Natural ulcerative colitis treatment: Natural remedies for ulcerative colitis
Natural remedies for ulcerative colitis
Ulcerative colitis is one of the two main types of inflammatory bowel disease. The symptoms occur in the large intestine and can be severe enough to make even simple daily activities more difficult.
Ulcerative colitis (UC) is the most common type of inflammatory bowel disease (IBD) around the world.
Although natural remedies cannot cure UC, they may help a person find relief from symptoms and flare-ups. Symptoms typically include blood or pus in the stool, fever, and a loss of appetite, alongside anemia, a rapid heart rate, and digestive problems. UC may also interfere with a person’s self-esteem, relationships, and career.
The most severe forms of UC can cause chronic symptoms, including pain and digestive problems, such as vomiting, diarrhea, and the urgent need to use the bathroom. People experiencing severe bouts of UC may develop dehydration or lose a large amount of blood. Without treatment, these forms of UC can be fatal.
In this article, we highlight several natural remedies that may alleviate UC symptoms.
There are several natural options for people looking to manage UC.
Eating foods that contain probiotics, such as yogurt, may help manage UC.
Probiotics are living bacteria or microorganisms that promote the growth of healthful bacteria in the digestive tract. Some foods, such as yogurt, contain natural probiotics. Alternatively, a person can purchase probiotics over the counter at most large food shops and drugstores.
A 2019 study looked at how people with UC responded to using probiotics. The researchers found that 57% of those who used the probiotics reported a positive overall experience. Also, 50% of the responders noted an improvement in their symptoms, including stool frequency and texture.
It is important to note that supplements are not medications and that the Food and Drug Administration (FDA) do not regulate them. This lack of regulation means that quality can vary significantly among brands or even batches of products.
Before purchasing any supplements, a person should check the label to find out what is in them. They may also wish to research the company’s reputation and check their reviews.
People who are interested in probiotics should talk to a healthcare professional. Healthcare professionals can often recommend reputable supplement brands.
However, a probiotic cannot replace traditional medication. People should continue to take any current medications according to their prescriptions.
A 2019 review highlighted several natural substances that may reduce UC symptoms, including:
- Andrographis paniculata extract
- aloe vera gel
- wheatgrass juice
- Plantago ovata seeds
- Boswellia serrata gum resin
In the review, the authors suggest that specific compounds in these herbal remedies support immune activity and provide antioxidants that reduce inflammation.
However, the review does not recommend any of these substances as a standalone treatment. The study authors suggest that people with UC should only use them as supplementary treatments alongside traditional medicines.
In some cases, a person with UC may find that making simple lifestyle changes provides some symptom relief. The following changes may be beneficial:
- making dietary changes
- participating in group therapy or joining support groups to help with the emotional effects of UC
- doing regular exercise, which can support weight management and increase energy levels
Specific dietary changes may make a difference in helping people reduce symptoms and flare-ups. These changes may include:
- drinking plenty of water to prevent dehydration, particularly during a bout of diarrhea
- drinking electrolyte beverages, which can help a person maintain an electrolyte balance should diarrhea lead to dehydration
- taking calcium and vitamin D supplements to avoid calcium deficiency and bone loss, as many people with UC do not absorb enough of these nutrients
- eating several small meals each day rather than three large ones
- eating well and avoiding restrictive diets — even fast food is preferable to no food at all for people with UC, particularly those with malnourishment
- eating a low fiber diet
- reducing the consumption of greasy, buttery foods
- avoiding milk products, as many people with UC have lactose intolerance
Some people may find that keeping a food journal can be helpful. By recording their food intake and symptoms, a person can work out which foods trigger flare-ups and then eliminate them from their diet.
There is no research supporting a specific diet plan for UC. However, some research indicates that certain chemical plant compounds called phytochemicals may help alleviate symptoms of UC.
In 2014, a review of studies found that phytochemicals from apples, cocoa, green tea, and other foods and supplements could reduce UC symptoms in animals. However, the review indicates a need for further studies to determine the benefits of these compounds in humans.
Learn more about how to relieve constipation symptoms during ulcerative colitis.
Natural remedies can help relieve UC, but people should use them alongside standard treatments that the doctor prescribes.
Long-term treatment with medications aims to prevent flares and reduce the impact of symptoms.
A doctor can prescribe a variety of different medications to treat bowel inflammation.
Current guidelines recommend long-term treatment with one of the following drug types:
- Tumor necrosis factor-alpha (TNF-alpha) antagonists, such as infliximab (Remicade) and adalimumab (Humira)
- anti-integrin agents, such as vedolizumab (Entyvio)
- Janus kinase inhibitors, for example, tofacitinib (Xeljanz)
- interleukin 12/23 antagonists, for instance, ustekinumab (Stelara)
- immunomodulators, such as the thiopurines azathioprine (Azasan) and methotrexate (Rheumatrex)
- 5-aminosalicylic acid (5-ASA), if they work well for an individual
These drugs are immune modifiers. They work by suppressing the immune system to reduce inflammation. They can have adverse effects, but a doctor will discuss a suitable treatment plan with the individual.
Some short-term medical options include:
- medications to relieve specific symptoms, such as nausea or diarrhea
- antibiotics to fight infections that may occur due to UC
- corticosteroids to reduce inflammation
A person should talk to their doctor about potential side effects when they receive a prescription for a new medication.
A person may be able to alleviate their symptoms by using some natural remedies alongside conventional treatments. Making dietary changes, taking probiotics, and exercising regularly can often help.
However, a person should always take medication according to their doctor’s instructions. If a person experiences any unwanted side effects from medications, they should talk to their doctor about their symptoms.
Having the support of people who have had similar experiences is vital in the management of ulcerative colitis. IBD Healthline is a free app for people who have received a UC diagnosis. The app is available on the App Store and Google Play. Download it here.
Read the article in Spanish.
6 Ways to Naturally Treat Ulcerative Colitis
Is yoga the key to soothing ulcerative colitis? Will an herb provide relief? Natural remedies for ulcerative colitis (UC) may not be your primary treatment approach, but they can help you manage symptoms and reduce the frequency of flares.
To date, there is no cure for UC, a chronic disease of the large intestine (colon) in which inflammation brought on by a faulty immune response creates sores or ulcers in the lining of the colon.
The chronic condition affects nearly 1 million Americans and tends to run in families. Epidemiological research shows that “Westernized” populations and people with diets high in fat are at higher risk for UC, as well as Caucasians and Ashkenazi Jews. But no one has yet uncovered the main cause of the disease.
“Although the official cause of ulcerative colitis has evaded the medical community, it’s important to understand that it results from an interaction of genetic, environmental, and lifestyle factors,” says Benjamin Snider, ND, a naturopathic doctor in private practice in Kitchener, Ontario.
Treatments for ulcerative colitis include medications such as nonsteroidal anti-inflammatory drugs, immune system suppressors, and steroids to control inflammation and other symptoms of the condition. Surgery to remove the colon and rectum is another form of treatment if medication doesn’t prove effective.
There are still other, nonmedical forms of relief. Research shows that a number of natural treatments, including everything from lifestyle changes to herbal medicine, are effective for colitis. Exercise, stress-reduction techniques such as tai chi and yoga, and a healthier diet full of foods with soluble fiber have all been identified as beneficial to managing UC symptoms. A review article published in July 2014 in the journal PLoS One found that mind-body practices like tai chi, qigong, meditation, and yoga reduced inflammatory markers in the body.
Less is known about other natural treatments, like herbs and supplements. But they’re a valid form of UC therapy that doctors are prescribing more frequently. A review published in October 2014 in the World Journal of Gastroenterology found that herbal therapy in combination with traditional medicine may provide new and better alternatives to ulcerative colitis treatment. The list of herbs that work best include:
- Aloe vera gel
- Tormentil extract
- Wheatgrass juice
- Curcumin (the active ingredient in turmeric)
Snider stresses that a holistic approach that factors in lifestyle, stress, supplements, and some natural remedies for ulcerative colitis offers the best chance at healing.
Read on to learn about some different kinds of natural therapies.
Herbal Medicine in the Treatment of Ulcerative Colitis
Ulcerative colitis (UC) is a refractory, chronic, and nonspecific disease occurred usually in the rectum and the entire colon. The etiopathology is probably related to dysregulation of the mucosal immune response toward the resident bacterial flora together with genetic and environmental factors. Several types of medications are used to control the inflammation or reduce symptoms. Herbal medicine includes a wide range of practices and therapies outside the realms of conventional Western medicine. However, there are limited controlled evidences indicating the efficacy of traditional Chinese medicines, such as aloe vera gel, wheat grass juice, Boswellia serrata, and bovine colostrum enemas in the treatment of UC. Although herbal medicines are not devoid of risk, they could still be safer than synthetic drugs. The potential benefits of herbal medicine could lie in their high acceptance by patients, efficacy, relative safety, and relatively low cost. Patients worldwide seem to have adopted herbal medicine in a major way, and the efficacy of herbal medicine has been tested in hundreds of clinical trials in the management of UC. The evidences on herbal medicine are incomplete, complex, and confusing, and certainly associated with both risks and benefits. There is a need for further controlled clinical trials of the potential efficacy of herbal medicine approaches in the treatment of UC, together with enhanced legislation to maximize their quality and safety.
Keywords: Herbal medicine, inflammatory bowel disease, therapy, ulcerative colitis
Ulcerative colitis (UC) and Crohn’s disease, collectively known as inflammatory bowel disease (IBD), are chronic inflammatory conditions of the gastrointestinal (GI) tract. Although the etiology remains largely unknown, it has been suggested that a combination of genetic susceptibility factors and the activation of the mucosal immune system in response to luminal commensal bacterial antigens along with persistent pathologic cytokine production contributes to the initiation and chronification of IBD.[1–3] The incidence of UC is approximately 10–20 per 105 per year with a reported prevalence of 100–200 per 105 in Western countries.[4–6] However, UC in China has some differences in clinical characteristics, and a population-based epidemiologic study is required to determine the prevalence and incidence. The number of UC patients has increased significantly in the past 10 years in China, lesions were commonly located to the left side colon, males and females were nearly equally affected, no positive relationship was found between smoking and severity of the disease, and familial relatives were rarely involved.  Evidences have shown that poor adherence is an important barrier to successful management of the patients with UC. Only 40%–60% of UC patients who were newly diagnosed or had longstanding disease are adherent to therapy.[9–11] Therefore, improving medication adherence has become one of the most important steps in the effective management of the disease.
To date, several medicines have been used in the treatment of UC, such as 5-aminosalicylate, azathioprine, 6-mecaptopurine, cyclosporine, and antitumor necrosis factor monoclonal antibody. The primary aims of medical therapy for patients with UC are directed at inducing and then maintaining remission of symptoms and mucosal inflammation to provide an improved quality of life with the least amount of steroid exposure. In recent years, herbal medicines have been used in the treatment of UC and shown to be effective in the clinic. In this review, we survey the current knowledge of the herbal therapy or traditional Chinese medicine (TCM) for the treatment of patients with UC, and discuss recent progress in their role in disease prevention.
The term “herb” is derived from the Latin word herba meaning “grass.” The term has been applied to plants of which the leaves, stems, or fruit are used for food, for medicines, or for their scent or flavor. Herbal medicine refers to folk and traditional medicinal practice based on the use of plants and plant extracts for the treatment of medical conditions. The use of herbs to treat diseases is almost universal among native people. A number of traditions have come to dominate the practice of herbal medicine in the West at the end of the twentieth century. Herbal medicine is one of the most common TCM modalities. It has been estimated that 28.9% of US adults regularly use one or more TCM therapies, 9.6%–12.1% of which are in the form of herbal products. Recent studies have indicated that the percentage of adults using TCM therapies for their GI symptoms ranges from 20% to 26%, but patients with functional GI disorders are more likely to make use of them, as are those with chronic GI conditions. [13,14]
The use of complementary medicine among patients with IBD, particularly in the form of herbal therapies, is widespread in the Western world as well as in many Asian countries including China and India. It seems that the use is continuously increasing despite the fact that only a small number of controlled trials dealing with either efficacy or safety of these natural products exist. So far, there are limited controlled evidences indicating the efficacy of TCM, such as aloe vera gel, wheat grass juice, Boswellia serrata, and bovine colostrum enemas in the management of patients with UC. Herbal medicine has always been considered to be preeminent among the various methods of healing within TCM, which is practiced extensively throughout clinics and hospitals in China alongside Western medicine.
There are numerous reports in the Chinese literature about the treatment of UC with herbal remedies, while only abstracts are available in English. It was noticeable that most of the respondents using herbal therapies believe that “natural” equates with “safe” and almost 30% of patients reported that such preparations cannot cause any harm. Herbs are dilute natural drugs containing many different chemicals, and their effects may be unpredictable. A few have been tested for their side effects, quality, or the potential for cross contamination by biological and chemical pollutants in the environments in which they are grown, transported, or sold.
Currently, TCM is widely used in the treatment of UC in Eastern Asian countries. Langmead et al has reported that herbal remedies for the treatment of IBD include slippery elm, fenugreek, devil’s claw, Mexican yam, tormentil, and Wei tong ning (a TCM).[16,17] Slippery elm, fenugreek, devil’s claw, tormentil, and Wei tong ning are novel drugs in the management of IBD. Chen et al reported that 118 cases of UC patients were treated with integration of TCM and that 86 cases of UC were treated with prednisone as controls.  The therapeutic effects were observed and compared after two therapeutic courses of 40 consecutive days. As a result, there were 39 cases cured, 60 cases improved and 19 cases failed, with a total effective rate of 84% in TCM-treated group. In contrast, there were 15 cases cured, 37 cases improved and 34 cases failed, with a total effective rate of 60.5% in prednisone-treated group (P < 0.01). These data indicate that treatment of UC by the integrated TCM method is superior to that by simple Western drugs, such as prednisone and that it is also safe and effective in maintaining remission of UC.[16,18]
Aloe vera is a tropical plant used in traditional medicine throughout the world. It has been studied for its ability to relieve UC. Aloe vera gel is the mucilaginous aqueous extract of the leaf pulp of Aloe barbadensis Miller. Aloe vera juice has anti-inflammatory activity and been used by some doctors for patients with UC. It was the single most widely used herbal therapy. A double-blind, randomized trial was undertaken to examine the effectiveness and safety of aloe vera gel for the treatment of mild-to-moderate active UC. Thirty patients took 100 mL of oral aloe vera gel and 14 patients had 100 mL of a placebo twice daily for 4 weeks. Clinical remission, improvement, and response occurred in 9 (30%), 11 (37%), and 14 (47%), respectively, in aloe vera-treated patients compared with 1 (7%), 1 (7%), and 2 (14%), respectively, in controls. Although the numbers are small in this study, the number of patients who responded to aloe vera is more than those who took placebo. However, the numbers are similar to placebo responses in other trials and the placebo response rate is very low. The exact mechanisms of action of aloe vera are unclear. In vitro studies on human colonic mucosa have demonstrated that aloe vera gel could inhibit prostaglandin E2 and IL-8 secretion, indicating its role in antimicrobial and anti-inflammatory responses. 
