Foods To Avoid With Ulcerative Colitis
- Added sugars and hyper-processed foods
Our North American love affair with low fibre, high sugar and high fat hyper-processed food is associated with our risk of ulcerative colitis. It is this type of eating that is thought to drive gut dysbiosis or the overgrowth of more pro-inflammatory gut bacteria that can harm gut barrier integrity leading to leaky gut and inflammation. In laboratory studies, this type of diet can decrease the number or acetate and butyrate producing bacteria and increase the risk of colitis.
Another issue with hyper-processed foods is that they contain emulsifiers like xanthan gum and carrageenan which may alter gut barrier integrity. While their true impact on gut health is still hotly debated, in one double-blinded trial, people with ulcerative colitis on a carrageenan free diet had lower relapse rates than those given two capsules of carrageenan. For me, this would not be the first place I look when adjusting someones diet instead, it would be a refinement only after taking more global steps towards a more whole foods, plant-based approach.
- Meat, particularly red meat
If you arent a huge fan of red meat, ditch it entirely. If you truly love red meat, try to limit yourself to one 3-4 ounce portion every week or two, no more.
Dairy could be impacting symptoms for a few reasons:
- Omega 6-rich cooking oils like soy, corn and safflower oils
Traditional Medicine Says What You Eat Doesnt Affect Disease But Were Proving That A Diet Can Stop A Lifelong Disorder
Published in Connection magazine, Spring 2018
Nutrition in Immune Balance Therapy: Using Diet to Treat Inflammatory Bowel Disease, by David L. Suskind, MD
When Flora Martinez started feeling mysterious stomach pain in 2016, her mom, Nadine Martinez, assumed it was an ordinary tummy ache. Then the pain started keeping Flora home from school and her weight plateaued. When Flora confided that shed been having a more alarming symptom bloody diarrhea her family rushed her to Seattle Childrens Emergency Department.
Tests revealed the 8-year-old had a form of inflammatory bowel disease , a lifelong condition that strikes when the immune system mistakenly attacks the digestive tract. IBD makes it harder to absorb nutrients and can delay puberty and development. It can also cause incessant diarrhea, severe pain and other symptoms that make it hard to go to school or participate in sports and activities.
I couldnt stop worrying that Flora was going to suffer for the rest of her life, Nadine Martinez says.
Making matters worse, standard treatments drugs and steroids that suppress the immune system only work for 30% to 50% of patients. After six months of being treated with immunosuppressants, Floras IBD flared up so badly that she was doubled over in pain and ready to try something new.
Luckily, her doctor, Dr. David Suskind, is spearheading clinical studies on an innovative diet that is putting some IBD patients into remission without drugs or their side effects.
How The Diet Works
The theory behind the Specific Carbohydrate Diet is that certain carbohydrates are not fully digested, so they remain in the gut and must be broken down by the bacteria there. This can cause an overgrowth of harmful bacteria, and waste products of the digestion process can set off a chain reaction, or âvicious cycle,â of irritation in the intestines.
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Does It Treat Digestive Disorders
The SCD was originally designed as a therapy for people with IBD, an umbrella term which includes ulcerative colitis, celiac disease and Crohns disease.
These diseases can hamper your ability to digest and absorb nutrients from food. Thus, the SCD aims to heal intestinal tissue in order to restore its functions.
The SCDs promoters claim that some people are less adept at digesting foods such as grains, legumes, refined sugar and high-starch food additives that result from settled agricultural practices and the modern food industry.
Supporters assert that continued ingestion of these carbs leads to an overgrowth of unhealthy bacteria in your gut which promotes inflammation, eventually diminishing your ability to digest.
Strict adherence to the SCD is supposed to eventually starve these bacteria by depriving them of food, allowing your gut tissue to heal.
To this day, the SCD is primarily used to treat intestinal disorders but with varied success.
One of the major criticisms of this diet is its lack of concrete scientific evidence.
The bulk of the available data is weak and limited to very small studies or anecdotal evidence, which isnt enough to definitively state whether or not the SCD works .
Ultimately, more research is needed to determine whether the SCD is truly an effective treatment for IBD.
Though the SCD is often promoted for people with IBD, there are very few studies that support its effectiveness.
A Diet Change A Life Change
Today, Adelynne is thriving and in clinical remission from Crohns.
Today, Adelynne has been in clinical remission for more than two years. Shes a healthy, happy and thriving 11-year-old girl.
I cant believe how far weve come. When we first walked into Seattle Childrens, she was an 8-year-old girl who was barely heavier than our 4-year-old. Now, shes growing and foods are no longer an enemy.
Adelynne and her family have embraced shopping local for natural, nutrient rich foods. And although its been an adjustment, the family now says the diet is just part of their every day life.
Her lunch doesnt look much different than other kids at school, said Kittelson. There are so many options out there. We havent felt like weve had to sacrifice. Weve even adjusted holiday traditions to fit into our new lifestyle. Instead of candy for special occasions, we swap them for other things.
