Ulcerative colitis and your diet

What is this information about?

This information is about ulcerative colitis. It explains: 

• what ulcerative colitis is.
• how your diet (what you eat and drink) can help to control how often and how badly you get the symptoms of ulcerative colitis.

It gives you suggestions for: 

• what to eat if you are having an ulcerative colitis flare-up (your symptoms are bad) or if you are in remission (you do not have many symptoms, or they are not too bad).
• how to make sure that you are getting enough of the things like vitamins and minerals to keep you as well-nourished as you can be when you have ulcerative colitis.

Why have I been given this information?

You have been given this information because you have ulcerative colitis. If you follow the advice in this information, it can help you: 

• have less of the painful and uncomfortable symptoms of ulcerative colitis
• get symptoms less often
• get enough nourishment from what you eat if your digestion is not working as well because of your ulcerative colitis.

What is ulcerative colitis?

Ulcerative colitis is a condition that causes the lining of your colon and rectum to: 

• become inflamed (swollen and irritated)
• get ulcers on it (become ulcerated).

Together, your colon and rectum are called your lower intestines. Your intestine is a long tube, made up of different sections which help to digest your food and get rid of the parts of what you eat that your body cannot digest. It runs from your stomach to your anus.

Your colon removes water and any nutrients which are still in your food after it has been through your stomach and the upper part of your intestines. Your rectum is the part of the ‘tube’ below your colon. It stores your poo before it is carried down to your anus and out of your body when you have a poo.

If the inflammation and ulcers are only in your rectum the condition is called proctitis rather than ulcerative colitis.

What is a flare-up of ulcerative colitis?

A flare-up (exacerbation) of ulcerative colitis is a time when your symptoms are worse than usual. When you have a flare-up you may: 

• bleed from your bottom (rectum)
• have mucus in your poo (stools)
• poo more often
• have tummy (abdominal) cramps and pain

Why is it important that I am well-nourished when I have a flare-up of my ulcerative colitis?

Nutrition is important when you are having a flare-up and when you are in remission. You should aim to be well nourished at all times. 

When you have symptoms during a flare-up your body needs more nutrition. This helps it to deal with inflammation and repair the damage that your ulcerative colitis is doing to your body. 

When you are having a flare-up you may not feel as hungry as usual and your body may not be able to digest and take in the nutrients from your food as well. This can mean that you are not getting enough nutrition. If this happens to you may:

• have weight loss 
• have muscle wasting (your muscles shrink) 
• get weakness 
• feel tired 
• not be able to concentrate 
• find wounds heal slowly 
• get more infections.

How, and what, should I eat when I have a flare-up?

It is important to eat as well as you can when you have a flare-up to make sure you are getting enough nutrition. 

• If you do not feel very hungry (you have a poor appetite) try to eat little and often.

• Choose foods which are higher in calories and protein so that even if you can only eat a small amount your food is still nourishing.

• Try to include meat, fish, and eggs in your diet as they provide protein. This helps to repair the damage that your flare-up does to your body and helps to prevent muscle wasting.

• Use full-fat dairy products. They are high in protein and have more calories to help prevent you from losing weight.

• Make sure that you drink plenty of fluids so that you do not get dehydrated (dried out) if you have diarrhoea (runny, watery poo). You do not have to drink only water. Milk is also good as it is very nourishing.

What ideas can I try to make sure that I am getting enough nourishment when I am having a flare-up?

Try these ideas:

Can nourishing drinks to help me to get enough nutrition when I am having a flare-up?

Yes. If you do not feel like eating, you may find a nourishing drink is easier to manage than food.  

Try to eat a meal and use a nourishing drink as a snack or as a drink before bed.  

You can make a nutritious milkshake by adding 1 level tablespoon of milk powder and 1-2 scoops of ice cream to one pint of full cream milk. You could flavour this with milkshake syrup, or liquidized tinned or fresh fruit.  

Complan and Build-up drinks are available from chemists and supermarkets in both sweet and savoury flavours.  

You may benefit from taking special nutritional supplement drinks. Your Dietitian will assess whether these could help you and may ask your Doctor to prescribe them.

What do I need to know about dietary fibre during a flare-up?

During a flare-up you may find that higher fibre foods such as wholemeal bread, high fibre breakfast cereals, dried fruit, pulses, lentils, and some vegetables make your diarrhoea worse.  

If this happens, then avoid the foods that are upsetting you and change to white bread and low fibre cereals such as rice krispies and cornflakes.  

When your symptoms improve you should add fibre back into your diet. Add a little fibre to your diet at first and cut down again if your symptoms get worse. Speak to your Dietitian if you need more information about fibre.

What should my diet be like when my ulcerative colitis is in remission?

When your ulcerative colitis is in remission do follow a healthy balanced diet with a variety of foods.  

• Base your meals on starchy foods such as bread, potatoes, pasta, rice, chapattis, and breakfast cereals. Choose higher fibre varieties if you can tolerate them. 