Boswellia or Indian frankincense is an ayurvedic herb that is derived from the resin of the plant, and has also been used traditionally to treat UC. Boswellic acid, the major constituent of Boswellia, is thought to contribute to most of the herbal pharmacologic activities. In vitro studies and animal models have shown that boswellic acid could inhibit 5-lipoxygenase selectively with anti-inflammatory and antiarthritic effects. Since the inflammatory process in IBD is associated with increased function of leukotrienes, the benefits of Boswellia in the treatment of UC have proven a positive result. Moreover, it has also been found to directly inhibit intestinal motility with a mechanism involving L-type Ca2+ channels. Boswellia has been found to reduce chemically induced edema and inflammation in the intestine in rodents. Other studies suggest that it has cytotoxic properties.
Gupta et al studied the treatment of 30 patients with chronic UC, and gave 20 patients a Boswellia gum preparation (900 mg daily divided into 3 doses for 6 weeks), and 10 patients sulfasalazine (3 gm daily divided into 3 doses for 6 weeks). They concluded that Boswellia was an effective treatment with few side effects, because 14 out of the 20 patients treated went into remission, and furthermore, 18 out of the 20 patients found an improvement in one or more parameters. In comparison, in the group taking sulfasalazine, 4 out of 10 went into remission, and 6 out of 10 showed improvement in one or more of the above parameters. In animal models of inflammation, it has been shown to be effective against Crohn’s disease, UC, and ileitis.
Butyrate is an important energy source for intestinal epithelial cells and plays a role in the maintenance of colonic homeostasis. Butyrate enemas have been studied for use in treating UC. Some studies have shown that the topical use of butyrate may help decrease the inflammation in the colon. Nancey et al proposed a possible explanation for the decreased oxidation in UC patients who showed that butyrate oxidation could be reduced by TNF-α at concentrations found in inflamed human mucosa. This anti-inflammatory effect of butyrate via NF-κB inhibition, contributing, for example, to decreased concentrations of myloperoxidase, cyclo-oxygenase-2, adhesion molecules, and different cytokine levels, has been confirmed in several in vitro and in vivo studies.[25,26] A diminished capacity of the intestinal mucosa to oxidize butyrate has been reported in patients with active UC. However, in patients with inactive UC a normal butyrate oxidation has been found in vivo, suggesting that in UC patients, abnormal butyrate oxidation is not a primary defect in colon mucosa. Administration of enteric-coated tablets (4 g of butyrate daily) in combination with mesalazine vs mesalazine alone significantly improved the disease activity score in patients with mild-to-moderate UC.
Licorice, which is derived from the root of the plant, is used extensively in TCM for a variety of conditions and ailments. Licorice has also got immune modulatory and adaptogenic property, which is required for the pathogenesis of UC. A number of active chemicals, including glycyrrhizin are thought to account for its biologic activity. Diammonium glycyrrhizinate is a substance that is extracted and purified from licorice, and may be useful in the treatment of UC. Evidence has also reported that diammonium glycyrrhizinate could improve intestinal mucosal inflammation in rats and, importantly, reduce expression of NF-κB, TNF-α, and ICAM-1 in inflamed mucosa. Clinical studies on licorice have also been performed in combination with other herbs and demonstrated to be effective in the management of UC. The antiestrogenic action documented for glycyrrhizin at high concentration has been associated with glycyrrhizin-binding estrogen receptors. However, estrogenic activity has also been reported for licorice and is attributed to its isoflavone constituents. It has been suggested that glycyrrhizin may exert its mineralocorticoid effect via an inhibition of 11b-hydroxysteroid dehydrogenase. Evidences have proven that glycyrrhizin could also suppress both plasma renin activity and aldosterone secretion. In addition, licorice has been shown to have chemopreventive effects through influencing Bcl-2/Bax and inhibiting carcinogenesis.[33–35]
Slippery elm (Ulmus fulva)
Slippery elm is a supplement that is made from the powdered bark of the slippery elm tree. It has long been used by Native Americans to treat cough, diarrhea, and other GI complaints. Recently, slippery elm has been studied for use as a supplement for IBD. A study has confirmed the antioxidant effects of slippery elm when used in patients with IBD. The research so far has been promising, but there is not enough to warrant the widespread use of slippery elm in the treatment of IBD.
Tormentil extracts have antioxidative properties and are used as a complementary therapy for chronic IBD. In individual patients with UC positive effects have been observed. Sixteen patients with active UC (clinical activity index ≥ 5) received tormentil extracts in escalating doses of 1200, 1800, 2400, and 3000 mg/day for 3 weeks each. Each treatment phase was followed by a 4-week washout phase. The outcome parameters were side effects, clinical activity index, C-reactive protein, and tannin levels in patient sera. Mild upper abdominal discomfort was experienced by 6 patients (38%), but did not require discontinuation of the medication. During therapy with 2400 mg of tormentil extracts per day, median clinical activity index, and C-reactive protein improved from 8 (6 to 10.75) and 8 (3 to 17.75) mg/L at baseline to 4.5 (1.75 to 6) and 3 (3 to 6) mg/L, respectively. During therapy, the clinical activity index decreased in all patients, whereas it increased during the washout phase. Neither undegraded nor metabolized tannins could be detected by liquid-mass spectrometry in sera. Tormentil extracts appeared safe up to 3000 mg/day.
The wheat grass (Triticum aestivum)
The wheat grass juice has been used for the treatment of various GI conditions. A double-blind study has demonstrated that supplementation with wheat grass juice for 1 month results in clinical improvement in 78% of people with UC, compared with 30% of those receiving a placebo. The amount of wheat grass used is 20 mL per day initially, and this is increased by 20 mL/day to a maximum of 100 mL per day (approximately 3.5 ounces). No serious side effects are noticed. Wheat grass juice appears to be effective and safe as a single or adjuvant treatment of active distal UC.
Curcumin is a compound in turmeric (Curcuma longa) that has been reported to have anti-inflammatory activity. It has been found to induce the flow of bile, which helps break down fats. Additionally, it could reduce the secretion of acid from the stomach and protect against injuries such as inflammation along the stomach (gastritis) or intestinal walls and ulcers from certain medications, stress, or alcohol. In a preliminary trial, 5 of 5 people with chronic ulcerative proctitis had an improvement in their disease after supplementing with curcumin. Curcumin inhibits the activation of NF-κB. NF-κB promotes the synthesis of many antioxidant enzymes. Curcumin directly binds to thioredoxin reductase and irreversibly changes its activity from an antioxidant to a strong pro-oxidant.
The amount of curcumin used was 550 mg twice a day for 1 month, followed by 550 mg 3 times a day for 1 month. Hanai and colleagues published the results of the first randomized, multicenter, double-blind, placebo-controlled trial from Japan to study curcumin‘s effect on UC maintenance. All 97 patients who enrolled and 89 patients who completed the study took a standard dose of mesalamine or sulfasalazine and either 1 g of curcumin or placebo twice daily for 6 months and then were followed for another 6 months off study medications. The relapse rate at 6 months on therapy was greater for the placebo group than for those who took curcumin (P = 0.049). Thus, curcumin may confer some additional therapeutic advantages when used in combination with conventional anti-inflammatory medications in UC.
Germinated barley foodstuff
Two open-label Japanese trials have shown the efficacy of Germinated barley foodstuff (GBF) in the treatment of UC, consisting mainly of dietary fiber and glutamine-rich protein that function as a probiotic.[41–44] In the first report, 11 patients given GBF for 4 weeks as an adjunctive treatment showed a greater decrease in clinical disease activity than 9 patients given conventional therapy alone. In a follow-up study, 24 weeks of treatment of 21 patients with GBF together with continuing 5-aminosalicylic acid and steroid therapy reduced rectal bleeding and nocturnal diarrhea. Adjunctive GBF also produced a lower relapse rate over 12 months when given to 22 patients with UC in remission than did conventional therapy in 37 patients. The potency of GBF on modulating microflora, as well as the high water-holding capacity, may play an important role in the treatment and prolongation of remission in UC.
Bromelain is an anti-inflammatory and has been used as a digestive aid and a blood thinner, as well as to treat sports injuries, sinusitis, arthritis, and swelling. Bromelain has been studied for use as a supplement for IBD, especially UC. Emerging research on pineapple suggests that pineapple’s “active” component, bromelain, may help relieve the inflammation associated with UC. The mechanisms that are primarily responsible for its anti-inflammatory effects are still unclear. However, proteolytic activity is required for the anti-inflammatory effect of bromelain on T-cell activation and cytokine secretion in vitro and in murine models of IBD in vivo. [46,47] The major mechanism of action of bromelain appears to be proteolytic in nature, although evidence also suggests an immunomodulatory and hormone-like activity acting via intracellular signaling pathways. Bromelain has been shown to reduce cell surface receptors, such as hyaluronan receptor CD44, which is associated with leukocyte migration and induction of pro-inflammatory mediators.[48,49] Additionally, bromelain is also reported to significantly reduce CD4+ T-cell infiltrations, which are primary effectors in animal models of inflammation in the gut. Bromelain has been found to be effective in improvement of clinical and histologic severity of colonic inflammation in a murine colitis model of IL-10-deficient mice. Previous work also reported clinical trial with bromelain in the treatment of mild UC. Although those 2 patients were unable to achieve remission on standard therapy, clinical and endoscopic evidence of improvement was documented.
Psyllium comes from a shrub-like herb called Plantago ovata and is classified as a mucilaginous fiber due to its gel-forming properties in water. It has a long history of use as a laxative as it absorbs water and expands as it travels through the digestive tract. The psyllium husk contains a largely insoluble fiber (hemicellulose), which helps to retain water within the bowel and effectively increases stool moisture content and weight. Soluble fibers (including psyllium) are noted for their effect on the stomach and small intestine, whereas insoluble fibers are noted for their effect on the large intestine, although some carbohydrates (such as psyllium) have an effect on both. Psyllium also has hypocholesterolemic effects, although the exact mechanism by which psyllium husk brings about a reduction of cholesterol is not totally clear. Animal studies have shown that psyllium increases the activity of cholesterol 7α-hydroxylase (a rate-limiting enzyme in bile acid synthesis, also referred to as cytochrome 7A) more than twice that of cellulose or oat bran, but less than cholestyramine. In animals fed a high-fat diet, psyllium could increase the activity of cholesterol 7α-hydroxylase and HMG-CoA reductase.
In a double-blind trial, patient with UC had a reduction in symptoms such as bleeding and remained in remission longer than those who took 20 g of ground psyllium seeds twice daily with water compared with those who were on the medication mesalazine alone.
There are many trials on herbal medicine for UC except mentioned above, which has good response. Withania somnifera, member of family Solanaceae, has good response in anti-inflammatory activity. Immunomodulatory role of W. somnifera roots and anti-inflammatory activity using adjuvant-induced arthritic rat models was also demonstrated. Considering the various biological activities, roots of W. somnifera can potentially be utilized for the effective treatment of various inflammatory conditions. Recently, Pawar et al studied that dose of the rectal gel applied at 1000 mg of WSRE (Withania somnifera root extract) per kg rat weight showed significant mucorestorative efficacy in the IBD-induced rats.
The present study analyzed the intestinal anti-inflammatory potential of oil-resin Copaifera langsdorffii (ORCL) and its diterpene constituent, kaurenoic acid (KA) in rat models of UC induced by acetic acid (AA-UC), and trinitribenzene sulfonic acid (TNBS-UC), and in indomethacin- and ischemia-reperfusion-induced intestinal inflammation (IND-II and I/R-II).
Plant tannins can help decrease the inflammation of UC patients. Patients with UC don’t have the protective benefit of normal mucin production, which can also leave them vulnerable to oxidized molecules increase the inflammation and mucosal injury seen in UC. The tannins appear to exert a protective effect against oxidative stress-induced cell death. Condensed tannins can also help return the GI flora to a state of balance. Patients with UC have GI flora that favor pathogenic bacteria. Current research with flavonoids and UC demonstrate a protective effect in mice treated with the colitis-inducing agent, dextran sulfate sodium, so as to prevent the occurrence of colitis. Green tea polyphenols have shown similar benefits in mice by attenuating colonic injury induced by experimental colitis.
Guggulsterone is a plant steroid found in the resin of the guggul plant, is an anti-inflammatory compound with the capacity to prevent and ameliorate T-cell–induced colitis. These data ground the use of GS, a natural cholesterol-lowering agent, in the treatment of chronic inflammatory diseases. Guggulsterone inhibits LPS- or IL-1b-induced ICAM-1 gene expression, NF-κB transcriptional activity, IκB phosphorylation/degradation, and NF-κB DNA-binding activity in IEC and strongly blocked IKK activity. Guggulsterone significantly reduced the severity of DSS-induced murine colitis as assessed by clinical disease activity score, colon length, and histology. Furthermore, tissue upregulation of IκB and IKK phosphorylation induced by DSS was attenuated in guggulsterone-treated mice. The guggulsterone derivative GG-52 has both protective and therapeutic effects on inflammation in the colon, indicating that it has a potential clinical value for the treatment of IBD.
There is small clinical study with 21 ulcerative colitis and Crohn’s disease patients showed a proprietary extract of Agaricus subrufescens (agaricus blazei) had an anti-inflammatory effect. Xu et al. found the therapeutic effect of herb-partitioned spread moxibustion for treatment of chronic nonspecific UC is better than that of the oral administration of sulfasalazine with less adverse reaction. Sixty cases were randomly divided into a spread moxibustion group (n = 28) and a western medicine group (n = 32). The cured-markedly effective rate was 71. 4% (20/28) in the spread moxibustion group, and 25.0% (8/32) in the western medicine group.
