Microscopic colitis is the inflammation of colon visible under a microscope. The colon to a naked eye will appear normal; therefore, it is necessary to get biopsy of the colon done to diagnose the condition. It is often associated with abnormal immune response to the bacteria residing in the gut and might also be associated with other inflammatory bowel diseases (Crohn’s disease, ulcerative colitis), infections (bacteria, virus), certain medications (NSAIDs, simvastatin, PPIs, lisinopril), autoimmune diseases (rheumatoid arthritis, psoriasis, Hashimoto’s disease) and bile acid malabsorption. Microscopic colitis can either be presented as lymphocytic colitis or collagenous colitis; however, the symptoms and treatment for both types are the same.
Microscopic colitis is associated with chronic, water, non-bloody diarrhea along with nausea, fatigue, pain, cramps, abdominal bloating, dehydration, weight loss, fecal urgency and incontinence. Although, microscopic colitis is managed with medications such as antidiarrheals, corticosteroids, anti-inflammatories, antibiotics, cholestyramine, anti-TNF and immunomodulators, it is essential to modify one’s lifestyle and diet to help reduce and prevent the symptoms of microscopic colitis.
What Are The Lifestyle Changes For Microscopic Colitis?
The evidence regarding the link between microscopic colitis and lifestyle changes such as diet (proteins, carbohydrates, fats, fiber, zinc and sucrose) has been minimal. Probiotics have been suggested in people with microscopic colitis as the bacteria and yeasts help relieve symptoms of other associated irritable bowel diseases. However, probiotics should only be taken after consulting a doctor. It is also necessary to drink plenty of water during bouts of diarrhea to avoid dehydration.
Certain lifestyle changes in foods and drinks should be avoided, which cause gastrointestinal irritation and may trigger or worsen the symptoms of microscopic colitis. It is beneficial to avoid caffeine (coffee, tea, cola, energy drinks, and chocolate), lactose (milk, cream, yogurt, and cheese, ice-cream) and spicy foods. It is helpful to maintain a diary and identify any food/drink that triggers or worsens the symptoms and those foods/drinks should be avoided. An individual can also follow a diet plan recommended by a dietician/doctor based on their symptoms.
Lifestyle changes for diarrhea can be managed by a low fiber diet and some patients may benefit from diet with low fiber and their symptoms might be relieved during diarrhea bouts in microscopic colitis. Foods rich in fiber such as raw fruits and vegetables (broccoli, cauliflower, and spinach), beans, pulses, peas, nuts, seeds, potatoes, whole wheat, cereals, pasta and rice should be avoided.
Patients with celiac disease benefit from gluten free diet and these patients have similar symptoms of microscopic colitis; also celiac disease patients have a greater chance of having microscopic colitis. These patients should avoid gluten rich foods such as cereals, wheat, rye, barley, bread, pasta, cakes, pastries and processed foods. Patients with microscopic colitis should be ruled out for celiac disease.
Avoiding FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides and polyols) is beneficial for individuals suffering from inflammatory bowel disease and it is a good lifestyle change. Foods rich in FODMAP include fruits and vegetables, dairy products, products containing wheat and rye, sugars and artificial sweeteners.
People suffering from microscopic colitis should not only pay close attention to their diet lifestyle change, but also should limit their intake of alcohol as excessive alcohol consumption has been linked to increased chances of microscopic colitis. Patients with microscopic colitis have noted a relief in their symptoms when abstaining or limiting alcohol intake.
Smoking has also been linked to increased chances of developing microscopic colitis and other digestive disorders. It has also known to worsen the symptoms of microscopic colitis, so it is best advised to quit smoking in patients suffering from microscopic colitis.
Certain medications have also been linked to microscopic colitis. These include NSAIDs (aspirin, ibuprofen, and naproxen), lansoprazole, acarbose, ranitidine, sertraline, carbamazepine, clozapine, esomeprazole, lisinopril, omeprazole, pantoprazole, rabeprazole and simvastatin. A doctor should be consulted regarding the intake of these medications.
If lifestyle changes alone do not resolve the symptoms of microscopic colitis then a doctor should be consulted regarding the management of microscopic colitis with medications. By far, budesonide, a corticosteroid, has been considered the most effective medication for treating microscopic colitis.
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