Ulcerative Colitis Diet

Diet

In my opinion diet is very important in relation to Ulcerative Colitis; whilst in a flare-up and also when in remission. Many UCers, (including myself in the past) go back to a 'normal' diet whilst in remission. I now believe this is one of the reasons that some UCers go back into a flare-up. As ever with Colitis, some UCers are lucky and don't get any symptoms at all from their diet, where as others have an incredibly restricted diet because they get symptoms from almost all types of food - I hope some of the ideas on this website will help them.

We're all different!

Diet is a very good example of just how individual Ulcerative Colitis is: in any Colitis forum, when someone comments on a food that has had a positive effect on their symptoms, there are always replies from other UCers saying they can't eat it.

This page is a synopsis of common food types that can affect Colitis, not an in depth study simply because diet is so different for each UCer. It almost seems pointless mentioning the effects it has on me, but I've referred to it in places just in case it rings a bell with anyone. Detailed results and 'recipes' of diets and foods that have helped Colitis sufferers can be found on the Remedy Ideas page

Trial and error

Colitis Diet - Trial and error

I think it can take quite a long time for UCers to accept, and perhaps even understand that the best way to find out which diet is beneficial to them is through trial and error with their own diet. Although other UCer's diets can provide an insight to troublesome foods, generally there's no point worrying about why others can eat certain foods and you can't, it's just not relevant.

On the internet you can find lists of foods that have been found to cause or affect symptoms of a lot of Colitis sufferers, but perhaps it's best to see these lists more as a starting point than a must follow. Here's a page I added which has a list of foods from a survey looking at Dietary triggers of a flare-up.

A basic rule I follow is to be wary of anything that works the colon. To me that means: food/drink that causes gas (baked beans, brussel sprouts, carbonated drinks, cooking oils, hot liquids such as gravy, soup, tea etc.); food that doesn't break down (insoluble fibre etc.); food that stays hard (seeds, pips etc.)

I've also decided to begin making long term changes to my diet that I hope will affect the frequency of my flare-ups. These changes have included almost completely removing dairy, sugar, fried food, cooking oils, wheat and gluten from my diet. I now eat them very rarely - normally when they're part of another food and I don't have a choice.

After my worst flare-up I learnt an important lesson, which is that I should not gradually fall back into eating cheap, processed food. I am determined to stick to eating real food, and that means changing for life!! I've realised that paying more for healthier food actually saves you money in the long term. Surely there can't be a better investment for UCers that are lucky enough to be able to choose what they eat?

Colitis Diary

In reference to diet, it's worth mentioning that it's very useful to keep a diary. The longer you keep the diary; the more useful it becomes, just as, the more in depth the diary; the more useful it is. Colitis diary details/ideas

Don't get mixed up!

Colitis Diet - Confused

This has happened to me a few times so I think it's worth saying: in the world of flare-ups, symptoms, foods, meds etc. it's very easy to get confused about what's causing problems and what's beneficial. It's common for UCers to try different approaches, see different results and get them mixed up. I know I have!

Talking of getting mixed up, something else I've done is to mix-up information about eating healthily with eating for Colitis - they're two completely different things, but when you're desperately looking for ideas it's an easy mistake to make. Sounds strange but; concentrate on your Colitis diet, not on what's considered a healthy diet e.g. a diet with lots of insoluble fibre is considered healthy!

I found the only way to avoid getting mixed up is to extend the amount of time I stick to the same diet. In fact I've now stuck to the same diet for months and it has been very useful in helping me spot other things that cause symptoms e.g. an ingredient, a virus etc. Sticking to the same diet for a period of time can be a real test of will power, but it has been worth it for me.

One trick is to get some variety into the diet by changing the way I prepare the food, or putting the ingredients together in different ways. That way, at least I can look forward to different types of meals instead of exactly the same thing each day.

Eating for health

So, as I pointed out in the previous section, sometimes eating healthily doesn't work for Colitis. A nice salad is considered a healthy meal but it contains ingredients than can cause symptoms for some UCers e.g. lettuce, tomatoes etc.

However, a good rule of thumb is for everyone to ask themselves: what's the nutritional value of the food I'm eating? I have to admit I sometimes struggle with this concept (especially when I'm hungry), but this question is even more relevant for us Colitis sufferers who are often undernourished and deficient in certain vitamin and minerals.

Colitis - Healthy Diet

So an example of this could be a snack, where instead of eating a bag of crisps (chips), you might eat an avocado. This means, instead of your body having to move nutritionless crisps through the system, it moves the avocado through, but takes vitamin B5, vitamin K, copper, folate, vitamin B6, potassium, vitamin E, vitmain C and healthy fats as it does so. The result is you're no longer hungry and your body has taken much needed nutrients from the avocado as opposed to the crisps.

