Living With UC

People with ulcerative colitis are concerned about functioning at work or missing it altogether because of diarrhea, abdominal pain or reduced energy levels commonly associated with flare-ups. Fatigue and loss of appetite may make it difficult to concentrate and keep spirits up. Talk with your loved one about how he/she feels. Listen to his/her concerns or problems. Your support is very important and an understanding, non-judgmental ear is often the best support you can offer.

Ulcerative colitis affects different people in different ways. While some people find the condition debilitating and may want to stay home due to fear of flare-ups, others keep a positive attitude and continue to enjoy the little pleasures of life. Encourage your loved one with ulcerative colitis to continue to do the things he/she likes.

People with ulcerative colitis are conscious of their personal attractiveness and the effect of the condition on relationships with their family and friends. They may feel guilty and embarrassed because of not being able to fully function as spouses, parents or friends. Know that your loved one is still the same person and be patient. Support him/her and appreciate what you have been able to accomplish together.

Work with your loved one to develop a reminder system for daily medication to help him/her treat active ulcerative colitis and maintain remission. It's important your loved one comply fully with the doctor's prescribed regimen.

Accompany your loved one to their next doctor's visit to learn more about ulcerative colitis and the specific ways you can help. This will also give you a chance to meet your loved one's healthcare team, if you have not already done so. Let the doctor know in advance that you'll be accompanying your loved one.

The Crohn's and Colitis Foundation of Canada (CCFC) is the only national organization dedicated to finding a cure for these diseases. The foundation is committed, first and foremost, to raising funds for medical research. It also provides educational resources and access to a network of supportive volunteer chapters in some 80 communities across Canada . For more information, call the CCFC at 1-800-387-1479 or visit www.ccfc.ca.³

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There is not a standard diet that works for all people with ulcerative colitis. Your food choices will depend upon the severity of your disease, whether it is active or in remission, the medications you're taking, your individual nutrient needs and your individual food tolerances.

There is no current evidence that any single dietary factor causes ulcerative colitis. However, dietary consideration may help you in managing your disease. There are common dietary guidelines that people with UC can follow to improve their health and prevent serious complications of the disease. Developing an individual diet plan with your doctor and a nutritionist may also be helpful.

Malnutrition
Malnutrition occurs when the body doesn't get enough of the nutrients it needs (such as vitamins, minerals, trace elements and proteins) or is unable to absorb them from food.

In UC patients, the following factors can contribute to malnutrition:

• Inadequate nutrient intake due to:
  • Decreased food intake
  • Inability to tolerate solid foods
  • Uncomfortable symptoms
  • Altered taste
• Increased nutrient needs
  • Higher metabolic rate (stress response to inflammation, infection, healing)
  • Growth
• Malabsorption of nutrients
  • Decreased absorptive surface of the bowel due to active disease or surgery
  • Drug interference
  • Bacterial overgrowth in the small intestine
• Increased nutrient loss due to:
  • Diarrhea
  • Fistulae
  • Blood loss

It is important to monitor your body's needs and ensure you get proper nutrition. If you feel you may be malnourished, consult your doctor to develop a plan to ensure your body obtains the nutrition it needs.

Diet modifications
If your UC is controlled, you don't need to restrict foods or modify your diet. Use Canada's Food Guide to Healthy Eating as a tool. Nutrient-dense foods supply plenty of vitamins, minerals, proteins and carbohydrates that your body needs, making every bite count. Some examples include whole grain breads and cereals, lean meats, low-fat dairy products and fresh fruits and vegetables. Talk with your healthcare team about whether you should incorporate vitamin or mineral supplements into your diet.

If, on the other hand, your disease is active, diet modifications may help manage UC symptoms such as cramping, bloating, gas and diarrhea. It is important that dietary changes do not compromise your health, so be sure to maintain your weight, energy levels and a healthy relationship with food.

Diet modification strategies should always be undertaken with your doctor's input. It is important to monitor what's been changed, ensure it doesn't cause other problems with regular nutrition and keep an eye on how it has affected your symptoms. Keep a food diary that tracks what you eat and your associated symptoms.

Your doctor may recommend one of the following diet modification strategies to slow stool output:

• Increase fibre/increase soluble fibre
• Increase binding (stool thickening) foods
• Restrict dairy lactose (See Lactose intolerance section, below)
• Reduce fat
• Reduce simple sugars/fructose/sugar alcohols
• Use gas-reducing strategies (chewing foods well or planning on regular fruit snacks between meals)
• Reduce caffeine/eliminate guarana
• Reduce alcohol
• Modify spices and seasonings
• Adjust meal sizes and timing
• Separate solids from liquids

Ask your doctor for more information on implementing any of the above dietary changes.

Make sure you drink enough fluids (six to eight 8-ounce glasses of water per day, or more if you exercise or drink caffeinated beverages) to make up for the water you lose through diarrhea¹

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Lactose is a sugar commonly found in milk and dairy products.

While dairy products do not cause IBD and generally don't result in flare-ups, you may experience uncomfortable symptoms if you have lactose intolerance and drink milk or eat dairy products.

What is lactose intolerance?
In some people, drinking milk and eating dairy products can be the source of temporary gas, cramps, diarrhea and bloating.

Do I need to totally eliminate milk and other dairy products?
Tolerance of lactose-containing foods varies among individuals. For example, some people experience symptoms after drinking only a small amount of milk, while others can drink a glass or two of milk without problems. Also, some people eat smaller portions of foods that contain lactose so they may enjoy dairy products without problems.

Which foods contain the most lactose?

• Milk, buttermilk, ice cream, yogurt and cream contain the highest amounts of lactose
• Cheeses tend to have lower amounts of lactose per serving
• Processed foods may also include hidden lactose. Read labels for words such as casein (or caseinate), lactoglobulin, milk by-products, milk solids and whey, which indicate the presence of lactose

What are some alternatives?

• Lactase enzyme drops and caplets can be added to dairy products before they are consumed
• Pre-treated, reduced-lactose milk, such as Lacteeze^® (Gaylea) or 99.9% LactoseFree^® (Natrel)
• Calcium-fortified juice beverages
• Non-dairy milk substitutes can be used on cereals or in cooking
• Non-dairy, lactose-free soy or rice milks
• Yogurt can often be tolerated by people with lactose intolerance because yogurt has active cultures that help break down the lactose¹

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