How do you know if you are in remission?

So… How do you know if you are in remission?

The topic of remission is rarely fully explained after a diagnosis of IBD so often people come to me with  many questions like:

How do I know if I’m in remission?

My doctor says I’m in remission, but I still have symptoms… What does this mean?

How do I know if I’m out of a flare?

Do these sound familiar?

They sure do for me, because I get questions like these on a weekly basis.

What I’ve found is that if I can help you finally grasp a solid understanding of what remission truly is- it can actually provide a lot of relief and even improve your relationship with food.

Knowing that not every little sign of discomfort does not mean you are out of remission can really be a relief for many.

Reduced anxiety around food can help you take a big picture approach to your IBD nutrition plan by reducing foods we know are connected to flares and expanding your diet to include a more diverse diet.

Next I’m going to identify the three types of remission, help you understand which you are in, and what to do next to ensure the best self-care.

Type 1: Clinical Remission

Clinical remission occurs when you are not experiencing UC symptoms and may feel better. However, you can still experience some of the symptoms such as bloating, constipation, and diarrhea. Some people also refer to this as symptom remission. Approximately, half of those with Crohn’s and Ulcerative colitis have IBS or irritation symptoms despite being in clinical remission (no inflammation).

Irritation symptoms can be managed well with a solid nutrition plan and lifestyle changes. However, just because symptoms are gone- it doesn’t mean there isn’t inflammation. It’s always a good idea to check in regularly with your providers to ensure there is no inflammation. Your provider might run markers like C-reactive protein, Sedimentation rate, Fecal Calprotectin or others to evaluate the state of your IBD.

Your Next Steps Are:

• Continue to support digestive health by eating a diverse diet (30+ unique plants weekly)
• Expand the diet to things you would normally avoid in a flare
• Monitor for deficiencies regularly
• Work with a IBD Dietitian who can make help get on a solid plan to reduce risk of flare
• Continue to avoid foods identified as inflammatory for IBD
• If symptomatic, working with a Dietitian can also help reduce “irritation” like symptoms
• Try to incorporate “stress resilience” tools like meditation to reduce stress & flare risk
• Work on avoiding eating in a “stressed state”- try 5-7-3 breathing before meals

 

Type 2: Biochemical Remission

Biochemical remission occurs when no signs of inflammation are shown on blood and stool tests. Your provider might run markers like C-reactive protein, Sedimentation rate, Fecal Calprotectin or others to evaluate the inflammation. While this is a good sign that inflammation is well controlled, this doesn’t mean that there isn’t damage to the mucosal lining in the GI and also doesn’t mean there will not be symptoms present.

Your Next Steps Are:

• Continue to stay on your treatment plan (medication, dietary & supplement strategies) to keep inflammation controlled and increase the likelihood off intestinal healing
• If symptomatic, continue to work on strategies to reduce symptoms
• Work with an IBD focused dietitian if struggling to consume enough food or if you start skipping meals

 

Type 3 & 4: Endoscopic & Histological Remission

Endoscopic Remission is when the intestinal lining tests show no signs of inflammation. Histologic Remission is when there are no signs of IBD present.This differs from biochemical and clinical remission in that there are also signs of mucosal healing. Getting to a deeper remission can also make it less likely to have a relapse or flare up. However, there is still a possibility of having relapse of disease activity or symptom activity. Even in deep or histological remission, you can still have irritation or IBS like symptoms.

Your Next Steps Are:

• Continue to monitor labs yearly check for inflammation
• Run labs yearly to check for deficiencies like Vitamin D or Anemia
• Work on expanding the diet to include a wide variety of plant foods
• Continue to avoid foods identified as inflammatory for IBD

 

Final Thoughts

Regardless of where you are at in the remission spectrum, the evidence is supportive of including a solid nutrition plan for Crohn’s and Colitis in helping to reduce the risk of having a flare and reducing the severity of flares. If you aren’t sure where to start- I’ve got you covered.I’m continually working on resources to support you wherever you are at in your IBD journey. If you are curious about which of these resources or forms of coaching might be best for you, reach out and schedule a call here. Also, check out our IBD group program + course here.

 

P.S. If you are curious about the Differences between IBS & IBD check out my answer here.

If you don’t have IBD but you want to know how to better support your loved one with IBD, check out the blog I did here.