The reality is that as a general rule, this is a good thing to try to achieve e.g. changing from food with no nutrients to a nutrient rich diet that feeds our body is beneficial in the long term. However, it's not always easy because it can mean: spending more money; having to prepare food for a snack; not eating food that we crave etc.

From personal experience I know how hard this can be at first, but if you can persevere with it, you'll notice that cravings for unhealthy foods diminish. I used to struggle a lot when I first started changing my diet, but it's much easier now - a good rule is to not let yourself get too hungry, where there's the danger of grabbing unhealthy snacks out of desperation.

Some UCers have found making a batch of healthy snacks works, that way they can grab them the moment hunger pangs strike. As ever, food is very individual, so not all healthy foods will be good for your Colitis - remember: trial and error!

I note that some UCers with a very limited diet sometimes find the only thing they can eat is what's considered junk food. Hopefully they'll be supplementing the diet to ensure they get the vitamins and minerals. However, when there's an improvement, it might be an idea to trial healthier equivelants e.g. organic red meat as opposed to fast food burgers etc.

Bland is beautiful!

Bland Colitis Diet - Rice

In reference to colitis symptoms and diet, the general advice is to cut back to a bland diet (often referred to as a low residue diet) which will, fingers crossed, eliminate some of the symptoms, give the colon a rest and settle things down. You then introduce one food back in to see if you get any symptoms. If you don't get any symptoms, it goes on your 'safe food' list. It can be a long process but is absolutely worth it - try not to think too far ahead!!

Bland Colitis Diet - Fish

Finding a bland diet that works can take a long time - I've read comments in colitis forums where a UCer has tried something for a couple of days but then started eating other foods. Unfortunately you have to be disciplined and stick with the bland diet only.

You also need to stick with it for more than a couple of days (unless you get a bad reaction; in this case you should stop eating it immediately). I've heard it said that to see any benefits when testing a bland diet, you should continue with it from 2 weeks up to 1 month.

Bland Colitis Diet - Chicken Broth

So, common foods that get mentioned a lot when discussing bland diets are:

  • Breakfast: porridge or white toast
  • Lunch: chicken soup/broth
  • Dinner: potato/white rice, chicken/fish

Here's a real life example of a bland diet

Insoluble Fibre

If you're still learning about your colitis, a general rule is to be wary of insoluble fibre. Insoluble fibre bulks up stool and helps move material through the colon but can cause problems because it doesn't dissolve in water. This means it stays in its original form and can aggravate inflamed areas as it sweeps through the colon. However, outside of Colitis fibre is good for you, so finding a way to get it into your body is important: whether that's through eating soluble fibre, finding insoluble fibre food that doesn't cause symptoms or taking supplements e.g. a fibre gel drink.

Colitis Diet - Insoluble Fibre

Confusingly, many foods contain soluble and insoluble fibre but can be okay to eat because of the ratio. Preparation of foods (boiling, peeling etc.) can also change the ratio of insoluble fibre. Basically, it's a good idea to use caution and trial a small amount to see if it causes any symptoms.

The lists in the tables below are NOT exhaustive, but they are probably the best known insoluble foods to UCers. This is because they contain higher amounts of insoluble fibre.

Vegetables Fruit Fibre Foods Beans Nuts Misc
  • Vegetable skins
  • Green beans
  • Cauliflower
  • Broccoli
  • Celery
  • Onion
  • Cabbage
  • Sweet Corn
  • Fruit skins
  • Tomato
  • Berries
  • Whole Grain
  • Whole Meal
  • Whole Wheat
  • Wheat Bran
  • High Fibre Bread
  • Whole Grain Cereals
  • Whole Wheat Cereals
  • Whole Bran Cereals
  • Baked
  • Brown
  • Soya
  • Kidney
  • Red
  • Navy
  • Pistachio
  • Almonds
  • Walnuts
  • Dried Coconut
  • Mushrooms

Soluble Fibre

Colitis Diet - Soluble Fibre

For most UCers soluble fibre is a friend! This is because it breaks down easily, is much easier to digest and moves through the large colon without aggravating inflamed areas. Also it's a way to get fibre into your body, something that can prove tricky for UCers depending on their diet and symptoms.

A few examples of soluble fibre.

Vegetables Fruit Fibre Foods
  • Peeled Potato
  • Peeled Sweet Potato
  • Peeled Apple
  • Peeled Pear
  • Porridge Oats
  • White Rice

Bread

Colitis Diet - Bread

A staple of many peoples' diets, I've read many times that plain white bread is okay for UCers. There are a lot of ingredients in some bread, including preservatives. However, I've never had a problem with white bread but eat it in moderation, also to avoid all the preservatives, I make my own bread. I avoid brown bread like the plague because of the insoluble fibre it contains - it has bought on flare-ups for me in the past.

