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Ulcerative Colitis

MagazineApril 2009 (Vol. 20 Issue 1)Ulcerative Colitis

Q) I've recently been diagnosed with ulcera-tive colitis

Q) I've recently been diagnosed with ulcera-tive colitis. My doctor wants to start me on drug therapy as soon as possible, but I'd rather try natural treatments first. What do you suggest?-C.S., via e-mail

A) Ulcerative colitis (UC) is a type of inflammatory bowel disease (IBD) that leads to frequent bowel movements and diarrhoea accom-panied by blood or mucus; other symptoms include weight loss, abdominal cramps, anaemia, fever and fatigue. No one knows for sure what triggers UC, but it appears to be a combination of genetic and environmental factors.

Conventional treatment usually involves drug therapy or surgery. However, both options are risky and not always effective. Indeed, 40-60 per cent of IBD patients will not benefit from the available treatments (J Clin Gastroenterol, 2007; 41: 799-809).

It's not surprising, then, that so many sufferers turn to alternative ways to manage UC naturally.

Nutritional strategies

- Address deficiencies. Working with a qualified health practitioner to identify and correct nutritional deficiencies may improve specific symptoms as well as overall health. Helpful supplements are vitamins A, C, E and K as well as beta-carotene, folic acid, calcium, magnesium, selenium and zinc (Altern Med Rev, 2003; 8: 247-83).

- Rule out allergy. Although doctors continue to rebut any link between food allergy and UC, this may be one of the first things to check. UC sufferers put on an elim-ination diet excluding commonly allergenic foods had significantly fewer symptoms (primarily diarrhoea and rectal bleeding) compared with patients on a normal diet. Foods likely to trigger symptoms include dairy, pork, tomatoes, spicy foods, citrus fruit, apples, grapes and shellfish (S Afr Med J, 1995; 85: 1176-9). Avoiding sulphur-containing amino acids (such as eggs, cheese, whole milk, ice cream, mayonnaise, soy milk, wine, mineral water, nuts and cruciferous vegetables) can also ease symptoms and reduce relapse rates (Altern Med Rev, 2003; 8: 247-83).

- Increase fibre. Too little fibre increases the risk of UC, so a high-fibre diet might be protective (Digestion, 1989; 44: 217-21). Specifically, psyllium husks (4-10 g twice a day) and germinated barley foodstuff (GBF; 10 g twice a day) may be especially beneficial (Altern Med Rev, 2003; 8: 247-83). During flare-ups, how-ever, fibre may need to be reduced until inflammation subsides.

- Limit sugar and fat. A high intake of sugar and animal fat is associated with an increased risk for UC (Gut, 1997; 40: 754-60).

- Take probiotics. In a double-blind trial of 116 UC sufferers, therapy with a non-pathogenic strain of Escherichia coli was as effective

as low-dose mesalazine for control-ling symptoms and maintaining remission. Both achieved around 70-per-cent remission, lasting for about six months on average (Lancet, 1999; 354: 635-9). A combination using four strains of Lactobacillus, three strains of Bifidobacterium and one strain of Streptococcus has also proved to be beneficial (Drugs, 2006; 66: 1371-87).

- Try EFAs. Fish-oil supplements, rich in omega-3 fatty acids, can reduce inflammation and lower the need for anti-inflammatory drugs. With few exceptions, studies show

its beneficial effects in UC patients (Altern Med Rev, 2003; 8: 247-83). The recommended dosage is 1-2 g of EPA/DHA three times a day.

- Other nutrients. Bromelain (0.5-1 g twice a day), quercetin (500 mg two or three times a day) and glutamine (1.5-3 g/day) may help to improve symptoms of UC (Altern Med Rev, 2003; 8: 247-83).

Other natural treatments

- Herbs. The gum resin of Bos-wellia serrata (Indian frankincense) is a traditional Ayurvedic remedy for inflammatory diseases. Clinical trials in patients with UC and other irritable bowel disorders (IBDs) have proved promising (Wien Med Wochen-schr, 2002; 152: 373-8). In one study, 82 per cent of UC patients treated with the resin (350 mg three times a day for six weeks) achieved remission vs 75 per cent with the drug sulpha-salazine (Eur J Med Res, 1997; 2: 37-43).

Another natural anti-inflamma-tory is aloe vera. In a double-blind trial, oral aloe gel resulted in remission or improved symptoms in 47 per cent compared with 14 per cent with placebo (Aliment Pharmacol Ther, 2004; 19: 739-47). Other helpful herbs are Ginkgo biloba, ginger, slip-pery elm, fenugreek and devil's claw (Carcinogenesis, 2008 Jun 20, Epub ahead of print; J Ethnopharmacol, 2008 May 15, Epub ahead of print; Aliment Pharmacol Ther, 2002; 16: 197-205).

- Melatonin. This natural hor-mone may be useful in the treatment of UC (Inflamm Bowel Dis, 2008 Jul 14,

Epub ahead of print). However, while melatonin is freely available as a supplement in the US, it's difficult

to find in the UK and other European countries. Also, further study is needed on its side-effects and potential drug interactions.

- Hypnotherapy. A recent UK study had 17 patients with active

UC undergo a 50-minute session of 'gut-focused' hypnotherapy and com-pared them with controls who listened to music. Blood levels of interleukin-6, a marker of inflamma-tion in the body, fell by 53 per cent

in the hypnosis group, whereas the music-listeners showed no changes whatsoever (Am J Gastroenterol, 2008; 103: 1460-9).

For more information on UC and IBDs, see The WDDTY Guide to Good Digestion, which is available from our website at


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