A new herbal drug Fufangkushen colon-coated (FCC) capsule, is effective and safe in the treatment of active UC. In the double-blind, double-dummy, multicenter, randomized, and controlled study, 320 active UC patients with TCM pattern of damp–heat accumulating in the interior were assigned to 2 groups: 240 treated with FCC plus HD placebo treatment, 80 with HD plus FCC placebo. At the 8th week, 72.50% of patients in FCC group (170 of 234) and 65.00% of patients in HD group (52 of 80) had achieved a clinical response. One of the Chinese herbal suppository named Qingchang Shuan is commonly used for the treatment of UC. It has the effects of clearing away heat and toxic materials, and promoting tissue regeneration by removing blood stasis.
Although many of these herbs seem to be effective in the management of UC based on clinical experiences, the long-term efficacies of these herbal medicines need further investigation.
Alternative and Complementary Therapies for Ulcerative Colitis
When you have ulcerative colitis, you want to do whatever you can to keep it from flaring up. So you may be looking for anything that helps, in addition to the medicine and advice your doctor gives you.
Complementary, or integrative, medicine doesn’t replace your usual treatments. These are therapies you might try along with your regular medical care.
People in other parts of the world have used some of these methods, like acupuncture, for centuries. But they can be hard for researchers to study. So before you try anything, you should check with your doctor to make sure it won’t cause problems with your main treatment or cause side effects.
Module: video The Importance of Your Treatment PlanAs you start to feel better, the temptation to loosen the reins on your treatment plan may cross your mind. Here’s why you should stick with it. 159Douglas Wolf, MD<br> Director of IBD research, Atlanta Gastroenterology Associates/delivery/aws/c4/d0/c4d0f4b0-e7ff-3304-a710-559441e66705/funded-expert-feature-importance-of-staying-on-treatment_,4500k,2500k,1000k,750k,400k,.mp411/30/2018 12:00:00650350photo of woman walking/webmd/consumer_assets/site_images/article_thumbnails/video/ulcerative_colitis_stay_on_treatment_plan_video/650x350_ulcerative_colitis_stay_on_treatment_plan_video.jpg091e9c5e81b538bf
Mind and Body Techniques
Stress doesn’t cause ulcerative colitis. But it can worsen the symptoms and trigger flare-ups. There are several ways you can try to ease it.
Biofeedback. This is a system that teaches you how to control things like muscle tension and rapid heartbeat. At first, a machine helps you recognize what your body is doing. You learn how to quiet the symptoms of stress, and you eventually stop needing the machine.
Deep breathing. You inhale from all the way down, making your tummy expand and pull back in. That helps relax the body, particularly the muscles in your belly. That can be good for your intestines.
Exercise. Physical activity, even if it’s mild, can make you feel better and release stress. But if you do too much or make your workout too hard, it might backfire. If you’re not active now, ask your doctor what types of exercise would be good to try.
Hypnosis. Sessions with a trained hypnotherapist can help you deal with stress and anxiety. Early research suggests that hypnosis may help relieve the inflammation involved in ulcerative colitis.
Progressive muscle relaxation. You tighten and release various muscle groups, going one group at a time. It’s simple to learn, and you can do it anywhere, anytime.
Yoga and meditation. These can help you let go of stress. If you don’t have time for a yoga session, you might try even a few minutes of meditation. Just turn your attention to your breath, or to a word or thought that you find calming. Other thoughts will come up. Try to let those go. You might also want to try tai chi, a Chinese martial art known for its slow, meditative movements.
Acupuncture and Moxibustion
Acupuncture is a form of traditional Chinese medicine that places needles in key “acupoints” to ease tension, pain, and other health problems. In moxibustion, practitioners warm and stimulate the same acupoints with burning dried mugwort (moxa) instead of needles. Some studies suggest that these practices can help symptoms of inflammatory bowel disease, like belly pain, nausea, inflammation, diarrhea, constipation, bloating, and gas.
But not all of the studies were exact in the way they collected information, and some studies showed no statistical difference between those who got the treatments and those who didn’t. Some evidence shows that acupuncture can help mood and mental health in people with ulcerative colitis, though more study is needed here as well.
There isn’t a lot of research that backs using supplements to help manage your ulcerative colitis. These may hold some promise, but the scientific evidence isn’t complete, so check with your doctor first:
Aloe vera. It might help ease inflammation. But it could give you diarrhea.
Fish oil. This also might ease inflammation, and it may help in combination with prescription drugs from a group called aminosalicylates, though more studies are needed.
Psyllium. This comes from the ground seeds of the psyllium plant, and it supplies fiber. If you have diarrhea because of ulcerative colitis, it may help. But too much of it might cause irritation. For some people, fiber from flaxseed or oat bran may work better. Psyllium can interfere with some medications.
Turmeric. This spice contains a chemical called curcumin. When combined with standard treatments for UC, it may have some benefits, but more research is needed.
These are “good” bacteria that live in your digestive system and help it work. The research on whether they help your body handle ulcerative colitis isn’t certain.
Some studies have found no benefit. But others showed that a particular probiotic called VSL #3 may do some good in addition to your regular medical treatment. There’s also some research showing that a drink that includes fermented milk and another probiotic, bifidobacteria, may also help in addition to ordinary treatment.
Finally, if you’re curious about going to a chiropractor to help with pain, ask your doctor what they think. It might be fine to try, but as usual, it’s best to let your medical team know so they have a complete picture of your health.
How do Naturopathic Doctors Diagnose and Treat Crohn’s Disease and Ulcerative Colitis?
diagnosing and treating patients with acute or chronic gastrointestinal (GI)
symptoms, licensed naturopathic doctors (NDs) address the whole
person—including body, mind, emotions, genetics, environmental exposures, and
socio-economic status. NDs employ a variety of diagnostic approaches to
pinpoint the underlying causes of distress. Trained rigorously in clinical nutrition, behavioral medicine, botanical medicine, and conventional pharmaceuticals, NDs draw on a
broad and deep spectrum of treatments, expanding options for patients with
Crohn’s disease and/or ulcerative colitis.
What are Crohn’s Disease and Ulcerative Colitis?
Crohn’s disease (CD) and ulcerative colitis (colitis or UC) are the most common disorders in a group of auto-immune GI diseases referred to as inflammatory bowel diseases (IBDs). Crohn’s may develop anywhere in the digestive tract; ulcerative colitis is limited to the large intestine and rectum.
Thought to be caused by your body’s immune system having an abnormal reaction to normal bacteria in your intestine, both diseases are chronic, lifelong, and often debilitating. Intestinal pain, dangerous obstructions, and blockages, abscesses and ulcers are all possible complications. Acute flare-ups can be triggered by foods, stress, anxiety, depression, or acute infections. Tobacco products can also trigger flares of Crohn’s disease.
Crohn’s and Colitis Awareness Week is Dec. 1-7th, 2018. Learn more about individual stories by following #myIBD online, or visiting the official Awareness Week page.
How are Crohn’s and Colitis Diagnosed?
Crohn’s and ulcerative colitis can be hard to diagnose because symptoms vary from person to person, and are similar to those of other diseases. For example, the most common symptoms of Crohn’s are intense abdominal pain and diarrhea. However, a person with Crohn’s disease can have constipation and diarrhea and sometimes blood in the stool, although some people with constipation will not have any diarrhea or blood in the stool. In addition, the typical symptoms of Crohn’s can be identical to those of small intestinal bacterial overgrowth (SIBO). With ulcerative colitis, symptoms typically include bloody diarrhea, frequently accompanied by abdominal pain and weight loss.
To treat Crohn’s and ulcerative colitis, naturopathic
doctors address the whole person—including body, mind, emotions, genetics, environmental
exposures, and socio-economic status.
complexities of Crohn’s and ulcerative colitis, a correct diagnosis is
essential to effective treatment. There is no one definitive test for Crohn’s
disease. Testing is determined by the suspected location, small vs. large
bowel. In addition to a comprehensive health history and an in-office exam, a
naturopathic doctor may order stool testing to assess gut bacteria,
markers of inflammation, and immune markers. NDs may also order blood testing
for food sensitivities/allergies, celiac antibodies, folic acid deficiency, and
inflammatory indicators such as C-reactive protein.
An ND may expand diagnostic testing for Crohn’s
gut bacteria, markers of inflammation such as C-reactive protein and fecal
calprotectin, immune markers, food sensitivities, celiac antibodies, and folic
usually involves endoscopic or imaging studies in patients with compatible
clinical history, and naturopathic doctors refer patients to gastroenterologists
for this vital testing. Colonoscopy is
the most appropriate first test for a patient presenting with diarrhea and
suspected large bowel CD. Wireless capsule endoscopy is increasingly being
used for evaluation of suspected small bowel CD. Imaging studies are
generally considered more appropriate for those with abdominal pain and to
evaluate the small bowel. These can include upper GI radiography with
barium, computed tomography (CT) and computed tomography with enterography
(CTE), magnetic resonance imaging (MRI), and magnetic resonance enterography
(MRE). Diagnosis can also be supported by specific findings such as
perianal skin tags or abdominal tenderness.
Naturopathic doctors also frequently test fecal calprotectin, an inflammatory substance produced by neutrophil white blood cells. Measuring calprotectin is helpful in establishing that there is inflammation in the lower intestinal tract.
Individualized Naturopathic Treatment for Crohn’s
patient has been diagnosed with Crohn’s, ulcerative colitis, or other IBDs, a
naturopathic doctor will create a tailored treatment plan based on each
patient’s individual presenting symptoms understood in context with the
patients’ overall health and lifestyle. While there are no well-documented
cures for either disease, the goal is to help
prevent flare-ups, achieve and maintain remission, and heal as much of the
underlying inflammation (even in periods without symptoms) as possible.
Specific treatments a naturopathic doctor may recommend include:
- Elimination/challenge diets or other approaches to reducing food triggers (including elemental diets) to prevent or curtail flare-ups
- Curcumin in tincture, capsule, or whole turmeric powder form to reduce inflammation
- However, there are contraindications to the use of turmeric. For instance, turmeric should be avoided in patients who readily form calcium oxalate kidney stones.
- Probiotics to modulate the immune system and prevent flare-ups
- Stress reduction by various techniques
- Artemisia absinthium (wormwood) capsules
Because they are lifelong conditions, Crohn’s and ulcerative colitis must be carefully monitored and managed, with more aggressive interventions necessary during flare-ups. Research shows that a naturopathic medical approach emphasizing diet and other lifestyle changes can be used to successfully manage these conditions. Naturopathic therapies may eliminate the need for prescription drugs (such as prescription anti-inflammatory medications, immune system suppressors, and antibiotics) or surgery, which have the potential to cause more side effects and long-term problems.
Research shows that a naturopathic medical approach
emphasizing diet and other lifestyle
changes can be used to successfully manage Crohn’s and colitis,
and may potentially eliminate the need for prescription drugs.
However, if natural approaches are not successful, naturopathic physicians do not hesitate to prescribe palliative medications (when state licensure allows) or to refer patients for treatment with various medications, biologic drugs, or surgery. A naturopathic medical approach has the added benefit of focusing on engaging patients in managing their own health—a crucial component of living a long and healthy life with these challenging conditions.
A service for consumers from the American Association of Naturopathic Physicians (AANP) and the Institute for Natural Medicine (INM). The AANP and the INM would like to acknowledge Eric Yarnell, ND, for his contributions to the content of this FAQ.
Image by Natiya Guin.
4 Herbal Remedies to Try
Try these herbs for ulcerative colitis natural treatment and get started finding relief today.
While there may be no known cure for inflammatory bowel diseases like ulcerative colitis, there are many natural strategies that can help you to control your symptoms, such as making dietary changes, taking probiotics, getting regular exercise, and addressing a small intestinal bacterial overgrowth (SIBO), to name a few. Supplementing with herbal remedies can also make a big difference; try these herbs for ulcerative colitis natural treatment and get started finding relief today.
Herbs for ulcerative colitis treatment
- Aloe vera is best known for treating sunburns, but helping to heal the skin is only one of the many health benefits of this plant. The gel from the aloe vera plant has remarkable anti-inflammatory and wound healing properties. Ulcerative colitis has been shown to respond well to aloe vera treatment. Laboratory studies show that aloe vera has antioxidant effects, and it inhibits the production of prostaglanins and interleukins, compounds associated with colitis symptoms. In one study, patients with active ulcerative colitis who took 100 mL of aloe vera gel twice daily for four weeks found significant improvements in symptoms. Specifically , 30% of patients taking aloe vera achieved clinical remission after four weeks, compared to only 7% of those taking placebo. Making this one of the best natural remedies for colitis.
- Andrographis paniculata. Native to India and Sri Lanka, this herb has been traditionally used to treat conditions like the common cold. It is also particularly effective in relieving symptoms of ulcerative colitis. In one study, patients with active ulcerative colitis were given either 1,200 mg or 1,800 mg of andrographis or placebo. Andrographis was more effective than placebo, with those patients taking 1,800 mg the most likely show clinical improvement in their symptoms. This herb is an one of the most effective natural remedies for ulcerative colitis.
- Boswellia is a potent anti-inflammatory herb that is useful in treating inflammatory conditions such as asthma. Laboratory studies have shown that boswellia can protect against colitis in animals. In humans, boswellia has been compared to sulfasalazine, a conventional drug treatment for ulcerative colitis. The results of the study favored boswellia over pharmaceutical treatment, as it was better at reducing symptoms and inducing remission. The recommended dose for ulcerative colitis is 300 to 400 mg three times daily.
- Curcumin is the active compound found in the common spice turmeric. It has been extensively studied for its anti-inflammatory capabilities in the gastrointestinal tract and its abilities to decrease cytokines and interleukins associated with inflammatory bowel disease. Studies have shown that adding curcumin to drug therapy can help improve symptoms of ulcerative colitis.[7,8] In one study, patients who failed to improve after drug therapy were given either 3 g per day of curcumin capsules or placebo for one month, in addition to their current drug treatment. Improvement was seen in 65% of the curcumin group, compared to only 12% of the placebo group. The study found that 43% of the curcumin group experience remission, while none of the placebo-treated patients went into remission. Try 2 to 3 g daily.
