Ulcerative colitis is a form of inflammatory bowel disease. You may see it written as UC. It causes your immune system to attack healthy tissue that lines your large intestine and rectum, leading to inflammation and ulcers.
The symptoms tend to come and go. ‘Flare-ups’ can lead to severe tummy pain and diarrhoea, as well as fatigue. Changing what you eat during a flare-up may help reduce your symptoms.
The causes of ulcerative colitis are complex – many factors are involved, including your age, ethnicity, genetics and gut microbiome.
Lifestyle factors, such as a Western diet, stress, pollutants and overuse of certain medications (like antibiotics), might also play a role.
In this article, we’ll explore how foods affect ulcerative colitis, including foods that can help during a flare-up and those you should limit. We’ll also suggest dietary approaches that may be useful for some people.
Then, we’ll look at the research to consider whether probiotics and other supplements are likely to help.
Finally, we’ll suggest some meal plans for people with ulcerative colitis and discuss factors beyond your diet that can contribute to symptoms.
Diet and ulcerative colitis
The relationship between diet and ulcerative colitis is complex and still not fully understood.
What you eat when you’re experiencing a flare-up might be different from what you eat the rest of the time, when the condition is in remission.
Experts agree that it’s important for people with ulcerative colitis to have a healthy, balanced diet when they’re not experiencing a flare-up.
The British Dietetic Association recommends:
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eating plenty of fruit, veggies, nuts, seeds and whole grains
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not limiting your fibre intake
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having protein-rich foods, but reducing animal fat and processed meats
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restricting your intake of high-fat, high-sugar and high-salt foods
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taking a vitamin D supplement – from October to March, or throughout the year if you have a vitamin D deficiency
During a flare-up, you may lose your appetite or struggle to digest certain foods. So, some people find it helpful to change their diet when this happens.
Drinking enough fluids is important during a flare-up. When your large intestine is inflamed, it may not properly absorb liquids from foods and drinks.
And if you have diarrhoea, your body loses lots of water, so if you don’t drink enough, you could become dehydrated.
If you have a stoma, your IBD team might recommend adding extra salt to meals or taking an oral rehydration solution.
Overall, your dietitian or doctor may recommend temporary changes during a flare-up, such as:
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eating smaller amounts more often, rather than three large meals
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eating less fibre
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cutting down on any foods that worsen your symptoms
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taking vitamin or mineral supplements if you’re not eating a balanced diet
Still, speak with your IBD team or dietitian before making any big changes.
If you feel that certain types of foods are triggering your symptoms, it’s important not to cut out entire food groups, such as dairy or grains. This could keep you from getting enough of certain important nutrients.
To help you and your dietitian identify triggering foods, it can help to keep a food diary, recording your symptoms and what you’re eating. You may find that you struggle with specific foods rather than food groups.
Good foods to eat during a flare-up
During a flare-up of ulcerative colitis symptoms, it can help to:
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eat smaller meals more often
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opt for softer foods, like mash, soups, smoothies, soft meat or fish, blended beans, and well-cooked and peeled fruit and veg
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take a vitamin and mineral supplement if you're struggling to eat
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fortify meals with skimmed milk powder or nut butter to increase calories and protein
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try to include oats, broccoli, carrots, tomatoes and other foods that contain soluble, viscous fibres (such as beta-glucans and pectins)
Some people find it hard to consume enough fibre during a flare-up. Have as much fibre as you can handle. And when your symptoms are in remission, there’s no need to limit fibre unnecessarily.
If a flare-up is reducing your appetite and making it hard to have full meals, soups or smoothies may be easier to stomach.
Another tip is to focus on foods that contain healthy fats, like avocados, nut butters or extra virgin olive oil. These are rich in calories, so they’ll help you consume enough energy when you’re not eating as usual.
It’s also important to get plenty of protein during a flare-up, as your body needs more than usual to repair the damage. So, try to include foods like fish, eggs, tofu and chicken.
If you can tolerate dairy products, full-fat versions are best during a flare-up, as they’re rich in protein and have more healthy calories than reduced-fat versions.
If dairy makes your symptoms worse, try alternatives made with soya, oats, nuts or rice.
