Microscopic colitis diet: Which foods to eat and which to avoid

Microscopic colitis (MC) causes recurrent episodes of chronic, watery, nonbloody diarrhea. Other symptoms of this condition can include:

• abdominal pain or cramping
• fatigue
• muscle and joint pain
• unintentional weight loss
• dehydration

The symptoms of MC tend to come and go, and diarrhea can last for weeks or months. In some people, the condition may resolve without treatment. The cause of MC is still not clear.

In this article, we consider whether dietary changes can help treat MC and look at which foods to eat and which to avoid. We also cover other lifestyle changes and medical treatment.

Can diet help?

Researchers are currently studying the possible connection between diet and MC.

So far, there is little evidence to suggest a link between what people eat and the symptoms of MC. Researchers in Sweden published a study in 2016 that followed 135 people with MC over the course of 22 years and monitored their intake of the following:

• protein
• carbohydrate
• sucrose
• saturated, monounsaturated, or polyunsaturated fat
• omega-3 or omega-6 fatty acids
• fiber
• zinc

The researchers were unable to find an association between any of these dietary components and MC.

Certain foods and drinks may irritate the bowel and worsen or trigger symptoms in people with MC. In particular, some people may find it beneficial to avoid caffeine, lactose, and spicy foods.

Foods and drinks that contain caffeine can include:

• energy drinks
• coffee and tea
• cola
• chocolate

Foods and drinks that contain lactose can include:

• milk, buttermilk, and cream
• yogurt
• cottage cheese, cream cheese, and sour cream
• soft cheeses
• ice-cream

Keeping a food diary can help people identify any foods that trigger or worsen their symptoms.

A doctor or dietician can also recommend a diet plan to suit an individual’s needs based on their symptoms. For example, if a person has fatty or oily stools, a doctor may recommend a low-fat diet.

People may need to stick to an elimination diet for several weeks before they notice any improvement in their symptoms. Some people may also benefit from eating smaller meals more frequently, as opposed to having three large meals a day.

Fiber

For people with MC, doctors may recommend a low-fiber diet to help manage diarrhea. Fiber aids the passage of food through the digestive symptom. In some people, a low-fiber diet may help relieve symptoms of diarrhea during an episode of MC.

Foods that are high in fiber include:

• beans, pulses, and peas
• nuts and seeds
• potatoes
• raw fruits
• raw vegetables, such as broccoli, cauliflower, and spinach
• whole-wheat or whole-grain bread, cereals, pasta, and rice

It is best to speak to a doctor or dietician before adopting a low-fiber diet. They can provide advice on which foods to avoid.

Gluten

In people with celiac disease, eating foods containing gluten causes digestive symptoms similar to those of MC, including diarrhea and abdominal pain. People with celiac disease are more likely to have MC than people without this condition.

A person with MC should see their doctor for a blood test to rule out celiac disease. There is no cure for celiac disease, but a gluten-free diet will help minimize or prevent symptoms.

Gluten is a general name for the proteins that are naturally present in wheat, rye, and barley, which are types of cereal grain. People with celiac disease should avoid foods that contain gluten, such as:

• breakfast cereals
• most types of bread and pasta
• cakes and pastries
• many processed foods

Specific types of carbohydrate

Certain carbohydrates, including fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs), are difficult for the body to digest and can cause digestive symptoms. People on a low-FODMAP diet avoid foods containing these carbohydrates. These foods include some:

• fruits and vegetables
• dairy products
• wheat and rye products
• sugars and artificial sweeteners

Although there is little research relating to MC specifically, a low-FODMAP diet can help relieve symptoms in people with other digestive disorders, such as IBS.

Anyone wanting to try a low-FODMAP diet should speak a doctor or dietician first.

Researchers believe that excessive alcohol consumption might increase the risk of developing MC. Some people with MC may find that avoiding or limiting alcohol consumption improves their symptoms.

Smoking can increase the risk of a range of digestive disorders, including MC, or make them worse. Doctors usually advise people with MC who smoke to quit this habit.

There is not yet any scientific proof that medications can cause MC. However, research suggests that there is a strong association between MC and certain medications, including some anti-depressants, several cardiovascular drugs, and nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen, and naproxen.

A doctor can provide information on which medications may worsen or trigger symptoms of MC. It is essential to always speak to a doctor before stopping any prescription medications.

Medical treatment

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

• medications that reduce or prevent diarrhea
• corticosteroids and other drugs that treat inflammation
• antibiotics
• immunomodulators and anti-TNF therapies

Many doctors consider budesonide, a type of corticosteroid, to be the most effective medication for treating MC. A 2014 review reported that budesonide was effective at relieving symptoms in up to 80 percent of people with MC after 8 weeks. However, symptoms can return once the course of medication is complete.

Takeaway

There is only limited research on which foods may help or worsen MC. Keeping a food diary can help a person identify and avoid any foods that seem to trigger symptoms. People should avoid foods containing any substances that they are intolerant to, such as lactose or gluten.

It is vital to drink plenty of water during episodes of diarrhea to prevent dehydration. People with MC may also benefit from reducing their caffeine intake and eating a balanced and healthful diet. Quitting smoking and avoiding alcohol may also help.

If medications or dietary and lifestyle changes are not helping, it is best to speak to a doctor.

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