What’s the Best Diet for Ulcerative Colitis?

What you eat can make a difference if you have ulcerative colitis (UC). The right food can ease your symptoms when you have a flare and provide the nutrients you need when you’re well. But there’s no one-size-fits-all diet for everyone with UC.

“The first-line treatment is still medication, and there is really no one specific diet that either helps you or hurts you,” says Shirley Ann Cohen-Mekelburg, MD, a clinical lecturer at the University of Michigan.

But you can use food along with medication to reduce your symptoms, she says.

The best plan for you will depend on your specific symptoms, your intolerances, and how many changes you want to make, says Ryan Warren, a registered dietitian nutritionist at Weill Cornell Medicine.

Here are some of the popular diets for ulcerative colitis.

Specific Carbohydrate Diet (SCD)

You cut all grains and starchy vegetables like potatoes on this plan. You also skip many processed foods, milk, and all forms of sugar besides honey. SCD eliminates carbohydrates that take a lot of work to digest, Warren says.

“It removes complex carbs in hope of starving some of the gut microbes that are responsible for a lot of digestive symptoms,” Warren says. “It can help reduce annoying gastrointestinal symptoms like gas, bloating, and diarrhea.”

The diet can be hard to follow, Warren says. Expect to pay close attention to ingredients and food labels and make real changes in what you eat.

Mediterranean Diet

You eat mostly plants on the traditional Mediterranean diet, including fruits and vegetables, whole grains, legumes, and nuts. Limit red meat and opt for olive oil, fish, and poultry. Warren often recommends this anti-inflammatory diet first for people without too many symptoms.

“This condition is an inflammatory bowel disease,” she says. “So we are looking for things that we can include in the diet that are going to help manage inflammation.”

If fruits, vegetables, and nuts are hard for you to eat whole because of UC symptoms like diarrhea, bloody bowel movements, stomachaches, and bloating, try to change how you prepare them.

“I never want these patients to sacrifice the actual healthy nutritious plant foods that they’re eating,” Warren says. “Instead, we talk about how we can still get those things in the diet but in a soft, easier-to-manage way.” Think fruit and vegetable smoothies, soups, and purees.

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Gluten-Free Diets

Gluten is a protein found in some grains including wheat, barley, and rye.

Gluten is just a large, difficult-to-digest protein that we often eliminate when patients are really trying to use food and nutrition to manage something autoimmune in nature like this,” Warren says. “It basically helps to protect the immune system from being bombarded with a big, complicated protein like gluten.”

Like most other diets, there’s no research that proves going gluten-free will help UC, Cohen-Mekelburg says. But you might have gluten intolerance that could be adding to your UC, or gluten might make things worse when you’re having a flare, she says. If you quit gluten for a trial period, you can see if your symptoms improve.

“The idea is really just to restrict specific foods that someone might be intolerant of and see if that will help,” Cohen-Mekelburg says.

Low-Residue Diet

Designed to be low in fiber, a low-residue diet cuts down on the amount of stool in your intestines. Residue is the fiber left in your colon after digestion. You’ll choose white bread over whole grain, and eat canned or cooked fruits and vegetables instead of raw. Limit your dairy and skip nuts, legumes, seeds, and dried fruits.

Many of her patients find green, leafy vegetables irritate them when they’re having a flare, Cohen-Mekelburg says. “A lot of this is really is on a personal level, where they’ll know ‘I can’t eat a salad when I flare,’" she says. “It helps treat symptoms to avoid those foods for a period of time.”

If you eat this way long-term, you might not get enough folic acid or vitamin C. To maintain a healthy, whole-foods diet, try to modify tough textures instead of banning fiber, Warren says. For example, opt for smooth almond butter instead of whole almonds or a blended smoothie in place of a dish of blueberries.

Low-FODMAP Diets

FODMAPs are a group of carbohydrates that might be harder to digest and can ferment in your intestines. They’re in foods including dairy, wheat, beans, and stone fruits.

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If you’re sensitive to FODMAPS, they can cause gas, diarrhea, constipation, bloating, and cramping. In this diet, you eliminate high-FODMAP foods for 4-6 weeks, then add them back in slowly.

