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Ulcerative Colitis (Holistic)

About This Condition

Keeping an eye on your diet is essential to caring for colon inflammation. According to research or other evidence, the following self-care steps may be helpful.
  • Don’t forget the fish oil

    Help reduce inflammation and prevent relapses by taking a daily supplement delivering 5.4 grams of omega-3 fatty acids

  • Drink aloe juice

    Improve your symptoms, and your chances for remission, by drinking 100 ml of an Aloe vera herbal extract twice a day

  • Try herbal boswellia

    Reduce severity and encourage remission by taking 550 mg of boswellia gum resin three times a day

  • Check up on nutrition

    Visit a qualified health professional regularly to detect and treat nutritional deficiencies caused by colitis

About

About This Condition

Ulcerative colitis (UC) is a chronic inflammatory disease of the colon, which is relatively common but remains poorly understood.

Diagnosis must be made by a healthcare practitioner—typically a gastroenterologist. Irritable bowel syndrome, a completely unrelated and less serious condition, was sometimes called mucous colitis in the past. As a result, the general term “colitis“ is still sometimes used inappropriately to refer to irritable bowel syndrome. It is critical that people who are diagnosed with “colitis” find out whether they have irritable bowel syndrome or UC.

Symptoms

UC is characterized by frequent abdominal pain and bloody diarrhea. Other symptoms may include fatigue, weight loss, decreased appetite, and nausea.

Healthy Lifestyle Tips

For unknown reasons, smokers have a lower risk of UC. The nicotine patch has actually been used to induce remissions in people with UC,1 although this treatment has been ineffective in preventing relapses.2 On the other hand, Crohn’s disease, which is in many ways similar to UC, is made worse by smoking.3 Despite the possible protective effect of smoking in people with UC, a strong case can be made that risks of smoking outweigh the benefits; even the use of nicotine patches carries its own side effects and remains experimental.

Eating Right

The right diet is the key to managing many diseases and to improving general quality of life. For this condition, scientific research has found benefit in the following healthy eating tips.

Recommendation Why
Cut back on sugar
Some studies have shown that high sugar intake is associated with an increased ulcerative colitis risk.
Some studies have shown that high sugar intake is associated with an increase in risk for UC.4 , 5 Other research has failed to find any association between UC and sugar intake.6 , 7 Until more is known, persons with inflammatory bowel diseases, including UC, should consider limiting their intake of sugar.
Limit fat and fast foods
To reduce your risk, forego fast food and other sources of excessive animal fats and margarine.

In two studies, people with a high intake of animal fat, cholesterol, or margarine had a significantly increased risk of UC, compared with people who consumed less of these fats.8 , 9 Although these associations do not prove cause-and-effect, reducing one’s intake of animal fats and margarine is a means of improving overall health and possibly UC as well.

There is preliminary evidence that people who eat fast food at least twice a week have nearly four times the risk of developing UC than people who do not eat fast food.10

Try sprouted barley
In a preliminary study, people with ulcerative colitis experienced significant improvement after taking 30 grams per day of a germinated barley product for four weeks.

In a preliminary study, 39 patients with mild to moderate ulcerative colitis experienced significant improvement after receiving 30 grams (about 1 oz) per day of a germinated barley product for four weeks.11 Controlled trials are needed to confirm this report.

Uncover food allergies
Avoiding allergenic foods often reduces the severity of ulcerative colitis. Work with a knowledgeable healthcare provider to find out your sensitivities.

More than a half-century ago, several doctors reported that food allergies play an important role in some cases of UC.12 , 13 Since that time, many doctors have observed that avoidance of allergenic foods will often reduce the severity of UC and can sometimes completely control the condition. In other old studies, milk has been reported to trigger UC,14 and people with UC were found to have antibodies to milk in their blood, a possible sign of allergy.15 Today the relationship between food allergies and UC remains controversial16 and is not generally accepted by the conventional medical community. People who wish to explore the possibility that food sensitivities may trigger their symptoms may wish to consult with an appropriate healthcare provider.

