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How to Treat Ulcerative Colitis with Diet

The rotten egg gas, hydrogen sulfide, is one of the main malodorous compounds in human flatus (in other words, one of the main reasons farts can smell so bad) but the larger concern is that it may be responsible for relapses of inflammatory bowel diseases such as ulcerative colitis. In my video Preventing Ulcerative Colitis with Diet, I talk about the role animal protein may play in the development of these diseases, thought to be because of effectively putrefying animal protein gas. (For more on that, see my video Bowel Wars: Hydrogen Sulfide vs. Butyrate.) But what if you already have ulcerative colitis? Can cutting down on sulfur-containing amino acids help? Previously, the only dietary intervention shown to help at all was the withdrawal of milk.

In Treating Ulcerative Colitis with Diet, I discuss the role of diet in ulcerative colitis. Case reports going back decades described patients with ulcerative colitis whose flares appeared to be triggered by cow’s milk. The elimination of all dairy products from the diet was reported to “frequently result in a dramatic improvement in symptoms.” But, when milk was reintroduced back into patients’ diets, it could trigger an attack. The role of milk wasn’t formally studied, though, until 1965. Was it just a small group of patients who were allergic? Or, could a milk-free diet help with this disease in general?

Researchers randomized patients presenting with an attack of ulcerative colitis into a milk-free diet group or a control placebo “dummy” diet group, in which they told people not to eat random foods to make it seem like they were getting special treatment. The milk-free diet worked better: Twice as many were symptom-free when they were off all dairy, and fewer patients suffered relapses. So, there does seem to be a certain proportion of ulcerative colitis patients who would benefit from eliminating all dairy products. These researchers estimated that milk is a trigger in about one in every five cases, so, certainly, sufferers should try a dairy-free trial to see if they’re one of the lucky ones who can control this condition with such a simple dietary intervention.

What about cutting back on sulfur-containing amino acids in general? A study of four ulcerative colitis sufferers found that their daily bouts of bloody diarrhea significantly lessened when they did just that. Reduced intake of sulfur-containing, amino acid-rich foods produced an improvement in moderately severe ulcerative colitis. What happened when they added these foods back into their diets? The researchers felt the effect was so dramatic that going back to eating foods such as meat, dairy, eggs, and wine with sulfites was considered unethical.

That was just a pilot study, though. Researchers then set up a study in which 191 ulcerative colitis patients in remission were followed for a year to determine which foods were associated with a relapse. These turned out to be meat and alcohol, which makes sense because they’re both rich sources of sulfur, which may increase the concentration of hydrogen sulfide, which, if you remember, is toxic because it interferes with our body’s utilization of fiber that our good bacteria turn into a beneficial compound called butyrate.

How can we increase fecal butyrate levels to counteract any hydrogen sulfide? Butyrate enemas have been shown to be of benefit, but if butyrate is made from fiber, can’t we then just get it the regular way—that is, by eating it? Yes. Ulcerative colitis sufferers were given oat bran for three months to make their good bacteria happy. None of the patients relapsed, and their symptoms appeared to be under better control.

One of the common questions we physicians treating patients with inflammatory bowel disease are often asked is whether changing diet could positively affect the course of their disease. So far, our answer—especially for ulcerative colitis––has been, “We don’t know; there are no special recommendations.” This may now change, though, with a study suggesting that consumption of meat may aggravate the course of inflammatory bowel disease. So, folks may want to cut down on meat, eating it no more than once a week. While we don’t yet have confirmation from interventional studies to support the specifics, this could be considered the best available evidence we have right now.


For more information on ulcerative colitis, see my videos Preventing Ulcerative Colitis with Diet, Bowel Wars: Hydrogen Sulfide vs. Butyrate, Striking with the Root: Turmeric Curcumin & Ulcerative Colitis, and Wheatgrass Juice for Ulcerative Colitis. More on this epic fermentation battle in our gut can be found in my Stool pH and Colon Cancer video.

I also discuss inflammatory bowel disease in Titanium Dioxide & Inflammatory Bowel Disease, Preventing Crohn’s Disease with Diet, Dietary Treatment of Crohn’s Disease, and Vitamin D for Inflammatory Bowel Disease.

Is the concept of sulfur-rich proteins new to you? Check out my videos Starving Cancer with Methionine Restriction and Methionine Restriction as a Life Extension Strategy.

