Complementary therapies for ulcerative colitis

This page gives a brief overview of the most common complementary approaches in ulcerative colitis.

The illness needs careful management by a specialist medical team and complementary therapies should not be seen as a treatment for ulcerative colitis in their own right. Most complementary approaches are used by people alongside lifestyle changes such as a healthy diet and stressRelating to injury or concern.-management techniques.

Many of the approaches listed only have a limited amount of scientific evidence to support their use. This is partly because there is a lack of good-quality trials and partly because their effectiveness is difficult to evaluate with many established research methods.

It is important to speak to your doctor before you try any of these approaches, as some, such as herbal remedies, may interfere with conventional treatment.

For more information on nutritional approaches and supplements, see Nutrition in IBD.

Summaries about therapies are placed under five standard headings below to indicate what evidence there is for effectiveness:

  • Positive evidence and likely to help
  • Unclear evidence but MAY help
  • Unclear evidence and NOT likely to help
  • Negative evidence
  • Unclear or lacking evidence and unknown if likely to help

Important
Speak to your doctor before you try any of these approaches. Some therapies interfere with conventional treatment - for example, herbs may interact with medication you are taking and can present their own side-effects. Herbs should be supplied by a qualified, registered herbalist.

Positive evidence and likely to help

There are currently no complementary approaches listed in this section.

Unclear evidence, but MAY help

The term probiotics describes the use of live 'friendly' lactic-acid producing bacteriaA group of organisms too small to be seen with the naked eye, which are usually made up of just a single cell. which, when consumed in adequate amounts, provide health benefits.

Learn more about probiotics.

Lactic acid-producing bacteriaA group of organisms too small to be seen with the naked eye, which are usually made up of just a single cell. produce short-chain fatty acids, such as butyrate, which act as a 'food' for cells in the bowel lining. As abnormal metabolismThe chemical reactions necessary to sustain life. of butyrate has been implicated in the development of ulcerative colitis, probiotics might be expected to help.

Some varieties of Bifidophilus probiotic bacteriaA group of organisms too small to be seen with the naked eye, which are usually made up of just a single cell. have shown benefits in preventing relapses and maintaining remission. However, there is not enough evidence at present to show that probiotics are definitely beneficial for people with ulcerative colitis.[1,2]

Nutrition in IBD

Unclear evidence and NOT likely to help

There are currently no complementary approaches listed in this section.

Negative evidence

There are currently no complementary approaches listed in this section.

Unclear or lacking evidence and unknown if likely to help

Acupuncture

There is limited evidence from randomised controlled trialsStudies comparing the outcomes between one or more different treatments for a disease (or in some instances, preventive measures against that disease) and no active treatment at all (the placebo group). Study participants are allocated to the various groups on a random basis. May be abbreviated to RCT. to show that acupunctureA complementary therapy in which fine sterile needles are inserted into the skin at specific points. is beneficial for ulcerative colitis.

Learn more about acupuncture.

In one small trial, 15 patients received acupunctureA complementary therapy in which fine sterile needles are inserted into the skin at specific points. twice a week for 5 weeks, while 14 people underwent sham acupunctureA complementary therapy in which fine sterile needles are inserted into the skin at specific points. in which needles were inserted in areas that were not recognised acupunctureA complementary therapy in which fine sterile needles are inserted into the skin at specific points. points.

No significant differences in quality of life were found between the real acupunctureA complementary therapy in which fine sterile needles are inserted into the skin at specific points. and sham acupunctureA complementary therapy in which fine sterile needles are inserted into the skin at specific points., but a small, significant improvement in disease activity occurred in those receiving the true treatment. More research is needed to be able to draw any firm conclusions.[3,4]

Aloe vera juice

Aloe vera gel contains a polysaccharide, called acemannan, which has an effect on immune function to reduce inflammationThe body’s response to injury. and accelerate healing. There is limited evidence from randomised controlled trialsStudies comparing the outcomes between one or more different treatments for a disease (or in some instances, preventive measures against that disease) and no active treatment at all (the placebo group). Study participants are allocated to the various groups on a random basis. May be abbreviated to RCT. to show that Aloe vera juice is beneficial for ulcerative colitis.[3]

In one randomised, double-blind, placebo-controlled study 44 people with ulcerative colitis took either 100ml Aloe vera gel, twice a day for four weeks, or placebo.[3a] In those taking Aloe vera, 30% (nine people) went into remission, and another 37% (11 people) showed clinical improvement, compared with remission in one person (7%) and improvement in one (7%) taking placebo. However, this was a small study and no significant differences were seen between the groups using sigmoidoscopy Examination of the lower part of the intestine with a sigmoidoscope, an instrument with an attached light source and camera or optical system.(direct visualisation of the bowel lining using a fibreoptic viewing device).

