Diet Recommendations for Ulcerative Colitis

Ulcerative colitis (UC) is a type of inflammatory bowel disease (IBD) that causes inflammation and ulcers in the large intestine and rectum. Symptoms typically first appear when you are between 15-35 years old with the most common symptom being rectal bleeding, which is when blood can be seen in the stool (poop). Additional symptoms may include diarrhea, weight loss, and abdominal pain. 

UC symptoms occur during what is called a flare or flare-up, when the disease is active. The symptoms may subside during periods known as remission. Medications can play a big role in reaching and maintaining remission. Dietary changes may also help in managing UC.

While there is not a specific diet recommended for people with ulcerative colitis, there are certain diets that are effective in controlling symptoms. You might also find that prioritizing or avoiding certain foods can help your ulcerative colitis. 

Foods To Eat if You Have Ulcerative Colitis

Dietary modifications for people with UC are highly individualized. Different foods might trigger symptoms in different people. However, in general, a well-balanced diet is recommended for people with ulcerative colitis.

More specifically, foods that contain omega-3 fatty acids, probiotics, and protein might be especially helpful in managing UC symptoms. 

Omega-3 fatty acids are a type of “healthy” fat that may reduce inflammation. Probiotics are live microorganisms that can help balance the intestinal tract. Protein is an essential nutrient the body uses to help grow and repair tissues. Each can help keep UC in remission and prevent flare-ups.

Foods High in Omega-3 Fatty Acids

Omega-3 fatty acids have been associated with a decrease in ulcerative colitis symptoms and an increase in remission. For instance, research has shown that people with UC who consume omega-3s have a decrease in intestinal inflammation.

Foods high in omega-3 fatty acids include:

• Fatty fish like salmon, herring, mackerel, tuna, and sardines
• Plant oils such as flaxseed oil and walnut oil
• Nuts (though they trigger flare-ups for some people)

Fish oil supplements are another way you can increase your intake of omega-3.

Foods High in Probiotics

Probiotics might help in preventing the frequency of UC flares. Not only can the microorganisms possibly extend remission time, but they may also even encourage remission in the first place. More research is needed to determine the actual impact of probiotics for people with UC, though.

Foods high in probiotics include:

• Greek yogurt
• Kefir
• Cheese
• Sourdough bread

If you find that fat triggers your UC, you may want to opt for low-fat options of these foods.

Foods High in Protein

When the body is in an inflammatory state—as is the case when someone with UC is experiencing a flare-up—there is an increased need for protein to prevent and repair damage from the inflammation to the intestines. This need can be met by incorporating lean proteins into the diet. 

High-protein foods include:

• Fish
• Greek yogurt 
• Chicken
• Turkey
• Eggs

Legumes are another source of protein. However, they trigger flare-ups for some people. If trying legumes, ensure they are thoroughly cooked and mashed, and start with small amounts.

Foods To Avoid

There aren’t any foods that everyone with UC must avoid. Researchers haven’t found any one particular food that causes or worsens UC symptoms for everyone with the disease. However, you might find certain foods may trigger symptoms for you. You can try to figure out which foods cause symptoms by keeping a food diary. Once you identify those foods, you can avoid them.

If you are experiencing a UC flare-up, you may want to consider avoiding certain fibrous foods as well as whole grains from your diet for the duration of the flare. These foods are high in insoluble fiber (fiber that does not dissolve in water), which can sometimes worsen symptoms. 

Foods high in insoluble fiber include: 

• Raw vegetables and fruits
• Brassica vegetables, unless cooked and pureed
• Peppers, unless cooked and pureed
• Nuts such as walnuts, pecans, almonds, and pine nuts
• Seeds such as sunflower seeds, flax seeds, and chia seeds
• Whole grains such as oats, barley, quinoa, brown rice, and popcorn

When you are in remission, these foods rich in insoluble fiber may be tolerated perfectly fine.

If UC is causing diarrhea and gas, certain foods may make these symptoms worse. This includes fatty, greasy, or fried foods as well as sauces like butter, margarine, and heavy cream.

Research also suggests that avoiding red meat and processed meat and instead choosing white meat and fish might benefit UC symptoms.

Meal Ideas for Ulcerative Colitis

Based on what foods may trigger your symptoms, meals can vary widely with UC. But as you prepare meals, keep in mind that smaller, more frequent meals are sometimes better tolerated than larger meals. Below are some meal ideas that might help you manage your ulcerative colitis. It may be a good idea to meet with a healthcare provider or registered dietitian to make a customized eating plan.

Breakfast

These quick and easy breakfasts will help get your day off to a good start, particularly in times of UC remission:

• Greek yogurt parfait with fresh fruit and pecans
• Oatmeal with blueberries and almond butter
• Egg and potato breakfast taco with rice flour tortilla and grapes

If you are in the middle of a UC flare, a meal of three scrambled eggs and canned pears packed in water or 100% juice may be well-tolerated.

