Ulcerative Colitis natural and alternative treatment with diet, food, supplements, probiotics, prebiotics, and herbs, home remedy therapy by Ray Sahelian, M.D.
November 10 2016

Ulcerative colitis is a severe inflammatory bowel disease of the colon that produces bloody diarrhea. With Crohn's disease the inflammation typically involves the small intestine, but it can affect any part of the gastrointestinal tract, whereas with ulcerative colitis, the disease is usually confined to the colon and rectum.

The cause of this disease is still not well understood. Risk factors include a history of recent infection with Salmonella or Campylobacter, living in Western industrialized nations, and a family history of the disease. The incidence peaks in early adulthood, but patients can develop the disorder from early childhood through adulthood.

Lifestyle factors
Symptoms of this condition may be reduced by engaging in physical activity, eating a healthy diet, keeping a normal weight, and by not smoking.

Not getting the right amount of sleep raises the risk of ulcerative colitis,  American Gastroenterological Association, news release, Oct. 21, 2014.

Diet, food, does what we eat have an influence?
People who eat lots of red meat, concentrated milk fats, cook with certain types of oil, and use some kinds of polyunsaturated fatty acid (PUFA)-heavy margarines increase their risk of a painful inflammatory bowel disease. These foods are high in linoleic acid and people who are the heaviest consumers of this omega-6 PUFA are more than twice as likely to develop ulcerative colitis as those who consume the least. Dr. Andrew Hart of the University of East Anglia in Norwich, UK, found that eating more eicosapentaenoic acid, an omega-3 fatty acid found in fish and fish oils, is associated with a lower risk of the disease. While a Western-style, red-meat-heavy diet is high in this fatty acid and low in omega-3s, a more Mediterranean style eating pattern -- with plenty of fruits and vegetables, fish, and nut oils -- would be low in linoleic acid and high in omega-3. Dr. Andrew Hart thinks that if omega-3s do help prevent ulcerative colitis, eating a couple of servings of fish a week would probably be of benefit. Gut, December 2009.

Salmon diet in patients with active ulcerative colitis reduced the simple clinical colitis activity index and increased the anti-inflammatory fatty acid index - a pilot study.
Scand J Clin Lab Invest. 2010.
Department of Internal Medicine, Stavanger University Hospital, Stavanger, Norway.
Data concerning the anti-inflammatory effect of dietary n-3 polyunsaturated fatty acids (PUFAs) in patients with ulcerative colitis (UC) are inconsistent. Salmon fillet contains n-3 PUFAs and bioactive peptides that may improve its effects compared to fish oil alone. We assessed the efficacy of a salmon-rich diet in patients with mild ulcerative colitis. Methods. An 8-week intervention pilot study was designed to assess the effects of 600 grams Atlantic salmon consumption weekly in 12 UC patients. Simple clinical colitis activity index (SCCAI), a dietary questionnaire, sigmoidoscopy, selected serum inflammatory markers, fecal calprotectin, and plasma and rectal biopsy fatty acid profiles were assessed before and after intervention. The levels of C20:4n-6 arachidonic acid in biopsies after dietary intervention were correlated with histology and endoscopy scores. The concentrations of n-3 PUFAs, C20:5n-3 eicosapentaenoic acid, C22:6n-3 docosahexaenoic acid, and the n-3/n-6 ratio increased in plasma and rectal biopsies. The anti-inflammatory fatty acid index increased both in biopsies and plasma accompanied with a significantly reduced SCCAI. Based on evidence of SCCAI and anti-inflammatory fatty acid index and a tendency of decreased levels of CRP and homocysteine, intake of Atlantic salmon may have beneficial effects on disease activity in patients with mild ulcerative colitis.

Increasing fiber intake appears to be of benefit.

Nutritional treatment to ulcerative colitis symptoms
Doctors are still trying to figure out the best option for a natural approach to the treatment of ulcerative colitis. Little by little more data is coming in, however, as of 2011, I am only aware of a few studies with natural supplements that have shown some promise. I am not sure if the supplements discussed below will help a particular person with ulcerative colitis get better. Discuss these findings with your doctor and see what he or she says.

