Does Coffee Cause Ulcerative Colitis Flare-ups?

Ulcerative colitis (UC) is a type of inflammatory bowel disease (IBD) that affects the colon. It’s associated with sores and ulcers throughout the lining of the colon or large intestine.

Symptoms of a UC flare include bloody diarrhea, frequent stools, mucous-like stools, abdominal pain, general feelings of fatigue, and weight loss. During remission, those symptoms reside (1).

Research indicates that lifestyle, including your diet, may play a role in the development of UC and the onset of flares (2, 3).

Coffee is known to impact the digestive tract. Yet, research on how this beverage may influence the risk of developing UC and management of its symptoms is still evolving (4).

This article discusses the relationship between coffee and UC, whether coffee triggers UC flares, and tips for managing potential gut-related side effects from drinking coffee.

Coffee is a popular drink enjoyed worldwide. It’s often considered a part of a healthy diet if consumed in moderation.

A cup of coffee contains caffeine, beneficial antioxidant plant compounds known as polyphenols, and acids like chlorogenic acid (4).

The drink may increase stomach acid, lead to heartburn, stimulate defecation, and affect the gut microbiome — the colony of microorganisms that reside in your gut (4).

Some of these effects might explain why research indicates that drinking coffee could protect you from developing UC and why the drink may exacerbate symptoms for someone already living with the condition.

Still, a lot remains unknown about coffee’s impact on UC.

Summary

Coffee contains many active compounds, including caffeine and antioxidants, that may influence the drink’s effects on your body and UC.

Emerging research indicates that drinking coffee isn’t associated with an increased risk of developing UC. In fact, it may even lower your risk (3, 5, 6).

However, the exact reason behind coffee’s possible UC benefits is not fully understood.

Coffee may have anti-inflammatory properties, and research suggests that an anti-inflammatory diet could help reduce the risk of UC. Plus, coffee is rich in antioxidant polyphenols, which may have similar effects (4).

Coffee has also been found to positively affect the gut microbiome as it has prebiotic properties. In other words, coffee feeds the good bacteria in your gut and lowers harmful specifics of microbes, thereby supporting a healthy microbiome in the large intestine (7).

Summary

Research suggests that drinking coffee isn’t a risk factor for UC. It may even protect you from developing the condition.

While some people attribute their UC symptoms to certain foods, only a few high quality studies have assessed how your diet may impact the condition. Further, to date, no studies have focused on UC and coffee consumption (8).

Instead of relying on studies, people with UC often identify which foods and beverages trigger their intestinal problems through trial and error — either on their own or with the help of a healthcare professional like a registered dietitian (9, 10).

Caffeine and UC symptoms

Caffeine is considered a stimulant drug that boosts energy and alertness.

Even though there is a lack of research on caffeine and UC symptoms, the Crohn’s & Colitis Foundation lists coffee and other caffeinated drinks like soda as potential UC flare triggers (11).

Coffee can cause contractions within your digestive tract and speed up the elimination of its contents. In fact, one in three people report that drinking coffee increases the desire to defecate as soon as four minutes after consumption (12, 13).

This effect was once attributed to coffee’s natural caffeine content. However, both decaffeinated and caffeinated coffee has been shown to stimulate bowel movements, so the effect is likely caused by other chemical compounds like polyphenols or acids (4, 12).

Because diarrhea is a common symptom of UC, anything that increases bowel movements may be undesirable. So, whether or not caffeine is at fault, coffee may be best avoided if you have UC and find that it worsens your symptoms.

Eliminating coffee may improve UC symptoms in some people

While many people with IBD drink coffee, some do avoid it and attribute some of their intestinal symptoms to the drink (14).

In a 2015 study in 443 people with IBD — both Crohn’s and UC — 73% of the participants consumed coffee regularly. A whopping 96% of the participants who attributed a positive impact of coffee on IBD symptoms regularly enjoyed the drink (14).

Of those not drinking coffee, 62% believed that the drink worsened intestinal symptoms, though this was more prevalent for those with Crohn’s disease than people with UC. Plus, a negative perception of coffee did not always translate to avoiding it (14).

In a 2021 survey in 208 people in UC remission, 37% believed diet can initiate symptoms and 24% reported avoiding coffee (15).

In other words, it appears that some, but not all, people living with UC avoid coffee as they believe it may affect their symptoms. Still, many people with the condition drink coffee with no perceived negative effects (14, 15).

Summary

There is little data on coffee’s role on UC. While it may trigger symptoms in some people, others may tolerate it. Thus, the best way to identify if coffee affects you is to work with a healthcare professional.

Although not ideal, the main approach to IBD symptom management is generally trial and error. This is also the case when learning what you can eat and drink.

The Crohn’s & Colitis Foundation recommends using a food diary to figure out which foods may be your triggers (16).

Depending on what your triggers are, consider these tips to see if they improve your tolerance to coffee.

Try a smaller serving size

Maybe you’re unable to tolerate larger servings of coffee, but sticking to smaller portions can be possible.

