This article is for informational purposes only. None of the information here should be taken as medical advice. If you suspect you may have digestive issues, seek medical help.
You may try the complementary approaches listed below if you and your doctor determine that they could be appropriate for you. Discuss the strategies listed here with your doctor. Remember that none of them should ever be done in place of what your doctor recommends or prescribes.
Crohn’s disease (CD) and ulcerative colitis (UC) are two of the most frequently diagnosed subtypes of inflammatory bowel disease (IBD). The cause of IBD lies in a complex interplay of genetic and environmental factors .
Crohn’s mostly affects the small intestine and involves ulcerations of all cell layers of the gut lining. Ulcerative colitis typically affects the colon and rectum, and involves the inflammation of the gut mucosal layer [2, 3].
FODMAPs are a group of carbohydrates identified as some of the prime irritants in IBD. FODMAPs is a catchy acronym that stands for Fermentable Oligosaccharides, Disaccharides, Monosaccharides, And Polyols, such as [4, 5, 6]:
- Fructans and galactans
- Polyols (sugar alcohols)
Some experts recommend a low FODMAP diet to help control the symptoms of ulcerative colitis and Crohn’s disease. This diet isn’t appropriate for everyone—talk to your doctor or dietician to determine whether it could be right for you.
For more about the low FODMAP diet, check out this post on how it works and this post on which foods are included.
The low FODMAP diet eliminates specific foods that may trigger gut inflammation.
A recommended dietary pattern to keep IBD in remission also includes :
- Increased intake of fiber, especially from fruits and vegetables
- Avoiding processed vegetable oils
- Cutting back on red meat
- Reduced intake of sweets and refined carbs
The Mediterranean diet generally follows the above pattern. It’s rich in fruits, vegetables, nuts, whole grains, and olive oil. It implies a moderate intake of fish while cutting back on red meat and sweets.
Some experts recommend the Mediterranean diet as a complementary approach to digestive disorders such as IBD. The incidence of IBD is lower in the Mediterranean regions, compared with northern Europe [10, 11. 9].
Due to high fiber content, IBD patients may want to avoid this kind of diet during the active phases of “flares” .
Eat More Fish
In a small clinical trial on 20 people with ulcerative colitis, a commercial extract with the green tea polyphenol epigallocatechin gallate (Polyphenon E) helped improve the symptoms and maintain remission. Green tea and its polyphenols were similarly effective in multiple studies of animals with colitis [15, 16].
Epigallocatechin gallate also improved pouchitis, a complication that may occur in ulcerative colitis patients after the surgical removal of the colon, in a pilot trial on 9 people .
So far, butyrate’s potential benefits have been better studied in ulcerative colitis than in Crohn’s disease. However, in one study of 13 people with Crohn’s disease, a type of IBD, butyrate supplements improved 69% of cases, with symptoms completely disappearing in 54% (seven participants) [18, 19, 20, 21, 22].
Butyrate is available as a supplement; dietary factors also affect how much butyrate is produced by your gut bacteria. The best foods to increase butyrate production are those with plenty of resistant starches—starch that you can’t digest, but that the gut flora can. Baked potatoes and green bananas are two good sources of resistant starch [18, 23, 24].
Smoking is clearly associated with an increased incidence of Crohn’s disease, while its effects on ulcerative colitis are less evident — this condition seems to be more common among former smokers but less among people who currently smoke .
While exercise helps prevent IBD, people with active disease may or may not be able to adjust their physical activity, depending on their condition. It’s essential to stay physically fit and exercise regularly as a means of prevention [30, 31, 32].
If you have IBD, we recommend talking to your doctor about how much physical activity would be beneficial in your case.
Many people with IBD develop anxiety and depression associated with their debilitating gastrointestinal symptoms. Furthermore, psychological stress may worsen the symptoms of IBD. Because of this potential feedback loop, many doctors emphasize the importance of managing the mental health of IBD patients [35, 36, 37, 38].
Stress raises inflammatory cytokines and worsens gut inflammation.
Taking 1,200 – 1,800 mg Andrographis daily for 8 weeks reduced the symptoms of mild-to-moderate colitis in adults; the 1,800 mg dose was more effective. However, it did not affect remission rates any more than placebo .
People with IBD often have impaired gut microbiome, which may worsen their disease. In a meta-analysis, a blended probiotic containing Lactobacillus and Bifidobacterium strains increased remission rates by 1.7x in ulcerative colitis patients .