In health,

Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:

Discuss

Michael Greger M.D., FACLM

Michael Greger, M.D. FACLM, is a physician, New York Times bestselling author, and internationally recognized professional speaker on a number of important public health issues. Dr. Greger has lectured at the Conference on World Affairs, the National Institutes of Health, and the International Bird Flu Summit, testified before Congress, appeared on The Dr. Oz Show and The Colbert Report, and was invited as an expert witness in defense of Oprah Winfrey at the infamous "meat defamation" trial.


61 responses to “How to Treat Ulcerative Colitis with Diet

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  1. Don’t have the problem but if I did I think my first attempt at relief would be Inulin. I take it in small amounts throughout the day and my bowel movements are just fine.

  2. Its sad how the GI docs recommend a low fiber diet for UC Patients. I went vegan and ate tons of fiber, shunning Surgery(to save my life they said). Doing the opposite of what the GI docs said is what cured me of UC.

    1. Yes, very good question. I have been trying to read up on the underlying question but sofar found no answers. Yes, the sulfur amino acids in onions, but ,more importantly, in cruciferous veggies form the extremely important sulforaphane, which, yes, sometimes leads to extra flatus. Also the H2S which is bad in the GI tract is in moderate amounts very good in the blood! Can we have it both ways?
      Perhaps dr. G. & Friends can throw light on this matter…..

      1. Hi Julie and pjmbeerden@gmail.com
        As Dr Greger explains, the toxic effects of hydrogen sulfide appear to be a result of blocking the ability of the cells lining our colon from utilizing butyrate, which is what our good bacteria make from the fiber and resistant starch we eat. It’s like this constant battle in our colon between the bad metabolites of protein, hydrogen sulfide, and the good metabolites of carbohydrates, butyrate. Using human colon samples, researchers were able to show that the adverse effects of sulfide could be reversed by butyrate. So, we can either cut down on meat, eat more plants, or both.
        What Animal Protein Does in Your Colon

        1. This is an interesting comment you made about sulfides blocking butyrates.
          So, I eat dried apricots and dried pears. These dried foods always give me stinky gas. I guess it is because these dried fruits are preserved in a sulfide chemical of some type. So, my conclusion is that eating dried apricots and dried pears may not be a good idea because they produce sulfites that will block my butyrates. Is that correct?

    2. Hi Julia, thanks for your question. The sulfur containing food such as red meat, cheese, milk, fish, nuts, and eggs, also in preservatives found in commercial breads, beers, many alcoholic drinks, sausages, and dried fruits tend to result in faecal sulphide levels increase after consumption of above food. Mercaptides such as sodium hydrogen sulphide (one of the main malodorous compounds in human flatus) are reducing agents that help maintain anaerobic conditions in the colonic lumen. They are produced in the human large intestine by bacterial reduction of dietary inorganic sulphate and sulphate and by fermentation of sulphur amino acids. However, ingestion of food that produces butyrate in bacterial colon dampen the bad effect of sulfur containing food. So resistant fibre such as oats has resulted in an increase in the population of Bifidobacillus and Lactobacillus in the colon and an increase in faecal butyrate concentrations to dampen the damaging effect of bacteria that ferment of sulphur amino acids.
      Diet and relapsing ulcerative colitis: take off the meat?

  3. Dr. Greger
    I have had a recurrence of UC. It began initially about 1 year ago at age 70–first time. Was controlled by Lialda and VSL#3 probiotic. I am basically a vegetarian, about 80% of the time. I am a serious weight lifter (compete in powerlifting competitions). My breakfast usually consists of a smoothy made from fruit, kale and whey protein. I realize I need to cut out all wine (I was basically off it and we went on vacation around the holdiays when I had a recurrence and both diet and wine consumption changed). I need to get back to my normal diet. What about whey protein and yogurt? Can I continue to use these in my smoothies or should I cut them out. Many thanks in advance.

    1. I am not a doctor but do eat whey protein and real yogurt. I suspect that your problem may have to with fermentation of foods inside the stomach. Try to separate eating fruits at other time or skip it for a while to see if your condition will improve. For vegetables then slightly cook instead of eating completely raw. My stomach does not digest too much raw vegetables either although I have no digestive issue to start. By slightly cooking, you actually enhance the nutrients absorption.

