ULCERATIVE COLITIS

Visit The Healthy Living Bookshelf:

21 Online Health Books From Rodale

View Our Related Product Sections:

Boswellia
Folic Acid
Psyllium

Checklist for Ulcerative Colitis

Rating	Nutritional Supplements	Herbs
	Butyrate (enema) Fish oil Folic acid Probiotics	Boswellia Psyllium
		Aloe Calendula Chamomile Flaxseed Licorice Marshmallow Myrrh St. John’s wort (oil, taken as an enema) Yarrow
Reliable and relatively consistent scientific data showing a substantial health benefit. Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit. An herb is primarily supported by traditional use, or the herb or supplement has little scientific support and/or minimal health benefit.

What are the symptoms of UC? UC is characterized by frequent abdominal pain and bloody diarrhea. Other symptoms may include fatigue, weight loss, decreased appetite, and nausea.

How is it treated? Conventional treatment of UC includes avoiding raw fruits and vegetables. Sometimes a milk-free diet is suggested. Anti-diarrheal drugs may be prescribed, such as anticholinergic drugs, loperamide, diphenoxylate, or even deodorized opium tincture. These drugs must be used with extreme caution to prevent toxic dilation of the colon. Therapy with corticosteroids (e.g., hydrocortisone, orally or as an enema) is commonly prescribed. Mesalamine may be prescribed in some cases, as an enema, orally, or in suppository form. Other drugs used include sulfasalazine, azothioprine, 6-mercaptopurine, and cyclosporine. Toxic colitis, a grave medical emergency complication of UC, is treated intensively in emergency departments with a combination of antibiotics, intravenous fluid replacement, and either corticosteroids or adrenocorticotropic hormone (ACTH). Emergency surgical removal of the colon is sometimes necessary in the most severe cases. Elective surgery may be recommended for milder cases.

Dietary changes that may be helpful: Some studies have shown that high sugar intake is associated with an increase in risk for UC.^{1 2} Other research has failed to find any association between UC and sugar intake.^{3 4} Until more is known, persons with inflammatory bowel diseases, including UC, should consider limiting their intake of sugar.

In two studies, people with a high intake of animal fat, cholesterol, or margarine had a significantly increased risk of UC, compared with people who consumed less of these fats.^{5 6} Although these associations do not prove cause-and-effect, reducing one’s intake of animal fats and margarine is a means of improving overall health and possibly UC as well.

There is preliminary evidence that people who eat fast food at least twice a week have nearly four times the risk of developing UC than people who do not eat fast food.⁷

More than a half-century ago, several doctors reported that food allergies play an important role in some cases of UC.^{8 9} Since that time, many doctors have observed that avoidance of allergenic foods will often reduce the severity of UC and can sometimes completely control the condition. In other old studies, milk has been reported to trigger UC,¹⁰ and people with UC were found to have antibodies to milk in their blood, a possible sign of allergy.¹¹ Today the relationship between food allergies and UC remains controversial¹² and is not generally accepted by the conventional medical community. People who wish to explore the possibility that food sensitivities may trigger their symptoms may wish to consult with an appropriate healthcare provider.

In a preliminary study, 39 patients with mild to moderate ulcerative colitis experienced significant improvement after receiving 30 grams (about 1 oz) per day of a germinated barley product for four weeks.¹³ Controlled trials are needed to confirm this report.

Lifestyle changes that may be helpful: For unknown reasons, smokers have a lower risk of UC. The nicotine patch has actually been used to induce remissions in people with UC,¹⁴ although this treatment has been ineffective in preventing relapses.¹⁵ On the other hand, Crohn’s disease, which is in many ways similar to UC, is made worse by smoking.¹⁶ Despite the possible protective effect of smoking in people with UC, a strong case can be made that risks of smoking outweigh the benefits; even the use of nicotine patches carries its own side effects and remains experimental.

Nutritional supplements that may be helpful: UC is linked to an increased risk of colon cancer. Studies have found that people with UC who take folic acid supplements or who have high blood levels of folic acid have a reduced risk of colon cancer compared with people who have UC and do not take folic acid supplements.^{17 18 19} Although these associations do not prove that folic acid was responsible for the reduction in risk, this vitamin has been shown to prevent experimentally induced colon cancer in animals.²⁰ Moreover, low blood folic acid levels have been found in more than half of all people with UC.²¹ People with UC who are taking the drug sulfasalazine, which inhibits the absorption of folic acid,²² are at a particularly high risk of developing folic acid deficiency. Folic acid supplementation may therefore be important for many people with UC. Since taking folic acid may mask a vitamin B12 deficiency, however, people with UC who wish to take folic acid over the long term should have their vitamin B12 status assessed by a physician.

