Living with a chronic disease like ulcerative colitis can be daunting, but don't throw in the towel yet - it doesn't have to feel like a life sentence! With accurate diet and lifestyle changes, natural remedies, and understanding support from those around you – reclaiming your energy (and joy) is totally do-able.
Instead of just functioning again, this time around, you can start striving for full enjoyment of life once more!
So, what’s the first step to start reclaiming your life if you have ulcerative colitis?
➢ Identify any food intolerances
When it comes to treating ulcerative colitis, it’s important to identify and remove any foods that cause flare-ups using an elimination diet or undergoing food intolerance testing. The most common offending foods are wheat and dairy.
Other common culprits include:
Fatty, greasy, or fried foods
Hot or spicy foods
Caffeinated or sugary beverages
Candy, sweets, and other sources of added sugar
Another food group to pay close attention to are the nightshades, a botanical family of foods and spices that contain compounds called alkaloids. Examples of edible nightshades include tomatoes, potatoes (but not sweet potatoes), eggplants, bell peppers, and chili peppers. A few studies in animals suggest that naturally occurring alkaloids in nightshades may worsen intestinal inflammation.
However, that doesn’t mean everyone should be cutting nightshades out of their diet. If you suspect you have a sensitivity to nightshades, try to cut back on their intake for a few weeks while keeping a close eye on symptoms to test for tolerance.
➢ Avoid red and processed meats
It's also wise to stay away from red and processed meats. Consuming red meat as a part of a high-protein, high-fat diet is associated with an increased incidence of IBD. This is because red meat disturbs the gut microbiome, affecting the production of short-chain fatty acids, intestinal barrier function, and the immune response.
➢ Watch your omega-6 fat intake
The same holds true for refined vegetable oils rich in omega-6 fatty acids, such as sunflower oil and corn oil. Omega-6 fats have been shown to increase the risk of ulcerative colitis. Therefore, replacing refined vegetable oils for small amounts of extra virgin olive oil in food preparation is your best bet.
➢ Increase your fiber intake
People with inflammatory bowel disease (IBD) often avoid fiber-rich foods such as fruits and vegetables because they are afraid of triggering symptoms. However, you can’t have good gut health without fiber. In fact, eating more fruits and vegetables can help normalize bowel movements, improve sluggish bowels or diarrhea, and decrease the risk and frequency of flares.
To better tolerate more fiber, slowly increase your intake. If you don’t experience symptoms such as frequent diarrhea, abdominal pain, gas and bloating, your body is likely tolerating the amount of fiber consumed.
2. Specific Nutrients
The importance of correcting nutritional deficiencies in ulcerative colitis cannot be overstated. Deficiencies in both macronutrients and micronutrients cause changes in gastrointestinal function and structure and can further impair nutrient absorption. This can lead to a vicious cycle of further damage and malabsorption and further reduce nutrient status.
➢ Vitamin D
Vitamin D deficiency is quite common in IBD due to decreased absorption. In fact, studies show that serum levels of vitamin D are lower in more than half of patients with IBD. Vitamin D plays an important role in supporting proper immune regulation — it influences T- regulatory cell function and dampens pro-inflammatory cytokines. Patients with IBD are also at increased risk of developing bone diseases such as osteoporosis and osteomalacia.
Zinc deficiency occurs in approximately 45% of patients with the disorder due to low dietary intake, poor absorption, and excess fecal losses. Zinc is important for healthy immune function, digestion, absorption, and wound healing, and is a cofactor for many proteins. Low zinc status may predispose the mucosa to injury so it’s essential to ensure levels are adequate.
Magnesium is another mineral often deficient in people with IBD due to diarrhea and supplementation of 400mg per day in divided dose is required. Calcium and potassium supplementation should also be considered due to possible deficiencies.
Iron deficiency anemia is very common in IBD, largely because of the chronic blood loss through the gut. Serum ferritin levels should be checked consistently, and iron should be supplemented if required. Make sure you promote absorption by supplementing with vitamin C concurrently.
➢ Vitamin A
Often people with IBD, have difficulty converting vitamin A to its active form due to deficient cofactors such as zinc and magnesium. Vitamin A is essential for the proper functioning of the gut mucosa and the secretion of mucus. Studies have shown that vitamin A supplementation can help alleviate symptoms of ulcerative colitis by decreasing the colonic inflammatory response.
➢ Folic acid and B12
Other deficiencies which are common in IBD are folate and vitamin B12 deficiency due to malabsorption and as many medications can deplete them. A folate deficiency promotes further malabsorption as it alters the structure of the intestinal mucosal cells. If you have UC, folate supplementation is beneficial to reduce your risk of colon cancer. Supplementing with vitamin B12 can assist with energy production.
Due to its significant anti-inflammatory properties, the plant flavonoid quercetin, can help support a normal inflammatory response. Also, quercetin may help to further protect the immune system in the mucosa by influencing the composition of the microbiome, and reducing inflammatory factors associated with UC damage.
Quercetin can be found abundantly in fresh fruits and vegetables, especially red onions, apples, red grapes, dark berries, cherries, green tea, and cruciferous and green leafy vegetables. Supplementation is inexpensive too.
Chronic inflammation can lead to the depletion of glutathione (GSH), the body’s main antioxidant defense. Research illuminates that depleted GSH levels correlate with increased pro-inflammatory mediators, subsequently prompting a cycle of inflammation. Therefore, it is integral to consider GSH concentrations and functionality when treating chronic inflammatory diseases such as ulcerative colitis. Supplementation of glutathione or its precursor, N-acetylcysteine, should be considered.
