Ulcerative colitis

Ulcerative colitis – a chronic inflammatory bowel disease

Colitis ulcerosa

Ulcerative colitis: The longer the disease persists, the higher the risk of colorectal cancer.

Ulcerative colitis is a chronic inflammation of the intestinal mucosa that occurs in episodes

Ulcerative colitis: causes and symptoms

Around 300,000 people in Germany suffer from ulcerative colitis. Women are affected just as often as men. The typical age of onset is between the ages of 20 and 40. In contrast to Chrohn’s disease – a second chronic inflammatory bowel disease – the inflammation affects only the top layer, the intestinal mucosa, whereas in Crohn’s disease the entire intestinal wall is riddled with inflammation.

The longer the disease persists, the higher the risk of colorectal cancer. But also the concomitant diseases and the side effect of the administered drugs can be very unpleasant.

Typical symptoms of ulcerative colitis include:

  • Recurring diarrhea with
    • Intestinal bleeding
    • Painful abdominal cramps (colic)
  • Fever
  • Fatigue
  • General feeling of illness
  • In rare cases: Inflammation of the skin, eyes or joints

Most affected (more than 60%) ulcerative colitis patients show mild symptoms in the course of an episode of the disease. The inflammation is limited to the rectum and usually disappears on its own. During the episode, sufferers have bloody, mucous stools up to five times a day. Other than that, they have no symptoms and usually feel well and mostly healthy. In moderately severe ulcerative colitis, the frequency of bowel movements increases to six to eight times per day. Abdominal cramps occur, the temperature is slightly elevated, and general well-being is significantly impaired. About 25 percent of patients are affected by this moderately severe form of the disease. One in ten patients suffers from severe ulcerative colitis with more than eight bowel movements a day. Those affected have a high fever, severe pain, are pale and feel powerless and miserable.

The cause is still unclear. It seems that heredity, immune system and psyche are involved. It was previously assumed that in genetically predisposed people an abnormally increased immune reaction against the intestinal flora leads to the outbreak of the disease. More recent findings rather point to a weakened immune system. A special protein responsible for the formation of the inflammatory messenger NFkB seems to be constantly active. The immune system, in turn, is significantly influenced by environmental factors such as diet, stress or other strains.

The most important facts about nutrition in ulcerative colitis:

  • Avoid diet that promotes inflammation:
    • fried and fatty foods such as French fries, smoked and fried foods, foods that are too spicy, foods that are too hot or too cold
    • industrially highly processed foods such as sweets, ready-made sauces or fruit yogurts
  • Relieve the colon by eating little fiber during the acute phase.
    Easily digestible are the carbohydrates from white bread or unpeeled rice.
  • Oatmeal (oatmeal boiled in water) is just as gentle on the intestines as a porridge of
    millet flakes protects the intestine and provides important nutrients.
  • Pureed soups made from mild vegetables such as potatoes, cauliflower,
    broccoli or zucchini are also good
  • Often there is a sugar intolerance (lactose, fructose, sorbitol) due to relapses, so dairy products, vegetables with peel and some fruits cause severe flatulence.
  • The frequent diarrhea results in severe fluid loss – drink two to three liters a day: preferably mild, unsweetened herbal teas (chamomile, fennel or peppermint), green tea or still water. Blueberry mother juice is also recommended. By adding 1-2 tablespoons of glucose and 3 grams of table salt to one liter of water or tea, you can counteract the loss of electrolytes during severe diarrhea.

The most important rule is: always eat in peace, and chew long and thoroughly!

Ulcerative colitis – natural help and symptom relief

In ulcerative colitis, a deficiency of micronutrients (vitamins, minerals, trace elements, phytochemicals, etc.) is very common. On the one hand, because of the absorption disorder caused by the inflammation of the intestine and the diarrhea. On the other hand, because of the food intolerances and the associated unbalanced diet. The permanent inflammation in combination with medication regularly leads to a disturbed intestinal flora and intestinal function with a resulting vital substance deficit.

One of the most common complications of ulcerative colitis is anemia. The intestinal mucosa, which is highly inflamed during the episode, bleeds and thus the organism loses iron. However, this anemia is not only based on iron loss, but often also on a deficiency of vitamin B12 (absorbed in the end region of the ileum – the last section of the small intestine before the valve that releases the food pulp into the large intestine) and leads to fatigue and lower performance in patients.

Micronutrients also play an important role in protecting against cancer and maintaining bone density. In principle, ulcerative colitis is a “precancerous condition (that is, a tissue change) that is associated with a statistically significant increased risk of malignant disease. Osteoporosis is also a very common complication in patients with ulcerative colitis, precisely because the inflammatory altered intestinal mucosa can no longer absorb micro- and also macronutrients well. Thus, osteoporosis with the risk of frequent bone fractures occurs in more than half of all patients with ulcerative colitis.

At the THERA Praxisklinik, we attach great importance to targeted laboratory diagnostics at the beginning of each treatment. One focus here is on the detailed testing of the micronutrient status.

The trace elements zinc and selenium are of particular importance. It was only recently proven that even a slight zinc deficiency can trigger a bout of inflammation. Selenium has a high antioxidant effect and has an anti-inflammatory effect. It thus protects the body from free radicals, which promote inflammation of the intestines. It is also involved in a variety of detoxification reactions in the body.

