Ulcerative colitis, or UC, is a chronic inflammatory bowel disease that occurs mainly in the colon and rectum. The inflammation destroys the intestinal mucosa. The onset of UC usually occurs between the ages of 15 and 30. Both men and women are affected equally, and family history is the most significant risk factor.
Causes and Symptoms
The real cause of UC is unknown. The immune system of UC patients is unable to react normally to bacteria in the digestive tract. Certain foods or emotional distress may trigger UC but are not the causes. Symptoms of UC include bloody diarrhea, abdominal pain, fever, weight loss, arthritis and inflammation of the eye.
Treatment
Treatment options for UC can include antibiotics, immunosuppressive medications, immunomodulators and surgery. The medication options help treat acute infections or control or reduce inflammation. The common surgical procedure for ulcerative colitis is a total colectomy, in which all of the colon is removed. Surgical interventions are indicated if there is a perforation, obstruction or abscess.
Nutrition Implications
Ulcerative colitis has several nutrition implications. Diarrhea can result in malabsorption of all nutrients. Abdominal pain results in decreased consumption. Pain may also contribute to poor appetite. Deficiencies in iron, zinc, magnesium and electrolytes are common due to losses with diarrhea. Due to these implications, protein, energy and micronutrients requirements are increased.
Nutrition Therapy for Exacerbation
When a flare-up of ulcerative colitis occurs, parenteral or enteral nutrition may be necessary in severe cases. Parenteral nutrition is nutrition that is administered directly into the circulatory system. Enteral nutrition is feeding to the gastrointestinal tract through a tube which delivers nutrition beyond the oral cavity. The amount of weight loss or presence of infection will help to determine calorie and protein needs. Protein needs may be as high as 1.5 to 1.75g per kilogram body weight.
Oral Diet
Once an oral diet can be started during or after an exacerbation, the diet should be low in fiber and lactose-free. Foods recommended include well-cooked meat, poultry, fish or eggs. Breads, cereals and pastas made with white or refined flour are recommended. Most well-cooked vegetables without seeds can be eaten. Bananas, melons, peeled apples and fruit juice without pulp are recommended. Limit fats and oils. Caffeine, spicy and fried foods should be avoided. Eat several small meals throughout the day and get plenty of fluids to prevent dehydration. Add foods back into your diet as you can tolerate them. Taking a multivitamin is also recommended.
Nutrition Therapy for Remission
During periods of remission of UC, you should maximize your calorie and protein intake. If you have experienced weight loss, gaining weight should be your main goal. Antioxidant-rich foods such as fruits and vegetables are recommended. Omega-3 fatty acids are recommended and can be found in foods such as tuna, salmon and nuts. Nutrition therapy can be very individualized, but a variety of foods is recommended if you can tolerate them.
References
- National Digestive Disease Information Clearinghouse: Ulcerative Colitis.
- "Nutrition Therapy and Pathophysiology"; Marcia Nelms, Kathryn Sucher, Sara Long; 2007
- Crohn's and Colitis Foundation of America: Diet and Nutrition.
