The Best Diet for Ulcerative Colitis Treatment

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One of the most common questions physicians treating patients with inflammatory bowel disease (IBD) are asked is whether changing one’s diet can positively affect the course of their disease. Traditionally, our answer had been we have no clue, but this may now be changing, given the evidence that hydrogen sulfide may be playing a role in ulcerative colitis. And since the sulfur-containing amino acids concentrated in meat cause an increase in colonic levels of this rotten egg gas, maybe we should take off the meat. See, animal protein isn’t just associated with an increased risk of getting inflammatory bowel disease in the first place, but also IBD relapses once you have the disease.

This is a recent development. Because the concept of IBD as a lifestyle disease mediated mainly by a Westernized diet is not widely appreciated, an analysis of diet in the follow-up period after diagnosis in relation to a relapse of inflammatory bowel disease has been ignored. But not any longer. Ulcerative colitis patients in remission and their diets were followed for a year to see which foods were linked to the bloody diarrhea coming raging back. And the strongest relationship between a dietary factor and an increased risk of relapse observed in this study was for a high intake of meat.

What if you have people lower their sulfur-containing amino acid intake by decreasing their consumption of animal products? They tried it on four ulcerative colitis patients, and without any change in meds, they experienced like a four-fold improvement in their loose stools. In fact, they felt so much better that they didn’t think it ethical to try switching them back. Since sulfur-containing amino acids are the primary source of dietary sulfur, a “low sulfur” diet essentially means a shift from a typical diet high in animal protein and fat, and low in fiber, to more of a plant-based diet. Westernized diets are pro-inflammatory, and plant-based diets are anti-inflammatory.

Let’s see what treatment with a plant-based diet can do, after the onset of ulcerative colitis during a low-carbohydrate weight-loss diet. A 36-year-old man lost 13 pounds on a low-carb diet, but also lost his health, diagnosed with ulcerative colitis. Put him on a diet centered around whole plant foods, though, and poof—symptoms resolved without medication. Okay, but this is just one case. Case reports are just like glorified anecdotes. The value of case reports lies in their ability to inspire researchers to put it to the test, and that’s exactly what they did.

There had never been a study published focusing on using plant-based diets for the treatment of ulcerative colitis, until now. Considering the lack of a suitable diet to be the biggest issue faced in the current treatment of inflammatory bowel disease, and regarding it as a lifestyle disease caused mainly by our omnivorous diet, a group of Japanese gastroenterologists have been providing a plant-based diet to all patients with IBD for over a decade, and publishing extraordinary results—far better than have to date been reported in the medical literature elsewhere. I profiled some of their early work in one of the first videos that went up on NutritionFacts.org, found to be effective in the maintenance of remission in Crohn’s disease by 100 percent at one year and 90 percent at two years. So, how about a plant-based diet for relapse prevention in ulcerative colitis?

Educational hospitalization meant bringing patients into the hospital to control their diet and educate them about the benefits of plant-based eating, so they’d be more motivated to continue it at home. Most patients—about three-quarters—experienced improvements such as disappearance or decrease of bloody stool during hospitalization. Fantastic!

Okay, but here’s the really exciting part. Then, they followed the patients for five years, and 81 percent were able to remain in remission the whole time, and 98 percent were able to keep the disease at bay for at least a year. That blows other treatments away. Those relapse rates are far lower than those reported with medication. Under conventional treatment, other studies found that about half relapse, compared to only 2 percent among those taught to eat healthier.

A plant-based diet was previously shown to be effective in both the active and quiescent stages of Crohn’s disease. The current study has shown that a plant-based diet is effective in both the active and quiescent stages of ulcerative colitis as well. And so, they did another study on even more severely affected cases with active disease and found the same thing, far beating out conventional drug therapy. People felt so much better that they were still eating more plant-based even six years later. The researchers conclude that a plant-based diet is effective for treating ulcerative colitis to prevent a relapse.

Why? Well, plant-based diets are rich in fiber, which feeds our good gut bugs. That might partly explain why a plant-based diet prevents a variety of chronic diseases. And so, that’s what we may be seeing with inflammatory bowel disease, suggesting that replacing an omnivorous diet with a plant-based diet is the right approach.

It’s like using plant-based diets to treat the cause of heart disease, our #1 killer. It’s not just safer and cheaper, but it works better. No adverse side effects noted for plant-based eating. Let’s compare that to the side effects of immunosuppressants used for ulcerative colitis, like cyclosporine. Side effects include … (see video at 5:27 for the list of side effects.)

And now, we have even fancier drugs that cost about $60,000 a year (that’s $5,000 a month), and they don’t even work very well, with clinical remission at one year of only like 17 to 34 percent. And instead of no adverse side effects, they can give you a stroke. They can give you heart failure. They can even give you cancer, including a rare type of cancer that often results in death. Or how about a serious brain disease known as progressive multifocal leukoencephalopathy, which can kill you, and for which there is no known treatment or cure? Yeah, yeah increased risk of death, but did we mention how nice and small the pill was and the easy-to-open bottle?

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• Chiba M, Tsuda S, Komatsu M, Tozawa H, Takayama Y. Onset of ulcerative colitis during a low-carbohydrate weight-loss diet and treatment with a plant-based diet: A case report. Perm J. 2016;20(1):80-4.
• Chiba M, Nakane K, Tsuji T, et al. Relapse prevention in ulcerative colitis by plant-based diet through educational hospitalization: A single-group trial. Perm J. 2018;22:17-167.
• Chiba M, Nakane K, Tsuji T, et al. Relapse prevention by plant-based diet incorporated into induction therapy for ulcerative colitis: A single-group trial. Perm J. 2019;23:18-220.
• Mayo Clinic. Cyclosporine (oral route): Description and brand names. September 1, 2020.
• Milev S, DiBonaventura MD, Quon P, et al. An economic evaluation of tofacitinib for the treatment of moderately-to-severely active ulcerative colitis: Modeling the cost of treatment strategies in the United States. J Med Econ. 2019;22(9):859-68.
• Milev S, DiBonaventura MD, Quon P, et al. An economic evaluation of tofacitinib for the treatment of moderately-to-severely active ulcerative colitis: Modeling the cost of treatment strategies in the United States. Supplementary Info. J Med Econ. 2019;22(9):859-68.
• Farrell RJ. Biologics beyond anti-TNF agents for ulcerative colitis - efficacy, safety, and cost? N Engl J Med. 2019;381(13):1279-81.
• REMICADE.
• Simponi.
• HUMIRA.
• Entyvio.
• Xeljanz.

Video production by Glass Entertainment

Motion graphics by Avocado Video

• animal products
• anti-inflammatory
• cancer
• Crohn's disease
• diarrhea
• fiber
• gut flora
• heart failure
• inflammation
• inflammatory bowel disease
• longevity
• low-carb diets
• meat
• microbiome
• mortality
• Plant-Based Diets
• side effects
• stroke
• ulcerative colitis
• vegans
• vegetarians
• weight loss