Don’t let your ulcerative colitis get the better of you; these herbs can help you to feel better and keep your symptoms under control. To read about natural remedies for Crohn’s disease, such as fish oil and probiotic therapy, learn more in 4 Natural Options for Crohn’s Treatment.To get started, choose one herb and take it for several weeks to see if it works for you. You may then want to add additional herbs if needed.
Share your experience
Do you have ulcerative colitis? What ulcerative colitis natural treatment strategies have you tried? Have any of these herbal remedies worked for you? Share your experience in the comments section below.
Originally published in 2015, this post has been updated.
 Aliment Pharmacol Ther. 2004 Mar 1;19(5):521-7.
 Aliment Pharmacol Ther. 2004 Apr 1;19(7):739-47.
 Am J Gastroenterol. 2013 Jan;108(1):90-8.
 Phytother Res. 2014 Sep;28(9):1392-8.
 Altern Med Rev. 2008 Jun;13(2):165-7.
 Altern Med Rev. 2011 Jun;16(2):152-6.
 J Crohns Colitis. 2015 Feb;9 Suppl 1:S300.
 Clin Gastroenterol Hepatol. 2015 Feb 24. pii: S1542-3565(15)00158-5.
Ulcerative Colitis Diet: Foods, Supplements & Natural Remedies
Ulcerative colitis is an inflammatory bowel disease that causes long-lasting inflammation and ulcer symptoms, or sores in the digestive tract. Ulcerative colitis affects the innermost lining of the large intestine and rectum.
This inflammatory disease can be debilitating, and sometimes it can even lead to life-threatening complications. Ulcerative colitis may lead to a narrowed area of the intestines, making it harder to pass stool. It may also lead to swelling in the colon, intense diarrhea, joint pain, and scarring of the bile ducts and pancreas.
Ulcerative colitis most often begins gradually and can become worse over time. The symptoms of this inflammatory disease can be mild to severe, and most people have periods of remission, times when the symptoms disappear, which can last for weeks or years. While there is no known cure for ulcerative colitis, there are natural treatments that can greatly reduce signs and symptoms of the disease and result in long-term remission.
New research continues to come out with hope for a more permanent treatment for ulcerative colitis and other inflammatory bowel diseases. A 2017 study found that the protein NLRP12 regulates inflammation in the body. Analysis found low levels of NLRP12 in twins with ulcerative colitis, but not in twins without the disease. When NLRP12 was low, there were lower levels of friendly bacteria as well as high levels of harmful bacteria and inflammation. Researchers believe they could add back more of the friendly bacteria in people with inflammatory bowel diseases with reduced NLRP12 expression to reduce inflammation and restore healthy bacteria, ending the cycle and offering treatment to those with ulcerative colitis. (1)
Symptoms of Ulcerative Colitis
Ulcerative colitis symptoms can vary, depending on the severity of inflammation and where it occurs; they typically develop over time. Most people experience mild to moderate symptoms, but the course of ulcerative colitis may vary and some people have long periods of remission. The symptoms depend on the location of the disease-causing inflammation. If you have ulcerative colitis, you may have the following signs and symptoms:
- Diarrhea, often with blood or pus
- Abdominal pain and cramping
- Rectal pain
- Rectal bleeding
- Urgency to discharge stool
- Inability to discharge stool, despite the urgency
- Weight loss
- Fatigue or chronic fatigue syndrome
- Failure to grow (in children)
Living with ulcerative colitis can lead to some serious health conditions and complications. These occurrences include:
- Severe bleeding
- A hole in the colon
- Severe dehydration
- Liver disease
- Bone loss
- Inflammation of the skin, joints and eyes
- Sores in the lining of the mouth
- An increased risk of colon cancer
- A rapidly swelling colon
- An increased risk of blood clots in veins and arteries
Diet and stress were always known to be the root causes of ulcerative colitis, but recently doctors have concluded that these factors may aggravate the inflammatory condition but do not cause it, according to the Mayo Clinic. (1b) One possible cause is an immune system malfunction. When the immune system tries to fight off an invading virus or bacterium, an abnormal immune response causes the immune system to attack the cells in the digestive tract.
Ulcerative colitis usually begins before the age of 30, but there are some cases when people did not develop the disease until after age 60. You are at a higher risk of developing ulcerative colitis if you have a close relative with the disease, such as a parent or sibling. Another major risk factor is a certain medication used to treat scarring cystic acne, called isotretinoin. In studies published in the American Journal of Gastroenterology, a link between the development of ulcerative colitis and isotretinoin was established. (2)
Stress can also cause a flare-up. It’s important to avoid stress, particularly chronic stress, by exercising, stretching, and practicing relaxation techniques and breathing exercises.
Conventional ulcerative colitis treatment usually involves either drug therapy or surgery, and according to a review done at Harvard Medical School, anti-inflammatory drugs are typically the first step in treatment. (3) Two common anti-inflammatory medications that are prescribed for ulcerative colitis include aminosalicylates and corticosteroids. Although these medications can be effective in reducing symptoms of ulcerative colitis, they come with a number of side effects.
For instance, some aminosalicylates, including mesalamine, balsalazide and olsalazine, have been associated with kidney and pancreas problems. Corticosteroids, which are given to patients with moderate to severe symptoms, have numerous side effects, including a puffy face, excessive facial hair, night sweats, insomnia and hyperactivity. More serious side effects of this type of medication includes high blood pressure, diabetes, osteoporosis, bone fractures, cataracts, glaucoma and increased chance of infection. This is why these conventional medicines and treatments are not utilized for long periods of time.
Immunosuppressant drugs are also used to treat ulcerative colitis. These medications suppress the immune system response that starts the process of inflammation in the first place. According to a study published in Digestive Diseases, the standard treatment of ulcerative colitis is directed towards inducing and maintaining remission of symptoms and mucosal inflammation. (4)
The key factor that is used by doctors to access the most appropriate treatment is the severity and extent of inflammation. Some other conventional treatment medications include antibiotics, which are given when a patient has a fever, anti-diarrheal medications, pain relievers and iron supplements, which are needed by patients who experience chronic intestinal bleeding and may develop iron deficiency anemia. Of course, relying too much on antibiotics can lead to antibiotic resistance.
In severe cases, surgery can eliminate ulcerative colitis, but it usually involves removing the entire colon and rectum. (5) According to a scientific review published in Surgical Treatment, the underlying rationale for surgical treatment of ulcerative colitis is that the disease is confined to the colon and rectum, and therefore proctocolectomy (rectum and colon removal) is curative.
In most cases, this involves a procedure called ileoanal anastomosis that eliminates the need to wear a bag to collect stool. In this case, a pouch is constructed at the end of the small intestine and then attached directly to the anus, allowing for the discharge of waste. In some cases, the surgeon is able to create a permanent opening in the abdomen so stool can pass through into a small bag that is attached.
To treat ulcerative colitis naturally, it’s important to understand that a healing diet is the foundation. Certain foods trigger an aggressive immune response and inflammation in the digestive tract, and these foods need to be pin-pointed and removed from your diet. Some problematic foods include dairy products, spicy foods and refined sugar. There are also beneficial foods that reduce inflammation and help with nutrient absorption, like omega-3 foods and probiotic foods.
Exercise is also an important factor in treating ulcerative colitis, since the benefits of exercise are so wide-ranging. Moderate-intensity exercise reduces stress, which is a root cause of this inflammatory disease. Exercise (especially yoga and swimming) also stimulates digestion, boosts the immune system and aids relaxation.
Relaxation is a vital element in combating ulcerative colitis because it calms the body and allows it to digest food more easily. Meditation, stretching and breathing practices can help improve circulation, regulate the digestive system, and keep the body out of fight or flight mode.
Foods to Avoid
The foods that make ulcerative colitis worse typically depend on the person and the location of inflammation. For some people, fiber is bothersome during flare-ups because high-fiber foods are harder to digest. Removing fibrous foods like nuts, seeds, whole grains, and raw fruits and vegetables from the diet is sometimes called a low-residue diet. Although this can help people with ulcerative colitis to ease pain, cramps and other symptoms, it does not get rid of inflammation.
If raw fruits and vegetables lead to discomfort, it may help to steam, bake or stew them. This makes foods in the cabbage family, such as nutrient-dense broccoli and cauliflower, easier to digest. Some other problematic products include spicy and fatty foods and caffeinated, carbonated drinks.
People with ulcerative colitis may have trouble with these foods and drinks:
- carbonated drinks
- dairy products (for people who are lactose intolerant or sensitive)
- raw fruits and vegetables
- dried beans, peas and legumes
- dried fruits
- foods that have sulfur or sulfate
- high-fiber foods
- nuts and crunchy nut butters
- products that have sorbitol (like sugar-free gum and candies)
- refined sugar
- spicy foods
The Ulcerative Colitis Diet
1. Omega-3 Fatty Acids
Studies have found that an omega-3 fatty acid called eicosapentaenoic acid (known as EPA) has the power to fight inflammation. It blocks certain chemicals in your body called leukotrienes. A benefit of fish oil is it’s a good source of EPA, and in some tests, people benefited from very high doses of it.
A 2010 case report published in the Journal of the Royal Society of Medicine evaluated a 38-year-old woman who had ulcerative colitis and used omega-3 fatty acids as part of her treatment. (6) In 1998, at the age of 27, she went to the emergency department after 10 days of bloody diarrhea and lower abdominal cramping pain. She described up to 15 bowel motions daily with urgency, and she lost approximately six pounds. She was also clinically dehydrated.
After weeks of various treatments that only led to short-term results, the patient turned to omega-3 fatty acid treatments. The EPA and DHA doses were well-tolerated and had no side effects. Her bowel frequency slowly decreased, and within a week all rectal bleeding had resolved. The woman continued to take one gram of omega-3s and 2.4 grams of mesalazine, an anti-inflammatory medication that did not have the same reactions when given alone. The patient went into remission after adding omega-3s into her diet.
Probiotics are bacteria that line your digestive tract and support your body’s ability to absorb nutrients and fight infection. Probiotics crowd out bad bacteria, yeast and fungi. They also create enzymes that destroy bad bacteria that can lead to inflammation and infections. Probiotics have the power to boost the immune system and improve digestive function.
Digestive experts agree that the balance of gut flora should be approximately 85 percent good bacteria and 15 percent bad bacteria. If this ratio gets out of balance, the condition is known as dysbiosis, which means there is an imbalance of too much of a certain type of fungus, yeast or bacteria that affects the body in a negative way. By consuming certain types of probiotics foods and supplements, you can help bring these ratios back into balance.
Probiotics work by acting as a barrier; they line the intestinal tract and prevent bacteria from stimulating an immune response. They also enhance mucus production, which protects the body from invasive bacteria. Probiotics alter the function of the mucosal immune system and make it more anti-inflammatory and less pro-inflammatory, which makes probiotic foods also excellent anti-inflammatory foods. They have the power to stimulate dendritic cells to make them slightly less responsive and slightly less reactive to bacteria, thereby reducing the inflammation that leads to ulcerative colitis symptoms.
According to a peer-review published in Gastroenterology and Hepatolgy, when probiotic treatment was compared to mesalamine treatment, a medication used to reduce inflammation in ulcerative colitis patients, the two were found to be equally effective. (7) In clinical trials, probiotic benefits have proven to be effective in treating ulcerative colitis because of its ability to stimulate mucus and alter the mucosal immune system that triggers inflammation.
Top probiotic and fermented foods include kefir, sauerkraut, kimchi, natto, probiotic yogurt, miso, kombucha and raw cheese. Another food that helps with ulcerative colitis is Manuka honey. In fact, Manuka honey ulcerative colitis research on rats showed it “possesses a potent antiulcer activity, which may be due to its antioxidants abilities which result in reducing lipid peroxidation and interfering with the inflammatory process.”
3. Iron-Rich Foods
A major symptom of ulcerative colitis is anemia, which occurs when the body doesn’t have enough healthy red blood cells. Bleeding ulcers and bloody diarrhea can cause anemia, and to fight it you need to boost your blood iron levels.
Aside from preventing anemia, iron is a nutrient needed to maintain general well-being, energy and a healthy metabolism because it helps support overall cellular health and is involved in many enzyme functions. An iron deficiency can mean that you aren’t able to produce enough oxygen-carrying red blood cells; therefore, your body struggles to transport oxygen to your brain, tissues, muscles and cells, leaving you feeling exhausted and weak. Iron-rich foods include liver, beef, navy beans, black beans, spinach, Swiss chard and egg yolks.
4. Folate-Rich Foods
Folate is another important vitamin for people with ulcerative colitis because it helps the body make new cells, specifically by playing a role in copying and synthesizing DNA. A folate deficiency causes anemia, poor immune function and poor digestion.
According to a publication for the American Association for Cancer Research, folate supplementation may even reduce the risk of colorectal dysplasia and cancer in patients with chronic ulcerative colitis. (8) The top folate foods include chickpeas, lentils, asparagus, avocado, beets and broccoli. Keep in mind that these foods can be difficult to digest when eaten raw, so if you notice an increase in symptoms when eating these foods, try to steam or bake them.
One of the most powerful aspects of turmeric, or curcumin, is its ability to control inflammation; it’s actually one of the most effective anti-inflammatory compounds in the world! Oftentimes, people with digestive and stomach complaints become intolerant to medical interventions because the stomach flora is already compromised and drugs can literally tear up the mucosal lining.
An in-depth analysis of all the studies evaluating curcumin’s ability to manage inflammatory bowel disease found that many patients were able to stop taking their prescribed corticosteroids because their condition improved so dramatically by taking curcumin. For many patients with ulcerative colitis, taking corticosteroids reduces their pain symptoms but damages the intestinal lining over time, which actually makes the condition worse. However, supplementing with curcumin did not have these side effects, and because of its anti-inflammatory properties, actually helped heal the gut and supported the growth of good bacteria.
