In this article, we look at ulcerative colitis, an idiopathic bowel disease, and how diet contributes to both its onset and management.

What is Ulcerative Colitis?

Ulcerative colitis is a chronic inflammatory disease of the colon of unknown cause, characterized by periods of exacerbation and remission. The severity and progression of the disease vary from person to person. The main symptoms during exacerbation are abdominal pain, diarrhea, and blood in the stool.

Risk Factors for Ulcerative Colitis

The exact cause of ulcerative colitis is unknown; however, several factors are associated with an increased risk of developing it. Some of these factors include:

• Smoking
• Obesity
• Diet: A diet rich in highly processed foods, red meat, saturated and trans fatty acids, and low in fruits, vegetables, and fiber has been associated with an increased risk of developing the disease.

Effects of Ulcerative Colitis

During periods of exacerbation, there is a risk of malnutrition. Malnutrition can result from:

• Reduced food intake due to anorexia caused by inflammation
• Increased nutrient requirements due to malabsorption
• Interaction of food with certain medications

Nutritional Treatment of Ulcerative Colitis in Remission

• A healthy dietary pattern with adequate calories, macronutrients, and micronutrients is recommended. A good choice is a Mediterranean-type diet that meets the individual's needs. Specifically, a diet that includes a variety of fruits and vegetables, fish, lean chicken, and olive oil as the main fat source is recommended. Red meat, sweets, and packaged foods should not be consumed frequently.
• It is recommended to avoid foods containing trans fatty acids (processed foods) and those high in ω-6 fatty acids (nuts, seeds, tofu and soy, vegetable oils).
• If there is an intolerance to certain foods (often dairy, herbs, spices, fried foods, gas-causing foods, and high-fiber foods), they should be removed from the diet temporarily and then reintroduced gradually.
• Supplementation is recommended in case of micronutrient deficiencies, mainly zinc, vitamin D, and folic acid.

Nutritional Treatment of Ulcerative Colitis During Exacerbation

An individualized diet is recommended to ensure good nutritional status and alleviate symptoms. Specifically, it is recommended to:

• Eat small, frequent meals
• Maintain adequate hydration
• Eat protein-rich foods such as fish and chicken
• Eat starchy foods such as potatoes and rice
• Avoid dietary fiber, including fruits with skin, vegetables, and whole grain products
• Avoid spicy and fried foods
• Avoid spices
• Avoid gas-causing foods such as broccoli, cauliflower, and legumes

Finally, as during remission periods, it is recommended to administer micronutrient supplements when deficiencies are present, as well as probiotics to induce remission.

Artificial Nutrition in Ulcerative Colitis

Enteral nutrition is used to prevent and treat deficiencies or malnutrition, usually during exacerbation, and to achieve remission in pediatric patients. Parenteral nutrition is administered when enteral nutrition is not tolerated or does not achieve satisfactory growth in children.

Bibliography

Bischoff SC, Bager P, Escher J, Forbes A, Hébuterne X, Hvas CL, Joly F, Klek S, Krznaric Z, Ockenga J, Schneider S, Shamir R, Stardelova K, Vranesic Bender D, Wierdsma N, Weimann A. ESPEN guideline on Clinical Nutrition in inflammatory bowel disease. Clin Nutr. 2023 Mar;42(3):352-379. doi: 10.1016/j.clnu.2022.12.004. Epub 2023 Jan 13. PMID: 36739756.