Ulcerative Colitis Blog

A common question among UC patients is whether their diet may have caused or contributed to colitis. Numerous researchers have investigated this topic and found no conclusive evidence that there are specific food items that cause or worsen the state of inflammation in the colon.

Certainly, there are some foods which are more likely to result in GI symptoms than others. For example, if a person eats a whole bag of prunes, he or she is likely to develop diarrhea regardless of whether the individual has IBD or not. The food does not necessarily make the colon more inflamed, but it can cause common symptoms in almost every individual.

As an analogy, think about a cut on the skin. If lemon juice is squeezed over the cut, the cut will burn and hurt. The cut skin is not necessarily worse in terms of inflammation nor will it take longer to heal, it just temporarily hurts more because of the lemon juice. The same is true of various food effects on the colon in UC. When the colon is inflamed, ingestion of gas producing foods containing lactose or high fiber products may result in abdominal cramping and discomfort. These foods, however, will not cause the lining of the colon to develop more ulcers or bleeding.

Along the same line, bowel rest and intravenous nutrition may decrease the number of bowel movements a person has, but it does not specifically translate into healing of the lining of the colon. Your doctor may decrease your food intake if you are hospitalized for a flare to help you feel better until medicines begin to heal the colon.

Future blogs will contain more information about diet advice and UC.

Brenda wrote in to our blog regarding her daughter who was recently diagnosed with UC and is having difficulty with low potassium levels. Brenda's question was whether or not her daughter's recurrent symptoms of diarrhea could be a result of low potassium levels in the blood.

The medical term for low blood potassium is "hypokalemia". In general, there are 3 ways people can develop low potassium levels:
1) The potassium in the blood can move into cells in the body making the blood level low
2) Excessive potassium can be lost by the kidneys and excreted in the urine
3) Excessive potassium can be lost by the gastrointestinal tract through vomiting and/or
diarrhea.

In IBD patients, a common cause of low potassium levels is diarrhea. A considerable amount of potassium can be lost in stool which can disrupt electrolyte balances. As such, it is more likely that diarrhea would cause the low potassium levels as opposed to the other way around (ie; low potassium levels causing diarrhea). When bouts of diarrhea occur, it is important that individuals (both those with and without IBD) rehydrate themselves with drinks that contain glucose, sodium, and potassium. The glucose and sodium help the body retain more fluid and stay hydrated while the potassium makes up for losses in vomit and stool. Gatorade and Pedialyte are examples of drinks which contain these components.

Another cause of low potassium in IBD patients is steroids. The addition of steroids (which is necessary to decrease inflammation and treat the disease) can affect hormones that regulate steroid balance in the body. Potassium supplements may be needed to maintain a stable balance.

Although these are probably two of the more common reasons one would see low potassium levels in IBD, it should be noted that there are many causes of low potassium levels including other medications, hormone effects, and kidney conditions. Therefore, if you are suffering from low potassium levels it is important to inform your doctor of all the medications you are taking - both prescription and nonprescription - and all medical conditions for which you are being treated. By simultaneously analyzing potassium levels in the blood, urine, and stool, your doctor may be able determine where the loss is occuring and gain a better understanding of the cause.

In a recent blog I touched on the role of probiotics in UC. Another burgeoning area of research is the utility of "prebiotics" in the treatment of UC. Prebiotics are non-digestible dietary carbohydrates (think fiber, bran, germinated barley) that help protect the normal bacteria of the colon, stimulate the growth/metabolism of colon cells, and aid in the production of protective mucus lining the colon. When these food products are ingested, bacteria in the colon ferment them to make chemicals called "short chain fatty acids" or SCFAs. Scientists believe that these SCFAs may have anti-inflammatory properties that can help reduce colon inflammation in UC.

At present, only a handful of studies examining prebiotics in UC have been performed in humans. In one study of patients with mild to moderate UC, consumption of germinated barley foodstuff showed a significant reduction in disease activity up to 24 weeks. Another investigation showed that UC patients in remission who consumed 20 grams of germinated barley foodstuff daily had improved clinical results and fewer relapses than patients who were not taking the prebiotic. No significant side effects were noted in either study.

While no studies have conclusively shown that any specific type of food causes or worsens UC, these investigations raise the interesting possibility that certain foods may be helpful in decreasing inflammation. There is no data to suggest that these food products can or should replace standard medicines; rather, they may serve as a helpful adjuvant in the management of UC.

A common question asked by patients is whether they need to change their diet after being diagnosed with UC. As discussed in previous blogs, there is no evidence that specific foods contribute to inflammation in IBD. While there is not a "colitis diet" that individuals need to adhere to, certain foods or their components may produce symptoms of loose stools or gas. Some general considerations regarding diet for UC patients:

1) Eating smaller more frequent meals may help alleviate cramping and gas associated with larger meals.

2) Dietary fiber intake may have differential effects depending on the segment of the colon involved with colitis. Some patients with colitis limited to the rectosigmoid region find that fiber helps to bulk stool and aid with passage of bowel movements. Others with more extensive colitis, may develop discomfort with higher amounts of fiber as these products pass through inflamed segments.

3) It is possible to have lactose intolerance in addition to UC. Lactose intolerance is caused by gradual loss over time of the enzyme that digests lactose in dairy products. Symptoms of gas, bloating, and or/diarrhea after dairy products could suggest a diagnosis of lactose intolerance. Simple elimination of these foods from the diet or ingestion of a tablet containing a lactase enzyme usually results in symptom improvement.

4) Eating a balanced diet is more important restricting specific foods.

5) Alcohol will not affect inflammation in the gut related to UC, but can result in flatulence and diarrhea. Alcohol can be consumed in moderation in IBD.

6) In general, consumption of a daily multivitamin is a good idea. Patients with a history of steroid use or osteopenia/osteoporosis should also take 1500mg of calcium daily and 400-800 IU of vitamin D daily. Take note that an excess of vitamins can result in toxicity. Consult your physician or pharmacist if you are unsure regarding the dosage of vitamins and minerals that should be taken daily.

7) While fish oil has a theoretical anti-inflammatory effect, research studies regarding fish oil in UC have shown only a mild improvement in symptoms if any. Although fish oil is not harmful, there is insufficient evidence that it produces any significant benefit in UC at this time.