Ulcerative colitis (UC) is an inflammatory bowel disease that causes ulcers in the digestive tract. This inflammation usually starts in the rectum and works its way up the GI tract. It is the most common type of inflammatory bowel disease and accounts for a quarter-million medical appointments yearly; medical costs exceed 4 billion dollars annually. The onset of the disease typically starts in early adulthood, ages 20-30, or older adulthood, ages 60-70. Ulcerative colitis is associated with an increased risk of colon cancer. While it is not usually fatal, it can cause a lot of discomfort and lead to complications that can be life-threatening.
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Ulcerative Colitis Signs & Symptoms
Bloody diarrhea is the hallmark symptom of ulcerative colitis. This can be with or without pus or mucus. Symptoms may come in "flares" and then go into remission with treatment. Other associated symptoms can include:
- Abdominal pain or cramping
- Weight loss
- Malaise / fatigue
- Rectal pain or bleeding
- The urgency to defecate or inability to defecate despite urgency
- Fever
- Failure to grow in children
What Causes Ulcerative Colitis
The medical literature has not identified a clear cause for ulcerative colitis. However, several lifestyle risk factors and genetic predispositions have been identified.
- Age - onset is usually before the age of 30 or after the age of 60.
- Race or ethnicity - whites and those of Ashkenazi Jewish descent have the highest risk of developing UC.
- Genetic predisposition / Family history - those with a 1st-degree relative are four times higher risk of developing UC.
- Gut dysbiosis - alteration of the GI flora has been implicated in the development of UC.
- Environmental toxin exposure - small retrospective studies are looking at the role of toxins in the development of UC. Studies show a higher incidence of disease in urbanized developed countries over developing countries.
- Diet - high sulfide foods, especially red meat and processed meat, eggs, dairy, alcohol, and dried fruits, were associated with an increased relapse risk of UC.
How is Ulcerative Colitis Diagnosed
Gastrointestinal endoscopic procedures with biopsy are the only way to diagnose ulcerative colitis definitively. This is a procedure where a small flexible tube camera is used to view the colon and take small tissue samples for analysis. A biopsy is required to make a diagnosis.
Other tests, such as blood and stool tests, help identify the presence of complications such as anemia, infection, or inflammation. Advanced imaging, such as CT (computerized tomography) or MRI (magnetic resonance imaging), can be used to identify the presence of inflammation in the bowel or other GI tract complications.
Functional Medicine Labs to Test for Root Cause of Ulcerative Colitis
Inflammatory markers - such as ESR & CRP, are commonly run during any suspected inflammatory diagnosis. *It's important to note that these markers may also be normal in asymptomatic patients, especially with isolated involvement of the ileum, so relying on these tests alone is not advised. Other tests commonly run are:
- CBC with differential - to assess the presence or absence of anemia or infection
- The test for anti-Saccharomyces cerevisiae antibodies (ASCA) is used to help distinguish between Crohn's disease (CD) and ulcerative colitis (UC).
- A positive P-ANCA is found in 60-70% of UC patients.
- Carcinoembryonic antigen (CEA) is a protein typically found in very low levels in the blood of adults. The CEA blood level may be increased in non-cancerous conditions, including ulcerative colitis.
- Comprehensive stool test - to assess the gut microbiome and rule out the presence of bacterial or parasitic infection.
- Fecal calprotectin - elevated levels correlate with increased neutrophils in the intestine and, therefore, can help rule out inflammatory bowel disease.
- Food sensitivity testing - can be considered to help identify food sensitivities that may be perpetuating bowel inflammation.
Conventional Treatment for Ulcerative Colitis
Conventional treatment for ulcerative colitis is based on both the extent of the disease and its severity.
The prognosis during the first decade after diagnosis is often generally good, and most patients go into remission. Rectal application of medical therapy via suppositories or enemas is usually the first line of treatment.
These include anti-inflammatory medications, steroids, immune system suppression medications, and biological therapies. These medications generally work by blocking the inflammation in the body in various ways and putting the inflammation into "remission."