      It’s not because you are a vegan that you cannot have digestive issues.

      1. PLEASE BE AWARE that “Jerry Lewis” and his “advice” and bologna agenda are contrary to just about every study presented on this site and others. He is a dangerous source of wild misinformation and n=1 unsupported anecdotes.

      2. U may want to avoid whey protein. Very difficult to verify organic and contaminent free. I am a retired fitness specialist. Powerlifting. Got seriously ill. Autoimmune. When added protein powder to my diet.i verified my product and still got poisoned, i realize that was then and contolls r now rigorous but research verifies extra protien is not necessary for hypertrophy.

    2. Have you tried any vegan protein powders? I know there are more and more bodybuilders who are turning toward plant-based eating, and there are several plant-based protein powders out there. Maybe you can find one that doesn’t irritate your UC. I have UC too but am not a bodybuilder so I don’t currently use any powders so can’t make any recommendations.

      1. Sunwarrior is a plant based protein powder I like it a lot. I have colitis and have had it since I was 19 years old , I’m 36 now. Cutting meat out of my diet the last 4 years and most dairy helped my colitis so much and like I read someone else say, when you read about colitis diets it says loose the fiber. Back in my 20s when I had terrible flares I couldn’t even touch raw carrots but when your not flaring is the time to slowly start working your way up with fiber and maintaining eating it , it’s been the best thing for my colon. I make my own almond milk that I use in my smoothies.

      1. Whey protein is milk without casein. Please educate yourself.

        So Dr G said that casein is bad, blah blah blah which is not quite true. But if whey is milk without casein then what does he have to say?

        1. Jerry

          Why do you have to keep making these fatuous comments? Dr Greger has never said that casein is the only dairy or animal protein that raises health concerns. You knoiw that and still you try to mislead people about what Dr Greger’s position is.

          For one thing, animal protein in general raises IGF! levels and high IGF1 levels are associated with increased cancer risk.
          https://www.theguardian.com/science/2014/mar/04/animal-protein-diets-smoking-meat-eggs-dairy

          There is also concern about Neu5Gc in dairy products and animal proteins, andits possible association with various diseases
          http://www.abc.net.au/science/articles/2003/10/01/957750.htm

          Frankly, Jerry, I get the impression that you deliberately try to deceive people about what Dr Greger has reported and what the scientific evidence shows about a whole range of subjects.

    3. Mike

      As Dr Greger says in his blog “there does seem to be a certain proportion of ulcerative colitis patients who would benefit from eliminating all dairy products. These researchers estimated that milk is a trigger in about one in every five cases, so, certainly, sufferers should try a dairy-free trial to see if they’re one of the lucky ones who can control this condition with such a simple dietary intervention”

      I am not a lifter but if you think that you really need high protein consumption for your sport, there are quite a few non-dairy alternatives available I understand. Michael Bluejay also has some information on the protein requirements of bodybuilders and athletes.
      https://michaelbluejay.com/veg/protein.html

        1. Hello Jack and thank you for your question,
          I am a family doctor with a private practice in lifestyle medicine, and also a volunteer moderator for this website.

          It is difficult to advise you without understanding exactly what foods you eat, and what foods that you know can aggravate your IBS. It’s good that you’re off dairy, because that is a frequent contributor to IBS symptoms in my experience.

          Having said that, the simple answer to your question is that you need to eat more calories. If you are eating mostly vegetables and fruit, that can be difficult to accomplish, because you would need to eat very large quantities.

          Eating foods with higher fat content is the most efficient way to get more calories in. However, most fats are very unhealthy, especially saturated fat — even if it’s from a plant source (coconut oil and palm oil are two examples of generally unhealthy plant oils). Probably the healthiest oil is flaxseed oil, due to its very high content of omega-3 fatty acids. Eating ground flax seeds is better than the oil, because that gives you the benefit of the lignans and fiber.

          All nuts and seeds are high in calories and fat. Some of the healthiest ones (which have appreciable omega-3 content, and not just omega-6 fatty acids) are flax, chia, and hemp seeds, and walnuts.

          Beans are also fairly high in calories, so if you tolerate them, you should definitely eat more beans.