You can also consider drinking some tea. Tea has polyphenols, which are micronutrients found naturally in tea plants. Tea polyphenols may have antioxidant and anti-inflammatory effects in IBD, helping manage UC symptoms. Green tea has more polyphenols than black tea or oolong tea.

Lunch

When deciding on lunch, consider that homemade meals will allow you to better control what’s in your food. During times of disease remission, you might find the following meals help keep you symptom-free:

• Homemade chicken salad on lettuce wraps with sliced apples
• Leafy green salad with grilled chicken and vinaigrette
• Homemade quinoa and black bean salad with sliced avocado

During a flare, white pasta and grilled chicken tossed with salt-free herb seasoning, fresh garlic, and a small drizzle of olive oil is a good meal option.

Dinner

If your dinner involves bread, like toast or a bun, consider selecting potato bread or white bread. Both types are low in fiber. Bread or no bread, here are some dinners that would be good in times of UC remission:

• Turkey burger with lettuce bun and homemade baked sweet potato fries
• Baked salmon with steamed vegetable medley and rice
• Stewed cod with tomatoes and spinach

During a flare, a meal of fresh herb steamed white fish and steamed zucchini (peeled and seeds removed) is generally well-tolerated.

Snack

Especially since smaller meals are better tolerated by people with UC, consider adding more snacks to your day. These snacks could include: 

• Apple and peanut butter
• Hard cheese and grapes
• Sliced cucumbers with homemade Greek yogurt ranch dip
• Celery with cream cheese and raisins
• Homemade peanut butter oat balls

Two boiled eggs with unsweetened applesauce might be a particularly helpful snack during a flare.

Diets for Ulcerative Colitis 

While there is not a singular diet proven to treat UC, there are a few diets that might be successful in alleviating UC symptoms for some people.

Mediterranean Diet

The Mediterranean diet has been shown to be effective in reducing inflammation caused by UC and is thought to be fairly easy to follow. The Mediterranean diet is high in fresh produce, fish, nuts, whole grains, and olive oil. This diet limits red meats, alcohol, and refined sugars.

IBD Anti-Inflammatory Diet (IBD-AID)

The main goal of the IBD-AID is to improve the gut microbiome (the mix of bacteria that live in your gut). It’s believed that the inflammation of IBD may be due to an imbalance of the gut microbiome, so IBD-AID helps keep a good balance between healthy and harmful bacteria. 

With IBD-AID, you avoid certain carbohydrates like grains and fiber and add more foods that contain prebiotics and probiotics. Prebiotics promote the growth of beneficial organisms and are in foods like onion, garlic, and almonds. Probiotics provide microorganisms and are in foods like yogurt and kefir. 

Autoimmune Protocol Diet (AIP)

The goal of the AIP diet is to limit food that may contribute to an imbalance of good and bad bacteria in the gut as well as food that can trigger inflammation.

The AIP diet gradually eliminates several types of foods like grains, legumes, eggs, nuts, and processed foods. Instead, the AIP diet focuses on nutrient-dense foods, lean protein, fruits, and vegetables.

In addition to dietary changes, the AIP diet also encourages practicing other factors that can help with UC, including managing stress and getting physical activity.

Low-FODMAP Diet

FODMAP stands for fermentable oligo-saccharides, disaccharides, mono-saccharides, and polyols. These are fibers and sugars your intestines might not absorb well. A low-FODMAP diet is a short-term diet that limits foods high in these ingredients, which can include leeks, garlic, and lentils.

For some people, foods high in FODMAPs might cause symptoms like bloating, gas, and diarrhea. If your ulcerative colitis tends to cause these types of symptoms, following a low-FODMAP diet may help ease symptoms. A low-FODMAP diet will not help with actual inflammation reduction.

Ulcerative Colitis Elimination Diet (UCED) 

The UCED is a low-protein, low-fat, high-fiber diet consisting of two phases that each lasts six weeks. In the first stage, you will cut out all processed foods, refined sugars, and fatty meats. Vegetables, fruits, rice, and potatoes can be consumed in unlimited quantities, while eggs, poultry, yogurt, and pasta should be consumed in limited quantities. 

If you’re in remission by week six, you can then add in more fruits, vegetables, thoroughly cooked and mashed legumes, as well as cooked cereal grains. 

The UCED is not intended to last for an extended time. Rather, it’s for the short term to aid in getting UC into remission.

A Quick Review

Ulcerative colitis is an autoimmune condition that causes inflammation in your colon and rectum, leading to symptoms like bloody stool, diarrhea, and abdominal pain. Making dietary changes might help reduce inflammation and relieve symptoms. In general, eating a well-balanced diet high in omega-3s, probiotics, and protein can help with ulcerative colitis. 

As for the specific foods to eat or avoid, that is highly individualized since people respond differently to certain foods. You can keep a food diary to help figure out which foods seem to improve or trigger symptoms. You may also find that following certain diets may help you manage your ulcerative colitis. While no one diet has been proven to treat ulcerative colitis, some, such as the Mediterranean diet, have been shown to help symptoms. 

Before starting any diet or making any dietary changes, speak with your healthcare provider about the potential benefits and any considerations you should keep in mind.