If you keep a food diary, also record how much of the food or beverage you consume. You might find your sweet spot at one cup of coffee per day versus three.

Keep in mind that 1 cup of coffee is defined as 8 ounces (236. 6 mL) and that the smallest size offered at many coffee shops can be more than this.

Limit excess added sugars and sugar alcohols

Sugary foods are also on the list of potential trigger foods from the Crohn’s & Colitis Foundation (11).

Lattes, frappuccinos, and macchiatos from cafes can be loaded with upwards of 20 grams of sugar. At-home coffee creamers are typically lower in sugar, with around 5 grams per serving (17, 18, 19).

Meanwhile, sugar alcohols like sorbitol and mannitol may be added to sugar-free coffee creamers. Sugar alcohols are also listed as potential UC triggers and may induce diarrhea in some people (11, 20).

Try opting for unsweetened coffee to see if this triggers any UC symptoms. If you like and tolerate milk, milk alternatives, or cream in your drink, choose unsweetened versions of these add-ons.

Choose a dairy-free alternative

Many people with IBD avoid dairy due to adverse symptoms resulting from dairy consumption. If you’re unsure whether the coffee or dairy may aggravate your symptoms, try to trial and error them separately (15)

There are many plant-based milk and creamer options available — including soy, almond, oat, and coconut — that you can add to your coffee instead.

Avoid sources of carrageenan

Carrageenan is a food additive derived from seaweed. It’s used to thicken and preserve many foods, including some coffee creamers (21).

In a small 2017 study, 12 people with UC were told to avoid all sources of carrageenan in the diet. Half received a placebo while the other half received carrageenan. Participants were interviewed every 2 weeks and followed for a year or until relapse (21).

No participants receiving the placebo experienced a relapse, whereas three receiving the carrageenan supplement did (21).

Although interesting, this is just a small, preliminary study, and it only showed marginal differences in UC outcomes. Ultimately, more research is needed to learn more — especially since carrageenan is not commonly consumed in supplement form.

Summary

Keeping a diary of the types and quantities of foods and drinks you consume can help identify potential triggers of your symptoms.

Staying hydrated with water is always important, but especially so if you’re experiencing a UC flare and losing a lot of liquid through frequent, runny stools.

In addition, consider adding electrolyte tablets to water or drinking electrolyte drinks during a severe flare. It’s important to replenish lost electrolytes to stay hydrated and keep your body’s nervous system and muscles working optimally (22, 23).

Tea, including green tea, may also be a good drink option for those with UC. Tea is rich in antioxidants that may have anti-inflammatory properties and could help reduce symptoms of a flare-up (24).

However, keep in mind that green, black, and oolong tea all have caffeine. Some herbal varieties can also have a laxative effect on some people. If you react negatively to drinking it, it’s likely best to avoid it (24).

Summary

Try to stay hydrated with water or tea, if tolerated. This is especially important during a flare-up to counteract water losses from diarrhea or runny stools.

A lot is still unknown about the role of diet on UC.

This can be frustrating since it means that there’s no clear-cut answer for which foods may cause a UC flare in those with UC.

Currently, coffee is flagged by professionals as a drink you may need to avoid during a flare. Further, it’s speculated that it may trigger unwanted gut symptoms in some people. Yet, to date, minimal data supports or refutes this stance.

Managing UC is an individualized approach. Lean on your gastroenterologist or seek out a registered dietitian specializing in digestive conditions for additional support and guidance.

If you do find that coffee triggers or worsens your UC symptoms, there are many coffee alternatives to enjoy instead.

Just one thing

Try this today: If you’re unsure about which foods and drinks to eat and avoid with UC, check out this article on safe foods to eat during a flare or this piece on foods to avoid.

Was this helpful?

Does Coffee Cause Ulcerative Colitis Flare-ups?

Ulcerative colitis (UC) is a type of inflammatory bowel disease (IBD) that affects the colon. It’s associated with sores and ulcers throughout the lining of the colon or large intestine.

Symptoms of a UC flare include bloody diarrhea, frequent stools, mucous-like stools, abdominal pain, general feelings of fatigue, and weight loss. During remission, those symptoms reside (1).

Research indicates that lifestyle, including your diet, may play a role in the development of UC and the onset of flares (2, 3).

Coffee is known to impact the digestive tract. Yet, research on how this beverage may influence the risk of developing UC and management of its symptoms is still evolving (4).

This article discusses the relationship between coffee and UC, whether coffee triggers UC flares, and tips for managing potential gut-related side effects from drinking coffee.

Coffee is a popular drink enjoyed worldwide. It’s often considered a part of a healthy diet if consumed in moderation.

A cup of coffee contains caffeine, beneficial antioxidant plant compounds known as polyphenols, and acids like chlorogenic acid (4).

The drink may increase stomach acid, lead to heartburn, stimulate defecation, and affect the gut microbiome — the colony of microorganisms that reside in your gut (4).