          Dr. Greger has done lots of great videos on flax and on beans, and a few on IBS, which you might want to check out. I hope this helps.

          Dr. Jon
          PhysicianAssistedWellness.com
          Volunteer moderator for NutritionFacts.org

  4. I just read the first paragraph and can tell that the rest is just TAT. Dr G, if you really try to help people then talk about real nutrition rather than pushing your vegan agenda. Being vegan is a noble cause but let’s not mix up nutrition with idealism. Otherwise it will look like some fanatic religion that forbids people from eating certain foods just based on religious ground.

    Nothing is further from the truth than the following statement as billions of people in the world including Okinawans and Chinese eat animal foods without a single problem. Of course they also eat a lot of plant foods along. You have to look at the entire picture and not just one part of what people eat and come up with a fantasy novel that some well known TAT had written.

    “I talk about the role animal protein may play in the development of these diseases”

    1. Jerry, thanks for fulfilling the role of NF.O Naysayer. ‘-)

      Everything needs a foil, irregardless of the validity, to give the “customer” the option of which side to choose.

      Obviously you elevate Dr Greger and WFPB diets to greater and greater heights.

      (com’on, your occasional rational posts give you away… that this is all an act ‘-)

      1. Yes I eat a lot of whole foods, plant and animal origin. For plants, I eat more than most people on this board. For instance, I just finish a steamed bitter melon and raw moringa salad for lunch. How many people on this board eat bitter food? For drink, I will drink fermented blueberry. How many people drink that? And my bone broth soup this morning contains a lot of mushroom and kale and spinach and various herbs. How many people consume that (just the plant part)?

        You are right Lonie, I am an ardent follower of Dr G and WFPB.

        On the subject of stem cell, you may find the following video informative. It talks about stress free life to extend your longevity. Judging from the posts of some people on this board, they are not living a stress free life at all.

        https://www.youtube.com/watch?v=ZPNFQkzMdo4

    2. PLEASE BE AWARE that “Jerry Lewis” and his “advice” and bologna agenda are contrary to just about every study presented on this site and others. He is a dangerous source of wild misinformation and n=1 unsupported anecdotes.

  5. As someone who suffers from UC, I ditched all dairy, meat, and eggs, and have been doing much better overall. I also ditched alcohol, but after reading this, what about sulfites in balsamic vinegar? I use it in salad dressing a lot and wonder if a recent flare may be the result of the accumulation of the sulfites it contains.

      1. Hi Marilyn,

        Great idea! Never considered using it for salad dressing but have used it in other recipes. I love love love balsamic vinegar so may take some getting used to but if it may help my colon issues, then totally worth it.

    1. Hi Tim! You are right about sulfites in balsamic vinegar, but it looks like Marilyn has already given you a great suggestion of switching to ACV!

  6. I have been following this humorist on YouTube. His name is Kasey but his youtube channel is called Vegetable Police. He is a purist vegan. In this video he explains how he overcame ulcerative colitis by following a high fruit vegan diet. You may disagree with him, but he gives an interesting vegan perspective on overcoming ulcerative colitis.

    https://www.youtube.com/watch?v=XcnRmt6hxyc

    1. Thanks John for posting the video. I knew very little about ulcerative colitis prior to watching Dr G’s videos, and today I learned a bit more. Hearing successful testimonies from courageous people like “greg”, in the comments above and Kasey is amazing to me!

      1. Hi Susan, I am glad that you like Kasey’s testimony and his protocol for curing ulcerative colitis. I was afraid that most people would not like Kasey because he is a comedian. His entire YouTube channel is about humor and vegan. But, he researches and researches and tries out all kinds of diets on himself. He has already watched every Dr. Greger video there is.
        He is fully aware of all of the information given out by Esselstyn, John McDougal, Ornish, and the others. Plus, he is an expert on all the other VEGAN youtubers such as John Rose, Durien Rider, Happy Vegan, Vegan Gains.
        Kasey knows and understands of the information coming out of nutrition experts. He even reads Dr. Mercola’s stuff. But, the thing about Kasey is he actually LIVES it. He lives the vegan life style and has overcome ulcerative colitis by first drinking cabbage juice. When you drink cabbage juice you are getting the right micro-organism in your gut that will help you to overcome ulcerative colitis. For any of you who have never seen Kasey on YouTube as the Vegetable Police you can watch one of his 900 vidoes on this link. But, let me warn you, Kasey clowns around. He is comedian and his channel always has degrees of slap stick and comedy in it. So, don’t expect to hear a sterile lecture by some expert in the field of nutrition. Here is the LINK:

        https://www.youtube.com/watch?v=XcnRmt6hxyc

        It would be interesting to hear Tom Goff’s comments about Kasey, because Tom only considers highly scientific peer review papers and does not like personal testimonies.