Agaricus blazei mushroom
Effect of an extract based on the medicinal mushroom Agaricus blazei Murill on expression of cytokines and calprotectin in patients with ulcerative colitis and Crohn's disease.
Scand J Immunol. 2011. Department of Gastroenterological Surgery, Oslo University Hospital, Ullevål, Oslo, Norway.
An immunomodulatory extract (AndoSan) based on the medicinal mushroom Agaricus blazei Murill has shown to reduce blood cytokine levels in healthy volunteers after 12 days' ingestion, pointing to an anti-inflammatory effect. The aim was to study whether AndoSan™ had similar effects on cytokines in patients with ulcerative colitis (UC) and Crohn's disease (CD). Ingestion of an Agaricus blazei-based medicinal mushroom by patients with IBD resulted in interesting anti-inflammatory effects as demonstrated by declined levels of pathogenic cytokines in blood and calprotectin in faeces.

PLoS One. 2016. Effect of a Medicinal Agaricus blazei Murill-Based Mushroom Extract, AndoSan, on Symptoms, Fatigue and Quality of Life in Patients with Ulcerative Colitis in a Randomized Single-Blinded Placebo Controlled Study. 50 patients with symptomatic ulcerative colitis were block-randomized and blinded for oral daily intake of AndoSan or placebo for the 21 days' experimental period.Beneficiary effects on symptoms, fatigue from AndoSan consumption were demonstrated in this per-protocol study, supporting its use as a supplement to conventional medication for patients with mild to moderate symptoms from ulcerative colitis.

Aloe Vera use
Randomized, double-blind, placebo-controlled trial of oral aloe vera gel for active ulcerative colitis.
Aliment Pharmacol Ther. 2004 Apr. Centre for Gastroenterology, Institute of Cellular and Molecular Science, Barts and The London, Queen Mary School of Medicine and Dentistry, London, UK.
The herbal preparation, aloe vera, has been claimed to have anti-inflammatory effects and, despite a lack of evidence of its therapeutic efficacy, is widely used by patients with inflammatory bowel disease. We performed a double-blind, randomized, placebo-controlled trial of the efficacy and safety of aloe vera gel for the treatment of mildly to moderately active ulcerative colitis. Forty-four evaluable hospital out-patients were randomly given oral aloe vera gel or placebo, 100 mL twice daily for 4 weeks, in a 2 : 1 ratio. Clinical remission, improvement and response occurred in nine (30%), 11 (37%) and 14 (47%), respectively, of 30 patients given aloe vera, compared with one (7%), one (7%) and two (14%), respectively, of 14 patients taking placebo. The Simple Clinical Colitis Activity Index and histological scores decreased significantly during treatment with aloe vera, but not with placebo. Sigmoidoscopic scores and laboratory variables showed no significant differences between aloe vera and placebo. Adverse events were minor and similar in both groups of patients. Oral aloe vera taken for 4 weeks produced a clinical response more often than placebo; it also reduced the histological disease activity and appeared to be safe.

Anti-inflammatory effects of aloe vera gel in human colorectal mucosa in vitro.
Aliment Pharmacol Ther. 2004 Mar. Centre for Adult and Paediatric Gastroenterology, Institute of Cellular and Molecular Science, Barts and the London, Queen Mary School of Medicine and Dentistry, London, UK.
Oral aloe vera gel is widely used by patients with inflammatory bowel disease and is under therapeutic evaluation for this condition. The anti-inflammatory actions of aloe vera gel in vitro provide support for the proposal that it may have a therapeutic effect in inflammatory bowel disease.

I would appreciate your view on the use of AMP ( aloe mucilagenous polysaccharides ) for the treatment of ulcerative colitis.
   A short term study with aloe vera for a month showed some improvement, but longer studies are not available to determine how effective aloe is for this condition. 