Some of these effects might explain why research indicates that drinking coffee could protect you from developing UC and why the drink may exacerbate symptoms for someone already living with the condition.

Still, a lot remains unknown about coffee’s impact on UC.

Summary

Coffee contains many active compounds, including caffeine and antioxidants, that may influence the drink’s effects on your body and UC.

Emerging research indicates that drinking coffee isn’t associated with an increased risk of developing UC. In fact, it may even lower your risk (3, 5, 6).

However, the exact reason behind coffee’s possible UC benefits is not fully understood.

Coffee may have anti-inflammatory properties, and research suggests that an anti-inflammatory diet could help reduce the risk of UC. Plus, coffee is rich in antioxidant polyphenols, which may have similar effects (4).

Coffee has also been found to positively affect the gut microbiome as it has prebiotic properties. In other words, coffee feeds the good bacteria in your gut and lowers harmful specifics of microbes, thereby supporting a healthy microbiome in the large intestine (7).

Summary

Research suggests that drinking coffee isn’t a risk factor for UC. It may even protect you from developing the condition.

While some people attribute their UC symptoms to certain foods, only a few high quality studies have assessed how your diet may impact the condition. Further, to date, no studies have focused on UC and coffee consumption (8).

Instead of relying on studies, people with UC often identify which foods and beverages trigger their intestinal problems through trial and error — either on their own or with the help of a healthcare professional like a registered dietitian (9, 10).

Caffeine and UC symptoms

Caffeine is considered a stimulant drug that boosts energy and alertness.

Even though there is a lack of research on caffeine and UC symptoms, the Crohn’s & Colitis Foundation lists coffee and other caffeinated drinks like soda as potential UC flare triggers (11).

Coffee can cause contractions within your digestive tract and speed up the elimination of its contents. In fact, one in three people report that drinking coffee increases the desire to defecate as soon as four minutes after consumption (12, 13).

This effect was once attributed to coffee’s natural caffeine content. However, both decaffeinated and caffeinated coffee has been shown to stimulate bowel movements, so the effect is likely caused by other chemical compounds like polyphenols or acids (4, 12).

Because diarrhea is a common symptom of UC, anything that increases bowel movements may be undesirable. So, whether or not caffeine is at fault, coffee may be best avoided if you have UC and find that it worsens your symptoms.

Eliminating coffee may improve UC symptoms in some people

While many people with IBD drink coffee, some do avoid it and attribute some of their intestinal symptoms to the drink (14).

In a 2015 study in 443 people with IBD — both Crohn’s and UC — 73% of the participants consumed coffee regularly. A whopping 96% of the participants who attributed a positive impact of coffee on IBD symptoms regularly enjoyed the drink (14).

Of those not drinking coffee, 62% believed that the drink worsened intestinal symptoms, though this was more prevalent for those with Crohn’s disease than people with UC. Plus, a negative perception of coffee did not always translate to avoiding it (14).

In a 2021 survey in 208 people in UC remission, 37% believed diet can initiate symptoms and 24% reported avoiding coffee (15).

In other words, it appears that some, but not all, people living with UC avoid coffee as they believe it may affect their symptoms. Still, many people with the condition drink coffee with no perceived negative effects (14, 15).

Summary

There is little data on coffee’s role on UC. While it may trigger symptoms in some people, others may tolerate it. Thus, the best way to identify if coffee affects you is to work with a healthcare professional.

Although not ideal, the main approach to IBD symptom management is generally trial and error. This is also the case when learning what you can eat and drink.

The Crohn’s & Colitis Foundation recommends using a food diary to figure out which foods may be your triggers (16).

Depending on what your triggers are, consider these tips to see if they improve your tolerance to coffee.

Try a smaller serving size

Maybe you’re unable to tolerate larger servings of coffee, but sticking to smaller portions can be possible.

If you keep a food diary, also record how much of the food or beverage you consume. You might find your sweet spot at one cup of coffee per day versus three.

Keep in mind that 1 cup of coffee is defined as 8 ounces (236.6 mL) and that the smallest size offered at many coffee shops can be more than this.

Limit excess added sugars and sugar alcohols

Sugary foods are also on the list of potential trigger foods from the Crohn’s & Colitis Foundation (11).

Lattes, frappuccinos, and macchiatos from cafes can be loaded with upwards of 20 grams of sugar. At-home coffee creamers are typically lower in sugar, with around 5 grams per serving (17, 18, 19).

Meanwhile, sugar alcohols like sorbitol and mannitol may be added to sugar-free coffee creamers. Sugar alcohols are also listed as potential UC triggers and may induce diarrhea in some people (11, 20).

Try opting for unsweetened coffee to see if this triggers any UC symptoms. If you like and tolerate milk, milk alternatives, or cream in your drink, choose unsweetened versions of these add-ons.

Choose a dairy-free alternative

Many people with IBD avoid dairy due to adverse symptoms resulting from dairy consumption. If you’re unsure whether the coffee or dairy may aggravate your symptoms, try to trial and error them separately (15)

There are many plant-based milk and creamer options available — including soy, almond, oat, and coconut — that you can add to your coffee instead.