Surgery to remove part of the colon is the next treatment option for patients whose body fails to respond to medical therapy.
5 Natural Treatment Options for Ulcerative Colitis
1. Nutrition
There is no specific diet recommended for UC patients, according to guidelines. However, many people with UC respond well to an anti-inflammatory diet that includes phytonutrient-rich fruits, vegetables, and fiber. Diets high in polyunsaturated fatty acids, as found in oily fish, have also shown protective properties.
Potential Trigger Foods to Avoid:
- Insoluble fiber foods that are hard to digest: fruits with skin and seeds, raw green vegetables (especially cruciferous vegetables such as broccoli, cauliflower, or anything with a peel), whole nuts, and whole grains.
- Lactose: sugar found in dairy, such as milk, cream cheese, and soft cheeses
- Alcohol and caffeinated drinks: beer, wine, liquor, soda, and coffee.
- High-fat foods: butter, coconut, margarine, and cream, as well as fatty, fried, or greasy food
- Non-absorbable sugars: sorbitol, mannitol, and other sugar alcohols found in sugar-free gum, candy, ice cream, and certain types of fruits and juices such as pear, peach, and prune
- High sulfur foods.
2. Balance The Gut Microbiome
Some small studies suggest that treatment with pro/pre/and synbiotics have helped maintain remission for UC sufferers. Probiotic supplements based on Lactobacillus and Bifidobacterium or more than one strain are more likely to benefit IBD remission.
3. Herbs & Supplements
Recently, herbal medicine has been employed in many clinical trials worldwide for UC treatment. Seven placebo-controlled clinical trials showed that herbal medicines could induce positive clinical response and remission in IBD patients without serious side effects. Some of the most common studied herbs and supplements are:
Curcumin: Clinical trials have evaluated the therapeutic effect of curcumin in patients with mild-to-moderate UC. In a randomized, double-blind, single-center pilot study, patients received oral 5-aminosalicylic acid in combination with curcumin preparation. The patients receiving additional curcumin preparation treatment showed improvements in disease activity compared to those with placebo enemas. Indicating that curcumin may offer additional therapeutic advantages when combined with conventional anti-inflammatory medications in UC.
Butyrate: The most common treatment used for UC patients. This supplement helps keep UC patients in remission without increasing gastrointestinal complaints during scientific trials.
Dietary saffron and flaxseed have been shown to be beneficial in decreasing inflammation and disease severity in UC patients in small trials.
Other anti-inflammatory supplements such as berberine and resveratrol are also showing promising results of decreased flares in small trials.
4. Lifestyle Changes
Ulcerative colitis is an inflammatory condition; therefore, decreasing the overall toxin burden can help mitigate inflammation in the body. Chemical toxins in our air, water, and food can promote inflammation.
You can test your water, consult the EWG (environmental working group) tap water database, and use an NSF-certified water filter if indicated.
HEPA filters and air purifying plants can help reduce toxins in the air.
Glyphosate has been linked to ulcerative colitis, among other health conditions, and by choosing organic foods, you can reduce glyphosate exposure.
By eliminating outside toxins as much as possible, you can also decrease the toxin burden on your body. Ultimately this allows the body to focus on reducing inflammation inside the body and heal from UC.
5. Managing Stress
Research shows that stress can trigger a UC flare. Depression and anxiety are often concurrent conditions in UC sufferers. There are many ways to manage stress. Cognitive behavior therapy (CBT), medical hypnosis, yoga, breathwork, and mindfulness practices have all demonstrated a decrease in symptoms for UC patients. Many apps are available for home use to help guide people in yoga, breathwork, and mindfulness-based practices.
Summary
Ulcerative colitis is the most common inflammatory bowel disease. Its hallmark symptom is the presence of bloody diarrhea. While the disease is not fatal, it can cause a lot of discomfort for its sufferers and lead to potentially threatening complications.
The cause of UC is unknown, but lifestyle, genetics, and toxins seem to be predisposing factors. Living a clean and anti-inflammatory lifestyle can decrease the symptoms and flares of the disease.
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