When Rayna Kraman, 75, who lives near Waco, Texas, was diagnosed with ulcerative colitis (UC) four years ago, she had no idea her condition – a type of inflammatory bowel disease (IBD) – might be connected to her Jewish ancestry. It wasn’t until her son sent her a link he found on the internet that she made the connection. Unfortunately for Kraman, the information posed more questions than answers.

A Late and Unexpected Diagnosis

At first, Kraman’s doctor didn’t suspect ulcerative colitis, partly because of her age. Ulcerative colitis can strike anytime; however, it usually starts between ages 15 and 25. When diagnosed later in life, it's more likely to be seen in men than women. What's more, Kraman didn’t have the abdominal pain that usually comes with ulcerative colitis.

“My doctor told me it was just diarrhea and that it would be gone in 21 days. I kept arguing with him that there was something wrong with me,” Kraman says. When the doctor took a look inside her colon, he realized she was right. It was inflamed, and he made the diagnosis.

Kraman notes her heritage never came up in her diagnosis, but she recalls her father telling her about having symptoms that could have been UC. He, too, may have had late-onset UC, but he died of cancer in his early seventies, so she’ll never know for sure.

Kraman also wrote to some family members on her father’s side, asking if anyone had ulcerative colitis. One of her father’s first cousins might have had UC, but that relative had passed away, so Kraman couldn’t explore further.

The Role of Family History in IBD 

According to a November 2012 chapter on the genetics of inflammatory bowel disease in the book Pediatric Inflammatory Bowel Disease, ulcerative colitis is more common among Caucasians, especially those of Jewish heritage. And Ashkenazi Jews have a two to ninefold greater prevalence of IBD over non-Jews.

“Family history is important in both ulcerative colitis and Crohn’s disease, but the relationship is much stronger in Crohn’s,” says Ashkan Farhadi, MD, director of the Digestive Disease Center at Memorial Care Medical Group in Costa Mesa, Calif., and a gastroenterologist at Orange Coast Memorial Medical Center in Fountain Valley, Calif.

If a patient comes to Dr. Farhadi complaining of having constant diarrhea, rectal bleeding, abdominal pain, weight loss, fatigue, and is Jewish, he might more readily investigate whether it's ulcerative colitis; but he would consider that possibility with anyone having those symptoms, he explains.

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Is Ulcerative Colitis Genetic? 

While some genes have been identified with the functioning of the intestines, the cause of ulcerative colitis is still unknown.

The inner lining of the intestines is meant to keep harmful bacteria and toxins from passing through their walls. In some people, this barrier breaks down. “We call this intestinal hyper-permeability,” says Farhadi. It could be an early step in the development of inflammatory bowel disease. The question is, could this be the result of faulty genes, or is it environmental, or both?

The thinking is that having a more permeable intestine provokes an immune response, Farhadi says. “When activation of the immune system gets out of hand, the intestinal lining will be caught in the crossfire, and we can see damage to the intestinal lining.”

“It seems that even if intestinal permeability is not the sole reason for the development of UC, it contributes to its creation in those who are immunologically susceptible,” Farhadi adds. But what provokes or controls the autoimmune response in some people has yet to be answered, he says.

What You Can Do 

There’s no way to prevent ulcerative colitis. “It’s not like heart disease, where if you eat a low-fat diet and exercise, you can ward it off,” says Neville Bamji, MD, a clinical instructor of medicine at The Mount Sinai Hospital and a gastroenterologist with New York Gastroenterology Associates.

If you’re Jewish and have a close relative who has UC, do your best to follow a healthy lifestyle. Manage your response to stress, maintain good sleep hygiene, keep your weight within normal range for you, and don’t gorge on saturated animal fats and processed foods, Farhadi advises.

If you have gastrointestinal discomfort that doesn’t go away in a reasonable time, see your doctor. “We have very effective treatments for ulcerative colitis,” says Dr. Bamji. Many people can control symptoms with diet and medication. About 25 to 35 percent of patients do require surgery to remove their colon at some point, though.

Kraman tried allopathic, naturopathic, and homeopathic remedies, to no avail. Prescription medication helped some, but eventually, she had to have surgery. Even if she had known about the possible genetic link, she doesn’t believe she would have done anything differently. “I exercised, and I didn’t smoke,” she says. “Sometimes,” she adds, “you just have to take what life throws at you.”