Many with ulcerative colitis (UC) have diligently learned to cook at home with foods that don't exacerbate symptoms or trigger flares, but dining out can diminish that sense of control.
"Whenever someone with ulcerative colitis eats at a restaurant, they may not be fully aware of all the ingredients in a dish," says Nayana George, MD, a gastroenterologist at Orlando Health Digestive Health Institute in Florida. "Dishes that seem to be 'safe' might have certain seasonings or ingredients that worsen their condition." Because of that, it's common to feel some level of anxiety about what's being served, she says.
Fortunately, with some planning and awareness, you don't have to forego restaurants altogether. Here are six top tips for going out to eat when you have UC.
1. Do Your Homework and Check the Menu Beforehand
When possible, check out the menu options in advance by looking at a restaurant's website, says Adrian Hernandez, RDN, a certified gastrointestinal dietitian nutritionist and the owner of AEH Nutrition in Washington, DC.
"If you have sensitivities like gluten and dairy, check to see if the restaurant has an allergen menu or can make accommodations to your dietary needs in advance," he says. "Many kitchens that cook meals individually can make adjustments relatively easily. Also, consider calling to ask about ingredients in sauces, marinades, drinks, and seasonings if you have an allergy or sensitivity. Doing this type of advance work can ensure a smooth experience at the restaurant."
2. Use the Mediterranean Diet as a Guide
If you're looking for a general framework for choosing a restaurant meal, consider the Mediterranean diet, says Dr. George. This way of eating appears to be linked to better symptom management and gut health for those with UC, according to research.
"Everyone with inflammatory bowel disease such as UC should follow this type of diet because it contains mostly fresh fruits and vegetables, monounsaturated fats, fatty fish, complex carbohydrates, and lean protein," she says. "Foods like these have been shown to have anti-inflammatory properties."
The diet also involves limiting intake of dairy, red meats, sugary drinks, sweets, and butter.
3. Monitor Your Symptoms When You Eat Fiber
If you choose to follow the Mediterranean diet, one modification for UC may involve monitoring how many high-fiber foods you eat, including certain vegetables and whole grains. It’s important to note that, although fiber is important for digestive health, too much fiber may lead to bloating, gas, nausea, and other symptoms for some people, says George. To avoid eating too much, it can help to focus on cooked, low-fiber veggies such as:
Peeled potatoes
Butternut squash
Peeled yams or sweet potatoes
Carrots
Baby spinach
Asparagus tips
Vegetables like these have been shown to decrease inflammation when eaten regularly.
If you’re thinking about limiting or skipping certain foods, keep an eye on your symptoms when you eat foods with fiber. George suggests avoiding high-fiber vegetables like broccoli, cauliflower, onions, and Brussels sprouts, as well as fiber-rich options like whole grains, beans, and dried fruits if you find they exacerbate your symptoms. It can also help to avoid raw veggies, which tend to cause more digestive upset than cooked ones.
4. Get Sauces on the Side
For some people, heavy seasonings and spices can be irritating or even cause a flare. If this is true for you, you can request a lower spice level, or ask for sauce to be served on the side of the meal so you can adjust it to a level that's more tolerable, says Hernandez.
That can apply to any type of sauce that's added after a meal is cooked, from a lemon butter drizzle over a piece of salmon to hollandaise on an eggs benedict. But it won't apply to any sauces used as a marinade or during the cooking process, which is why it's helpful to chat with your server about what's used to prepare a dish.
5. Drink Wisely
Alcohol can be tricky with UC, because it's considered pro-inflammatory and may increase risk of a flare, says Hernandez. Ideally, it's best to avoid alcoholic drinks altogether, but if you're at a restaurant and want to have a drink, there are a couple ways to make them more UC-friendly, he says.
"I'd recommend avoiding mixers with simple syrup, because sugar can make inflammation worse, on top of the alcohol," he says. "You can ask for a drink to be made without that ingredient, or have a cocktail that's not sweet. When choosing wine, opt for a dry varietal, as it will have a lower sugar content."
6. Go for Salmon or Chicken Instead of Steak
When selecting a protein, George recommends choosing fish that's high in omega-3 fatty acids, since that nutrient can reduce inflammation. Those options include salmon, tuna, and mackerel. A lean protein like chicken breast also tends to be well tolerated among people with UC, says Hernandez.
While red meat can be okay in moderation, it's been linked to inflammation and worsened flares in both UC and Crohn's disease, along with other commonly problematic foods like corn, seeds, spicy foods, leafy vegetables, dairy, and fried foods. Because of that, it's best to limit consumption of choices like steak and burgers when you're eating at a restaurant, particularly if you don't know how red meat will affect your symptoms.
The Takeaway
To avoid eating foods that could aggravate your ulcerative colitis (UC) symptoms, it’s helpful to review a menu in advance and talk with your server.
The Mediterranean diet has been shown to be beneficial for those with UC, and it can serve as a helpful guide to what foods to choose at a restaurant.
Get any sauces on the side so you can control how much is used, and opt for low-fiber vegetables and grains to avoid any gastrointestinal upset.
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Resources
Radziszewska M et al. Nutrition and Supplementation in Ulcerative Colitis. Nutrients. 2022.
Levine A et al. Dietary Guidance From the International Organization for the Study of Inflammatory Bowel Diseases. Clinical Gastroenterology and Hepatology. May 2020.
White BA et al. The Impact of Alcohol in Inflammatory Bowel Diseases. Inflammatory Bowel Diseases. March 2022.
Yuying Luo, MD, is an assistant professor of medicine at Mount Sinai West and Morningside in New York City. She aims to deliver evidence-based, patient-centered, and holistic care for her patients.
Her clinical and research focus includes patients with disorders of gut-brain interaction such as irritable bowel syndrome and functional dyspepsia; patients with lower gastrointestinal motility (constipation) disorders and defecatory and anorectal disorders (such as dyssynergic defecation); and women’s gastrointestinal health.
She graduated from Harvard with a bachelor's degree in molecular and cellular biology and received her MD from the NYU Grossman School of Medicine. She completed her residency in internal medicine at the Icahn School of Medicine at Mount Sinai, where she was also chief resident. She completed her gastroenterology fellowship at Mount Sinai Hospital and was also chief fellow.
Elizabeth Millard is a freelance writer based in northern Minnesota. She focuses on health, wellness, and fitness, and has written for Runner's World, Bicycling, Self, Women's Health, Men's Health, Prevention, Experience Life, and more. She is an American Council on Exercise–certified personal trainer and a Yoga Alliance-registered yoga teacher. She graduated from Harvard University with a bachelor's degree in English.
