Tuning into how you feel after meals is an important part of managing ulcerative colitis. There’s no exhaustive list of foods to avoid with ulcerative colitis and also no definitive proof that foods cause chronic inflammatory bowel disease (IBD) like ulcerative colitis in the first place. But there are certain categories of foods you should be mindful of in case they aggravate symptoms—like bloating, diarrhea, or pain—during flare-ups.
That said, it’s best to avoid overly restrictive diets—which can be harmful, says Simon Hong, M.D., a gastroenterologist specializing in inflammatory bowel disorders and clinical assistant professor at NYU Grossman School of Medicine.
“One of the big issues with IBD is appropriate nutrition,” Dr. Hong tells SELF. “We don’t want people to start cutting out all these things and end up being malnourished.”
And it’s important to consider that diet is just one aspect of the condition. “For most patients with ulcerative colitis, when their inflammation is gone—which is achievable for many patients now with medicines—they generally can eat what they want unless it’s something that they’re intolerant to,” Russell Cohen, M.D., professor of medicine and director of the University of Chicago’s Inflammatory Bowel Disease Center, tells SELF.
So with those caveats in place, here are six types of foods that could make your ulcerative colitis symptoms worse:
1. Beans and high fiber foods
Many people hail fiber as a magical nutrient that can lower your risk of developing heart disease, type 2 diabetes, and potentially offer some protection against Crohn’s disease—another type of IBD.
However, some people with ulcerative colitis may want to avoid a high-fiber diet, depending on their symptoms, suggests The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).
People who have diarrhea may want to eat less insoluble fiber because it moves food through the intestine quickly—which only makes the problem worse. Consider reducing the amount of beans, cruciferous vegetables, nuts, and whole wheat flour in your diet to see if your symptoms improve.
Although high-fiber diets may affect some people with ulcerative colitis during a flare-up, experts generally recommend making sure to get enough fiber during remission. Some studies and reviews show that it may help prolong periods without inflammation—except for in people who have strictures, or a narrowing of the intestine. “In those patients, we do advise less fiber, because fibers can clump up and cause an obstruction or blockage,” says Dr. Hong.
FODMAP stands for fermentable oligosaccharides, disaccharides, monosaccharides, and polyols. These short-chain carbohydrates are difficult for our bodies to digest, can produce gas, and increase fluid to our colon—ultimately causing diarrhea and gastrointestinal distress in some people. They’re present in an abundance of foods, including onions, legumes, ice cream, apples, honey, and artificial sweeteners.
Experts commonly recommend a low-FODMAP plan to treat irritable bowel syndrome (IBS), a term that describes a collection of symptoms including abdominal pain, bloating, gas, and diarrhea or constipation. People with IBS do not always have inflammation in the digestive tract like people with IBD do. However, ulcerative colitis and IBS share some common symptoms, so your doctor may recommend trying a low-FODMAP diet if you have ulcerative colitis, says Dr. Hong.
Researchers are studying whether low-FODMAP diets can relieve ulcerative colitis symptoms, but so far studies have been small. A retrospective study in the journal Inflammatory Bowel Diseases found that a low-FODMAP diet reduced symptoms in 38 ulcerative colitis patients. More research studying larger numbers of people is necessary to determine whether FODMAPs are a critical factor in ulcerative colitis symptoms. However, anecdotally, some people with ulcerative colitis report that curbing their FODMAP intake seems to help their gut symptoms.
Initially, the low-FODMAP diet is very restrictive: The idea is to cut out all FODMAPs before slowly reintroducing some to determine which you can tolerate. It’s important to work with your health team when making any dietary change to avoid nutritional deficiencies.
3. Cheese, milk, and dairy products
“Dairy is a tricky one: Lactose intolerance can be perceived as a flare of ulcerative colitis,” says Dr. Hong. “One of the things we recommend is if you’re feeling unwell with things you’re eating, try cutting out the dairy. If that does help, then maybe get tested for lactose intolerance, which is an easy test to do and is warranted.”
