Studies suggest that ulcerative colitis (UC)—an inflammatory disorder affecting the large intestine—may often be linked to underlying imbalances in the body. Many of these imbalances may involve nutritional deficiencies, metabolic dysfunction, immune dysregulation, or even factors related to other conditions such as celiac disease. By identifying and addressing these areas, individuals with ulcerative colitis may be able to better manage symptoms and promote intestinal healing.
Below, we will explore several potential contributors to UC, categorized into nutritional factors, inflammatory markers, metabolic imbalances, environmental triggers, and hormone-related factors. We will also discuss how a naturopathic doctor and our clinic can provide natural therapies and comprehensive testing to identify any underlying issues and create personalized treatment plans. Keep in mind that each person’s case is unique, and these factors may vary from one individual to another.
Nutritional Factors in Ulcerative Colitis
1. Vitamin D and Ulcerative Colitis
Vitamin D deficiency is common in those with UC, and research indicates it may be associated with disease activity and inflammation. A 2022 systematic review and meta-analysis found that vitamin D supplementation appeared to improve inflammatory blood markers, such as C-reactive protein and erythrocyte sedimentation rate, in patients with ulcerative colitis. Another study from 2021 concluded that severe vitamin D deficiency may mark a more aggressive clinical course of inflammatory bowel disease, further highlighting the importance of adequate vitamin D levels.
Additionally, vitamin D deficiency can coexist with iron deficiency in UC. A 2022 investigation found that lower vitamin D levels correlated with iron deficiency, suggesting that optimizing vitamin D status may support iron metabolism in people with UC.
2. Iron Status and Ferritin
Iron deficiency is especially common among patients with inflammatory bowel disease. Some individuals report fatigue, lower exercise tolerance, and other complications. A 2020 study noted that people who later develop IBD showed signs of iron deficiency years before official diagnosis, including lower ferritin levels. Ferritin is a key storage marker of iron in the body, and low ferritin often implies low iron stores. It is important to address low iron to help improve energy levels and well-being.
Transferrin—another iron-related marker—was found to be reduced in active IBD according to a 2017 study. This decrease may reflect both chronic inflammation and issues with protein and iron handling. By checking iron markers (ferritin, transferrin, iron, and others), our clinic aims to assess whether iron deficiency or anemia is contributing to your symptoms.
3. Folate, B12, and Homocysteine
Studies have demonstrated that folate (vitamin B9) can influence inflammation in the colon. One 2020 investigation showed that low serum folate levels correlated with heightened inflammatory markers and active disease in IBD. Another earlier study confirmed that hyperhomocysteinemia (elevated homocysteine) in ulcerative colitis is often linked to folate deficiency or lower serum folate levels. Homocysteine is an amino acid that, when high, may contribute to vascular and inflammatory issues. Meanwhile, vitamin B12 also works synergistically with folate to regulate homocysteine levels.
In active ulcerative colitis, homocysteine may become further elevated. One 2006 publication found that patients with active UC had higher homocysteine compared to those in remission and healthy controls—even if they had normal folate status. Identifying folate or vitamin B12 deficiencies and homocysteine elevations is crucial, as supplementation and dietary changes may help manage both inflammation and potential vascular complications.
4. Zinc and Selenium Status
Zinc and selenium are essential trace minerals for immune function, antioxidant capacity, and tissue repair. In Korean IBD patients, a 2017 study found that about 39% had low serum zinc levels, and 30.9% were deficient in selenium. Although the data encompassed both Crohn’s disease and ulcerative colitis, it underscores how many individuals with UC may lack these critical nutrients.
Furthermore, another investigation from 2021 reported high rates of vitamin D, B12, and ferritin deficiencies in patients with IBD. In practice, zinc can be essential for wound healing in the intestinal mucosa, while selenium supports antioxidative processes. Our clinic offers a comprehensive nutritional panel that examines these and other nutrient levels, allowing us to tailor dietary recommendations and potential supplementation.
5. Vitamin C Deficiency
Often overlooked, vitamin C deficiency is also documented among people with IBD. One 2022 study revealed that about 21.6% of individuals with IBD had inadequate vitamin C levels. Furthermore, vitamin C is involved in collagen synthesis, immune function, and iron absorption. A 2020 publication suggests that vitamin C deficiency may increase the risk of osteoporosis in IBD patients, hinting at the broader impact of nutritional imbalances on bone health. Addressing vitamin C status, therefore, could hold benefits not only for inflammation but also for musculoskeletal integrity.
Inflammatory Factors: C-Reactive Protein and Disease Activity
1. Elevated C-Reactive Protein
CRP is often used in clinical settings to gauge inflammation. A 2023 study showed a robust correlation between CRP elevation (>100 mg/L) and the presence of deep ulcers in active UC. Indeed, CRP also helps predict the response to therapy in acute severe UC, making it a reliable surrogate marker when assessing disease severity.