Supplements

What Are Star Ratings?

Our proprietary “Star-Rating” system was developed to help you easily understand the amount of scientific support behind each supplement in relation to a specific health condition. While there is no way to predict whether a vitamin, mineral, or herb will successfully treat or prevent associated health conditions, our unique ratings tell you how well these supplements are understood by the medical community, and whether studies have found them to be effective for other people.

For over a decade, our team has combed through thousands of research articles published in reputable journals. To help you make educated decisions, and to better understand controversial or confusing supplements, our medical experts have digested the science into these three easy-to-follow ratings. We hope this provides you with a helpful resource to make informed decisions towards your health and well-being.

3 Stars Reliable and relatively consistent scientific data showing a substantial health benefit.

2 Stars Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit.

1 Star For an herb, supported by traditional use but minimal or no scientific evidence. For a supplement, little scientific support.

Supplement Why
2 Stars
Aloe
100 ml of an Aloe vera herbal extract twice a day
Drinking aloe juice may improve your symptoms and your chances for remission.

Aloe vera juice has anti-inflammatory activity and been used by some doctors for people with UC. In a double-blind study of people with mildly to moderately active ulcerative colitis, supplementation with aloe resulted in a complete remission or an improvement in symptoms in 47% of cases, compared with 14% of those given a placebo (a statistically significant difference).17 No significant side effects were seen. The amount of aloe used was 100 ml (approximately 3.5 ounces) twice a day for four weeks. Other traditional anti-inflammatory and soothing herbs, including calendula, flaxseed, licorice, marshmallow, myrrh, and yarrow. Many of these herbs are most effective, according to clinical experience, if taken internally as well as in enema form.18 Enemas should be avoided during acute flare-ups but are useful for mild and chronic inflammation. It is best to consult with a doctor experienced with botanical medicine to learn more about herbal enemas before using them. More research needs to be done to determine the effectiveness of these herbs.

2 Stars
Boswellia
550 mg of gum resin three times a day
Supplementing with boswelia may help reduce severity and encourage remission.

A small clinical study found that people with UC taking 550 mg of boswellia gum resin three times daily for six weeks had similar improvement in symptoms and the severity of their disease as people with UC taking the drug sulfasalazine.19 Overall, 82% of patients receiving boswellia, along with 75% of patients taking sulfasalazine, went into remission.

2 Stars
Butyrate
Consult a qualified healthcare practitioner
Butyrate, administered by enema, has been shown to improve ulcerative colitis symptoms in most studies.

A fatty acid called butyrate, which is synthesized by intestinal bacteria, serves as fuel for the cells that line the small intestine. Administration of butyrate by enema has produced marked improvement in people with UC in most,20 , 21 , 22 , 23but not all, preliminary trials. Butyrate taken by mouth is not likely to be beneficial, as sufficient quantities do not reach the colon by this route. Although butyrate enemas are not widely available, they can be obtained by prescription through a compounding pharmacy, which prepares customized prescription medications to meet individual patient needs.

2 Stars
DHEA
Take under medical supervision: 200 mg daily
In one trial, 6 of 13 people with ulcerative colitis went into remission after taking supplementing with DHEA.

In a preliminary trial, 6 of 13 people with ulcerative colitis went into remission after taking 200 mg per day of DHEA for eight weeks.24 This large amount of DHEA has the potential to cause adverse side effects and should only be used under the supervision of a doctor.

2 Stars
Fish Oil
5.4 grams daily of omega-3 fatty acids
Supplementing with fish oil may help reduce inflammation and prevent relapses.

Preliminary25 and double-blind trials26 , 27 , 28 have found that fish oil supplementation reduces inflammation, decreases the need for anti-inflammatory drugs, and promotes normal weight gain in people with UC. However, fish oil has not always been effective in clinical trials for UC.29 Amounts used in successful clinical trials provided 3.2 grams of EPA and 2.2 grams of DHA per day—the two important fatty acids found in fish oil.

