Ulcerative Colitis is a form of Inflammatory Bowel Disease (IBD). This form only effects the colon, which is the end of your digestive tract. The colon has a lot of important jobs, but it’s main one is re-absorption of fluid. When our colon is inflamed, this stops it’s working as efficiently. Therefore can lead to increased diarrhoea.

For most people this condition presents itself by going through periods of inflammation or “flares” and periods of remission. During remission, your gut is not inflamed and most people have no symptoms or they’re well controlled.

This blog discusses the best way’s to nutritionally manage ulcerative colitis in a ‘flare’ and when it’s in remission.

Nutrition During a flare:

Unfortunately, no dietary interventions have been shown to induce remission at this point. However, there are some thing’s that can be helpful for symptom management.

• Aiming for 5-6 smaller meals throughout the day has been shown to help with diarrhoea. This is because it’s smaller portions of food for the body to try and digest. It also helps to make sure that we’re getting the nutrition we need.
• If you’re struggling with your oral intake and losing weight. It could help to opt for more nutrient dense foods (high calorie, high protein foods)
• Plenty of non-caffeinated fluids to replace the fluid you’re losing with diarrhoea
• Chew food well, taking time with meals and snacks
• Limit intake of spicy foods, caffeine, fatty foods and alcohol
• Some people find it helpful to reduce thier intake of high fibre foods (such as wholegrain cereals, nuts, seeds, legumes and certain higher fibre fruits and vegetables) as this may reduce how often you’re opening your bowels. However, there is no specific fibre foods to avoid, and bare in mind that fibre foods are important for nutrients and gut health. Therefore, if you see little improvement when restricting fibre, maybe consider reintroducing it.
• Chai seeds or pysilium husk can help reduce the diarrhoea by binding and gelling with the excess water in your stool.

Probiotic

Evidence has shown that probiotic therapy using E. coli Nissle 1917 or brand name “Vivomix”, is effective at inducing remission in patients with mild-moderate UC, and also in maintaining remission (BSG 2019, ESPEN 2020)3,4.

Nutrition in remission 

In 2020, the International Organization for the Study of Inflammatory Bowel Diseases provided valuable recommendations to assist patients in managing their IBD and sustaining remission. They encourage including a variety of plant-based products to help to optimise and strengthen your gut health, such as:

• Incorporating fruits and vegetables
• Ensuring an intake of Omega-3 fatty acids from sources like nuts, seeds, and whole grains

Certain fibres from these foods get fermented within the gut into short-chain fatty acids (SCFAs). Currently evidence suggests that these SCFAs are anti-inflammatory and help regulate inflammation.

Wholegrain carbohydrates are an important food group for our gut health. When wholegrains digest they release the beneficial by-products SCFAs. Wholegrains additionally provide us with our main source of energy so are important to have at every meal.

Reducing Red and Processed Meat, and Animal fats

International Organization for the Study of Inflammatory Bowel Diseases (2020) recommended to reduce the following foods.

• Saturated & Trans fats (mostly found in animal fats or processed foods)
• Dairy fats
• Red & Processed Meats

Diets low in fibre and high in animal protein have been shown to encourage ‘bad bacteria’ that is associated with IBD inflammation. 

The world health organisation (WHO) currently recommends limiting red meat consumption to no more than 70g per week to reduce your health risks. 

Embrace Plant-based proteins

According to current evidence, increasing plant-based protein sources can be an effective strategy to reduce the intake of red and processed meats and animal fats. Incorporating beans, lentils, pulses, nuts, or seeds as whole plant proteins can have a positive impact on your health. Other options include tofu, seitan, tempeh, Quorn, or alternative meat products.

It is advisable to prioritize whole plant foods over highly processed alternative meat options whenever possible, as they tend to contain fewer additives. Some meat alternatives may also be high in salt, sugar, and fat. Nonetheless, they serve as valuable tools in reducing reliance on animal-based protein and increasing plant-based options.

Limit Ultra-processed foods

Recent evidence is suggesting that certain additives found in ultra-processed foods could play a part in the development of IBD and also the flares of inflammatory bowel disease. 
The following additives are advised to be limited or avoided if possible:

• Emulsifiers & thickeners
• Artificial sweeteners, such as maltodextrins
• Titanium Dioxide
• Carrageenans

Takeaway message

We know that a UC diagnosis can be overwhelming, and often patients have conflicting information about what they should be doing with their diet.

It’s important to reach out to a dietitian who specialises in ulcerative colitis, so that you can get reputable, expert guidance to support you on your journey.

Have you recently been diagnosed with ulcerative colitis and want more guidance? Or have you been suffering with flares and want to know how you can manage this a bit better? Book with me below to discuss how I can best support you.