Ulcerative colitis, a subcategory of inflammatory bowel disease, is a chronic inflammatory disease in which the large intestine becomes inflamed and ulcerated, leading to episodes of bloody diarrhea, fever, abdominal cramps and sometimes severe pain. Unlike Crohn’s disease, ulcerative colitis usually doesn’t affect the full thickness of the intestine and never affects the small intestine. The disease usually begins in the colon or rectum and spreads partially or completely through the large intestine.
Although the exact cause of ulcerative colitis remains undetermined. Many physicians claim that there is no cure for UC, however most patients can keep their condition under control with medication, diet, and/or supplements. The condition appears to be related to a combination of genetic, dietary and environmental factors. Conventional treatment seeks to reduce inflammation and replace lost fluids or nutrients, and although it can be effective in maintaining remission and decreasing the length of active disease periods, the treatment is not without side effects, and a significant number of patients fail to respond to even the strongest drugs. Naturopathic physicians claim that natural therapies can not only control symptoms of UC but can sometimes heal the injured intestines.
Unlike Crohn’s disease, ulcerative colitis can affect any part of the inner most lining of the colon. Diarrhea can occur 4 times a day with mild tenderness and lower abdominal cramping. Some blood can show in the stool and fatigue can ensue as a result of excessive blood loss and anemia. A physical examination usually shows peri-anal irritation, fissures, hemorrhoids and abscesses. Weight loss occurs in severe cases as appetite is often decreased during periods of disease exacerbation.
Consumption of a “Western diet” may increase the risk for ulcerative colitis. Some suggestions are: Some common-sense dietary suggestions include:
- Eliminate excess refined sugar to minimize dysbiosis (eradicated bowel flora).
- Severely limit the intake of alcohol, caffeine and soft drinks (including aspartame).
- Limit consumption of raw fruits and vegetables since they may irritate the lining of the large intestine.
- Desensitize and/or eliminate food allergies, especially dairy products, wheat gluten, eggs and white flour. Utilize the ELIMINATION DIET.
- Cow’s milk and cheese may severely increase symptoms (due to antibodies to the principal cow’s milk protein), and the patient should try avoiding it.
- Patients are encouraged to eat the FDA-recommended amount of fish each week for the anti-inflammatory effects and the additional health benefits from omega-3 fatty acids.
- Attempt to consume more whole grains, fiber-rich foods, legumes, and green and yellow vegetables (juicing is helpful). Fiber can be therapeutically beneficial for people with UC. Diets low in fiber increase risk.
- Attempt to eat more easily digestible foods since ulcerative colitis is associated with low pancreatic enzyme secretion.
Long-term nutritional deficiencies are a serious concern for these patients. They should supplement with extra minerals, vitamins and amino acids. Loss of appetite and weight are additional concerns. Maintain an adequate calorie intake. Since patients with ulcerative colitis have an increased risk of getting colon cancer, a high fiber diet with additional folate is recommended and protective.
It is estimated that 1-2 million Americans suffer with IBD; approximately half of those have ulcerative colitis. The diagnosis appears to affect men and women equally. Osteoporosis is a serious complication of inflammatory bowel disease. Loss of electrolytes and nutrients because of excessive and prolonged diarrhea can leach out calcium and magnesium over time.
There has been some discovery that susceptible genes for ulcerative colitis on chromosomes 1 and 4, although these loci have not been uniformly confirmed.
Among the environmental and pathological factors are increases in inflammatory mediators, signs of oxidative stress (from free-radicals causing loss of antioxidants), increased intestinal permeability and increased sulfide production.
While it has been hypothesized that ulcerative colitis is a T-helper cell (Th1) dominated immune reaction, there is evidence that T-helper cell 2 (Th2) is also present.
Non-steroidal anti-inflammatory drugs (NSAIDS) are believed to cause colitis as well as exacerbate existing disease by increasing permeability and contributing to colon bleeding.
PROBIOTIC SUPPORT An abnormal host immune response to certain intestinal microflora is believed to play a part in the pathogenesis of UC. Colitis patients have reduced amounts of healthy bacteria in their gut and giving them extra helpings of friendly bacteria has proven effective in managing UC. Probiotics help control the number of potentially harmful bacteria, reduce inflammation and improve the integrity of the colon’s protective lining. Probiotic bacteria may include Lactobacillus and Bifidobacteria. Dosage: 1-2 capsules between meals 3-4 times a day, as directed.
ESSENTIAL FATTY ACIDS Changes in omega-3 and omega-6 fatty acid profiles have been observed in ulcerative colitis patients. These changes may influence fatty acid synthesis by colon tissue potentially playing a part in disease pathogenesis. The DHA component of EFA’s has the best anti-inflammatory action. Dosage: 4-8 capsules a day (4-10 grams) helps to decrease inflammation and aid in lubrication of the intestines.
MULTIPLE VITAMIN-MINERAL FORMULA Taking a daily multiple vitamin-mineral formula is recommended by all health professionals. Because UC may have poorer digestion it may be advantageous for the patient to take a whole-food vitamins or powder. Dosage: As directed.
VITAMIN C and QUERCETIN (BIOFLAVONOIDS) In addition to the antioxidant activity of vitamin C to reduce oxidative stress, vitamin C also decreases the inflammatory process associated with UC and improved tissue recovery. Dosage: 500-2,000mg daily. Buffered C preferred. The bioflavonoid QUERCETIN has reduced lesions and colon surface damage. Its anti-inflammatory actions, mast cell stabilizing, and free-radical scavenger properties are acute. Dosage: 100-500 mg daily.
