Ulcerative Colitis

Ulcerative Colitis (UC) is an inflammatory disease on the inside surface of the colon.  It most often involves the left colon and rectum.  The cause of UC is not known, although a person's genes and the body's immune reaction are both clearly important.

It is natural to assume that something that is eaten or not eaten is somehow important in UC.  After all, the colon is where the fiber and food residue we eat ends up.  Is it not possible that these foods we eat or don't eat may be part of the problem?  Studying this medically is difficult because animal and plant foods contain many different chemicals.  When these multiple natural substances interact in the intestines with the over 1,000 different bacteria in the colon, and with a total bacteria count of many trillions, it is simply very difficult unraveling what foods are best and even which ones may be a problem.

The bottom line consensus among most physicians is that diet by itself rarely reverses a flare of the disease but likely helps to keep the disease under control.

Dietary Recommendations

There are basic nutritional guidelines for good nutrition for ulcerative colitis, which have stood the test of time.  It is important that the colitis patient work with the physician to get the disease under control, usually with medications.  Without this basic achievement, the full benefit of any dietary program becomes difficult to achieve.  The following are crucial key dietary goals:

• Weight - Maintain a good weight by ingesting enough calories, minerals and vitamins.

• Protein - The amount of required protein each day depends on weight, age, exercise, pregnancy and, especially, on the activity or seriousness of the colitis process.  For the 150 lb person, about 54 grams of protein is recommended.  This amounts to regular servings of meat, poultry, fish or its equivalent in vegetable protein each day.  Regular vigorous exercise, pregnancy or active disease may require more protein.

• Carbohydrates - Complex carbohydrates are those that have not been processed into simple ones.  Complex carbohydrates are present in whole grains, brown rice, and fresh vegetables and fruits.  They contain a lot more than calories, such as minerals, fiber and vitamins.  Simple carbohydrates are refined grains where all these other good ingredients have been removed.  "Enriched flour" means that the food manufacturer has now added back some vitamins, which were removed, along with minerals and fiber.  Consume complex carbohydrates wherever you can.
• High Fructose Corn Syrup (HFCS) and Sugar - HFCS is manufactured from corn.  It is all sugar and fructose, both empty calories.  HFCS is cheaper for the manufacturer so it is now widely used throughout the food industries, and especially in soft drinks.  There are many physicians who now think that HFCS and excess sugar may worsen the disease of the Crohn's disease patient.  The bottom line is to severely restrict HFCS and simple sugar as much as possible.

• Fats - The body needs a certain amount of fat, especially from the mono and unsaturated vegetable oils, such as in olive oil.  Highly marbled meats, creams and all trans fat products should be used sparingly.  However, they do add calories for that person whose weight needs to be increased.

Vitamins

• Multiple Vitamin with Minerals - Many physicians feel that a well-balanced diet containing lots of whole grains, fresh vegetables and fruits contain all the vitamins and minerals you need.  Others, especially some in academic medical centers, suggest that it is okay to take a multi-vitamin each day.  They would agree that there is little medical evidence one way or the other.  If you feel better with a multi-vitamin, by all means take one.  If you feel better eating fresh foods as mentioned above, then do that.

• Folic Acid - This vitamin is an important one, especially for pregnant females, as its absence during pregnancy may lead to serious developmental problems in the fetus.  Furthermore, one medication called mesalamine, used in treating inflammatory bowel disease, may interfere with folic acid absorption.  So, this would make the case for using a folic acid supplement or a multi-vitamin with folic acid if you take a mesalamine medication.  Check with your physician.

• Vitamin D - Vitamin D is important for bone health. Crohn's disease patients may be particularly susceptible to early osteoporosis, especially if they take steroid medicine such as prednisone.  There are vitamin D receptors or attachment points on the cells of many organs in the body including the brain, heart and colon.  So, it is likely that vitamin D has a role in good colon nutrition.  Some authorities are recommending 800-1200 IU per day rather than the previous standard 400 IU per day.  Check with the physician.  A blood test may be needed.

Minerals

• Calcium - Even if you are Caucasian and live in the subelt where the sun causes the skin to make vitamin D, you still need an adequate amount of calcium by mouth.  Milk, dairy products, shellfish, green leafy vegetables, canned fish and, if needed, calcium supplements are the main sources.  The goal is at least 1200 mg of calcium per day.

• Iron - Many ulcerative colitis patients have low iron levels which may lead to weakness, fatigue and anemia or low blood count.  The physician may check the iron blood level periodically.

• Selenium - Selenium is a mineral that is needed in the body in tiny amounts for normal metabolism.  This mineral has been found to be low in some patients with ulcerative colitis.  However, taking a selenium supplement is not recommended, as elevated blood levels are associated with diabetes and cholesterol problems.  Brazil nuts are very high in selenium and eating one or two a day likely gives you all the selenium you need.  A blood tests by the physician may be indicated.

Fish, Fish Oil and Herbs

• Fish and Flaxseed Oil - Fish oil has been found in medical studies to be helpful for some Crohn's disease patients.  Flax seed oil has the same type of oil as in fatty fish.  Fatty fish (blue, mackerel, salmon and sword), fish oil capsules and flaxseed oil can all be recommended.

• Herbs - Herbs are dried plans that are ground into powders.  Labeling something an herb does not transform it into a magical medicine.  All plants contain hundreds of different chemicals, many of which are still not known to science.  Until good evidence is obtained on a specific herb's benefit, it is best for CD patients to avoid them all.  Get your "herbs" from a rich supply of fresh plant food.

General Advice

The following are good dietary recommendations upon which most physicians agree:

• Smaller, more frequent meals - The lower intestine may handle foods better when smaller portions arrive there more frequently. The body and intestines will generally let you know if 4 or 5 smaller meals work better.