Boswellia serrata (frankincense)

Ulcerative colitis is an inflammatory bowel diseaseA group of inflammatory conditions of the intestine. The two major forms are Crohn’s disease and ulcerative colitis. linked with the production of inflammatory chemicals called leukotrienes. Boswellic acids, found in frankincense, block an enzymeA protein that speeds up chemical reactions in the body without being used up itself. involved in leukotriene production and might be expected to improve symptoms.

There is limited evidence from randomised controlled trialsStudies comparing the outcomes between one or more different treatments for a disease (or in some instances, preventive measures against that disease) and no active treatment at all (the placebo group). Study participants are allocated to the various groups on a random basis. May be abbreviated to RCT. to show that Boswellia serrata is beneficial for ulcerative colitis. Studies from India suggest that the remission rate with Boswellia is 70% to 82% compared with 40% to 75% in those taking conventional treatment (sulfasalazine).[3,5]

Bromelain

Bromelain, an extract from the pineapple plant, consists of a group of enzymes that can digest protein.

In the laboratory, bromelain has been shown to decrease the production of inflammatory substances (cytokines) in colonThe large intestine. biopsyThe removal of a small sample of cells or tissue so that it may be examined under a microscope. The term may also refer to the tissue sample itself. cells obtained from people with ulcerative colitis.[6] It may therefore be helpful for the treatment of ulcerative colitis, but further studies are needed to test whether or not this is the case.

Devil's claw (Harpagophytum procumbens)

The root tuber of devil's claw contains substances that have an antioxidantA chemical that can neutralise damaging substances called oxygen free radicals., painkilling action. It has traditionally been used to treat ulcerative colitis. Its antioxidantA chemical that can neutralise damaging substances called oxygen free radicals. action has been confirmed in scientific studies, but its effectiveness in improving ulcerative colitis symptoms remains unknown.[7]

Fish oils

Omega-3 fish oils have an anti-inflammatoryAny drug that suppresses inflammation action that is believed to result from suppressing the production of inflammatory immune substances (cytokines).

Eating oily fish has been shown to help people with other inflammatory conditions, such as rheumatoid arthritisInflammation of one or more joints of the body., and might also have a beneficial effect on inflammatory bowel diseases.

Some randomised, placebo-controlled studies have shown a beneficial effect of omega-3 fish oils in reducing symptoms of ulcerative colitis, but others have shown no benefit and more research is needed.[2]

Omega fatty acids in your diet

Glucosamine

Inflammatory bowel disease has been linked with reduced activity of an enzymeA protein that speeds up chemical reactions in the body without being used up itself., glucosamine synthetase, which is needed to repair the bowel wall.

In a pilot study, children with chronicA disease of long duration generally involving slow changes. inflammatory bowel diseaseA group of inflammatory conditions of the intestine. The two major forms are Crohn’s disease and ulcerative colitis. received 3g to 6g N-acetyl glucosamine supplements per day, divided into 3 doses, which were either taken orally or given via an enemaThe introduction of a liquid into the bowel via the anus either to deliver a drug or to wash out the contents of the rectum..

Out of 6 children with ulcerative colitis who received the glucosamine by enemaThe introduction of a liquid into the bowel via the anus either to deliver a drug or to wash out the contents of the rectum., one showed a rapid response within three days, three showed clear improvement within one month, two showed slow improvement over two to four months, and only one showed no clear improvement. The two children with ulcerative colitis who took oral supplements both showed clinical improvement within two to three weeks. These are promising initial results, but larger trials are needed to confirm these findings in both children and adults.[8,9]

Homoeopathy

Homoeopathy is a popular treatment for inflammatory bowel diseaseA group of inflammatory conditions of the intestine. The two major forms are Crohn’s disease and ulcerative colitis. in several European countries.[10] However, there do not appear to be any published studies to show the effectiveness of treating ulcerative colitis with homeopathic remedies.

Hypnotherapy

Hypnotherapy is a popular treatment for conditions in which stressRelating to injury or concern. plays a role.

In one study, 17 people with active ulcerative colitis received a 50-minute gut-focused hypnotherapyAny form of psychotherapy that uses hypnosis. session, while eight patients acted as controls. Hypnosis was found to significantly reduce levels of some inflammatory substances found in the bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. stream or in the rectal lining towards levels seen in inactive disease. No such changes were found in the patients who did not undergo hypnotherapyAny form of psychotherapy that uses hypnosis..[11]

In another study, 15 people with 'severe' or 'very severe' inflammatory bowel diseaseA group of inflammatory conditions of the intestine. The two major forms are Crohn’s disease and ulcerative colitis., who had not responded to corticosteroidsA group of hormones that are produced by the adrenal glands, which sit on top of the kidneys., received 12 sessions of gut-focused hypnotherapyAny form of psychotherapy that uses hypnosis.. They were then followed for an average of over five years. Thirteen patients responded with four going into complete remission, and nine had their condition down-graded (eight down to 'mild' and one to 'moderate'). Only two patients failed to respond and required surgery.[12] These studies suggest that hypnotherapyAny form of psychotherapy that uses hypnosis. may be helpful for people with ulcerative colitis, and further research is needed to confirm its effectiveness.

