Ulcerative Colitis

Trial and error eventually pointed CJ Cabrera to the biologic medication that has put his UC into remission—and restored his energy and optimism!

Here’s the good news: Your dreams of freedom—from painful symptoms, unpredictable bowel habits and being held back by ulcerative colitis (UC)—are within reach. Even though there is no cure for it, treatment advances can help you feel as if you don’t have it. The key to unlocking that potential? Working closely with your doctor toward a common treatment goal: remission.

Tell me about remission—and how I get there!
When you’re in remission, the disease is no longer active and is not causing damage to your gastrointestinal tract. Signs of remission include:

• You experience no more, or very few, symptoms such as diarrhea, abdominal pain and fatigue.
• Blood tests show no signs of inflammation.
• Bowel lesions start to heal.
• You feel normal and enjoy better quality of life.

Achieving remission often takes perseverance—things like keeping all your medical appointments, taking medication as directed, and being willing to try other therapies until your symptoms are well controlled. That’s especially important because uncontrolled intestinal inflammation can not only trigger symptoms, but also lead to serious complications, such as severe ulcers and bowel blockage. It can also increase the risk of developing cancer or pre-cancerous lesions.

Above all, remember this: You are the most important member on the team. By providing your doctor with vital information—i.e., describing your symptoms and how they affect daily activities—you can stay ahead of UC.

Will I need medication?
Most likely, and finding the one that will work for you requires being open and honest with your care provider about your symptoms. Also, never skip a blood test, as your doctor uses the results to assess how well your treatment is working.

It’s important to be informed about all your medication options, so review the table here. If you’re still experiencing symptoms on your current regimen, ask your care provider about newer options, such as biologics, which have been helping many people with treatment-resistant UC achieve remission.

What about surgery?
Most patients with UC can be managed with medical therapy; however, surgery is also an option in emergency situations and when medical therapy has failed.

A surgery option for those with UC is a proctocolectomy (removal of the entire colon and rectum) along with the creation of an internal pouch to collect stool; the most commonly used pouch is known as the J-pouch.

Surgery may also be a consideration if pre-cancerous lesions or colon cancer develops over the course of the disease. 

The importance of lifestyle choices
First and foremost: If you use tobacco, quit! Research shows that smoking can trigger more frequent and more severe symptoms.

Also, although there’s no proven diet to treat UC, certain foods or drinks could be triggers for you. Keeping a food and symptom diary can help you pinpoint possible culprits so you can avoid them.

And avoid taking over-the-counter NSAIDs (nonsteroidal anti-inflammatory agents) like ibuprofen, as these can trigger symptoms.

Finally, stay on top of your overall health: Get good sleep, find ways to relieve stress and keep active. Also, because having UC increases your risk of colorectal cancer, you will need more frequent colonoscopy screenings. 

Which medication?

Medication can help keep your symptoms and inflammation under control. It may even help you avoid surgery or improve the outcome if an operation becomes necessary. Talk about all the symptoms you’re having to help your doctor determine the right treatment plan for you 

More options than ever!
Good news for patients using or interested in starting a biologic to treat their ulcerative colitis: The FDA recently approved a biologic drug—one with a long track record of successfully treating IBDs—for UC via subcutaneous injection, rather than infusion. That means, once your starting doses are complete, you can inject your medication on your own—at home, on-the-go or anywhere—without needing to make an appointment with your doctor’s office or pharmacy. Ask your healthcare team if an injectable biologic could work for you!

CJ, Shonda and Daanish are living well with ulcerative colitis (UC) thanks to their focus on positivity and healthy habits. Now, they’re guiding others on how to stay active with the disease by sharing the strategies that work for them.

“Today I feel unstoppable!”
____________________
CJ CABRERA
MANASSAS, VA

Deadlifts. Bench presses. Pull-ups. CJ Cabrera works hard in the gym, where he’s happy to be spending more time now that his UC is in remission. In fact, the, Marine veteran has a goal: “I want to reach 150 pounds,” says CJ, who at 5’7” is about 10 pounds shy of that. That may sound like a modest achievement, but for CJ, who at one point dropped close to 40 pounds during one of his worst UC flares, it’s a hard-sought victory he’s determined to claim.

