What to Eat for Better Management

If you have been diagnosed with ulcerative colitis, your healthcare provider may have told you that making changes to your diet can help you manage symptoms. Research has indicated that many people who have mild-to-moderate ulcerative colitis benefit from making changes to their diet in conjunction with other treatments (such as medication). 

As with any health condition, one way of eating won’t necessarily work for everyone who has ulcerative colitis. However, if you can identify the foods and beverages that are more (or less) likely to give you a flare-up of ulcerative colitis symptoms, it may be easier for you to manage your symptoms.

What to Eat

If your digestive tract is inflamed because of a condition like ulcerative colitis, certain kinds of food and drink may worsen your symptoms. For instance, spicy foods or those that are high in fat (like fried foods) may trigger certain symptoms.

People who have severe ulcerative colitis may also experience certain complications, such as strictures, that require them to avoid entire food groups or adhere to a certain type of diet for a longer period of time.

In general, the more fiber a food has, the more work your intestines have to do to break it down during digestion. When you are not feeling well and have ulcerative colitis symptoms, you may find that sticking to bland food that doesn’t have a lot of fiber and is, therefore, easier to digest helps reduce your discomfort. 

Foods that don’t leave a lot of undigested material behind in your colon (called low-residue foods) may also be helpful if you are having a flare of ulcerative colitis symptoms. When you have less of this food residue in your intestines, you won’t have as many bowel movements.

It might require some trial and error, but you can create a balanced and nutritious ulcerative colitis diet that meets your individual tastes and nutritional needs along with helping you control your symptoms.

• Fruits and Vegetables: Raw fruits and veggies may be too irritating for your sensitive gut if you have ulcerative colitis. However, many can be made easier to digest by peeling, cutting, and cooking.
• Grains: When you’re having symptoms, choose bread, pasta, and other carbohydrates that are low in fiber. Usually, this means they’re made from refined white flour instead of whole grains. White rice is another low-fiber option that can be soothing and easy to digest. Sourdough bread, hot cereal, grits, and packets of oatmeal that are low in sugar may also work.
• Dairy: Low-fat yogurt that doesn’t have any added sugar, especially if it’s rich in probiotics.
• Protein: Lean protein-like skinless chicken breast plainly cooked can work well both when you are having symptoms as well as when you’re symptom-free. Be careful not to overcook the meat, avoid frying, and don’t add any butter, spices, or rich sauces. Tofu or tempeh are other options for non-meat protein. 
• Desserts: Plain gelatin can be a treat, as well as hard candy and gum. However, if you choose sugar-free varieties, be sure to look at the list of ingredients.
• Beverages: Stick to water or beverages recommended by your healthcare providers such as electrolyte-replacement drinks and liquid nutritional supplements. 

What Not to Eat

Certain foods are known triggers for people with ulcerative colitis. These include:

• Alcoholic beverages
• Carbonated drinks
• Caffeine
• Dried beans and legumes
• Fatty meat
• Fried foods
• Nuts, popcorn, and dried fruit
• Sugar substitutes like xylitol and sorbitol
• Desserts like cake, cookies, ice cream, and pudding
• Brown rice, wild rice, or rice pilaf
• Fruits and vegetables that cause gas, like corn, broccoli, and prunes

You should also avoid eating foods that are high in fiber and foods that contain sulfur or sulfate.

Keeping a Food Journal

Not everyone with ulcerative colitis has the same food triggers. This is why dieticians recommend keeping a food journal so you can identify which foods trigger your symptoms and which foods you tolerate well. You can use a simple paper journal or an app for your smartphone.

Note everything you eat in your journal and the time you ate it. If you experience symptoms that day, note those, too. It may take a few weeks of logging everything you eat and the symptoms you experienced before you will have a good idea about which foods are triggering for you.

Eating Habits 

Timing

If you’re having a flare of ulcerative colitis symptoms, you may find that you feel better eating a little bit at a time rather than having a large meal. As long as you eat frequently enough to get adequate calories and nutrition, this strategy can be effective. 

Some people with IBD find eating this way helps them manage their condition even during periods when they are symptom-free. People with ulcerative colitis may also prefer to eat and drink at separate times to avoid feeling overly full or getting full too quickly when they are having meals. 

