Ulcerative colitis: Changing your diet

Crohn’s disease and ulcerative colitis are types of inflammatory bowel disease. They cause inflammation and sores (ulcers) in the digestive tract. This can lead to symptoms such as diarrhea, belly pain, loss of appetite, fever, bloody stools, and weight loss. Often symptoms are worse after eating.

If you have an inflammatory bowel disease, it may be hard to get important nutrients such as vitamins, minerals, and protein. Your intestines may not be able to take all the nutrients from the food you eat. You may lose nutrients through diarrhea. This can lead to problems such as anemia or low levels of vitamins, such as vitamin B12 and folic acid.

To control their symptoms, some people eat only bland foods, like pasta, and they avoid fruits and vegetables. But you need to eat a variety of foods to get the nutrients you need for good health. This Actionset can help you learn more about how to eat so you can manage your symptoms but still get the nutrition you need.

Key points

• Inflammatory bowel disease can make it hard to get the nutrients you need.
• It is important to eat a healthy, varied diet to help you keep your weight up and stay strong.
• Some foods can make symptoms worse. Not eating these foods may help reduce your symptoms.
• No one diet is right for everyone with an inflammatory bowel disease. Keep a food diary to find out which foods cause problems for you. Then you can avoid those foods and choose others that supply the same nutrients.
• Because you may not be absorbing all the nutrients from the food you eat, you will need to eat a high-calorie, high-protein diet. This may be easier to do if you eat regular meals plus 2 or 3 snacks each day.
• You may need to take vitamin and mineral supplements to help you get the nutrients you need.

 What are some common problem foods?
 Why is it important to pay attention to what you eat?
 How to eat when you have inflammatory bowel disease
 Where to go from here

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Some foods may make your symptoms worse, especially during a flare-up. For many people, common problem foods include:

• Dairy products for people who are lactose-intolerant.
• High-fiber foods, such as raw fruits and vegetables, and whole grains. Often people have the most problems with gas-producing foods, such as beans, cabbage, broccoli, and onions, or foods with hulls, such as seeds, nuts, and corn.
• High-fat foods, such as fried foods, butter and margarine, mayonnaise, peanut butter, nuts, ice cream, and fatty cuts of red meat.
• Spicy foods.
• Foods with caffeine, such as chocolate and coffee.
• Carbonated drinks.
• Alcohol.

Continue to Why is it important to pay attention to what you eat?
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What you eat does not increase the inflammation that causes your disease. But some types of foods, such as high-fiber fruits and vegetables, may make your symptoms worse. This is especially true during a flare-up. As a result, you may be tempted not to eat these foods at all. But that can make it hard to get the nutrients you need to stay healthy.

A better idea is to keep a food diary to find out which foods cause problems for you. Then you can avoid those foods and choose others that supply the same nutrients. Foods that cause symptoms during a flare-up may not bother you at other times.

To learn more about nutrients and the types and amounts of food you need to be healthy, see the topic Healthy Eating.

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No one diet is right for everyone with an inflammatory bowel disease. Foods that bother one person may not bother another. Your diet has to be tailored for you. But the following basic ideas can help you feel better and get the nutrition you need.

Find your problem foods

Find out your problem foods by keeping a food diary. As soon as you know what foods make your symptoms worse, your doctor or dietitian can help you plan a diet that avoids problem foods but gives you plenty of nutrients and enough calories to keep you at a healthy weight.

To make a food diary, get a small notebook and keep it with you. Make notes after each meal or snack.

• On the left side of the page, write down what you ate, about how much of each food you had, and what time you ate. Be honest—write down everything.
• On the right side of the page, note any symptoms you had and what time they occurred.

If you notice certain foods make your symptoms worse, talk to your doctor about these foods at your next visit.

Make smart food choices

During a flare-up, avoid or reduce foods that make symptoms worse. But instead of cutting out a whole group of high-nutrient foods, try replacing them with healthy choices.

• Choose dairy products that are low in lactose, such as yogurt or hard cheeses like cheddar. Or try drinking lactose-reduced milk.
• If you are having fat in your stools, choose low-fat foods instead of high-fat ones. For instance, some cuts of red meat have a lot of fat. A low-fat choice would be lean beef (such as sirloin, top and bottom round, chuck or diet lean hamburger), poultry, or fish, such as cod. Instead of frying foods, try baking or broiling them.
• Cook fruits and vegetables without hulls, skins, or seeds. Try different ways of preparing them, such as steaming, stewing, or baking. Peel and seed fresh fruits and vegetables if these bother you, or choose canned varieties.

Get the calories and nutrients you need

Your body may not be able to absorb all the nutrients it needs from the food you eat. To stay as healthy as you can:

• Eat a varied, nutritious diet that is high in calories and protein.
• Try eating 3 meals plus 2 or 3 snacks a day. It may be easier to get more calories if you spread your food intake throughout the day.
• Take vitamin and mineral supplements if your doctor recommends them.
• Try adding high-calorie liquid supplements, such as Ensure Plus or Boost Plus, if you have trouble keeping your weight up.
• Drink plenty of fluids. This can help you avoid dehydration, kidney problems, and gallstones.
• See your doctor or dietitian if your diet feels too limited or you are losing weight.

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Now that you have read this information, you are ready to follow an eating plan for inflammatory bowel disease.

Talk with your doctor

If you have questions about this information, take it with you when you visit your doctor or dietitian. You may want to mark areas or make notes in the margins where you have questions.

If you would like more information on inflammatory bowel diseases, the following resources are available:

For more information on nutrition, see the topic Healthy Eating.

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Other Works Consulted

• Beyer PL (2008). Inflammatory bowel diseases section of Medical nutrition therapy for lower gastrointestinal tract disorders. In LK Mahan, S Escott-Stump, eds., Krause's Food and Nutrition Therapy, 12th ed., pp. 689–706. Philadelphia: Saunders Elsevier.

• Botoman VA, et al. (1998). Management of inflammatory bowel disease. American Family Physician, 57(1): 57–68.