Update: I have been eating gluten / wheat free bread for a few months now to see if there are any benefits.

Gluten

Most of us have heard about gluten sensitivities, but may not think this is something that crosses over with Colitis. The fact is that some UCers see an improvement of symptoms when gluten is taken out of the diet (for others there's no change). Research is ongoing into the causes and effects of gluten.

Fortunately there are sections of gluten free products in most supermarkets now, so trying a gluten free diet is not as difficult as it used to be. As I mentioned above, I cut out bread during my most recent flare-up and decided to go completely gluten free. I saw no improvements in my flare symptoms, although it can take months for inflammation caused by gluten to repair itself, so I'm hoping it may be a long term benefit.

Dairy

Another set of foods that affects many UCers; one of the main symptoms of dairy appears to be that it produces extra mucus. Personally, during a flare-up, I Colitis Diet - Dairy eliminate milk and cheese from my diet but continue to use small amounts of butter (from grass fed cows).

I recently looked at some surveys of UCers and their dietary triggers for flare-ups - interestingly, dairy came top of every survey! I cut dairy out during my flare-up at the beginning of the year and decided to keep it that way. It's not something I miss too much although I was a cheese lover, I'd rather see if eliminating dairy has a long term beneficial effect on my Colitis.

Hot/Cold Liquids

I've not seen this mentioned too many times, but I think there may be something in it. When I say liquids I mean gravy, soup, tea, hot chocolate, water etc. I don't drink coffee but would add it to the list if I did. I've noticed for me that soup and gravy especially cause extra gas: extra work for the colon!

I've read a few articles that say hot or cold water can speed up the metabolism. Now I'm not certain this is true, but personally, I try to avoid anything where there is a possibility that it might alter my digestion in any way. This means I stay away from any hot drinks, soups and gravy. I also try to avoid hot sauces on food. I drink a lot of room temperature, filtered water.

Caffeine

Caffeine, in particularly Coffee, appears high up in surveys of dietary triggers for Colitis flare-ups and is often in lists of foods to avoid for Colitis sufferers. Some UCers report that during flare-ups, caffeine exacerbates diarrhea and cramping.

Cooking Oils

Colitis Diet - Oil

Many cooking oils contain a high amount of Omega 6 e.g. 100g (3.5oz) Linoleic Sunflower Oil contains 65.7g of Omega 6. Research is showing that high amounts of Omega 6 can cause inflammation.

Thousands of years ago the ratio of Omega 3 to Omega 6 in humans was around 1:1. In the modern Western diet the ratio of Omega 6 to Omega 3 is as high as 15:1 but has been measured as high as 45:1. It's thought that this unbalanced ratio could be one of the reasons behind many modern diseases seen in the west (UC included).

In ref to colitis symptoms, cooking oils cause the same reaction as hot liquids for me, that is: they cause gas and therefore work the colon. It doesn't matter if it's the 'healthy' olive oil or not: it's the same. Recently I learnt that the hotter many cooking oils get, the more likely they are to contain free radicals which can damage cells and accelerate the progression of cancer. Another reason I bake or boil my food!

For those that like to use oils to cook, a simple guide is that at high temperature: solid saturated fats (e.g. ghee, butter, coconut oil, lard) are the most stable for cooking; monounsaturated fats (e.g. olive oil, avocado oil) are less stable and polyunsaturated fats (e.g. vegetable oil, sunflower oil) are the least stable.

Colitis Diet - Carbonated

Carbonated drinks (fizzy drinks)

The simple fact is that carbonation sends lots of extra air through your system which works the colon. Apart from gas, it also causes cramps and blood for many UCers.

Fat

Something that most people have an opinion on! Fat can take longer for the body to breakdown and may travel through to the large colon. After doing some research, I personally believe some saturated fats are good for you, but may not be suitable whilst in a flare up - trial and error!!

Sugar / Refined Carbohydrates

Colitis Diet - Refined Carbohydrates

Most of us will be aware that too much sugar is not good for us. However, it's not as well known that refined carbohydrates are a chief suspect in many modern diseases and at the very least, are a big factor in symptoms of Colitis for some UCers.

Refined carbohydrates can be found in processed foods such as white bread, pasta, white flour, cakes, biscuits etc. (it's easy to find comprehensive lists on the internet).

In reference to colitis, refined carbohydrates can cause the pH level to become acidic in the colon, which disrupts the normal bacteria. It can also help feed certain types of bacteria which can lead to an imbalance and a growth of yeast.

Alcohol

The question of alcohol comes up quite a lot in Colitis forums - UCers often wonder if it's okay to drink it. As ever with Colitis there's no definitive answer, some have no problems while others are affected by ingredients in their drink.

