Unlock the Secrets: How the Right Diet Can Transform Your Life with Microscopic Colitis

Microscopic colitis (MC) is a type of inflammatory bowel disease (IBD) characterized by inflammation in the colon, only visible under a microscope. It manifests primarily as chronic, watery, non-bloody diarrhea. While there is currently no cure for MC, symptoms can often be managed effectively through medication, dietary changes, and lifestyle adjustments. It's important to note that MC is not related to other inflammatory bowel diseases like ulcerative colitis or Crohn’s disease, or infections like pseudomembranous colitis (C. difficile).

Understanding Microscopic Colitis

Microscopic colitis includes two main subtypes:

Collagenous colitis (CC): Characterized by a thickened layer of collagen in the colon tissue.
Lymphocytic colitis (LC): Characterized by an accumulation of lymphocytes (white blood cells) on the inner surface of the colon.

Both subtypes share similar symptoms, with the most common being chronic, watery diarrhea. Other symptoms may include abdominal pain or cramping, fatigue, muscle and joint pain, unintentional weight loss, and dehydration. Age is also a risk factor, with 75% of people affected being over 50 years old. There is also a strong association between microscopic colitis and the use of various medications.

The Role of Diet in Managing Microscopic Colitis

While research on the direct link between diet and microscopic colitis is limited and sometimes contradictory, dietary changes can play a significant role in managing symptoms, particularly during flare-ups. It may take some trial and error, but the right combination of medication and food changes can usually help you feel better.

General Dietary Recommendations

Most people with microscopic colitis find that following a low-fiber, low-fat diet is beneficial. Foods that are typically eliminated from one’s diet are spicy foods, alcohol, fried foods, gluten, and dairy because they can often cause digestive issues.

Read also: Weight Loss with Low-FODMAP

Focus on easily digestible foods: Choose foods that are gentle on the digestive system, reducing the workload on the inflamed colon.
Identify and avoid trigger foods: Keeping a food diary can help pinpoint specific foods that worsen your symptoms.
Stay hydrated: Diarrhea can lead to dehydration, so it’s crucial to replenish fluids and electrolytes.
Consider smaller, more frequent meals: Eating several smaller meals rather than a few large meals can be easier on the digestive system.

Foods to Include in Your Diet

White rice or pasta: These are low in fiber and fat, making them easy to digest.
Lean proteins: Choose lean protein sources such as skinless chicken, turkey, and fish, as fatty meats take longer for the body to digest and may contribute to inflammation.
Potatoes: Soft, cooked potatoes (both sweet and regular) are generally well-tolerated.
Eggs: Eggs are soft, easy to digest, and provide high-quality protein.
Bananas: Bananas contain soluble fiber and prebiotics, which are beneficial for digestive health and can help ease diarrhea.
Applesauce: Because it does not contain the skin, applesauce is easier to digest than whole apples.
White bread: White bread contains less fiber than whole-grain bread, making it a better choice during symptomatic periods.
Cooked or canned fruits and vegetables: These are typically softer and easier to digest compared to raw options. Cooking vegetables until they are fork-tender helps your body digest them more easily, which can help prevent uncomfortable bloating and gas. Beets, carrots, green beans, and squash are typically well-tolerated by people with microscopic colitis.
Hydrating fluids: Drink a combination of hydrating fluids each day such as water, sports drinks, and broths.
Low-fat dairy products or dairy alternatives: If dairy is a trigger for you, choose dairy alternatives such as almond milk, coconut milk, or oat milk.
Foods high in omega-3 fatty acids: The anti-inflammatory properties of omega-3 fatty acids may help with intestinal inflammation. Food sources include walnut butter, flaxseed oil, and fatty fish such as salmon, herring, and mackerel.

Foods to Avoid

Caffeinated drinks: Caffeine can stimulate the intestines, exacerbating symptoms, especially diarrhea. Opt for decaf options.
Alcoholic beverages: Alcohol can cause dehydration and may trigger symptoms of inflammatory bowel disease.
Spicy foods: Spicy foods can irritate the intestines and worsen symptoms.
Fatty or fried foods: These can be hard on the digestive system. Choose grilled, baked, or broiled options.
Dairy products (if lactose intolerant): Avoid milk, cheese, yogurt, and ice cream if you have lactose intolerance.
High-fiber foods: Consuming too much fiber can aggravate abdominal cramping, bloating, and diarrhea. Limit high-fiber foods like beans and lentils.
Foods high in sugar: High amounts of sugar can cause inflammation.
Gluten-containing foods (for those sensitive to gluten): For those who have a gluten sensitivity, consuming foods like bread, pasta, cereal, and bakery items can aggravate symptoms.
Foods high in FODMAPs: You may need to temporarily avoid high FODMAP foods which include dairy, beans, lentils, wheat, rye, and certain fruits and vegetables.
Nuts and seeds: Nuts and seeds are rich in fiber and in fat. While they do provide several health benefits, they may be difficult to digest for someone with microscopic colitis.
Certain raw vegetables: Certain raw vegetables can cause excess gas and abdominal discomfort. Raw vegetables such as broccoli, cabbage, onions, and celery should be avoided to prevent symptoms.
Processed foods: Highly processed foods often contain ingredients that contribute to intestinal inflammation.
Certain artificial sweeteners: Artificial sweeteners (such as sucralose and aspartame) may induce intestinal inflammation and cause digestive upset.

