Foods That Can Worsen Microscopic Colitis Symptoms
Patients with microscopic colitis should avoid high-FODMAP foods, gluten, dairy products, caffeine, alcohol, and processed foods as these are most likely to trigger symptoms and worsen diarrhea.
Common Food Triggers for Microscopic Colitis
Microscopic colitis is an inflammatory bowel disease characterized by chronic watery diarrhea that can significantly impact quality of life. While dietary management is not extensively covered in guidelines specific to microscopic colitis, certain foods have been identified as potential triggers:
High-Priority Foods to Avoid:
High-FODMAP Foods
- Fermentable oligosaccharides, disaccharides, monosaccharides, and polyols can exacerbate symptoms 1
- Examples include:
- Fructans (wheat, onions, garlic)
- Excess fructose (corn syrup, honey, certain fruits)
- Sorbitol and artificial sweeteners
- Legumes and certain vegetables
Dairy Products
- High-lactose dairy can worsen symptoms, especially in those with concurrent lactose intolerance
- Consider limiting milk, ice cream, and soft cheeses
Gluten-Containing Foods
- While not all patients with microscopic colitis have gluten sensitivity, some may benefit from limiting gluten
- Wheat, barley, and rye products should be approached with caution
Caffeine and Alcohol
- Both can stimulate intestinal motility and worsen diarrhea
- Coffee, tea, energy drinks, wine, beer, and spirits may trigger symptoms
Processed Foods
- Foods high in additives, preservatives, and artificial ingredients
- Ultra-processed foods have been associated with increased inflammation 1
Additional Considerations:
Red and Processed Meats: May increase inflammation and worsen symptoms, particularly in patients with overlapping ulcerative colitis symptoms 1
High-Fat Foods: Particularly saturated fats from animal sources can be difficult to digest and may exacerbate symptoms
Spicy Foods: Can irritate the digestive tract and trigger diarrhea in sensitive individuals
Practical Dietary Approach
Step 1: Food Diary and Elimination
- Keep a detailed food diary to identify personal triggers
- Consider a systematic elimination diet, removing potential trigger foods for 2-4 weeks before gradually reintroducing them
Step 2: Consider Low-FODMAP Diet
- A low-FODMAP diet may be beneficial for patients with microscopic colitis who have IBS-like symptoms 1
- This approach limits fermentable carbohydrates that can cause bloating, gas, and diarrhea
Step 3: Focus on Safe Foods
- Recommended foods that are generally well-tolerated:
- Well-cooked, peeled, and mashed vegetables
- Low-FODMAP fruits (e.g., bananas, oranges, strawberries)
- Lean proteins (chicken, fish)
- Rice, oats (if tolerated)
- Moderate amounts of healthy fats (olive oil)
Special Considerations
Stricturing Disease: Patients with strictures should be particularly cautious with high-fiber foods and may need to consume well-cooked, pureed, or blended vegetables rather than raw ones 1
Mediterranean Diet: Consider adopting elements of the Mediterranean diet, which has shown benefits for overall inflammatory bowel health, with modifications based on personal triggers 1
Nutritional Adequacy: Ensure that dietary restrictions don't lead to nutritional deficiencies; consultation with a registered dietitian is recommended 1
Caveats and Pitfalls
- Food triggers are highly individual - what worsens symptoms in one patient may not affect another
- Avoid overly restrictive diets without professional guidance as this can lead to malnutrition
- Remember that microscopic colitis may coexist with bile acid malabsorption in up to 41% of cases, which may require specific treatment beyond dietary changes 1
- Non-evidence-based self-directed exclusion diets should be discouraged as they can lead to limited diet quality and nutrient deficiency 1
By systematically identifying and avoiding food triggers while maintaining a nutritionally complete diet, patients with microscopic colitis can significantly improve their symptoms and quality of life.