“It would hit me—I’ve got five minutes to find a bathroom!”
It wasn’t until CJ was out of the Corps and pursuing his associates degree that he first started having symptoms: blood in his stool, then abdominal pain. Initially, doctors blamed hemorrhoids caused by heavy lifting in the gym. He was instructed to eat a high-fiber diet, but his symptoms worsened. Home after a fun night out with friends, CJ got a shock. “I filled the entire toilet bowl with blood,” he recalls. “I looked down and thought—Oh, my God.’ ”

CJ’s doctor prescribed a colonoscopy, but when his symptoms mysteriously vanished, CJ canceled the appointment. “Young, dumb and naïve,” he admits. And the diarrhea, stool with bloody mucus, and sensations of urgency didn’t stay away for long. “It eventually got to the point where I’d drive and it would hit me: I’ve got five minutes to find a bathroom. Over time, it raised my anxiety to the point I was going to the bathroom 10 times a day. For a year and a half, I couldn’t drive.”

 “I lost my faith…”
Learning he had UC following a colonoscopy in April 2018, CJ became laser-focused on two things: achieving remission and, with an associate’s degree under his belt, continuing his education. Working closely with his doctor at the VA, he tried one medication after another. Biologics? He didn’t hesitate. “I just wanted to feel better. Whatever that would take.”

Unfortunately, nothing brought relief. With his symptoms unmanageable, he was forced to drop out of school. “Bedrest—that was all I could do. I had fatigue so extreme, I couldn’t even get to the hospital for my infusions. I lost my faith. I isolated myself completely, dropped almost 40 pounds. I was unrecognizable to myself.”

“…but I refused to stay down”
Maybe it took hitting bottom for CJ to get the “bounce back” he needed. “I had failed a couple drugs and it kind of broke me. There weren’t many options left.” He finally agreed to try a new biologic—and, eureka!, it was the one that worked. At the same time, he looked at what he could do and examined his lifestyle. “I focused on my mental health. Back then, I didn’t love myself. It took every day working on self-care, self-love.”

His health didn’t turn around overnight, CJ says. “It took a while. I got my sleep schedule down. Paid attention to my diet. I started figuring out what I did that triggered a flare. Now I know my body and what I need to do for it to be good and stay good.”

And out of a multi-year struggle with UC came the best rewards: Remission, and this: “Now I love myself.”

These strategies helped CJ manage his UC. Could they help you?

Put your health first. CJ quit the security job that he’d held for years after complications forced him to leave a job site to care for himself. “I never went back to that job,” he says. And the result of saying “no” to work issues that undermined his health has been positive: CJ has been in remission since June 2021.

Talk out your feelings. “I got therapy through the VA (Veterans’ Association) and have done mostly group therapy with other IBDers. Therapy shows you you’re not alone,” says CJ. “And I bought a big notebook and journal whenever I need to figure things out. That book helped me get my mental health straight.”

“You can rise to the challenge!”
____________________
SHONDA BERRY, 43
CHICAGO

Shonda Berry started seeing signs of IBD at 14 years old. “The first symptom I ever had was blood in my stool. I was scared and confused,” she says. After a colonoscopy in 2004, she was diagnosed with UC by a gastroenterologist.

The lowest point of her journey was when she didn’t feel in charge of her body. “I started having new uncontrollable symptoms,” says Shonda. “My medication at the time stopped working, and the flare was not calming down. I was getting sicker, losing weight, and I developed an infection and then sepsis. I had many complications with the disease for months and was struggling mentally.”

It’s been a journey to ease her symptoms, and today, Shonda’s in a good place with her UC. “The symptoms subsided a few months ago, since I started my new treatment, which seems to be working well. I’m currently in the loading stage of a new biologic, which means I need my dosing more frequently, but I’ll be moving to only needing a dose once every eight weeks soon, which will be a relief.” Shonda’s annual colonoscopy, scheduled in a few months, will tell her definitively if the treatment is working and she can be considered “in remission.”

“Life doesn't stop while living with IBD, it's just beginning,” says Shonda, who is a coach, entrepreneur, patient advocate and mom to 19-year-old daughter Da’Riah. “Once I had a better understanding of UC and my body, I embarked on an entirely new journey. My UC is part of my purpose here on earth, and I’m up for the challenge.”

Here, Shonda shares the tips that helped her do just that:

Speak up. “I took control of my health and life by amplifying my voice. That was the best thing I could do for myself. I started asking questions and giving my opinion from a patient perspective when talking with my healthcare team,” says Shonda. For example, “after being very sick in 2019, I told my doctor I wanted to stop my current medication and move to a new one. So we discussed my options, and together chose the medicine we thought would be best for my next steps.” 

Prevent stress. “I do the best I can to manage my stress, which is one of my UC triggers,” says Shonda. That means she’s stopped overextending herself and is staying away from people who ignore her boundaries, especially when she’s not feeling well.  And when she’s feeling anxious or on edge, she finds walking helps. “It’s great, and it doesn’t put too much strain on my body,” she adds.