Alcohol consumption is known to promote folic acid deficiency and has also been linked to an increased risk of colon cancer.²³ People with UC should, therefore, keep alcohol intake to a minimum.

Preliminary²⁴ and double-blind trials^{25 26 27} have found that fish oil supplementation reduces inflammation, decreases the need for anti-inflammatory drugs, and promotes normal weight gain in people with UC. However, fish oil has not always been effective in clinical trials for UC.²⁸ Amounts used in successful clinical trials provided 3.2 grams of EPA and 2.2 grams of DHA per day—the two important fatty acids found in fish oil.

A fatty acid called butyrate, which is synthesized by intestinal bacteria, serves as fuel for the cells that line the small intestine. Administration of butyrate by enema has produced marked improvement in people with UC in most,^{29 30 31 32 33 34} but not all,³⁵ preliminary trials. Butyrate taken by mouth is not likely to be beneficial, as sufficient quantities do not reach the colon by this route. Although butyrate enemas are not widely available, they can be obtained by prescription through a compounding pharmacy, which prepares customized prescription medications to meet individual patient needs.

In preliminary³⁶ and double-blind³⁷ trials, a probiotic supplement (in this case, a non-disease-causing strain of Escherichia coli) was effective at maintaining remission in people with UC. In a double-blind trial, a combination probiotic supplement containing Lactobacilli, Bifidobacteria, and a beneficial strain of Streptococcus has been shown to prevent pouchitis, a common complication of surgery for UC.³⁸ People with chronic relapsing pouchitis received either 3 grams per day of the supplement or placebo for nine months. Eighty-five percent of those who took the supplement had no further episodes of pouchitis during the nine-month trial, whereas 100% of those receiving placebo had relapses within four months. Preliminary evidence suggests that combination probiotic supplements may be effective at preventing UC relapses as well.³⁹

In a preliminary trial, people with UC significantly improved on a sugar-free, low-allergen diet with additional nutritional supplementation that included a multivitamin-mineral supplement (2–6 tablets per day); a fish oil supplement (400 mg per day); borage oil (400 mg per day); flaxseed oil (400 mg per day); and a probiotic formula containing Lactobacillus acidophilus and other species of beneficial bacteria.⁴⁰ Some participants received slight variations of this regimen. Since so many different supplements were given and since the trial was not controlled, it is not possible to say which, if any, of the nutrients was responsible for the improvement observed by the researchers.

Are there any side effects or interactions? Refer to the individual supplement for information about any side effects or interactions.

Herbs that may be helpful: A small clinical study found that people with UC taking 550 mg of boswellia gum resin three times daily for six weeks had similar improvement in symptoms and the severity of their disease as people with UC taking the drug sulfasalazine.⁴¹ Overall, 82% of patients receiving boswellia, along with 75% of patients taking sulfasalazine, went into remission.

In a preliminary trial, people with UC remained in remission just as long when they took 20 grams of ground psyllium seeds twice daily with water as when they took the drug mesalamine.⁴² The combination of the two was slightly more effective than either alone. Controlled trials are now needed to confirm a therapeutic effect of psyllium for UC.

German doctors practicing herbal medicine often recommend chamomile for people with colitis.⁴³ A cup of strong tea drunk three times per day is standard, along with enemas using the tea when it reaches body temperature.

Enemas of oil of St. John’s wort may also be beneficial.⁴⁴ Consult with a doctor before using St. John’s wort oil enemas.

Aloe vera juice has been used by some doctors for people with UC. Although aloe is known to have anti-inflammatory activity, it has not been studied specifically in people with UC. The same is true of other traditional anti-inflammatory and soothing herbs, including calendula, flaxseed, licorice, marshmallow, myrrh, and yarrow. Many of these herbs are most effective, according to clinical experience, if taken internally as well as in enema form.⁴⁵ Enemas should be avoided during acute flare-ups but are useful for mild and chronic inflammation. It is best to consult with a doctor experienced with botanical medicine to learn more about herbal enemas before using them. More research needs to be done to determine the effectiveness of these herbs.