➢ Probiotic therapy
Emerging evidence reveals that the unique composition of gut microflora may be significantly linked to pathogenesis in those with ulcerative colitis, as an imbalance can result in exaggerated inflammatory responses.
In fact, individuals who have inflammatory bowel diseases such as ulcerative colitis and Crohn’s have been shown to have very low levels of faecalibacterium prausnitzii, which plays an important role in providing energy to the colonocytes and maintaining the intestinal health. Research has shown that a deficiency of F. prausnitzii might provoke and enhance inflammation.
Research has also demonstrated that probiotics are as effective in treating UC than traditional drug therapy.
A 2004 German study involving 327 UC patients found that those who received either mesalazine or Escherichia coli Nissle 1917 (a probiotic) experienced the same average time to remission and quality of it after one year's use. Additionally, Lactobacillus GG has been shown in clinical trials to help sustain remission in UC.
Inflammasomes are one of the newest and most exciting discoveries in research related to inflammatory processes and diseases. These protein complexes serve as intracellular sensors, allowing our bodies to detect potential damage or danger caused by pathogens, metabolic instability, and stress, which then trigger essential immune responses that enable us to stay healthy.
Though normally protective, overactivity or dysregulation of inflammasomes can contribute to a range of illnesses with persistent inflammation states, including IBD.
CoQ10 is an essential antioxidant that works diligently throughout the body; its most remarkable feature being a direct connection to cellular mitochondria, where it aids in vital oxidative processes and energy production.
Research has demonstrated that CoQ10 can potentially neutralize the triggers of inflammasome activation and reduce reactive oxygen species production.
There are also various herbal remedies that can assist in treating ulcerative colitis, including:
Marshmallow root — a demulcent with soothing effects on the mucous membranes
Echinacea — antibacterial, anti-inflammatory and used to promote normalization of the immune system
Goldenseal — inhibits the growth of many enteropathic bacteria
Poke root — used for healing ulcerations of the intestinal mucosa
Slippery Elm — a demulcent
Andrographis — an immune-modulator and anti-inflammatory
3. Lifestyle tips
➢ Don’t suffer in silence
It’s not uncommon to feel isolated from those around you if you have inflammatory bowel disease. Having to cancel social plans so you can stay home close to the bathroom can have an impact on your relationships, especially if you haven’t explained to them your reasons.
Don't be afraid to reach out and spark a conversation about your condition. Sharing the facts can help educate anyone not familiar with UC, while at the same time working towards breaking down any existing stigma. Seek support from your friends and family.
➢ Plan ahead to manage your symptoms
Navigating the complexities of life with UC away from your home base can be a tricky endeavor. Having support from your boss and a flexible work schedule or the ability to work from home, if possible, is key.
If you’re going out, it can be helpful to identify ahead of time where there are available bathrooms, and to always carry extra toilet paper.
If you’re dining out, look at the menu beforehand, know what you can and can’t eat, and choose the restaurant accordingly. In some situations, you may even need to eat beforehand and simply purchase a drink or a salad so you can still spend time with your friends.
➢ Identify stress management strategies that work for you
The majority of people suffering from autoimmune diseases report uncommon emotional stress before disease onset.
Therefore, learning how to manage your stress properly is key to managing ulcerative colitis.
There are many different things you can do to manage your stress better and it’s important to identify what works for you. Some ideas to get you started include:
Meditation and deep breathing exercises
Going for a walk or run
Getting out in nature
Taking a bath
Getting a massage
Playing with your pet
Talking with your loved ones
➢ Get adequate sleep
Disturbed sleep quality has been associated with an increased risk of disease flare in those with UC. UC can also cause physical and emotional symptoms that make it harder to get a good night’s rest.
Setting a sleep schedule, having a sleep routine, adjusting your sleep position, meditating, avoiding any screens in the hour before bedtime, and changing your mealtimes could all lead to better sleep.
➢ Exercise regularly
Exercise can do wonders for those living with ulcerative colitis. Not only is it a great anti-inflammatory, relieving the painful symptoms of UC, but its ability to reduce stress makes exercise an essential part of managing this condition.
Studies have also found that exercising regularly may help lower one's risk for developing colon cancer, which is a complication of UC.
On top of all these amazing benefits, being active helps prompts your body to make endorphins, which are natural painkillers as well as feel-good chemicals.
That doesn’t mean you should start high-intensity cardio workouts, hit the gym, and do heavy weights. Start gently and don’t exercise too hard, as it may trigger a flare up of UC. Find activities that you love to do and do them regularly.
While the principles and remedies outlined above can really help, when it comes to treating ulcerative colitis, there is no cookie-cutter, one size fits all approach. It’s important to determine what dietary choices work best for you as an individual, depending on your different food intolerances, test results, and severity of the disease. Getting a health professional to guide you through treatment is highly recommended and they can also formulate for you a maintenance plan going forward to prevent flares.
Recipe Spotlight: Eggplant and Chickpea Stew
This hearty and warming dish is packed full of protein thanks to the chickpeas. In fact, weight for weight, chickpeas contain almost as much protein as fillet steak, at a fraction of the cost and with many more health benefits. Chickpeas help to reduce cholesterol and protect against heart disease, circulatory problems and bowel cancer. Chickpeas are also great for both the gut and the immune system as they feed the beneficial bacteria in your gut and promote a healthy microbiome. Enjoy!
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