Ulcerative colitis is a disease of the colon that is closely related to Crohn's disease. The two are grouped in a category called inflammatory bowel disease (IBD), because they both involve inflammation of the digestive tract.

The major symptoms of ulcerative colitis include abdominal pain and bloody diarrhea. When the disease becomes severe, fever, weight loss, dehydration, and anemia may develop. Sometimes, constipation develops instead of diarrhea. Arthritis, skin sores, and liver inflammation may occur as well.

One of the most feared consequences of ulcerative colitis is dramatic dilation of the colon, which can lead to fatal perforation of the colon. Ulcerative colitis also leads to a greatly increased risk of colon cancer.

Ulcerative colitis tends to wax and wane, with periods of remission punctuated by severe flare-ups. Medical treatment aims at reducing symptoms and inducing and maintaining remission.

Sulfasalazine is one of the most common medications for ulcerative colitis. Given either orally or as an enema, it can both decrease symptoms and prevent recurrences. Corticosteroids such as prednisone are used similarly in more severe cases, sometimes combined with other immunosuppressive drugs such as azathioprine and cyclosporine. Partial removal of the colon may be necessary in severe cases.

Principal Proposed Natural Treatments

People with ulcerative colitis can easily develop deficiencies in numerous nutrients. Chronic bleeding leads to iron deficiency. Malabsorption, decreased appetite, drug side effects, and increased nutrient loss through the stool may lead to mild or profound deficiencies of protein, vitamins A, B12, C, D, E, and K, folate, calcium, copper, magnesium, selenium, and zinc.1–10 If you have ulcerative colitis, supplementation to restore adequate body stores of these nutrients is highly advisable and may improve specific symptoms as well as overall health. We recommend working closely with your physician to identify any nutrient deficiencies and evaluate the success of supplementation in correcting them.

Essential Fatty Acids

Fish oil and evening primrose oil contain healthy fats called essential fatty acids. According to some, though not all, of the small, double-blind, placebo-controlled trials reported, fish oil might be helpful for reducing symptoms of active ulcerative colitis.11–15 Evening primrose oil has also shown promise.18 However, larger studies will be necessary to discover for certain whether fish oil or evening primrose oil really help.

Regular use of fish oil alone, or in combination with gamma-linolenic acid (found in evening primrose oil), has not been found effective for preventing disease flare-ups in people whose ulcerative colitis has gone into remission.16,17,35

For more information, including dosage and safety issues, see the Fish Oil and Evening Primrose Oil articles.

Probiotics

Friendly bacteria, or probiotics, might be helpful in ulcerative colitis.

A double-blind trial of 116 people with ulcerative colitis compared probiotic treatment against a relatively low dose of the standard drug mesalazine.19 The results suggest that probiotic treatment might be equally effective as low-dose mesalazine for controlling symptoms and maintaining remission. Evidence of benefit was seen in other trials as well.20,40

Probiotics might be useful for people with ulcerative colitis who have had part or all of the colon removed. Such individuals frequently develop a complication called "pouchitis," inflammation of part of the remaining intestine. Two double-blind, placebo-controlled studies found that probiotics can help prevent pouchitis, and also reduce relapses in people who already have it.21,38 The probiotic mixture used in these trials contained four strains of Lactobacillus, three strains of Bifidobacterium, and one strain of Streptococcus salivarius.

In addition, some evidence hints that probiotics might reduce the joint pain that commonly occurs in people with inflammatory bowel disease. 41

For more information, including dosage and safety issues, see the Probiotics article.

Aloe

In a double-blind, placebo-controlled trial, 44 people hospitalized with severe active ulcerative colitis were given oral aloe gel or placebo twice daily for 4 weeks.39 The results showed that aloe was more effective than placebo in inducing full or partial remission of symptoms.

For more information, including dosage and safety issues, see the full Aloe article.