Make safe food choices. “Even though food isn’t a major trigger for me, there are still some I need to be mindful of,” says Shonda. “For instance, I try to avoid sugar, mainly because it’s not good for me. But salmon, which is an anti-inflammatory food, is one of my safe go-to options when I’m not feeling well. Potatoes are another good choice.”

Seek good vibes only. “I enjoy being in the presence of positive people. Energy is transferable, and my body loves good energy,” she says. “I’ve found that talking about my disease with my family, friends and my therapist has been excellent for my mental health.”

Prepare for flares. Shonda finds comfort in being ready for a flare. “I keep a packed bag in my car with a pain reliever, water, a journal, extra clothes, toiletries and my emergency contacts.” And at times when her UC has the upper hand, she stays cool: “I've learned to give myself grace and not beat myself up when I have no control over my body,” says Shonda.

Enjoy peppermint. “I wish I knew about peppermint earlier! Eating a peppermint, drinking peppermint tea, and inhaling peppermint essential oil has been soothing to my digestive tract and helpful with stress management,” says Shonda.

Taking a few deep breaths in a stressful situation helps everyone relax a little, but for people with ulcerative colitis (UC), it may actually help them either avoid or better cope with symptoms. Consider: The effect of psychological stress on the GI tract may worsen IBD symptoms and increase the risk of an flare, according to research in the journal Gut.

It’s something personal trainer, yoga instructor and IBD coach Jennifer Tabrizi (healingwithjennifer.ca) knows firsthand: “Every time I have a flare, there’s some kind of significant stress going on in my life,” affirms Jennifer, who was diagnosed with IBD in February 2012, when she was experiencing up to 12 episodes of diarrhea a day. Today, she takes a biologic medication to help manage her condition and curbs inevitable tension and anxiety by doing these breathing techniques and gentle movements each day. “Being consistent and persistent with my breathing practice has helped me heal!”

Stretch and release tension in the upper back and torso with: Chair Twist

Start by sitting up tall in your chair. Gently twist your body toward the right, looking over your right shoulder. Hold the twist for three to five breaths (think of breathing into your lower belly). Slowly come back to center. Perform five to eight times on your right side. Repeat the movement on your left side. Perform five to eight reps on your left side.  

Relieve the stress from weak upper body muscles and poor posture with:  Seated Spine Lengthener

Start by sitting at the edge of your chair. Place both hands (palms down) underneath your thighs. Think of keeping your spine long and chin tucked. Take 8-10 deep breaths.

Alternate “deep breath” days with either of these two breathing techniques:

Find serenity with: The breath disillusion. (This can also be performed standing or lying down.)

1. Inhale as you normally do, then exhale.
2. Next, inhale more deeply, then exhale.
3. Next, take your deepest inhalation, then exhale.

Now, repeat the above sequence backwards (e.g., #3, deepest breath; #2, deeper breath; #1, regular breath). Pause one to two seconds, breathing normally. Repeat the cycle.

Beginners: 5-10 rounds total. More advanced: 10-15 rounds.

Center yourself with: Box breathing. Visualize your breathing as a box: Inhale for two counts. Hold for two counts. Exhale for two counts. Pause for two counts. Perform 10-12 times total.

To progress: Try making each breath and pause last three counts, then four counts. If necessary, shorten the pauses between inhalations and exhalations to a length that’s comfortable for you.  

Stretch the chest and boost posture with: Standing Tall Pose

Start in a standing position. Feel your feet ground into the earth. Keep your chin tucked, your spine long. Clasp your hands behind your back. Think of slightly lifting through the chest. Focus on eight to 10 deep breaths here. (You can also do the above breathing techniques in this pose, too.)

Stretch the back and ease upper body tension with: Self-Love Hug

Start by standing with a straight spine, as in the Standing Tall Pose above. Gently roll the shoulders down and away from the ears. Reach both arms out in front of you. Cross your arms and grab the opposite shoulder with each hand. Focus on eight to 10 deep breaths.

Important! Always consult with your healthcare provider before starting any new fitness program.

Illustrations by Juhee Kim

Living with an irritable bowel disease (IBD) like ulcerative colitis (UC) doesn’t have to mean eating bland food—just ask Abigail Marie, a professional chef who also happens to have IBD and loves coming up with delicious, digestion-friendly recipes she shares on her site AbigailMarieTheChefWithIBD.com. 