Avoid sources of carrageenan

Carrageenan is a food additive derived from seaweed. It’s used to thicken and preserve many foods, including some coffee creamers (21).

In a small 2017 study, 12 people with UC were told to avoid all sources of carrageenan in the diet. Half received a placebo while the other half received carrageenan. Participants were interviewed every 2 weeks and followed for a year or until relapse (21).

No participants receiving the placebo experienced a relapse, whereas three receiving the carrageenan supplement did (21).

Although interesting, this is just a small, preliminary study, and it only showed marginal differences in UC outcomes. Ultimately, more research is needed to learn more — especially since carrageenan is not commonly consumed in supplement form.

Summary

Keeping a diary of the types and quantities of foods and drinks you consume can help identify potential triggers of your symptoms.

Staying hydrated with water is always important, but especially so if you’re experiencing a UC flare and losing a lot of liquid through frequent, runny stools.

In addition, consider adding electrolyte tablets to water or drinking electrolyte drinks during a severe flare. It’s important to replenish lost electrolytes to stay hydrated and keep your body’s nervous system and muscles working optimally (22, 23).

Tea, including green tea, may also be a good drink option for those with UC. Tea is rich in antioxidants that may have anti-inflammatory properties and could help reduce symptoms of a flare-up (24).

However, keep in mind that green, black, and oolong tea all have caffeine. Some herbal varieties can also have a laxative effect on some people. If you react negatively to drinking it, it’s likely best to avoid it (24).

Summary

Try to stay hydrated with water or tea, if tolerated. This is especially important during a flare-up to counteract water losses from diarrhea or runny stools.

A lot is still unknown about the role of diet on UC.

This can be frustrating since it means that there’s no clear-cut answer for which foods may cause a UC flare in those with UC.

Currently, coffee is flagged by professionals as a drink you may need to avoid during a flare. Further, it’s speculated that it may trigger unwanted gut symptoms in some people. Yet, to date, minimal data supports or refutes this stance.

Managing UC is an individualized approach. Lean on your gastroenterologist or seek out a registered dietitian specializing in digestive conditions for additional support and guidance.

If you do find that coffee triggers or worsens your UC symptoms, there are many coffee alternatives to enjoy instead.

Just one thing

Try this today: If you’re unsure about which foods and drinks to eat and avoid with UC, check out this article on safe foods to eat during a flare or this piece on foods to avoid.

Was this helpful?

Is it possible to drink milk, coffee and alcohol? / Blog / Clinic EXPERT

IBD and milk

An important issue that often arises both in patients and doctors is intolerance to milk and products based on it in patients with IBD. Domestic sites for patients often recommend eliminating milk from the diet, and absolutely all patients. Foreign authors (for example, experts from the European Society for Enteral and Parenteral Nutrition), analyzing the results of clinical studies, advise limiting or excluding milk only in the presence of lactase deficiency.

What is lactase deficiency?

Lactase deficiency is a deficiency of the enzyme lactase, which breaks down the milk sugar, lactose, in the small intestine. As a result, a large amount of undigested milk sugar accumulates in the intestinal lumen, which causes diarrhea, bloating, nausea, heaviness and pain in the upper abdomen.

It is known that during the transition to an adult type of nutrition in some people, the activity of the lactase enzyme may gradually decrease. This process is genetically mediated. As a result, a person who previously tolerated milk and dairy products well develops unpleasant symptoms.

This condition is called adult lactase deficiency (hypolactasia).

Adult lactase deficiency occurs in 90% of Asians and 80% of African Americans, while in whites in Western and Northern Europe this condition is observed quite rarely – 10-15% of cases.

How to detect lactase deficiency?

The easiest way to diagnose lactase deficiency is elimination diet when milk and products based on it are excluded from the diet, after which the symptoms completely disappear. In patients with IBD in the exacerbation phase, the results of such a “test” are difficult to interpret due to the large number of symptoms associated with disease activity.

A more accurate way – molecular genetic study with the determination of the mutation of the gene responsible for the production of the lactase enzyme.

The advantage of the method is its low invasiveness, only a small amount of the patient’s blood is required for the study. However, the presence of a gene mutation does not always reflect the true activity of the enzyme in the small intestine. Lactase activity on the surface of cells in the small intestine can be reduced in Crohn’s disease, without genetic mutations.

Laboratory methods for diagnosing lactase deficiency include hydrogen breath test . It is used as an indirect method for diagnosing a disease. The essence of the test is to measure the concentration of hydrogen in the exhaled air (for example, with the LaktofaN2 hydrogen analyzer) after consuming lactose. In lactase deficiency, unsplit lactose is used by the microflora of the colon with the release of hydrogen. However, the false-positive rate of the lactose breath test is as high as 20%.

The gold standard for diagnosing lactase deficiency is the determination of lactase activity on the surface of small intestine cells.

