Ulcerative colitis, the most common inflammatory bowel disease, can significantly interfere with quality of life for patients and families. There is no cure, so patients are forced to cope with a wide range of symptoms—from chronic diarrhea to fatigue to eye irritation to joint pain. These symptoms typically worsen over time, and even patients who achieve remission are constantly at risk of an unexpected flare-up.
Common conventional treatment options for ulcerative colitis include anti-inflammatory medications like aminosalicylates and corticosteroids, as well as other drugs like antibiotics and methotrexate. However, the side effects and questionable efficacy of some of these drugs have driven more patients and families to seek more natural options, such as nutritional supplementation. Because of the high demand among patients and families for natural ulcerative colitis therapies, it is possible to find a plethora of recommendations for such treatment methods online. However, only some of these options are backed by empirical evidence. When considering the possibilities for natural ulcerative colitis therapy, it can be helpful to know what researchers have uncovered about some of the most promising options.
Natural Ulcerative Colitis Therapy Through Supplementation with Anti-Inflammatory Compoundslate 1980s, for example, scientists first began examining the potential therapeutic effects of fish oils for ulcerative colitis patients. Because fish oils are high in omega-3 fatty acids, which have well-documented anti-inflammatory effects, researchers hypothesized that they might be able to combat inflammation in the GI tracts of patients with ulcerative colitis. However, clinical evidence supporting this hypothesis remains mixed, and scientists are still attempting to clarify the pathophysiological mechanisms through which fish oil supplements may ease symptoms in patients with ulcerative colitis.
More recently, scientists have been studying how curcumin, another compound with anti-inflammatory properties, may affect patients with ulcerative colitis. Curcumin is best known as the active chemical constituent in turmeric, a common spice, but it may also hold potential in therapeutic applications for a wide range of inflammation-related conditions. Although only a few rigorous research studies have been conducted so far, early evidence suggests that curcumin supplements may help prevent relapse in patients with ulcerative colitis, and it may also lower the risk of inflammation-related symptoms like nausea and loose stools. This may be particularly true of highly bioavailable curcumin supplements designed to optimize therapeutic benefits.
The Promise of Probiotics for Ulcerative Colitis Prevention and Relief
Over the last few years, probiotic supplements have become a growing area of interest for researchers studying natural ulcerative colitis therapy. Understanding the connection between probiotic supplements and the inflammation that characterizes ulcerative colitis has long been a goal for researchers. Currently, it appears that multiple factors play a role. By lining the intestinal tract and promoting the production of intestinal mucus, probiotics can help prevent “bad” bacteria from colonizing the gut microbiome.
Probiotics may also support the production of anti-inflammatory compounds and limit the activities of pro-inflammatory mediators. In a breakthrough study out of the University of North Carolina in 2017, researchers demonstrated a clear link between probiotics and NLRP12, a protein that normally suppresses inflammatory signals. They found that patients with ulcerative colitis had low levels of NLRP2 and microbial gut profiles that included more bacterial strains known to drive inflammation, such as Erysipelotrichaceae. Importantly, when protective bacteria known to produce anti-inflammatory compounds, such as Lachnospiraceae, were added to the gut microbiome, the scientists were able to reverse the effects of the low levels of NLRP2. Based on this success, there are now exciting opportunities for more studies on the effectiveness of probiotic supplementation as a natural ulcerative colitis therapy.
While a variety of bacterial strains have been studied, two strains in particular—Escherichia coli Nissle 1917 and VSL #3—have strong evidence from multiple studies supporting their efficacy for the prevention and treatment of mild to moderate cases of ulcerative colitis. In several trials, they have been shown to reduce disease activity and/or lower the risk of remission. As yet, it is not entirely clear why these two bacterial strains stand out among the rest—in fact, some researchers suspect that it is simply a lack of rigorous research on other strains. Future randomized, controlled trials may demonstrate that other strains can be just as effective.
As in all gastrointestinal treatments, the efficacy of particular bacterial strains may also depend on the microbial composition of the individual patient’s gut. As such, some researchers are recommending probiotic-based, natural ulcerative colitis therapy that is tailored to the patient’s microbiome. The idea is that the microbial composition of the patient’s gut will be examined, and the patient’s probiotic supplementation regimen will be determined based on the particular beneficial strains that are lacking from that microbiome. Ideally, this strategic supplementation would make the patient’s microbiome look like that of a healthy patient.
Ginseng and Fiber Supplements: Combining the Benefits of Anti-Inflammatory and Probiotic Supplements
Among the many herbal supplements that have been proposed for the treatment of ulcerative colitis—most of which remain unsubstantiated by rigorous research—ginseng appears to be one of the most promising. Preliminary research suggests that ginseng has direct anti-inflammatory effects and can also support the gut microbiome. In one study, researchers identified a specific biochemical mechanism through which ginseng can reduce inflammation: by promoting the apoptosis (controlled cell death) of inflammatory cells. Additionally, there is evidence indicating that ginseng can support the growth of beneficial gut bacteria in vitro and in rat models of ulcerative colitis.