Curcumin is an extract from turmeric
Curcumin in Combination With Mesalamine Induces Remission in Patients With Mild-to-Moderate Ulcerative Colitis in a Randomized Controlled Trial. We investigated curcumin in inducing remission in patients with active mild-to-moderate UC. We performed a multicenter randomized, placebo-controlled, double-blind study of 50 mesalamine-treated patients with active mild-to-moderate UC who did not respond to an additional 2 weeks of the maximum dose of mesalamine oral and topical therapy. Patients were randomly assigned to groups who were given curcumin capsules 3 g/day or an identical placebo for 1 month, with continued mesalamine. Addition of curcumin to mesalamine therapy was superior to the combination of placebo and mesalamine in inducing clinical and endoscopic remission in patients with mild-to-moderate active UC, producing no apparent adverse effects. Curcumin may be a safe and promising agent for treatment of UC.

Curcumin maintenance therapy for ulcerative colitis: randomized, multicenter, double-blind, placebo-controlled trial.
Clin Gastroenterol Hepatol. 2006. Department of Endoscopic and Photodynamic Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan; Center for Gastroenterology, Hamamatsu South Hospital, Hamamatsu, Japan.
The aim in this trial was to assess the efficacy of curcumin as maintenance therapy in patients with quiescent ulcerative colitis. Eighty-nine patients with quiescent ulcerative colitis were recruited for this randomized, double-blind, multicenter trial of curcumin in the prevention of relapse. Forty-five patients received curcumin, 1g after breakfast and 1g after the evening meal, plus sulfasalazine or mesalamine, and 44 patients received placebo plus SZ or mesalamine for 6 months. Of 43 patients who received curcumin, 2 relapsed during 6 months of therapy (4%), whereas 8 of 39 patients (20%) in the placebo group relapsed. Recurrence rates evaluated on the basis of intention to treat showed significant difference between curcumin and placebo. A 6-month follow-up was done during which patients in both groups were on sulfasalazine or mesalamine. Eight additional patients in the curcumin group and 6 patients in the placebo group relapsed. Curcumin seems to be a promising and safe medication for maintaining remission in patients with quiescent ulcerative colitis. Further studies on curcumin should strengthen our findings.

Modulation of neutrophil motility by curcumin: Implications for inflammatory bowel disease.
Inflamm Bowel Dis. 2010. Larmonier CB, Midura-Kiela MT, Ramalingam R, Laubitz D, Janikashvili N, Larmonier N, Ghishan FK. Department of Pediatrics, Steele Children's Research Center, Tucson, Arizona.
Curcumin attenuated lipopolysaccharide (LPS)-stimulated expression and secretion of macrophage inflammatory protein (MIP)-2, interleukin (IL)-1β, keratinocyte chemoattractant (KC), and MIP-1α in colonic epithelial cells (CECs) and in macrophages. Curcumin significantly inhibited PMN chemotaxis against MIP-2, KC, or against conditioned media from LPS-treated macrophages or CEC, a well as the IL-8-mediated chemotaxis of human neutrophils. At nontoxic concentrations, curcumin inhibited random neutrophil migration, suggesting a direct effect on neutrophil chemokinesis. Curcumin-mediated inhibition of PMN motility could be attributed to a downregulation of PI3K activity, AKT phosphorylation, and F-actin polymerization at the leading edge. Our results indicate that curcumin interferes with colonic inflammation partly through inhibition of the chemokine expression and through direct inhibition of neutrophil chemotaxis and chemokinesis.

