Ulcerative Colitis Diets
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.
Eating During an Ulcerative Colitis Flare-Up
Some foods – especially foods high in fiber – might trigger issues like cramps, diarrhea, and bloating, among others. That’s because it takes more effort for your gut to break down and digest them.
So it’s not always easy to know which foods are best when you’re trying to pick a well-balanced, nutritious meal that’s easy to digest.
In general, during a flare-up, you should pick foods that your gut is able to tolerate well on a day-to-day basis. This usually includes low-fiber foods in all major food categories. A good way to weed out trigger foods is to read the nutrition label if it’s packaged food. Look for foods that have no more than 1-2 grams of fiber in one serving.
As for fruits, vegetables, and meats: Processed, canned, or cooked versions tend to have less fiber. And stick with soft, bland foods till the flare-up eases.
During a flare-up, turn to foods like:
- Honeydew melon
- Cooked fruits like applesauce
- Canned peaches with no skins
- Fresh juices without pulp or fiber
- White meat poultry
- Lean cuts of pork
- Firm tofu
- Creamy peanut butter. Avoid chunky.
- Sourdough bread
- Potato or other types of gluten-free bread
- White rice
- White pasta
- Asparagus tips
- Cooked green beans
- Pureed tomato paste or sauce
It might make it hard to meet your nutritional needs with this diet. Check with your doctor before you take supplements or vitamins.
Potential trigger foods to avoid:
- Fruits with skin and seeds
- Raw green vegetables such as broccoli and cauliflower. Avoid vegetables with peels, too.
- Whole nuts
- Whole grains like whole wheat and brown rice
- Whole milk
- Cream cheese
- Soft cheeses
Sugary foods, including foods labeled “sugar alternative”
- Juice with pulp
- Sugar-free candies and chocolates
- Ice cream
While spices are great for your taste buds, they might upset your gut during a flare-up. It’s best to skip spicy hot seasonings or chilis for a while until your condition comes under control.
If you’re unsure about what to leave out and what to include, talk to your doctor or a registered dietitian. They can customize a meal plan that suits you best.
What Is the Best Diet for Ulcerative Colitis?
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) for Ulcerative Colitis
You cut all grains and starchy vegetables like potatoes and plantains 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,” she says. “It can help reduce annoying gastrointestinal symptoms like gas, bloating, and diarrhea.”
Mediterranean Diet for Ulcerative Colitis
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.
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. Find out how to follow the Mediterranean diet.
Gluten-Free Diets for Ulcerative Colitis
“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 with 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. Watch a video on the truth about gluten.
Low-Residue Diet for Ulcerative Colitis
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 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. Watch a video about low-residue diets.
Low-FODMAP Diets for Ulcerative Colitis
FODMAPs stands for fermentable oligo-saccharides, di-saccharides, mono-saccharides, and polyols. They’re 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.
“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.” View a slideshow to learn more about low-FODMAP foods.
Plant-Based Diets for Ulcerative Colitis
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.” Learn more about plant-based diets.
Paleo Diet for Ulcerative Colitis
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 the 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. View a slideshow to learn all about the paleo diet.
Keto Diet for Ulcerative Colitis
“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) for Ulcerative Colitis
IBD-AID is a spinoff 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, kimchi, sauerkraut, and miso) every day.
GAPS Diet for Ulcerative Colitis
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.
Intermittent Fasting for Ulcerative Colitis
Intermittent fasting is when you alternate eating, or “feeding,” periods with fasting periods. Fasting periods might mean you don’t eat at all (time-restricted feeding) or that you eat much less than normal (intermittent energy restriction). You could fast daily between 9 p.m. and 1 p.m. the next day, and eat only between 1 p.m. and 9 p.m. (a version of time restriction). Or you may alternate a full day of fasting with a day of normal eating (alternate-day fasting).
Though research continues, several studies show several health benefits of intermittent fasting. Studies in humans with chronic disease have shown that the eating plan has resulted in better control of their disease. But these studies are done only over a period of months. It’s unclear if the benefits would remain for years if the diet is continued throughout life.
More research is needed to know if it is safe long-term. Most studies of the effects of intermittent fasting have been done on overweight, middle-aged adults. More research is needed to determine if it is safe for people who are older or younger or people at a healthy weight.
Talk to your doctor if you’re considering intermittent fasting as a way to manage your ulcerative colitis.
Meal Prep and Planning for Ulcerative Colitis
The bottom line is it’s important to eat well if you have UC. Doing so can help you feel your best and may ease your symptoms. Good nutrition also is a must, because UC can affect how your body digests food and absorbs nutrients. Diarrhea, which is a common symptom of UC, can make your body less able to absorb carbohydrates, fat, protein, water, vitamins, and minerals.
Usually, soft, bland foods are less irritating for people who have UC. But your diet can still include a number of different foods from all the food groups (unless you’re lactose-intolerant and can’t digest dairy foods).
In general, you should:
- Stay hydrated. It aids in overall health and may reduce inflammation. And your UC symptoms – especially diarrhea – can cause you to become dehydrated.
- Avoid drinking with straws because they can cause you to gulp air, which can lead to gas.
- Eat several small meals a day. This gives your body time to digest the food and may reduce symptoms.
- Stock up on foods that you tolerate well.
- Track what you eat along with symptoms. This can help you pick up on any patterns.
- Stick to cooking methods such as broiling, steaming, poaching, and grilling.
- Make your meals ahead of time, so you know you have good choices ready to heat and eat.
You may want to ask your doctor if they recommend any supplements to make sure you’re getting enough vitamins and minerals.
When your UC symptoms ease up or go away and you enter remission, you can slowly start to bring certain foods back into your diet unless your doctor recommends staying on a low-sodium diet. As you do, make sure to stay hydrated. You can add liquids to your diet, such as:
- Rehydration solutions like sports drinks with electrolytes
- Tomato juice
Foods that you might be able to tolerate well and may keep you hydrated are:
- Proteins like lean meats, tofu, fish, and eggs
- Fruits and vegetables. You can eat a variety, but get rid of the seeds and peels if they bother you.
- Foods with lots of fiber like beans, oat bran, barley, and whole grains like brown rice and whole wheat
- High-calcium foods, including yogurt, kefir, collard greens, and milk if you’re able to tolerate lactose
- Foods that have probiotics, like yogurt, tempeh, kimchi, miso, and sauerkraut
Don’t make drastic changes to your diet without talking to your nutritionist or doctor first. This could upset your stomach or affect your nutrition.