Biopsy specimens of the small intestine mucosa obtained during gastroscopy are used as a material for research. The method allows you to accurately determine the deficiency of the lactase enzyme and to identify the degree of its deficiency.

How common is lactase deficiency in IBD?

As mentioned above, exclusion of milk (rarely dairy products) is indicated for patients with IBD and proven lactase deficiency. But how often does it generally occur in such patients? Data from clinical studies vary, probably due to the ethnic diversity of the study groups. So, in Crohn’s disease, the frequency of detecting lactase deficiency by a breath test and / or genetic research varies from 17 to 70% of cases, with ulcerative colitis, enzyme deficiency is found in 4-44% of patients.

A regularity was revealed, according to which the localization of the inflammatory process in the small intestine in Crohn’s disease is more often accompanied by lactase deficiency (100% of cases with lesions of the jejunum, 68% with terminal ileitis, 55% with ileocolitis) compared with an isolated lesion of the large intestine (with colitis Crown – 43.5%).

Unreasonable exclusion from the diet of milk and dairy products for all patients diagnosed with IBD. Undoubtedly, a patient with proven lactase deficiency requires a sharp restriction of whole milk in the diet. But if milk intolerance was detected only during an exacerbation of IBD, this does not mean at all that the symptoms of intolerance will persist during remission. Many patients who experience unpleasant symptoms when drinking whole milk tolerate products based on it well. Dairy products that are generally well tolerated even in severe lactase deficiency include yogurt and cheese. In diet therapy, lactose-free milk and products based on it can also be used. Some patients with proven lactase deficiency are well tolerated by the use of small volumes of whole milk (less than 250 ml per day) along with other foods.

IBD and coffee

Although in Russia the number of people who drink coffee is inferior to the number of tea lovers, the number of people in our country who drink at least occasionally a cup of coffee is 60-75% according to various estimates.

The positive effect of drinking coffee has been proven for several chronic diseases (non-alcoholic fatty liver disease, type 2 diabetes, Parkinson’s disease, constipation, etc.). A large prospective study in 2012 (involving more than 400 thousand people) showed a decrease in overall mortality, the frequency of death from stroke and heart disease in people who drink coffee.

Coffee drinkers also include patients with IBD. How does coffee affect the intestines? How bad (or good) is drinking coffee for Crohn’s disease and ulcerative colitis?

Coffee has a prebiotic effect, positively affecting the intestinal microbiota, and also has antibacterial activity, reducing the number of E. coli, Clostridium bacteria and increasing the number of lacto- and bifidobacteria. In addition, a stimulating effect of caffeine on colonic motility and an increase in rectal sphincter tone have been described. A 2014 study showed that coffee consumption reduces the risk of developing primary sclerosing cholangitis, which is often associated with IBD.

Coffee consumption does not affect the risk of developing IBD, although a recent meta-analysis showed a trend towards a reduced risk of ulcerative colitis with coffee consumption.

Swiss researchers in 2015, after interviewing 442 patients with IBD, found that 3/4 of the respondents regularly drink coffee. Among those who did not drink coffee at all or drank very infrequently, 62% attributed their refusal to the drink to worsening symptoms of the disease. More often, such a response was given by patients with Crohn’s disease – 76.4%. With ulcerative colitis – 44.4%. If we evaluate the effect of coffee on symptoms in all 442 patients, then its negative effect was noted by 45. 2% of patients with Crohn’s disease and 20.2% with ulcerative colitis.

No other significant studies have been conducted using laboratory and endoscopic methods to assess disease activity in patients with IBD. Thus, patients with Crohn’s disease and ulcerative colitis can consume coffee if it does not worsen symptoms or new complaints.

IBD and alcohol

One of the most popular questions from patients (after “What to eat?”) is “What can I drink?” Similar questions are asked by patients with mild disease without severe symptoms or after achieving remission.

What do we know about alcohol in IBD? Has any research been done on this topic? Oddly enough, they were carried out (and quite large and convincing).

In 2017, the results of the EPIC study, which included 262,451 participants, were published (Bergmann MM. et al., 2017). The study participants’ alcohol use was assessed by quantity (does not drink, used before, low, moderate, high alcohol consumption), taking into account norms for men and women. From the moment of observation (i.e. from 1993 years), ulcerative colitis was first diagnosed in 198 participants, Crohn’s disease in 84 people. The statistical analysis carried out showed that alcohol consumption does not in any way affect the likelihood of developing ulcerative colitis and Crohn’s disease.

These results were later confirmed (albeit only for ulcerative colitis) by a meta-analysis of clinical trials, which statistically evaluated the results of 9 studies on alcohol as a risk factor for IBD. The result is the same – alcohol consumption is not a risk factor for ulcerative colitis.

But chronic alcohol abuse (alcoholism) increases the risk of IBD , as evidenced by a study by Chinese authors. They analyzed data from a 10-year follow-up of nearly 58,000 cases of hospitalized individuals diagnosed with alcohol intoxication, comparing them with a control group who did not abuse alcohol. The risk of detecting new cases of IBD was 3. 17 times higher among those suffering from alcoholism persons, of which 4.4 times for Crohn’s disease, 2.33 times for ulcerative colitis.

“Thank you, doctor,” the patient will say, “but I would like to be absolutely sure that alcohol will not provoke an aggravation of my disease.”

Such fears are not unfounded. It is known that ethanol, which is part of alcoholic beverages, reduces the activity of intestinal immune cells and suppresses the production of certain cytokines, and also (most importantly for IBD!) increases the permeability of the intestinal wall. Thus, in theory, it is possible to harm the intestines by drinking alcohol, but the extent of the negative effect of ethanol is still unknown.

Studies do not provide a clear answer to the question of how alcohol affects the course of the disease. On the one hand, their number is limited, and the number of subjects rarely exceeds a few dozen people. On the other hand, most of these studies are based on surveys, including retrospective ones.

However, some interesting data is available for analysis. In 2004, Jowett et al published a follow-up of 191 patients with ulcerative colitis in clinical remission. During the year, patients were periodically interviewed about the amount and nature of consumed foods and drinks, including alcohol. After 12 months, exacerbation of the disease was observed in 52% of patients.

Moderate alcohol consumption was found not to increase the risk of exacerbation, while high alcohol intake increased the risk of exacerbation of ulcerative colitis by 2.71 times. The disadvantage of the study was the lack of accurate information about the dangerous and safe doses of alcohol.

Another interesting work was done in the USA. 14 patients with ulcerative colitis and Crohn’s disease in remission, as well as 7 healthy volunteers, took part in a study that assessed the effect of drinking wine on the course of the disease. During the week, each patient drank 1-3 glasses of dry red wine per day (approximately 0. 4 g of ethanol per 1 kg of body weight). Blood tests, stool tests for fecal calprotectin, and intestinal permeability were assessed before and after the study. There were no cases of exacerbation of the disease during the study period. Patients showed a significant increase in small intestine (in Crohn’s disease) and large intestine (in ulcerative colitis) permeability. Since intestinal permeability plays an important role in the development of IBD and can generally be considered an early marker of inflammation, it is likely that regular drinking of even small amounts of wine will exacerbate the disease. At the same time, most of the participants before the start of the study had an increased level of fecal calprotectin, that is, it is possible that the remission of the disease was only clinical.

Interestingly, one week after daily wine consumption, the level of calprotectin in patients with IBD significantly decreased.

Finally, one of the latest studies, also performed in the United States at the end of December 2017, assessed the symptoms of the digestive system in people who drink alcohol. Of the 90 patients with inactive IBD, 62% were regular drinkers of varying amounts, which is broadly comparable to data for the nation as a whole (61% of Americans drink occasionally). Of the total number of alcohol drinkers, 75% of patients with IBD noted that subsequently they had a worsening of symptoms (abdominal pain, loose stools, bloating, etc.). This study was again based on a patient survey, which limits its value.

The question remains unanswered: “Which alcohol is less harmful to the intestines?” Large studies assessed drinking in general, small studies assessed drinking red wine.

Probably the most important factor will be the total amount of ethanol in the daily glass, rather than its type.

After analyzing the results of clinical studies, it becomes clear that it is possible to drink alcohol in IBD, but “in moderation” (infrequently and in moderation). The constant use of alcohol, especially in high doses, can provoke an exacerbation of the disease.

Concomitant use of alcohol with certain medications taken by patients with IBD is not recommended. Severe drug-induced liver damage can occur with concomitant use of metronidazole and ethanol. The use of other medications (mealazines, azathioprine/mercaptopurine, steroid hormones) does not exclude the possibility of episodic alcohol consumption in small doses.

Conclusion

There is no universal diet and dietary recommendation for patients with ulcerative colitis and Crohn’s disease. The decision to prescribe a particular diet is made by the attending physician.

Particular issues of diet therapy / Blog / Clinic EXPERT

IBD AND MILK

An important issue that often arises both in patients and doctors is intolerance to milk and products based on it in patients with IBD. Domestic recommendations, websites for patients often give recommendations on the exclusion of milk from the diet, and to all patients in a row. Foreign authors (for example, experts from the European Society for Enteral and Parenteral Nutrition), analyzing the results of clinical studies, advise limiting or excluding milk only in the presence of lactase deficiency.

What is lactase deficiency?

Lactase deficiency is a deficiency of the enzyme lactase, which breaks down milk sugar, lactose, in the small intestine. As a result, a large amount of undigested milk sugar accumulates in the intestinal lumen, which causes diarrhea, bloating, nausea, heaviness and pain in the upper abdomen.

It is known that during the transition to an adult type of nutrition in some people, the activity of the lactase enzyme may gradually decrease. This process is genetically programmed. As a result, people who previously tolerated milk and dairy products well begin to experience unpleasant symptoms. This condition is called lactase deficiency (hypolactasia) in adults. Interestingly, adult lactase deficiency occurs in 90% of Asian peoples and 80% of African Americans, while in the representatives of the white race in the countries of Western and Northern Europe this condition is observed quite rarely – 10-15% of cases.

How to detect lactase deficiency?

The easiest way to diagnose lactase deficiency is an elimination diet, when milk and products based on it are excluded from the diet, after which the symptoms completely disappear. In patients with IBD in the exacerbation phase, the results of such a “test” are difficult to interpret due to the large number of symptoms associated with disease activity.

More accurate is a molecular genetic study to determine the mutation of the gene responsible for the production of the lactase enzyme. The advantage of the method is its low invasiveness, the study requires only a small amount of blood from the person being examined. Among the disadvantages, it should be noted that the presence of a gene mutation does not always reflect the true activity of the enzyme in the small intestine. Lactase activity on the surface of cells in the small intestine can be reduced in Crohn’s disease, while genetic mutations are absent.

Laboratory methods for diagnosing lactase deficiency also include a hydrogen breath test. It is used as an indirect method for diagnosing a disease. The essence of the test is to measure the concentration of hydrogen in the exhaled air after ingestion of lactose. In lactase deficiency, unsplit lactose is used by the microflora of the colon with the release of hydrogen.

Another method is the determination of lactase activity on the surface of cells in the small intestine. Biopsy specimens of the small intestine mucosa obtained during gastroscopy are used as a material for research. The method allows you to accurately determine the deficiency of the lactase enzyme and to identify the degree of its deficiency.

How common is lactase deficiency in IBD?

As mentioned above, exclusion of milk (rarely fermented milk products) is indicated for those patients with IBD who have proven lactase deficiency. But how often does it even occur in these patients? The data of clinical studies differ significantly among themselves, which is probably due to the ethnic diversity of the studied groups of patients. So, in Crohn’s disease, the frequency of detecting lactase deficiency by a breath test and / or genetic research varies from 17 to 70% of cases, with ulcerative colitis, enzyme deficiency is found in 4-44% of patients.

A regularity was revealed, according to which the localization of the inflammatory process in the small intestine in Crohn’s disease is more often accompanied by lactase deficiency (100% of cases with lesions of the jejunum, 68% with terminal ileitis, 55% with ileocolitis) compared with an isolated lesion of the large intestine (with colitis Crown – 43.5%).

Exclusion from the diet of milk and dairy products for all patients diagnosed with IBD is incorrect. Undoubtedly, a patient with proven lactase deficiency requires a sharp restriction of whole milk in the diet. At the same time, it is known that if milk intolerance was detected only during an IBD exacerbation, this does not mean at all that intolerance symptoms will persist during remission. Moreover, many patients who experience unpleasant symptoms when drinking whole milk tolerate products based on it well. Dairy products that are generally well tolerated even in severe lactase deficiency include yogurt and cheese. In diet therapy, lactose-free milk and products based on it (for example, yogurt, cheese, etc.) can also be used. Interestingly, in a number of patients with proven lactase deficiency, the use of small volumes of whole milk (less than 250 ml per day) along with other foods is well tolerated.

VZK AND COFFEE

Although in Russia the number of people who drink coffee is inferior to the number of “tea lovers”, the number of people in our country who drink at least occasionally a cup of coffee is, according to various estimates, 60-75%.

The positive effect of drinking coffee is shown in some chronic diseases (non-alcoholic fatty liver disease, type 2 diabetes, Parkinson’s disease, constipation, etc.). A large prospective study in 2012 (involving more than 400,000 people) showed a reduction in overall mortality, stroke deaths, and heart disease among coffee drinkers.

Coffee drinkers also include people with IBD. How does coffee affect the intestines? How bad (or good) is drinking coffee for Crohn’s disease and ulcerative colitis?

Coffee has a prebiotic effect, positively influencing the intestinal microbiota, and also has antibacterial activity, reducing the number of E. coli, Clostridium bacteria and increasing the number of lacto- and bifidobacteria. In addition, a stimulating effect of caffeine on colonic motility and an increase in rectal sphincter tone have been described. A 2014 study showed that coffee consumption reduces the risk of developing primary sclerosing cholangitis, which is often associated with IBD.

Coffee consumption does not affect the risk of IBD, although a recent meta-analysis showed a trend towards a lower risk of ulcerative colitis with coffee consumption.

Swiss researchers in 2015, asking 442 patients with IBD, found that 3/4 of them regularly drink coffee. Among those who did not drink coffee or did so very rarely, 62% explained their refusal to drink as worsening symptoms of the disease. This response was more common among people with Crohn’s disease (76.4%) compared with ulcerative colitis (44.4%). If we evaluate the effect of coffee on symptoms in all 442 patients, then its negative effect was noted by 45. 2% of patients with Crohn’s disease and 20.2% with ulcerative colitis.

No other significant studies have been conducted using laboratory and endoscopic methods to assess disease activity in patients with IBD. Thus, it seems that patients with Crohn’s disease and ulcerative colitis can consume coffee if it does not increase symptoms or new complaints.

