Best Foods to Eat with Ulcerative Colitis: A Registered Dietitian's Guide
Managing ulcerative colitis can be challenging, but certain foods can help alleviate symptoms and promote gut health. This blog covers the best food choices for people living with colitis and offers advice on how to incorporate them into your daily diet. If you need assistance, I am happy to work with you. Check out my website for more details.
Foods to Eat with Ulcerative Colitis: A Registered Dietitian's Approach
Living with ulcerative colitis (UC) means making thoughtful choices about what you eat. As a Registered Dietitian Nutritionist, I've worked with many clients who have UC. I've seen firsthand how diet is helpful for symptoms to support a quality of life with UC, despite still needing more research on the role of nutrition in ulcerative colitis. While there isn't a one-size-fits-all approach to UC-friendly foods, certain dietary strategies can help reduce inflammation, promote healing, support medications, and improve overall well-being.
What is Ulcerative Colitis, and How Can Diet and Nutrition Help?
UC is an Inflammatory Bowel Disease (IBD), which results when the immune system interacts with genetics and the environment. The immune system misinterprets bacteria and antigens as foreign invaders and begins to attack the colon, resulting in ulceration of the intestines. This disease is characterized by remissive-relapsing disease cycles, which result in painful flare-ups, bloating, urgency, blood in stool with diarrhea, and digestive discomfort. Proper nutrition can help reduce inflammation, help medications work better, and prolong the time spent in remission, reducing the risk for future flare-ups.
Best Foods to Eat During an Ulcerative Colitis Flare-Up
When experiencing a UC active disease flare-up, you may have been told to stick to low-fiber, easy-to-digest foods, but you actually need the anti-inflammatory benefits from fruits, vegetables, and whole grains. However, you may need to alter the particle size of these foods, opting for smoothies, soups, stews, nut butters, and fork-tender vegetables that are soft against the roof of your mouth. This allows for more digestive comfort during a time of ulceration while still getting your body the nutrition that it needs.
Some of the top food choices include:
Grain-bowl bases: Carbohydrates may feel easy on the digestive tract. You can top with a protein-rich complete protein. Here’s a guide on grain pairings for complete proteins to help preserve your muscle during an active disease flare.
Some examples include:
oats
millet
Here is some research about how it may improve intestinal inflammation
teff
corn
flour will be better tolerated than a kernel, especially in active disease flare-ups
arrowroot
rice
Orzo
Farro
couscous
semolina or durum pasta
Broth-based stews and soups: Hydrating and soothing, especially during flare-ups
Smoothies: Blending fruits and vegetables makes them easier to digest
Another important goal while experiencing active disease flares is to continue nourishing your body. You may experience a decrease in appetite due to the inflammatory process. However, inflammation requires healing, which requires more, not less, nutrition. Here are some examples of nutrient-dense foods you can add:
Hummus
Nut and seed butters
Guacamole
Greek yogurt
Olive-oil based pesto
Oatmeal
Rotisserie chicken, cheddar cheese, avocado wrapped in a tortilla (whole grain if tolerated)
Best Foods for Ulcerative Colitis Remission
When you're not amid a flare-up, you can slowly add more textures from fiber for a diverse, varied diet that is rich in omega-3 fatty acid from fish.
Some options to consider include:
Lean proteins: Chicken, turkey, fish, and tofu, and edamame provide essential nutrients without irritating your colon. Omega-3 from fatty fish, like salmon, has been shown to exert an anti-inflammatory effect in ulcerative colitis, and Greek yogurt has been shown to play a role in protection against colorectal cancer and to be associated with decreased risk for developing UC.
Complete proteins, when paired with carbs play an important role in muscle health. Poor muscle health is a risk factor for IBD active disease flare-ups, so these are important nutritional components to include in your diet!
Plenty of fruit and vegetables: If you’re no longer bleeding, slowly experiment with increasing the textures in your diet to include seeds and skins of fruit. Remission is the time to play with texture (unless contraindicated by another medical condition or directed by your physician). Including the texture of different fibers in the diet can help aid in digestion.
Fermented foods: Yogurt with live cultures, kefir, and sauerkraut can help improve gut flora, promoting overall digestive health
You can read more about probiotic-rich foods here and food’s role in the gut microbiome’s health here
Fats: Avocado and olive-oil especially offer anti-inflammatory properties and fats to nourish your body
What Foods to Avoid with Ulcerative Colitis:
While many foods can help manage colitis, some can worsen symptoms and possibly increase risk for shorter time spent in remission. Remember that nutrition needs to be personalized to each individual, but in general is best to avoid:
Soft cheeses and cow’s milk: Dairy as a whole category is quite broad, and although there’s no increased risk of IBD flare-ups, many people as they age may experience lactose-intolerance, which can lead to bloating and discomfort. This may be an especially sensitive experience immediately after a flare-up or surgery.
High-fat foods: Saturated fatty acids and those high in myristic acid, like palm and coconut oil, and high-fat dairy, are associated with an increase in disease flares
Spicy foods: The capsaicin in spicy foods may lead to more bowel movements and possibly more disease flares. When possible if culturally preferential, use herbs in lieu of spices that create heat.
Alcohol: Alcohol be irritating to your digestive system, and alcohol is carcinogenic, or cancer-causing. It’s best to avoid in a flare with active disease to help your intestines heal.
Caffeine: coffee can be anti-inflammatory and liver-protective, but it is a stimulant laxative, so you may have increased bathroom frequency. In a flare, proceed with caution.