In a preliminary trial, people with UC significantly improved on a sugar-free, low-allergen diet with additional nutritional supplementation that included a multivitamin-mineral supplement (2–6 tablets per day); a fish oil supplement (400 mg per day); borage oil (400 mg per day); flaxseed oil (400 mg per day); and a probiotic formula containing Lactobacillus acidophilus and other species of beneficial bacteria.30 Some participants received slight variations of this regimen. Since so many different supplements were given and since the trial was not controlled, it is not possible to say which, if any, of the nutrients was responsible for the improvement observed by the researchers.

2 Stars
Folic Acid
Consult a qualified healthcare practitioner
People with ulcerative colitis may be at a higher risk of colon cancer, supplementing with folic acid may reduce the risk.

UC is linked to an increased risk of colon cancer. Studies have found that people with UC who take folic acid supplements or who have high blood levels of folic acid have a reduced risk of colon cancer compared with people who have UC and do not take folic acid supplements.31 , 32 , 33 Although these associations do not prove that folic acid was responsible for the reduction in risk, this vitamin has been shown to prevent experimentally induced colon cancer in animals.34 Moreover, low blood folic acid levels have been found in more than half of all people with UC.35 People with UC who are taking the drug sulfasalazine, which inhibits the absorption of folic acid,36 are at a particularly high risk of developing folic acid deficiency. Folic acid supplementation may therefore be important for many people with UC. Since taking folic acid may mask a vitamin B12 deficiency, however, people with UC who wish to take folic acid over the long term should have their vitamin B12 status assessed by a physician.

Alcohol consumption is known to promote folic acid deficiency and has also been linked to an increased risk of colon cancer.37 People with UC should, therefore, keep alcohol intake to a minimum.

2 Stars
Probiotics
10 to 600 billion colony-forming units per day of probiotic bacteria, or 250 mg of Saccharomyces boulardii three times daily
Supplementing with probiotics has been shown to help people with ulcerative colitis.

In preliminary and double-blind trials,38 , 39 a probiotic supplement (in this case, a non-disease-causing strain of Escherichia coli) was effective at maintaining remission in people with UC. In a double-blind trial, a combination probiotic supplement containing Lactobacilli, Bifidobacteria, and a beneficial strain of Streptococcus has been shown to prevent pouchitis, a common complication of surgery for UC.40 People with chronic relapsing pouchitis received either 3 grams per day of the supplement or placebo for nine months. Eighty-five percent of those who took the supplement had no further episodes of pouchitis during the nine-month trial, whereas 100% of those receiving placebo had relapses within four months. Preliminary and double-blind research suggests that combination probiotic supplements may be effective at promoting recovery and preventing UC relapses as well.41 , 42 , 43

In a preliminary trial, people with UC significantly improved on a sugar-free, low-allergen diet with additional nutritional supplementation that included a multivitamin-mineral supplement (2–6 tablets per day); a fish oil supplement (400 mg per day); borage oil (400 mg per day); flaxseed oil (400 mg per day); and a probiotic formula containing Lactobacillus acidophilus and other species of beneficial bacteria.44 Some participants received slight variations of this regimen. Since so many different supplements were given and since the trial was not controlled, it is not possible to say which, if any, of the nutrients was responsible for the improvement observed by the researchers.

2 Stars
Psyllium
Refer to label instructions
Taking psyllium may help people with ulcerative colitis maintain remission.
In a preliminary trial, people with UC remained in remission just as long when they took 20 grams of ground psyllium seeds twice daily with water as when they took the drug mesalamine.45 The combination of the two was slightly more effective than either alone. Controlled trials are now needed to confirm and therapeutic effect of psyllium of UC.
2 Stars
Wheat Grass Juice
20 ml per day initially; increased by 20 ml per day to a maximum of 100 ml per day
In one trial, supplementing with wheat grass juice improved symptoms in 78% of people with ulcerative colitis.
In a controlled trial, supplementation with wheat grass juice for one month resulted in clinical improvement in 78% of people with ulcerative colitis, compared with 30% of those receiving a placebo.46 The amount of wheat grass used was 20 ml per day initially; this was increased by 20 ml per day to a maximum of 100 ml per day (approximately 3.5 ounces).
1 Star
Calendula
Refer to label instructions
Calendula is an anti-inflammatory and soothing herb that may be effective in the treatment of ulcerative colitis.

