Key takeaway
- While there is no cure for ulcerative colitis (UC), dietary changes can help manage symptoms and reduce flare-ups, with several diets like low FODMAP and the Mediterranean diet showing promise.
- General dietary recommendations for UC include maintaining a balanced diet and avoiding trigger foods during flares, while specific diets like the Crohn’s disease exclusion diet (CDED) and specific carbohydrate diet (SCD) focus on limiting certain foods to improve gut health.
- Several diets, including the Mediterranean diet, IBD anti-inflammatory diet (AID), gluten-free diet, and autoimmune protocol (AIP) diet, have shown potential in managing UC symptoms by reducing inflammation and promoting a healthy gut microbiome. However, it is essential to work with a healthcare professional to avoid nutritional deficiencies.
The gut microbiome plays a crucial role in the inflammation of the gut in people with ulcerative colitis (UC). While foods do not cause UC, some may trigger UC flares.
While diet does not directly cause UC, certain foods can trigger or worsen UC symptoms. Specific UC diets limit and allow certain foods and food groups to prevent UC flares and improve gut health.
This article explores different diets typically recommended for people with UC, how they can help, and their risks.
Microbiome resources
For more research-backed information about the microbiome and how it affects your health, please visit our dedicated hub.
There is no single best diet for UC. Finding the right diet can help a person with UC lessen the occurrence of flares, improve their quality of life, and ensure proper nutrition.
People with UC, and other autoimmune conditions,
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It is essential for people with UC to maintain a balanced diet. General recommendations that can improve a person’s nutrition include:
- eating small, nutrient-packed meals or snacks when a person’s appetite has decreased
- staying hydrated
- drinking slowly and avoiding using a straw, which can cause people to ingest air, which may cause gas
- preparing meals in advance
- adopting simple cooking techniques — boil, grill, steam, poach
- using a food journal to keep track of what food and any symptoms
A person with UC can have periods of increased symptoms called flares and periods where symptoms are quiet or absent.
Getting the appropriate nutrition during particular periods can control the symptoms and help achieve remission or delay symptoms from coming back, and maintain remission.
When in remission, a person will not have symptoms. While there is not always a way to avoid them from returning, a person may prolong the state of remission.
A person will benefit from an expansive and nutrient-rich food source.
What to eat during flares
Aside from taking medications to manage flares and achieve remission, a person should avoid certain foods and look for other food sources to get the nutrients they need. Foods to include are:
- foods high in protein such as tofu, chicken, fish, eggs, turkey, beans, yogurt, chia seeds, and nut butters
- low fiber fruits, cooked fruits, and fruits without hard peels
- cooked non-cruciferous vegetables, and vegetables without seeds and skin
- refined grains such as white bread, white rice, and pasta
Fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs) are types of carbohydrates or sugars in certain foods. They are poorly absorbed in the small intestine, affect gut motility, and are rapidly fermented by bacteria, causing gas, stomach pain, and other symptoms.
A 2021 review of studies found that a low FODMAP diet led to significant improvements in symptoms and quality of life. It is also
However, this type of diet can be challenging to sustain and may cause
Foods to eat and avoid
A low FODMAP diet instructs individuals to limit foods high in FODMAPs.
High FODMAP foods include:
- fruits, such as apples, mangoes, and pears
- sweeteners, such as corn syrup, fruit juice, dried fruits
- dairy, including milk, yogurt, ice cream, and soft cheese
- vegetables such as asparagus, Brussels sprouts, garlic, fennel
- starches, cereals, and grains, including beans, lentils, wheat, gluten-based bread, and pasta
- legumes, such as red kidney beans and lentils
On the other hand, low FODMAP foods include:
- fruits such as banana, grapes, honeydew, and strawberry
- lactose-free milk product substitutes such as sorbet and hard cheese
- vegetables such as carrots, celery, corn, and eggplant
- glucose, sucrose, and artificial sweeteners that do not end in “-ol”
The Crohn’s disease exclusion diet aims to limit or exclude foods that might negatively impact the gut microbiome. A person on this diet will eat whole foods along with a variable amount of formula as partial enteral nutrition (PEN), and there are three phases:
- Phase 1: For the first 6 weeks, 50% of a person’s calories will come from PEN.
- Phase 2: Over the next 6 weeks, 25% of a person’s calories will come from PEN.
- Phase 3: After 12 weeks, additional foods are included in the diet, and a person will get 25% of their calories from PEN.
Foods to eat and avoid
The diet excludes the following foods:
- wheat
- dairy
- animal fat
- additives
- processed foods
- red meat
- coffee
- alcohol
- artificial sweeteners
A person can include the following foods:
- fruits
- vegetables
- rice
- potatoes
- lean meats
- eggs
Similar to the low FODMAP diet, the SCD restricts certain carbohydrates from a person’s diet to help reduce gastrointestinal symptoms.
