Ulcerative colitis is a chronic disease which involves inflammation of the lower end of the digestive system, including the large bowel and rectum. It affects the lining of the colon and causes the formation of small sores or ulcers which can then produce pus and mucus, causing pain and the need to frequently empty your bowels. Symptoms appear over time rather than suddenly.
Diet and nutrition are a major part of life when you have inflammatory bowel disease (IBD) yet there is no single diet that works for everyone. Nutrition affects your overall health and well-being, without a good diet, your ulcerative colitis symptoms can cause serious complications such as nutrient deficiencies, weight loss and malnutrition.
Follow our tips for a healthy diet during the inflammatory phase of a “flare up” and also when things settle down in the “remission phase”.
Tips for meal planning:
- Keep hydrated – drink enough fluids to keep your urine a light yellow to clear colour. This can include water, squash, herbal teas, clear broths/soups and rehydration sachets, if needed.
- Sip fluids and avoid drinking quickly or through a straw which may increase the amount of air ingested, which can later cause gas.
- Try to eat four to six small meals per day rather than three larger meals.
- Avoid frying foods and stick with boiling, grilling, steaming or poaching.
- Keep a food diary, which will help you identify foods that may trigger your symptoms.
What to eat during a flare up:
When your ulcerative colitis is inflamed or “mid-flare” there are many foods you may need to avoid. Some foods seem to trigger cramping, bloating and/or diarrhoea. Whilst other foods may help you get the right amount of nutrients, vitamins and minerals.
Insoluble fibre is hard to digest: these include any fruits with skins and seeds, whole nuts and whole grains and any raw green vegetables with peel or those which are wind inducing such as broccoli or cauliflower. Dried beans, peas and legumes, dried fruits and berries with pulp can also be difficult to digest.
- Lactose: sugars found in dairy, such as milk, soft cheeses or cream cheeses
- Non-absorbable sugars: sorbitol, mannitol, sugars in gum, candy, ice cream, fruit juices.
- High fat foods: butter, cream, fried and greasy foods.
- Spicy foods: hot spices in foods, such as curries.
- Alcohol and caffeinated drinks: beers, wine, coffee, sodas, energy drinks
- Chocolate: contains sugar and caffeine which can irritate the digestive tract
- Refined sugar: can pull more water into the gut and cause diarrhoea
Low fibre foods are usually better tolerated as they will help to slow the bowel down. This is typically recommended for those who have had surgery. Some examples are below:
- Refined grains gluten free bread, sourdough or potato bread, white pasta, white rice, and oatmeal. Instant oatmeal is easier to digest during a flare up as it has less fibre.
- Salmon and tuna contain omega-3 fatty acids which can help reduce inflammation during a flare and may help you stay in remission for longer. Mackerel, flaxseed and whole nuts (which can be ground up if you have recently had surgery) are also rich in omega-3.
- Eggs are usually well tolerated during a flare up. They are full of omega 3 – fatty acids which can help with inflammation.
- Cooked squash is often well tolerated during a flare up. It is full of vitamin C and beta carotene .
- Avocado’s are an excellent source of protein and healthy fats. They are also high in water so they can be easily digested
- Smoothies can be tolerated by some during a flare and can help you maintain good nutrition. Be mindful of the fruit you are using. Add banana or instant porridge to help thicken the fruit used.
- Carrot juice is full vitamin A and antioxidants and many people with ulcerative colitis can tolerate it.
- Soy-based protein can be substituted for animal protein in cow’s milk. Or try other nutritious milks such as nut milks or coconut milk. This is ideal for those who are vegetarian or vegan. Make sure you look out for the ones which are fortified so you don’t miss out on calcium.
Speak to your GP or dietician about any foods you feel you need to reduce or avoid and you will be provided with guidance about an elimination diet, which needs close supervision. By removing certain foods for a period of time and then reintroducing them, during a remission period, can help you learn which foods are causing the symptoms. Your GP or dietician may also provide you with any supplements you may need to take if you are avoiding certain food groups.
What to eat in remission of symptoms?
If you have eliminated some foods, it is important to reflect upon which ones have aggravated your symptoms and which have not. Could it be time to re-introduce the safe foods back into your diet? Here are some tips on how stay healthy and hydrated:
- Fibre- rich foods: oat bran, beans, barley, nuts and whole grains are rich in fibre. Nuts and wholegrains will be foods to avoid if you had recent bowel surgery such as an ileostomy, intestinal narrowing, stricture or if your doctor/nurse has advised you take a low residue diet.
- Protein: Meats (low fat/lean) fish, eggs, nuts and tofu.
- Calcium rich foods: Milk (try alternatives such as soya, coconut and nut milks if you have a dairy or lactose intolerance/allergy),
- Fruits and vegetables: peel away the skins and seeds. Unsweetened apple sauce is very bland and maybe tolerated after a flare up.
- Foods with probiotics are good because they can aid digestion, so having yogurts and milk drinks will work well.
Remember that you can always speak to your healthcare professional if you have any questions or concerns.