Certain fiber supplements—including oat bran, wheat bran, psyllium, and germinated barley—have also been associated with declines in disease activity in small-scale studies of patients with ulcerative colitis. In addition to the general observation that fiber consumption is associated with a reduction in system-wide inflammatory markers, there is some evidence to suggest that fiber supplements directly support “good” gut bacteria. For instance, in one study, an oat bran supplement significantly increased stool concentrations of butyric acid, a compound that is known to be produced by beneficial bacteria and that can directly combat inflammation in the GI tract through a variety of mechanisms.
Lifestyle Interventions for Ulcerative Colitis: The Evidence for Diet and Exercise
While the supplementation options for patients with ulcerative colitis abound, the possible dietary interventions are even more numerous. With a quick web search, patients can find everything from strict exclusion diets to general guidelines for foods to avoid. While some patients have found relief from options like low-residue or semi-vegetarian diets, research-based evidence supporting these strategies is limited. Without rigorous research to support specific dietary interventions, many health professionals remain skeptical. Patients can certainly adopt a diet if they find it makes them feel better, but more extensive clinical studies are needed before the research and clinical communities embrace any single ulcerative colitis diet.
The research supporting regular exercise as a natural ulcerative colitis therapy is more concrete. From a biochemical perspective, exercise causes muscle cells to release myokines, which are small proteins that combat inflammation. Exercise is also a well-known stress reliever, and effective stress management may aid in the prevention and management of ulcerative colitis flare-ups. Plus, exercise can naturally help combat some of the most common complications of ulcerative colitis, including low bone density, mental health problems, and weight management challenges. While some clinical studies indicate that the physical activity of some ulcerative colitis patients may be limited by the severity of their symptoms, the results are generally positive for patients who are able to engage in general exercise.
Choosing Between Natural Ulcerative Colitis Therapy Options
With so many natural ulcerative colitis therapy options available, it can be a challenge for patients and practitioners to identify the most effective combination for each particular case. Based on the existing research, high-quality supplements that have anti-inflammatory properties and/or support the health of the gut microbiome can be a great place to start. Lifestyle interventions like diet and exercise can also be effective on a case-by-case basis. As future clinical studies provide more evidence for or against specific interventions, it may become easier for patients and practitioners to navigate the many options and create treatment plans that provide meaningful and durable symptom relief.
Barbalho SM, Goulart RA, Quesada K, Bechara MD, Carbalho ACA. 2016. Inflammatory bowel disease: Can omega-3 fatty acids really help? Annals of Gastroenterology. 29(1):37-43. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4700845/
Bliski J, Brzozowski B, Mazur-Bialy A, Sliwowski Z, Brzozowski T. 2014. The role of physical exercise in inflammatory bowel disease. BioMed Research International. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4022156/
Chen L, Wilson JE, Koenigsknecht MJ, Chou WC, Montgomery SA, et al. 2017. NLRP12 attenuates colon inflammation by maintaining colonic microbial diversity and promoting protective commensal bacterial growth. Nature Immunology, 18(5):541-51. https://www.ncbi.nlm.nih.gov/pubmed/28288099
Chibbar R, Dieleman LA. 2015. Probiotics in the management of ulcerative colitis. Journal of Clinical Gastroenterology. 49(1):S50-5. https://www.ncbi.nlm.nih.gov/pubmed/26447965
Fedorak RN. 2010. Probiotics in the management of ulcerative colitis. Gastroenterology & Hepatology. 6(11):688-90. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3033537/
Garg SK, Ahuja V, Sankar MJ, Kuma A, Moss AC. 2012. Curcumin for the maintenance of remission in ulcerative colitis. Cochrane Database of Systematic Review. 10:CD008424. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4001731/
Guo M, Ding S, Zhao C, Gu X, He X et al. 2015. Red ginseng and semen coicis can improve the structure of gut microbiota and relieve the symptoms of ulcerative colitis. Journal of Ethnopharmacology. 162:7-13. https://www.ncbi.nlm.nih.gov/pubmed/25554637
Haskey N, Gibson DL. 2017. An examination of diet for the maintenance of remission in inflammatory bowel disease. Nutrients. 9(3):259. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5372922/
Jin Y, Hofseth AB, Cui X, Windsut AJ, Chumanevich AA et al. 2010. American ginseng suppresses colitis through p53 mediated apoptosis of inflammatory cells. Cancer Prevention Research. 3(3):339-47. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2833220/
McCall TB, O’Leary D, Bloomfield J, O’Morain CA. 1989. Therapeutic potential of fish oil in the treatment of ulcerative colitis. Alimentary Pharmacology & Therapeutics. 3(5):415-24. https://www.ncbi.nlm.nih.gov/pubmed/2562385
Narula N, Fedorak RN. 2008. Exercise and inflammatory bowel disease. Canadian Journal of Gastroenterology. 22(5):497-504. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2660805/
Rios-Covian D., Ruas-Madiedo P, Margolles A, Guiemonde M, Reyes-Gavilan CG, Salazar N. 2016. Intestinal short chain fatty acids and their link with diet and human health. Frontiers in Microbiology. 185. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4756104/
Ulcerative colitis. NIH. https://www.niddk.nih.gov/health-information/digestive-diseases/ulcerative-colitis