Nutrition is an important part of the lives of people diagnosed with ulcerative colitis (UC), but the big challenge is that there is no "one-size-fits-all" diet that works for everyone. The foods you eat play a crucial role in managing symptoms, preventing nutritional deficiencies, and repairing your gut.
In a recent Reddit AMA (Ask Me Anything) hosted by WebMD, Puja V. Khanna, MD, a gastroenterologist specializing in autoimmune and inflammatory diseases at Cedars-Sinai Medical Center, answered users' questions about diet and nutrition.
What Is Ulcerative Colitis?
Ulcerative colitis is a chronic inflammatory bowel disease (IBD) that causes inflammation and ulcers in the lining of the colon and rectum. This condition can trigger symptoms such as abdominal pain, cramps, rectal bleeding, fatigue, fever, an urgent need to poop, and frequent diarrhea.
"Diet plays a powerful role in protecting your gut, maintaining remission, and supporting a healthy, balanced microbiome," Khanna says.
UC can reduce your appetite and cause you to lose blood and protein through the inflamed lining of your colon. Diarrhea can also cause fluid and electrolyte loss. Together, these problems can lead to vitamin deficiencies and malnutrition, especially during severe or long-lasting flares. Changes to your diet and lifestyle may help manage symptoms and extend the time between flares.
"Research shows that certain foods can lower the risk of developing inflammatory bowel disease (IBD) and promote long-term gut health," Khanna says. Major health organizations have developed guidelines and recommendations to help you eat a healthy, well-balanced, and nutrient-rich diet. But it's very important to talk to your doctor or a nutritionist specialized in ulcerative colitis to help you develop a personalized meal plan.
What Can You Eat if You Have Ulcerative Colitis?
"Your diet should include more fiber-rich foods, less fat including animal fat, and less ultraprocessed foods. To feed your good gut bacteria, feed it with fiber that promotes short chain fatty acid production and also focus on whole fermented foods," Khanna says.
Her list of foods associated with a lower risk of IBD includes:
- Fiber-rich foods, such as whole grains, fruits, vegetables, and legumes
- Dairy products, including yogurt, kefir, and low-fat dairy
"Fiber is especially important. It helps your gut bacteria produce short-chain fatty acids (SCFAs), which strengthen your intestinal barrier and reduce inflammation," Khanna says.
Khanna also suggests adding naturally fermented foods to your diet. "Instead of probiotic supplements (which vary widely and may not colonize the gut), choose foods naturally rich in beneficial byproducts— called postbiotics — that help your microbiome thrive," Khanna says.
She emphasizes the following:
- Yogurt
- Kefir
- Kimchi
- Sauerkraut
- Miso
- Kombucha
"These fermented foods can provide B vitamins, polyphenols, serotonin, acetic acid, and amino acids, all of which help calm inflammation and nourish your gut lining," she says.
It is also important to prioritize proteins like lean meats, fish, eggs, nuts, and tofu, and complement your diet with vitamin supplements to prevent nutritional deficiencies.
Can Foods Cause Flare-Ups?
A relapse or flare-up happens when symptoms develop as a result of active inflammation in the intestine. Follow these eating guidelines during a flare-up:
- Adjust the texture of fiber-rich foods so they're easier to digest.
- Eat more protein because your body needs more when the disease is active.
- Avoid overly restrictive diets without the guidance of a healthcare professional.
- Control symptoms through proper nutrition and hydration.
What Foods Should You Avoid During a Flare-Up?
Certain foods can act as triggers for symptoms or flare-ups. Here are the most common:
- Foods high in insoluble fiber that can be difficult to digest, such as raw kale, apple skins, and sunflower seeds
- Vegetables high in fiber, including Brussels sprouts, cabbage, cauliflower, and asparagus
- Dairy products high in lactose, such as cow's milk, cream, ice cream, and custard
- Sugar alcohols and artificial sweeteners, including sorbitol, mannitol, xylitol, sucralose, aspartame, and saccharin
- Sweets like cookies, pastries, coconut sugar, honey, and maple syrup
- Foods high in fat, including butter, cheese, and fried foods
- Spicy condiments, such as sriracha or chili powder
- Alcohol
- Coffee, tea, and caffeinated energy drinks
- Sugary drinks, such as sodas and juices
Red meats, processed foods (cold cuts, sausages, bacon), coconut and palm oils, and dairy fat can increase the risk of inflammation, so it's recommended to only eat them occasionally and in moderation.
Diet Tips During Remission
If you were adjusting the texture of certain foods to make them easier to digest during a flare-up, you can reintroduce tougher-to-digest foods once you're in remission.
Some trigger foods only cause symptoms when the disease is active, while others can cause discomfort both when the disease is active and during remission.
Try to keep your diet as varied as possible. Include as many plant-based foods as you can, such as fruits, vegetables, nuts, seeds, herbs, and whole grains.
Choose foods that help prevent active disease, and limit those that can trigger flare-ups.
Your healthcare team can help you follow an elimination diet. You'll remove certain foods to figure out what triggers your symptoms. This process will help you identify common foods to avoid during a flare-up.
Tips for Better Nutrition
Here are some tips that can be useful if you have ulcerative colitis:
- Avoid restrictive diets recommended by friends, family, or people on the internet.
- Eat four to six small meals every day.
- Increase the amount of protein you eat daily.
- Drink more liquids.
- Prioritize nutrient-rich meals and snacks.
- Minimize dietary restrictions.
- Use simple cooking techniques like boiling, roasting, steaming, and poaching.
- Drink slowly and avoid using straws, as they can cause gas.
- Prepare meals in advance and keep foods you tolerate well on hand.
- Use a food diary to keep track of what you eat and any symptoms you may have.
There is no one-size-fits-all diet for everyone with UC. The best option is the one that meets your nutritional needs and helps you manage your symptoms. Your healthcare team, including a dietitian specializing in inflammatory bowel disease, can help you create a meal plan that fits your health needs.
Show Sources
Image: DigitalVision/Getty Images
SOURCES:
WebMD/Reddit AMA: "I’m a Gastroenterologist Who Treats Ulcerative Colitis — Ask Me Anything."
Puja V. Khanna, MD, gastroenterologist specializing in autoimmune and inflammatory diseases, Cedars-Sinai Medical Center.
National Library of Medicine: “Dietary Guidance From the International Organization for the Study of Inflammatory Bowel Diseases.”
Mayo Clinic: “Overview,” “Diagnosis and testing,” “Can seasonal and life changes trigger ulcerative colitis flares?” “Ulcerative colitis flare-ups: 5 tips to manage them.”
Crohn's & Colitis Foundation: “What Should I Eat with IBD?” “Malnutrition and IBD,” “How Diet Impacts IBD,” “Vitamin and Mineral Supplementation,” “Does diet cause Crohn’s disease or ulcerative colitis?”
American Gastroenterological Association (AGA): “Clinical Practice Update: Diet and Nutritional Therapies in Patients with IBD.”
European Crohn's and Colitis Organisation (ECCO): “Dietary Management of Inflammatory Bowel Disease: an ECCO Consensus.”
National Institute of Diabetes and Digestive and Kidney Diseases: “Eating, Diet, & Nutrition for Ulcerative Colitis.”
