Ulcerative Colitis Diet: Foods to Eat and Avoid and Sample Menu

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Ulcerative colitis (UC) is an inflammatory condition that affects the colon or large intestine.

Symptoms generally include diarrhea, abdominal pain, the urgency to pass stool, and feelings of incomplete bowel evacuation.

The specific cause of UC remains unknown, but diet is thought to play a role in its development and can also be used to manage UC symptoms.

This article explains what to eat and avoid with ulcerative colitis and provides a sample ulcerative colitis diet menu.

What is ulcerative colitis?

UC is the most common form of inflammatory bowel disease (IBD) worldwide (1).

IBD is an umbrella term used to describe inflammatory disorders that affect the digestive tract. Crohn’s disease is the other major type of IBD.

UC only affects the colon or large intestine, whereas Crohn’s disease can affect any region of the digestive tract.

UC usually develops between the age of 15 and 30 years but it can develop in later years too (1).

The main symptom of UC is bloody diarrhea, with other symptoms like stomach pain, unintentional weight loss, fatigue, a feeling of incomplete bowel evacuation, and urgency to pass stool also occurring to varying degrees (1).

It’s common for people with UC to experience flare-ups, during which these symptoms temporarily worsen, as well as periods of remission, during which they disappear.

Approximately 25% of people with UC will require a colectomy, a type of surgery that removes severely inflamed or damaged portions of your colon (2).

This procedure may be done in conjunction with an ileostomy, which is done by creating a new opening in your body called a stoma to help pass stool.

The cause of UC remains largely unknown, but several genetic and environmental factors are thought to play a role in its development by altering the composition of the bacteria that colonize the intestines or by compromising the body’s immune response and intestinal barrier, resulting in leaky gut (1).

UC is a lifelong disorder and there is currently no cure. Instead, treatments focus on managing symptoms, primarily with medications, but also diet.

Types of diets for ulcerative colitis

Diet is an important environmental risk factor for UC.

Specifically, the Western — or standard American diet (SAD) — diet has been strongly associated with the development of UC (3, 4).

The Western diet is generally characterized by high intakes of pre-packaged foods, refined carbohydrates, processed meats, fried foods, and added sugars from sugar-sweetened beverages.

These foods tend to be pro-inflammatory and disrupt the gut microbiota, causing an imbalance in its composition.

The Western diet is also very low in fiber, which reduces microbial diversity and encourages a more inflammatory environment that can lead to small intestinal bacterial overgrowth (SIBO) (5).

Conversely, several diets have been suggested to reduce intestinal inflammation and alleviate symptoms.

These diets include:

• Low-FODMAP diet: This diet limits fermentable carbohydrates, including oligo-, di-, and monosaccharides and polys (FODMAPs).
• Specific carbohydrate diet (SCD): This diet limits all grains, sugars, and most milk products and processed foods.
• The GAPS diet: This diet is based on the specific carbohydrate diet and limits many of the same foods.
• Autoimmune protocol (AIP) diet: This is a paleo-type diet that eliminates foods thought to trigger inflammation, especially Western diet foods.

These diets are considered elimination diets because they involve eliminating specific foods or ingredients that are thought to trigger symptoms.

However, studies have found mixed results with these diets for decreasing inflammation and achieving remission of symptoms (6, 7, 8).

As such, there is no single best diet that works for everyone since UC affects people differently (9).

Still, there are some best practices that you can implement and individualize to fit your needs, ideally with the help of a registered dietitian.

Best diet practices of UC

Diet recommendations are generally based upon whether you’re experiencing an active flare-up or if your symptoms are in remission.

Active symptoms

There is insufficient evidence to recommend a specific diet for promoting remission during active UC.

However, you should consume more protein to support the immune system, reduce muscle loss, and alleviate some of the negative side effects of medications.

Aim to consume protein in the range of 0.55–0.68 grams (1.2–1.5 grams per kilogram) of body weight (9).

