From the Guidelines
For patients with microscopic colitis, a low-fat, low-fiber diet is generally recommended during active flare-ups, with gradual reintroduction of fiber as symptoms improve. This approach is based on the principle of reducing irritation to the inflamed colon lining and decreasing the osmotic load in the intestines. Patients should avoid known dietary triggers, particularly caffeine, alcohol, dairy products (if lactose intolerant), gluten-containing foods (especially for those with celiac disease), and artificial sweeteners like sorbitol and xylitol 1.
Key Dietary Recommendations
- Avoid lactose-containing products, alcohol, and high-osmolar supplements during active flare-ups 1
- Drink 8-10 large glasses of clear liquids a day to prevent dehydration from diarrhea 1
- Eat frequent small meals, such as bananas, rice, applesauce, toast, and plain pasta, to help manage symptoms 1
- Consider keeping a food diary to identify individual triggers and monitor symptom response to different foods
Medical Therapy
Medical therapy for microscopic colitis may include medications like budesonide, bismuth subsalicylate, or cholestyramine, depending on symptom severity and individual response 1. Budesonide is recommended as the first-line treatment for induction of clinical remission, with a strong recommendation and moderate quality of evidence 1. Maintenance therapy with budesonide may also be considered for patients who experience clinical relapse after cessation of induction therapy, with the goal of maintaining clinical remission and improving quality of life 1.
Probiotics and Other Supplements
Some patients may benefit from supplementation with probiotics, although the evidence for their effectiveness varies 1. The American Gastroenterological Association provides a conditional recommendation against the use of probiotics due to the uncertain balance between benefit and harm 1. However, in clinical practice, probiotics may still be considered as an adjunctive therapy for patients with microscopic colitis, particularly those who have not responded to other treatments.
From the Research
Dietary Approach for Microscopic Colitis
There is limited research on the specific dietary approach for patients with microscopic colitis. However, some studies suggest that certain diets may be beneficial in managing symptoms.
- A low FODMAP diet has been shown to reduce gut symptoms in patients with quiescent inflammatory bowel disease 2.
- A low-fat, high-fiber diet has been found to reduce markers of inflammation and dysbiosis and improve quality of life in patients with ulcerative colitis 3.
- There is no direct evidence on the effectiveness of a specific diet for microscopic colitis, but some studies suggest that dietary interventions may be beneficial in managing symptoms 4.
Key Components of a Dietary Approach
Some key components of a dietary approach for microscopic colitis may include:
- A low FODMAP diet to reduce gut symptoms 2
- A low-fat, high-fiber diet to reduce markers of inflammation and dysbiosis 3
- Avoiding trigger foods that may exacerbate symptoms
Limitations and Future Research
There is a need for more research on the specific dietary approach for microscopic colitis, including randomized controlled trials to provide direct and reliable evidence 5. Additionally, more studies are needed to investigate the effectiveness of different dietary interventions in managing symptoms and improving quality of life for patients with microscopic colitis.