“What I see people do wrong with the FODMAP diet is doing it on their own and just eliminating all these foods and not realizing the diet is a diet to help detect what food is a problem instead of just restricting long term,” Cohen-Mekelburg says. “The trick is to figure out what food is the culprit.”

Plant-Based Diets

This can be a very healthy way of eating, but you may need some expert guidance. It's a good idea to ask your doctor, gastroenterologist, or nutritionist for guidance to make sure you meet all your nutritional needs.

There are many ways to eat a diet centered on plants. Options include vegan, which includes no animal foods, vegetarian (including eggs and dairy), pescatarian (including eggs, dairy, and fish), or mainly plants with animal products kept to a minimum.

Plant-based diets rich in fruits and vegetables may help with inflammation. Still, there are many processed foods made without animal products that aren't good for you, including lots of junk food. Plant-based or not, you want to get as much nutritional value from your food as possible.

“It depends on the variety of the plants you’re eating," Warren says. “I recommend a mostly plant-based diet with animal protein if desired."

If you totally cut out animal products, you'll need to supplement vitamin B12 if you don't get enough of it from fortified foods. And if you're low in iron because of your UC, you may need to make sure you get enough iron from a vegetarian or vegan diet. Plus, a diet of only plants can be tough to stomach when you have active UC, Warren says.

"In some of these [inflammatory bowel disease] conditions you’re already prone to certain nutrition deficiencies, like iron deficiency in ulcerative colitis," Warren says. “So make sure you’re doing this with guidance.”

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Paleo Diet

Based on the foods people might have eaten during the Paleolithic era, the paleo diet includes lean meats, fruits, and vegetables. You don’t eat dairy, grains, or legumes.

Going paleo helps you cut out grains and reduce carbohydrates without the strict rules of SCD, Warren says.

“It’s trendy, a lot of people know about it, and it’s easier to go out to eat, for instance,” she says. “But some people use this as an excuse to eat bacon all time. It has to be done right. What should be focused on is fruits and vegetables.”

One drawback, Warren says: The paleo diet removes whole grains and legumes (like peanuts), which can be part of a healthy anti-inflammatory diet.

Keto Diet

You eat a lot of fat in this very low-carbohydrate diet. That means oils and meat, small amounts of fruit, and certain vegetables like greens, bell peppers, and cauliflower.

“The issue with keto is because of how low-carb it is, it really makes it difficult to get the variety of plants that I would ideally like [patients] to get,” Warren says. “I never recommend it.”

IBD Anti-Inflammatory Diet (IBD-AID)

IBD-AID is a spin-off of the specific carbohydrate diet. It aims to balance good and bad bacteria in your gut to cut bowel inflammation. The diet introduces foods in phases and leaves out grains, processed food, refined sugar, and milk.

The big difference: IBD-AID emphasizes eating prebiotic foods (like oats, bananas, and onions) and probiotic foods (like yogurt, sauerkraut, and miso) every day.

GAPS Diet

The name stands for gut and psychology syndrome. Another SCD offshoot, the diet restricts carbohydrates that take a lot of digestive power. Warren says she recommends SCD instead because there’s more evidence behind it.

WebMD Medical Reference Reviewed by Jennifer Robinson, MD on May 24, 2019

Sources

SOURCES:

Shirley Ann Cohen-Mekelburg, MD, clinical lecturer in gastroenterology and internal medicine, University of Michigan.

Ryan Warren, registered dietitian nutritionist, Weill Cornell Medicine, Center for Inflammatory Bowel Disease.

North American Society for Pediatric Gastroenterology, Hepatology and Nutrition/Stanford Medicine: “The Specific Carbohydrate Diet.”

Mayo Clinic: “Mediterranean Diet: A Heart-Healthy Eating Plan,” “Gluten-free Diet,” “Paleo Diet: What Is It and Why Is It So Popular?”

Northwestern Memorial Hospital: “Low-Fiber, Low-Residue Diet.”

Stanford Health Care: “Low FODMAP Diet.”

Harvard Medical School: “What is a Plant-based Diet and Why Should You Try it?” “Should You Try the Keto Diet?”

Cleveland Clinic: “What Is the Keto Diet (and Should You Try It)?”

UMass Medical School: “IBD-AID Diet.”

Academy of Nutrition and Dietetics: “Position of the Academy of Nutrition and

Dietetics: Vegetarian Diets.”

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