Aloe vera juice has anti-inflammatory activity and been used by some doctors for people with UC. In a double-blind study of people with mildly to moderately active ulcerative colitis, supplementation with aloe resulted in a complete remission or an improvement in symptoms in 47% of cases, compared with 14% of those given a placebo (a statistically significant difference).47 No significant side effects were seen. The amount of aloe used was 100 ml (approximately 3.5 ounces) twice a day for four weeks. Other traditional anti-inflammatory and soothing herbs, including calendula, flaxseed, licorice, marshmallow, myrrh, and yarrow. Many of these herbs are most effective, according to clinical experience, if taken internally as well as in enema form.48 Enemas should be avoided during acute flare-ups but are useful for mild and chronic inflammation. It is best to consult with a doctor experienced with botanical medicine to learn more about herbal enemas before using them. More research needs to be done to determine the effectiveness of these herbs.

1 Star
Chamomile
Refer to label instructions
Practitioners of herbal medicine often recommend chamomile to people with colitis.

German doctors practicing herbal medicine often recommend chamomile for people with colitis.49 A cup of strong tea drunk three times per day is standard, along with enemas using the tea when it reaches body temperature.

1 Star
Flaxseed
Refer to label instructions
Flaxseed is an anti-inflammatory and soothing herb that may be effective in the treatment of ulcerative colitis.

Aloe vera juice has anti-inflammatory activity and been used by some doctors for people with UC. In a double-blind study of people with mildly to moderately active ulcerative colitis, supplementation with aloe resulted in a complete remission or an improvement in symptoms in 47% of cases, compared with 14% of those given a placebo (a statistically significant difference).50 No significant side effects were seen. The amount of aloe used was 100 ml (approximately 3.5 ounces) twice a day for four weeks. Other traditional anti-inflammatory and soothing herbs, including calendula, flaxseed, licorice, marshmallow, myrrh, and yarrow. Many of these herbs are most effective, according to clinical experience, if taken internally as well as in enema form.51 Enemas should be avoided during acute flare-ups but are useful for mild and chronic inflammation. It is best to consult with a doctor experienced with botanical medicine to learn more about herbal enemas before using them. More research needs to be done to determine the effectiveness of these herbs.

In a preliminary trial, people with UC significantly improved on a sugar-free, low-allergen diet with additional nutritional supplementation that included a multivitamin-mineral supplement (2–6 tablets per day); a fish oil supplement (400 mg per day); borage oil (400 mg per day); flaxseed oil (400 mg per day); and a probiotic formula containing Lactobacillus acidophilus and other species of beneficial bacteria.52 Some participants received slight variations of this regimen. Since so many different supplements were given and since the trial was not controlled, it is not possible to say which, if any, of the nutrients was responsible for the improvement observed by the researchers.

1 Star
Licorice
Refer to label instructions
Licorice is an anti-inflammatory and soothing herb that may be effective in the treatment of ulcerative colitis.

Aloe vera juice has anti-inflammatory activity and been used by some doctors for people with UC. In a double-blind study of people with mildly to moderately active ulcerative colitis, supplementation with aloe resulted in a complete remission or an improvement in symptoms in 47% of cases, compared with 14% of those given a placebo (a statistically significant difference).53 No significant side effects were seen. The amount of aloe used was 100 ml (approximately 3.5 ounces) twice a day for four weeks. Other traditional anti-inflammatory and soothing herbs, including calendula, flaxseed, licorice, marshmallow, myrrh, and yarrow. Many of these herbs are most effective, according to clinical experience, if taken internally as well as in enema form.54 Enemas should be avoided during acute flare-ups but are useful for mild and chronic inflammation. It is best to consult with a doctor experienced with botanical medicine to learn more about herbal enemas before using them. More research needs to be done to determine the effectiveness of these herbs.

