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  • Q&A with Australian Health Practitioners

    How do I control my eating with diabeties and ulcerative colitis?

    Related Topics
    Crohn's Disease & Ulcerative Colitis Digestive Health Endocrinology
    some days I can't eat because I am not hungry than other days I eat like a horse which then affects me Ulcerative colitis.

    I am also a diabetic so gets complicated for me how do I control my eating habits?
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    Dr Kevin Lee

    Endocrinologist, Nuclear Medicine Physician

    Consultant Physician in Endocrinology, Diabetes & Nuclear Medicine. I am on Twitter @dr_kevinlee. I am on Facebook https://www.facebook.com/kevinleefracp/ I help patients with obesity, diabetes, thyroid, … View Profile

    Depends on if steroids are being used to treat the Ulcerative Colitis.

    Steroid-induced hyperglycemia is a complicated management problem and can often lead to symptoms by the hyperglycemia itself.

    Symptoms such as fatigue, lethargy, muscle cramping, loss of appetite, nausea, thirst, frequent urination.

    Steroids can also cause increased hunger.

    Therefore this is a highly complicated management issue and warrants review with a GP in the first instance.

    However a team approach is desirable which would typically involve diabetes specialist, diabetes educator, dietitian.

    Regards,
    Dr Kevin Lee
    BSc(Med), MBBS, MHS(Clin Epi), FRACP
    Consultant Physician Endocrinologist

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    Prof Rupert Leong

    Gastroenterologist

    Professor Rupert Leong is the Director of Endoscopy at Concord Hospital, Sydney. He conducts private endoscopy services at both Macquarie University Hospital (9812 3880) and … View Profile

    Ulcerative colitis should not be managed long term on corticosteroids. Steroid-sparing immunomodulators, 5-ASA and biological agents are effective in treating this chronic condition. Therefore you need to see a gastroenterologist to have effective treatment rather than suffer from steroid-induced diabetes.

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    Anonymous

    Unfortunately I  become diabetic when put on high dose of hydrocortosone which cause me to suffer from steroid induced diabetes then I  was on long term prednisone for over 2 years as nothing was working for me and as soon tapered I would flare again. Eating what is recommended for Uc is not what recommended for diabetes.   catch22 I'm seeing Dr but because I'm allergic to 5Asa I've been limited to medication I can take.

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    Elizabeth Newsham-West

    Dietitian

    It is not uncommon to do exactly what you are doing if you eat very little one day, you can make up for it on another day. To avoid this it may be helpful to realise that healthy eating and healthy eating habits can be very helpful for IBD and can help control symtoms and keep you in remission longer and appetite may not be the best to rely on.

    Inflammatory bowel disease (IBD) can affect people's eating a lot because they link food with causing the symptoms, or the disease or eliminating some foods prevents the unpleasant symptoms being experienced. Food does not cause UC and is not responsible for causing the inflammation. However poor diets those high in refined processed carbohydrate and poor lifestyle habits smoking and alcohol ( which isn't great for diabetes as well) are not helpful in managing remission or symptoms. However often when you are able to slowly move into eating a healthy diet/ eating habits periods of remission can last longer.

    There is no diet specific for UC. Dietary recommendations are to aim for a healthy diet, specific for the individual dependant on symtoms being experienced, often what we encourage for the whole population and those with diabetes. The foods and lifestyle habits helpful for diabetes are also helpful for UC, you just need to know how to use them in the form that is helpful for you.

    Food changes are used to manage the symptoms ( pain, bloating, bowel frequency) of UC  or during times of inflammation and can be helpful for some. This may be around fat, some fermentable carbohydrate foods ( lactose/fructose/fructans etc), pips, seeds or skins, soluble fibre. There are always individual foods that some will avoid specific to them.

    This disease relies on medication to manage the inflammation, and I have seen when this has been established and working well, a healthy diet is well tolerated. When inflammation is not getting controlled it is far more tricky and you see food being manipulated much more to help control the symptoms.

    I have also seen people who are following a very healthy diet , feeling very good in themselves without any GI symptoms even when significant inflammation is present, identified only by blood tests. It is the role of medication to be manipulated to manage this further and your specialist is important here.

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    anne j

    HealthShare Member

    thank you, what you say makes sense, I have been trying fodmap diet as well only slight improvement with decrease in flautance and bloating but still have symptoms.  I have been thinking about paleo/Special Carb diet .What are your thoughts on these diets.

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    Elizabeth Newsham-West

    Dietitian

    The Paelo diet and Specific Carbohydrate diet remove processed carbohydrates ( sugar sweetened beverages, packaged foods both high in fat, sugar and food additives) which has benefits for everyone including those with UC and diabetes. The Specific Carbohydrate diet is really a little like the FODMAPS diet removing poorly absorbed carbohydrates which for some cause unpleasant symptoms. The FODMAPS and Carbohydrate Specific Diet help identify problematic foods based on their carbohydrate source. Depending on your diabetes medication ( if using insulin) you may need to talk to your GP if you are choosing to remove most of the carbohydrate from your diet as medication changes may be required.

    However both the diets you are considering remove groups of foods which  may not be so healthy for you overall. And often maybe unnecessary as not all these foods are going to be a problem for you. So remove foods that you know are causing you a problem is a much better approach, but be careful that this is not too many as you may not be meeting your nutrient needs for other parts of your health and wellbeing.

    Eating plans based around the Mediterranean diet is what I would recommend more about the fresh, less processed, fruit and vegetable and lots of fish and a little of the others rather than removing groups of foods. Often when symptoms are not being controlled it is natural to try and change food and think this is the answer. I have a patient just like this who has tried to remove just about all groups of food at one point or other with little significant long term change. She now realises how important medication , her emotions and state of wellbeing, has on her gut function and then leaving out a few foods she knows are causing her a problem has been her answer.

    Other things that may be causing your symptoms may be related to adhesions or scaring of the bowel and we know some foods may not be so helpful if they are bulky, stingy or fibrous. The challenge is still having adequate fibre using alternative foods and fibres to help bowel function.

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