Omega-3 fatty acids are important counterparts to the omega-6 fatty acids and saturated fatty acids (animal fats, sunflower oil, margarine) that dominate the diet today. Omega-3 fatty acids form anti-inflammatory proteins, while omega-6 fatty acids form pro-inflammatory proteins.

Secondary plant compounds, i.e. all the substances that give vegetables and fruit their bright color, also have a strong anti-inflammatory effect. For example, only recently the positive effect of curcumin was found in sufferers of ulcerative colitis. Furthermore, it has also been recognized that micronutrients prevent numerous complications of colitis. Particularly feared is involvement of the heart. Thus, a deficiency of carnitine can lead to progressive heart failure in ulcerative colitis patients. In addition, carnitine shows significant effects against intestinal inflammation.

Lecithin, a protein substance that is needed, among other things, for the production of messenger substances and acts as a kind of transporter to and from the cell to conduct substances, is an important component of the intestinal mucosa. Initial studies conducted in Germany have produced encouraging results with the use of lecithin in active ulcerative colitis.

The above-mentioned studies show that natural micronutrients alleviate the symptoms of ulcerative colitis.

Today, there are possibilities to significantly prolong the remission phases with the help of pro- and prebiotics or anti-inflammatory agents such as curcumin, lecithin or frankincense. Of course, always in combination with a diet appropriate to the disease.

Furthermore, treatment with pre- (dietary fiber) and probiotics (intestinal bacteria) can be of great benefit to patients with ulcerative colitis. Consistent intake of pro- and prebiotics can achieve a long-lasting remission as well as a reduction in the amount of medication. At THERA Praxisklinik, we specialize in intestinal health. Through targeted stool analysis targeted stool analysis , a quick overview can be gained of how the intestinal microbiome, the intestinal mucosa, the milieu and the digestive performance is basically in the intestine and where the intestine needs support in its function.

Ulcerative colitis and nutrition

Above we have already shown how important nutrition and micronutrients are in ulcerative colitis. And, of course, the usual rules of healthy nutrition always apply in the first instance. However, you should distinguish between the diet in the relapse and in the relapse-free interval.

The tolerance of fruits and vegetables is very different. It should be adjusted depending on the disease and individually.

Well tolerated in general:

  • Potatoes, carrots, cauliflower, asparagus, broccoli, zucchini, spinach, fennel, chicory, green beans and celery.
  • Bananas, ripe apples, soft pears, strawberries, raspberries peeled peaches and melons
  • Cooked and pureed fruits often have a regulating effect.

Not well tolerated in general:

  • citrus fruits, plums, grapes, cherries, currants
  • fruit juices (have an irritating effect)

It can often be helpful and improve tolerance to remove the peel from fruit or even peppers and tomatoes, as it often has a laxative effect. An exception is the apple (grated). The pectins consumed in this way have a stool-regulating effect.


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Nutrition as medicine. This video explains, among other things, that the intake of hemp seeds reduces inflammation in the intestine and barley juice powder (10-20g/d) “repairs” the intestinal mucosa.

Lactose intolerance

The ability to digest lactose (milk sugar) often comes to a standstill in severe disease states. In this case, unacidified milk (milk products) should be avoided for a longer period of time (especially in acute inflammatory episodes). Milk protein intolerance occurs more frequently in ulcerative colitis than in Crohn’s disease.

Various ready-made and canned products also regularly contain lactose in varying amounts (sausages, breads, rusks, ready-made salad dressings, etc.). From a nutritional point of view, products with various artificial additives should be avoided anyway.

Meat, fish, eggs should be used sparingly

Since meat and meat products do not contain fiber, they often have a constipating effect in people with Crohn’s disease or colitis. Combined with a possibly reduced digestive capacity, this can lead to the formation of putrefactive products in deeper parts of the intestine – caused by a change in the intestinal flora – which are unpleasant because they usually lead to painful gas accumulations in the intestine.

Fish is basically a very good source of iodine, protein and omega-3. However, when consuming it regularly, it is essential to ensure that it is of organic and high quality, as there is often a pronounced contamination with heavy metals (especially mercury).


Sugar is especially problematic in that we consume it in unnatural, unprecedented amounts. The average person eats 4-6 tablespoons of sugar per day. Since sugar is purely a source of energy, with no vitamins, minerals or fiber, a lot of energy can be absorbed quickly through this source. For many people it has become a habit to consume “sugar infusions” on a regular basis. And this includes not only “cola”, but to the same extent (for example) the naturally cloudy apple juice.

If we now talk about our gastrointestinal tract, then sugar not only causes caries, but also clearly leads to a disturbance of the intestinal flora. The consequences include an altered environment with flatulence, reduced absorption of foods rich in vitamins and minerals, and the triggering or intensification of inflammation.

Ulcerative colitis: eating right during the resting phase

If there is no diarrhea (more than three stools daily) and no visible blood in the stool, this is called remission. For this phase, a light, alkaline whole food diet that is rich in calories, vitamins and fiber is recommended. This means plenty of whole grain products (finely ground), vegetables, mild fruits (pear, banana), nuts and legumes. On the other hand, foods and preparation methods that frequently trigger symptoms should be avoided: for example, fried and fatty foods such as French fries, smoked foods, fried foods with breadcrumbs, strongly spiced foods, foods that are too hot or too cold.

Anti-inflammatory foods such as flax oil, spinach, broccoli or berries can help. We will be happy to support you at the THERA Praxisklinik with any questions you may have about proper nutrition with individual nutritional counseling.