        1. The guy used to eat a SAD diet and then he switched to a cabbage diet and then fruit diet and his ulcerative colitis is cured. Of course, any diet will be better than a SAD diet. But that does not prove anything that eating animal foods caused his ulcerative colitis because the guy eat meat the wrong way. it’s like comparing apple and orange. How about if I compare a vegan who eat potato chip with a guy who eat hamburger? I bet that the guy eating hamburger is more healthy but that does not prove anything.

          If you read Dr Mercola, or Dr Axe, or Dr Hyman, or Chris Kresser, they will tell you to select the right source of meat and how to cook it. They will also tell you to minimize your meat consumption but eat mostly plant foods, but you have to eat certain amount of animal foods for optimal health. Nobody tells you to eat hamburger at McDonald’s or eat processed foods.

          Just look at this example of foods that Dr Axe recommends. I bet that if this guy eats Dr Axe diet then he would not have ulcerative colitis to begin with and he will be a lot more healthy than a lot of vegans.

          https://draxe.com/healing-diet/

          1. You know Jerry I think that internet entrepeneurs like Mercola, Hyman, Kresser and Axe are missing a valuable commercial opportunity.

            Considering their target audience, there must be a huge market for tinfoil hats there. Just think, they could offer both standard sizes and made-to-order models in a range of colours. They would fit in quite nicely with the pills, [otions and whatever they already sell.

            But speaking seriously, people wanting advice on diet and health should go to credible sources not individuals selling snake oil and fad diets for personal profit. I find Dr Greger a relaible source but major reports on nutition and health are also freely available for downlad. They also base their recommendations on the scientific evidence rather than the pseudoscience which is the stock in trade of people like Mercola, Hyman, Kresser and Axe.

            http://apps.who.int/iris/bitstream/10665/42665/1/WHO_TRS_916.pdf
            http://www.wcrf.org/sites/default/files/Second-Expert-Report.pdf
            https://ods.od.nih.gov/pubs/2015_DGAC_Scientific_Report.pdf

            Nobody should take dietary advice from snake oil merchants, no matter how plausible their informercials and misleading books are.. Go with the science instead of the bs.

            1. Mercola, Hyman, Kresser and Axe did 100 times more good to humanity that the guy from down under who post crap tad every night and he is himself very sick, both physically and mentally.

              If you have read and learned from Mercola, Hyman, Kresser and Axe then you would not have been in this predicament because of your fanatic belief in the fake low fat theory. But that’s your choice so be it.

              1. Jerry

                I am 67 and ate a standard Western diet for most of my life, as well as smoking and drinking. Yet now the only prescription medication I take is eye drops for glaucoma.

                Your insistence on depicting me as “sick” and in a health “predicament” is as inaccurate and false as all your other claims.

                It is hard to tell if you simply revel in trollish behaviour or whether you genuinely believe the litany of falsehoods you post on this site. For your sake, I hope it is the former although I fear that you are quite loopy enough for the latter to be the case.

                As for believing the fictions and falsehoods posted by internet entrepeneurs in an attempt to boost their sales of snake oil, I am not suicidally inclined. I wonder just how many people have died, suffered heart attacks and strokes or been propelled into diabetes and dementia as a result of believing their false claims about dietary saturated fat and blood cholesterol.

  7. Throughout some of the posts others have asked about things in a WFPB diet, say onions, beans… that may also cause the nasty sulfur gas. I’d be interested to know if this is the same as meat and alcohol on its affects to the bowel.

