A Low-Residue Diet for Colitis

Severe flare-ups are one of the greatest challenges of living with ulcerative colitis. One option to try is a low-residue diet, designed to reduce the amount of dietary fiber and 'residue' — or, undigested remains of fiber and other food — that goes through your digestive system and irritates the bowel.

A low-fiber diet can help reduce your most stressful symptoms of ulcerative colitis, such as abdominal pain and cramping. While a low-residue diet isn't intended for the long-term, it can help the bowel heal during active flare-ups of this inflammatory bowel disease (IBD).

The Advantages of a Low-Residue Diet

“One reason people with an active flare of colitis go on a low-residue diet is to reduce symptoms in addition to trying to treat them,” says David T. Rubin, MD, Joseph B. Kirsner professor of medicine and chief for the section of gastroenterology, hepatology, and nutrition at the University of Chicago Medicine. “It helps to heal the bowel by reducing the amount of indigestible or poorly digestible fibers. This will reduce trauma to the bowel and, therefore, allow the bowel to heal.”

But Dr. Rubin cautions that dietary changes won't cure or treat ulcerative colitis — they're used in addition to other medical treatments to help manage symptoms associated with IBD.

“Symptom management is not the same as disease control,” says Rubin. Diet alone isn't enough to put colitis in remission.

He adds that your diet must take into account your body’s nutritional needs. Long-term use of restrictive diets, like the low-residue diet, could increase the risk of nutrient deficiencies — when you're not getting enough of what your body needs for daily function.

What to Avoid on a Low-Residue Diet

Dietary fiber is a type of carbohydrate found in plants that cannot be readily digested by the body. Residue is the undigested remains of fiber and food that goes into the stool.

A low-residue diet limits the amount of indigestible or hard-to-digest fiber in the diet to reduce the amount of residue that enters the large intestine.

The goal of a low-residue diet for people with IBD is to limit total fiber consumption to less than 10 to 15 grams per day. Rubin urges people to work with their physician to make sure they receive the nutrition their bodies need while at the same time eliminating foods that make the bowel work more, like beans and legumes, whole grains, and most raw fruits and vegetables.

“Elimination diets don't work,” says Rubin. “People can avoid certain foods when they are actively flaring, but not chronically. The goal is to provide a healthy and enjoyable quality of life for patients.”

Nuts, seeds, dried fruits, and other foods with hulls, like corn, also add residue to the stool and should be avoided when you're on a low-residue diet. You'll also want to skip fatty, spicy, and sugary foods.

What to Eat on a Low-Residue Diet

Put together low-residue meals from these groups:

Cooked vegetables You can include spinach, pumpkin, eggplant, skinless potatoes, green beans, wax beans, asparagus, beets, carrots, and yellow squash (without seeds) as long as they are thoroughly cooked or canned. You can also drink juices made from these vegetables.

Refined grains You can have white bread and dry cereals containing less than one gram of fiber per serving (such as puffed rice, corn flakes, and others) on a low-residue diet.

Dairy products Include yogurt, cottage cheese, milk, or creamy soups — set a limit of 2 cups per day — or 1.5 ounces of hard cheese.

Very ripe fruits Apricots, bananas, cantaloupe, honeydew melon, papayas, peaches, plums, watermelon, and nectarines are okay to eat on a low-residue diet. You can include juices without pulp and fruit sauces like applesauce, but avoid all other raw fruits.

Protein Choose servings of cooked meat, bacon, poultry, eggs, and smooth peanut butter. Make sure the meats are tender and not chewy — and remove all residue-producing gristle.

Before starting a low-residue diet, talk to your doctor or registered dietitian about whether you may need a supplement to meet all your vitamin and mineral requirements, both while you're on the diet and on other days.