Are there any side effects or interactions? Refer to the individual herb for information about any side effects or interactions.

1. Reif S, Klein I, Lubin F, et al. Pre-illness dietary factors in inflammatory bowel disease. Gut 1997;40:754–60.

2. Tragnone A, Valpiani D, Miglio F, et al. Dietary habits as risk factors for inflammatory bowel disease. Eur J Gastroenterol Hepatol 1995;7:47–51.

3. Thornton JR, Emmett PM, Heaton KW. Diet and ulcerative colitis. BMJ 1980;1:293–4.

4. Jarmerot G, Jammark I, Nilsson K. Consumption of refined sugar by patients with Crohn’s disease, ulcerative colitis or irritable bowel syndrome. Scand J Gastroenterol 1983;18:999–1002.

5. Reif S, Klein I, Lubin F, et al. Pre-illness dietary factors in inflammatory bowel disease. Gut 1997;40:754–60.

6. Kono S. Dietary and other risk factors of ulcerative colitis. A case-control study in Japan. J Clin Gastroenterol 1994;19:166–71.

7. Persson PG, Ahlbom A, Hellers G. Diet and inflammatory bowel disease: a case-control study. Epidemiology 1992;3:47–52.

8. Rowe AH. Chronic ulcerative colitis—allergy in its etiology. Ann Intern Med 1942;17:83–100.

9. Andresen AFR. Ulcerative colitis—an allergic phenomenon. Am J Dig Dis 1942;9:91–8.

10. Truelove SC. Ulcerative colitis provoked by milk. Brit Med J 1961;5220:154–60.

11. Taylor KB, Truelove SC. Circulating antibodies to milk proteins in ulcerative colitis. Brit Med J 1961;5257:924–9.

12. Candy S, Borok G, Wright JP, et al. The value of an elimination diet in the management of patients with ulcerative colitis. S Afr Med J 1995;85:1176–9.

13. Kanauchi O, Iwanaga T, Mitsuyama K. Germinated barley foodstuff feeding: a novel neutraceutical therapeutic strategy for ulcerative colitis. Digestion 2001;63 Suppl:60–7.

14. Pullan RD, Rhodes J, Ganesh S, et al. Transdermal nicotine for active ulcerative colitis. N Engl J Med 1994;330:811–5.

15. Thomas GA, Rhodes J, Mani V, et al. Transdermal nicotine as maintenance therapy for ulcerative colitis. N Engl J Med 1995;332:988–92.

16. Rhodes J, Thomas GA. Smoking: good or bad for inflammatory bowel disease? Gastroenterol 1994;106:907–10 [editorial].

17. Lashner BA, Heidnreich PA, Su GL, et al. Effect of folate supplementation on the incidence of dysplasia and cancer in chronic ulcerative colitis. Gastroenterol 1989;97:255–9.

18. Lashner BA. Red blood cell folate is associated with the development of dysplasia and cancer in ulcerative colitis. J Cancer Res Clin Oncol 1993;119:549–54.

19. Lashner BA, Provencher KS, Seidner DL, et al. The effect of folic acid supplementation on the risk for cancer or dysplasia in ulcerative colitis. Gastroenterol 1997;112:29–32.

20. Kim YI, Salomon RN, Graeme-Cooke F, et al. Dietary folate protects against the development of macroscopic colonic neoplasia in a dose responsive manner in rats. Gut 1996;39:732–40.

21. Elsbord L, Larsen L. Folate deficiency in chronic inflammatory bowel disease. Scand J Gastroenterol 1979;14:1019–24.

22. Halsted CH, Gandhi G, Tamura T. Sulfasalazine inhibits the absorption of folates in ulcerative colitis. N Engl J Med 1981;317:1513–7.

23. Kaltsky AL, Armstrong MA, Friedman GD, Hiatt RA. The relations of alcoholic beverage use to colon and rectal cancer. Am J Epidemiol 1988;128:1007–15.

24. Salomon P, Kornbluth AA, Janowitz HD. Treatment of ulcerative colitis with fish oil n--3-omega-fatty acid: an open trial. J Clin Gastroenterol 1990;12:157–61.