1 Star
Marshmallow
Refer to label instructions
Marshmallow is an anti-inflammatory and soothing herb that may be effective in the treatment of ulcerative colitis.

Aloe vera juice has anti-inflammatory activity and been used by some doctors for people with UC. In a double-blind study of people with mildly to moderately active ulcerative colitis, supplementation with aloe resulted in a complete remission or an improvement in symptoms in 47% of cases, compared with 14% of those given a placebo (a statistically significant difference).55 No significant side effects were seen. The amount of aloe used was 100 ml (approximately 3.5 ounces) twice a day for four weeks. Other traditional anti-inflammatory and soothing herbs, including calendula, flaxseed, licorice, marshmallow, myrrh, and yarrow. Many of these herbs are most effective, according to clinical experience, if taken internally as well as in enema form.56 Enemas should be avoided during acute flare-ups but are useful for mild and chronic inflammation. It is best to consult with a doctor experienced with botanical medicine to learn more about herbal enemas before using them. More research needs to be done to determine the effectiveness of these herbs.

1 Star
Myrrh
Refer to label instructions
Myrrh is an anti-inflammatory and soothing herb that may be effective in the treatment of ulcerative colitis.

Aloe vera juice has anti-inflammatory activity and been used by some doctors for people with UC. In a double-blind study of people with mildly to moderately active ulcerative colitis, supplementation with aloe resulted in a complete remission or an improvement in symptoms in 47% of cases, compared with 14% of those given a placebo (a statistically significant difference).57 No significant side effects were seen. The amount of aloe used was 100 ml (approximately 3.5 ounces) twice a day for four weeks. Other traditional anti-inflammatory and soothing herbs, including calendula, flaxseed, licorice, marshmallow, myrrh, and yarrow. Many of these herbs are most effective, according to clinical experience, if taken internally as well as in enema form.58 Enemas should be avoided during acute flare-ups but are useful for mild and chronic inflammation. It is best to consult with a doctor experienced with botanical medicine to learn more about herbal enemas before using them. More research needs to be done to determine the effectiveness of these herbs.

1 Star
St. John’s Wort
Refer to label instructions
St. John’s wort, administered as an enema, may be beneficial for people with ulcerative colitis.

Caution: It is likely that there are many drug interactions with St. John's wort that have not yet been identified. St. John's wort stimulates a drug-metabolizing enzyme (cytochrome P450 3A4) that metabolizes at least 50% of the drugs on the market.59 Therefore, it could potentially cause a number of drug interactions that have not yet been reported. People taking any medication should consult with a doctor or pharmacist before taking St. John's wort.

Enemas of oil of St. John’s wort may be beneficial for ulcerative colitis.60 Consult with a doctor before using St. John’s wort oil enemas.
1 Star
Turmeric
Refer to label instructions
Curcumin, a compound in turmeric, is anti-inflammatory and may improve symptoms of ulcerative colitis.

Curcumin is a compound in turmeric (Curcuma longa) that has been reported to have anti-inflammatory activity. In a preliminary trial, five of five people with chronic ulcerative proctitis (a condition similar to ulcerative colitis) had an improvement in their disease after supplementing with curcumin. The amount of curcumin used was 550 mg twice a day for one month, followed by 550 mg three times a day for one month.61 In a double-blind trial, supplementation with curcumin in the amount of 1 gram twice a day for six months decreased the relapse rate in patients with ulcerative colitis in remission. The relapse rate was 4.7% among people receiving curcumin and 20.5% in the placebo group, a statistically significant difference. All patients in the study also received conventional therapy.62

1 Star
Yarrow
Refer to label instructions
Yarrow is an anti-inflammatory and soothing herb that may be effective in the treatment of ulcerative colitis.