Certain probiotic strains have been studied in people with Crohn’s disease, including Lactobacillus rhamnosus, Lactobacillus casei, Bifidobacterium breve, Bifidobacterium longum, and Saccharomyces boulardii. Of these, the first four showed some promise for people with active Crohn’s disease, while S. boulardii and L. rhamnosus may be helpful for keeping the disease at bay in patients in remission .
People with IBD may have alterations in their gut bacteria that result in lower production of butyrate, a short-chain fatty acid that preserves the ability of the gut lining to take up nutrients while blocking the absorption of microbes and their toxic products [48, 49].
The potential benefits of butyrate can be obtained by taking probiotics that restore the gut microbiota or supplementing with sodium butyrate.
High intake of fish oil omega-3 fatty acids may be protective against the development of Crohn’s disease .
It is unclear whether omega-3 supplementation can help Crohn’s disease that has already developed and progressed. However, multiple studies have suggested that omega-3s may help keep it in remission [8, 50].
Supplementation with 500 mg/day resveratrol for 6 weeks improved disease severity and quality of life by reducing inflammation and oxidative damage in 2 clinical trials on 106 people with ulcerative colitis [55, 56].
A study of over 400,000 men associated a high dietary intake of polyphenols, including resveratrol, with a lower incidence of Crohn’s disease .
Berberine is a compound found in several different plants, including barberry (Berberis vulgaris), oregon grape (Mahonia aquifolium), goldenseal (Hydrastis canadensis), and Chinese goldthread (Coptis chinensis). It has a 3000-year history of use in traditional Chinese and Indian medicine .
In a phase I trial on 16 people with ulcerative colitis, berberine (900 mg/day as an add-on to mesalamine) reduced gut tissue damage .
Berberine also improved IBD and prevented it from developing into cancer in animal studies by reducing inflammation and oxidative damage, restoring gut barrier function and microbiota, and regulating the development of T cells [67, 68, 69, 70, 71, 72].
Crohn’s disease (and the steroids used to treat it) have been linked to calcium and vitamin D deficiencies and subsequent osteoporosis. Your doctor will monitor your vulnerability to these deficiencies, and if appropriate, prescribe supplements. If vitamin D supplements are not recommended, the best way to make sure you’re getting enough is with moderate sun exposure [73, 74, 75].
Celiac disease is an immune gut disorder in which gluten, a protein found in most grains, damages the small intestine. The immune cells recognize gluten as a threat and trigger an aggressive inflammatory response, usually causing digestive issues and malabsorption [76, 77].
Gluten intolerance is a condition in which the body can’t digest gluten well. It results in similar digestive symptoms, but, unlike celiac disease, it may not cause inflammation or damage the gut .
Most people with celiac disease can manage the symptoms by following a strict gluten-free diet.
Celiac disease is a disorder in which the immune system causes inflammation and damages the small intestine in response to gluten, a protein found in most grains.
The only effective treatment for celiac disease is a strict gluten-free diet. Most people can successfully manage their symptoms by avoiding gluten. This protein is present in the following grains and their products :
Foods that are most likely to contain gluten include :
- Pies and sweets
- Meat substitutes
- Oats (often processed with other grains)
- Salad dressings and sauces
Gluten-free grains and pseudo-grains are :
The gluten-free diet has gained popularity among healthy people as well. However, it comes with a risk of certain deficiencies and may not necessarily be a healthy choice for someone who tolerates gluten and has no digestive issues [81, 82].
A strict, lifelong gluten-free diet is the only treatment for celiac disease. In most patients, it enables complete symptom control.
Preliminary research suggests that avoiding lectins may reduce the symptoms of autoimmune conditions in sensitive individuals .
Still, more research is needed to clarify the possible connection between lectins and autoimmunity in humans.
Gut damage and inflammation in celiac disease may cause temporary lactose intolerance. Such patients may need to avoid dairy until their gut lining recovers .
Elimination diets such as the Lectin Avoidance Diet may help identify and remove common food irritants — such as lectins, gluten, and dairy — that may be worsening autoimmunity in sensitive individuals [84, 85, 87].
Certain dietary compounds, such as lectins and dairy, may contribute to inflammation in people with celiac disease. Elimination diets may help identify these food sensitivities, although their therapeutic potential is not well-researched.
Patients with undiagnosed and untreated celiac disease often lack zinc and other nutrients due to impaired absorption .
On the other hand, a gluten-free diet (GFD) also bears a risk of zinc deficiency. In an extensive review of 73 studies, 40% of people on a GFD had zinc deficiency .
