Lifestyle and behavior changes may help improve symptom burden and quality of life in patients with ulcerative colitis. Recommendations for such changes should be personalized based on factors that include a patient’s job, habits, and disease activity.

Lifestyle and behavior encompass many different things, including what you do, how you conduct yourself, and what you eat. So, when I think about lifestyle, I ask my patients with ulcerative colitis what they do for a living because lifestyle has a lot to do with their profession. For example, their access to a restroom may be affected by their profession. I want patients to have easy access to a restroom while they are at their jobs and while they travel to and from work—or anywhere else, for that matter. Further, if they have a job that is stressful and they do not enjoy it, their lifestyle is going to be affected by that.

Additionally, when individuals with ulcerative colitis are at home, do they have time for themselves to do things like exercise? Regular exercise is good for the gut, weight control, and stress relief, so we recommend it. We also discuss behavior modifications to help with stress reduction, such as mindfulness, meditation, deep breathing, yoga, and pet ownership; whether they need a therapist; and the importance of avoiding cigarette smoking and vaping and limiting alcohol consumption.

While all of these are important considerations for those with ulcerative colitis, diet is probably the most important topic of discussion that we have with patients. The big take-home point that I want my patients to understand right away is that what one should eat differs for those with active vs inactive disease. Ulcerative colitis is a mucosal disease, so strictures are uncommon but can occur with very high levels of inflammation. Those cases, along with cases in which patients are experiencing severe flares, are the ones that we consider in terms of avoidance of indigestible fiber, which may stick to the lining of the colon and irritate it, causing bloating, cramps, and more bowel movements. When a patient is in remission, the spectrum of what they can eat is much broader and includes indigestible fiber because their colon looks and behaves normally.

In addition, overall, the closer a patient’s diet can get to a Mediterranean diet, the better off they will be. A Mediterranean diet focuses on plant-based foods, olive oil, and fish and poultry rather than red meat, with very few processed foods. It also is in and of itself symbiotic, so it contains both prebiotics and probiotics that may help support a healthy microbiome in the colon. For patients who live in “food deserts,” simply trying to minimize red and processed meats is a step in the right direction. The less processed the foods that the patient eats are, the healthier their gut is going to be because processing removes nutrients and adds additives and preservatives. Lastly, a multivitamin is good for everybody, as we probably do not get enough nutrients from foods alone if we eat a processed diet.