Louise Chang, MD
Diet alone doesn't cause ulcerative colitis or other inflammatory bowel diseases (IBD), and avoiding certain foods won't cure these conditions.
"But following a proper diet can help ease symptoms and promote healing," says David T. Rubin, MD, co-director of the Inflammatory Bowel Disease Center at the University of Chicago. In other words, choosing the right foods can make it much easier to live with ulcerative colitis and other chronic conditions.
A proper diet means two things:
• Eating nutritious meals composed of foods that are easy to digest and may even soothe the bowels.
• Avoiding foods that irritate or otherwise aggravate your symptoms.
It sounds easy. But in practice, knowing which foods to choose and which to avoid can be tricky. Certain items frequently show up on lists of IBD offenders, including:
• Foods containing caffeine
• Acidic foods
But doctors say there's very little rhyme or reason to what causes problems for one person and not another. Even the same sufferer may experience a flare-up with a particular food at one meal and not at another.
How can you know which foods affect your symptoms? The best strategy, experts say, is to keep a food-and-symptom diary. "Every patient is different," says Rubin. "Individual experience should guide your food selection. That's why keeping a food diary for a few weeks can be very useful."
The idea is simple. By recording exactly what you eat over a period of time and how you feel afterward, you can nab particular foods that cause your symptoms to flare up. You'll also be able to identify foods that soothe your digestive tract.
Make recording your meals convenient for you. Some dietitians recommend using a notebook small enough to carry with you. That way you can jot down what you eat at meals and in between throughout the day. Others say it's fine to keep a notebook by the side of the bed and record everything you ate that day before going to sleep.
"Most people are pretty good at remembering what they ate over a 24-hour period," says dietitian Tracie Dalessandro, RD, author of What to Eat with IBD. "I find that filling in the diary just once a day is easier and more convenient for many people than pulling it out after every meal."
Whatever approach you choose, these strategies are worth remembering:
• Write down everything you eat. A food-and-symptom diary only works if you record everything. The more accurate your inventory, the more reliable the insights you'll get. Your dietitian may also want to review your food diary to make sure you're eating a well-balanced diet that provides all the nutrients you need, so an accurate record is crucial.
• Record amounts and how foods are prepared. Some people are bothered by large servings of chocolate but untroubled by a bite-sized piece. Fried chicken may exacerbate symptoms while grilled chicken goes down fine. Write down not just what you ate but how much and how it was prepared.
• Keep track of your ulcerative colitis symptoms. Some people use a scale of 1 to 10 to describe how they're feeling. Others prefer written notes. Use whatever system helps you be as accurate as possible.
• Don't be afraid to experiment. While keeping a food-and-symptom diary, try small amounts of foods that you tend to avoid for fear they'll cause problems. That way you can test whether they really do spell trouble for you. If a large serving of something bothers you, try cutting the serving size in half. Remember that your goal is to eat as wide a variety of foods as you can.
• Stick with your diary for at least three weeks. You'll need that much time to observe patterns. Remember, too, that you can always go back to keeping a food-and-symptom diary if you introduce new foods to your diet.
In some cases, drawing conclusions from your diary can be straightforward. "If a certain food always seems to give you problems afterwards, you know to avoid it," says Walter J. Coyle, MD, director of the gastrointestinal program at Scripps Clinic Medical Center In La Jolla, Calif.
Often the patterns aren't quite so simple. Meals, after all, are made up of many different foods, in different preparations and different amounts. The amount of time it takes food to reach the large intestines, where ulcerative colitis is focused, also varies for different foods. Pinpointing the real problem may take trial and error.
What's more, some foods are so ubiquitous that it's hard to eliminate them. "A lot of people say they're intolerant to soy, for instance," Coyle tells WebMD. "If you look at food labels, there's soy in almost everything. So it's very hard to know if soy is a problem -- and even harder to avoid it."
Still, a food diary can provide useful insights -- and yield some nice surprises. "Some people who think of themselves as lactose intolerant may discover that they can tolerate small amounts of milk and other dairy products," Dalessandro says. Others may discover that a food they never suspected makes their symptoms worse.
Ultimately, your goal should be to end up with a diet that offers you as much variety as possible. "Some people really are intolerant to certain foods, and then it's wise to avoid such foods," says Rubin. "But the goal is to control the disease and improve quality of life. We don't want patients to have to avoid a long list of foods that makes it impossible to eat normally."
If a food-and-symptom diary is helpful for pinpointing troublemakers in your diet, it's just as useful for discovering what foods you can welcome back into your life. And since ulcerative colitis and other inflammatory bowel diseases are chronic and usually lifelong, the more normal and varied a diet you follow, the better your quality of life will be.
David T. Rubin, MD, co-director, Inflammatory Bowel Disease Center, University of Chicago.
Walter J. Coyle, MD, director, gastrointestinal program, Scripps Clinic Medical Center, La Jolla, Calif.
Tracie Dalessandro, RD, author, What to Eat with IBD: A Comprehensive Nutrition and Recipe Guide for Crohn's Disease and Ulcerative Colitis.
Crohn's & Colitis Foundation of America.
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