Ulcerative Colitis (UC) is one of a subset of Irritable Bowel Syndrome (IBS) conditions that also includes Crohn’s Disease (CD). While Ulcerative Colitis is confined to the large intestine (colon), Crohn’s Disease can affect both the colon and the small intestine. When the bowels become inflamed, for whatever reason, they are not able to properly absorb nutrients and process food in a healthy way. This can lead to a host of issues that include malnutrition, cramps, bleeding, diarrhea and anemia.

Your doctor and gastroenterologist are invaluable for developing a diagnosis and will most likely need to do a colonoscopy to make a definitive determination. You will most likely be prescribed a steroid of some sort to help with healing and a “maintenance” medicine to take when you are “better”, which means not showing symptoms. When you are showing symptoms, you are said to be in a “flare” and your maintenance medicine will help prevent and mitigate future flares.

There is a lot of information available relating to additional dietary steps you can take, including the Specific Carb Diet (SCD) and other similar diets that will help get you out of a flare and help prevent future flares by focusing your attention on different foods that cause your digestive system to respond in adverse ways. This is where the real trouble for the patient begins.

There are too many testimonials that start with a patient being told that what they eat does not matter and that success is wholly dependent upon pharmacological solutions. The treatment suggestions below from the Journal of the American Medical Association(JAMA) notably leave out any reference to diet and suggest that patient who are non-responsive to medical intervention should be reviewed for colectomy.

TREATMENT – JAMA 1/4/2012 – Janet M. Torpy, MD, Writer; Cassio Lynm, MA, Illustrator; Robert M. Golub, MD, Editor

• Medications including aminosalicylates (drugs related to aspirin), steroids, immunosuppressive agents, and other anti-inflammatory medications are often used alone or in combination to reduce injury to the lining of the colon.
• Anxiety and depression should be treated if present. It is common to have these mental health issues along with any chronic disease. Stress reduction techniques may also help to reduce intestinal symptoms, even though stress is not a cause of the disease.
• In more severe ulcerative colitis, consultation with a surgeon may be necessary. Removal of the involved part of the colon, called a colectomy, may be required if treatment with medications does not help.
• Individuals who have ulcerative colitis may have an increased risk of developing colon cancer.

The Royal College of Nursing comes close to the issue in their clinical guidelines.

National Collaborating Centre for Nursing and Supportive Care (UK). Irritable Bowel Syndrome in Adults: Diagnosis and Management of Irritable Bowel Syndrome in Primary Care [Internet]. London: Royal College of Nursing (UK); 2008 Feb. (NICE Clinical Guidelines, No. 61.) 7, Diet and lifestyle. Available from: http://www.ncbi.nlm.nih.gov/books/NBK51960/

• The notion of food intolerance and food allergy is not new and many IBS patients give a history of food intolerance, although few clinicians consider food hypersensitivity to be a cause of IBS.

The problem with the statement above, is that it seems to be largely misunderstood by the medical community. The idea that IBS and related conditions are not caused by food hypersensitivity does NOT mean that such hypersensitivity does not exacerbate the condition. The volume of anecdotal evidence and the successes when using the Specific Carb Diet (SCD) to treat IBS clearly indicate a very strong dietary component and doctors are doing their patients a disservice by ignoring this aspect in the treatment regimen.

The next issue we have run into, is many of the people advocating the various dietary solutions, have been less than thorough in either their research or their reporting. We have found misinformation, contradictions and omissions in well intentioned and otherwise well founded programs.

Compounding the medical reluctance and the non-medical exuberance is the fact that dietary needs seem to change as the individual advances in the healing process. Foods that were initially not tolerated may become tolerated while others may never be tolerated. The SCD allows all types of meat, even in the initial stages but there are some patients who do not tolerate beef well initially and later only in smaller quantities. This leads to the “individualization” of the diet in ways that can, at times be quite confusing.

Many IBS patients would benefit if the medical institutions would embrace the effect diet has on the treatment of these conditions and would support more objective studies to help determine what dietary changes have the most impact and greatest benefit. A set of guidelines could then be developed that would contain fewer “exceptions” and would be more helpful in navigating the times when proscribed procedures don’t seem to be working.