This equates to 83–102 grams of protein per day for a 150-pound (68.2-kg) person.

Animal-based proteins like fresh beef, pork, poultry, and seafood are generally well-tolerated.

Dairy like milk, yogurt, and cottage cheese are also good protein sources to eat if you’re not lactose intolerant.

Some plant-based protein sources such as beans, peas, nuts, and seeds are tolerated by some people, otherwise, you might try following a bland diet.

Beyond increasing your protein intake, you should consume an overall healthy diet rich in fruits, vegetables, and whole grains that you can tolerate.

Avoid or limit foods that tend to be pro-inflammatory and may worsen your symptoms, such as processed meats, fried foods, sugar-sweetened beverages, and refined grains like biscuits, crackers, desserts, and pastries.

Taking a specific probiotic that contains Lactobacillus reuteri (VSL#3) during periods of active UC to promote remission (9).

You can find this probiotic on Amazon.

Remission

When you aren’t experiencing active symptoms, continue to follow a healthy diet while restricting foods to which you may be intolerant.

Common food intolerances in people with UC include (10, 11):

• Fruits: apples, kiwifruit, oranges, limes, lemons, grapefruit
• Vegetables: cabbage, broccoli, corn, garlic, onion
• Grains: wheat, whole-grain bread, popcorn
• Dairy: ice cream, milk, cream
• Other items: fried foods, chili, chocolate, pizza
• Beverages: alcohol, coffee, fruit juice

Although the food additive carrageenan is thought to trigger UC-related symptoms, there is no strong evidence to support this (11).

Remember, UC affects everyone differently so you may still be able to tolerate these foods in certain amounts or in no amount at all.

Although fiber-rich foods like certain fruits, vegetables, and whole grains may be poorly tolerated by some, you should aim to consume as much of these foods as you comfortably can since fiber promotes gut health and decreases intestinal inflammation (12).

Beyond fiber, these foods also provide a variety of beneficial plant compounds called polyphenols, which possess powerful antioxidant and anti-inflammatory effects.

Diets rich in fruits, vegetables, and whole grains have also been associated with a lower risk of colon cancer, which is important since people with ulcerative colitis are at a greater risk for developing colon cancer (13).

You should also avoid limiting or restricting dairy products — specifically milk and yogurt — if you can tolerate them since they are good sources of vitamin D, calcium, vitamin B12, and protein.

But if you are sensitive to dairy, unsweetened fortified soy milk is a good alternative and provides similar amounts of these nutrients.

Continued supplementation with Lactobacillus reuteri (VSL#3) is also recommended while in remission (9).

3-day sample ulcerative colitis diet

Here’s a 3-day sample UC diet during remission:

Day 1

• Breakfast: spinach omelet and oats made with soy milk
• Lunch: herbed chicken caesar salad
• Snack: avocado toast and grapes
• Dinner: pork tenderloin, quinoa, and sauteed carrots

Day 2

• Breakfast: blueberries and cream of rice made with soy milk
• Lunch: angel hair pasta with shrimp and mixed veggies
• Snack: peanut butter and banana wrap
• Dinner: pot roast with carrots and potatoes

Day 3

• Breakfast: Greek yogurt and peach slices
• Lunch: salmon patties with a tomato and cucumber salad
• Snack: hard-boiled eggs and sugar snap peas
• Dinner: baked salmon, white rice, and sauteed green beans

Use this sample menu to help guide your food choices.

You may be unable to tolerate some of these foods but aim to include as many fruits, vegetables, whole grains, and lean proteins as you can to promote a healthy gut and reduce your risk of colon cancer.

The bottom line

UC is a type of inflammatory bowel disease that affects the colon.

Still, UC affects everyone differently so an individualized diet approach is necessary for symptom management.

Aim to increase your protein during active UC and follow a healthy diet while excluding or limiting foods to which you are intolerant.

You should continue to follow a healthy diet and avoid food to which you are intolerant while in remission as well.