Carbonated alcohol like lager, or alcohol mixed with carbonated drinks like vodka and coke are known to cause symptoms such as cramps, blood and diarrhea for some UCers. This is due to the extra gas from the carbonation moving through the colon.

How I protect myself: alcohol and colitis

Meat/Fish

Colitis Diet - Chicken

I seem to be okay with most meat at the moment, but I generally stick to chicken which also appears to be the favourite choice for many UCers. The bland diet of chicken and potatoes/rice is a staple for many UCers during a flare-up. I also seem to do okay with some red meat, and meaty fish such as salmon or tuna.

Barbecued / overcooked / charcoaled food

Colitis Diet - Burnt Food

I know a lot of UCers become experts in food and diet, so I'm guessing many are aware of the dangers of over cooked / burnt / charcoaled food. For those that aren't, the more burnt the food, the more carcinogenic it is. Carcinogens are cancer causing agents that contain free radicals. Everyone should try to minimise eating this type of food, but specifically in relation to Ulcerative Colitis, it's something UCers should avoid.

I've become used to picking chicken apart and cutting off any blackened meat at BBQs - a pile of burnt meat shrapnel is a small price to pay!

Processed Food

Colitis Diet - Processed Food

It's a good idea for everyone to cut out processed foods, but as UCers I think it's even more important to try to cut back on as many preservatives and additives as possible. I'm aware that many UCers are severely limited on what they can eat so it's not always easy, but where you have a choice to eat a healthier option, it's worth the investment.

I've added an extra 25% on my weekly food budget because of my new food choices! Whereas I used to shop for cheaper foods, I now look at the organic and natural foods as an investment. I heard a cheesy saying recently, which for all its cheesiness is still relevant: if you buy cheap food now, you pay for it later!

Fruit and Veg

Fruit and veg is often an area that's confusing for Ulcerative Colitis sufferers, when they decide to eat 'healthily' but it causes symptoms.

Unfortunately, healthy for most can still be a problem for UCers, and if you experience problems, trial and error is important. For example, by the very nature of a salad, there can be a lot of different vegetables and/or fruit (not forgetting dressings), so perhaps it's worth starting with less ingredients to make it easier to spot anything that causes symptoms.

Common sense says that eating plenty of fruit and veg is good for us, but Colitis adds another perspective. Some UCers found eating raw fruit or veg caused a flare-up e.g. I've seen a few mention lettuce as something that causes symptoms. However, once cooked, veg can be easier on the system - during my flare-ups I realised I had problems with raw carrots but was okay when they were cooked. The downside is that the cooking process removes many nutrients, but is the preferred option for most, especially during a flare.

As ever, it's very individual and depends on the sufferer. Personally, I now avoid anything with tomato and have recently cut down a lot on other nightshades that were a staple of my diet e.g. potato.

Juicing

Colitis Diet - Juicing

Juicing can be a great way to get nutrients from fruit and vegetables into your system whilst eliminating the fibre. I've seen juicing discussed a fair amount in colitis forums although often it's about which is the best juicer to buy (the good ones aren't cheap).

If you intend to try it out, it's probably not worth investing until you're sure it's something you'll use. If you don't get any colitis symptoms and find it beneficial, my advice would be to spend as much as you can afford. A good sturdy juicer that gets rid of skin and seeds/pips can be a great health investment.

I'm researching fruit, vegetables, herbs and spices that are linked to helping the digestive system and healing ulceration. I recently tried juicing because I'm hoping it's a natural way to help stay in remission. Once a day, I juiced together: carrots, apples, spinach & chinese leaf (napa cabbage).

Update: after experiencing weird feelings in the transverse colon whilst juicing, I stopped for a few months. I've now started but with less ingredients. At the moment I'm juicing 2 carrots; 3rd of a cucumber and 2 sticks of celery and I have not experienced the strange feelings that I did last time. There could be many factors that caused the feeling (even nothing to do with juicing!), but I suspect the cabbage was the problem because I have taken it out of the juice (I've also taken spinach out but I eat this cooked or raw with meals.)

Another update: I've now changed my juice to cucumber, apple, ginger and red cabbage - I've not had any issues (touch wood ). Red cabbage contains Glutamine which is very good for the intestinal tract.

More info on juicing and smoothies

Colitis Diet - Smoothie

Smoothies

Smoothies are slightly different from juices because the fibre remains in the drink. But it's a great way to get nutrients and fibre into the body if you can't handle many solids. Because smoothies contain fibre, they can keep hunger pangs away; something UCers on a bland diet will be familiar with!

Be wary that smoothies you buy at the supermarkets can contain seeds/pips - this is why I'm careful if I buy them.

More info on smoothies and juicing