Best food sources of zinc include meat, seafood (especially oysters), and seeds .
Celiac disease patients are often zinc-deficient. In turn, the lack of this mineral may worsen inflammation by stimulating HLA class II molecules.
In one clinical trial, adding 900 mg of black seed oil daily to a gluten-free diet helped restore iron levels and reduce inflammation and gut damage. The same group of authors found that black cumin oil may help with dermatitis herpetiformis, a skin condition caused by CD [95, 96].
According to some authors, gut microbiome disturbance is one of the mechanisms by which the HLA-DQ2 haplotype contributes to celiac disease. It’s associated with fewer Bifidobacterium strains and more harmful strains such as Clostridium, Bacteroides, and Enterobacteria [97, 98].
Bacterial overgrowth in the small intestine may worsen celiac disease and hinder gut recovery .
Probiotic (Bifidobacterium spp.) supplementation in patients with celiac disease has yielded mixed results. In one trial, it improved the symptoms but not immunological markers. In another, it only improved lab markers of inflammation [99, 100].
In 109 patients with celiac disease and IBS, a mixture of probiotic strains significantly improved IBS symptoms .
Microbiome disturbance plays a role in celiac disease. Probiotic supplementation may help, but the results are inconclusive.
Multiple studies have found that certain dietary polyphenols conferred protection against peptic ulcers. Quercetin, a common flavonoid found in many fruits and vegetables, appears to protect the lining of the digestive tract by suppressing acid secretion [102, 103].
Some of the foods richest in quercetin include leafy green vegetables, red grapes, and berries.
Other polyphenols may protect the lining of the digestive tract by stimulating blood flow or preventing the release of histamine. Still others scavenge free radicals, inhibit oxidizing enzymes, and stimulate the body’s antioxidant defense mechanisms [103, 104, 105].
Garlic is a hotly debated complementary approach for ulcers. In a recent meta-analysis, its active compound allicin improved healing rate and remission of the symptoms when used as an add-on therapy in case of H. pylori infection with ulcers .
However, the authors of this analysis noted that the evidence was still relatively weak and in need of further investigation.
Garlic can be irritating on the stomach, so caution is advised if you already have ulcers.
Some documents and guidelines advise against eating chili peppers if you have ulcers, but a surprising amount of research has suggested that capsaicin, the active ingredient in chili, could actually be beneficial [107, 108, 109].
Capsaicin inhibits the growth of H. pylori bacteria, which may explain why people given chili powder healed more quickly than their peers in a study of 50 ulcer patients .
This compound prevents stomach ulcers in animals, and may also help heal existing ones. It inhibits stomach acid secretions, reduces acidity, promotes mucus secretion, and stimulates blood flow in the stomach .
We advise caution with capsaicin if you already have stomach ulcers, because it can also irritate the stomach.
Extracts from cruciferous vegetables such as kale and cabbage prevented the development of ulcers in different animal models by stimulating the production of mucus and lowering stomach acids [112, 113, 114].
In H. pylori-infected type 2 diabetic patients, broccoli sprout powder, in addition to standard triple therapy, considerably improved H. pylori eradication. It also improved markers of heart health in these subjects .
Most doctors and researchers agree that psychological stress and peptic ulcers are closely linked. In fact, a cohort study of 17,525 Danish adults found that people under high stress were more than twice as likely as people under low stress to develop ulcers [121, 122].
Anxiety disorders, personality disorders, and panic disorders have also been directly linked to peptic ulcers. One study further found that alcohol or nicotine dependence exacerbated the connection between anxiety and ulcers; that is, people with anxiety disorders who were also dependent on alcohol or nicotine were even more likely to have ulcers [123, 124].
A large body of research suggests that managing stress is very important for healing peptic ulcers. Some researchers have recommended the inclusion of cognitive behavioral therapies and other psychological strategies to help manage family, job, economic, and workload problems .
In a study of 88 patients with indigestion positive for H. pylori, black seed helped eradicate the bacteria and symptoms. A minimal dose of 2 g of the seeds (in combination with omeprazole) was effective and comparable to standard triple antibiotic therapy, while both lower and higher doses were less efficient .
Ginger increased protective prostaglandins in the stomach lining in 43 osteoarthritis patients who used NSAIDs long-term. Ginger could potentially be useful in people who developed ulcers from NSAIDs, but further clinical trials are needed .
Licorice was a good adjunctive treatment to standard clarithromycin triple therapy in the treatment of H. pylori in a clinical trial on 120 people and increased the eradication rate by about 20% .