Psylium seed (Plantago ovata)

Seeds and husks from the plant species, Plantago ovata (also known as blonde psyllium or ispaghula) are an effective source of fibre that helps to maintain bowel regularity. It has a high mucilage content, which swells to many times its original volume when mixed with water. In the intestines, psyllium forms a bulk that acts rather like a sponge to improve diarrhoeaWhen bowel evacuation happens more often than usual, or where the faeces are abnormally liquid., or as a bulk laxative to improve constipation.

Psyllium fermentation by bacteriaA group of organisms too small to be seen with the naked eye, which are usually made up of just a single cell. in the bowel also produces butyrate, a short-chain fatty acid that acts as a 'food' for cells in the bowel lining. Some research suggests that psyllium may be as effective as a prescribed drug (mesalamine) in maintaining remission in people with ulcerative colitis but more studies are needed to confirm this.[2,13,14]

Slippery elm bark

The bark of the slippery elm, a tree native to North America, has traditionally been used to 'soothe' inflammationThe body’s response to injury. in gastrointestinal conditions such as ulcerative colitis. Its antioxidantA chemical that can neutralise damaging substances called oxygen free radicals. action has been confirmed in scientific studies, but its effectiveness in improving ulcerative colitis symptoms remains unknown.[7]

Fenugreek

Fenugreek, an aromatic herb, is used in traditional Ayurvedic medicine to treat inflammatory bowel conditions such as ulcerative colitis.

It contains steroidal saponins, which may have a steroid-like action to reduce inflammationThe body’s response to injury.. It also has an antioxidantA chemical that can neutralise damaging substances called oxygen free radicals. action that has been confirmed in scientific studies, but its effectiveness in improving ulcerative colitis symptoms remains unknown.[7]

Stress management approaches

People with ulcerative colitis who experience a stressful life event, or persistent (chronicA disease of long duration generally involving slow changes.) stressRelating to injury or concern., are more likely to have a relapse of their symptoms than those who are not stressed.

Stress appears to increase production of immune substances (cytokines) that are linked with inflammationThe body’s response to injury..[15]

Measures to control stressRelating to injury or concern., such as relaxation techniques, and time management skills, may therefore help to maintain remission, although this has not been tested in clinical trials.

Tormentil (Potentilla tormentilla)

The red root of Tormentil, a member of the rose family that grows throughout Europe, has traditionally been used to treat diarrhoeaWhen bowel evacuation happens more often than usual, or where the faeces are abnormally liquid. and ulcerative colitis. Its antioxidantA chemical that can neutralise damaging substances called oxygen free radicals. action has been confirmed in scientific studies, but its effectiveness in improving ulcerative colitis symptoms remains unknown [7].

Traditional Chinese medicine

There is limited evidence from randomised controlled trialsStudies comparing the outcomes between one or more different treatments for a disease (or in some instances, preventive measures against that disease) and no active treatment at all (the placebo group). Study participants are allocated to the various groups on a random basis. May be abbreviated to RCT. to show that traditional Chinese medicines are beneficial for ulcerative colitis.[3]

In these studies, herbal remedies were either given as tablets or, more commonly, as enemas and compared with the effects of standard treatments. In several cases, improvement was significantly greater with the Chinese herbal mixtures than with the standard treatments. However, it is difficult to interpret these results because of poor study design.

In some studies, patients were not randomised, and there was no 'blinding' - a hallmark of good quality trials, in which neither patients nor doctors know which treatment is being assessed to avoid any bias.

In addition, unusual conventional treatments were often used as a comparison, which, in some cases, included antifungal treatments and B vitamins as well as sulfasalazine or prednisolone.

The antioxidantA chemical that can neutralise damaging substances called oxygen free radicals. action of one traditional Chinese medicine, Wei tong ning, has been confirmed in scientific studies, but its effectiveness in improving ulcerative colitis symptoms remains unknown.[7]

Wheat grass (Triticum aestivum) juice

There is limited evidence from randomised controlled trialsStudies comparing the outcomes between one or more different treatments for a disease (or in some instances, preventive measures against that disease) and no active treatment at all (the placebo group). Study participants are allocated to the various groups on a random basis. May be abbreviated to RCT. to show that wheat grass is beneficial for ulcerative colitis.[3]

In a randomised, double-blind, placebo-controlled study, involving 21 people with active ulcerative colitis, those who took oral wheat grass juice for four weeks showed greater improvements than those taking placebo.[16] This is a promising finding but larger studies are needed to confirm the results.