• Fluids - Adequate fluid intake is a must if diarrhea is a significant symptom.  For most people, the body tells you when you are thirsty and need fluid.  Some authorities recommend eight glasses of water per day.

• Caffeine - Caffeine in coffee, tea, soft drinks, and power drinks stimulates the colon to contract and promotes more bowel movements. So, caffeine limitation may be helpful.  Caffeine by itself is not known to damage the intestine or colon.


• Alcohol - Red wine and beer contain sulfates and may contribute to the malordorous smell of flatus.

• Allergies and Food Intolerance - True food allergies, which cause hives and trouble breathing, are rather uncommon.  Shellfish and peanuts can induce such serious problems in the allergic person.  However, intolerance to certain foods is very common.  If a certain food causes abdominal symptoms, it should be avoided.

• Fast Food - Most fast food restaurants offer a variety of healthy choices. Dairy products, such as milk, milkshakes and yogurt are available. Pizza provides considerable protein and calcium.

• Lactose and Dairy Products - Milk and dairy products provide good nutrition, protein and calcium.  However, symptoms from lactose intolerance such as bloating, cramping and diarrhea may mimic ulcerative colitis symptoms for the colitis patient.  A simple home test can be done.  Drink 16 ounces of fat free milk on a Saturday or Sunday morning and do not eat or drink anything else.  If symptoms of bloating, cramps or diarrhea do not occur in 3-4 hours, you likely are not lactose intolerant.

• Celiac Disease or Sprue - This is a disorder whereby the gluten protein in wheat and certain other grains damages the small intestine. This disorder is much more common than was thought in the past. The symptoms may be similar to those of ulcerative colitis. A simple blood test can usually screen for this disorder. Ask your physician about Celiac Disease.

Fiber

Fiber is a special consideration for ulcerative colitis patients. Food fibers are healthy and should be well-understood so they can be used in a beneficial way.

Insoluble fiber does not dissolve in water; it is not digested by the small bowel and is not fermented by the colon bacteria. It does, however, retain water and so produces a larger, bulkier stool. Soluble fiber, on the other hand, does dissolve in water. It is fermented by the colon bacteria and is used as a fuel source by the bacteria to maintain a healthy environment in the colon. However, if too much is taken, soluble fibers may promote excess harmless colon gas and flatus.

Eat plant food has both insoluble and soluble fiber.  A food generally will be predominantly one type or the other.  For instance, wheat is mostly insoluble fiber; oats are about half and half; and psyllium supplement powder is 90% soluble.  Prebiotic powders are 100% soluble.

A diet with generous portions of plant foods, up to 25-35 grams per day, is now recommended for most people.  However, colitis patients need to do this carefully, as excess gas may occur with too much soluble fiber, causing harmless cramps and/or diarrhea.  Plant fiber does not damage the bowel wall.

The Colon Bacteria

Probiotics

Probiotics are bacteria in food such as yogurt, other dairy products and now in pill form. There are some early medical studies that show that certain types of probiotics given in pill form may favorably influence the course of ulcerative colitis. However, the study of bacteria in the colon is difficult. The human colon has the most densely packed collection of bacteria anywhere in the world. There are over 1,000 different types of bacteria and the total number of bacteria in the colon is many trillions. The commercial probiotic preparations use from one up to six different bacteria and usually claim to have 5-10 billion organisms per pill. This sounds like a lot. But compared to the trillions of bacteria that are already there, it is small. It also should be noted that the bacterial makeup of the colon returns to its previous state 2-3 weeks after probiotics are stopped. So, if a probiotic is helpful, it would have to be used long term. People with immune deficiencies, such as HIV, AIDS and chemotherapy, should probably not take probiotics. One probiotic with some early favorable results is called VSL#3. Ulcerative colitis patients should always discuss the use of probiotics with their physician.

Prebiotics

• nourish the cells that line the colon, the very ones that become inflamed in ulcerative colitis
• decrease the ability of the bacteria to move through the colon wall
• make the colon contents more acidic

Hydrogen Sulfide (H₂S) - The Gas

H₂S is a gas that is made in the colon by certain colon bacteria.  It is a nasty gas.  It is what gives flatus its foul smell.  Most ulcerative colitis patients make H₂S.

• H₂S is toxic.  In higher doses, it can irritate the eyes.  In even higher concentrations, it is as toxic and fatal as hydrogen cyanide.
• Most patients have ulcerative colitis in the left side of the colon, which is exactly where the bacteria that make H₂S live.
• When the good bacteria in the colon ferment prebiotics, they make energy pods (short chain fatty acids) which make the colon more acidic.
• There are now significant medical studies that incriminate H₂S in the inflammation in the colon wall of ulcerative colitis patients.
• Adequate prebiotic plant fibers in the form of prebiotic vegetables and fruit or supplements make the left colon acidic.
• Here is a possible key point.  These H₂S producing bacteria do not grow in an acidic environment so keeping the colon acidic may be important.  When flatus no longer smells, it is likely that the H₂S producing bacteria are no longer growing.

Final Recommendations

You should:

• Keep close contact with your physician to review all dietary factors.
• Follow good dietary practices, as outlined above.
• Increase the consumption of prebiotic rich vegetables and fruits containing inulin and oligofructose.
• If needed, use an oligofructose enriched inulin supplement as Prebiotin to acidify the stool and, hopefully, stop the hydrogen sulfide bacteria from growing.

The goal is to make your colon more acidic and inhospitable for the H₂S gas producing bacteria.  On final point.  This information has considerable research behind it.  Some of it is not yet conclusive, but it is the best available at this time.  Finally, check with your physician regarding all dietary and therapeutic aspects of your care.

References