How to Treat Ulcerative Colitis with Diet

The rotten egg gas, hydrogen sulfide, is one of the main malodorous compounds in human flatus (in other words, one of the main reasons farts can smell so bad) but the larger concern is that it may be responsible for relapses of inflammatory bowel diseases such as ulcerative colitis. In my video Preventing Ulcerative Colitis with Diet, I talk about the role animal protein may play in the development of these diseases, thought to be because of effectively putrefying animal protein gas. (For more on that, see my video Bowel Wars: Hydrogen Sulfide vs. Butyrate.) But what if you already have ulcerative colitis? Can cutting down on sulfur-containing amino acids help? Previously, the only dietary intervention shown to help at all was the withdrawal of milk.

In Treating Ulcerative Colitis with Diet, I discuss the role of diet in ulcerative colitis. Case reports going back decades described patients with ulcerative colitis whose flares appeared to be triggered by cow’s milk. The elimination of all dairy products from the diet was reported to “frequently result in a dramatic improvement in symptoms.” But, when milk was reintroduced back into patients’ diets, it could trigger an attack. The role of milk wasn’t formally studied, though, until 1965. Was it just a small group of patients who were allergic? Or, could a milk-free diet help with this disease in general?

Researchers randomized patients presenting with an attack of ulcerative colitis into a milk-free diet group or a control placebo “dummy” diet group, in which they told people not to eat random foods to make it seem like they were getting special treatment. The milk-free diet worked better: Twice as many were symptom-free when they were off all dairy, and fewer patients suffered relapses. So, there does seem to be a certain proportion of ulcerative colitis patients who would benefit from eliminating all dairy products. These researchers estimated that milk is a trigger in about one in every five cases, so, certainly, sufferers should try a dairy-free trial to see if they’re one of the lucky ones who can control this condition with such a simple dietary intervention.

What about cutting back on sulfur-containing amino acids in general? A study of four ulcerative colitis sufferers found that their daily bouts of bloody diarrhea significantly lessened when they did just that. Reduced intake of sulfur-containing, amino acid-rich foods produced an improvement in moderately severe ulcerative colitis. What happened when they added these foods back into their diets? The researchers felt the effect was so dramatic that going back to eating foods such as meat, dairy, eggs, and wine with sulfites was considered unethical.

That was just a pilot study, though. Researchers then set up a study in which 191 ulcerative colitis patients in remission were followed for a year to determine which foods were associated with a relapse. These turned out to be meat and alcohol, which makes sense because they’re both rich sources of sulfur, which may increase the concentration of hydrogen sulfide, which, if you remember, is toxic because it interferes with our body’s utilization of fiber that our good bacteria turn into a beneficial compound called butyrate.

How can we increase fecal butyrate levels to counteract any hydrogen sulfide? Butyrate enemas have been shown to be of benefit, but if butyrate is made from fiber, can’t we then just get it the regular way—that is, by eating it? Yes. Ulcerative colitis sufferers were given oat bran for three months to make their good bacteria happy. None of the patients relapsed, and their symptoms appeared to be under better control.

One of the common questions we physicians treating patients with inflammatory bowel disease are often asked is whether changing diet could positively affect the course of their disease. So far, our answer—especially for ulcerative colitis––has been, “We don’t know; there are no special recommendations.” This may now change, though, with a study suggesting that consumption of meat may aggravate the course of inflammatory bowel disease. So, folks may want to cut down on meat, eating it no more than once a week. While we don’t yet have confirmation from interventional studies to support the specifics, this could be considered the best available evidence we have right now.


For more information on ulcerative colitis, see my videos Preventing Ulcerative Colitis with Diet, Bowel Wars: Hydrogen Sulfide vs. Butyrate, Striking with the Root: Turmeric Curcumin & Ulcerative Colitis, and Wheatgrass Juice for Ulcerative Colitis. More on this epic fermentation battle in our gut can be found in my Stool pH and Colon Cancer video.

I also discuss inflammatory bowel disease in Titanium Dioxide & Inflammatory Bowel Disease, Preventing Crohn’s Disease with Diet, Dietary Treatment of Crohn’s Disease, and Vitamin D for Inflammatory Bowel Disease.

Is the concept of sulfur-rich proteins new to you? Check out my videos Starving Cancer with Methionine Restriction and Methionine Restriction as a Life Extension Strategy.

In health,

Michael Greger, M.D.

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