25. Stenson WF, Cort D, Rodgers J, et al. Dietary supplementation with fish oil in ulcerative colitis. Ann Intern Med 1992;116:609–14.

26. Hawthorne AB, Daneshmend TK, Hawkey CJ, et al. Treatment of ulcerative colitis with fish oil supplementation: a prospective 12 month randomised controlled trial. Gut 1992;33:922–8.

27. Aslan A, Triadafilopoulos G. Fish oil fatty acid supplementation in active ulcerative colitis: a double-blind, placebo-controlled, crossover study. Am J Gastroenterol 1992;87:432–7.

28. Dichi I, Frenhane P, Dichi JB, et al. Comparison of omega-3 fatty acids and sulfasalazine in ulcerative colitis. Nutrition 2000;16:87–90.

29. Scheppach W, Sommer H, Kirchner T, et al. Effect of butyrate enemas on the colonic mucosa in distal ulcerative colitis. Gastroenterol 1992;103:51–6.

30. Scheppach W. Treatment of distal ulcerative colitis with short-chain fatty acid enemas. A placebo-controlled trial. German-Austrian SCFA Study Group. Dig Dis Sci 1996;41:2254–9.

31. Vernia P, Marcheggiano A, Caprilli R, et al. Short-chain fatty acid topical treatment in distal ulcerative colitis. Aliment Pharmacol Ther 1995;9:309–13.

32. Steinhart AH, Brzezinski A, Baker JP. Treatment of refractory ulcerative proctosigmoiditis with butyrate enemas. Am J Gastroenterol 1994;89:179–83.

33. Patz J, Jacobsohn WZ, Gottschalk-Sabag S, et al. Treatment of refractory distal ulcerative colitis with short chain fatty acid enemas. Am J Gastroenterol 1996;91:731–4.

34. Breuer RI, Buto SK, Christ ML, et al. Rectal irrigation with short-chain fatty acids for distal ulcerative colitis. Preliminary report. Dig Dis Sci 1991;36:185–7.

35. Steinhart AH, Hiruki T, Brzezinski A, Baker JP. Treatment of left-sided ulcerative colitis with butyrate enemas: a controlled trial. Aliment Pharmacol Ther 1996;10:729–36.

36. Rembacken BJ, Snelling AM, Hawkey PM, et al. Non-pathogenic Escherichia coli versus mesalazine for the treatment of ulcerative colitis: a randomised trial. Lancet 1999;354:635–9.

37. Kruis W, Schutz E, Fric P, et al. Double-blind comparison of an oral Escherichia coli preparation and mesalazine in maintaining remission of ulcerative colitis. Aliment Pharmacol Ther 1997;11:853–8.

38. Gionchetti P, Rizzello F, Venturi A, et al. Oral bacteriotherapy as maintenance treatment in patients with chronic pouchitis: a double-blind, placebo-controlled trial. Gastroenterology 2000;119:305–9.

39. Venturi A, Gionchetti P, Rizzello F, et al. Impact on the composition of the faecal flora by a new probiotic preparation: preliminary data on maintenance treatment of patients with ulcerative colitis. Aliment Pharmacol Ther 1999;13:1103–8.

40. Edman JS, Williams WH, Atkins RC. Nutritional therapies for ulcerative colitis: literature review, chart review study, and future research. Altern Ther Health Med 2000;6:55–63.

41. Gupta I, Parihar A, Malhotra P, et al. Effects of Boswellia serrata gum resin in patients with ulcerative colitis. Eur J Med Res 1997;2:37–43.

42. Fernandez-Banares F, Hinojosa J, Sanchez-Lombrana JL, et al. Randomized clinical trial of Plantago ovata seeds (dietary fiber) as compared with mesalamine in maintaining remission in ulcerative colitis. Am J Gastroenterol 1999;94:427–33.

43. Weiss RF. Herbal Medicine. Beaconsfield, UK: Beaconsfield Publishers Ltd, 1989, 26.

44. Weiss RF. Herbal Medicine. Beaconsfield, UK: Beaconsfield Publishers Ltd, 1989, 114–5.

45. Weiss RF. Herbal Medicine. Beaconsfield, UK: Beaconsfield Publishers Ltd, 1989, 114–5.

---

Copyright © 2002 Healthnotes, Inc.  All rights