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Ulcerative Colitis


Ulcerative colitis (UC) is a chronic inflammatory disease in the family of inflammatory bowel diseases (IBD) that causes inflammation and damage to the large intestine and/or rectum.

 
  • Overview
  • Action Plan
  • Ask The Doctor
  • Read & Watch
  • Success Stories
  • See Also

Overview


Ulcerative colitis (UC) is more common in Western and Industrialized countries and seems to be increasing in developing countries as they adopt Western habits, such as poor diet. Approximately 0.2% of the U.S. population suffers from UC.1

Some of the potential explanations of this geographical trend include Westernized factors, such as antibiotic use, hygiene, exposures to certain infections, pollution, and diet. A higher risk follows those with a family history of the disease as well. Intestinal permeability (leaky gut) and altered intestinal bacteria seem to play an important role, but it is still not known exactly what causes UC.

Those with UC may experience some or all of the following symptoms:

  • Abdominal pain
  • Diarrhea
  • Dehydration
  • Weight loss
  • Nausea
  • Rectal bleeding
  • Fever
  • Possible joint pain

Nutrition plays a key role to help those with UC. Improvements in lower inflammation and intestinal bacterial balance precede improvements in symptoms, and even remission is possible.

 
References
  1. Kappelman MD, Moore KR, Allen JK, Cook SF. Recent trends in the prevalence of Crohn's disease and ulcerative colitis in a commercially insured US population. Dig Dis Sci 2013, 58:519-525.

Action Plan


Diet

  • Modern Western diets are pro-inflammatory, and higher intake of animal products, fast food, and high-glycemic refined carbohydrates is associated with an increased risk of inflammatory bowel diseases (IBD; Crohn’s disease and ulcerative colitis).1,2
  • A modified Nutritarian diet may be used to help manage ulcerative colitis (UC). It is important to avoid processed grains, oils, commercial baked goods, fried foods, and most animal products.
  • Maximize the intake of high-fiber, immune-system-regulating, anti-inflammatory foods, such as cruciferous vegetables, other vegetables, berries, beans, onions, garlic, nuts, and seeds. Vitamins and minerals are essential for proper immune function, and carotenoids, flavonoids, cruciferous-derived isothiocyanates, and other phytochemicals have anti-inflammatory effects and promote a healthy microbiome. Cruciferous vegetables may be especially beneficial for intestinal immune function.3-7
  • Anti-inflammatory spices such as turmeric, ginger, cayenne pepper, cloves, garlic, and cinnamon should be used in seasoning dishes.8-11
  • Modifications to the Nutritarian diet may be needed and may need to be personalized, particularly during a flare-up. When experiencing a flare-up, raw and higher fiber (especially insoluble fiber) foods, such as raw vegetables, salads, fresh fruits, and beans, for example, may make symptoms worse. The use of more cooked, soft, starchy vegetables, such as butternut and acorn squash, cooked turnips, parsnips, peas, and carrots are recommended and may be tolerated better. Additional modifications that may be helpful during a flare-up are to blend more food (smoothies and pureed soups) and add vegetable juices.
  • Fruit intake may need to be reduced to low or moderate amounts for some people with UC.
  • During a flare-up, medication may be required to control the inflammation and/or bleeding. Medically supervised fasting may also be appropriate.
  • Many with UC will find they are sensitive to gluten, processed foods such as sugar, and animal products, and removing or reducing them may help. Other foods may be triggers and may be unique to each person. Fruit intake may need to be reduced to low or moderate amounts in some people with UC.
     

Supplements

  • Dr. Fuhrman’s general supplement protocol for adults (see Vitamin Advisor for details) includes:

  • Additional supplements:

    • Probiotics: UC and Crohn’s disease are both associated with alterations in the gut microbiome that are thought to be involved in the disease process.12 Studies suggest probiotics may be helpful for promoting remission in ulcerative colitis.13 Eating foods rich in fiber and resistant starch also helps to maintain a healthy gut microbiome.

    • Omega-3 fatty acids: High-dose DHA and EPA have anti-inflammatory effects that may be beneficial in Crohn’s disease.14,15 Talk to your doctor to find out if high-dose omega-3s are appropriate for you.

    • Curcumin: Curcumin, a collection of phytochemicals from turmeric, has anti-inflammatory effects. Limited evidence suggests curcumin supplements help to maintain remission in ulcerative colitis.16,17

Read

Find additional help

ONLINE: All members of DrFuhrman.com can search the Ask the Doctor archives for discussions on this topic. Platinum and Diamond members can connect with Dr. Fuhrman by posting questions in the forum. Not a member? Join now.