Cooking Tips

Not only does cooking provide you with the opportunity to change how your food tastes, but it also gives you the chance to alter the food’s physical properties to make it easier for your gut to digest. 

If you have ulcerative colitis, you may want to avoid adding spices, oils, butter, lard, or cheese to your food, as these products can be difficult to digest and/or irritating to your intestines. The exception is olive oil, which in small amounts (such as what you’d use for cooking) may help decrease the risk of ulcerative colitis, according to research from the University of East Anglia. They presented a paper on a small human research study. Most of the studies have been done on mice, showing good effects of extra-virgin olive oil on markers of inflammation and the gut biome.

You’ll also want to avoid any food that has been fried, as the batters make these meals especially greasy, dense, and high in fat. 

Foods that are high in fiber, such as raw veggies, may be easier for you to digest if you cook them. You’ll also want to make sure you remove any stems, seeds, and peels from fresh produce as you’re preparing to cook. 

Steaming vegetables can help break down the tough fibers in the produce, meaning your digestive system has to do less work. Most produce can be poached, boiled, grilled, blanched, and even microwaved. 

Duration

As is often the case with chronic inflammatory bowel disease, how often you need to adopt an ulcerative colitis diet and how long you need to stick with it will depend on many factors, such as how severe the condition is, whether or not you have complications, other health problems and dietary needs you have, as well as the treatments your healthcare provider has prescribed.

If you have symptoms often, you may find that paying attention to the composition of your diet is an essential part of managing the condition. Some people with ulcerative colitis only adjust their diet when they’re having symptoms, but others may choose to follow a special diet all the time because they feel it helps prevent flares of symptoms.

You can work with your healthcare provider, as well as other health professionals who have specific knowledge of nutrition (such as a registered dietitian) to figure out what you need to include in your ulcerative colitis diet to meet your needs.

In some cases, your healthcare provider may ask you to follow a specific restricted diet to help you prepare for a procedure or recovery from surgery. For example, if you need to have a colonoscopy to assess your ulcerative colitis’ progress, you will need to follow a special diet as part of the prep for the procedure.

If you have certain complications from IBD, such as narrowing of the bowel (strictures), develop a bowel obstruction, or need to have surgery, your healthcare provider may ask you to follow a soft diet until you are healed. These adjustments are usually temporary. Your healthcare provider will let you know when you can begin to transition back to your regular diet. Strictures are common in Crohn’s Disease, but not in ulcerative colitis.

Modifications

If you have other health conditions or food allergies that require you to pay special attention to what you eat, you may need to modify your ulcerative colitis diet. 

There may be situations where you need to make significant, but temporary, changes to your diet. One example is if you become pregnant. IBD symptoms may increase during this time, in part because of the fluctuation in hormones which may affect the gut. But you also may have fewer flares during this time—everyone is different. 

If you are having a flare of ulcerative colitis symptoms while you’re pregnant, or even just trying to manage gastrointestinal symptoms related to pregnancy, the most important consideration for your diet is ensuring you get enough nutrition. 

Things to Keep in Mind

Managing your ulcerative colitis can be challenging, and there are a few things you should keep in mind as you’re developing your eating plan.

General Nutrition

Eating a varied diet that provides all the nutrition you need can be challenging if you avoid or limit certain types or groups of food. If you have a flare of ulcerative colitis symptoms or experience intense complications, such as bowel obstruction, you may find it difficult to eat enough to meet your daily caloric needs. 

It’s important that you talk with your healthcare provider if you have concerns, especially if you are not sure if you are eating enough or if what you are eating provides the nutrition you need. 

If you are malnourished, have lost a lot of weight, have experienced complications, or are recovering from surgery, your healthcare provider may want you to have a feeding tube. Usually this is only a short-term measure, however, some people with severe ulcerative colitis may need to use parenteral or enteral nutrition for longer. 

Supplements

Talk to your healthcare provider about whether you need to take supplements. Ideally, you should try to get everything you need from the foods you eat, but sometimes this isn’t possible, especially when you are experiencing a flare. Some of the supplements your healthcare provider may recommend include:

• Calcium
• Folic acid
• Vitamins A, D, E, K, and B12
• Zinc
• Iron

Cost

For the most part, the foods you can choose from when creating an ulcerative colitis diet are generally affordable. Some staples, like white rice, can be even cheaper if you buy them in bulk. 