    1. Happiest Outdoors. The answer is YES. Beans give people with ulcerative colitis problems. Listen to Kasey. He is an expert on ulcerative colitis. He struggled with it for years and tried everything. He finally cured his ulcerative colitis on a vegan cabbage and celery juice diet, then switched over to a fruit diet. And, now he can eat just about anything, except he is a pure vegan. Kasey talks about beans and ulcerative colitis. But, let me warn you, he is a comedian, but he knows everything about ulcerative colitis, plus he has watched every video that Greger has ever made and can quote Greger word for word if he wants to. Here’s the link:
      https://www.youtube.com/watch?v=XcnRmt6hxyc&t=94s

      1. The YouTuber you recommend watching is not an authority on nutrition and medicine. In fact is he at the opposite end of the spectrum: he believes in auras, clairvoyance, angels, detoxification regimes, you name it. He should only speak about his experience with UC, not make generalizations and claim that a vegan diet cures it. There is no known cure for UC, it’s possible that he’s in remission and will relapse at any time. I also have UC and have been in remission thanks to Dr. Greger’s work. I would recommend people with UC watch Dr. Greger who is an authority on the subject, not someone else who claims to be.

        1. You should tell the YouTuber, Casey, that you believe that he is not cured of ulcerative colitis. Your debate should be with him, not me. I am just leaving a link to his testimony. Tell him that you know more about ulcerative colitis than he does, and that you believe he has not cured it with whole plant fruit diet. Go ahead tell him.

  8. B”H

    I am a personal chef and have worked with two people who had UC and irritable bowel syndrome (IBS).

    The person w IBS also has more serious MS and is in a wheelchair. Her IBS was easily cured through a plant based whole foods diet with fish once a week. Due to Dr Greger’s writings she (and I too) are now completely vegan. She has had no need for IBS medication over the last seven years.

    A local Pittsburgh MD suggested that I meet w a 25 yr old young man w UC. He was completely disabled and unable to go to work or even get through the night. He was in and out of the hospital with transfusions and IV feeding. He had blood in his feces and seemingly could not digest anything.

    I suggested to him and his mother that we try rebuilding his digestive process with the easiest, gentlest foods we could make. We eliminated all animal food and started him with organic non-pasteurized miso vegetable soup and pre-soaked org brown and sweet brown rice cooked overnight with an umeboshi plum. The miso and umeboshi are powerful whole food probiotics.

    Within 48 hours he slept through the night. We introduced other cooked vegetables and within a week he was feeling almost completely better. In two weeks he went back to work.

  9. Dear volunteers and sympathisants,

    What about the sulfur amino acids in plants like the cruciferous family? Does it have an effect on people with UC? Beneficial of maleficious? Does it depend on if the person is in remission or when the inflamation is high?

    Secondly I would like a bit more information about beans and UC. Should people with UC avoid beans all around or just when there out of remission?

    Thanks for al the free information and help.

    1. Hi Erdal and thanks for your question – During an acute flare with bloody stools, you may need to avoid foods such as beans as well as raw fruits and vegetables. Removal of animal products (including dairy), alcohol, gluten will help as a starting point. Steamed cruciferous vegetables can be included, either chewed well or blended. Steaming all fruits and vegetables and blending into smoothies and soups will be a great way to maintain adequate phytonutrients and fiber while allowing your colon to heal. You may find other helpful information with this link:
      https://www.drfuhrman.com/learn/health-concerns/63/ulcerative-colitis

  10. My partner has ulcerative colitis… or *had* it, I should say. Had been flaring up on and off, each flare up was worse, since his late teens. Just before 30 he went vegan. His next check up showed very little ulceration, but the specialist warned he should “watch his fibre” and “try to eat more protein.” … He thought about following that within a vegan paradigm for a while but couldn’t be bothered.

    At his next check-up: asymptomatic. “You must be doing something right, keep doing what you’re doing.” He says he’s vegan.” “Oh, make sure you don’t get too much fibre, that could be irritating.” …? Ok.

    Next several check-ups: asymptomatic… at which point he quit getting check-ups because he was worried he’d damage his eyes with all the eye rolling. I’m sure he’ll go back eventually out of curiosity/when he thinks his eyeballs are up to the challenge… or when the specialists finally catch up…

  11. JUNE 14TH, 2018 AT 5:55 PM
    Did anyone else notice that Dr. Gregers article on Stevia was incorrect? He claimed you could only consume two stevia sweeteded drinks a day.
    I did the math from the product and amt. I use and it was safe to use it for 10-12 drinks a day! (4mg.stevia per kg.of body weight.)

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