Ulcerative Colitis Diet · What Is It, Foods to Include and Avoid, and More

Ulcerative colitis (UC) is a chronic inflammatory condition that typically affects the large intestine, also known as the colon. Ulcers develop on the colon's inner lining, leading to symptoms such as abdominal pain, diarrhea, bloody stools, fatigue, loss of appetite, and weight loss. In addition to gastrointestinal symptoms, individuals with ulcerative colitis can experience extraintestinal symptoms, including arthritis, mouth ulcers, erythema nodosum (i.e., tender, red bumps under the skin), pyoderma gangrenosum (i.e., large, painful ulcers), and conjunctivitis. 

While the cause of ulcerative colitis is currently unknown, it is hypothesized to be related to a combination of genetic, environmental, and autoimmune factors. Ulcerative colitis is a chronic lifelong condition; however, it can be managed with medications (e.g., aminosalicylates, corticosteroids, immunosuppressants), lifestyle changes, and dietary modifications. Surgery may be an option if ulcerative colitis is refractory to medications. 

The best foods to eat on an ulcerative colitis diet include fruits and vegetables (e.g., leafy greens, berries, and colorful vegetables), which are a great source of fiber, antioxidants, vitamins, and minerals. Whole grains, including oats, brown rice, quinoa, and whole wheat bread, can be beneficial as they are nutrient-rich, a good source of fiber, and allow for easier passage of stool. Additional foods to include in an ulcerative colitis diet include lean proteins such as chicken, turkey, and fish; plant-based proteins such as tofu and legumes; and fermented foods such as kimchi, kombucha, yogurt, and sauerkraut. Fermented foods and yogurt contain beneficial bacteria (i.e., probiotics) that can help promote a healthy gut microbiome. This can be especially important for individuals with ulcerative colitis, as the condition can disrupt the balance of bacteria in the gut.  

During an ulcerative colitis flare-up, however, raw fruits and vegetables can exacerbate inflammatory symptoms since they are more challenging to digest. Cooked or steamed fruits without skins or seeds and pureed soups and sauces made from vegetables may be easier to digest. Additionally, nuts and seeds, pureed into butter or pressed into oils, can be a healthy way to consume nutritious fats without irritating the gastrointestinal system. Like raw vegetables, whole grains are generally harder to digest and should be avoided during an ulcerative colitis flare-up. It is suggested that one eats a lower fiber diet during a flare-up to help the colon recover more quickly, such as refined grains and starches (e.g., white pasta, white rice, and white bread).  Rice pilaf, couscous, crackers, and wraps are likewise good options. Once the symptoms resolve, it is acceptable to re-incorporate high-fiber foods to supplement the gut microbiome.  

Lastly, staying hydrated with water is crucial for individuals with ulcerative colitis. Water helps promote motility of the gastrointestinal tract and prevents constipation. Notably, a diet that works for one individual may not work for another. Therefore, it is best to work with a healthcare provider or registered dietitian to determine the best diet plans for managing ulcerative colitis.