The SCD involves limiting complex carbohydrates and eliminating the following foods:
- all grains
- all sugars, with the exception of honey
- all milk products, with the exception of hard cheese and fermented yogurt
- most processed foods
It theorizes that people do not fully digest complex carbohydrates and therefore they remain in the gut. These carbohydrates cause an
The authors of a 2023 literature review state that more research is necessary to establish the effectiveness of this diet and its effects on IBD. However, previous research appears to be promising.
Research from a 2016 study showed 33% reported clinical remission within 2 months after starting the SCD. Almost half of the people were in remission within 6 to 12 months of starting the diet.
An individual following this diet may find it difficult to maintain a moderate weight and consume enough nutrients, including:
- B vitamins
- calcium
- vitamin D
- vitamin E
Doctors will closely monitor individuals on this diet.
Foods to eat and avoid
Foods allowed in the SCD include:
- meats, or substitutes without additives
- shellfish
- eggs
- fresh or frozen fruit and vegetables
- certain legumes such as dried beans, lentils, and peas
- dairy — limited to hard cheeses such as cheddar
- homemade yogurt fermented for at least 24 hours
- most nuts and nut flours
- healthy fats such as olive oil
- most teas and coffees
- vinegar
- juices with no sugar or additives
Foods to avoid include:
In addition, a person cannot eat anything processed and canned, including most processed meats. Other prohibited foods include:
- certain legumes such as chickpeas and bean sprouts
- seaweeds and their byproducts
- potatoes, sweet potatoes, and turnips
- all milk and milk byproducts with high lactose, including sour cream, ice cream, and commercial yogurt
- candies and chocolates
The Mediterranean diet
It is a primarily plant-based diet with the addition of healthy fats. A person can include lean proteins, such as fish and poultry and limit their intake of dairy products.
Foods to eat and avoid
A Mediterranean diet consists of the following:
- higher quantities of olive oil, legumes, grains, vegetables, nuts, seeds, and fruits
- moderate quantities of fish, dairy, and poultry
- low quantities of processed foods, red meats, and processed meats
The IBD-AID is an adaptation of SCD. While it follows the principles of SCD, it is less restrictive, which may make it easier to follow. It includes foods that provide complete and balanced nutrition.
It primarily aims to restore the microbiome in people with IBD. The diet focuses on foods that colonic bacteria can easily degrade dietary fibers and produce short-chain fatty acids (SCFAs). SCFAs are vital in downregulating inflammatory markers in the colon.
IBD-AID is relatively new, hence the limited studies. A 2020 study on people with IBD following the IBD-AID diet for 4 weeks showed a reduction in symptoms and use of medications.
Foods to eat and avoid
Foods to eat include:
Foods to avoid include:
- foods containing lactose, refined sugar, wheat, and corn
- processed foods
- fast foods
Gluten is a protein family found in grains such as:
- barley
- rye
- wheat
Around
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- inflammatory markers
- quality of life
- disease severity
The authors state that it is too early to suggest a gluten-free diet as a safe and beneficial diet for those with UC.
Foods to eat
Foods that a person following a gluten-free diet can eat include:
- all gluten-free starches and grains
- dairy
- fruits
- vegetables
- fresh meat, fish, and poultry
- juices
- nuts and seeds
While there is some overlap, such as eliminating certain grains, the gluten-free diet for UC does not include a low FODMAP diet. However, a person may combine the two diets.
The AIP diet is an extension of the paleo diet. It aims to relieve symptoms and reduce inflammation caused by autoimmune diseases such as UC and other conditions, including lupus and rheumatoid arthritis.
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Foods to eat and avoid
The diet encourages the consumption of fresh, nutrient-dense foods, fermented foods, and bone broth. Meanwhile, foods eliminated from the diet include:
- grains, nuts, and seeds
- nightshade vegetables
- legumes
- dairy and eggs
- refined and processed sugars and food additives
- oil
Creating a UC diet can be a trial-and-error process as a person’s food triggers and dietary needs change with their symptoms.
Moreover, foods that trigger symptoms can vary from person to person. It is ideal to use a food journal to help identify food triggers and ensure that a person receives adequate nutrition.
A person should work with a dietitian or another health professional to avoid complications associated with nutritional deficiencies common in people with IBD, especially those who restrict their intake of certain foods.
UC is a chronic condition that currently does not have a cure. A complex interplay of genes, environment, and body function may cause it.
Diet also plays a huge role in the disease process, and dietary changes can improve a person’s symptoms and quality of life.
UC diets have different aims and have similarities in the food they allow and restrict. A person should consult a doctor about the ideal diet and other treatments to help manage their symptoms.