N-acetyl-L-cysteine is a potent antioxidant
N-acetyl-L-cysteine combined with mesalamine in the treatment of ulcerative colitis: randomized, placebo-controlled pilot study.
World J Gastroenterol. 2008. Guijarro LG, Mate J, Gisbert JP, Perez-Calle JL, Marin-Jimenez I, Arriaza E, Delgado M, Castillejo MS, Prieto-Merino D, Gonzalez Lara V, Pena AS. Unidad de Toxicologia Molecular Hepatica, Department de Bioquimica & Biologia Molecular, Universidad de Alcala, E-28871, Alcala de Henares, Spain.
To evaluate the effectiveness and safety of oral N-acetyl-L-cysteine (NAC) co-administration with mesalamine in ulcerative colitis (UC) patients. Thirty seven patients with mild to moderate ulcerative colitis were randomized to receive a four-wk course of oral mesalamine (2.4 g/d) plus N-acetyl-L-cysteine (0.8 g/d) (group A) or mesalamine plus placebo (group B). Analysis per-protocol criteria showed clinical remission rates of 63% and 50% after 4 wk treatment with mesalamine plus N-acetyl-L-cysteine (group A) and mesalamine plus placebo (group B) respectively. Clinical responses were 66% (group A) vs 44% (group B) after 4 wk of treatment. Clinical improvement in group A correlated with a decrease of IL-8 and MCP-1. Rates of adverse events did not differ significantly between both groups.  In group A (oral NAC combined with mesalamine) contrarily to group B (mesalamine alone), the clinical improvement correlates with a decrease of chemokines such as MCP-1 and IL-8. NAC addition not produced any side effects.

Phophatidylcholine is a phospholipid, also known as lecithin
Low levels of phosphatidylcholine in the mucous tissues of the colon may contribute to the development of ulcerative colitis. Dr. Wolfgang Stremmel, from University Hospital Heidelberg in Germany, and colleagues randomly assigned 60 patients to receive phosphatidylcholine or a placebo four times daily for 12 weeks. The preparations were encapsulated so that they would not be released until they reached the intestines. Fifteen of 30 patients in the phosphatidylcholine group were able to stop using steroids while maintaining a low clinical disease activity index or improving the index. By contrast, just 3 of 30 patients in the placebo group achieved this outcome. Mild bloating was the most common side effect seen with phosphatidylcholine use. Annals of Internal Medicine, November 6, 2007.

Probiotics are known as friendly bacteria
Probiotics, living, non pathogenic micro organisms with a beneficial effect on the host, and prebiotics, oligosaccharides promoting the growth of the beneficial microflora, have been studied to this effect. Taking a mixture of several probiotic bacteria reduces symptoms in patients with ulcerative colitis that doesn't respond to conventional medications. The probiotic mixture contained four strains of Lactobacillus, three strains of Bifidobacterium and one strain of Streptococcus salivarius -- all well-known species of good bacteria. Researchers from the University of Alberta in Edmonton, Canada enrolled 34 patients with active ulcerative colitis who were treated with the probiotic mixture twice daily for 6 weeks. A variety of standard treatments had been tried on the patients first, with no help. Remission occurred in 53 percent of the patients and an additional 24 percent experienced some degree of improvement in symptoms. A few patients experienced no improvement or worsening of their symptoms. The only apparent side effect from the probiotic mixture was increased bloating. Testing of sampled colonic tissue provided direct evidence that the probiotic bacteria had, in fact, reached the diseased sites of the colon.  American Journal of Gastroenterology, 2005.

Effect of probiotics on pro-inflammatory cytokines and NF-kappaB activation in ulcerative colitis.
World J Gastroenterol. 2010. Hegazy SK, El-Bedewy MM. Department of Clinical Pharmacy, Faculty of Pharmacy, Tanta University, Egypt. Thirty patients with mild to moderate UC were randomly classified into two groups: sulfasalazine group, who received sulfasalazine 2400 mg/d; and probiotic group, who received sulfasalazine 2400 mg/d with probiotic. The patients were investigated before and after 8 wk of treatment with probiotic (Lactobacillus delbruekii and Lactobacillus fermentum). Oral supplementation with probiotics could be helpful in maintaining remission and preventing relapse of UC.

Zhonghua Wei Chang Wai Ke Za Zhi. 2013. Efficacy of probiotics on ulcerative colitis and its mechanism.

