Symptoms of ulcerative colitis (UC), like diarrhea and loss of appetite, can increase your risk of malnutrition. Working with a dietitian who specializes in UC can help ensure you’re getting the nutrients you need.
UC is a type of inflammatory bowel disease (IBD) that causes inflammation and ulcers in the lining of the large intestine, or colon. People with UC may experience a variety of digestive issues, including bloody stools, weight loss, and loss of appetite. These effects can lead to other complications, including nutritional and health-related issues.
Malnutrition is a common problem in IBD patients, affecting up to 62% of UC patients. Malnutrition is a condition in which the body does not get enough or an imbalance in the intake of energy and nutrients it needs to perform its daily functions. Malnutrition can result from a variety of factors and can have significant effects on gut health and overall health.
Here, experts discuss the link between UC and nutritional health, and also explain steps people can take to prevent malnutrition and its associated complications.
In UC, several factors can cause malnutrition: Many of these factors act simultaneously to worsen gut health and nutritional status.
“Active inflammation in the large intestine can lead to poor absorption of nutrients, loss of protein in the stool, and loss of vitamins and minerals,” says Minnesota gastroenterologist Christopher Stevens, M.D. “On the other hand, inflammation increases a person’s body’s nutritional needs.”
“Patients may avoid certain foods or avoid eating them altogether, which can worsen symptoms such as abdominal pain or diarrhea,” he added.
“Certain medications that people with UC take can decrease the absorption of certain nutrients and lead to deficiencies,” says IBD registered dietitian Brittany Rogers, MS, RDN, CPT.
Collectively, these factors affect how well the body absorbs nutrients from the food a person eats and can lead to vitamin deficiencies, energy insufficiency, and a variety of nutrition-related complications.
“The people at highest risk of developing malnutrition are those with the highest symptoms and disease burden,” Stevens explained. “Colon inflammation is the primary driver, so patients with severe pancolitis (inflammation of the entire colon), hospitalized patients, and patients requiring advanced medical care or surgery are likely to be most likely to develop malnutrition.”
Rogers noted other potential risk factors for malnutrition include:
- Loss of appetite or skipping or avoiding meals to avoid symptoms
- Avoiding multiple foods and food groups
- experience nausea or vomiting
“The primary sign or symptom of malnutrition that patients or caregivers will notice is sudden, unintentional weight loss or being very low weight for height,” Stevens said. “Sudden weight gain in patients with uncontrolled UC can also be another sign of malnutrition.”
Other symptoms people may notice include:
- Significant hair loss or changes in hair texture
- Loss of muscle mass or strength
- Visible changes in the appearance of the face or body
- Slower wound healing
- Bruises
- Swelling in the legs, ankles, or feet
- Malaise
- Frequent illnesses and long recovery periods
- Depression and anxiety
“There are two simple questions people can ask themselves to self-screen for malnutrition: ‘Have I lost weight recently, unintentionally?’ and ‘Have I lost my appetite and therefore eaten less?'” says Rogers. “If you answer yes to either question, you may be at risk for malnutrition and should see a registered dietitian who specializes in IBD.”
Malnutrition in UC is often accompanied by deficiencies of various micronutrients, including:
- Vitamins such as A, B6, B12, D, E, and K
- Minerals such as iron, calcium, and magnesium
- Trace elements such as selenium, zinc, and manganese
A deficiency in these compounds can affect the body’s ability to perform functions and lead to health problems such as:
- Anemia or low blood counts
- Increased risk of fractures
- Impaired wound healing
- Blood clots
- Increased inflammation
Malnutrition may also reduce the effectiveness of UC treatment.
“Protein loss and malnutrition make many of the best treatments, such as biologics, less effective because they rely on protein transport in the blood,” Stevens said. “Continued protein loss can mean that medications are lost in the stool and IVs and injections become ineffective.”
“Similarly, if an illness requires surgery, being malnourished can make it much more difficult to have a successful operation and recover,” he added.
Rogers also said malnutrition
“The best thing people can do is make sure they’re really engaged with their gastroenterology team,” Stevens says.
This includes regularly monitoring for signs of malnutrition, such as changes in appetite, unexplained weight loss, changes in nutritional test results, etc. Gastroenterologists can also help UC patients get into remission and reduce the chance of complications from the disease.
“I also encourage all UC patients to meet with a registered dietitian who has a special interest in helping people with IBD,” Stevens says.
Dietary recommendations to avoid malnutrition are given individually based on your individual needs and symptoms but may include:
- Eat a varied diet rich in fruits and vegetables
- Avoid highly processed foods and sugary drinks
- Stay away from ketogenic diets
“For people who are losing weight because they’re afraid of eating inflammatory foods, I tell them that no food is more inflammatory to the body than malnutrition,” Rogers says. “So worry less about what you’re going to eat and just worry about eating more now.”
People with UC and malnutrition should be closely monitored by their UC care team and nutrition team to make sure they are getting the care they need.
“I actively monitor my UC and adjust medications to ensure I’m in remission,” Stevens says. “More frequent lab tests may be required to track vitamin, nutrient, and inflammatory marker levels.”
In severe cases, hospitalization may be necessary to restore safe electrolyte and nutrient levels and prevent serious complications.
Diet expert Rogers recommends a number of different ways to increase your nutrient and calorie intake, including:
- Aim for three balanced meals and three snacks per day
- Taking oral nutritional supplements or protein drinks in addition to or between regular meals
- Add healthy fats to your diet, such as avocados, olive oil, nut and seed butters, and tahini-based sauces.
- Eat homemade baked goods
A registered dietitian or gastroenterologist who specializes in IBD can provide additional support and more tailored recommendations if needed.
“Malnutrition in UC patients is very common but often goes unrecognized,” Stevens says. “UC patients should ask their healthcare providers about malnutrition and work with an IBD dietitian for advice on managing and preventing malnutrition. Good nutrition is increasingly being recognized as a key component in achieving the best outcomes and quality of life for UC patients.”
