Ulcerative Colitis
Ulcerative colitis (UC) is a chronic disease characterized by bloody diarrhea and an inflamed colon. UC is relatively common but remains poorly understood. Diagnosis must be made by a health care practitioner—typically a gastroenterologist. Irritable bowel syndrome, a completely unrelated and less serious condition, was sometimes called mucous colitis in the past. As a result, the general term “colitis” is still sometimes used inappropriately to refer to irritable bowel syndrome. It is critical that people who are diagnosed with “colitis” find out whether they have irritable bowel syndrome or ulcerative colitis.
Conventional treatment for UC is often essential in emergency circumstances. However, conventional treatments for UC are often only partial solutions and/or may be accompanied by significant side effects. For this reason, many people with UC look to natural medicine in an attempt to deal with their condition. All people with UC wishing to use natural approaches need to be working with a nutritionally-oriented doctor.
Lifestyle changes that may be helpful: Smokers have a lower risk of UC for unknown reasons. The nicotine patch has actually been used to create remissions in people with UC
1 but it has not been found to help maintain remissions.2 This is hard to understand, especially because the disease most similar to UC—Crohn’s disease—is made worse by smoking.3 Despite the possible protective effect of smoking, people with UC should not smoke, because the health consequences of smoking are so severe. Even the use of nicotine patches remains experimental and carries its own side effects.It also makes sense for people with UC to avoid alcohol.
Dietary changes that may be helpful: Although sugar intake has been linked with almost a tripling of risk for UC in an Israeli study,
4 other research has not found this link.5 6 A fourfold risk with a high intake of animal fat and dietary cholesterol was also reported in the Israeli study.7 This fits with Japanese research finding a link between eating a Western-style diet and the risk of UC.8 Both studies also found at least some protection linked with increased intake of fruit and vegetables. Although the association between UC and diet remains unclear, eating more produce and cutting back on sugar, meat, and dairy fat is beneficial for overall health.For many years, exacerbation of UC has been linked with food allergies.
9 10 Although elimination of offending foods appears to help, some foods causing trouble in people with UC may not be common allergens, making the diagnosis difficult. Moreover, researchers have found it difficult to reproduce problems in the same person using the same food, which further complicates the issue.11 People who wish to explore the possibility that food sensitivities might trigger their symptoms should see a nutritionally oriented doctor.Nutritional supplements that may be helpful: UC is linked to an increased risk of colon cancer. Researchers have found links between folic acid supplements or higher blood levels of folic acid and reduced risk of colon cancer in people with UC.
12 13 One study found that people with UC who supplement with 1,000 mcg of folic acid per day may be able to cut their risk of colon cancer almost in half, though the study design was too weak for this dramatic result to be statistically significant.14 The protective effect of folic acid may be due to the ability of the vitamin to donate what chemists call “methyl groups.” Conversely, alcohol, which has the opposite effect, has been linked with increasing the risk of colon cancer. These two factors—less alcohol and sufficient folic acid—appear to be important in the prevention of colon cancer and its precursor, adenomatous polyps.15 As a result, people with UC should avoid alcohol and supplement with folic acid (800 mcg per day is probably a reasonable amount). It is particularly critical for people with UC who are taking the drug sulfasalazine to supplement with folic acid.16Omega-3 fish oil has anti-inflammatory activity; inflammation of the colon is an essential part of the damage found with UC. As a result, researchers have studied the effects of fish oil in the treatment of UC. In a four-month, double-blind trial, people with UC who were given fish oil (containing 3.2 grams of EPA and 2.2 grams of DHA per day—the two important fatty acids found in fish oil) required lower levels of prescription anti-inflammatory drugs.
17 Other improvements were noted (such as weight gain), all of which suggested better health. Another study found a modest reduction in the need for anti-inflammatory steroids but no benefit when people were experiencing no symptoms.18 Other research shows at least some positive effects from the use of fish oil for people with UC.19 20Glutamine may be useful for ulcerative colitis because this amino acid serves as a source of fuel for cells lining the intestines, is important for immune function, and, in animal research, glutamine has anti-inflammatory effects.
Are there any side effects or interactions? (Refer to individual supplement for complete information.) Folic acid is remarkably safe. However, folic acid supplements can mask a vitamin B12 deficiency in individuals lacking adequate vitamin B12, which could lead to permanent neurological damage. Although this problem is rare, folic acid and vitamin B12 should always be taken together, to prevent masked vitamin B12 deficiencies.
A nutritionally oriented doctor should be consulted before long-term use of more than 3–4 grams of fish oil, since a high intake has been reported to elevate blood sugar levels. Side effects from EPA and DHA include nose bleeds (because of reduced blood clotting), gastrointestinal upset, and “fishy” burps.
No clear toxicity has emerged in glutamine studies.
Herbs that may be helpful: One study has been done using boswellia, a gummy Ayurvedic herb, to treat people with ulcerative colitis.
21 There was definite improvement when boswellia was taken in capsules, each containing 550 mg, three times per day.Aloe vera juice has been used by some doctors of natural medicine for treatment of UC. Although aloe has shown anti-inflammatory activity in other conditions, it has not been studied specifically in people with ulcerative colitis. The same is true of comfrey.
German doctors practicing phytotherapy have recommended chamomile for treatment of colitis.
22Are there any side effects or interactions? (Refer to individual herb for complete information.) Boswellia is generally safe when used as directed; rare side effects can include diarrhea, skin rash, and nausea.
Except in the rare person who is allergic to aloe, topical application of gel is harmless. Laxative preparations, if used for more than ten consecutive days, can aggravate constipation and cause dependency.
Comfrey should not be used internally without careful supervision by an herbal practitioner, as it can damage the liver.
Although rare, allergic reactions to chamomile have been reported. These reactions have included bronchial constriction with internal use and allergic skin reactions with topical use. While such side effects are extremely uncommon, persons with allergies to plants of the Asteraceae family (ragweed, aster, and chrysanthemum) should avoid use of chamomile. There are no contraindications to the use of chamomile during pregnancy or lactation.
Nutritional Supplements |
Herbs |
Homeopathic Remedies |
| Folic acid | Boswellia
Comfrey |
No homeopathy commonly used for this condition |
References:
1. Pullan RD, Rhodes J, Ganesh S, et al. Transdermal nicotine for active ulcerative colitis. N Engl J Med 1994;330:811-5.References (continued):
18. Hawthorne AB, Daneshmend TK, Hawkey CJ, et al. Treatment of ulcerative colitis with
fish oil supplementation: a prospective 12 month randomised controlled trial. Gut
1992;33:922-8.
19. Aslan A, Triadafilopoulos G. Fish oil fatty acid supplementation in active ulcerative
colitis: a double-blind, placebo-controlled, crossover study. Am J Gastroenterol
1992;87:432-7.
20. Salomon P, Kornbluth AA, Janowitz HD. Treatment of ulcerative colitis with fish oil n-3-omega-fatty
acid: an open trial. J Clin Gastroenterol 1990;12:157-61.
21. Gupta I, Parihar A, Malhotra P, et al. Effects of Boswellia serrata gum resin in
patients with ulcerative colitis. Eur J Med Res 1997;2:37-43.
22. Weiss RF. Herbal Medicine. Beaconsfield, UK: Beaconsfield Publishers Ltd, 1989:26.
Copyright © 1998 Virtual Health, LLC
It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. For many of the conditions discussed, treatment with prescription or over-the-counter medication is also available. Consult your physician, nutritionally-oriented health care practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications.The information presented in HealthNotes Online is for informational purposes only.