When CRP levels remain elevated, it could indicate ongoing inflammation in the colon, which sometimes correlates with a greater likelihood of complications. Identifying CRP levels can guide the choice of therapies and help patients and practitioners make informed decisions about treatment plans.
Metabolic Factors in Ulcerative Colitis
1. Malnutrition and Its Effects
Malnutrition commonly coexists with UC, worsening overall outcomes and the risk of complications. Chronic inflammation, decreased dietary intake, and malabsorption can deplete protein stores, vitamins, and minerals. Additionally, severe disease flares often reduce appetite, compounding the malnutrition.
2. The Role of Iron Metabolism
Chronic inflammation can elevate hepcidin—a hormone that limits iron release from body stores—thus perpetuating iron deficiency in UC. According to a 2022 study, vitamin D deficiency can also modulate hepcidin levels, potentially aggravating iron deficiency. Adequate management of iron deficiency may involve not only iron supplementation but also interventions for underlying inflammation or vitamin D deficiency. By identifying and addressing these metabolic disruptions, patients may find better energy levels, improved concentration, and a lowered risk of anemia-related complications.
Environmental Factors
1. Celiac Disease Overlap
A 2022 analysis using two-sample Mendelian randomization found a bidirectional causal relationship between celiac disease and inflammatory bowel disease, including UC. This suggests that individuals with UC may have a higher predisposition to celiac disease, and vice versa. If someone exhibits symptoms like persistent bloating, unexplained deficiencies, or non-responsive disease flares, screening for celiac disease could be pivotal.
The Importance of Personalized Testing
Before starting or adjusting any treatment for UC, it’s crucial to conduct extensive testing to identify specific deficiencies or imbalances. Why test first?
Targeted Approach: Identifying whether a patient’s CRP is elevated, or if their vitamin D or folate is low, may inform which treatments are likely to be effective.
Safety and Efficacy: Treating a deficiency without confirming it (e.g., giving high-dose iron to someone without low iron) may lead to unwanted side effects.
Individualized Ranges: At our clinic, we use personalized ranges to interpret blood work, tailored specifically to each patient and their unique context. Standard blood ranges often lack customization and may not account for individual health needs. By focusing on precise targets, we aim to support specific conditions. Research suggests that certain conditions tend to improve quicker at certain nutritional blood target levels.
Natural Therapies and Supportive Approaches
The therapies for ulcerative colitis should be individualized based on each person’s lab results and clinical presentation. Naturopathic doctors at our multidisciplinary clinic frequently use the following:
Dietary Adjustments
Nutritional Supplementation
Therapies for managing Inflammatory Markers
Treatment of Electrolyte Imbalances
Conclusion
Ulcerative colitis is a complex condition influenced by many factors, including nutritional deficiencies, inflammatory markers (like CRP), metabolic disruptions, and immune interplay with possible co-conditions, such as celiac disease. By recognizing these underlying factors and performing thorough testing, our clinic aims to create a targeted plan that addresses each person’s unique needs.
Our philosophy emphasizes natural therapies, dietary modifications, and supportive measures that align with naturopathic principles. We do not claim that any single nutrient or intervention can “cure” UC, but we believe a strategic, evidence-based approach can significantly improve quality of life and disease outcomes.
At our clinic, we use personalized ranges to interpret blood work, tailored specifically to each patient and their unique context. Standard blood ranges often lack customization and may not account for individual health needs. By focusing on precise targets, we aim to support specific conditions. Research suggests that certain conditions tend to improve quicker at certain nutritional blood target levels.
If you suspect nutritional factors are contributing to your UC, consider a consultation to explore testing options and personalized strategies. We offer a comprehensive nutritional panel that looks at vitamins, minerals, inflammatory markers, and other factors identified in scientific literature. A carefully interpreted set of results can guide how best to optimize nutrient levels, reduce inflammation, and enhance gut health.
Lastly, though this overview offers a glimpse into some of the associations with UC, remember each person’s journey is distinct. Embracing a holistic perspective—covering nutrition, natural therapies, stress management, and any relevant medical treatments—may support a more comfortable and fulfilling life with ulcerative colitis.
Disclaimer: This post is for informational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always consult your healthcare provider or a qualified medical professional before starting any new treatment or if you have questions about your medical condition. While we aim to provide accurate, research-based information, individual needs and responses to treatments can vary. Our clinic offers personalized consultations to discuss health concerns and develop tailored care plans. Never disregard professional medical advice or delay seeking it because of information you have read on this site.