According to the University of Maryland Medical Center, powerful turmeric benefits may help people with ulcerative colitis stay in remission. In one double-blind, placebo-controlled study, people whose ulcerative colitis was in remission took either curcumin or placebo, along with conventional medical treatment, for six months. Those who took curcumin had a significantly lower relapse rate than those who took placebo. (9)
A great way to incorporate turmeric into your diet is by drinking my Turmeric Tea Recipe that I refer to as “liquid gold.” This tea recipe is sure to help heal your body from ulcerative colitis and a number of other inflammatory health conditions.
Supplements for Ulcerative Colitis
Because ulcerative colitis may interfere with your ability to absorb nutrients, it’s important that you use supplements to ensure that your body gets the vitamins and minerals that are necessary. Some supplements that may be helpful when combating the symptoms of ulcerative colitis include:
- Calcium — improves bone strength and hormone secretion
- Vitamin D — fights autoimmune diseases and contributes to bone health
- Multivitamin — ensures that you are getting the necessary vitamins and minerals
- Probiotics — provide good bacteria, reduce inflammation and minimize immune responses
- Fish oil — fights inflammation and blocks chemical reactions
1. Keep a Food Journal
Because ulcerative colitis is triggered by a variety of foods, it’s important to evaluate which foods are problematic for you. I suggest you keep a food journal for a few weeks or months, until you understand what foods aggregate your symptoms and what foods soothe them. Write down what you eat throughout the day and how your body reacted to those foods. This will give you some insight about your own specific sensitives and intolerances.
2. Drink Plenty of Liquids
It’s common that people with ulcerative colitis become dehydrated. It’s important that you drink plenty of water throughout the day in order to protect yourself from dehydration. It’s also essential that dehydrating liquids, like alcohol and caffeine, are avoided.
Acupuncture has traditionally been used in the treatment of inflammatory bowel disease in China and is increasingly applied in Western countries. A 2006 study done at the Friedrich-Alexander-University of Erlangen-Nuremberg in Germany evaluated the efficacy of acupuncture treatment on 29 patients with mild to moderately active ulcerative colitis. (10) As a result of 10 acupuncture sessions over a 10-week period, patients experienced a significant improvement in general well-being and quality of life.
4. Essential Oils
Using essential oils like peppermint, fennel and ginger essential oil may reduce ulcerative colitis symptoms because of their anti-inflammatory properties. Add one drop of these essential oils to water three times daily, or rub two to three drops over the abdomen two times daily.
5. Eat Small Meals and Drink Smoothies
Because cramping is a common ulcerative colitis problem, try eating five to see small meals throughout the day. It’s easier for the digestive system to deal with smaller amounts of food, and if the digestive system is able to work with these smaller batches of food, it’s also able to absorb the nutrients that are needed. Consuming smaller amounts of food reduces pain and provides the body with a stream of vitamins and minerals.
Smoothies and meal-replacement drinks can also be a good way to get nutrition when you can’t handle solids. If you are having trouble keeping on weight, smoothies provide nutrients and calories. They also lower your chances of dehydration, as they supply a good amount of fluid. For some smoothie ideas, check out these 20 Greatest Green Smoothie Recipes.
Cilantro Ginger Smoothie Recipe
This delicious smoothie includes beneficial cilantro, which helps your body detoxify, and ginger, which helps soothe inflammation.
Total Time: 2 minutes
- 1 bunch cilantro
- 1 cucumber, cut into pieces
- 1 lime, juiced
- ½ finger length ginger
- 5 little pieces pineapple
- 1 large tomato cut into slices
- Mix all ingredients in blender until smooth
Read Next: Fecal Transplants Can Help
Colitis, Candida, IBS
City Clinical Hospital # 31 – IBD: Ulcerative colitis. What does the patient need to know? (page 8)
Page 8 of 10
Ulcerative colitis treatment
The tasks of treating a patient with UC are:
- achieving and maintaining remission (clinical, endoscopic, histological),
- minimization of indications for surgical treatment,
- reducing the incidence of complications and side effects of drug therapy,
- reduction in hospital stay and cost of treatment,
- improvement of the patient’s quality of life.
The results of treatment largely depend not only on the efforts and qualifications of the doctor, but also on the willpower of the patient, who clearly follows the medical recommendations. The modern drugs available in the doctor’s arsenal allow many patients to return to normal life.
Complex of therapeutic measures includes:
- dieting (diet therapy)
- taking medications (drug therapy)
- surgery (surgical treatment)
- lifestyle change.
Diet therapy. Usually, in the period of exacerbation, patients with UC are recommended a variant of a slag-free (with a sharp restriction of fiber) diet, the purpose of which is mechanical, thermal and chemical sparing of the inflamed intestinal mucosa. Fiber is limited by excluding fresh vegetables and fruits, legumes, mushrooms, tough, stringy meat, nuts, seeds, sesame seeds, poppy seeds from the diet. With good tolerance, juices without pulp, canned (preferably at home) vegetables and fruits without seeds, ripe bananas are acceptable.Only refined flour baked goods and baked goods are allowed. For diarrhea, meals are served warm, pureed, limit foods with a high sugar content. The use of alcohol, spicy, salty, foods, dishes with the addition of spices is highly undesirable. In case of intolerance to whole milk and lactic acid products, they are also excluded from the patient’s diet.
In a severe course of the disease with loss of body weight, a decrease in the level of protein in the blood, the daily amount of protein in the diet is increased, recommending lean meat of animals and poultry (beef, veal, chicken, turkey, rabbit), lean fish (pike perch, pike, pollock) , buckwheat and oatmeal, chicken egg white.In order to replenish protein losses, artificial nutrition is also prescribed: special nutrient solutions are injected through a vein (usually in a hospital) or through the mouth or a tube special nutritional mixtures in which the main food ingredients have been specially processed for their better digestibility (the body does not need to waste its forces for the processing of these substances). Such solutions or mixtures can complement or replace natural nutrition. Currently, special nutritional mixtures have already been created for patients with inflammatory bowel diseases, which also contain anti-inflammatory substances.
Failure to comply with the principles of medical nutrition during an exacerbation can lead to an aggravation of clinical symptoms (diarrhea, abdominal pain, the presence of pathological impurities in the stool) and even provoke the development of complications. In addition, it should be remembered that the reaction to different foods in different patients is individual. If attention is drawn to the deterioration of health after eating any product, then after consultation with the attending physician, he should also be eliminated from the diet (at least during an exacerbation).
Drug therapy defined by:
- the prevalence of colon lesions;
- by the severity of UC, the presence of complications of the disease;
- the effectiveness of the previous course of treatment;
- individual patient tolerance of drugs.
Treatment for mild and moderate forms of the disease can be carried out on an outpatient basis. Patients with severe UC require hospitalization.The choice of the necessary medicines by the attending physician is carried out step by step.
In mild to moderate disease, treatment is usually started with the appointment of 5-aminosalicylates (5-ASA) . These include sulfasalazine and mesalazine. Depending on the duration of the inflammatory process in UC, these drugs are recommended in the form of suppositories, enemas, foams, which are injected through the anus, tablets or a combination of local and tablet forms. The drugs reduce inflammation in the colon during an exacerbation, are used to maintain remission, and are also proven to prevent colon cancer when taken for a long time.Side effects more often occur while taking sulfasalazine in the form of nausea, headache, increased diarrhea and abdominal pain, and renal dysfunction.
If there is no improvement or the disease has a more severe course, then the patient with UC is prescribed hormonal drugs – systemic glucocorticoids (prednisolone, methylprednisolone, dexamethasone). These drugs faster and more effectively cope with the inflammatory process in the intestine. In severe UC, glucocorticoids are administered intravenously.Due to serious side effects (edema, increased blood pressure, osteoporosis, increased blood glucose levels, etc.), they should be taken according to a specific scheme (with a gradual decrease in the daily dose of the drug to a minimum or up to complete cancellation) under the strict guidance and supervision of the attending physician doctor. In some patients, there are phenomena of steroid refractoriness (lack of response to treatment with glucocorticoids) or steroid dependence (resumption of clinical symptoms of exacerbation of UC when trying to reduce the dose or soon after hormone withdrawal).It should be noted that during the period of remission, hormonal drugs are not a means of preventing new exacerbations of UC, therefore, one of the goals should be to maintain remission without glucocorticoids.
With the development of steroid dependence or steroid refractoriness, severe or often recurrent course of the disease, the appointment of immunosuppressants is indicated (cyclosporine, tacrolimus, methotrexate, azathioprine, 6-mercaptopurine). Drugs in this group suppress the activity of the immune system, thereby blocking inflammation.Along with this, influencing the immune system, they reduce the resistance of the human body to various infections, and have a toxic effect on the bone marrow.
Cyclosporine, tacrolimus are fast-acting drugs (the result is evident in 1-2 weeks). Their timely use in 40-50% of patients with severe UC avoids surgical treatment (removal of the large intestine). The drugs are given intravenously or given in pill form. However, their use is limited by their high cost and significant side effects (convulsions, kidney and liver damage, increased blood pressure, gastrointestinal disorders, headache, etc.)).
Methotrexate is a drug for intramuscular or subcutaneous administration. Its action unfolds after 8 to 10 weeks. When using methotrexate, one also has to reckon with its high toxicity. The drug is prohibited for use in pregnant women, as it causes malformations and fetal death. The effectiveness of the application in patients with UC is being specified.
Azathioprine, 6-mercaptopurine are slow-acting drugs.The effect of taking them develops no earlier than 2-3 months later. The drugs are able not only to induce, but also to maintain remission with prolonged use. In addition, the appointment of azathioprine or 6-mercaptopurine allows you to gradually stop taking hormonal drugs. They have fewer side effects compared to other immunosuppressants, and are well combined with 5-ASA drugs and glucocorticoids. However, due to the fact that in some patients thiopurines have a toxic effect on the bone marrow, patients should definitely undergo a CBC periodically to monitor this side effect and take timely treatment.
At the end of the 20th century, a revolution in the treatment of patients with inflammatory bowel diseases (Crohn’s disease, UC) was the use of fundamentally new drugs – biological (anticytokine) drugs. Biologicals are proteins that selectively block the work of certain cytokines – key participants in the inflammatory process. This selective action contributes to a more rapid onset of the positive effect and causes fewer side effects compared to other anti-inflammatory drugs.Currently, active work is underway all over the world to create and improve new and existing biological drugs (adalimumab, certolizumab, etc.), and they are conducting large-scale clinical trials.
In Russia, for the treatment of patients with inflammatory bowel diseases (UC and Crohn’s disease), the only drug of this group has been registered so far – infliximab (trade name – Remicade) . Its mechanism of action is to block the multiple effects of the central pro-inflammatory (supportive of inflammation) cytokine, tumor necrosis factor α.First, in 1998, the drug was licensed in the United States and Europe as a backup drug for the treatment of refractory and fistulous forms of Crohn’s disease. In October 2005, based on the accumulated experience of the high clinical efficacy and safety of infliximab in the treatment of UC patients, a round table dedicated to the development of new treatment standards for UC and CD in the EU and the USA decided to include in the list of indications for treatment with infliximab and UC. Since April 2006, infliximab (remicade) has been recommended for the treatment of patients with severe ulcerative colitis in Russia as well.
Infliximab has become a real breakthrough in modern medicine and is considered the “gold standard” with which most of the new drugs (adalimumab, certolizumab, etc.) currently undergoing clinical trials are being compared.
For UC infliximab (Remicade) is prescribed:
90 014 90 015 patients in whom conventional therapy (hormones, immunosuppressants) is ineffective
90,015 patients dependent on hormonal drugs (withdrawal of prednisone is impossible without resumption of exacerbation of UC)
90,015 patients with moderate and severe course of the disease, which is accompanied by damage to other organs (extraintestinal manifestations of UC)
90,015 patients who would otherwise need surgical treatment
90,015 patients in whom successful treatment with infliximab caused remission (to maintain it).
Infliximab is administered as an intravenous infusion in a treatment room or at an anti-cytokine therapy center. Side effects are rare and include fever, joint or muscle pain, and nausea.
Infliximab is faster than prednisone in terms of symptom relief. So, in some patients, within the first 24 hours after the administration of the drug, an improvement in well-being occurs. Reduced abdominal pain, diarrhea, bleeding from the anus.Physical activity is restored, appetite increases. For some patients, for the first time, hormone cancellation becomes possible, for others, saving the colon from surgical removal. Due to the positive effect of infliximab on the course of severe forms of UC, the risk of complications and deaths decreases.
This drug is indicated not only for achieving remission of UC, but can also be administered as intravenous infusions over a long period of time as maintenance therapy.
Infliximab (Remicade) is currently one of the most studied drugs with an optimal benefit / risk profile. Infliximab (Remicade) is even approved for use in children from 6 years of age.
However, biologics are not without side effects. By suppressing the activity of the immune system, as well as other immunosuppressants, they can lead to an increase in infectious processes, in particular tuberculosis. Therefore, before prescribing infliximab, patients need to undergo chest x-ray and other studies for the timely diagnosis of tuberculosis (for example, the quantiferon test is the “gold standard” for detecting latent tuberculosis abroad).
A patient receiving infliximab therapy, like any other new agent, should be monitored continuously by his or her physician or anti-cytokine specialist.
Before the first infusion of infliximab (Remicade), patients undergo the following tests:
- chest X-ray
- Mantoux skin test
- blood test.
Chest X-ray and Mantoux skin test are done to exclude latent tuberculosis.A blood test is necessary to assess the general condition of the patient and to rule out liver disease. If an active, severe infection (eg, sepsis) is suspected, other tests may be needed.
Infliximab (Remicade) is injected directly into a vein, drip, as an intravenous infusion, slowly. The procedure takes approximately 2 hours and requires constant monitoring by medical personnel.
The standard recommended single dose of infliximab in patients with UC is 5 mg per kg of body weight.
An example of calculating a single dose of infliximab required for a single infusion. With a patient weighing 60 kg, a single dose of infliximab is: 5 mg x 60 kg = 300 mg (3 vials of Remicade, 100 mg each).
Infliximab (Remicade), in addition to its therapeutic efficacy, provides patients with a gentle therapy regimen. In the first 1.5 months at the initial, so-called induction stage of therapy, the drug is administered intravenously only 3 times with a gradually increasing interval between subsequent injections carried out under the supervision of a physician.At the end of the induction period, the doctor evaluates the effectiveness of treatment in this patient and, if there is a positive effect, recommends continuing therapy with infliximab (Remicade), usually according to the scheme once every 2 months (or every 8 weeks). It is possible to adjust the dose and the mode of administration of the drug, depending on the individual course of the disease in a particular patient. Infliximab is recommended to be used throughout the year, and, if necessary, for a longer period.
