We’re not going to sugarcoat it: Ulcerative colitis (UC) can be erratic and hard to manage. This inflammatory bowel disease (which is also an autoimmune disease, in which the immune system mistakenly attacks your own body) causes inflammation and ulcers to develop on the inner lining of the colon, or large intestine, which can cause diarrhea, abdominal pain and cramping, bloody stools, and other debilitating symptoms.
UC is characterized by periods of symptoms (known as flare-ups) followed by periods of remission in which you’re symptom-free for anywhere from a few days to a few years. Technically, there’s no cure for ulcerative colitis, but medication can help manage it, and you can significantly minimize flare-ups and extend remission with strategic diet and lifestyle tweaks. Read on for more information on ulcerative colitis and the natural remedies that may combat these painful symptoms.
What are the symptoms of an ulcerative colitis flare-up?
An ulcerative colitis flare-up refers to the return of symptoms after a period of remission. During this time, there is significantly increased inflammation in the colon, which can lead to the formation of ulcers and aggravate existing ulcers. According to the Crohn’s & Colitis Foundation, symptoms of ulcerative colitis flare-ups may include:
- Loose and urgent bowel movements
- Bloody stool
- Mucous in stool
- Abdominal cramps and pain
- Loss of appetite
- Low energy and fatigue
What causes ulcerative colitis flares?
It’s not always super clear what brings on a flare—and it can be different for everyone—but your diet, stress levels, and certain medications may all contribute. Here are some common triggers:
- Certain foods and beverages: While research doesn’t suggest that specific foods cause ulcerative colitis in the first place, certain foods can exacerbate UC and contribute to flare-ups—particularly those that are pro-inflammatory or promote permeability of the gut lining such as highly processed carbohydrates, added sugars, and alcohol, says Cori Cohen, a New York-based health coach and registered dietitian with Parsley Health. It’s good to scale back on these foods, but keep in mind, food triggers can also be unique to the individual. This is why keeping a food/symptom journal is so helpful.
- Stress: Like food, stress is not believed to cause UC, but it can exacerbate it. High-stress levels can stimulate the immune system and contribute to chronic inflammation, both of which may contribute to an ulcerative colitis flare. In one study of ulcerative colitis and Crohn’s disease patients, 45 percent of those who experienced a relapse said they’d been exposed to “quite a lot of stress” the day prior.
- NSAID pain relievers: Non-steroidal anti-inflammatories (NSAIDs) such as aspirin, ibuprofen, and naproxen may also contribute to flares. These drugs can be irritating to the gastrointestinal tract and should be avoided with UC, according to the Crohn’s & Colitis Foundation. Tylenol is generally considered a more GI-friendly OTC pain reliever.
- Missing your meds: Medication is often needed to keep UC symptoms in check, and missing a dose, even when symptoms are in remission, may result in a flare-up. This is why it’s so important to have a team—like the docs and health coaches at Parsley Health—managing your care plan and guiding you on if/when it’s ever appropriate to wean off medication (and yes, it is possible in some cases, says Cohen).
How to prevent ulcerative colitis flare-ups
What are actionable steps you can take to make your symptom-free stretches last as long as possible? “Nutrition and stress management are probably the two biggest things as far as prevention goes,” says Cohen. Parsley Health providers and health coaches often work with members who have ulcerative colitis to find a diet that helps them minimize flares and a stress management routine. Below, we’ll dive into some specific ways to optimize your diet with natural remedies and make adjustments to your lifestyle while living with ulcerative colitis.
1. Eat an anti-inflammatory diet with plenty of veggies.
Because inflammation is at the root of inflammatory bowel diseases like ulcerative colitis, eating to minimize inflammation is key. In fact, research suggests that an IBD anti-inflammatory diet—which encourages the intake of prebiotics (fiber-rich plant foods and legumes), probiotics (fermented foods), and omega-3 fats to restore intestinal flora—may ease symptoms. In addition to scaling back on pro-inflammatory added sugars and highly processed carbs, there are two big ways to up the anti-inflammatory power of your diet, according to Cohen: Ramping up your veggie intake and focusing on the right fats (easy natural remedies).
“At a minimum, you want to be having three servings of vegetables per day, since low vegetable intake is associated with a higher incidence of UC,” says Cohen. Vegetables contain a range of polyphenol antioxidant compounds to fight inflammation, along with digestion-supporting fiber.
And as for fat, “make sure you’re limiting omega-6s from processed seed and vegetable oils and getting enough omega-3s, which are anti-inflammatory,” says Cohen. Most Western diets are sky-high in omega-6s and low in omega-3s, and this imbalance in essential fatty acids can promote inflammation. Get your fill of omega-3s from fatty fish like salmon and sardines, walnuts, chia seeds, flaxseeds, and hemp seeds, or consider a supplement.
