1. Iron
“There is frequent loss of blood from the inflammation and ulcers in the colon even if they aren’t seeing blood in the stool,” says Alyssa Parian, MD, a gastroenterologist who specializes in inflammatory bowel diseases (IBD) at Hackensack Meridian Medical Group in New Jersey.
“We recommend checking iron levels every 6 to 12 months,” says Brogan Taylor, RD, who specializes in gastrointestinal health at Banner Health in Phoenix.
Dr. Parian and Taylor both note that iron can be difficult to tolerate when taken orally. Some patients find that iron bisglycinate, an iron supplement that’s more easily absorbed, is easier on the stomach, says Taylor.
“When the iron is significantly low, we frequently will supplement with IV iron, which brings iron levels up faster and without the GI side effects,” says Parian.
2. Calcium
People with UC may also be low in calcium, a mineral that’s important for tooth and bone health. Low calcium levels can lead to reduced bone density and osteoporosis, which raises the risk of bone fractures.
“Many patients with UC also have lactose intolerance or sensitivity, especially during flares, and may have some calcium deficiency,” says Parian. But calcium supplements may not be the best remedy for low calcium.
According to Parian, if tolerated, yogurt or other dairy sources are still the best option, provided they don’t have too much added sugar.
You should talk to your doctor before taking calcium supplements.
3. Vitamin D
Vitamin D is another nutrient that is frequently low in people with IBD, says Parian, and it’s one that can be hard to get enough of from dietary sources.
“We frequently check these levels in the blood and recommend oral supplements. Studies have shown an association between higher vitamin D levels and improved outcomes, such as fewer hospitalizations and fewer flares,” she says.
4. Zinc
Zinc deficiency can develop in people with UC, especially if they have severe diarrhea, says Parian. In those people, there is some evidence that zinc supplements can improve outcomes and reduce the risk of hospitalization and surgery.
“Unfortunately, there isn’t great data to support the benefits of zinc supplementation if the levels are not low. In addition, excessive zinc can cause toxicity, so it’s important to discuss zinc with your doctor before taking it,” she says.
5. Fiber
Fiber can be tricky when it comes to IBD, says Taylor. “It’s important to adjust dietary intake of fiber when you are in a flare, but you can increase intake at baseline. We usually do not recommend a fiber supplement immediately and would recommend dietary adjustments first,” she says.
During flares, many patients feel better on low fiber diets, says Parian. “However, this doesn’t mean that people with ulcerative colitis shouldn’t consume fruits and vegetables,” she says.
The painful bloating and gas can be minimized by cooking vegetables until they are very soft, and fruits can be pureed into smoothies, Parian suggests.
Both Taylor and Parian cite the difficulties of finding the right level of fiber intake as one of the reasons it’s a good idea to work with an RD who is well-versed in UC.
“An RD, especially one with experience with IBD patients, is invaluable to review your specific and individualized dietary plan,” says Parian.
6. Prebiotics
Prebiotics are good for the microbes that live in your gut. “Psyllium husk is one example [of a fiber supplement with some prebiotic benefit], which can come in capsules or powder (Metamucil is a popular brand) has been shown to improve the good bacteria in your colon and potentially mediate inflammation in people with ulcerative colitis,” says Parian.
“We recommend this to patients when they are in remission. Because it can cause gas and bloating, it’s best to start with a small dose and monitor and adjust accordingly over time,” Parian says.
7. Probiotics
Probiotics are live bacteria and yeasts that are believed to have beneficial effects on the body, particularly the digestive tract. Some foods, such as yogurt and raw sauerkraut, contain probiotics, and you can also buy probiotic supplements, usually in capsule form.
“Probiotics have very mixed data and are not regulated by the FDA. Some studies do show some beneficial effects for ulcerative colitis patients, and they may help certain patients,” says Parian.
As far as what strain of bacteria or yeast might be best, so far there have been no head-to-head studies of probiotics to know, says Parian.
Probiotics is another area of research that is still evolving when it comes to diet and UC, says Taylor. “We do not usually recommend patients start with a probiotic, and we especially would not introduce these during a flare. If symptoms such as gas, bloating, or irregular stool continue when inflammation has subsided, you could speak with your gastroenterologist to see if a probiotic could help,” she says.
8. Folate (B9) and B12
Folate (vitamin B9) and vitamin B12 are also commonly low in people with UC, says Taylor. “This can be due to poor absorption in the gut due to inflammation and because some UC medications can further limit absorption.”
People on a plant-based diet or people who have had an ileal resection — the surgical removal of a part of the small intestine — are at high-risk for vitamin B12 deficiency, says Jacquelin Danielle Fryer, RD, who focuses on athletic performance at Banner Sports Medicine in Scottsdale, Arizona.
“It is important to monitor labs frequently in people with these risk factors,” says Taylor.
9. Omega-3s
Omega-3 fatty acids are essential fatty acids that your body can’t produce on its own, so they must be consumed in foods, such as plant oils and fish, or in supplements.
“Omega-3s can be beneficial for UC due to the role they can play with decreasing inflammation. But I would recommend patients get their omega-3s from dietary sources such as fatty fish a few times per week,” says Taylor.
Parian agrees, saying that omega-3s have been shown to have the most benefit when they’re consumed as part of a healthy diet. “For example, eating foods from the Mediterranean diet, which has been shown to be anti-inflammatory,” she says.
“However, if you struggle with increasing your dietary sources of omega-3 fats, then you could also include a supplement,” says Taylor.