The future in the treatment of inflammatory bowel disease (UC and Crohn’s disease) looks very promising.The fact that infliximab (Remicade) is included in the public care scheme for patients with UC and Crohn’s disease means that more patients can access the most modern treatment.
In case of ineffectiveness of conservative (drug) therapy, the question of the need for surgical intervention is being resolved.
90,000 Treatment of ulcerative colitis (nyak) in Germany ✔️ Cost of treatment, rating, reviews
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Ulcerative colitis is a diffuse inflammatory process in the large intestine that does not go beyond its mucous membrane.The disease is most common in North America, Northern Europe and Australia. Ulcerative colitis is a pathology with high mortality. One of the most dangerous complications is malignancy (the development of colon cancer against the background of an inflammatory process).
Diagnosis of ulcerative colitis
Symptoms of the disease, as well as laboratory tests, help the doctor to suspect ulcerative colitis:
- In the blood – anemia, inflammatory markers, a decrease in the amount of total protein
- severe course)
- In feces – erythrocytes, leukocytes, intestinal epithelium
To confirm the diagnosis are used:
- Irrigoscopy – X-ray examination of the intestine with the introduction of a contrast agent.
- Colonoscopy – an endoscopic examination involving the penetration of instrumentation and the optical system into the large intestine.
- Biopsy – a sample taken during a colonoscopy is sent for a histological examination, which allows not only to confirm the diagnosis, but to establish the severity and duration of the inflammatory process.
Recommended clinics for the diagnosis of ulcerative colitis in Germany:
University Hospital Düsseldorf
University Hospital of the University of MunichLudwig-Maximilian
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Ulcerative colitis treatment
Ulcerative colitis is treated conservatively. A diet with limitation of spicy foods and milk is prescribed. In severe cases, a ballast-free diet with a minimum fiber content is prescribed. In practice, this means that the patient, when planning his menu, should give preference to a small amount of high-calorie food.
Drug treatment is carried out with 5-amino-salicylic acid, glucocorticoids, cytostatics.If they are ineffective, antagonists of tumor necrosis factor-alpha are prescribed. Detoxification of the body, correction of anemia is carried out, and in case of exacerbations – antibacterial treatment.
Surgical treatment consists of removing the problem area of the large intestine.The volume and type of surgery is determined by the doctor, based on the clinical situation, technical and personnel potential of the clinic.
Innovative treatment of ulcerative colitis
The main goal of new developments in treatment is to increase the effectiveness of conservative therapy, reduce the need for surgical treatment, and reduce the risk of complications and mortality in ulcerative colitis.
In recent years, the following directions of therapy of the disease have appeared:
- Leukocyte apheresis .Cleansing the blood of activated T cells helps to achieve remission, according to various studies, in 20-80% of cases. According to a study conducted in clinics in Germany, remission was achieved in 52% of patients who did not respond to drug treatment with azathioprine. According to another study, the rate of onset of remission depends on the frequency of the procedure. So, when using leukocyte apheresis 1 time per week, remission occurred on average after 22 days. If the procedure was performed 3 times a week, the average time to achieve remission was 7.5 days.
- Use of interferon alpha . New studies have shown that pegylated interferon-alpha at a dose of 0.5 μg / kg can achieve remission in 60% of patients, provided that daily injections are performed for 12 days.
- The drug “Alikaforsen” . In 2016, the third phase of clinical trials of the drug began. This desensitizing oligodeoxynucleotide inhibits the activity of leukocytes that provoke an inflammatory process in the large intestine.
- Bacterial intestinal recolonization . Used to increase the duration of remission. Cultures of bacteria, mainly E. coli Nissle and Lactobacillus acidophilus, are administered orally or in the form of enemas into the human intestine. There is also evidence of the effectiveness of fecal bacteriotherapy (administration of feces from a healthy person to a patient using an enema). It is assumed that the mechanism of therapeutic action is due to the competition between pathogenic and opportunistic bacteria.
- Helminthotherapy . A new direction that is still being explored. Major developments are underway in America. A person is infected with helminths, which are not able to reproduce in his body. According to a study by the University of Iowa (USA), infecting humans with Trichuris suis (pig whipworm) eggs can achieve sustained remission in 70% of cases.
Recommended clinics for ulcerative colitis in Germany:
University Hospital Düsseldorf
Endoscopic conservative treatment of ulcerative colitis
Resection of part of the intestine in inflammatory diseases (Crohn’s disease or ulcerative colitis)
University Hospital of the University of Munich.Ludwig-Maximilian
Endoscopic conservative treatment of ulcerative colitis
Resection of a part of the intestine in inflammatory diseases (Crohn’s disease or ulcerative colitis)
University Hospital Charite Berlin
Endoscopic conservative treatment of ulcerative colitis
Resection of part of the intestine in inflammatory diseases (Crohn’s disease or ulcerative colitis)
Show all treatment programs
Rehabilitation for ulcerative colitis
Rehabilitation is the process of recovery of the body after operations or diseases.It can have a different focus: oncological, orthopedic, neurological, etc. There is also general therapeutic rehabilitation. It is indicated for patients after conservative and surgical treatment of diseases of internal organs.
Directions of general therapeutic rehabilitation
There are the following main directions of therapeutic rehabilitation:
- Medical – restoration of the patient’s health, normalization of body functions, stimulation of compensatory capabilities, elimination of chronic pain, etc.e.
- Physical – increased efficiency, improved exercise tolerance. In difficult situations, its goal may be to restore the ability to self-care.
- Psychological – elimination of mental disorders resulting from the disease (phobias, depression, apathy), increasing a person’s motivation and adaptation to life conditions changed as a result of the disease.
The World Health Organization identifies 3 phases of rehabilitation: hospital, convalescence and maintenance.Different tasks are solved in different phases. Sick leave is carried out immediately after treatment. After its completion, the second phase begins, which usually takes place in sanatoriums or rehabilitation centers. This is the line between two periods: illness and later life. Then a support phase is required: the patient maintains the achieved level of health and physical activity at home or attends a rehabilitation center from time to time.
Methods of therapeutic rehabilitation
In Germany, the most modern rehabilitation schemes are used, which are individually adapted to each patient, based on the previous illness, age, physical capabilities and treatment results.Various specialists take part in the rehabilitation process: therapists, psychologists, rehabilitation therapists, kinesitherapists, physiotherapists.
The following rehabilitation methods are used:
- Dosed physical activity
- Exercises on simulators and in the pool
- Physiotherapy procedures
- Manual therapy
- Compression therapy
- Lymph drainage 15 Natural factors thermal waters, etc.
Rehabilitation may include medication support. It is imperative that the patient is consulted on proper nutrition and lifestyle, which he needs, taking into account the current situation.
In Germany, rehabilitation programs are designed for a period of 2 weeks or more. But if necessary, they can last much longer. In this country, the patient is provided with quality care, accommodation in comfortable rooms and individually selected meals.
Rehabilitation programs in Germany show some of the best results in the world.Here, most patients successfully restore their ability to work and well-being. They remain physically active and return to full social and family life.
Recommended clinics for general therapeutic rehabilitation in Germany:
Show all rehabilitation programs
Author: Dr. Nadezhda Ivanisova
What is included in the cost of services
you can find out here.Leave a request and we will provide a free consultation with a doctor and organize the entire treatment process.
- Obtaining an invitation for treatment to quickly obtain a medical visa
- Appointment at a convenient time for you
- Preliminary organization of a comprehensive examination and discussion of a treatment plan
- Provision of a transfer from the airport to the clinic and back to the airport
- Provision of the services of an interpreter and personal medical coordinator
- If necessary, assistance in organizing further surgical treatment
- Provision of medical insurance against treatment complications with a coverage amount of 200,000 euros
- Preparation and translation of medical statements and recommendations from the clinic
- Assistance in subsequent communication with your attending physician, including consultations on repeated X-ray images through the unique medical document management system E-doc
nonspecific ulcerative colitis was performed by surgeons at Medical City
The most complicated operation to remove and reconstruct the colon due to the development of ulcerative colitis was performed by the surgeons of Medical City
The most complicated operation to remove and reconstruct the colon due to the development of ulcerative colitis was performed by the surgeons of the Neftyanik clinic: Dr. Andrey Stradchuk and Professor Kazbek Autlev.
The disease killed the intestines of a 28-year-old woman in a matter of weeks. Having struck the rectum, the disease spread with lightning speed to the large intestine. From endless diarrhea, bleeding and the development of local complications, the patient’s body was severely depleted: in two months the girl lost 30 kg in weight.She could not lead the old way of life, the patient even had to leave her job.
After the consultation, the doctors of the purulent surgery department of the Neftyanik clinic, together with the surgeons of the OKB-2, where the patient was initially admitted, decided to transfer her to the hospital of the medical unit for emergency surgical treatment. On April 30, she underwent laparoscopic coloproctectomy – complete removal of the large intestine followed by reconstruction. A reservoir was created from the small intestine, which performs the function of the large intestine.This drive was connected to the anus to allow natural defecation.
Now the patient’s life is not in danger, she lives a full life. “Ulcerative colitis is a disease affecting the large intestine,” comments Andrey Stradchuk. – The diagnosis and the severity of the course of the disease play a decisive role in setting the correct approach to eliminating the problem. Surgical treatment is recommended when the body does not respond, or reacts negatively to drug treatment, also with total damage to the large intestine, in the presence of polyps / pseudopolyps in the large intestine, signs of cancer development. “
Professor Kazbek Autlev says that surgical treatment of ulcerative colitis in the region is performed only by the surgeons of the Neftyanik clinic. Operations are performed both open and laparoscopically. The key point in the work of the clinic’s surgeons is the performance of reconstructive interventions while preserving natural defecation. The quality of life of such patients is fundamentally different from the quality of life of patients with intestinal stomas.
Ulcerative colitis, treatment
Effective treatment of ulcerative colitis in the early stages of the disease in patients at least 20 years old
Ulcerative colitis refers to chronic progressive autoimmune diseases of the gastrointestinal tract.The health of the whole organism as a whole depends on the proper functioning of the intestines. Through its mucous membrane, the body receives all the nutrients, absorbing them from products.
The intestinal microflora synthesizes hormones, vitamins and many active substances and enzymes that are important for the normal functioning of the body. About 1/4 of the mucous membrane works on the immune system. As a result, a large number of special cells of the immune system are produced, the main task of which is to destroy microbes and viruses “foreign” for a given organism.
The cause of ulcerative colitis
The disease occurs as a result of a malfunction in the body’s immune system. The intestinal mucosa, in this disease, is perceived by the body’s immune system as a foreign tissue. The body directs antibodies to destroy a foreign body, as a result of which it destroys its own intestinal mucosa and provokes the formation of ulcers. As a result: a decrease in the protective properties of the mucous membrane, the development of inflammatory processes and dysfunction of the intestines.
Treatment of ulcerative colitis
Two approaches are used in treatment:
Drug therapy of ulcerative colitis
Drug treatment of nonspecific ulcerative colitis, which currently does not exist for nonspecific ulcerative colitis able to heal the immune system. Symptomatic treatment is used with the use of hormones and other medications that provide only temporary assistance to patients.Such treatment is unable to heal intestinal ulcers, and the disease is constantly progressing. The process of recovery and treatment slows down the general exhaustion of the body, progressive anemia and bleeding.
Computer reflexology for ulcerative colitis
Computer reflexology treatment is aimed at restoring bowel function. Treatment is carried out by exposure to an ultra-low direct current on a system of biologically active points connected into a single network with the brain through the human autonomic nervous system.
In this case, the body’s immune system ceases to perceive the intestinal mucosa as a foreign body, stops constant “attacks” on the mucous membrane, old ulcers heal, and new ones are not formed. The intestinal functions are restored.
This type of treatment is suitable only for patients from 20 to 80 years old and without drugs, allows:
to significantly reduce the severity and number of exacerbations, until termination;
significantly reduce pain during treatment;
restore stool, get rid of the presence of blood in the stool;
reduce the dosage and the amount of medications taken, and subsequently cancel it altogether;
restore good health and performance.
restore the immune system.
restore the natural bowel function.
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It is important not to miss the time when it is still possible to cure ulcerative colitis. Long-term use of potent drugs will not stop the disease, it will progress! To avoid irreversible changes in the body – do not postpone treatment, send to the registry
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The information on the site is not intended for self-diagnosis and self-medication. If unwell, do not run the disease, seek qualified medical help.
- To come for treatment to the Gavrilova Clinic from another city, do not waste time thinking how to organize all this, call 8-800-55-00-128 from Russia for free, to call from other countries dial +7 846 374-07 -08 or +7 927 725 -11-44 (WhatsApp, Viber, Telegram). The consultant’s assistant will promptly answer your questions and help you organize your trip as comfortably as possible.
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Video about treatment in the clinic
Examples of treatment of various diseases
Diagnostics of ulcerative colitis and Crohn’s disease in Anapa
Ulcerative colitis is an erosive lesion of the colon mucosa caused by inflammatory processes. Ulceration gradually spreads, covering healthy areas, and may deepen to the submucosal layer.Ulcers cause perforation of the intestinal wall with the development of peritonitis, therefore, timely diagnosis and treatment is required. At the NeoMed Medical Center, you can learn about the threat at the earliest stages, when there are no symptoms yet, and start treatment.
Causes and clinic of the disease
The exact cause of ulcerative colitis is unknown to medicine, therefore it is called nonspecific. But there is an opinion that people with a genetic predisposition are prone to it. The formation of ulcers is provoked by infections, uncontrolled intake of drugs, an inactive lifestyle, an unhealthy diet with excess calories and fats, and an unfavorable environment.
The erosive and ulcerative process can begin in any part of the large intestine, but always affects the rectum. In the total form, the entire colon is affected. The disease is characterized by inflammation, edema and the formation of non-healing ulcers on the mucous membrane. The length of the intestine is usually shortened, and the lumen is enlarged.
This is a chronic disease that develops gradually with exacerbations and remissions. During an exacerbation, swelling increases, ulcers fester, capillaries expand, which can lead to bleeding.