VITAMIN A and CAROTENOIDS Retinol and carotenoids (naturally sources of vitamin A) play an essential role in enhancing the mucosal integrity of the gut. One study found that beta-carotene was the carotenoid most significantly reduced in ulcerative colitis. Lycopene also significantly reduced signs of inflammation. Dosage: 10,000-25,000 IU daily.
BOSWELLIA and CURCUMIN Boswellia and Curcumin are both COX-2 anti-inflammatory herbs from India that has been shown to perform as well as the prescription drug sulfasalazine on some patients with severe UC. The active ingredient in boswellia has been found to block the chemical reactions involved in inflammation in the body. Curcumin supplementation has been shown to help maintain remission in patients with UC. Dosage: Boswellia up to 900mg daily. Curcumin 1,000 mg after breakfast and dinner.
MELATONIN The amount of melatonin found in the GI tract is 10-100 times the amount found in the blood. While there have been no clinical studies to confirm its efficacy, melatonin may provide some efficacy in ulcerative colitis. Dosage: Higher doses are need, see qualified practitioner.
ALOE VERA GEL (JUICE) Ingestion of high-quality aloe vera juice helps to soothe mucous membrane lining and improve over all digestion an d healing of the entire intestinal tract. Studies have also found that aloe has an anti-inflammatory effect. Aloe vera has a laxative effect so avoid during episodes of diarrhea. Dosage: 1 or tablespoons once or twice a day. Taper off after a month.
DEHYDROEPIANDROSTERONE (DHEA) Hormonal levels of DHEA have been found to be low in people with chronic inflammatory conditions. DHEA, at least in animal studies, has been shown to inhibit pro-inflammatory cytokines, providing a potential benefit.
DHEA and PREGNENOLONE are sex hormones that are precursors to other male and female hormones and have been found to be in low in levels in patients with ulcerative colitis. Dosage: As directed by a qualified practitioner.
MAGNESIUM Deficiency of this vital mineral is prevalent in ulcerative colitis. UC inherently causes malabsorption and increased intestinal loss of magnesium. Higher magnesium intake relaxes the stomach and GI muscles and has been shown to reduce the risk of inflammatory bowel disease. Dosage: 400-800 mg per day.
GLUTAMINE In addition to being the main fuel source for the mucosal cells in the ileum, glutamine may decrease the severity of colitis without altering mucosal absorption capacity. Dosage: As directed on label.
WHEAT GRASS JUICE A juice produced from wheat harvested much earlier in its life cycle than regular wheat. Studies have shown that it has the ability to improve overall disease activity, including severity of rectal bleeding and abdominal pain. Dosage: 20-100 ml daily.
VITAMIN E Vitamin E levels have been found to be low in some patients with IBD. Vitamin E supplementation may decrease oxidative stress. Use primarily Gamma-E. Dosage: 200-800 IU per day.
FOLIC ACID Patients with UC generally have low levels of B-complex vitamins in their blood. A deficiency of folic acid may be associated with high homocysteine levels often seen in UC patients. Individuals with UC have an increased risk of developing colon cancer compared to the general population. Studies have shown that folate supplementation decreases this risk. Folic acid status is often low in UC patients due to reduced dietary intake, diarrhea, and the drug sulfasalazine. Dosage: 400 mcg to 1 gram daily.
PHOSPHATIDYLCHOLINE Phosphatidycholine seems to prevent collagen deposits on the inflamed colon. PI supplementation may result in significant mucosal recovery and decreased permeability. Dosage: As directed on package.
BROMELAIN Bromelain is a proteolytic enzyme derived from pineapple that has anti-inflammatory characteristics that may benefit UC patients. Dosage: Take 1-3 capsules 10-15 minutes before larger meals to aid in digestion.
CALCIUM CITRATE A deficiency of calcium is most likely due to decreased dietary intake, malabsorption, corticosteroid treatment and vitamin D deficiency. Dosage: 500-1,000 mg daily. The citrate form is preferred over the carbonate form.
ZINC Because zinc is important for the impact of vitamin A metabolism, zinc deficiency may exacerbate IBS symptoms. Dosage: 10-50 mg daily.
IRON Iron deficiency and anemia are frequently associated with UC due to chronic GI bleeding. Dosage: 30-60mg daily.
DIMERCAPTOSUCCINIC ACID (DMSA) DMSA is a non-toxic, water-soluble treatment for most heavy metal toxicity. DMSA is an effective chelator of metals stored in the gut, and may decrease the absorption and whole body retention of the metal. DMSA has been used to treat ulcerative colitis. Dosage: Must be under the supervision of a qualified practitioner.
VITAMIN K Inflammatory bowel disease has also been shown to be associated with vitamin K deficiency. Vitamin K deficiency also leads to lower levels of vitamin E. Dosage: 500mcg- 1 mg daily.
COLOSTRUM This pre-milk from cows has been used to ease irritable bowel that may be associated with UC. Dosage: As directed on package.
Barbieri, K. Ultimate Ulcer. Energy Times, January 2007. 17(1): 14-15.
Boswellia and Ulcerative Colitis. Medi Herb Monitor. No. 25, March 1998. Brochure.
Dean, W. Customers’ Corner, July 2005. www.vrp.com
Disease Prevention and Treatment. (Third edition). Life Extension Foundation, Hollywood, FL 2000.
Dorren, R. Health Strategies for Ulcerative Colitis. Alive #270, March 2005. pp 62-63.
Gaby, AR. Literature Review and Commentary. Townsend Letter #287. June 2007. P. 52.
Head, KA, Jurenka, JS. Inflammatory Bowel Disease Part I: Ulcerative Colitis. Alternative Medicine Review, August 2003. 8(3):247-278.
Nutriceutica data base. The JAG GROUP. 1993-1999.