2. Prioritize gut-supporting nutrients.
No single nutrient or supplement is a magic bullet for keeping UC flares at bay, but anything that reduces inflammation in the gut, helps repair and heal the gut’s epithelial lining, and fosters growth of healthy gut bacteria may be helpful, explains Cohen. Your veggie-heavy, anti-inflammatory diet will help, but these nutrients (which you can find get via food or supplements) may provide an extra boost for gut health:
- Probiotics, naturally found in fermented foods, are a good maintenance tool for promoting gut microbial balance.
- Turmeric is a powerful spice that contains the potent antioxidant compound curcumin to help combat both chronic inflammation and gut inflammation.
- L-glutamine is the primary fuel source for cells lining the intestinal wall and has been shown to help reduce hyperpermeability of the gut lining. Collagen powder and bone broth both contain this powerful amino acid.
If you want to start a supplement, talk to your healthcare provider. Parsley Health’s doctors create specific supplement protocols for each member based on the results of advanced testing.
3. Implement stress-busting practices.
Whether you’re dealing with a bad relationship, toxic job, lack of sleep, or even a medical scare, they can all trigger a stress response in the body that initiates a flare-up. While you can’t always control these stressors, you can combat the physiological effects they have on your body. Simple natural remedies to lower stress or mitigate its effects include going to bed at a reasonable hour (and on a consistent schedule), meditating, deep breathing, practicing yoga, going for a hike, or doing anything that brings you pure joy. Feeling stuck? Think about an activity that you do where time seems to stand still and you’re completely absorbed in the moment—that’s the ideal stress-buster!
4. Keep a food and symptom journal.
A key part of preventing flare-ups is knowing your personal ulcerative colitis triggers, which can vary from person to person. “Some people are triggered by gluten and dairy, while some people aren’t—so it’s important to identify what specific foods trigger you,” says Cohen. “Keeping up a food and symptom journal can be really helpful.”
Start jotting down what you eat and drink in a notebook so you can identify foods and beverages that may be causing flares to occur. If you start to see a pattern emerge, you can try eliminating that food/drink for a while to see if you get some relief. Parsley Health doctors and health coaches can guide you through the appropriate way to eliminate and reintroduce foods and help you identify triggers.
What to do during an ulcerative colitis flare to minimize symptoms
You’ll inevitably experience another UC flare-up at some point, despite your best prevention efforts. When this happens, there are a few ways you’ll need to tweak your normal routine to minimize the severity of your symptoms and get back into remission ASAP. Even some of your typically healthy habits like loading up on veggies may be a no-go. Here are a few natural remedies that may help:
1. Cut out raw veggies and other gut irritants.
In the midst of a ulcerative colitis flare, you want to be as gentle on your digestive system and colon as possible. “Give your gut a little vacation,” says Cohen. This ideally means eliminating or scaling back on: raw vegetables, raw and cooked fruits, high-fat foods (e.g. fatty cuts of meat), high fiber foods (e.g. beans, lentils, whole grains), spicy foods, alcohol, and caffeinated beverages. Basically, any food that takes significant digestive effort or stimulates the bowels.
2. Opt for easy-to-digest foods.
Focus on getting the bulk of your nutrition from cooked vegetables and easy-to-digest proteins like fish, lean meats, and eggs. Consuming some meals in the form of soups made with bone broth (which contains L-glutamine), smoothies, and veggie purees is also a great idea, says Cohen. These are much less abrasive on the gut and take less energy to digest. This allows energy to be diverted to more urgent matters, like healing the gut and taming inflammation.
2. Eat smaller meals.
Large meals can overstimulate the bowel and make ulcerative colitis symptoms like diarrhea worse. Keep meals on the smaller side and never eat until you’re stuffed. The Crohn’s & Colitis Foundation recommends 4-6 small meals per day as opposed to three larger meals.
3. Hydrate, hydrate, hydrate.
Because ulcerative colitis flares are accompanied by diarrhea, dehydration is a real concern. And while you don’t want to chug water, since this could further stimulate diarrhea, you do want to sip on liquids throughout the day—ideally liquids with electrolytes like coconut water or bone broth, says Cohen. Electrolytes may become depleted after bouts of diarrhea, but they are essential for maintaining proper hydration and fluid balance in the body.
4. Find ways to chill out.
All of the stress-busting suggestions above are extra important when you’re in the midst of a flare-up. Cohen also recommends implementing deep breathing exercises before every meal, as this “relaxes your body and mind allows you to digest more optimally.” And, since you’ll be eating 4-6 smaller meals, this is a great way to get a dose of calm at multiple points in the day.
Why working with a qualified care team is so important when it comes to managing ulcerative colitis
People being treated for UC typically aren’t getting dietary or lifestyle advice, which is a huge disservice, says Cohen. But managing ulcerative colitis and preventing (or at least delaying) flare-ups can be done! You just might need a little help from the experts.
Because UC isn’t one-size-fits-all and triggers are highly individual, enlisting the help of a care team like the clinicians at Parsley Health is wise. Providers can provide individualized supplement protocols based on lab testing, customized eating plans for periods of remission and flares, and communicate with your current GI doctor if necessary to streamline care.