For Adelynne and her family, SCD was the right treatment option. Its helped Adelynne get back to her normal life and find a love for food again.
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The Specific Carbohydrate Diet
Several studies have been published that suggest that SCD may be effective in IBD and most clinical observations have been in pediatric disease. These are reviewed in a separate chapter on diet and pediatric IBD. In adults, our group demonstrated that the fecal microbiome of IBD patients following the SCD may be different and more biodiverse than IBD patients following a Western diet based on 16 srRNA analysis of fecal microbiota composition . We also published a case series of fifty IBD patients on the SCD and showed that SCD-followers had decreased symptom scores and a high quality of life . The majority of these patients had colonic CD and some were able to maintain clinical remission using diet without maintenance medications. There is also evidence that following the diet is associated with improvements in ESR, CRP, calprotectin and Lewis score on capsule endoscopy nevertheless, concomitant medication use in some of these patients is a potential confounder . Results of an online survey of IBD patients following the SCD hints at the possibility of the diet helping to prevent IBD complications and hospitalizations though this is only patient reported and needs further study prospectively .
What To Eat During A Flare
All of the diets above are intended to be temporary and followed during a flare-up. Working with a dietitian can help prevent deficiencies in certain micronutrients, which is common with IBD.
During a flare its helpful to eat four to six small meals per day rather than fewer larger meals. Its also very important to drink fluids because diarrhea can occur with a flare and cause dehydration.
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The Helpfulness Of The Scd For Ibd
The short answer is that we don’t know if the SCD is helpful in treating inflammatory bowel disease . Some people have found that SCD is helpful for their IBD symptoms, but the diet can be difficult to follow because it is restrictive and requires patience and dedication.
The SCD is not endorsed by either patient advocacy groups or professional medical societies for the treatment or management of IBD.
The Crohns and Colitis Foundation says that while the diet will not reduce inflammation, trying it will probably not be harmful.
How To Follow The Diet
The SCD is a type of elimination diet.
An elimination diet generally consists of three phases elimination, maintenance, and reintroduction.
During the elimination phase, eliminate foods that the SCD prohibits, including grains, most dairy products, and processed foods, and consume only foods that the diet allows.
The next phase is the maintenance phase, during which, you continue to eat only the foods allowed.
Gottschall recommends following the maintenance phase for at least one year after symptoms have disappeared.
The final phase is the reintroduction phase, which involves reintroducing the foods you eliminated, one at a time, slowly over several weeks while you look for symptoms.
Although Gottschall doesnt recommend a reintroduction phase, you may be able to tolerate some of the foods you initially eliminated without experiencing symptoms, allowing for a more liberalized diet.
For example, in one study, children with Crohns disease who followed a modified SCD with oats and rice still experienced symptom relief and reductions in inflammatory markers .
Whats more, a different study showed that the SCD was no more effective than the Mediterranean diet for alleviating symptoms or decreasing markers of inflammation in adults with Crohns disease after 12 weeks .
The Mediterranean diet emphasizes fruits, vegetables, whole grains, and healthy proteins while limiting foods high in added sugar, sodium, and unhealthy fats.
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Foods To Eat With Ulcerative Colitis
My long-term nutrition goal for my clients with ulcerative colitis is always to move towards an anti-inflammatory diet where they eat as many whole plant foods as possible. It is thought that a more Mediterranean or anti-inflammatory diet pattern contributes to an healthier community of gut bacteria, a stronger gut barrier and a better immune balance between tolerance and inflammation. In one clinical trial, a plant-based diet improved relapse rates in ulcerative colitis. Other lab research suggests that a Mediterranean-style diet decreases risk of colitis. However, because of the nature of inflammation and irritation, it can often take very slow and sustained change over time to increase intake of plant-based foods comfortably.
- Fruits and Vegetables
Fruits and vegetables have been associated with a decreased risk of ulcerative colitis. They are high in anti-inflammatory phytochemicals and fibre, which is critical for production of short chain fatty acids by our gut bacteria that help to ease inflammation and support gut barrier function.
- Omega 3 rich seeds
We all need omega 3 rich foods in our daily diet ulcerative colitis is no exception. Data suggests that increased intake of omega 3 rich foods decreases risk of ulcerative colitis but clinical trials on fish oils have not offered conclusive benefits to disease outcomes.
- Calcium- and magnesium-rich foods
- High Fibre Foods, as tolerated
Crohns Disease Elimination Diet
The CD exclusion diet was developed to allow only access to whole foods, with exclusion of foods that presumably alter host barrier function, result in dysbiosis, and influence bacterial/viral factors that allow bacterial translocation. The food items excluded are hypothesized to alter the microbiome or intestinal permeability. Inflammatory food items excluded in this diet include wheat, dairy, emulsifiers, maltodextrins, carrageenans, and sulfites. There are only two uncontrolled clinical studies in the literature that have examined this diet, both with promising results in a total of 68 patients. In the first study, a total of 47 children and young adults were given partial EN with CD-elimination diet for a period of 6 weeks. Disease activity scores were used and CRP was measured at baseline and the end of the study. Crohns disease activity index decreased from 27.7 to 5.4 and CRP normalized in 21 of the 30 patients found to be in clinical remission . In a more recent study, 21 CD patients were included who had loss of response to biologics. These patients were given partial EN with 12 weeks of a CD exclusion diet. These patients with severe flares were given an initial 14 days of EEN followed by partial EN with a polymeric formula and the CD-elimination diet for 12 weeks. Clinical remission rates after 6 weeks were reported at 61.9% with normalization of CRP and albumin levels as well.
