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Yes, Where Do I Start?

Your Guide to Identifying and Reducing the Symptoms of Colitis

Understand How Colitis May Affect You and Ways to Feel Better

It would be wrong to sugarcoat it — struggling with the symptoms of colitis can be miserable. Colitis affects all aspects of life, causing symptoms that can include everything from bloody diarrhea and abdominal pain to fatigue, joint pain, and brain fog.   

On a more positive note, I frequently see patients with this condition transform their symptoms with the right diet, lifestyle and functional medicine approaches.

symptoms of colitis: Illustration of the large intestine against an image of a man with a stomachache

What Is Ulcerative Colitis?

Colitis, or more correctly, ulcerative colitis (as it can cause ulcers), is the most common form of inflammatory bowel disease or IBD (the other main type is Crohn’s disease). 

It’s an inflammatory condition of the colon (bowel or large intestine) that causes tissue damage to the lining of the rectum and colon. When you see blood in your stool, that’s a result of colon damage.

To get to a diagnosis of ulcerative colitis, you may have blood tests and gastroenterology-related tests such as a sigmoidoscopy, colonoscopy, biopsy, and x-rays.  

The most common gut symptoms of colitis are as follows [1]:

  • Bloody diarrhea with mucus (the main symptom)
  • Abdominal pain (in the lower abdomen)
  • Bowel urgency 
  • Tenesmus — a false feeling (often associated with cramping in the rectum) that you need to have a bowel movement, even if you’ve already had one

However, non-gut symptoms are also very common. These may include: 

  • Fatigue or malaise (a general feeling of lack of well-being)
  • Unexplained weight loss
  • Fever
  • Anemia
  • Eye inflammation problem, including redness, swelling, irritation, or blurred vision
  • Arthritic joints — for example, in the spine, knees, ankles, hips, wrists, or elbows
  • Painful nodules under the skin and ulcers on the skin
  • Hemorrhoids, occuring in 6.7% of ulcerative colitis patients who’ve had the condition for 10 years [2]
  • Brain fog — one of the common non-gut symptoms related to the systemic inflammation that occurs in people affected with IBD [3]

The Differences Between Colitis and Crohn’s

Colitis and Crohn’s disease are similar but occur in different places. Colitis affects the colon specifically, while Crohn’s disease may involve any part of the digestive tract from the mouth to the anus. You may also hear the term “pancolitis,” which refers to colitis that is present throughout the entire colon. 

Here is a quick glance guide to the primary differences in symptoms and where the inflammation occurs in each of these:

 Crohn’s DiseaseColitisPancolitis
Site of InflammationAnywhere along the gastrointestinal tract from mouth to the anus. Most commonly, it affects the lower part of the small intestine. Within the lining of the colon (large intestine or bowel) and rectum. It may be confined to the rectum, or extend further up into the colon. Still confined to the colon but in this more extensive form of colitis, inflammation occurs along the entire colon length. 
Common symptoms Upper or lower abdominal pain, gas and bloating, diarrhea (sometimes bloody). Also can include eye soreness, fatty liver, fatigue, weight loss and brain fog Lower abdominal and cramping, rectum pain, diarrhea with mucus and blood, eye inflammation, fatigue, brain fog.Colitis symptoms, but often at a higher intensity: abdominal cramps, urgency to empty the bowels, diarrhea with blood and mucus, fever, night sweat, weight loss.

Colitis (including pancolitis) and Crohn’s — the major types of inflammatory bowel disease — are both actually considered autoimmune diseases [4]. This is when your immune system has an overactive response causing your body to attack its own tissues (in this case, the lining of the colon).

Symptom Flare-ups are Common

Colitis is a condition that often occurs in waves. In other words, you are likely to have periods with only mild symptoms of colitis (a welcome relief), but then they may come back again with a vengeance (not so great). About 30% of people who are currently in remission from colitis will have a flare-up within the next year [5].

After having ulcerative colitis for eight years, your risk of developing colon cancer starts to rise according to the Crohn’s and Colitis Foundation. So having your regular colonoscopy is vital, as is doing all you can to understand the condition and improve your health.

