Ulcerative Colitis: Inflammatory Bowel Disease
DescriptionAn in-depth report on the causes, diagnosis, treatment, and prevention of Ulcerative Colitis.
Alternative NamesInflammatory Bowel Disease; Irritable Bowel Syndrome
Malnutrition is very common in ulcerative colitis (UC), although it tends to be more severe in Crohn's disease. Some experts recommend that children with IBD increase their calorie and protein intake by 150% of the daily recommended allowance for their specific ages and heights. Studies indicate that nutritional support in children is as important as medications for achieving remission. People whose weights are normal or no less than 90% of normal do not need to add extra calories.
Foods Important for Intestinal Protection
Fluids (Non-Caffeinated). Drinking plenty of water is extremely important. It not only benefits the intestine itself but also helps prevent kidney stones, which are common in IBD. Vegetable juice and sports drinks may be helpful for restoring important minerals.
Protein. Proteins are very important for growth in children and for repair of cells. Diarrhea can cause protein deficiency and so IBD patients may need more protein than the general population. Patients might consider using soy as one of their primary protein sources. One study reported that a soy protein diet was particularly useful for patients who were intolerant to milk products. Dried beans and legumes also provide protein.
Complex Carbohydrates. Complex carbohydrates found in whole grains, fruits, and vegetables should make up half of a patient's calories. Fresh fruit (such as apples, grapefruit, oranges, plums, blueberries, raspberries, and strawberries) might actually be specifically protective for IBD and may also reduce the risk for colon cancer.(Simple sugars can increase inflammation, however, so patients should avoid dried fruits and high-sugar fruits, such as grapes, pineapple, and watermelon.)
Foods made up of complex carbohydrates are also often a good source of fiber, which may help reduce damage in the intestinal tract caused by UC, and may even help protect against cancer.Oat bran is of specific interest. In the intestinal tract, this whole grain increases levels of a fatty acid called butyrate, which may help reduce GI symptoms due to ulcerative colitis. Note: high-fiber foods can cause gas, bloating, and pain, particularly in IBD patients. Commercial products (e.g., Beano) are available that can reduce gas. Eating small, frequent meals can also help.
Potassium-rich Foods. Potassium rich foods are helpful not just for protecting the intestine, but they also may reduce the risk for kidney stones. Such foods include bananas, oranges, pears, cantaloupes, tomatoes, dried peas and beans, nuts, potatoes, and avocados.
Fish Oil. Omega-3 fatty acids, which are found in oily fish, have been associated with protection against inflammation, including in the intestinal tract. Some studies have even reported lowered use of anti-inflammatory medications in people who consume fish oil. Such fatty acids are also available in supplements as docosahexaenoic (DHA) and eicosapentaneoic (EPA) acids. Standards for optimal amounts and forms of omega-3 fatty acids have not yet been established, however.
Eliminating Foods That Might Produce Symptoms (Exclusion Diets)
According to a 2002 major analysis, the exclusion (also called the elimination) diet was the only dietary approach to be effective for patients with ulcerative colitis. Exclusion diets are those that eliminate certain allergenic foods or those that might irritate the intestine. To determine these foods, patients use a so-called elimination/challenge approach. First they remove all suspect foods from their diet for two weeks and then reintroduce one food every three days. Patients then watch for any symptoms that might indicate an allergic or irritant response, including gastrointestinal problems, headaches, and flushing.
Typical avoidance foods are as follows:
Dietary Considerations for Reducing Kidney Stones
Kidney stones are painful and common complications in IBD, particularly in patients who have had intestinal surgery. IBD patients are at risk for the most common types of stones--those composed of either calcium oxalate or uric acid crystals. The following are some considerations in reducing the risk for stones:
The general recommendations for avoiding kidney stones need to be tailored to the dietary requirements of IBD. Patients should work with their physicians to develop an individualized plan.
Probiotics and Prebiotics
Researchers are currently investigating a mix of bacteria (called probiotics), specific foods (called prebiotics) that are metabolized by these bacteria, and the compounds they produce (called synbiotics). Some evidence suggests that alone or in combination, they may have significant benefits in the intestine.
Researchers are investigating probiotics, prebiotics, or both for intestinal protection, including benefits for patients with IBD. Foods and supplements containing these agents are available in the US and overseas. To date, however, no studies have determined any clear benefits on any specific agent or formulation. Further research is necessary. Medications based on probiotics (e.g., VSL-3) are also in development.
Vitamins and Other Supplements
Vitamins. Deficiencies of vitamins A, C, E, B12, and folate (a B vitamin) may result from malabsorption. In general, vitamin supplements may be recommended for everyone with IBD, particularly for children to avoid growth retardation. Vitamins A, C, and E are antioxidants, which are scavengers of damaging particles in the body. Folic acid supplements are particularly important for patients who must restrict fresh fruits and vegetables and for those taking sulfasalazine. Folate deficiencies may contribute to the increased risk for colon cancer in ulcerative colitis patients. Monthly injections of vitamin B-12 may be necessary. Vitamin D is necessary for bone protection. Because some vitamins, such as A and D, can be toxic in high doses, patients should discuss specific dosages with their physicians.
Mineral Supplements. Supplements of calcium, magnesium, zinc, selenium, and iron may be needed to offset deficiencies in patients with severe IBD. Zinc is specifically important for gastrointestinal health. Calcium and magnesium are critical for health and strong bones. Selenium is a potent antioxidant. Iron supplements may be required for anemia. A physician should advise patients carefully on the correct dosages since minerals can be toxic in high levels.