Lifestyle changes to help manage ulcerative colitis

Inflammatory bowel disease (IBD) is a growing problem in the United States. About 1.3 percent of US adults—or roughly 3 million people—were diagnosed with IBD in 2015, according to the Centers for Disease Control and Prevention (CDC).

IBD is a suite of conditions, most notably Crohn’s disease and ulcerative colitis. For reasons that aren’t entirely clear, the body’s own immune system attacks the lining of the digestive tract, leading to chronic diarrhea and abdominal pain.

“About 50 percent of my patients with IBD live normal lives,” says Rajiv Sharma, MD, a gastroenterologist with Terre Haute Regional Hospital in Terre Haute, Indiana. “Another 35 to 40 percent can live pretty normally, but it definitely affects their lives. They need to know where a bathroom is at all times. For the remainder, it’s debilitating.”

Surgery and medicine can help with IBD, but so can lifestyle changes. Here are six to try.

“Fiber makes for good colonic health,” says Dr. Sharma, but most people don’t eat enough. The average American man eats 18 grams per day, while women eat 15 grams. The average man under age 50 should eat between 31 and 34 grams per day, while women should have between 25 and 28 grams, according to federal dietary guidelines. Over age 50, men should shoot for 28 grams daily and women should target about 22 grams.

But some people with IBD need to be mindful of their fiber intake. Fiber may worsen symptoms, especially if you have a narrowing of the bowels from scarring (called a stricture). That’s because fiber—particularly insoluble fiber—could increase gas and bloating, which are already problems for people with IBD. 

During flares, your healthcare provider (HCP) may recommend following a low-fiber diet for a time. People whose IBD is in remission—meaning they aren’t experiencing symptoms—should eat their full daily recommended value unless they have a stricture. More than half of people with Crohn’s disease develop a stricture. They may be asked to follow a low-fiber diet permanently. 

A good rule of thumb: Talk to your HCP about how much fiber you should eat, given your level of disease activity and bowel changes.

Getting enough sleep is especially important when you have IBD because sleep reduces inflammation—or the “I” in IBD. “If you sleep well, it reduces flares,” says Sharma.

Sleeping enough—most adults need seven to nine hours per day—can be difficult for people with IBD. Symptoms like abdominal pain and diarrhea can wake you up, and the disease itself may disrupt the sleep cycle. Practice good sleep hygiene by:

• Avoiding electronics at least 30 to 60 minutes before bedtime
• Going to bed and waking up at the same time each day
• Avoiding long naps
• Not watching TV or reading in bed
• Keeping away from caffeine past the early afternoon
• Exercising as your symptoms allow 

“People with IBD who exercise just generally do better. They have lower stress levels and fewer symptom flares,” Sharma says. Exercise not only keeps your body strong, but it clears your mind, reduces stress and, in the long term, can help limit inflammation.

It’s not just the anti-inflammatory effect that benefits people with IBD. Physical activity can help cut down on problems that tend to crop up alongside IBD, as well. IBD is associated with a higher risk of osteoporosis and less dense bones; exercise has been shown to increase bone mass in people with Crohn’s disease.

IBD is also associated with a form of arthritis that affects the spine and vertebrae called ankylosing spondylitis. Exercise can improve spine flexibility and reduce vertebral pain.  

One possible cause or symptom trigger of IBD is an imbalance in the bacteria that live in the digestive tract. Probiotics are organisms—obtained through food or dietary supplements—that can restore the bacterial population in the gut to healthy levels.

“I have patients where no medication works on them, but who experience less pain when they take probiotics,” says Sharma. There is some evidence that certain probiotics can help with ulcerative colitis.

One review found that a mixture of eight bacteria types called VSL#3 helped bring about remission during active ulcerative colitis, and is about as effective as a first-line medication in preventing relapse for inactive (called quiescent) ulcerative colitis.

It’s important to note that the review found no benefit from other types of probiotics for ulcerative colitis. There doesn’t appear to be much benefit, if any, in taking probiotics for Crohn’s disease. 

Speak with your HCP before starting on any probiotics.

No one should smoke, but people with IBD have extra incentive to quit. Smoking is associated with an increased risk of developing Crohn’s disease, and can worsen the condition.

“Smoking induces more scarring in the colon, which is what a stricture is,” says Sharma. Research suggests smoking also harms the immune system and alters the balance of gut bacteria. “Smoking is carcinogenic, and people with IBD are already at increased risk of colorectal cancer,” Sharma adds.

Interestingly, smoking is associated with a decreased risk of ulcerative colitis—but that’s not a reason to light up.

You’ll also want to limit alcohol, or avoid it during a flare and if it aggravates your symptoms. In a small study published in the journal Alcohol, 75 percent of participants with IBD who drank reported worse symptoms. The researchers theorized that alcohol’s effects on the immune system and the high sugar content may be to blame.

FODMAPS are carbohydrates that are poorly absorbed in the intestines and fermented by gut bacteria, leading to bloating, gas, abdominal pain, or diarrhea. A low-FODMAP diet is usually associated with treating irritable bowel syndrome (IBS, not to be confused with IBD), but there is some evidence avoiding FODMAPs can help ease those IBD symptoms that mimic IBS, as well.

FODMAP foods include:

• Asparagus
• Beans
• Onions
• Garlic
• Wheat
• Rye
• Dairy and soy milk
• Cashews

A low FODMAP diet is restrictive and meant to be short-term. Experts, including Sharma, agree that a low-FODMAP diet should be started under the guidance of a nutritionist. “I always work closely with a dietitian,” says Sharma. “If you’re my patient, you’re seeing a dietician. That goes for any condition. To heal someone all the way you’ve got to fix the diet.”