Other Proposed Natural Treatments

Other Natural Treatments

A double-blind, placebo-controlled study of 24 people with ulcerative colitis examined the effects of wheat grass juice taken at a dose of 100 cc daily for one month.36 According to various measures of disease severity, participants given wheat grass juice improved to a greater extent than those given placebo. However, wheat grass juice is rather bitter, and it seems unlikely that the study could truly be blind, meaning that participants and doctors did’t know who was getting the wheat grass juice and who was getting the placebo. Indeed, when researchers polled the participants, a majority of those given wheat grass juice correctly identified it. For this reason, as well as its small size, the results of the study are not convincing.

Glutamine,22–25boswellia,26bromelain,27blue-green algae,28colostrum,37 and mesoglycan (glycosaminoglycans) have been suggested for the treatment of ulcerative colitis, but the evidence that they work remains highly preliminary at best.

There are also weak indications that allergies to foods such as milk may play a role in ulcerative colitis.29–34 .

Herbs and Supplements to Use Only with Caution

Various herbs and supplements may interact adversely with drugs used to treat ulcerative colitis. For more information on this potential risk, see the individual drug article in the Drug Interactions section of this database.

References

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21: Gionchetti P, Rizzello F, Venturi A, et al. Oral bacteriotherapy as maintenance treatment in patients with chronic pouchitis: a double-blind, placebo-controlled trial. Gastroenterology. 2000;119:305–309.

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23: Fox AD, Kripke SA, Berman JR, et al. Reduction of the severity of enterocolitis by glutamine-supplemented enteral diets. Surg Forum. 1987;38:43–44.

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27: Kane S, Goldberg MJ. Use of bromelain for mild ulcerative colitis [letter]. Ann Intern Med. 2000;132:680.

28: Merchant RE, Andre CA. A review of recent clinical trials of the nutritional supplement Chlorella pyrenoidosa in the treatment of fibromyalgia, hypertension, and ulcerative colitis. Altern Ther Health Med. 2001;7:79–80, 82–91.

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30: Bernstein CN, Ament M, Artinian L, et al. Milk tolerance in adults with ulcerative colitis. Am J Gastroenterol. 1994;89:872–877.

31: Candy 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;85:1176–1179.

32: Knoflach P, Park BH, Cunningham R, et al. Serum antibodies to cow's milk proteins in ulcerative colitis and Crohn's disease. Gastroenterology. 1987;92:479–485.

33: Ballegaard M, Bjergstrom A, Brondum S, et al. Self-reported food intolerance in chronic inflammatory bowel disease. Scand J Gastroenterol. 1997;32:569–571.

34: Dainese R, Galliani EA, De Lazzari F, et al. Discrepancies between reported food intolerance and sensitization test findings in irritable bowel syndrome patients. Am J Gastroenterol. 1999;94:1892–1897.

35: Middleton SJ, Naylor S, Woolner J, et al. A double-blind, randomized, placebo-controlled trial of essential fatty acid supplementation in the maintenance of remission of ulcerative colitis. Aliment Pharmacol Ther. 2002;16:1131-1135.

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37: Khan Z, Macdonald C, Wicks AC, et al. Use of the 'nutriceutical', bovine colostrum, for the treatment of distal colitis: results from an initial study. Aliment Pharmacol Ther. 2002;16:1917-1922.

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39: Langmead L, Feakins RM, Goldthorpe S, et al. Randomized, double-blind, placebo-controlled trial of oral aloe vera gel for active ulcerative colitis. Aliment Pharmacol Ther. 2004;19:739-48.

40: Kato K, Mizuno S, Umesaki Y et al. Randomized placebo-controlled trial assessing the effect of bifidobacteria-fermented milk on active ulcerative colitis. Aliment Pharmacol Ther. 2004;20:1133-41.

41: Karimi O, Pena AS, van Bodegraven AA et al. Probiotics (VSL#3) in arthralgia in patients with ulcerative colitis and Crohn's disease: A pilot study. Drugs Today (Barc). 2005;41:453-9.

Source: Third Age