• Include a variety of fruit and vegetables. Aim for five portions of fruit and vegetables each day. These can be fresh, frozen, or canned. 

• Meat, fish, eggs and vegetarian replacements give you the protein which you need for your body to repair. Try to include two portions of these foods each day. 

• Eat fish twice a week as part of a healthy diet. One of these portions should be oily fish. For example, salmon, sardines, mackerel or pilchards. 

• Milk and dairy foods provide calcium which is vital for your bones. For more information see the section on calcium later in this information. 

• Cut down on saturated fat. This is the fat found mainly in foods from animals such as meat and full fat dairy products. Instead, choose unsaturated fats which are from vegetable sources. For example, use vegetable, sunflower or olive oil and spreads rather than butter or lard. Also, choose lower fat dairy products and reduced fat cheeses. 

• Try to have less salt in your diet by not adding it to foods during cooking or at the table. Reduce the amount of salty foods you eat. For example, salted or smoked meat, crisps, and takeaways.

Am I getting enough calcium?

Calcium is vital for good bone health and it is needed to minimise your risk of osteoporosis. Osteoporosis is a condition where the bones become thinner and are at increased risk of breaking.  

People with ulcerative colitis have a greater chance of getting osteoporosis due to taking steroid medicines and avoiding dairy products. The inflammation that happens in ulcerative colitis may also mean it is more likely that you will get osteoporosis.   

The amount of calcium that people with ulcerative colitis should have is: 

• 1,000mg of calcium a day for adults 

• 1200 to 1500mg for postmenopausal women and men over 55 years old 

The following tables show the amount of calcium in portions of foods and drinks: 

Each full portion gives you about 250mg of calcium so aim for 3-4 portions of these each day:

Each full portion gives you about 50mg of calcium:

What other vitamins and minerals should I include in my diet?

Vitamin D

You need vitamin D to help your body to take in the calcium in your food and drinks. We get most of our vitamin D from sunlight. Research has shown that more people than was thought do not get enough vitamin D.  

Do try to include foods containing vitamin D in your diet. For example: 

• oily fish
• egg yolks
• liver
• fortified margarine

If you are taking steroid medicines you should also be prescribed a calcium and vitamin D supplement. If you are taking steroid medicines and you have not been prescribed a calcium and vitamin D supplement do tell your dietitian.

Iron

Iron from animal sources is taken into your body most easily. For example: 

• red meat, poultry and offal (liver, kidneys)
• eggs

Iron is also found in foods from fruit and vegetables such as:

• pulses  
• breakfast cereals that have had iron added to them (been fortified with iron) 
• dried fruit 
• dark green vegetables

Vitamin B12 and folate

Good dietary sources of vitamin B12 include: 

• red meat and meat products
• milk and dairy products
• white fish
• eggs
• fortified breakfast cereals

Good dietary sources of folate include:

• green leafy vegetables 
• most fruit 
• fortified breakfast cereals and breads

What causes anaemia and what are the symptoms of aneamia?

Anaemia can be caused by low levels of iron, folate or vitamin B12 in your blood. Symptoms of anaemia include tiredness, lack of energy, poor concentration, and feeling light-headed or dizzy. To reduce the chances of getting anaemia follow the advice on including iron, folate and vitamin B12 in your diet.

Is there a link between food allergy or food intolerance and ulcerative colitis?

There is no clear link between ulcerative colitis and food allergies or intolerances. However, some people find their symptoms are triggered or made worse by certain foods. Food allergy and intolerance tests that you can buy in shops or online are not reliable.

What do I need to know about excluding foods from my diet because I think I may be allergic or intolerant to them?

If you are concerned that you may be allergic or intolerant to any foods, then food exclusion and food elimination diets can be helpful. Talk with your Dietitian who can give you advice, information, and support with these diets. Do not start a food exclusion or elimination diet without talking with a Dietitian first.   

It is important not to exclude foods from your diet if you do not need to. Food sensitivities often only last for a short time. If there are foods that you are unable to eat, then do find suitable replacements so that your diet still gives you enough nutrition.   

Dairy products are a very good source of calcium so if you are unable to tolerate cows’ milk products choose calcium fortified alternatives such as soya, rice, and oat products.  

Wheat products are a good source of energy, carbohydrate, fibre and B vitamins so if wheat is an issue for you, replace these foods with alternatives such as rice, potatoes, wheat-free bread and pasta.

How can I tell if I am I well nourished?

Ask yourself the following questions: 

• am I underweight or overweight?
• am I avoiding certain foods?
• am I getting enough calcium from my diet?
• have I had my vitamin D levels checked?
• am I getting enough iron from my diet?
• have my vitamin B12 and folate levels been checked?

Do speak to your Dietitian if you:

• have lost weight
• have not been eating well and are underweight
• are avoiding foods and think you may not be getting all you need from your diet.

Leaflet produced by Western Sussex Hospitals Dietitians. For further information or to provide feedback please contact: