Ulcerative colitis is an inflammatory bowel disease that causes long-lasting inflammation and ulcers in the digestive tract. It affects the innermost lining of the large intestine and rectum. Symptoms include diarrhea, abdominal pain, rectal bleeding, and weight loss. Nutritional deficiencies can occur due to reduced intake, absorption issues, and increased losses. A comprehensive nutrition plan is important to improve symptoms and quality of life by addressing deficiencies, managing diet during flares and remission, and recommending foods and nutrients to support healing.

1. Bint e Hawa

2. Ulcerative collitis
• Ulcerative colitis is an
inflammatory bowel disease
(IBD) that causes long-
lasting inflammation and
ulcers in your digestive tract
• Ulcerative colitis affects the
innermost lining(mucosal
layer) of your large intestine
and rectum

3. • In a person with UC, the inflamed colon does
not absorb water properly resulting in
diarrhea, increased urgency to have a bowel
movement and increased frequency of bowel
movements

4. Symptoms
• Diarrhea, often with blood or pus
• Abdominal pain and cramping
• Rectal pain
• Rectal bleeding — passing small amount of
blood with stool
• Urgency to defecate
• Inability to defecate despite urgency
• Weight loss
• Fatigue
• Fever

6. Etiologic Theories in ulcerative collitis
Genetic
predisposition
UC
Mucosal Immune System
(Immuno-Regulatory
Defect)
Environmental Triggers
(luminal bacteria,
infection, NSAIDs,
smoking)

7. Diagnosis
• Blood test
• Stool test
• X-ray
• CT-scan
• colonoscopy

9. Nutritional need
• All symptoms of UC are thought to be
associated with diet so people with UC and
their families seek for a dietitian to enhance
the quality of their lives
• A comprehensive nutritional counseling and
therapy program can go a long way to
improving the quality of life in patients
ulcerative colitis

10. Questions prior to nutrition therapy
• Which inflammatory bowel disease is present: Crohn’s
disease or ulcerative colitis?
• What is the patient’s current disease phase (acute flare
or symptom-free interval)?
• Which segments of the digestive tract are affected?
Has the digestive function been significantly impacted?
• What medications does the patient take?
• Does the patient report any individual nutritional
intolerances?
• Have there been any disease complications?

11. Dietary causes
• Following are some of the proposed dietary
causes of UC
– Sulfur containing foods
– Alcohol intake
– Processed carbohydrates
– Fast food
– High intake of processed red meat
– Formula milk
Breast milk has been proved to protect against UC

12. Malnutrition during UC
• Malnutrition during UC is basically due to
– Reduced dietary intake
– Reduced absorption of nutrients
– Increased bowel movements in cases of diarrhea
with associated nutrient loss
– Interactions between pharmaceutical agents and
nutrients
– Increased nutritional requirements during phases
of active inflammation

13. DEFICIENCIES

14. CRITICAL NUTRIENTS AND THEIR
SOURCES
• Vitamin A:
– liver, butter, margarine, cheese, eel and tuna. Its
precursor β-carotin is found in yellow and red
fruits and vegetables, such as carrots, tomatoes,
apricots etc
• Vitamin B12:
– foods derived from animals, including fish, milk
and other dairy products, but in some cases oral
medication is not useful so injection is given

15. • Vitamin D:
– Vitamin D is contained in fatty fish, liver, vitamin-D fortified
margarines and egg yolk. The body itself produces vitamin D in
response to sunlight
• Folate:
– contained in wheat germ, soybeans, certain vegetables, such as
tomatoes, cabbage, spinach and cucumbers, certain fruits, such
as oranges and grapes, as well as in breads and other products
backed with whole wheat flour and in potatoes, meat, liver, milk
and dairy products, and in eggs.
– High doses of folate can mask vitamin B12 deficiency, the
regular intake of folate in dietary preparations should be
restricted to a folate equivalent of 1000 µg/ day or less

16. • Iron:
– Meat, fish and poultry
– The iron contained in foods of animal origin is
more easily absorbed than in those derived from
plants
– Usually IV injections of iron are referred by
physicians

17. MNT

18. • Goal:
– Reduce inflammation, allviate symptoms, correct
dehydration and nutritional deficiencies
• Phases:
1. Acute phase flare up: low fiber diet
2. Remission: high protein(1-1.5g/kg), nutrient dense
diet, 2 quarts of water daily
• Avoid:
– Diarrhea causing foods, warm foods, carbonated
beverages, alcohol, caffeine, milk

19. Diet during an acute inflammatory
flare
• Light full diet
• If not nutritionally sufficient than move to high
calorie liquid diet/ formula diet
• In case, malnutrition has started so provide extra
500kcal/day by these formula diets
• For fluid and electrolyte losses:
– A solution made according to the criteria of the World
Health Organization (WHO). This solution contains
sodium, potassium, chloride, citrate, bicarbonate and
glucose in amounts best suited for fluid replacement

20. • Route:
– If possible, nutritional intake, either as oral liquid
diet or tube feedings, should be preferred to
nutrition provided by intravenous infusion

21. Diet as the acute flare resolves
• Start normal diet
• step-wise progression to a normal full diet
• Step 1: begin with easily digested foods high in
carbohydrates, oat or rice meal and low-fat
broths
• Step 2: If tolerated, add white bread, jams, honey,
strained and cooked fruit, diluted fruit juices,
strained and boiled soft vegetables, cooked and
strained lean meat with a low-fat sauce, rice, low-
fat mashed potatoes, pasta, porridge made with
skim milk (0.3%) and low-fat curds

22. • Step 3: Add some fat 1.5%
• During this period, patients should still avoid raw
produce, including lettuce and uncooked fruit
• Step 4: Advance to light full diet
• Avoid:
– Vegetables of the cabbage family, legumes, fatty and
fried foods, fruits with hard peels (plums,
gooseberries etc.), vegetables cut into large chunks,
vegetables picked in vinegar, juices of acidic fruits,
fructose, sugar substitutes such as xylitol, sorbitol or
isomaltose may cause digestive symptoms in sensitive
persons

23. Light full diet

24. Final dietary recommendations
• Increase the intake of prebiotics and probiotics
• Use foods low in sulfur
• Increase intake of folate, vit A, vit D, vit B12 and iron
• Increase your fluid intake
• Avoid foods rich in oxalate
• Use finely milled whole grains
• Use fat free cuts of meat
• Reduce fat intake
• Increase the intake of fiber
• Use simple carbohydrates