Targeting convergent pathogenic pathways: precision nutrition and lifestyle strategies in ulcerative colitis

Ulcerative colitis (UC) exhibits rising global incidence and substantial disease burden. Limited therapeutic response and side effects of standard medications create demand for safe adjunctive management approaches. It appraises existing evidence for targeted nutritional supplementation and structured lifestyle adjustments in UC care, covering vitamin D, short-chain fatty acids (SCFAs) particularly butyrate, probiotics including Escherichia coli Nissle 1917 (EcN) and multi-strain blends, prebiotics, synbiotics, phytochemicals, and trace elements, together with physical activity, stress management, sleep regulation and therapeutic diets. It addresses their therapeutic effects, underlying mechanisms, and clinical practicability. Such interventions act through shared pathways including immune-inflammatory modulation, ferroptosis suppression, intestinal barrier repair and gut microbiota reshaping. A notable observation is that selenium supplementation at 200 μg/d for 10 weeks achieved higher clinical improvement among patients with mild-to-moderate active UC. The intervention yielded 38% clinical remission vs. 6% in the placebo group ( p = 0.014) and lowered circulating IL-17. Exploratory microbiome data indicated more prominent butyrate-related benefits in individuals with a low Firmicutes/Bacteroidetes ratio, accompanied by significant quality-of-life gains ( p = 0.003) and a non-significant trend toward reduced fecal calprotectin ( p = 0.09), though these subgroup outcomes await prospective verification. Variable treatment responses support biomarker-guided personalized intervention selection. Nevertheless, most supporting evidence derives conventional trials, exploratory subgroup analyses or preclinical studies rather than validated predictive stratification tools. This review synthesizes mechanistic and clinical data to build a hypothesis-driven framework for precision-oriented dietary and lifestyle adjuncts to routine UC treatment, while differentiating these strategies from established precision therapies and outlining necessary trials to translate findings into clinical practice.