Progress little by little. He takes his time. It can weaken the body and lead to complications that even put life at risk… With these words, the Mayo Clinic expresses that ulcerative colitis must be taken very seriously.
The most recent study, carried out by the Spanish Journal of Public Health of the Ministry of Health, Consumption and Social Welfare, indicates that ulcerative colitis affects 0.39% of the population. In clearer language: in Spain about 200,000 people suffer from it. The research highlights that this type of inflammatory bowel disease is increasing and that nearly 2,000 new cases are diagnosed each year.
To resolve doubts, problems and other questions, we have Alicia Salido, dietitian-nutritionist and Honorary Member of the Spanish Academy of Nutrition and Dietetics specialized in Functional Digestive Disorders, Oncology and Lipedema.
What is ulcerative colitis?
Ulcerative colitis is a disease of the large intestine that affects only the mucosa of the colon. “It is inflammatory, chronic and immune-mediated and evolves in outbreaks or crises (active phase) and periods of remission (inactive phase), which alter the body’s ability to digest food and absorb nutrients,” says the expert.
Is it serious?
Yes, if it is not controlled because, as Salido explains, “patients with ulcerative colitis have a higher risk of suffering from colon cancer.”
Is it different from other types of colitis?
Colitis is a inflammation of the colon what can become acute if it is connected with diseases of the digestive system.
They can be of several types:
- Crohn’s disease or ulcerative colitis, which is an autoimmune type.
- Microscopic colitis, of unknown origin.
- Chemical colitis, caused by treatments, such as chemotherapy or radiation therapy.
- Infectious colitis, caused by the bacteria Clostridium difficile, E.coli, or Yersinia enterocolitica.
Photo: Victoria Rómulo on Unsplash
Phases of the disease
When you suffer from ulcerative colitis, the large intestine becomes inflamed and ulcerated, that is, it erodes, causing ‘crisis’:
- active phase: It always starts in the rectum and sometimes progresses to the cecum, occupying the entire colon. Often the crisis remains in the rectum.”
- Inactive phase: remission periods.
How is Crohn’s disease different?
Ulcerative colitis only affects the colon, while Crohn’s disease affects the entire gastrointestinal tract, from the mouth to the year.
Furthermore, Crohn’s disease is ‘transmural’. The dietician-nutritionist explains it: “This means that it develops in all layers of the intestinal wall and can produce a narrowing of the intestine or stenosis and, as a consequence, a complete intestinal occlusion.”
Which is worse?
“Both are chronic and can be serious, neither is intrinsically worse,” says Alicia Salido. However, we can affirm that:
- Crohn’s disease: is often considered more complex due to its ability to affect any part of the digestive tract, “which can lead to more severe complications such as fistulas and obstructions.”
- Ulcerative colitis: “is limited to the colon, but carries a long-term risk of colorectal cancer, especially with extensive and prolonged involvement.”
Causes and risk factors
Ulcerative colitis occurs as a result of an inadequate response of the immune system to our body, normally in the mucosa of the intestine.
The disease is conditioned by:
- Polygenic genetic predisposition: many genes predispose to suffer from it.
- External agents: unbalanced diet, excess sugar intake, smoking and exposure to tobacco smoke, stress, consumption of oral antibiotics…
- Bacterial and viral infections: especially in childhood.
- Changes in the intestinal microbiota: if in the future we are able to modify it, it would be the great key to its treatment or non-appearance.
Main symptoms
Among the plethora of symptoms of ulcerative colitis, the most notable are diarrhea, blood in stool, abdominal cramps, abdominal pain, bloating, tiredness, loss of appetite, weight loss, fever and tachycardia.
One of the most effective tests to determine ulcerative colitis is calprotectin: it is measured in feces to see the degree of intestinal inflammation. It is a test that is prescribed when you suffer from persistent diarrhea.
This disease greatly alters the quality of life of patients when they are in active outbreaks, since they cannot lead a normal life. Some patients may experience fecal incontinence.
Prohibited foods in ulcerative colitis
Dietary treatment depends on the phase in which the patient is:
- In the active phase, you must follow an astringent diet that should include: rice, pasta, tubers such as potatoes, carrots, fruits such as unripe bananas; chicken meat, hard-boiled egg or omelette, natural yogurts and fresh cheese.
It is preferable for these patients to remove gluten and lactose from their diet.
- In remission phase: balanced and healthy diet, avoiding all processed and ultra-processed foods. Avoid sugars and increase simple culinary preparations that incorporate little fat. Distribute meals in different doses throughout the day and do not drink water during lunch and dinner.
Photo: Maryam Sicard on Unsplash
Treatment. Is there a cure for ulcerative colitis?
Not for now. The treatments used are pharmacological with aminosalicylates, corticosteroids, immunosuppressants and biologicals.
Latest developments
Among the most current, work is being done with mycotherapy and probiotics. Omega-3s are also used to alleviate intestinal inflammation, such as EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid).
On the other hand, maintaining adequate levels of vitamin D helps restore the immune system and mucous membranes.
Frequently asked questions about this pathology:
Can you apply for disability if you suffer from ulcerative colitis?
“Yes, since it is a chronic disease that can limit daily and work life.” The application is based on the impact of ulcerative colitis, not just the diagnosis, so it is essential to have detailed medical reports documenting the severity of symptoms, frequency, impact on activities and treatments performed.
Does coffee make ulcerative colitis worse?
Yes, when it is in the active phase.
What fruits can you eat?
It depends on the phase you are in, but it would be recommended that they are not ripe. “It is better to take them at their point, and if they are accompanied with some bread (picos, rusks) or foods rich in glucose, their absorption is easier in the small intestine and they produce less fermentation,” highlights the expert.
Can ulcerative colitis be cured with diet?
«No, but with the diet we can live in an inactive phase and this would help us a lot to have a better quality of life, which is very important in people who suffer from ulcerative colitis.» Dietary treatment is vital, so it is essential to see a specialized nutritionist dietician.
Recommended diet for ulcerative colitis
The diet varies depending on the phase the patient is in and the symptoms they have at that time. “The key is to personalize the treatment,” concludes Alicia Salido.
Alicia Salido. Honorary Member, member of the Steering Committee and Academic Director of the Spanish Academy of Nutrition and Dietetics. Treasurer of the General Council of Official Associations of Nutritionist Dietitians of Spain. Co-founder of the Andalusian Unit of TFD (Functional Digestive Disorders) and responsible for the nutrition area. Responsible for the Nutrition Area of the Milenium Sanitas Andalucía Centers. Responsible for the Nutrition Area of the LIPEDEMA Unit, in Seville. Diploma – Graduate in Human Nutrition and Dietetics from the University of Navarra Master in Obesity and Metabolism from the University of Navarra Master in Clinical Microbiology. European Institute of Chemistry, Physics and Biology Postgraduate in Oncological Nutrition. www.aliciasalido.com. Instagram @aliciasalido. Twitter: @salidoalicia
