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Nutrition Guidelines for Ulcerative Colitis
Ensuring good nutrition is an important part of managing Ulcerative Colitis (UC). People with UC may be at risk for developing malnutrition and nutrient deficiencies, which makes it more difficult for the body to heal and fight infection.
Malnutrition may also cause people to feel more fatigued and some medications may not be as effective when nutritional status is depleted. With proper monitoring and attention to nutrition, these complications can often be avoided.
There are several reasons that people with UC may be at nutritional risk. These include the following:
Decreased food intake due to decreased appetite, pain, diarrhea, or other symptoms (or fear of these symptoms)
Increased needs for calories, protein, and some vitamins and minerals
Diarrhea or other fluid losses can lead to dehydration if not replaced
Some medications prescribed for UC may affect appetite, taste sensation, or nutrient absorption
Diet restrictions (which may or may not be necessary)
Diet
There is no specialized diet for people with UC. Rather, the recommended diet for UC is a balanced diet focusing on adequate calories, protein, vitamins, minerals, and fluid. No specific foods are known to trigger UC or make the disease worse. Therefore, there are no specific foods that must be avoided by all patients with UC. Some individuals may have their own food intolerances or notice that certain foods cause discomfort. In such cases, those foods should be avoided. Nutrition needs may vary from person to person depending on the status of their disease, thus it is best to meet with a dietitian who can help you individualize your diet to best meet your needs.
Fiber
Dietary fiber is an important component of a balanced, healthy diet. Fiber is broken down in the colon into short chain fatty acids. The colon uses these short chain fatty acids as an energy source. In people with Ulcerative Colitis, there is no need to limit the intake of dietary fiber. Likewise, it is not necessary to increase fiber intake above the recommended levels for the general population. Recommended daily dietary fiber intake is 15-25 grams. Trial and error is the best way to figure out what amount of fiber you are able to tolerate in your diet. The amount of fiber tolerated varies between individuals and may also vary with an individual during a UC flare.
Calories and Protein
It is important to take in enough calories each day to maintain a healthy weight. Your calorie needs may be increased when you are acutely ill. Rapid, unintentional weight loss places you at risk for malnutrition.
The inflammation caused by UC may lead to increased protein needs. Inadequate protein intake may negatively affect healing and lead to muscle loss.
A dietitian can provide more specific guidelines for your individual calorie and protein needs, as well as provide you with more information on increasing calories and protein in the diet, if needed.
Vitamins and Minerals
Calcium and vitamin D are nutrients important for healthy bones. Many adults do not take in enough of these nutrients. Patients with UC are especially at risk because dairy products (which are the main source of calcium and vitamin D) are often avoided. However, such avoidance is often not necessary (see the section below on lactose and dairy products for more information).
The medication sulfasalazine may decrease absorption of the nutrient folic acid. If you are on sulfasalazine, your physician or nutritionist may recommend folic acid supplements.
Patients with UC are at risk for iron deficiency due to possible blood loss from the colon. Iron levels can be measured by a blood test; supplements may be recommended if levels become low.
Your physician or dietitian may recommend additional vitamin and/or mineral supplements based on laboratory values or other information.
Other issues
Lactose and dairy products
Lactose is a sugar found in dairy products. Some adults have difficulty digesting lactose and dairy products due to low levels of the enzyme (lactase) needed to break down lactose in the small bowel. Symptoms include cramping, bloating, gas, and/or diarrhea after consuming dairy products.
Since digestion of lactose occurs in the small intestine (not the colon which is affected by UC), patients with UC do not have a higher incidence of lactose intolerance than the general population. Therefore, routine avoidance of dairy products is not needed.
If tolerated, dairy products can be a good source of nutrition for patients with UC.
If dairy products do cause discomfort, they should be avoided or eaten in smaller amounts as tolerated. In such cases, discuss your calcium and vitamin D intake with your physician or dietitian.
More information on lactose intolerance is available from the Digestive Health Center; ask your physician or dietitian for additional handouts if needed.
Strictures, partial obstruction, or narrowed areas of bowel
If your doctor has told you have strictures, a partial bowel obstruction or that you have areas in the bowel which are narrowed, a low fiber diet may be beneficial.
On a low fiber diet, the following foods should be avoided: raw fruits and vegetables (especially those with pulp, edible skins or seeds), corn, beans, nuts, seeds, popcorn, raisins, whole grain products, bran products, and fiber supplements. A more complete list is available if needed. It is also important to chew all foods well.