Dietary Strategies and Specific Diets

BRAT Diet: The BRAT diet (bananas, rice, applesauce, toast) is often recommended during flare-ups to help slow down digestion and reduce the frequency of bowel movements. However, this diet should only be followed temporarily.
Low-FODMAP Diet: A low-FODMAP dietary intervention calls for the restriction of monosaccharides (e.g., fructose), disaccharides (e.g., lactose), oligosaccharides (e.g., fructans and galactans) and polyols (e.g., sorbitol and xylitol) in the patient’s everyday diet. This leads to fewer readily fermentable substrates in the distal small intestine and proximal colon, which are responsible for luminal distension and functional gut symptoms. The low FODMAP diet starts with an elimination phase, where all “high FODMAP” foods are eliminated for a period of time. After symptoms resolve, foods are slowly added back into the diet as tolerated. This diet may help identify specific trigger foods, but it must be followed properly. Because it is so restrictive, the low FODMAP diet can be challenging to follow and may put people at risk for nutrition deficiencies.
Low-Residue Diet: Clinicians may recommend a low-residue diet to decrease the number of bowel movements and ease diarrhea, bloating, and stomach cramping. While on a low-residue diet, a person can have refined grains (white bread, white pasta, and white rice), well-cooked or canned vegetables, skinless and seedless fruits, meat, seafood, and eggs. Foods that are not allowed include nuts, seeds, dried fruits, raw vegetables, fruit juices with pulp, and caffeine. A low-residue diet may be beneficial for patients with microscopic colitis to help ease symptoms. However, this diet does have a lot of restrictions and may require supervision by a physician or registered dietitian to ensure patient adherence.
Paleo Diet: The paleo diet is an eating pattern that is based on what humans were believed to eat during the Paleolithic Era. The idea behind this diet is that human genes are not well-adjusted to modern diets, so it includes only foods that could be hunted or gathered in the past. Foods included on the paleo diet are all fruits, vegetables, lean meats, fish, eggs, nuts, and seeds. All grains, legumes, sugar, and dairy products are excluded. Since dairy and gluten are excluded, following this diet pattern may be beneficial to you if you know these trigger your symptoms. However, research has not yet shown that this is an effective diet in treating symptoms of microscopic colitis. Sticking to this diet long-term may also be an issue because food choices are limited.
AIP Diet: The AIP (Autoimmune Protocol) diet is aimed at reducing intestinal inflammation by eliminating inflammatory foods. Grains, legumes, dairy, eggs, food additives, refined sugar, alcohol, coffee, nuts, seeds, and certain vegetables are avoided on this diet. During the elimination phase, fresh fruit, bone broth, and minimally processed meats are allowed. Eliminated foods can be slowly re-introduced as symptoms resolve.

Additional Considerations

Probiotics: Some researchers believe that getting probiotics from a concentrated, well-tested product like VSL#3 may help with symptoms. However, more research is needed to fully support the role of probiotics in managing microscopic colitis.
Calcium: Researchers found that participants with microscopic colitis consumed less calcium in their diet than those without the condition. Calcium may help improve the gut microbiome and reduce symptoms of watery diarrhea.
Vitamin D: There was a statistically significant change in vitamin D concentrations after a 6-week low-FODMAP dietary intervention.
Smoking: Doctors usually advise people with MC who smoke to quit.
Medications: A doctor can provide information on which medications may worsen or trigger symptoms of MC.
IBS and Low-FODMAP Diet: A study was conducted to evaluate the effectiveness of a low-FODMAP diet in patients who meet the diagnostic criteria for IBS whilst in IBD remission. A total of 200 patients in remission of IBD were included in the study. Sixty-five of these patients (32.5%) were diagnosed with IBS according to the R4DQ. Of the 59 patients with IBS diagnosed at baseline for whom data were collected at the end of follow-up, after the low-FODMAP intervention IBS-like symptoms were not present in 66.1% (n = 39). The low-FODMAP diet improved the gut symptoms of flatulence and diarrhea. It had no effect on the occurrence of constipation.

Medical Treatments

Medications are generally effective in treating MC. In addition to recommending dietary and lifestyle changes, a doctor or gastroenterologist may prescribe:

Antidiarrheal medicines
Corticosteroids, such as budesonide
Immunosuppressants
Biologics

In severe cases, a doctor may suggest surgery to remove a portion of your colon.

Seeking Professional Guidance

It is crucial to consult with a healthcare professional, such as a registered dietitian or gastroenterologist, to develop a personalized management plan for microscopic colitis. They can help you identify trigger foods, create a balanced diet, and determine the most appropriate medical treatments for your specific needs.

The Importance of a Holistic Approach

Managing microscopic colitis effectively requires a holistic approach that combines dietary modifications, lifestyle adjustments, and appropriate medical treatments. By working closely with your healthcare team and actively participating in your care, you can significantly improve your quality of life and find relief from the challenging symptoms of this condition.

Research Insights: Low-FODMAP Diet and IBS in IBD Remission

Recent research has focused on the overlap between irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD). Approximately 30% of patients with quiescent inflammatory bowel disease (IBD) meet the diagnostic criteria for irritable bowel syndrome (IBS). One study evaluated the effectiveness of a low-FODMAP diet in IBD patients in remission who also met the criteria for IBS.

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The study included 200 patients in remission from IBD, with 65 (32.5%) diagnosed with IBS. After a 6-week low-FODMAP diet intervention, 66.1% of the IBS patients reported a resolution of IBS-like symptoms. The diet was found to improve symptoms of flatulence and diarrhea but did not affect constipation. This study suggests that a low-FODMAP diet can be a beneficial intervention for IBD patients in remission who experience IBS-like symptoms.

Read also: Delicious Low FODMAP Chicken

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