Causes of Colitis

symptoms of colitis: Doctor holding a clipboard with ulcerative colitis written on it

It’s not entirely clear why some people get colitis, but risk factors include: [1

  • Having an overactive immune system
  • Hereditary factors, with some types of genetic make-up being more susceptible than others
  • Environmental factors that can initiate the harmful immune response in the intestines
  • Imbalances or issues within the gut, including SIBO and leaky gut

Could a Leaky Gut Be Contributing to Your Colitis Symptoms?

symptoms of colitis: Illustration of a normal and a leaky gut

Increased intestinal permeability, or leaky gut, occurs when the tight junctions between the cells that line your small intestine loosen, allowing undigested food particles, bacteria, or other irritants to “leak” into your bloodstream, stimulating an unwelcome immune response. 

There’s some fairly persuasive evidence that having a leaky gut could certainly perpetuate symptoms of colitis, in particular chronic inflammation [6].

Some pointers in this direction include: 

  • A 2019 review of 47 studies concluded that inflammatory bowel disease is among the chronic conditions most strongly associated with leaky gut [7]. 
  • Research has shown that when patients with IBD (in this case Crohn’s disease) experience a disease flare, their intestinal permeability clearly increases and appears to decrease as their symptom flare resolves [8]. 

Disrupted Gut Microbiota and SIBO 

Another theory is that alterations to the gut microbiota (the large collection of mostly friendly bacteria, yeasts and other organisms that reside in our colon) may contribute to ulcerative colitis development [9, 10].

In some countries, a positive association between childhood antibiotic use and later risk of IBD (especially Crohn’s disease) has been noted [11]. Antibiotics can interfere with the healthy balance of bacteria in our digestive tract, and a secondary effect may plausibly be an increase in the risk of inflammatory bowel disease. 

SIBO, or small intestinal bacterial overgrowth, may also play a role in the development of colitis. A 2019 systematic review and meta analysis of 11 observational studies concluded that incidence of SIBO was higher in people with IBD compared to controls [12].

Ways to Tame Colitis Symptoms

Various healthy food ingredients on a wooden surface

Treating the symptoms of colitis involves reducing inflammation and restoring immune system function. Mainstream treatments for ulcerative colitis and its flare-ups include anti-inflammatory aminosalicylates and biologics that tame the immune system. Sometimes, oral or rectal corticosteroids, such as prednisone, are also used. 

There are also a number of more natural ways to address and reduce inflammation, including with diet and certain supplements. These ways of tackling the symptoms of colitis may ultimately be gentler on your body and tackle the underlying causes better.

Potential Diet Therapies for Ulcerative Colitis

Diet-wise, a good place to start is with an anti-inflammatory diet rich in whole, real foods, such as vegetables, fruits, grains, nuts and seeds, spices, herbs, healthy fats, and organic or free-range meat, poultry, and fish (and avoiding sugary, processed foods and too much alcohol). 

A Paleo diet ticks many of those anti-inflammatory healthy eating boxes for many people and is the basic healthy regimen I recommend to most of my patients.

However, if your symptoms don’t improve with Paleo, you can move onto a more specialized diet, such as a low FODMAP diet or an autoimmune Paleo (AIP) diet.


FODMAPs are groups of carbohydrates that can feed bacterial overgrowths and cause digestive symptoms in some people.

In the low-FODMAP diet, which has been well studied in people with irritable bowel syndrome and SIBO, you remove FODMAPs from your diet and then reintroduce them in a controlled way to find your tolerance level.

There is some good evidence for the benefits of using a low-FODMAP diet to treat the symptoms of colitis and inflammatory bowel disease:

  • A comprehensive 2018 review involving a total of 319 patients found that a low-FODMAP diet helped reduce diarrhea, bloating, pain, fatigue, and nausea, in patients with inflammatory bowel disease (IBD) that wasn’t currently flaring [13].
  •  A 2017 randomized controlled trial (89 patients) found that a low-FODMAP diet improved IBS-like symptoms and increased quality of life in patients with inactive Inflammatory Bowel Disease (IBD) [14].
  • A 2020 randomized controlled trial (52 patients with inactive Crohn’s or colitis) found that a low-FODMAP diet improved symptoms and reduced the loss of healthy bacteria thought to regulate the immune response [15].

Autoimmune Protocol (AIP) Diet

The autoimmune protocol diet — also known as the autoimmune paleo or AIP diet — is a more restrictive diet than the standard Paleo. However, it may be applicable if you have stubborn gut symptoms related to autoimmunity.