References: 
  1. Natural Standard Database. Probiotics. Link
  2. Natural Standard Database. Fish oil. Link
  3. Review article: Complementary and alternative therapies for inflammatory bowel diseaseA group of inflammatory conditions of the intestine. The two major forms are Crohn’s disease and ulcerative colitis.. Langmead C, Rampton C. Alimentary Pharmacology and Therapeutics. 2006; 23: 341-349.
    3a. Langmead L et al.  Randomised double-blind placebo-controlled trial of oral aloe vera gel for active ulcerative colitis. Aliment Pharmacol Ther 2004;19(7):739-47.
  4. Acupuncture treatment in gastrointestinal diseases: A systematic review. Schneider A, Streitberger K, Joos S. World Journal of Gastroenterology. 2007; 13(25): 3417-24.
  5. Mechanisms underlying the anti-inflammatoryAny drug that suppresses inflammation effects of boswellic acid derivatives I experimental colitis. Anthoni, C, Laukoetter, M, Rijcken, E et al. Am J Physiol Gastrointest Liver Physiol. 2006; 290: 1131-1137
  6. Bromelain treatment decreases secretion of pro-inflammatory cytokines and chemokines by colonThe large intestine. biopsies in vitro. Onken JE, Greer PK, Calingaert B, et al. Clinical Immunology. 2008;126: 345-352
  7. Antioxidant effects of herbal therapies used by patients with inflammatory bowel diseaseA group of inflammatory conditions of the intestine. The two major forms are Crohn’s disease and ulcerative colitis.: an in vitro study. Langmead L, Dawson C Hawkins N et al. Aliment Pharmacol Ther. 2002;16: 197-205
  8. Glycoaminoglycan (GAG) deficiency in protective barrier as an underlying, primary cause of ulcerative colitis, Crohn's disease, interstitial cystitis and possibly Reiter's syndrome. Russell AL. Medical Hypotheses. 1999;52(4):297-301
  9. A pilot study of N-acetyl glucosamine, a nutritional substrate for glycosamineoglycan synthesis in paediatric chronicA disease of long duration generally involving slow changes. inflammatory bowel diseaseA group of inflammatory conditions of the intestine. The two major forms are Crohn’s disease and ulcerative colitis.. Salvatore S, Heuschkel R, Tomlin S et al. Alimentary Pharmacology and Therapeutics. 2000; 14(12):1567-79
  10. Use of complementary and alternative medicine in Germany. A survey of patients with inflammatory bowel diseaseA group of inflammatory conditions of the intestine. The two major forms are Crohn’s disease and ulcerative colitis.. Joos, S, Roseman,T, Szecsenyc, J et al. BMC Complementary and Alternative Medicine. 2006: 6:19
  11. The effect of hypnosisA sleep-like state induced by a hypnotist. on systemic and rectal mucosal measures of inflammationThe body’s response to injury. in ulcerative colitis. Mawdsley J, Jenkins D, Macey M, Langmead L, Rampton D. American Journal of Gastroenterology. 2008; 103(6): 1460-9.
  12. Treatment of inflammatory bowel diseaseA group of inflammatory conditions of the intestine. The two major forms are Crohn’s disease and ulcerative colitis.: A role for hypnotherapyAny form of psychotherapy that uses hypnosis.. Miller V, Whorwell, P. International Journal of Clinical and Experimental Hypnotherapy.  2008; 56(3): 306-17.
  13. Natural Standard Database. Psyllium. Link
  14. 1Randomised clinical trial of Plantago ovata seeds (dietary fiber) as compared with mesalamine in maintaining remission in ulcerative colitis. Spanish Group for the Study of Crohn's Disease and Ulcerative Colitis. Fernandez-Banares F, Hinojosa J, Sanchez-Lombrana JL et al. American Journal of Gastroenterology. 1999; 94(2):427-33
  15. The effect of acuteHas a sudden onset. psychologic stressRelating to injury or concern. on systemic and rectal mucosa measures of inflammationThe body’s response to injury. in  Ulcerative Colitis. Mawdsley, J, Macey, M, Feakins, K et al. Gastroenterology. 2006;131(2):410-419.
  16. Ben-Arye E et al. Wheat grass juice in the treatment of active distal ulcerative colitis:  a randomised double-blind placebo-controlled trial. Scan J Gastroenterol 2002;37(4):444-9.