Case experience series:
Ulcerative Colitis - Relevance of diet & thought process
We received a message from a friend who expressed concern about his friend's daughter, who had been receiving allopathic treatment for ulcerative colitis for a period of three years prior. She was admitted in the hospital. The doctors had now suggested surgery as the condition had worsened to the point of second-degree colitis, since she was weak they were considering to do the procedure or not. the Parents were looking for a medical specialty to treat this problem.
We connected with her through video call, she was born and raised in the Middle East. Her parents moved to India when she was 20 years old, and due to a change in climate and food, she had an episode of food poisoning. They were able to control the infection with antibiotics, but after one month, she once again experienced stomach problems with more than 20 toilet visits with green, watery stools and occasionally bloody stools, and she lost a lot of weight also. For last 3 years she is developing inflammation in the gut currently it became as second degree ulcerative colitis. She spent the previous week surviving on IV fluids because she was unable to eat anything due to nausea.
What is ulcerative colitis?
Ulcerative colitis is an inflammatory bowel disease (IBD) that causes inflammation and ulcers (sores) in your digestive tract. Ulcerative colitis affects the innermost lining of your large intestine, also called the colon and rectum.
Her case is diagnosed as Ulcerative colitis, E3 (Severe disease -spontaneous bleeding, ulceration)
Image of her report:
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Ayurvedic view:
Her digestive fire, or agni, is weak, and her Pitha dosh, or inflammation, increases in the lower abdomen, according to Ayurveda. We gathered a thorough history of her nutrition and way of life at the time in order to rule out the underlying causes of her increased Pitha/inflammation.
Her Diet and life style were as follows:
Waking up time: 7:0
Breakfast time 8:00 AM,
(Millet roti) Ragi roti Idli or dosa pancakes with fermented batter, spicy rice flacks with chillies, onions, and lime juice tea made with cow milk, toast with eggs, According to Ayurveda, foods like chicken egg toast, spicy poha, and fermented foods like idli cause inflammation.
Lunch: 1:00 PM
Wheat roti with vegetable curry: Since her digestive fire is weak, wheat may not digest properly and may trigger inflammation.
Afternoon Snacks: 4:00 PM,
primarily coffee with a few jaggery, spicy, and salty nibbles. All of these are foods that cause inflammation, especially jaggrey, which is an iron-rich sweetener with a laxative effect.
Dinner time 8:00 PM
Wheat or rice with vegetable or mustard leaf curry Wheat and mustard leaves both foods will aggravate inflammation.
Sleeping Time - 11:00 pm
First set of management
As a first step, we need to stop the nausea and slowly increase her digestive fire so that she is able to eat properly. For that purpose,
External treatment - we suggested to wipe her body with lukewarm nalapamara water, as nalapamara is a combination of 4 herbs that have blood purification properties, asked them to do this two times per day during daytime for two days. and continue the IV,
Did not start any internal medication or diet due to nausea .
On the third day, we began giving her puffer rice /Lajja water, As puffed rice is consider to increase agni or digestive capacity .
Preparation:-we made by adding 1 teaspoon of puffed rice to 100 ml of water, boiling it, and then reducing it to 50 ml. This helped her feel less queasy.
After the nausea subsided, we began the arrowroot decoration. Which will helps to reduce tiredness and helps the body to correct gut bacteria and enhance water absorption from intestine and reduce diarrhoea and gut inflammation .
Preparation :_For this, we added 1 teaspoon of arrowroot powder, 1/2 teaspoon of coriander seed, and a slice of dry ginger to 500 ml of water, then boiled it and reduced it to 50 ml. Gave this water for three days between 11:00 a.m. and 2:00 p.m. during the day.
Around 4:00 p.m., we also suggested her 50 ml of coconut water mixed with crushed cardamom seeds, but she refused to drink that, so we stopped that
Diet Pattern after 1 week :-
After a week, we began to feed plain ghee on an empty stomach with 50 ml of Lukewarm rice water.
Between 1:00 pm and 5:00 p.m., she ate arrow root porridge with coriander and dried ginger water. At this stage, she was able to eat the food through the mouth. IV support is withheld.
Second step of Treatment approach as per Ayurveda:
After one week once she able to eat properly we prepare the line of approach for her treatment as 3 stages
First phase: boost metabolism and lessen diarrhoea
Second stage: Repair the inflamed colon and streamline stool production.
Third stage: strengthen the gut bacteria and improve gut-brain axis function.
The key changes made in diet and lifestyle in the first stage
For 21 days, she should follow a very strict diet with few components, staying away from the majority of fibre-rich fruits, vegetables, grains, legumes, and sweeteners like honey and agave nectar.
First stage:
7:00 a.m.: Wakeup.