Foods that may worsen symptoms during a flare-up
If whole-grain foods are making your symptoms worse, try switching temporarily to lower-fibre versions, like white bread and cornflakes. When your flare-up is over, gradually bring fibre back into your diet.
Spicy and fatty foods can worsen ulcerative colitis symptoms (including diarrhoea) by irritating your gut. And if you drink alcohol, it’s worth limiting your intake during a flare-up.
Some people have trouble tolerating the lactose in dairy products, so you may prefer a lactose-free or dairy-free alternative.
Probiotics and supplements
Probiotics are ‘friendly’ bacteria that can have benefits for your gut health and general health. Probiotic supplements contain live bacteria, and they come as sachets, capsules or liquids.
There’s evidence that taking probiotic supplements can improve the balance of your gut microbiome, the community of bacteria and other microorganisms that live in your gut.
Scientists believe that the gut microbiome might play a role in the development of ulcerative colitis. For example, studies have shown that people with the condition have a lower diversity of microbes in their gut.
While further research is needed, studies have produced some promising results, suggesting that certain strains of probiotics may help reduce or prevent ulcerative colitis symptoms.
And some research has found that long-term treatment with a combination of probiotic supplements and anti-inflammatory drugs can be significantly more effective than the drugs alone.
If this is an approach that you’d like to explore, it’s a good idea to speak with your dietitian.
Other supplements
Early studies looking at cannabis extracts, prebiotics and curcumin (the active compound in turmeric) show some promise in helping with IBD symptoms in general.
You might also consider vitamin or mineral supplements. If you have any form of IBD, your gut may not absorb enough vitamins and minerals from your food, or you might find it hard to eat a balanced diet. This can sometimes lead to a vitamin or mineral deficiency.
Specifically, people with IBD often have low levels of iron, calcium or vitamin D, and a blood test can show whether you have a deficiency.
If you’re finding it hard to get enough vitamins and minerals from your diet, your doctor may prescribe vitamin or mineral supplements.
Meal plans for ulcerative colitis
Below, we’ll suggest some meals that can help you get enough nutrients and calories during a flare-up, without triggering or worsening symptoms.
However, everyone is different, and finding what works best for you may involve some trial and error. Keeping a food and symptom diary can help.
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Breakfast: Porridge with sliced banana.
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Lunch: A chicken and avocado sandwich on white bread.
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Dinner: A salmon and chickpea stew with white rice.
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Snacks: Fruits like melon and peeled apples or pears; oatcakes and flapjacks.
You can search Symprove’s recipes for more gut-healthy inspiration.
What triggers ulcerative colitis flare-ups?
Your diet isn’t the only thing that can contribute to an ulcerative colitis flare-up.
The full range of triggers isn’t clear, but experts believe that ongoing stress is one important factor.
You can manage stress with:
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Exercise: Regular physical activity can reduce stress and boost your mood. This doesn’t have to be intense – you could try a gentle walk or swim.
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Relaxation techniques: Breathing exercises, meditation and yoga can all help with relaxation.
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Talking: If you’re finding life with ulcerative colitis stressful, sharing your experiences can help, especially with others who have the condition. Ask your IBD team for a referral for talking therapy, or you may be able to refer yourself.
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Apps: You could try a mental health app to help with ongoing stress.
Crohn's and Colitis UK have local networks throughout the country that can offer support, including support with mental health.
Setting aside stress, the gut infection gastroenteritis, which increases inflammation, can occasionally trigger an ulcerative colitis flare-up.
So can taking non-steroidal anti-inflammatory medicines (NSAIDs), like ibuprofen. If you have ulcerative colitis, it may be safer to take paracetamol.
Summary
Ulcerative colitis isn’t caused by what you eat, but some people find that certain foods can trigger or worsen symptoms, while other foods help improve them.
When you’re not experiencing a flare-up, it’s important to have a healthy, balanced diet.
During a flare-up, it can help to eat smaller amounts, opt for softer foods, fortify meals and choose foods with soluble, viscous fibre.
If you’re struggling, it’s important to seek support. Speak with your IBD team or dietitian, or contact Crohn's and Colitis UK.
To learn more about other gut health topics, visit Symprove’s Gut Hub.
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