Symptoms and complications of ulcerative colitis
The symptoms of ulcerative colitis are difficult to distinguish from chronic, in which no manifestations are formed. Patients Complain:
- for cramping pains in the abdomen on the left, which are not relieved by analgesics;
- Frequent false urge to defecate;
- loose stools interspersed with mucus, blood, pus, alternating with constipation;
- purulent, bloody and mucous discharge from the intestines without defecation.
The disease cannot be classified as safe, it leads to serious complications:
- profuse intestinal bleeding;
- perforation of the colon wall and life-threatening peritonitis requiring urgent surgery;
- intestinal obstruction;
- colorectal cancer – with prolonged course and total damage.
Most often ulcerative colitis leads to enlargement of the colon, accompanied by intense pain and severe bloating, fever and weakness.
Diagnosis of intestinal diseases
To identify pathologies, there is only one effective method – colonoscopy. This is an examination of the intestines from the inside through endoscopy. Modern colonoscopes are equipped with a light source, a powerful optical system and the ability to connect to a monitor for video broadcasting of the examination.
Colonoscopy is used to diagnose all types of colitis, Crohn’s disease, rectal ulcers, bowel cancer, polyps. During the examination, a biopsy is performed – pinch off small pieces of damaged tissue for histological examination.Since many of the symptoms of bowel disease are similar, it is impossible to diagnose and prescribe the correct treatment without a colonoscopy and biopsy.
The most difficult thing is to distinguish ulcerative colitis from Crohn’s disease – granulomatous inflammation of various parts of the digestive tract. These diseases are similar in symptoms, but require a different approach to treatment.
Both diseases are characterized by the formation of multiple ulcers. But in ulcerative colitis, they are found mainly in the end sections of the colon, and Crohn’s disease most often affects the end of the small intestine and the beginning of the colon.In Crohn’s disease, affected areas alternate with healthy areas. Colitis is characterized by continuous inflammation of the mucous membrane.
To clarify the diagnosis and identify possible complications, additional examinations may be required: radiography with a contrast agent, computed tomography, ultrasound of the abdominal organs, blood and feces tests.
Methods of therapy
Conservative therapy is supportive. As a drug treatment, oral medications are prescribed in combination with local rectal agents – suppositories and enemas.
Surgical treatment for ulcerative colitis is indicated if the disease is severe, spreads rapidly, and there is hormonal dependence. The essence of the operation is excision of the affected part of the large intestine.
There are several types of operations. Preference is given to techniques that preserve the possibility of natural emptying through the anus. But the choice depends on the severity of the disease.
At the NeoMed Medical Center in Anapa, you can consult a proctologist, undergo a colonoscopy in medication sleep without pain and awkwardness.Sign up for a consultation or examination to get a diagnosis and start effective therapy.
Surgical treatment and biological therapy for ulcerative colitis | Khalif I.L.
Ulcerative colitis (UC) is an autoimmune disease characterized by prolonged inflammation of the mucous membrane of the rectum and colon. UC is characterized by episodic exacerbations with symptoms characterized by frequent loose stools mixed with blood in combination with urgency and tenesmus.The disease activity can vary from complete remission to fulminant form with systemic toxic manifestations. Although the exact pathogenesis of UC is still not well understood, the theory that gut flora triggers an aberrant intestinal immune response and subsequent inflammation in genetically predisposed people is the most extensively described theory.
Ulcerative colitis (UC) is an autoimmune disease characterized by prolonged inflammation of the mucous membrane of the rectum and colon.UC is characterized by episodic exacerbations with symptoms characterized by frequent loose stools mixed with blood in combination with urgency and tenesmus. The disease activity can vary from complete remission to fulminant form with systemic toxic manifestations. Although the exact pathogenesis of UC is still not well understood, the theory that gut flora triggers an aberrant intestinal immune response and subsequent inflammation in genetically predisposed people is the most extensively described theory.
Medical treatment of UC is aimed at controlling symptoms and resolving the underlying inflammatory process. Traditional treatments for UC include drugs such as 5-aminosalicylates (5-ASA), corticosteroids and immunosuppressants, incl. antimetabolites of purine and cyclosporine . Treatment regimens are selected taking into account the severity of UC, which is defined as mild, moderate or severe based on clinical and laboratory parameters, and the prevalence of the disease (total, left-sided colitis, proctitis or proctosigmoiditis) .
Principles of therapy
The main objectives of drug therapy for UC are the induction of remission and its maintenance for a long period. Drug therapy reduces the risk of long-term complications and improves the quality of life of patients by reducing the number of relapses that occur in 67% of patients at least once within 10 years .
Nevertheless, about 20% of patients with UC have chronic active disease, often requiring several courses of systemic steroids, followed by a relapse of symptoms with a decrease in the dose of steroids or soon after their withdrawal.Such patients are considered steroid dependent. Steroid dependence is associated with serious complications, which for a significant part of patients become an indication for surgery .
Since 2005, drug therapy for UC has entered the era of biological drugs – since the FDA approved the use of infliximab – monoclonal antibodies directed against tumor necrosis factor-α (TNF-α) . Biologics have revolutionized the treatment of UC patients and have made it possible to control the disease in patients with intolerance and / or ineffectiveness of conventional therapy.Currently, 2 biological drugs for the treatment of UC are registered in Russia: infliximab and golimumab.
Infliximab, which is antibodies to TNF-α, reduces the manifestations and symptoms of the disease, induces clinical remission and healing of the intestinal mucosa, and helps to discontinue the use of corticosteroids in patients with moderate to severe active UC who have not achieved an adequate response to therapy with corticosteroids or immunomodulators or there is an intolerance, or medical contraindications to therapy .
The first controlled study of this drug in patients with UC included patients with moderate to severe UC . This study described a high response rate to treatment, but the follow-up period was short. In studies of active UC (ACT I and AST II), 364 patients with moderate to severe UC and treatment failure (but not requiring hospitalization) were randomized to either placebo or infliximab . Both doses of infliximab (5 mg / kg and 10 mg / kg) resulted in a significant clinical response at 8 weeks.(68.4% and 61.5%, respectively, compared to 37.2% in the placebo group (p
In a recent study by J.F. Colombel et al. studied the relationship between early healing of the mucosa (defined as the Mayo endoscopic index on endoscopic examination at 8 weeks) and clinical outcomes in patients in ACT I and ACT II . The authors note that the low endoscopic index at 8 weeks. was statistically significantly associated with a lower level of colectomy at 54 weeks. follow-up (p = 0.0004; placebo p = 0.47) and better outcomes in terms of symptoms and steroid requirements at weeks 30 and 54 (p
The recently published PURSUIT, randomized, double-blind, placebo-controlled trial presented the results of the Phase 2 and 3 clinical trials of the new drug golimumab.Golimumab is an anti-TNF-α antibody and is a fully human antibody intended for subcutaneous administration (as opposed to infliximab, which is administered intravenously). The drug has previously been approved for the treatment of rheumatoid arthritis, ankylosing spodilitis and psoriatic arthritis. Since 2013, it has also been registered in Russia, Europe and the United States for the treatment of UC.
The study included patients with moderate and severe forms of UC (Mayo index from 6 to 12, endoscopic index ≥2) with varying duration of the disease, who did not have a response, had an insufficient response or an evasion of response when using 5-ASA drugs, oral corticosteroids, azathioprine, 6-mercaptopurine, or steroid dependence.
The second phase of the clinical trial included 169 patients who were randomized into 4 groups: one received a placebo, the rest received the drug in various dosages: 100/50 mg, 200/100 mg, 400/200 mg. An additional group (122 patients) was included in the study for safety assessment and pharmacokinetic analysis. At the end of this phase of the study, 200/100 mg and 400/200 mg were selected as prescribed doses. Phase 3 included 744 patients who were randomized into 3 groups: placebo, 400/200 mg and 200/100 mg of the drug at 0 and 2 weeks.All 1064 patients enrolled in the maintenance study with golimumab for 54 weeks.
The study showed that for 2 weeks. in the golimumab groups there was a decrease in the level of C-reactive protein, while in the placebo group it increased (–6.53 mg / l, –6.70 mg / l and +1.3 mg / l, respectively). The clinical response in the golimumab groups was noted significantly more often than in the placebo group (51.8% – at a dose of 200/100 mg, 55.5% – at a dose of 400/200, 29.7% – in the placebo group, p
In a study of maintenance therapy with golimumab, patients who responded to the induction course were randomized into 3 groups: placebo, 100 mg 1 r./ 4 weeks and 50 mg 1 r. / 4 weeks. Patients who did not respond to the induction course or did not respond to placebo were included in the study, but were not randomized. Patients who responded to placebo received placebo, the remainder received a dose of 100 mg until the 12-week assessment. If the condition did not improve by 16 weeks, patients were excluded from the study. Patients who had a relapse during the study were excluded from the study according to the results of sigmoidoscopy if the endoscopic Mayo index increased by 2 or more.
The study showed that a clinical response lasting up to 54 weeks was observed in 49.7 and 47% of patients receiving golimumab 100 and 50 mg, respectively, and 31.2% in the placebo group (p
Due to advances in the development of new targeted drugs, most patients with localized and advanced UC can control the disease with drug treatment, but 20–30% of patients still require surgery at some point in their lives .
The evolution of the surgical treatment of UC has made it possible to improve the quality of life of patients requiring colectomy. Until the early 1980s. The “gold standard” of surgical treatment was colproctomy with ileostomy, despite the occasional use of ileorectal anastomosis. Permanent Cock ileostomy was proposed in the 1960s, but it never became widespread, despite a fairly well-documented improvement in the quality of life compared to the quality of life after colproctomy with traditional ileostomy .Over the past 20 years, the new “gold standard” has been the reconstructive-plastic colproctomy with ileoanal reservoir anastomosis (IARA).
Colectomy rates for UC vary by sample and over time. E. Langholz et al. in 1994, published data that 25% of patients with UC require colectomy within 10 years after diagnosis . A study of the American population of UC patients showed that the frequency of colectomy over the past 10 years has not changed, although it did not take into account the relationship between the use of immunomodulators and surgical treatment .In addition, many data were published before the advent of studies on the effectiveness of infliximab in the induction and maintenance of remission in UC [15-17]. In addition, previous studies on the frequency of colectomy did not take into account the indications for surgical treatment.
A large retrospective study conducted in Canada compared the incidence of emergency and elective colectomy between 1997 and 2009. The study included adult patients hospitalized with an exacerbation of UC.437 patients underwent colectomy, 338 patients did not require surgical treatment. Of all patients who underwent colectomy, in 53.1% of cases it was performed on an emergency basis. The authors cite data that from 1997 to 2009 the performance of colectomy for UC decreased significantly (p
Over the past 20 years, the new “gold standard” has been the reconstructive-plastic colproctectomy with IARA, which was first described by A.G. Parks and R.G. Nichols in 1978 . This procedure avoids permanent stoma and preserves natural bowel movements .The introduction of this technique, most often with the formation of a J-shaped reservoir, was a real breakthrough: such patients receive radical treatment without the need to form a permanent stoma, which allows them to achieve a quality of life comparable to that in the general population . Nevertheless, this procedure is technically difficult, the recurrence of the disease is observed with a frequency of about 30%, the incidence of postoperative pelvic sepsis is in the range from 5 to 24% . Total colectomy with ileostomy can be considered the operation of choice at the first stage of the reconstructive operation, i.e.because it is quite safe and can be performed quickly by the hands of an experienced colorectal surgeon, which allows the patient to get rid of colitis, stop taking medications and return to optimal health .
Removal of the rectum and restoration of bowel continuity with IARA is performed in the second stage, when the patient is fully recovered, and removal of the temporary ileostomy may further reduce the risk of local sepsis secondary to anastomotic leak .In addition, the use of minimally invasive techniques can further reduce the incidence of postoperative complications and improve patient satisfaction .
Despite the fact that for all patients with UC, removal of the colon and rectum represents the final cure for the disease with the disappearance of symptoms, the withdrawal of drug therapy and the absence of the risk of developing malignant neoplasms associated with persistent inflammation , the operation is not without risk and can significantly affect the patient’s quality of life, therefore it is traditionally considered a method of rescue when drug therapy is ineffective .
Complications of treatment
Treatment with anti-TNF drugs is relatively safe when used as indicated. Adverse events (AEs) with the use of infliximab in AST studies did not differ from the expected AEs, which are known from the experience of the treatment of Crohn’s disease (CD) . Likewise, no new AEs have been identified in studies using golimumab. However, as with other biological therapies, there is a risk of severe infections, demyelinating diseases and associated death.In a combined analysis of 484 patients with UC who received infliximab in AST studies, similar complications developed in 3.5% (17/484) of patients .
In addition, while biological therapy is highly effective in treating UC, stepping up conservative treatment until surgery is strictly necessary can be risky. It has been shown that mortality within 3 years after elective colectomy for UC (3.7%) is significantly lower than after treatment without surgery (13.6%) or in the case of emergency surgery (13.2%) [24 ].In addition, a recent British study showed a significantly higher risk of serious complications during 5 years of follow-up in patients who received a longer course of drug therapy for acute severe attack of UC before surgery, although it was assumed that the risks of elective surgery may be too high in current practice. .
In a study conducted at the State Research Center of Coloproctology, predictors of the effectiveness of conservative therapy were assessed, and it was shown that the detection of deep ulcerative defects during colonoscopy before the start of biological therapy predicts the ineffectiveness of its continuation with a 78% probability .If clinical remission cannot be achieved after the second course of therapy, its continuation is not justified in such patients. The absence of clinical remission by the third course of therapy predicts the ineffectiveness of further therapy with 68% accuracy.
Surgical treatment of UC, despite the complete recovery of the patient from the disease due to the removal of the inflammation substrate – the colon, is also still associated with significant early and late postoperative complications, even taking into account the intensive development of surgical methods.For example, with anastomotic leak, pelvic sepsis, intestinal obstruction, reservoir inflammation, sexual dysfunction, decreased fertility in women . Reoperations are sometimes necessary. A population study has shown that for about 20% of patients who underwent surgery with the formation of IARA, at least 1 additional operation is required, for 15% – at least 2 additional operations . Reservoir insufficiency and the associated incidence of pelvic sepsis in a large series of patients is 5–15% ; the frequency of late resections of the small intestine after IARA ranges from 12 to 35%.The reservoir is the most common delayed complication of IARA . Finally, the risk of delayed reservoir failure has been reported in various studies ranging from 1% to 20% with an overall incidence of reservoir failure of less than 10% requiring ileostomy, reservoir excision and end ileostomy or reservoir revision .