“My goal is to help others with IBD live better lives through healing and flavorful foods,” she says. In line with that, here are three of her top replacements for typical takeout favorites, with a focus on low sugar and easily digested carbs. Why not give them a try tonight?

YEARNING FOR MEXICAN?

Enchilada Stuffed Poblano Peppers

Makes 4 servings

For the sauce:

• 3 Tbsp. olive oil
• 3 Tbsp. coconut flour
• 2 cloves garlic, minced
• ½ tsp oregano
• 1 Tbsp. chili powder
• 2 tsp. cumin
• 1 tsp. salt
• ½ tsp. pepper
• 2 Tbsp. tomato paste
• 2 cups chicken broth
• 1 tsp. apple cider vinegar
• 1 jalapeno, deseeded and pureed 
• 2 Tbsp. water

For the enchiladas:

• 4 chicken breasts
• 4 poblano peppers, halved and deseeded
• 1 cup mild cheddar
• Cilantro, chopped, for garnish

In a large sauté pan, heat the olive oil over medium heat. Add in the coconut flour and whisk until incorporated. Cook 1-2 minutes, stirring occasionally, then add the garlic and sauté for another 1-2 minutes. Add in the spices. Whisk together and cook for another 1-2 minutes, then add the tomato paste and chicken broth and simmer 5-6 minutes or until beginning to reduce. Add in the vinegar and pureed jalapeno; whisk to incorporate. Allow to reduce for 3-4 more minutes, then blend in a blender until smooth.

Next, add your chicken breasts to a slow cooker and pour 1 cup of the sauce on top. Cook on low 2 to 2 ½ hours or until the internal temperature has reached 165°F. Remove the chicken, let cool slightly, then shred and add back into the liquid.

Preheat your oven to 375°F. Line a sheet tray with foil and lay each poblano half face-up. Stuff with the chicken, and pour 1 cup of the remaining sauce on top. Bake for 15-20 minutes, top with cheese and bake for another 8-10 minutes. Remove from the oven and serve immediately.

CRAVING CHINESE?

Sweet Orange Sesame Chicken

Makes 4 servings

For the sauce:

• 1 ¼ cup orange juice, no sugar added, not from concentrate
• 1 Tbsp. ginger, grated
• 1 Tbsp. sesame oil
• 4 cloves garlic, minced
• 2 Tbsp. beef bone broth
• 1 Tbsp. red wine vinegar
• 1 Tbsp. apple cider vinegar
• ½ cup honey
• 2 Tbsp. tomato paste, no sugar added 
• ½ tsp. chili powder
• ¾ tsp. salt
• ½ tsp. pepper

For the chicken:

• 2 Tbsp. olive oil
• 4 chicken breasts, about 4 cups or 2 lbs., cubed
• ⅓ cup coconut flour
• Sesame seeds, for garnish
• Green onions, for garnish

Add all sauce ingredients to a small pot and bring to a rolling boil, whisking occasionally. Cook until reduced by three quarters and thick.

Meanwhile, heat the olive oil in a large sauté pan over medium heat. Dredge your chicken in the coconut flour and add to the hot pan. Sear on all sides, 2-3 minutes a side, or until the chicken has reached 165°F.

In a large bowl, add cooked chicken and toss with your orange sesame sauce until well coated. Top with sesame seeds and green onions. 

WISHING FOR ITALIAN?

Oven Baked Chicken Parmesan

Makes 4 servings

• 2 chicken breasts, medium, sliced horizontally
• ½ tsp. salt
• ¼ tsp. black pepper 
• 1 egg, beaten
• 2 Tbsp. almond milk, no additives or thickeners
• 1 cup almond flour
• 1 cup grated parmesan
• 1 tsp. oregano
• 2 cloves of garlic, finely minced
• 1 cup low-sugar tomato sauce
• ¾ cup grated provolone
• 2 Tbsp. parsley, chopped, for garnish

Preheat the oven to 375°F. Line a sheet tray with foil and place a baking rack on top, set aside.

Season the chicken with salt and pepper and set aside. In a shallow dish, whisk the egg and almond milk. In a second shallow dish, mix the almond flour, ¾ cup parmesan, oregano and garlic. Coat both sides of each breast with the egg mixture, then the almond flour mixture, and place on the sheet tray.

Bake 15-20 minutes or until you have reached 150°F. Add ¼ cup tomato sauce to the top of each breast, then top with the provolone and remaining parmesan.

Broil the chicken on high for 10 minutes or until the cheese has melted and the internal temperature reaches 165°F. Remove from the oven, garnish with parsley, and serve immediately.

Photos by abigailmariethechefwithibd.com