!)

8. Protein power

Don’t forget the power of protein too! Those of us with IBD need a lot of protein to help us repair the gut and to help with fatigue. Making sure you add a protein powder (I use a dairy-free pea one) can really help.

9. Take care of yourself.

And finally take care of yourself. If you are rushed off your feet and not resting, your body won’t be able to effectively use the food you’re supplying it with. The priority for gaining weight always has to be to get the flare under control first.

I hope that helped! Do share any tips of your own below; I’d LOVE to read them.

How to Gain or Lose Weight With Ulcerative Colitis 

The next step is to increase calories. Eating more calorie dense foods will help increase your daily calorie intake and therefore lead to weight gain. Try to eat lots of kinds of nut butter, steel cut oats, avocado, and coconut oil. Making a calorie dense smoothie of kefir, nut butter, avocado, and oats can be a great calorie booster.

In addition to increasing calories, you might want to start strength training. Strength training can help build lean muscle mass. Start with compound movements such as deadlifts, squats, bench press, single leg deadlifts, and single leg squats. (this is assuming you are not in a flare and can engage your core). Then, add in accessory movements such as bicep curls, tricep extension, shoulder press, shoulder raises, leg extensions, and more. 8-12 repetitions and 3-5 sets will ensure you stress your muscles enough to gain muscle mass. Eat a mixture of protein and carbs after your workout to build back the damaged muscle and therefore gain weight. Plant-based protein powder with zero sugar can be a great additive to your post-workout smoothie. Try the Garden Of Life Raw Protein and Greens for added micronutrients.

Losing Weight

Losing weight with IBD can be hard, since symptoms of stomach pain, fatigue, and urgency can make the gym an undesired destination. Just 20-30 minutes of light activity will help you burn calories and feel endorphins from your workout. By working out indoors, you can always have a bathroom nearby. Try to work out at the time of day where you feel your best.

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 and microscopic colitis that affects the colon (large intestine).

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

Ulcerative 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 is thought to develop when a person at genetic risk is exposed to certain environmental stressors.

These environmental stressors either change the ratio 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 (increased intestinal permeability).

What Causes Ulcerative Colitis?

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

Certain medications, like antibiotics and non-steroidal anti-inflammatory drugs, are known to increase disease risk and trigger flares. But be careful, abruptly stopping any medication may also lead to a flare. Only do so under a doctor’s approval.

Stress is also thought to be a major contributor, as well as diet (4, 5).

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

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

For example, 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 Do During a Flare

Medications are used to manage flares and induce remission as quickly as possible.

Doctors may prescribe a corticosteroid (like prednisone or budesonide), antibiotic, 5-aminosalicylate, immunomodulator or biologic.

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, more frequent meals as opposed to 3 large meals in a day (8).
  • 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.
  • Drink plenty of fluids to avoid dehydration.

Foods to Avoid

Different foods will trigger different people, but its best to avoid these foods to start:

  • Dairy: This one is controversial as long-term IBD sufferers tend to have an increased need for calcium. But anecdotal evidence indicates that cutting lactose can help in the beginning, and there can also be emulsifiers in milk that may be problematic.
  • Fatty meats
  • Caffeine
  • Alcohol
  • Carbonated beverages
  • High-fiber foods, like beans and legumes
  • Nuts or crunchy nut butters
  • Popcorn
  • Chocolate
  • Refined sugars
  • Spicy foods (6, 9, 10).

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. However, limited evidence suggests that certain diets can greatly improve comfort and quality of life.

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

Specific Carbohydrate Diet

The Specific Carbohydrate 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.

GAPS Diet, IBD Anti-Inflammatory Diet and Paleo Diet

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 IBD-AID (and SCD mentioned above) to improve IBD symptoms. Larger, more 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 60g 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 20–30g 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

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).

It’s important to note that the low FODMAP diet should not be followed long-term. FODMAPs must be reintroduced to the diet to some extent.

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.

Low-Residue Diet

A low-residue diet limits your fiber consumption to around 10 to 15 grams per day.

Essentially, you’re free to eat a variety of foods, as long as you keep your fiber intake down.

Foods should be easy to digest and can include dairy, refined grains (with less than 1/2 a gram of fiber per serving), meats, fish, eggs, fruits (except bananas) and most vegetables.

While a low-residue diet is often recommended during flares, there’s no evidence that supports its relief in symptoms. In fact, it could potentially lead to further gut flora imbalance (24).

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 (25).

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 evidence 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.

It’s best to be wary of any diet that claims to be a cure, especially when it comes with pricey supplements.

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

Probiotics 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).

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

Prebiotics 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.

I’m also weary of garlic and onion, which are very high in a FODMAP called oligosaccharides. This is known to cause digestive issues in a lot of people who are sensitive so I’d be looking at other prebiotic sources.

L-Arginine and L-Glutamine

L-arginine 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

Studies 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

High 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).

Studies have also 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 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.

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