Managing Ulcerative Colitis: Why Lifestyle Remedies Aren’t Always Enough

Role of lifestyle changes and supplements

UC affects people differently, so you may see an improvement in your condition with lifestyle changes and supplements. These lifestyle changes aren’t meant to replace a medication regimen. Talk with a doctor to see if adding these to your daily routine is safe and advisable.

Diet doesn’t cause UC, but avoiding certain foods may lessen the severity of flare-ups and reduce symptoms. These include greasy foods and vegetables that cause gas, like cauliflower and broccoli. Avoiding high fiber foods, lactose, and caffeine may also improve your symptoms. A 2023 paper states that dietary changes can help reduce symptoms of UC.

Some people with UC notice positive changes resulting from light exercise, relaxation techniques, and breathing exercises. These activities may reduce stress levels and help you cope with flare-ups.

Some nutritional supplements may also be helpful. Studies have shown that taking fish oil and probiotics may have a role in helping people with UC. Fish oil may help reduce inflammation, and probiotics can add good bacteria to your intestinal tract.

While lifestyle changes and supplements may help ease symptoms, they aren’t enough to manage UC alone. UC is a chronic condition that can lead to serious complications without proper medical treatment. The primary goal of care is achieving and maintaining remission, which typically requires prescribed therapies alongside supportive measures.

Here are some reasons why you can speak with your doctor or gastroenterologist about prescription medications and treatment.

Ulcerative colitis complications

Lifestyle changes and supplements may not control flare-ups as effectively as prescription medications. As a result, you may continue to have repeated bouts of diarrhea and bloody stool. The more attacks you have, the greater risk you have for complications and the more inflammation you’ll experience. Research shows that inflammation plays a key role in the development of colorectal cancer in people with UC.

Sores or ulcers in the lining of your colon can bleed and lead to bloody stools, while long-term intestinal bleeding can cause iron deficiency anemia. Symptoms of this condition include dizziness, fatigue, and lightheadedness. Your doctor can recommend iron supplements to correct this deficiency, but it’s also important to treat the underlying cause of bleeding. A prescription medication for UC can stop inflammation and heal ulcers in your colon.

Chronic diarrhea from UC can also cause problems. Diarrhea can decrease your fluid levels, causing dehydration and electrolyte imbalances. Signs of dehydration include:

• excessive thirst
• low urine output
• headaches
• dry skin
• dizziness
• confusion

Drinking more fluids can counter the effects of diarrhea. However, medication can treat the source of the inflammation to control symptoms and stop repeated relapses.

Drug therapies

There isn’t a cure for UC, but remission can make it feel like the condition is no longer affecting your daily life. Several medications are available to help reduce flare-ups and keep symptoms at bay. Talk with your healthcare team about your options. With the right treatment, many people go months or even years with no symptoms.

Prescription medications and drug therapies to help manage UC include:

• Aminosalicylates (5-ASAs): Used primarily for mild to moderate UC, these drugs reduce inflammation in the lining of the colon. Options include sulfasalazine (Azulfidine), mesalamine (Pentasa), olsalazine (Dipentum), and balsalazide (Colazal, Giazo). This class of drugs is also recommended for maintenance treatment to help prevent flare-ups.
• Tofacitinib (Xeljanz): This is a newer option in a class of medications called Janus kinase (JAK) inhibitors. It works in a unique way to reduce inflammation in people with moderate to severe UC.
• Corticosteroids: Prescribed for moderate to severe flare-ups, this class of drugs, including prednisone or budesonide, reduces inflammation by suppressing the immune system. Because of potential side effects, they’re typically not intended for long-term or maintenance use.
• Immunomodulators: These medications, also for moderate to severe symptoms, help suppress the immune response and are often used in conjunction with a corticosteroid. A few options include azathioprine (Azasan, Imuran), tacrolimus (Prograf), and 6-mercaptopurine.
• Biologics: Used for moderate to severe UC that doesn’t respond to other treatments, these injections or infusions block the proteins that cause inflammation in your colon. Examples include:
  • anti-TNF agents such as adalimumab (Humira), infliximab (Remicade), golimumab (Simponi)
  • integrin receptor antagonists such as vedolizumab (Entyvio)
  • IL-12/23 inhibitors such as ustekinumab (Stelara)
• Targeted synthetic small molecules and JAK inhibitors: The first oral JAK inhibitor approved for UC in 2023 by the Food and Drug Administration (FDA), tofacitinib (Xeljanz) is used in moderate to severe cases, particularly when other biologics haven’t worked. Newer JAK inhibitors like upadacitinib (Rinvoq) have also been approved more recently. These drugs fall under a broader class known as targeted synthetic small molecules, which also includes newer options like ozanimod (Zeposia) and etrasimod (Velsipity). These medications work by selectively modulating immune pathways involved in inflammation.

Newer biologics such as risankizumab-rzaa (Skyrizi), mirikizumab-mrkz (Omvoh), and guselkumab (Tremfya) are also emerging options for people whose UC hasn’t responded to older therapies.

Surgery is another option, but only as a last resort in severe cases. Surgeons will remove the entire colon in the case of colon rupture or uncontrolled bleeding. High cancer risk is another reason surgery may be recommended.

Although the procedure can cure UC, it requires a permanent ileostomy, or creation of a J-pouch. An ileostomy is when the end of the small intestine is connected to an opening in the belly, called a stoma. Waste comes out through this opening into a special bag that sticks to the skin. It’s a new way for the body to get rid of waste in the colon’s absence.

Reduce the risk of colorectal cancer

Colorectal cancer is a significant complication of UC. The risk of developing this type of cancer depends on the severity of your symptoms and how long you’ve had the disease. However, remission may cut your risk of cancer.

Lifestyle changes and nutritional supplements aren’t meant to replace any recommendations or prescriptions from your doctor. When taken as directed, medications reduce inflammation in your colon and help you achieve remission sooner. The longer your disease remains in remission, the less likely you are to develop colon cancer and precancerous cells.

Being under the supervision of a specialist also gives your gastroenterologist the opportunity to monitor your condition over time and schedule appropriate screenings. Once you’re diagnosed with UC, you’ll need to receive periodic colon cancer screenings — how often depends on your own health and family history.

The takeaway

The outlook for ulcerative colitis (UC) is different for each person, but a combination of drug treatments, lifestyle changes, and nutritional supplements may get your symptoms under control so you have fewer relapses. Rather than let this disease control your life, take control of your disease and speak with your doctor about your best options.