Even if you don’t think you’re lactose intolerant, there’s another reason consuming dairy could make you feel sick. Lactose is a FODMAP, which might explain why it gives you GI symptoms. Everyone reacts to FODMAPs differently, so it’s worth getting tested for lactose intolerance and working through the process of elimination with your medical team.
Ulcerative colitis is not the same as celiac disease, in which gluten triggers the immune system to attack the small intestine. However, some research indicates that people with ulcerative colitis are more likely to also have celiac disease. Alternatively, you might have gluten sensitivity, meaning you don’t have an immune response to gluten but find it causes symptoms including bloating, abdominal pain, diarrhea, and fatigue, all of which can also be symptoms of ulcerative colitis.
A 2014 Inflammatory Bowel Diseases study surveyed 314 people with an IBD—including 122 people with ulcerative colitis—and found that 56.5 percent reported less bloating while on a gluten-free diet. In addition, 42.6 percent reported less diarrhea, 41.5 percent reported less abdominal pain, and 38.3 percent reported that they had fewer, and less severe, flare-ups.
But don’t start tossing out your favorite cereal just yet. A high-FODMAP carbohydrate called fructan is in many of the same foods as gluten. So cutting out gluten means you’re eliminating many FODMAP foods, too, which can be too much of a change to just take on by yourself.
As with all of these foods, it’s a matter of trial and error and working with a professional can help you figure out what’s going on as safely as possible. “We don’t recommend gluten avoidance per se, and there’s no evidence that gluten worsens IBD,” says Dr. Hong. “If someone’s having symptoms, we’ll go down the list and try avoiding gluten, try avoiding FODMAPs, and if they seem to respond, then we’ll go down that path.”
5. Wine, beer, and other alcoholic beverages
Alcohol stimulates your intestines, which can make diarrhea worse. Plus, the high sugar content in many types of alcohol could also cause diarrhea. In addition, researchers believe the additive sulfite, found in beer, wine, and lager, may worsen symptoms, rather than the alcohol itself—which brings us to the last item on this list.
6. Sulfites and other additives
Researchers have studied the impacts of additives on people with ulcerative colitis. It’s important to mention that research on these additives is preliminary—most have been conducted on animals and the results in mice wouldn’t necessarily replicate in humans. “It’s a big area of study because additives are so prevalent in modern foods,” Dr. Hong says. “But there isn’t some strong evidence saying, ‘These are absolutely out-and-out bad for you.’ But there are thoughts that they could be bad.”
We’ve already mentioned sulfites, which manufacturers often use to lengthen the shelf life of products, including burgers, soft drinks made from concentrate, sausages, canned goods, meats, fish, and dried fruit. Experts theorize sulfites damage bacteria that promote gut health.
In addition, researchers have looked into potential ulcerative colitis impacts from carrageenan, which is derived from seaweed and works as a thickening agent in dairy products, milk alternatives such as almond milk, processed meats, and soy-based products. Carrageenan causes inflammation and ulcerations in animals that are similar to those seen in patients with ulcerative colitis. But again, there’s no evidence that this causes inflammation in people.
Unfortunately, there is no clearly defined list of “safe” foods to avoid with ulcerative colitis, or “safe” foods you can always incorporate into your diet. But there is good news! Medications can help treat inflammation, and when you’re in remission, you’re more likely to be able to eat whatever you want—barring anything you’ve always been intolerant of or allergic to. This is why it’s important to work with your gastroenterologist and a dietitian to develop a plan that works best for you. When you are having a flare-up, know that your doctors want to help you find the right medication and diet that makes you feel your best without giving up your favorite foods. Maintaining a food diary can help you identify troublesome foods to discuss with your doctor.
“Let us control inflammation, let us heal the intestine objectively. And then we’ll talk about ways to tweak your diet so that you can still enjoy all the foods you like while cutting out the ones that may be causing the symptoms,” says Dr. Hong.