Aloe vera juice has anti-inflammatory activity and been used by some doctors for people with UC. In a double-blind study of people with mildly to moderately active ulcerative colitis, supplementation with aloe resulted in a complete remission or an improvement in symptoms in 47% of cases, compared with 14% of those given a placebo (a statistically significant difference).63 No significant side effects were seen. The amount of aloe used was 100 ml (approximately 3.5 ounces) twice a day for four weeks. Other traditional anti-inflammatory and soothing herbs, including calendula, flaxseed, licorice, marshmallow, myrrh, and yarrow. Many of these herbs are most effective, according to clinical experience, if taken internally as well as in enema form.64 Enemas should be avoided during acute flare-ups but are useful for mild and chronic inflammation. It is best to consult with a doctor experienced with botanical medicine to learn more about herbal enemas before using them. More research needs to be done to determine the effectiveness of these herbs.

References

1. Pullan RD, Rhodes J, Ganesh S, et al. Transdermal nicotine for active ulcerative colitis. N Engl J Med 1994;330:811–5.

2. Thomas GA, Rhodes J, Mani V, et al. Transdermal nicotine as maintenance therapy for ulcerative colitis. N Engl J Med 1995;332:988–92.

3. Rhodes J, Thomas GA. Smoking: good or bad for inflammatory bowel disease? Gastroenterol 1994;106:907–10 [editorial].

4. Reif S, Klein I, Lubin F, et al. Pre-illness dietary factors in inflammatory bowel disease. Gut 1997;40:754–60.

5. Tragnone A, Valpiani D, Miglio F, et al. Dietary habits as risk factors for inflammatory bowel disease. Eur J Gastroenterol Hepatol 1995;7:47–51.

6. Thornton JR, Emmett PM, Heaton KW. Diet and ulcerative colitis. BMJ 1980;1:293–4.

7. Jarmerot G, Jammark I, Nilsson K. Consumption of refined sugar by patients with Crohn’s disease, ulcerative colitis or irritable bowel syndrome. Scand J Gastroenterol 1983;18:999–1002.

8. Reif S, Klein I, Lubin F, et al. Pre-illness dietary factors in inflammatory bowel disease. Gut 1997;40:754–60.

9. Kono S. Dietary and other risk factors of ulcerative colitis. A case-control study in Japan. J Clin Gastroenterol 1994;19:166–71.

10. Persson PG, Ahlbom A, Hellers G. Diet and inflammatory bowel disease: a case-control study. Epidemiology 1992;3:47–52.

11. Kanauchi O, Iwanaga T, Mitsuyama K. Germinated barley foodstuff feeding: a novel neutraceutical therapeutic strategy for ulcerative colitis. Digestion 2001;63 Suppl:60–7.

12. Rowe AH. Chronic ulcerative colitis—allergy in its etiology. Ann Intern Med 1942;17:83–100.

13. Andresen AFR. Ulcerative colitis—an allergic phenomenon. Am J Dig Dis 1942;9:91–8.

14. Truelove SC. Ulcerative colitis provoked by milk. Brit Med J 1961;5220:154–60.

15. Taylor KB, Truelove SC. Circulating antibodies to milk proteins in ulcerative colitis. Brit Med J 1961;5257:924–9.

16. Candy S, Borok G, Wright JP, et al. The value of an elimination diet in the management of patients with ulcerative colitis. S Afr Med J 1995;85:1176–9.

17. Langmead L, Feakins RM, Goldthorpe S, et al. Randomized, double-blind, placebo-controlled trial of oral aloe vera gel for active ulcerative colitis. Aliment Pharmacol Ther 2004;19:739–47.

18. Weiss RF. Herbal Medicine. Beaconsfield, UK: Beaconsfield Publishers Ltd, 1989, 114–5.

19. Gupta I, Parihar A, Malhotra P, et al. Effects of Boswellia serrata gum resin in patients with ulcerative colitis. Eur J Med Res 1997;2:37–43.