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Foods Allowed On The Mediterranean Diet
- Fruits and vegetables of all kinds
- Whole grains like brown rice, quinoa, oats, whole grain pasta, and bread
- Nuts and seeds, beans and legumes
- Seafood and fatty fish like salmon, shrimp, sardines, and herring
- Omega-3 fats and healthy fats like avocados and olives, ghee
Enteral Nutrition And Partial Enteral Nutrition
We chose to discuss an enteral diet because of its demonstrated efficacy as a steroid-sparing agent in the treatment of Crohns disease . Exclusive enteral nutrition is not effective for UC. EEN is intake of only liquid formulas without the intake of foods usually for a period of 68 weeks. It can involve different protein sources and can be classified into three types: elemental , semi-elemental , and polymeric formulas. These are hypoallergenic formulas that result in decreased antigen exposure in the intestine. All have similar efficacy . Recent pediatric studies, where the large body of research exists, find that EEN can induce remission in 6086% of children resulting in decreased biochemical markers of inflammation . This is particularly attractive in pediatrics, because intake of EEN can replace steroid use and therefore result in better bone growth and child development. A recent open-label non-placebo-controlled pediatric study assessed achievement of mucosal healing with the use of 8 weeks of EEN in combination with azathioprine and found mucosal healing was observed in 33% of patients .
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Diet Types To Consider For Ulcerative Colitis
What diet type is best for those who suffer from Ulcerative Colitis? This is a question many have pondered on and struggled with throughout the history of irritable bowel diseases. There is no single diet proven to aid in decreasing UC symptoms. We definitely know its NOT a diet filled with inflammatory foods, but a diet filled with easily digestible nutritious food for your gut. There are a plethora of recommended diet types for those who suffer from UC. Theres the Mediterranean diet, the Low-FODMAP diet, the gluten-free and dairy-free diet. The only way to know what works best for you is to try an elimination diet or stick with a diet that prevents flare-ups and doesnt upset your gut. How do you know what foods dont upset your gut, you ask. Simply put, going through a period following one diet, meal planning, tracking your symptoms, and food intake with a food diary or food journal tracker will help you pinpoint what foods make you feel good , and what foods make you feel bad.
You mightve read food diary, and immediately gotten anxious at the complexity of tracking your food and figuring out what your body can tolerate. Dont be worried, or scared! Logging your food with a food diary isnt as complex as it sounds.
These tips should not be used for anything other than educational purposes. To develop a safe, personalized meal plan, you MUST work with your doctor or a dietitian.
Foods Allowed On The Spc Diet
- All fresh and unprocessed fruit, organic is preferred
- Non-starchy unprocessed vegetables like mushrooms, asparagus, and brussel sprouts
- All fresh and frozen meats, organic preferred
- Plant-based milk like almond, coconut, or oat milk
- Hard cheeses aged over 90 days
- Nuts and seeds like pumpkin seeds, almonds, walnuts, pecans, and cashews
- Dried navy beans, lima beans, black beans, green string beans, and lentils
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Ulcerative Colitis Vs Crohns Disease
Crohns Disease is another inflammatory bowel disease that shares similarities to ulcerative colitis, with a few key differences. The first is that Crohns disease can technically occur along the entire length of the GI tract, as opposed to ulcerative colitis occurring exclusively in the colon. Crohns disease also presents in discontinuous patches as opposed to the continuous diseased areas in ulcerative colitis. Imbalances in gut bacteria tend to be more pronounced in Crohns disease than ulcerative colitis. Finally, the inflammation in ulcerative colitis typically does not go as deeply into the gut tissue layers as in Crohns disease, but both diseases show evidence of gut barrier dysfunction, or leaky gut.
What To Eat During An Ulcerative Colitis Flare Up
When youre in a flare, the most important thing to do is follow your doctors advice and avoid high fibre, irritating foods. For my clients who are already plant-based, this can take some work to lessen fibre while maintaining your nutrient intake. You may need doctor-supervised bowel rest, where nutrition is provided via other means. Or, you may need a low residue diet until the flare subsides.
However, you may also be advised to simply eat whatever you can if this is the case, I find is that so often, the foods chosen are not very healthy and may further the inflammatory response. So here, I recommend juicing small amounts of fruits and vegetables, and enjoying a lot of blended foods like smoothies, blended soups and easy to digest foods like noodles, nut butters, plant-based yogurts and rice.
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