IBD AND ALCOHOL

One of the most popular questions from patients besides “how to eat” is “what can I drink?”. To be more precise, most often the question is: “Doctor, don’t get me wrong, I’m not an alcoholic, but what can I drink for a holiday / birthday?”. Most often, this question is asked by patients who have either a mild course of the disease without severe symptoms, or have achieved remission of the disease. In this case, they begin to build long-term plans, incl. trying to imagine what their future lifestyle will look like.

What do we know about alcohol in IBD? Are there any studies on this topic? Oddly enough, there are, and quite large and convincing.

In 2017, the results of the EPIC study, which included 262,451 participants, were published (Bergmann MM. et al., 2017). The study participants’ alcohol use was assessed by quantity (does not drink, used before, low, moderate, high alcohol consumption), taking into account norms for men and women. From the moment of observation (i.e. from 1993 years) ulcerative colitis was first diagnosed in 198 participants, Crohn’s disease in 84 people. The statistical analysis carried out showed that alcohol consumption does not in any way affect the likelihood of developing ulcerative colitis and Crohn’s disease.

These results were later confirmed (albeit only for ulcerative colitis) by a meta-analysis of clinical trials, during which a statistical evaluation of the results of 9 studies on the question of “alcohol as a risk factor for IBD” was carried out. The result is the same – alcohol consumption is not a risk factor for ulcerative colitis.

But chronic alcohol abuse (alcoholism) increases the risk of IBD, as evidenced by a study by Chinese authors. They analyzed data from a 10-year follow-up of nearly 58,000 cases of hospitalized individuals diagnosed with alcohol intoxication, comparing them with a control group who did not abuse alcohol. The risk of detecting new cases of IBD was 3.17 times higher among those suffering from alcoholism, of which 4.4 times for Crohn’s disease, and 2.33 times for ulcerative colitis.

“Thank you, doctor,” the patient will say, “but I would like to be absolutely sure that alcohol will not provoke an aggravation of my disease.” The fear, it should be noted, is not unfounded. It is known that ethanol, which is part of alcoholic beverages, reduces the activity of intestinal immune cells and suppresses the production of certain cytokines, and also (most importantly for IBD!) increases the permeability of the intestinal wall. Thus, in theory, it is possible to harm the intestines by drinking alcohol, but the extent of the negative effect of ethanol is still unknown.

What do the studies say? Studies cannot accurately answer this question. On the one hand, their number is limited, and the number of subjects rarely exceeds 90,005 90,004 a few dozen people. On the other hand, the methodology for conducting most of these studies is such that they are often based on surveys, incl. retrospective (“remember what symptoms you had before”).

However, some interesting data is available for analysis. In 2004, Jowett et al. published the results of their observation of 191 patient with ulcerative colitis in clinical remission. During the year, patients were periodically surveyed about the amount and nature of the consumed foods and drinks, incl. alcohol. After 12 months, exacerbation of the disease was observed in 52% of patients.

It was found that moderate alcohol consumption did not increase the risk of exacerbation, while high alcohol intake increased the risk of exacerbation of ulcerative colitis by 2.71 times. The disadvantage of the study was the lack of accurate information about the dangerous and safe doses of alcohol.

Another interesting work has been done in the USA. 14 patients with ulcerative colitis and Crohn’s disease in remission, as well as 7 healthy volunteers, took part in a study that assessed the effect of drinking wine on the course of the disease. Each patient drank 1-3 glasses of dry red wine per day (approximately 0.4 g of ethanol per 1 kg of body weight) for a week. Pre- and post-study evaluations included blood counts, fecal calprotectin testing, and intestinal permeability as discussed above. There were no cases of disease exacerbation during the study period. Patients showed a significant increase in small intestine (in Crohn’s disease) and large intestine (in ulcerative colitis) permeability. Since intestinal permeability plays an important role in the development of IBD and can generally be considered an early marker of inflammation, it is likely that regular (constant) drinking of wine, even in small quantities, will exacerbate the disease. At the same time, I would like to note that the majority of study participants (patients with IBD) initially had an increased level of fecal calprotectin, i. e. it is possible that the remission of the disease was only clinical. Interestingly, one week after the daily use of wine, the level of calprotectin in IBD patients significantly decreased.

Finally, one of the latest studies, also performed in the United States at the end of December 2017, assessed the symptoms of the digestive system in people who drink alcohol. Of the 90 patients with inactive IBD, 62% were regular drinkers of varying amounts, broadly comparable to data for the US as a whole (61% of Americans occasionally drink alcohol). Of the total number of alcohol drinkers, 75% of patients with IBD noted that subsequently they had a worsening of symptoms from the gastrointestinal tract (abdominal pain, loose stools, bloating, etc.). Unfortunately, the study was again based on a patient survey, which limits its value.

The question remains – which alcohol is less harmful to the intestines . Large studies assessed the fact of drinking in general, small studies assessed the use of red wine.