If you want to try your hand at pureeing foods to make them easier to digest, the basic kitchen implements you’ll need (like blenders or handheld food processors) can be purchased for around $20. 

Popular brands of liquid nutritional supplements you can buy online, at the pharmacy, or the grocery store, can be expensive—especially if you need to drink one or more per day. If your healthcare provider wants you to make these products part of your ulcerative colitis diet, find out if your insurance will cover or reimburse you for the cost. 

Side Effects

Any time you change how you eat it may take some time for your body to adjust. If you start eating more or less fiber, for example, you will likely notice a change in your bowel habits. 

If you notice these symptoms aren’t improving or are getting worse, tell your healthcare provider. Sometimes, people following a low-fiber diet experience constipation. While it might be as simple as drinking more water or taking a fiber supplement, if you have a chronic digestive disorder it’s important to mention any changes in your bowel movements to your healthcare provider. Likewise, if you have diarrhea that is persistent, you’re at risk of becoming dehydrated. 

Energy and General Health

If you’re following a restricted or relatively “bland” diet to help cope with a flare of ulcerative colitis symptoms, or you’re on a liquid-only diet as your body heals from surgery, you may be getting fewer calories and nutrition. As a result, you might not have as much energy as you typically do. 

It’s important that you try your best to eat enough each day to meet your body’s nutrition and energy needs. Not only to help manage ulcerative colitis but to maintain your overall health. 

Complications from IBD, such as infections, may be more likely if your body is weakened from malnourishment, vitamin deficiencies, and dehydration. 

Preventing nutritional deficiencies may help prevent flares: In 2017, research from Beth Israel Deaconess Medical Center indicated that people with ulcerative colitis who are in remission may be more likely to experience a relapse of symptoms if they are deficient in vitamin D.

Dietary Restrictions

There are several situations where your other dietary needs and preferences may influence what you can include in your ulcerative colitis diet. 

For example, if you have celiac disease and need to avoid gluten and wheat, you will need to look for products such as bread, cereals, and pasta that are gluten-free. 

However, it’s important to check the ingredients list of gluten-free products, as some alternatives to wheat are made with beans, legumes, or corn—which may be irritating. 

If you are lactose intolerant, you are likely used to avoiding or limiting dairy products. Most dairy alternatives, such as rice, soy, and almond milk, are tolerated by those following an ulcerative colitis diet. 

For those who adhere to plant-based diets (such as vegetarians and vegans), it may be tricky to find popular foods that comply with the guidelines for your ulcerative colitis diet. For example, staples of a vegetarian diet such as whole grains, beans, nuts, and raw vegetables may not be tolerated if you have ulcerative colitis.

If you have any other dietary considerations, it’s important to talk to your healthcare provider. When you are restricting your diet in more than one way, such as to manage symptoms of a health condition and to meet your preferences, it may be more difficult for you to stay adequately nourished. Your healthcare provider may want you to take supplements or vitamins to ensure that you don’t become deficient.

Getting Support

If you have a chronic illness like ulcerative colitis, you might find joining a support group to be helpful. These support groups can either be in-person or online and typically include a community of patients who come together to discuss questions and concerns about living with ulcerative colitis as well as options for treatment. Dietary challenges and practices may fall under both categories. 

Even if you are not specifically discussing diet, being part of a support group can often be helpful just by providing a space for you to engage with others who know what it’s like to go through what you’re dealing with. While you may have support from your healthcare provider, family, and friends, if they don’t have the same condition you do they may not always understand how you feel. 

Having a safe space to commiserate with others who have shared experiences and worries can help you cope with the emotional aspects of having ulcerative colitis. 

Summary

Eating certain foods and avoiding other foods is an important part of ulcerative colitis management. Focus on low fiber, easy-to-digest foods, especially during flares. Avoid foods that are harder to digest such as whole grains, fried foods, and desserts. 

Following a restrictive diet may cause problems like poor nutrition, so it is always best to develop your diet with the help or your healthcare provider or a nutritionist.