20. Vernia P, Marcheggiano A, Caprilli R, et al. Short-chain fatty acid topical treatment in distal ulcerative colitis. Aliment Pharmacol Ther 1995;9:309–13.

21. Steinhart AH, Brzezinski A, Baker JP. Treatment of refractory ulcerative proctosigmoiditis with butyrate enemas. Am J Gastroenterol 1994;89:179–83.

22. Patz J, Jacobsohn WZ, Gottschalk-Sabag S, et al. Treatment of refractory distal ulcerative colitis with short chain fatty acid enemas. Am J Gastroenterol 1996;91:731–4.

23. Breuer RI, Buto SK, Christ ML, et al. Rectal irrigation with short-chain fatty acids for distal ulcerative colitis. Preliminary report. Dig Dis Sci 1991;36:185–7.

24. Andus T, Klebl F, Rogler G, et al. Patients with refractory Crohn's disease or ulcerative colitis respond to dehydroepiandrosterone: a pilot study. Aliment Pharmacol Ther 2003;17:409–14.

25. Salomon P, Kornbluth AA, Janowitz HD. Treatment of ulcerative colitis with fish oil n--3-omega-fatty acid: an open trial. J Clin Gastroenterol 1990;12:157–61.

26. Stenson WF, Cort D, Rodgers J, et al. Dietary supplementation with fish oil in ulcerative colitis. Ann Intern Med 1992;116:609–14.

27. Hawthorne AB, Daneshmend TK, Hawkey CJ, et al. Treatment of ulcerative colitis with fish oil supplementation: a prospective 12 month randomised controlled trial. Gut 1992;33:922–8.

28. Aslan A, Triadafilopoulos G. Fish oil fatty acid supplementation in active ulcerative colitis: a double-blind, placebo-controlled, crossover study. Am J Gastroenterol 1992;87:432–7.

29. Dichi I, Frenhane P, Dichi JB, et al. Comparison of omega-3 fatty acids and sulfasalazine in ulcerative colitis. Nutrition 2000;16:87–90.

30. Edman JS, Williams WH, Atkins RC. Nutritional therapies for ulcerative colitis: literature review, chart review study, and future research. Altern Ther Health Med 2000;6:55–63.

31. Lashner BA, Heidnreich PA, Su GL, et al. Effect of folate supplementation on the incidence of dysplasia and cancer in chronic ulcerative colitis. Gastroenterol 1989;97:255–9.

32. Lashner BA. Red blood cell folate is associated with the development of dysplasia and cancer in ulcerative colitis. J Cancer Res Clin Oncol 1993;119:549–54.

33. Lashner BA, Provencher KS, Seidner DL, et al. The effect of folic acid supplementation on the risk for cancer or dysplasia in ulcerative colitis. Gastroenterol 1997;112:29–32.

34. Kim YI, Salomon RN, Graeme-Cooke F, et al. Dietary folate protects against the development of macroscopic colonic neoplasia in a dose responsive manner in rats. Gut 1996;39:732–40.

35. Elsbord L, Larsen L. Folate deficiency in chronic inflammatory bowel disease. Scand J Gastroenterol 1979;14:1019–24.

36. Halsted CH, Gandhi G, Tamura T. Sulfasalazine inhibits the absorption of folates in ulcerative colitis. N Engl J Med 1981;317:1513–7.

37. Kaltsky AL, Armstrong MA, Friedman GD, Hiatt RA. The relations of alcoholic beverage use to colon and rectal cancer. Am J Epidemiol 1988;128:1007–15.

38. Rembacken BJ, Snelling AM, Hawkey PM, et al. Non-pathogenic Escherichia coli versus mesalazine for the treatment of ulcerative colitis: a randomised trial. Lancet 1999;354:635–9.

39. Kruis W, Schutz E, Fric P, et al. Double-blind comparison of an oral Escherichia coli preparation and mesalazine in maintaining remission of ulcerative colitis. Aliment Pharmacol Ther 1997;11:853–8.