The most pronounced negative effect of colproctomy with the formation of IARA has on fertility in women. In a Danish study of 290 patients with UC and 661 healthy women, colectomy was shown to reduce fertility by 80% (p
Despite the fact that reconstructive surgery does not exclude long-term complications such as urinary incontinence (10-60% of patients), reservoirs (about 50%) and sexual dysfunction (20-25%), In 5-15% of cases, most of these complications can be resolved with drug therapy, which explains the overall satisfaction in patients after IARA, which exceeds 90% in most cases .
A number of studies on the quality of life in patients with IARA show that the average level of quality of life in these patients is comparable to that in the general population [36, 37]. On the other hand, when evaluating long-term outcomes within 10 years after IARA, 12.6% have anastomotic leakage. The frequency of a normally functioning reservoir after 5, 10 and 15 years was 92.3, 88.7 and 84.5%, respectively. The average GIQLI (Gastrointestinal Quality of Life Index) is 107.8, which is 10.8% lower compared to the healthy population.A statistically significant negative correlation was found between quality of life and age over 50 years, reservoiritis, perianal inflammation, and increased stool frequency (p
Although surgery cures inflammation and reconstructive colproctomy with IARA maintains the normal anatomical passage for bowel movement, this intervention can lead to new symptoms such as diarrhea, nocturnal bowel movements, and in some patients it does not eliminate the need for treatment. In several surgical groups of patients, which were followed for at least 5 years, up to 60% of them had stools of more than 8 rubles./ day, 55% of patients reported incontinence, 50% – nocturnal bowel movements . In addition to the fact that many patients have at least one nighttime bowel movement, 30–40% of patients have to control their food intake to avoid the urge to defecate .
Several studies have shown that quality of life is directly related to functional outcomes. J.C. Coffey et al. found that, according to the Cleveland Quality of Life Index, the indicators differ in different groups of patients. 95.3% of patients are forced to adhere to restrictions and diet.All of these patients felt that such restrictions affect their quality of life. Eating late and drinking alcohol leads to diarrhea. This index was higher in patients with UC compared with patients with familial adenomatosis (0.84 and 0.78, p = 0.042). And this is primarily due to the fact that the frequency of stool in these patients before the operation was almost always lower than after it. In patients who became pregnant after IARA, the quality of life was also lower (0.7, p = 0.039) than in patients with UC, although the reservoir function was similar to that in other patients .I. Berndtsson and T. Oresland describe an improvement in the quality of life of patients after IARA, however, among the factors that reduce it, they indicate the frequency of nocturnal bowel movements (40%), perianal manifestations (51%) and the use of antidiarrheal drugs (61%) . In a German study on the quality of life after IARA, the main patient complaints were related to fatigue and arthralgia compared to the general population (p
A study conducted in the United States assessed the risk of depression in patients with CD and UC after surgical treatment in the volume of colectomy.The study included 707 CD patients and 530 UC patients who underwent colectomy and showed no signs of depression prior to surgery. The risk of developing depression within 5 years was identified in 16% of patients with CD and 11% with UC. There was no difference in the incidence of depression depending on the disease. The female gender, comorbidities, the use of immunosuppressants, perianal manifestations, the presence of a stoma and early surgery in the first 3 years after diagnosis are risk factors for the development of depression in patients with CD; female sex and concomitant diseases – in patients with UC .
At the same time, in another study from Canada, which compared 2 groups of children with UC (operated and unoperated), it was shown that the quality of life according to the IMPACT III and IBDQ questionnaires in operated patients was comparable to that in non-operated patients. Factors affecting quality of life include depression, fatigue, homeschooling, and medication .
Economic Indicators 90,447
Due to the early onset and chronic nature of inflammatory bowel disease (IBD), patients can be expected to use significant health resources.Cost analysis is complex because it is necessary to take into account the impact of therapy on direct health care costs and indirect costs for both patients and their families and the health care system . Operations and hospitalizations account for most of the direct health care costs of IBD, on the other hand, treatment costs account for a quarter of the total direct medical costs. In addition, cost data is uneven because while 25% of patients account for 80% of the total costs .It follows that the most effective cost-containment measure is one that reduces the number of hospitalizations and operations.
With improved response and remission with the use of infliximab for induction and maintenance treatment of IBD patients, clinical benefits are also likely to translate into economic benefits . An assessment of the economic component was carried out in a small study in the United States . S.D. Holubar et al. showed that a 2-year cost to health authorities was $ 10,328 for surgical UC patients and $ 6,586 for therapeutic UC patients.Patients with ileostomies were more economical than patients with ileoanal reservoirs. In a cohort of therapeutic patients, disease duration, rather than severity, is associated with high costs. However, in this study, drug treatment did not include biological therapy. Surprisingly, as a result of cost-benefit and benefit analysis, many researchers have suggested that the use of infliximab is associated with a fairly high increase in costs in terms of quality of life per year .The increased use of infliximab did not significantly affect the surgical treatment of patients with UC or CD, and the frequency of nonsurgical hospitalizations actually increased [50, 51]. Further pharmacoeconomic analysis is needed to truly assess the impact of infliximab treatment on the cost of UC treatment.
Drug therapy for UC is rapidly developing, the introduction of modern biological drugs has led to significant changes in the traditional principles of patient management and to new opportunities for disease control.Infliximab and golimumab, antibodies against TNF-α with targeted immunosuppressive effects, can achieve a clinical response, clinical remission, healing of the mucous membrane and an improvement in the quality of life in patients with moderate to severe UC who cannot tolerate traditional therapy or are refractory to it. In addition, infliximab, the first biological agent used in the treatment of UC, has been shown to significantly reduce the need for colectomy.
Surgery continues to play an important role in the treatment of UC, and its evolution has kept pace with advances in therapy.Reconstructive colproctomies with IARA, staggered interventions and minimally invasive surgery are important treatment tools that can reduce the incidence of postoperative complications and achieve excellent long-term results in patients with UC.
Aggressive drug therapy is not without complications, at the same time, surgical treatment significantly affects the lifestyle of patients and, in many cases, reduces the quality of life. Choosing between modern methods of surgical and drug treatment, the doctor must ask himself the question: can he influence the course of the disease with the help of medication, etc.h. biological therapy, does he have enough time and opportunities for conservative therapy? It is important to understand that you should not take away the patient’s chance to save the large intestine without using the possibilities of conservative therapy, however, it is equally important to understand in a timely manner that the possibilities of drug treatment have been exhausted, and not to miss the moment when it is necessary to operate the patient in a timely manner, when the conditions for performing a surgical intervention more favorable.
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Nutritional advice for lactose and milk intolerance in adults
“Why do I have such a reaction to milk?” – it is with this question that very often patients come to a visit to a gastroenterologist.Let’s figure it out!
Milk is an emulsion, and therefore, due to its physical properties, it is a very favorable product for the digestive tract. It has a viscosity and enveloping properties, which often has a good effect on the digestive system and the body as a whole.
Milk is a multicomponent product: proteins, fats, carbohydrates. How many sides a product has, so many variants of problems can be. Fat content is usually rare, but the carbohydrate composition most often causes criticism, mainly due to the main milk sugar – lactose!
Lactose intolerance (lactase deficiency) in adults is a fairly common phenomenon and depends both on hereditary predisposition and on the place of residence and the tradition of eating milk.For example, in northern Europe, lactose intolerance in adults occurs in 25% of the population, and among the indigenous peoples of Africa, Southeast Asia, North and South America, living closer to the equator, its frequency reaches 95%.
Lactase deficiency in adults is divided into secondary and primary. Primary lactase deficiency can manifest itself even in childhood, it can develop with age. Secondary occurs under the influence of intestinal infections and other causes that cause damage to cells of the small intestine of various origins.
According to the severity, it is subdivided into hypolactasia – partial deficiency of the enzyme, and alactasia – its complete deficiency.
Lactose and lactase what is the difference?
Lactose (milk sugar) is an organic carbohydrate, which consists of two molecules of glucose and galactose and is one of the main constituents of mammalian and human milk. In the undigested form, lactose cannot be absorbed by the intestinal cells.Therefore, for its assimilation in the small intestine, a reaction is performed that separates lactose into components – glucose and galactose, which, penetrating into the cells of the small intestine, enter the general bloodstream, and then into the liver. In the liver, they are used to synthesize and store glycogen, which is the fuel for the processes occurring in our body.
Useful properties of lactose
- plays the role of a prebiotic, improving the composition of microflora;
- participates in the synthesis of B vitamins;
- affects the absorption of calcium, magnesium, etc.microelements and their own enzymatic activity;
- is a source of energy.
Lactase is a special enzyme that is produced by cells of the small intestine and controls the lactose breakdown reaction. When the production of this enzyme decreases or stops, the undigested lactose enters the large intestine, where a fermentation reaction occurs with the participation of bacteria, in which an abundance of gases is formed. In addition, if the use of dairy products regularly causes loosening of the stool or pain, cramps, then an inflammation reaction is triggered, which can further lead to prolonged duodenitis or functional disorders of the gastrointestinal tract, changes in the intestinal microflora.
Symptoms of lactose intolerance
The main clinical symptoms are loose stools (diarrhea), bloating, as well as disturbances in the work of the gastrointestinal tract, which occur immediately or within 24 hours after taking milk or dairy products.
In addition, in the presence of intestinal dysbiosis, substances formed during the microbial breakdown of lactose in the large intestine have a toxic effect and can cause general malaise, headaches and, according to some reports, even mental disorders.
People with lactose intolerance are concerned about
- diarrhea and loose stools;
- rumbling in the intestines;
- abdominal cramps and pains;
- nausea and vomiting;
- increased fatigue;
The intensity of symptoms depends on the amount and on the amount of lactose obtained from food and lactase produced by the cells of the small intestine.
What foods contain lactose?
Milk and dairy products of animal origin contain naturally occurring lactose, and many manufactured products may contain added milk sugar. Any product containing milk, lactose, whey, cottage cheese, milk powder contains lactose, therefore, before purchasing products, you should familiarize yourself with the ingredients listed on its packaging.
Prepared foods which usually contain lactose include:
- cakes, biscuits and pastries;
- cheese sauce;
- puree soups;
- milk chocolate;
- some types of mashed potatoes.
Certain products may contain “latent lactose” and may not be declared on the packaging. Examples of products with latent lactose:
- granola bars;
- some instant soups;
- ham or sausage;
- sauce or salad dressing and mayonnaise.
90,015 breakfast cereals;
90,015 lollipops, chocolates and chocolates;
About 20% of prescription drugs, such as birth control pills, and about 6% of over-the-counter drugs, such as those for heartburn, contain lactose. Therefore, people with lactose intolerance (especially alactasia) need to inform their doctor about its presence when prescribing new drugs.
How to substitute milk for lactose intolerance?
Dairy products are a good and affordable source of calcium, proteins and vitamins.Therefore, people with lactose intolerance need to use their alternative sources.
Some people with reduced production of lactase retain some activity and can include various amounts of lactose in their diet without experiencing symptoms. For example, they have difficulty digesting fresh milk but eat certain dairy products such as cheese or yogurt without discomfort. These products are made using fermentation processes that break down most of the lactose in milk.In this case, yoghurts with live cultures, cheeses in which lactose has already been fermented by bacteria, or low-lactose dairy products are recommended.
If it is necessary to completely exclude milk, you can use lactose-free, in which lactose has already been split into glucose and galactose, as well as its plant alternatives – nut (almond, cashew, etc.), flaxseed, from cereals (oat, rice, buckwheat, etc.) , coconut or soy milk. Grocery stores often offer a wide variety of lactose-free alternatives to a variety of foods.
Instead of milk, you can add calcium sources of plant and animal origin to the diet :
- nuts and seeds;
- greens – dill, parsley;
90,015 soy milk and cottage cheese;
90,015 oily fish such as salmon, tuna and mackerel;
Alternative sources of vitamin A include:
- carrots, broccoli, sweet potatoes, pumpkin,
- melon, apricot, papaya, mango;
- liver, eggs.
Vitamin D levels may be increased by exposure to natural sunlight, oily fish, eggs, fish oil, and certain fortified foods.
Basics of a lactose-free diet
For both primary and secondary lactose intolerance, a lactose-free diet is the mainstay of treatment. Successful observance ensures recovery and cessation of disturbing symptoms.
The diet is selected individually, depending on the severity of symptoms and provides for the restriction or exclusion from the diet of foods containing lactose.The duration of the diet also depends on the cause of the disorder and the severity of the symptoms. The amount of lactose that can be consumed without harm to health depends on the nature of the disorder. Many people retain residual activity of the lactase enzyme, so everyone needs to determine their individual threshold dose of lactose tolerance after consulting a doctor.
When using a product with lactose, two factors are taken into account – the amount of milk sugar in it and its volume.To compose a diet, it is convenient to use tables with a lactose content of 100 g of product.
Lactose-free foods form the basis of the lactose-free diet. Lactose-free dairy products are a good substitute for common foods.
Expansion of the diet and the addition of a small amount of dairy products with a low lactose content :
- fatty foods – butter, cream;
- fermented foods – cheeses, yoghurts, fat cottage cheese.
The higher the fat content, the lower the milk sugar content.
When preparing meals, almond, soy, oat milk and any other herbal drinks will help replace regular milk. Alternative milk can be used to make not only drinks such as smoothies or cocktails, but also pancakes, omelets, waffles and pastries.
The diet of a person with lactose intolerance should be balanced and compensate for the deficiency of protein, vitamins and calcium, which he is deprived of, excluding dairy products.
If you are concerned about symptoms of lactose intolerance, do not switch to a lactose-free diet without consulting your doctor. It is possible that these symptoms can be caused by other causes, and in particular, inflammatory bowel disease. Nutritional supplements (enzymes containing lactase) can be an addition to the diet, they are taken in capsules or added to milk, used in homemade lactose-free fermented milk products.
Food intolerance to cow’s milk protein in adults
It remains to discuss the last facet of milk – protein .