When you have severe ulcerative colitis (UC), what you put on your plate can make a big difference in how you feel.
Sometimes, foods can trigger symptoms such as frequent, bloody diarrhea, belly pain, and more. Trigger foods can be different for you than for someone else with UC. But typical ones are fatty and fried foods, spicy dishes, or foods high in fiber like whole grains, nuts, and raw vegetables or fruits.
You may feel better and keep symptoms at bay if you avoid your trigger foods.
People with UC are at risk for dehydration, electrolyte imbalances, nutrient deficiencies, and malnutrition, says Ashley Baumohl, MPH, RD, CDN, an inflammatory bowel disease dietitian at the Center for Advanced IBD Care at Lenox Hill Hospital in New York City.
“A lot of patients avoid food out of fear of making symptoms worse or blaming their pain on what they are eating,” she says.
On top of that, “being in an inflammatory state means that the body is using up more energy because of the heightened immune response,” Baumohl adds. “So the calories you may have needed when in remission may not be enough when in a flare.”
“Another thing we see with inflammatory bowel disease is chronic fatigue. This is a type of exhaustion that can continue even when the disease is quiet. Chronic fatigue can have a huge impact on quality of life. When you are exhausted, the motivation to cook a nutrient-dense meal vanishes, making it easy to fall back on less nutritious, convenience foods,” says Baumohl.
That’s where smart meal planning and preparation come in. Prepping in bulk for the week ahead can take some of the decision-making, stress, and fatigue out of mealtime, Baumohl says.
What Is a Low-Residue/Low-Fiber Diet?
“A low-residue diet (often referred to as a low-fiber diet) limits foods that increase stool bulk. “Residue” refers to undigested food components, primarily fiber, that remain in the bowel,” says Grace Derocha, a registered dietitian and national media spokesperson for the Academy of Nutrition and Dietetics.
This way of eating slows down your digestive process so that you won’t have to poop as much, and your gut has a chance to heal.
But low fiber does not mean no fiber.
Generally, fiber is perfectly healthy and even helpful during a flare, Baumohl says. “It has been shown to reduce inflammation, improve gut health, and reduce the frequency of disease relapse.”
However, during an active flare, “roughage” (the tough, structural fibers in raw fruits and veggies) can act like sandpaper on an open wound,” she adds.
Soluble fibers, which dissolve in water, can actually be very healing for the intestines.
Some examples of foods to include in a low-fiber diet are:
- Refined grains (white rice, white bread, pasta)
- Well-cooked, skinless vegetables
- Canned or cooked fruits without skins or seeds
- Tender proteins (eggs, poultry, fish, tofu)
- Dairy (if you can tolerate it well)
- Limited nuts, seeds, legumes, and raw produce
“Low-residue diets are commonly recommended short-term during moderate to severe UC flares,” Derocha says. Work with your gastroenterologist or registered dietitian to build a diet based on your individual needs, she adds.
What to Buy and How to Prep
Set aside time to do your shopping for the week. Make a list of everything you’ll need to prepare your meals. Your grocery list could look something like this:
Proteins (cook in batches)
- Whole roasted/rotisserie chicken(s)
- Baked salmon
- Lean ground turkey (for meatballs or patties)
- Eggs (for scrambling and hard boiling)
- Tofu (firm, baked, or sautéed)
- Canned tuna in water
Prep and safety tips. Cook thoroughly, cool quickly, and portion into airtight containers labeled with dates. Store in the refrigerator for up to three to four days or freeze in single-meal portions. Keep the refrigerator at or below 40 F.
Grains and starches
- White rice (cook a large batch)
- Plain pasta
- Potatoes (mashed, baked with no skins)
- Sourdough bread, English muffins, white bread
- Oatmeal
Prep tip. Store rice in shallow containers to cool rapidly (within two hours). Refrigerate and reheat to steaming (165 F).
Vegetables
- Carrots (peeled, sliced, and steamed until soft)
- Green beans (well-cooked)
- Zucchini (peeled, seeds removed, cooked)
- Spinach (well-cooked and chopped)
- Squash (well-cooked)
Prep tip. Removing skin lowers insoluble fiber. Cooking breaks down plant cell walls, which makes digestion easier.
Fruits
- Avocado (a good source of healthy fat)
- Canned peaches or pears (in juice, drained)
- Ripe bananas
- Raspberries, blueberries
- Applesauce
- Peeled, baked apples (no skin)
Prep tip. Avoid seeds and tough skins during flares.
Dairy (if tolerated)
- Cottage cheese
- Greek Yogurt
- Milk (lactose-free if needed)
Other
- Olive oil, bone broth, hummus, honey, smooth nut butter
How to Put It All Together
Now that everything is bought and prepped, here’s how to combine your foods into easy, no-fuss meals:
Drink It All In
Staying hydrated is one of the most important things people with UC can do to manage the disease. You’re at higher risk of dehydration and electrolyte imbalances during a flare because of chronic diarrhea, Baumohl says.
Some research suggests coconut water may be especially beneficial in UC, she adds. One recent study showed that patients with UC who drank coconut water alongside their standard medical treatment showed significantly higher rates of clinical remission (having few or no symptoms) than those who had a placebo drink. Also, inflammatory markers normalized more effectively than those in the placebo group, she says.
“Smoothies are also a great option for maintaining hydration while also packing in some key nutrients. It’s an opportunity to have a combination of electrolytes,” Baumohl says.
This recipe provides potassium, calcium, and magnesium:
- One cup of coconut water
- Half cup Greek Yogurt
- One banana
- Half a cup of mango or pineapple
- Small handful of spinach
- One-quarter cup of avocado
- Pinch of sea salt
- Ice
Smoothies can be a tasty breakfast option as well.
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