How Do I Know if My Diet is Helping My Colitis?
One common question is, "How do I know if my diet is working?"
With UC, it can take time to see the effects of dietary changes, but here are some signs that your food choices are supporting your healing process:
Fewer flare-ups: You may notice fewer and less severe flare-ups over time.
Stable blood work: As part of your disease monitoring strategy, your micronutrients need to be monitored, and you can work with a dietitian to ensure this is part of your care that is being addressed regularly. Less commonly-identified deficiencies may be indicative of dietary adjustments that are working.
Increased energy: Nourishing yourself regularly will support more restful sleep and energy levels can also improve.
Improved digestion: Reduced bloating, bathroom urgency,, and stomach discomfort can be signs of improved digestion
Improved quality of life: Able to eat out with your friends? Feeling confident when it comes to ordering off of a menu? Do you know how to pivot IF a flare-up resurfaces to nourish your body through it? Are you able to participate rather than isolate when it comes to food-centric celebrations in your life?
Some people may find that no matter what they eat, they still don’t find symptom relief from UC. Targeting inflammation is the highest priority to decrease risk of progression and/or colorectal cancer, and sometimes medications may be needed for this process.
Nutrition can still be a powerful tool for improving a quality of life, decreasing risk for progression, supporting a body to help heal from active disease flares, and decreasing the risk of developing complications and/or other diseases. Nutrition, no matter which stage of UC you find yourself in today, should always be personalized. Whether you find yourself in symptom and disease remission, or you’re currently in a flare-up, nutrition for UC is still worth pursuing.
Stacey Collins Nutrition - Virtual Colitis Nutrition Support
Nutrition Guidance, Support And Education From A Dietitian Who Gets It.
If you need help managing what foods to eat with colitis, I can create a personalized nutrition plan tailored to your needs. Book an online appointment with me to start a journey toward better digestive health and quality of life.
Managing UC doesn't have to be overwhelming, especially with proper support to make nutrition take up less mental space through sustainable, practical interventions. Thoughtful, well-planned diet and nutrition can make all the difference in reducing symptoms and improving your overall well-being. Let's work together to create a path forward that works for you!
References:
Nutrition can support medications:
Andersen V, Hansen AK, Heitmann BL. Potential Impact of Diet on Treatment Effect from Anti-TNF Drugs in Inflammatory Bowel Disease. Nutrients. 2017
Fiber is still needed in a flare:
Yusuf K, Saha S, Umar S. Health Benefits of Dietary Fiber for the Management of Inflammatory Bowel Disease. Biomedicines. 2022;10(6):1242. Published 2022
Milajerdi A, Ebrahimi-Daryani N, Dieleman LA, Larijani B, Esmaillzadeh A. Association of Dietary Fiber, Fruit, and Vegetable Consumption with Risk of Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis. Adv Nutr. 2021
Millet:
Yang R, Shan S, An N, et al. Polyphenols from foxtail millet bran ameliorate DSS-induced colitis by remodeling gut microbiome. Front Nutr. 2022
Muscle-health and IBD:
Dhaliwal A, Quinlan JI, Overthrow K, et al. Sarcopenia in Inflammatory Bowel Disease: A Narrative Overview. Nutrients. 2021;13(2):656. Published 2021
Greek yogurt:
Kempinski R, Arabasz D, Neubauer K. Effects of Milk and Dairy on the Risk and Course of Inflammatory Bowel Disease versus Patients' Dietary Beliefs and Practices: A Systematic Review. Nutrients. 2024
Omega-3 from fatty fish:
Scaioli E, Salice M, Belluzzi A. Omega-3 as a Part of the Dietary Guidance for Patients with Ulcerative Colitis: Beyond the Natural Sources. Clin Gastroenterol Hepatol. 2021
Omega-9 from olive oil:
Farag MA, Gad MZ. Omega-9 fatty acids: potential roles in inflammation and cancer management. J Genet Eng Biotechnol. 2022;20(1):48. Published 2022
Dairy:
Kempinski R, Arabasz D, Neubauer K. Effects of Milk and Dairy on the Risk and Course of Inflammatory Bowel Disease versus Patients' Dietary Beliefs and Practices: A Systematic Review. Nutrients. 2024
Ratajczak AE, Rychter AM, Zawada A, Dobrowolska A, Krela-Kaźmierczak I. Lactose intolerance in patients with inflammatory bowel diseases and dietary management in prevention of osteoporosis. Nutrition. 2021
Higher-fat foods:
Barnes EL, Nestor M, Onyewadume L, de Silva PS, Korzenik JR; DREAM Investigators. High Dietary Intake of Specific Fatty Acids Increases Risk of Flares in Patients With Ulcerative Colitis in Remission During Treatment With Aminosalicylates. Clin Gastroenterol Hepatol. 2017
Coffee:
Kositamongkol C, Kanchanasurakit S, Auttamalang C, et al. Coffee Consumption and Non-alcoholic Fatty Liver Disease: An Umbrella Review and a Systematic Review and Meta-analysis. Front Pharmacol. 2021;12:786596. Published 2021 Dec 13. doi:10.3389/fphar.2021.786596
Spicy foods:
Y Chen, C Ma, Y Dang, K Chen, S Shen, M Jiang, Z Zeng, H Zhang, P082 Spicy food is a vital trigger for relapse in patient with inflammatory bowel disease, Journal of Crohn's and Colitis, Volume 14, Issue Supplement_1, January 2020