Synbiotic therapy for ulcerative colitis
A randomized controlled trial on the efficacy of synbiotic versus probiotic or prebiotic treatment to improve the quality of life in patients with ulcerative colitis.
Nutrition. 2009 Feb 6. Fujimori S, Gudis K, Mitsui K, Seo T, Yonezawa M, Tanaka S, Tatsuguchi A, Sakamoto C. Department of Internal Medicine, Division of Gastroenterology, Nippon Medical School, Tokyo, Japan.
Studies suggest that synbiotic therapy could prove more effective in the treatment of ulcerative colitis than therapies limited to probiotics or prebiotics. This study compared the effect of each of these therapies in the treatment of ulcerative colitis. One hundred twenty outpatients with ulcerative colitis were randomly sorted into three groups of 40 patients each for probiotic, prebiotic, or synbiotic therapy. The probiotic group ingested one daily capsule consisting of Bifidobacterium longum 2 x 10(9) colony-forming units and the prebiotic group ingested daily 8 gram doses of psyllium. The synbiotic group underwent both treatments. Patients with ulcerative colitis on synbiotic therapy experienced greater quality-of-life changes than patients on probiotic or prebiotic treatment. These data suggest that synbiotic therapy may have a synergistic effect in the treatment of ulcerative colitis.

Symptoms and diagnosis
Ulcerative colitis often presents with abdominal pain, diarrhea, and blood in the stools. It is important to exclude infectious etiologies. Anemia and an elevated erythrocyte sedimentation rate or C-reactive protein level may suggest inflammatory bowel disease, but the absence of laboratory abnormalities does not rule out ulcerative colitis. The diagnosis is suspected clinically and confirmed through endoscopic biopsy.

Medical treatment
First-line treatment is therapy with 5-aminosalicylic acid. Corticosteroids may be added if 5-aminosalicylic acid therapy is ineffective. Infliximab can be added to induce and sustain remission. Patients with severe or nonresponsive ulcerative colitis should be hospitalized, and intravenous corticosteroids should be given. If medical management has been ineffective, surgical intervention is indicated for severe disease. Patients with ulcerative colitis have an increased risk of colon cancer and should have periodic colonoscopy beginning eight to 10 years after diagnosis.

Some causes, more will be added
Adults who were physically or sexually abused as children may be at increased risk for the inflammatory bowel disease ulcerative colitis.

Perm J. 2016. Onset of Ulcerative Colitis after Helicobacter pylori Eradication Therapy: A Case Report.

Natural and alternative Ulcerative Colitis treatment questions
I was recently diagnosed with ulcerative colitis and am trying both prescription and natural ways to get into remission. I was reading about the studies done of germinated barley foodstuff and how it helps those with ulcerative colitis. I can't find any supplements however that are called germinated barley foodstuff . According to the studies the barley must be germinated to be effective for ulcerative colitis. Can you help me locate a supplement (prebiotic) germinated barley foodstuff.
   We can't find a product yet that is called germinated barley foodstuff but we will keep our eyes open.

This is briefly mentioned on your ulcerative colitis page. Just FYI, germinate barley foodstuffs are widely prescribed for mild cases of ulcerative colitis in Japan, and I believe the manufacturer is a Japanese beer manufacturer - can't remember if its Kirin or Asahi. It might be hard to get in the US but is easy to find in Japan.

Would cat's claw or boswellia be worth researching for effects on ulcerative colitis?
   Both cat's claw and boswellia have anti-inflammatory properties but we have not yet seen much human research on these herbs for the natural treatment of ulcerative colitis.

My husband, 74, has chronic ulcerative colitis for years, however, the last year and half, his condition is getting worse. According to his primary doctor, there is no lining (or very thin) in his colon, and needs to have his whole colon removed. He has diarrhea 30 times a day which also causes hemorrhoid. We have been referred to take extra flora, which seems little help. Shall he continue to take the medication that doctor has prescribed to him for life, sulfasalazine, which is an antibiotic, and this medication will kill whatever bacteria in the intestine. Would this contradict to taking flora and also the sulfasalazine? Please help and suggest a nutritional regiment. Thank you as we are desperate for natural healing, rather than to have surgery which has no guarantee. Can you suggest any nutritional supplements for ulcerative colitis?
   I can't give specific suggestions, but I don't think taking prebiotics or probiotics interferes with the medication. Perhaps some of the suggestions on this page will be of benefit that you can discuss with your doctor.