Ulcerative Colitis (UC) is a type of inflammatory Bowel Disease (IBD) affecting the innermost lining (the ‘mucosa’) of the large intestine and/or rectum.
UC is an autoimmune-related disease in which the body attacks what would normally be healthy tissue, leading to inflammation and often debilitating symptoms.
Common symptoms of UC include:
- Diarrhea
- Abdominal pain or cramps
- Pus or mucus in the stool
- Rectal bleeding
- Weight loss
- Fatigue
- Constipation despite the frequent urge to defecate
- In some patients, symptoms outside the gut may occur such as joint pain and inflammation, small ulcers in the mouth, skin lesions, and eye inflammation
Ulcerative colitis treatment focuses on managing these symptoms by targeting the underlying intestinal inflammation.
Currently Accepted Treatments for UC
Several effective medical treatment options exist for ulcerative colitis.
Depending on your type of colitis, severity, and medical history, a gastroenterologist will monitor your medications before and during treatment and administer medical tests to track the success of the medication.
Your doctor will also conduct routine blood, urine, and stool tests to evaluate ongoing gut, liver, and kidney health.
5-ASA (Aminosalicylates)
Mesalamine (also called mesalazine) is usually the first step for mild to moderate colitis. These are also called 5-ASAs or aminosalicylates and are known to reduce inflammation in the large intestine or rectum. Topical, oral, and suppository options are available and will be recommended based on the main location of the inflammation and in dosages relevant to your level of severity.
An older, more systemic form of aminosalicylate is sulfasalazine. Mesalamine is observed to have fewer side effects than sulfasalazine, but headaches and/or rashes are common to both medications. This medication is typically prescribed to put patients into remission or to manage remission but may not be effective for patients in a flare-up or with more severe ulcerative colitis.
Corticosteroids
Corticosteroids, known colloquially as “steroids”, are synthetic substitutes for cortisol, a naturally-occurring hormone that reduces the production of inflammatory agents in the body. These medications are generally reserved for moderate to severe UC patients, usually after trying 5-ASAs.
Because of many potential side effects when used for a long time, steroids are preferably preserved for short-term treatment, usually no more than several weeks at a time, and mainly to induce remission, i.e. to get flare-up symptoms under initial control.
Immunosuppressants
Immunosuppressants such as 6-mercaptopurine, azathioprine, and methotrexate treat ulcerative colitis by suppressing the immune system’s response.
Since UC is considered a condition with over-activation of the immune system towards the gut, suppressing the activity of the body’s natural defenses can help reduce symptoms. However, this also makes the patient more vulnerable to pathogens and can affect the bone marrow, where white blood cells (those that fight infection) are formed.
Therefore, immunosuppressants are often administered with close monitoring for adverse effects, and aren’t used often by IBD experts due to limited efficacy.
Biologics & Small Molecules
Biologics are another type of immunosuppressant. They are called biologics because they are made of proteins (usually antibodies) which are produced in living organism systems (biologic systems). Due to their protein content, biologics cannot be ingested as they will disintegrate in the stomach. Instead, they are administered by infusion or injection once every several weeks.
Most biologics also cause some degree of immunosuppression and may increase the risk of infections. Moreover, some may lose their efficacy over time for various reasons.
Small molecules are newer types of drugs used for UC which, unlike biologics, are ingested orally and are more similar to ‘regular’ pills and capsules. While they are effective and offer the ease of oral ingestion, they exert more immune suppression and are associated with more side effects than newer biologics.
Surgery
Where medications fail, or if a flare of UC is so severe it may put a patient’s life at risk, gastroenterologists may advise a surgeon to remove the colon. This operation is called a ‘total colectomy’, and involves two or three steps.
The intermediate first step is colon removal with the creation of a temporary ostomy, which ideally is removed 2-3 months later in a second operation in which the small intestine is re-connected to the anal area while creating an internal ‘pouch’ to help maintain more normal bowel movements.
This surgery is only for the most severe cases of ulcerative colitis, where other medical interventions have failed to reduce inflammation. However, it is also considered a “cure” for ulcerative colitis, since it removes the problematic part of the body.
Lifestyle & Dietary Recommendations for UC
Although UC is a chronic disease, remission is achievable through coordination with your doctor and maintaining a healthy lifestyle. Many experts recommend keeping a food diary, so you and your provider can track which foods cause flare-ups and how to get your daily recommended amount of nutrients while avoiding these trigger foods.
Managing stress and exercising regularly have also been shown to reduce the frequency of flare-ups and help improve quality of life.
Many UC patients also turn to complementary or alternative medicine (CAM) to help manage symptoms. For instance, acupuncture has been found in clinical studies to improve abdominal pain, diarrhea, constipation, gas, bloating, and nausea. A recent review of acupuncture’s therapeutic benefits found that it successfully reduces TNF-α levels in IBD patients – indicating a reduction in the body’s inflammatory response.
Natural Remedies for UC
In addition to pharmaceutical treatments and lifestyle changes, certain natural supplements have shown convincing results when included in IBD treatment regimes.
Curcumin
Curcumin is the active ingredient in turmeric root used in Ayurveda and Traditional Chinese Medicine for thousands of years to treat gut disorders due to its potent anti-inflammatory and antioxidant properties.
Curcumin not only inhibits inflammatory pathways directly associated with IBD inflammation but has a marked regulatory effect on the gut microbiome, meaning it can shift the microbiome’s composition towards a healthier balance of gut bacteria. This improves the intestinal immune system, countering inflammation and digestive symptoms.
Studies on mild-to-moderate UC patients on curcumin show a rapidly accelerated response rate – even on patients failing pharmaceutical patients. Additionally, curcumin was reported to improve remission maintenance.
Qing Dai
Qing Dai (Indigo Naturalis) is a plant better known for its blue-purple dyes. Chinese doctors have utilized its anti-inflammatory properties for thousands of years to treat a range of illnesses. Its active components, indigo and indirubin, activate the aryl hydrocarbon receptor (AhR) pathway, which secretes anti-inflammatory signals and maintains homeostasis in the intestinal immune system.
UC patients taking QD showed clear mucosal healing directly related to this pathway, making QD a unique and extremely promising natural therapy for IBD. Unlike curcumin alone, a combination of curcumin with QD was found in a placebo-controlled trial to be effective in inducing remission and reducing all symptoms in patients with moderate-severe flare, even those who had failed biologics or other advanced treatments.
Evinature’s Tips & Recommendations
Despite its potency, Qing Dai has been known to cause bloating, heartburn, diarrhea, abdominal pain, headaches, and nausea. Moreover, its dosing must be carefully tailored to the inflammatory severity to limit unnecessary high concentrations while maintaining its efficacy.
Due to these side effects and treatment considerations, it’s important to take a clinically proven dose for your specific level of inflammation and to consult with your doctor so they can monitor your condition throughout treatment.
If you’re interested in taking curcumin or Qing Dai for UC, it’s best to take our free online assessment, which will evaluate your disease activity and offer the safest, most effective protocol and suitable dosing for your individual needs.
Summer Pitocchelli-Schwartzman