Early morning rice water with ghee: Soak 1 teaspoon white rice overnight in 500 ml of water. The next morning, boil this water and reduce it to 50 ml. Add 1 or 2 teaspoons of plain ghee and drink.
7:30: Slight breathing exercise and chanting of Vishnu Manthra, which helps her reduce inflammation.
8:00 a.m.: Breakfast
Arrow root porridge with coriander, dry ginger water, and white sugar.
10:30 p.m.: No snacks or beverages
1:00 PM: Lunch
Carbohydrate –
Use: white rice, jowhar roti, and Arrow root powder roti.
Avoid millets like foxtail, Indian millet, ragi, etc.
Protein
Plant protein: use green or orange lentils.
Avoid: all other lentils and kidney beans.
Milk protein (Paneer): once every 2 weeks
Avoid fermented milk products.
Vegetables –
Use: snake gourds, bitter gourds, raw banana.
Avoid: leafy vegetables, tomatoes, small onions, cabbage, egg plant , pumpkin cauliflower, garlic, chilli pepper, and all other vegetables.
Fat
Use: butter, ghee, coconut oil, or olive oil (12 to 1 teaspoon per day).
Avoid mustard oil, sunflower oil, and pumpkin seed oil.
Spices –
Use: coriander seed, cardamon, fennel, dry ginger
Reduce: clove, bay leaf, fenugreek, turmeric, black pepper,
Avoid: red chilli, cumin, asafoetida, coriander powder, ginger, red pepper, fish sauce, sour Chinese sauce, cinnamon, star anise, and ajwain.
Evening snack time 4:00 PM:
Use sweet fruits, like poached apple or steamed banana, Coconut water with crushed cardamon
Reduce spicy snacks. If needed puffed rice with salt and pepper
Dinner time - 7:00 pm:
Carbohydrates with vegetables were recommended, like well-cooked vegetable rice or rice roti with vegetable curry.
avoided soup, salads, cheese, and fermented food for dinner.
Bed time 10:00 pm
Medication for the first stage:
1. Guluchyadi Kashayam Tablet
Dosage: 2 tablets after dinner.
2. Indukantham Kashayam Tablet
Dosage: 2 tablets after lunch.
External treatment: a herbal bath with lukewarm nalpamaradi water.
After the first phase of treatment, she was able to take food, the blood in the stools were stopped, stool colour changed to brown, she experiences pain in her stomach during defecation, and she showed physical and mental weakness.
In the second stage:
Further changes in diet
Morning rice water with ghee : - instead of plain ghee, introduce indukantham gritham.
Morning 10:00 am ;- advised to take medicated pomegranate juice three times time / week.
After lunch: - medicated buttermilk after lunch, 2 times per week.
Medication for the second stage:
Dosage: 12 teaspoon with lukewarm 50 ml rice water.
1/2 teaspoons after lunch and dinner for 4 days a week.
3: Guluchyadi Kashayam Tablet
Dosage: 2 tablets after lunch, 2 times per week.
External treatment:
Continue the herbal water bath with Nalapamaram choornam
Jadamayadi paste application: make a paste of jadamayadi choornam with boiling water and apply it on the tummy for 5 minutes.
After the second stage, bathroom visits are reduced to 6 to 8 times, in which 3 or 4 times the stool were normal with a yellow colour without any signs of inflammation.
Third Stage:
Continued the same schedule and diet
Medication for the third week:
Dosage: 1/2 teaspoon with lukewarm 50 ml rice water.
12 teaspoons after lunch and dinner for 4 days a week.
3: Indukantham Kashayam Tablet
Dosage: 2 tablets after lunch, 2 times per week.
External treatment:
Continue the herbal water with nalpamaradi water.
Instead of Jadamayadi Choornam, ask her to do Pichu with Ksheerabala Thailam.
Note:"Pichu" involves placing a piece of cotton soaked in oil on a particular area of the body for a period of time depending on the site and condition. Benefits. It is used for localised pain and inflammation.
Result :
After the 3rd stage of treatment done a colonoscopy , result as follows :
The ulcerative colitis improved to Grade1-2, with signs of colon recovery.
Observations:
- Avoiding foods and lifestyle choices that cause inflammation is necessary to minimise inflammation.
- Avoid hot, potent foods like seeds, millets, and red meat.
- While using antibiotics, be mindful of the increased inflammation noted in Pitta type personalities.
- Reduce the number of insoluble dietary fibres, multigrain foods, leafy vegetables, etc.; add more readily digestible simple starch foods; and drink no more than 800 ml to 1 litre of water each day to stop diarrhoea.
Prepared by
Dr. Poornima Sreelal
BAMS. M.Sc. Clinical Nutrition and dietetics.
The author can be contacted through info.ayurdiet.in@gmai.com or +91-9447762555
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