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References
  1. Schreiner P, Martinho-Grueber M, Studerus D, et al. Nutrition in Inflammatory Bowel Disease. Digestion 2020, 101 Suppl 1:120-135. doi: 10.1159/000505368
  2. de Castro MM, Pascoal LB, Steigleder KM, et al. Role of diet and nutrition in inflammatory bowel disease. World J Exp Med 2021, 11:1-16. doi: 10.5493/wjem.v11.i1.1
  3. Hoensch HP, Weigmann B. Regulation of the intestinal immune system by flavonoids and its utility in chronic inflammatory bowel disease. World J Gastroenterol 2018, 24:877-881. doi: 10.3748/wjg.v24.i8.877
  4. Li Y, Innocentin S, Withers DR, et al. Exogenous stimuli maintain intraepithelial lymphocytes via aryl hydrocarbon receptor activation. Cell 2011, 147:629-640. doi: 10.1016/j.cell.2011.09.025
  5. Kaulmann A, Bohn T. Bioactivity of Polyphenols: Preventive and Adjuvant Strategies toward Reducing Inflammatory Bowel Diseases-Promises, Perspectives, and Pitfalls. Oxid Med Cell Longev 2016, 2016:9346470. doi: 10.1155/2016/9346470
  6. Kaulmann A, Bohn T. Carotenoids, inflammation, and oxidative stress--implications of cellular signaling pathways and relation to chronic disease prevention. Nutr Res 2014, 34:907-929. doi: 10.1016/j.nutres.2014.07.010
  7. Higgins JA, Brown IL. Resistant starch: a promising dietary agent for the prevention/treatment of inflammatory bowel disease and bowel cancer. Curr Opin Gastroenterol 2013, 29:190-194. doi: 10.1097/MOG.0b013e32835b9aa3
  8. Mazidi M, Gao HK, Rezaie P, Ferns GA. The effect of ginger supplementation on serum C-reactive protein, lipid profile and glycaemia: a systematic review and meta-analysis. Food Nutr Res 2016, 60:32613. doi: 10.3402/fnr.v60.32613
  9. Zhu C, Yan H, Zheng Y, et al. Impact of Cinnamon Supplementation on cardiometabolic Biomarkers of Inflammation and Oxidative Stress: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Complement Ther Med 2020, 53:102517. doi: 10.1016/j.ctim.2020.102517
  10. Singh S, Aggarwal BB. Activation of transcription factor NF-kappa B is suppressed by curcumin (diferuloylmethane) [corrected]. J Biol Chem 1995, 270:24995-25000. doi:
  11. Aggarwal BB, Yuan W, Li S, Gupta SC. Curcumin-free turmeric exhibits anti-inflammatory and anticancer activities: Identification of novel components of turmeric. Mol Nutr Food Res 2013, 57:1529-1542. doi: 10.1002/mnfr.201200838
  12. Morgan XC, Tickle TL, Sokol H, et al. Dysfunction of the intestinal microbiome in inflammatory bowel disease and treatment. Genome Biol 2012, 13:R79. doi: 10.1186/gb-2012-13-9-r79
  13. Kaur L, Gordon M, Baines PA, et al. Probiotics for induction of remission in ulcerative colitis. Cochrane Database Syst Rev 2020, 3:CD005573. doi: 10.1002/14651858.CD005573.pub3
  14. Barbalho SM, Goulart Rde A, Quesada K, et al. Inflammatory bowel disease: can omega-3 fatty acids really help? Ann Gastroenterol 2016, 29:37-43. doi:
  15. Marton LT, Goulart RA, Carvalho ACA, Barbalho SM. Omega Fatty Acids and Inflammatory Bowel Diseases: An Overview. Int J Mol Sci 2019, 20. doi: 10.3390/ijms20194851
  16. Kumar S, Ahuja V, Sankar MJ, et al. Curcumin for maintenance of remission in ulcerative colitis. Cochrane Database Syst Rev 2012, 10:CD008424. doi: 10.1002/14651858.CD008424.pub2
  17. Coelho MR, Romi MD, Ferreira D, et al. The Use of Curcumin as a Complementary Therapy in Ulcerative Colitis: A Systematic Review of Randomized Controlled Clinical Trials. Nutrients 2020, 12. doi: 10.3390/nu12082296

Ask The Doctor


The following are sample questions from the Ask the Doctor Community Platinum and higher members can post their health questions directly to Dr. Fuhrman. (All members can browse questions and answers.)

Q.

I’ve been diagnosed with a mild form of ulcerative colitis. Hoping for a long-term solution to control this problem, I started your IBD protocol four days ago (I am only eating the foods listed in Phase 1, as noted in the March 2008 newsletter No 36 and taking all the recommended supplements) and was wondering about what to expect in terms of symptom reduction.

My current symptoms are blood and mucus with stool. How long should I expect to be on Phase 1 before the bleeding stops? Do I also need to wait for the mucus to stop completely before moving to Phase 2? In Phase 2, it says tofu can be added. Can beans be added then as well? When can whole grains (brown rice, quinoa, millet) be added back in?

A.

It usually takes about 3 months to bring micronutrients in the body’s tissues to a high enough level to reduce the inflammatory response. Juicing speeds up this process. It sounds like your condition is not so severe, so the likelihood of a recovery via nutrition is high.

After a few weeks of phase one, beans can be added, but only start with a small amount for the first week and then increase very gradually. I would stick with brown rice, wild rice, quinoa, and millet and not add back wheat for a few months, until you are considerably better. Make sure you are taking the supplements with probiotics, Vitamin D, and fish oil too.

 
Q.

I suffer from ulcerative colitis. The diet I am trying to heal with is:
Green smoothies without fruit; Dr. Fuhrman’s soup recipes, fully blended; homemade soft white bread; oatmeal; maybe a banana; some melon or a peach
What do you think? Will this diet help me heal?

A.

First you have to review my protocol for ulcerative colitis that I describe in more depth in my newsletter on inflammatory bowel disease. The supplemental protocol is important too. You have to avoid the white bread, and in fact, it would be best to avoid all gluten grains. Make sure you’re having steamed kale, collards, and bok choy, along with steamed asparagus, squash, avocado, carrots, peas, artichokes, and mushrooms. Include some tofu or tempeh a few times a week. Doing this will reduce inflammation and provide the protective phytonutrients that are critical to heal your gut. Continue to have blended salads without fruit. Steam all the greens, including leafy greens, before blending in your smoothie, and add steamed zucchini to the smoothie. Raw fruits and vegetables can be irritating for a person with bloody ulcerations, and I like to keep the diet mostly cooked until the bleeding stops, and then, slowly introduce small amounts of soft lettuce and other raw food gradually.