40. Gionchetti P, Rizzello F, Venturi A, et al. Oral bacteriotherapy as maintenance treatment in patients with chronic pouchitis: a double-blind, placebo-controlled trial. Gastroenterology 2000;119:305–9.

41. Venturi A, Gionchetti P, Rizzello F, et al. Impact on the composition of the faecal flora by a new probiotic preparation: preliminary data on maintenance treatment of patients with ulcerative colitis. Aliment Pharmacol Ther 1999;13:1103–8.

42. Miele E, Pascarella F, Giannetti E, et al. Effect of a probiotic preparation (VSL#3) on induction and maintenance of remission in children with ulcerative colitis. Am J Gastroenterol 2009;104:437–43.

43. Ishikawa H, Matsumoto S, Ohashi Y, et al. Beneficial effects of probiotic Bifidobacterium and galacto-oligosaccharide in patients with ulcerative colitis: a randomized controlled study. Digestion 2011;84:128–33.

44. Edman JS, Williams WH, Atkins RC. Nutritional therapies for ulcerative colitis: literature review, chart review study, and future research. Altern Ther Health Med 2000;6:55–63.

45. Fernandez-Banares F, Hinojosa J, Sanchez-Lombrana JL, et al. Randomized clinical trial of Plantago ovata seeds (dietary fiber) as compared with mesalamine in maintaining remission in ulcerative colitis. Am J Gastroenterol 1999;94:427–33.

46. Ben-Arye E, Goldin E, Wengrower D, et al. Wheat grass juice in the treatment of active distal ulcerative colitis: a randomized double-blind placebo-controlled trial. Scand J Gastroenterol 2002;37:444–9.

47. Langmead L, Feakins RM, Goldthorpe S, et al. Randomized, double-blind, placebo-controlled trial of oral aloe vera gel for active ulcerative colitis. Aliment Pharmacol Ther 2004;19:739–47.

48. Weiss RF. Herbal Medicine. Beaconsfield, UK: Beaconsfield Publishers Ltd, 1989, 114–5.

49. Weiss RF. Herbal Medicine. Beaconsfield, UK: Beaconsfield Publishers Ltd, 1989, 26.

50. Langmead L, Feakins RM, Goldthorpe S, et al. Randomized, double-blind, placebo-controlled trial of oral aloe vera gel for active ulcerative colitis. Aliment Pharmacol Ther 2004;19:739–47.

51. Weiss RF. Herbal Medicine. Beaconsfield, UK: Beaconsfield Publishers Ltd, 1989, 114–5.

52. Edman JS, Williams WH, Atkins RC. Nutritional therapies for ulcerative colitis: literature review, chart review study, and future research. Altern Ther Health Med 2000;6:55–63.

53. Langmead L, Feakins RM, Goldthorpe S, et al. Randomized, double-blind, placebo-controlled trial of oral aloe vera gel for active ulcerative colitis. Aliment Pharmacol Ther 2004;19:739–47.

54. Weiss RF. Herbal Medicine. Beaconsfield, UK: Beaconsfield Publishers Ltd, 1989, 114–5.

55. Langmead L, Feakins RM, Goldthorpe S, et al. Randomized, double-blind, placebo-controlled trial of oral aloe vera gel for active ulcerative colitis. Aliment Pharmacol Ther 2004;19:739–47.

56. Weiss RF. Herbal Medicine. Beaconsfield, UK: Beaconsfield Publishers Ltd, 1989, 114–5.

57. Langmead L, Feakins RM, Goldthorpe S, et al. Randomized, double-blind, placebo-controlled trial of oral aloe vera gel for active ulcerative colitis. Aliment Pharmacol Ther 2004;19:739–47.

58. Weiss RF. Herbal Medicine. Beaconsfield, UK: Beaconsfield Publishers Ltd, 1989, 114–5.

59. Markowitz JS, Donovan JL, DeVane CL, et al. Effect of St John's wort on drug metabolism by induction of cytochrome P450 3A4 enzyme. JAMA 2003;290:1500–4.

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