How to Reduce Symptoms of Microscopic Colitis

We have noticed an uptick in Microscopic Colitis clients lately as well as an increase in questions about the disease. In an effort to help you incorporate strategies to reduce your symptoms with Microscopic Colitis, we want to talk about the condition and identify ways to help! 

If you need a refresher on Microscopic Colitis before jumping into today’s article, check out our blog post on what to eat with Microscopic Colitis here. 

In order to properly understand Microscopic Colitis and ways to improve symptoms, we need to discuss the unique attributes of the disease and ways it can overlap with other conditions. 

How to Reduce Symptoms of Microscopic Colitis

How is Microscopic Colitis Different from IBS?

IBS, or Irritable Bowel Syndrome is a functional gastrointestinal disorder that causes uncomfortable symptoms, but doesn’t result in structural damage to the gut. You can read more about IBS here. Although both conditions can cause watery diarrhea and cramping, Microscopic Colitis is quite different from IBS. 

Microscopic Colitis is a type of inflammation in the colon, often caused by abnormal immune reactions. The hallmark clinical manifestation of nocturnal diarrhea tends to be the differentiating factor between Microscopic Colitis and IBS (2). 

How is Microscopic Colitis Different from IBD?

Microscopic Colitis is actually under the umbrella of inflammatory bowel diseases, making it a form of IBD. It has a different presentation than Crohn’s or Ulcerative Colitis in that it causes chronic, watery diarrhea without the presence of blood. 

Another differentiating factor is that laboratory investigations tend to be normal with Microscopic Colitis, including stool cultures and initial impressions from a colonoscopy. In some cases a colonoscopy might reveal some mild swelling or redness, but a biopsy of the colon above the rectum is necessary for a proper diagnosis. 

Overlap with Celiac Disease 

Those with Celiac Disease have a 70-fold increased risk of Microscopic Colitis than the general population. Patients with Celiac Disease who are also diagnosed with Microscopic Colitis tend to be older and have more severe villous atrophy, perpetuating the severity of the symptoms (1). When the two conditions are associated, Celiac Disease tends to be diagnosed first, but that’s not always the case. 

It’s imperative that those diagnosed with Microscopic Colitis also seek out a proper Celiac Disease screening to determine if both are potentially present. Remission will not be achieved if proper diagnoses are not achieved.  

Ways to Reduce Symptoms of Microscopic Colitis

Although there is relatively limited data on dietary strategies with Microscopic Colitis, we have found that incorporating strategies from other inflammatory bowel diseases with the available literature has been helpful for many of our clients. 

Dietary strategies to reduce symptoms of Microscopic Colitis

• Be aware of fats – Although malabsorption is not typically seen in Microscopic Colitis, mild fat malabsorption is sometimes reported in patients (2). Reducing higher fat foods, particularly saturated fats, can be a helpful strategy. 
• Modify fibers – Fiber intake is imperative in inflammatory bowel conditions, but often modifying textures or particle size is necessary to make the fiber intake tolerable. Work closely with a specialized dietitian to develop a plan that works for you! 
• Incorporate prebiotic and probiotic rich foods – Foods rich in pre- and probiotics help restore and maintain gut barrier function (3). Examples of prebiotic rich foods include onions, garlic, beans, and our product Back to Balance (PHGG). You can find probiotics in fermented products like kimchi and refrigerated pickles.    
• Stay hydrated – Restoring electrolytes and staying hydrated is important when chronic diarrhea is present. Using an electrolyte replacement is likely warranted, but be sure to discuss this with your doctor and dietitian.
• Limit triggers – Known triggers include things like caffeine, alcohol, red and processed meats, and dairy foods. Limiting these foods can be helpful in reducing symptoms of Microscopic Colitis. 

For more on what to eat with Microscopic Colitis, check out our other blog article here.

Lifestyle factors to reduce symptoms of Microscopic Colitis 

• Reduce or change medications – Certain medications like NSAIDs, Proton Pump Inhibitors, and some anxiety and depression medications (SSRI’s) can negatively impact Microscopic Colitis. Work closely with your doctor to discuss alternatives. 
• Stop smoking – Smoking cessation is a first line therapy for those who smoke and have been diagnosed with Microscopic Colitis. Discuss ways to do so with your doctor or reach out to a Smoking Cessation Advisor. 
• Check for Celiac Disease – As mentioned above, properly diagnosing Celiac is helpful in determining next steps since the prevalence rate is so high in Microscopic Colitis. 

Let Specialized Dietitians Help

Due to its relative rarity and lack of scientific studies, Microscopic Colitis patients can feel quite left out of the IBD community. For this reason, they also tend to find it difficult to find practitioners that can help or medication options to control their condition. 

We specialize in IBD here at the Crohn’s and Colitis Dietitians, and that includes Microscopic Colitis! We are well versed in the disease process, dietary strategies that can help, as well as lifestyle patterns and modifications that can be supportive. 

Key takeaways

If you or someone you know has been diagnosed with Microscopic Colitis and you’re finding it difficult to manage, we can help! We understand that there can be significant lag times between symptoms and diagnosis or diagnosis and therapies to manage symptoms. We can help coordinate your care and find strategies to improve your quality of life. 

If that sounds like something you want to explore, reach out for a free consultation call today. We would love to partner with you on your Microscopic Colitis journey and welcome you into the wonderful IBD community! 

References

1. Peter H.R. Green, Jun Yang, Jianfeng Cheng, Anne R. Lee, Jason W. Harper, Govind Bhagat,An Association Between Microscopic Colitis and Celiac Disease, Clinical Gastroenterology and Hepatology, Volume 7, Issue 11, 2009, Pages 1210-1216,ISSN 1542-3565, https://doi.org/10.1016/j.cgh.2009.07.011.
2. TAGKALIDIS, P., BHATHAL, P. and GIBSON, P. (2002), Microscopic colitis. Journal of Gastroenterology and Hepatology, 17: 236-248. https://doi.org/10.1046/j.1440-1746.2002.02640.x 
3. van Hemert, S., Skonieczna-Żydecka, K., Loniewski, I., Szredzki, P., & Marlicz, W. (2018). Microscopic colitis—Microbiome, barrier function and associated diseases. Annals of Translational Medicine, 6(3), 39. https://doi.org/10.21037/atm.2017.03.83