  • A 2019 trial with six ulcerative colitis and nine Crohn’s disease patients found that an 11-week AIP diet for patients with active inflammatory bowel disease (IBD) improved their quality of life [16].
  • A 2017 observational study (15 patients) also found AIP improved symptoms of inflammatory bowel disease. Six of seven patients who had follow-up endoscopies at week 11 showed signs of mucosal healing [17].

On a practical level, you’ll remove more potentially inflammatory foods than you would in a straight Paleo regimen such as eggs, nightshades, and other potential triggers for autoimmune disease. However, as your symptoms improve, you can experiment with re-introducing healthy foods one at a time and monitor how your body responds. 

Elemental Diet (Meal Replacement Regimen)

In some cases, your gut needs a more thorough reset in order to heal, which is where an elemental diet regimen may come in. In my clinical experience, the elemental diet is one of the most helpful therapies for stubborn symptoms of IBD.

An elemental diet is a liquid hypoallergenic meal replacement where the nutrients are fully digested, or broken down into elements. Elemental diets function as antibacterial, because they’re devoid of fiber and prebiotics that feed bacteria. They’re also anti-inflammatory, because the food particles are hypoallergenic and predigested.

  • Elemental diets have been shown to be an effective treatment for IBD in a number of clinical trials, decreasing inflammation, reducing autoimmunity, and preventing relapses [18, 19, 20, 21, 22, 23, 24, 25].
  • One study found that use of an elemental diet alone was even more effective than corticosteroids at healing inflammatory gut lesions in pediatric Crohn’s disease [26]. 

Elemental diets can be used as a complete meal replacement for a quick reset or for 2-3 weeks for stubborn cases. The elemental diet may also be used as an occasional meal replacement while following an anti-inflammatory diet.


Because probiotics can help to reduce inflammation and improve the balance of bacteria in the gut microbiome, colitis symptoms may improve if you take probiotics. Several studies have found this to be true:

  • One systematic review found that probiotics were effective at putting active ulcerative colitis into remission, especially when multiple strains were taken together [27].
  • Another study found that a specific probiotic strain was as effective as the anti-inflammatory medication mesalamine (an aminosalicylic drug) at preventing a colitis relapse [28].
  • A further clinical trial found that the probiotic strain Saccharomyces boulardii led to resolution of abdominal symptoms and improved the gut microbiome in IBD patients [29].

That said, not all studies on probiotics and colitis have yielded positive results, and probiotics can produce different results in different people. For example, a systematic review of four trials involving 587 ulcerative colitis patients in 2011 found probiotics didn’t help people maintain longer remission periods [30].

Natural Antimicrobials

Research suggests that antimicrobials may also be helpful in colitis. The theory is that antibacterial agents help to kill off some of the “bad bugs” and bacterial overgrowth that can contribute to inflammatory bowel symptoms. Some doctors may advise a conventional course of antibiotics for colitis, but there is some decent research backing more natural alternatives, including a comprehensive review of 1,484 subjects that found [31]:

  • Aloe vera gel, wheatgrass juice, Andrographis paniculata (green chireta) extract and topical Xilei-san were better than placebo at inducing remission or improvement in ulcerative colitis patients.
  • Curcumin (the active ingredient of turmeric) was better than placebo at maintaining colitis remission. 
  • Boswellia serrata (Indian frankincense) gum resin and Plantago ovata (desert Indian wheat) seeds were as effective as mesalamine at preventing colitis relapse.

It’s best to introduce these treatments one at a time, so that you can see what’s helping and what isn’t. Start by modifying your diet, then introduce probiotics, and add natural antimicrobial agents if your symptoms haven’t improved sufficiently. 

Symptoms of Colitis: The Bottom Line

While colitis symptoms may be tough to deal with, you can make strides towards fewer, less debilitating flare-ups by focusing on improving your gut health. To that end, find an anti-inflammatory diet that’s right for you and incorporate supplements and nutrients.

For more advice on how to transform your gut health and overall wellbeing, there’s plenty of useful advice in my book Healthy Gut, Healthy You. Or for more personalized advice, consider scheduling a virtual or in-person consult at our functional medicine center.

➕ References
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