How do patients with ulcerative colitis eat?

I. Overview

1. What is ulcerative colitis?

– Ulcerative colitis (UC) belongs to the group of inflammatory bowel diseases (IBD). Ulcerative colitis is a chronic, often relapsing disease with alternating periods of exacerbation and remission, characterized by mucosal inflammation in the colon and rectum.

UC is associated with a large incidence in Western countries and an increasing incidence in developing countries.

The multifactorial pathophysiology of UC includes genetics, epithelial barrier defects, dysregulated immune response, gut microbiota imbalance, and environmental factors. Chronic ulcerative colitis increases the risk of rectal cancer.

2. Symptoms of ulcerative colitis:

+ The most common symptom is bloody stools.

+ Diarrhea with blood several times a day, dehydration

+ Lower abdominal pain, urge to defecate

+ May experience anemia, fatigue, hypoalbuminemia, weight loss

+ Most are ulcerative sigmoid colon and rectum but can also affect higher places

2. Some nutritional problems of patients with ulcerative colitis

Anemia due to blood loss and iron deficiency

Anemia in UC patients can be attributed to decreased iron absorption by chronic inflammation in the gastrointestinal tract or bowel resection, malnutrition, and fecal blood loss.

Iron deficiency occurs on average in 13%–90% of patients with IBD. Iron deficiency is one of the most common extra-gastrointestinal complications of the disease and one of the most common causes of anemia in IBD patients.

Iron can have a particularly powerful effect on the health of people with chronic inflammatory diseases. Iron deficiency contributes to the severity of the disease.

Vitamin D and Calcium deficiency

Vitamin D deficiency is found in 10–75% of patients with IBD. This deficiency can be found in people with ulcerative colitis twice as often as in healthy individuals.

Vitamin D supports the absorption of Calcium and Phosphorus in the intestines and reabsorption in the kidneys, so vitamin D deficiency often leads to calcium not being absorbed. The body has to mobilize calcium from the bones into the blood, causing a disturbance in the calcification process in the bones, which leads to osteoporosis.

People with IBD are up to 40% more likely to break a bone than healthy people. The risk of osteoporosis is high in patients with IBD and is especially increased in patients treated with corticosteroids.

In addition, inadequate vitamin D intake in the body may be correlated with increased intestinal membrane permeability and impaired immune function, which not only contributes to the development of IBD but also increases the risk of relapse.

Causes of vitamin D deficiency may include less sun exposure, a diet low in vitamin D, malabsorption due to inflammation occurring in the gastrointestinal tract or bowel resection, increased absorption by inflammatory cells, impaired renal metabolism and increased catabolism and excretion.

Vitamin B9 deficiency

Folic acid deficiency is significantly more common in UC patients than in healthy individuals. This vitamin B9 deficiency can be attributed to inadequate intake, decreased absorption due to inflammation occurring in the gastrointestinal tract, increased utilization by inflammatory cells, and drug interactions, particularly methotrexate or sulfasalazine.

Sulfasalazine affects vitamin B9 deficiency by causing malabsorption syndrome. In contrast, methotrexate reduced the activity of dihydrofolate reductase, which is required for the conversion of dihydrofolic acid to tetrahydrofolic acid.

One dangerous complication of IBD is an increased risk of colorectal cancer. A meta-analysis of 10 studies by Burr et al demonstrated that folic acid supplementation may have a preventive effect on the development of colorectal cancer in patients with IBD.

3. Diet for patients with ulcerative colitis

Due to the specificity of ulcerative colitis, in addition to treatment with anti-inflammatory drugs, antibiotics and surgery, the application of appropriate diet and nutrition is an extremely important element of therapy, however, this factor is still underestimated and often overlooked in medical practice.

Despite the lack of specific dietary advice in inflammatory bowel disease, more than 70% of sufferers recognize that inadequate nutrition significantly affects disease progression and increases frequency and severity of symptoms.

There is no one specific diet for patients with ulcerative colitis and it is based on the patient’s adaptation to variable food choices. But in general, the diet when symptoms flare up is based on these principles:

– Smaller meals, eating several smaller meals more often throughout the day, instead of three large meals, can help control symptoms.

– Avoid hard, high-fiber foods (insoluble fiber) to reduce the amount and frequency of stools as well as not affect the ulcer. These are foods such as whole grains, beans with skin on, raw or uncooked vegetables, …

– Fight diarrhea by using foods rich in soluble fiber such as brown rice, bran flour, cornstarch, spinach, … In addition, soluble fiber also helps to develop beneficial intestinal bacteria, balance the microflora.

– The use of probiotics may be beneficial in the treatment of ulcerative colitis during the remission phase of the disease as well as during the acute phase of ulcerative colitis. Probiotics can prevent recurrences of acute flares, and during flares of ulcerative colitis, they help calm inflammation.

– Prevent dehydration by drinking Oresol solution or fruit and vegetable juices

– Avoid gas-producing foods such as eggs, milk, carbonated soft drinks, etc. You can use soy milk or soy yogurt instead.

– Avoid caffeine and alcoholic beverages because of nerve stimulation, increased stress and inflammation levels.

– Ensure the diet provides adequate energy, vitamins and minerals to prevent malnutrition and anemia

+ Minimum energy 30 kcal/kg/day

+ Minimum dietary protein 1-1.2 g/kcal/day

References:

[1] M. Radziszewska, J. Smarkusz-Zarzecka, L. Ostrowska, and D. Pogodziński, “Nutrition and Supplementation in Ulcerative Colitis”, Nutrients, vol. 14, no. 12, p. 2469, June 2022, doi: 10.3390 /nu14122469.

[2] J.-Y. Nie and Q. Zhao, “Beverage consumption and risk of ulcerative colitis”, Medicine (Baltimore), vol. 96, p.h 49, p e9070, December 2017, doi: 10.1097/MD.0000000000009070.

[3] F. Wang et al., “Carbohydrate and protein intake and risk of ulcerative colitis: Systematic review and dose-response meta-analysis of epidemiological studies”, Clin Nutr, vol. 36, p.h 5, pp. 1259–1265, m. October 2017, doi: 10.1016/j.clnu.2016.10.0.009.

[4] “Ulcerative colitis – Living with”, nhs.uk, 3 October 2018. https://www.nhs.uk/conditions/ulcerative-colitis/living-with/ (accessed 16 December 2022).

[5] Le Thi Huong, Clinical nutrition- moderation. Hanoi Medical University: Medicine Publishing House, 2016.

Article source: Nutrition Research and Development Institute (https://inrd.vn/)

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