Cause: Unknown, but infectious and/or automimmune causes are suspected.

Useful Supplements: Butyrate, Fish Oil, Folic Acid.

Useful Herbs: Boswellia, Chamomile.

Further information: Ulcerative colitis is an inflammation of the large intestine (colon, hence the term colitis)and rectum. Symptoms include diarrhea (can be more than ten times daily) with blood present, abdominal pain, fever, weight loss, nausea, and gastrointestinal bleeding, causing bloody diarrhea. The disease usually begins in the rectal area, spreading and extending through the large intestine. Unlike Crohn’s disease, the small intestine is not involved. Repeat episodes lead to permanent thickening of the intestine wall and rectum due to scar tissue. The incidence of colon cancer is increased in patients with ulcerative colitis, and regular surveillance is recommended.

The cause of ulcerative colitis is unknown. Risk factors include family history of the disease and Jewish ancestry. Curiously, cigarette smoking seems to have a protective effect, and many people with ulcerative colitis develop their symptoms three to six months after smoking cessation.

Treatment is aimed at decreasing the inflammation of the colon lining, and includes anti-inflammatories that are aspirin derivatives as well as steroids such as prednisone. In severe cases, surgery may be required, but since ulcerative colitis only affects the colon, removal of the colon is curative.

Several dietary changes may help lessen the symptoms of ulcerative colitis. High fat and cholesterol intake appears to increase the risk of ulcerative colitis.¹ In contrast, a diet high in fruit and fiber may help lessen the frequency of attacks.²

Food allergies will exacerbate ulcerative colitis.³ An elimination diet may be recommended to find the culprit food items.⁴ When colitis is active, or "flaring", bowel rest or diets low in fiber are generally recommended to minimize irritation of the colon. When the flare is resolved, one may go back to a higher fiber content in the diet.

The following nutrients and herbs may be helpful in the treatment of ulcerative colitis:

Butyrate, a short chain fatty acid, is used by colon cells for energy. It is effective in the treatment of ulcerative colitis.⁵

Fish Oil’s anti-inflammatory properties can reduce the need for prescription anti-inflammatory medications by ulcerative colitis patients.⁶ In addition, other positive effects are seen, including weight gain and less abdominal pain.^7,8

Folic Acid supplements are highly recommended, as they appear to reduce the risk of colon cancer in people with ulcerative colitis.⁹ Supplementation of 1000 mcg daily may reduce the risk of cancer by as much as 50%.¹⁰ It is especially important for patients being treated with the drug sulfasalazine to take Folic Acid supplements, as this medication depletes Folic Acid stores.¹¹

The herb boswellia, when taken in a dose of 550 mg three times daily, appears to help people with ulcerative colitis.¹²

Chamomile may also be effective in the treatment of ulcerative colitis.¹³

Other measures such as those discussed under Crohn’s disease may also be of benefit.

References:

¹Reif S, Klein I, Lubin F, et al. Pre-illness dietary factors in inflammatory bowel disease. Gut 1997;40:754–60.
²Kono S. Dietary and other risk factors of ulcerative colitis. A case-control study in Japan. J Clin Gastroenterol 1994;19:166–71.
³Munkholm, P., et al. Intestinal permeability in patients with Crohn's disease and ulcerative colitis and their first degree relatives, Gut, 35(1): 68-72, 1994.
⁴Candy S, Borok G, Wright JP, et al. The value of an elimination diet in the management of patients with ulcerative colitis. S Afr Med J 1995;85:1176–9.
⁵Hairg, J., Soergel, K., et al. N Engl J Med, 320: 23-28, 1989.
⁶Stenson WF, Cort D, Rodgers J, et al. Dietary supplementation with fish oil in ulcerative colitis. Ann Intern Med 1992;116:609–14.
⁷Aslan A, Triadafilopoulos G. Fish oil fatty acid supplementation in active ulcerative colitis: a double-blind, placebo-controlled, crossover study. Am J Gastroenterol 1992;87:432–7.
⁸Salomon P, Kornbluth AA, Janowitz HD. Treatment of ulcerative colitis with fish oil n-3-omega-fatty acid: an open trial. J Clin Gastroenterol 1990;12:157–61.
⁹Lashner BA, Heidnreich PA, Su GL, et al. Effect of folate supplementation on the incidence of dysplasia and cancer in chronic ulcerative colitis. Gastroenterol 1989;97:255–9.
¹⁰Lashner BA, Provencher KS, Seidner DL, et al. The effect of folic acid supplementation on the risk for cancer or dysplasia in ulcerative colitis. Gastroenterol 1997;112:29–32.
¹¹Halsted CH, Gandhi G, Tamura T. Sulfasalazine inhibits the absorption of folates in ulcerative colitis. N Engl J Med 1981;317:1513–17.
¹²Gupta I, Parihar A, Malhotra P, et al. Effects of Boswellia serrata gum resin in patients with ulcerative colitis. Eur J Med Res 1997;2:37–43.
¹³Weiss RF. Herbal Medicine. Beaconsfield, UK: Beaconsfield Publishers Ltd, 1989:26.