April 2018 Volume 3 Issue 3 May 19 is World IBD Day, a cooperative venture of IBD patient organizations around the world to raise awareness. The focus in the past has been on Crohn's Disease and Ulcerative Colitis with no mention of Microscopic Colitis, even though it is an IBD and every bit as prevalent. Our foundation is making an effort to change that, and this will be our first year participating in the event. Watch for updates on Facebook, Twitter and email. I Just Started the Diet. How Long Will It Take Before I Begin to See Improvements? After someone who has MC learns that the symptoms of the disease can usually be controlled by diet changes, and they decide to commit to the diet, their first question is usually, “How long will it take before I begin to see improvements?” The normal tendency is for someone to try the diet for a few days and then when no benefits are immediately apparent, an incorrect decision is made that the diet isn't going to work, so they give up too soon. This question comes up so frequently on microscopic colitis discussion and support forums where the diet is recommended that perhaps we should look in detail at the many factors that are involved in this process. Not surprisingly with such a complex disease, the correct answer to the question depends on many factors. At least a dozen such reasons readily come to mind, and surely there are others. The amount of time spent reacting before treatment is begun While this effect varies by the individual, surely the amount of time that elapses between the onset of symptoms and the start of treatment, makes a difference. Once the reactions begin, the amount of damage to the intestines
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April2018Volume3Issue3
May 19 is World IBD Day, a cooperative venture of IBDpatientorganizationsaroundtheworldtoraiseawareness.The focus in the past has been on Crohn's Disease andUlcerative Colitis with no mention of Microscopic Colitis,even though it isan IBDandeverybitasprevalent. Our
foundation ismakinganeffort tochange that,and thiswillbeour firstyearparticipatingintheevent.WatchforupdatesonFacebook,Twitterandemail.
IJustStartedtheDiet.HowLongWillItTakeBeforeIBegintoSee
Improvements?
AftersomeonewhohasMClearnsthatthe symptoms of the disease canusually be controlled by diet changes,andtheydecidetocommittothediet,theirfirstquestionisusually,“Howlongwill it take before I begin to seeimprovements?” The normal tendencyisforsomeonetotrythedietforafewdays and then when no benefits areimmediately apparent, an incorrectdecision is made that the diet isn't
goingtowork,sotheygiveuptoosoon.
This question comes up so frequently on microscopic colitis discussion andsupportforumswherethedietisrecommendedthatperhapsweshouldlookindetailat themany factors thatare involved in thisprocess. Not surprisinglywithsuchacomplexdisease, thecorrectanswer to thequestiondependsonmanyfactors.Atleastadozensuchreasonsreadilycometomind,andsurelythereareothers.
Theamountoftimespentreactingbeforetreatmentisbegun
While this effect varies by the individual, surely the amount of time thatelapsesbetweentheonsetofsymptomsandthestartof treatment,makesadifference.Oncethereactionsbegin,theamountofdamagetotheintestines
continues to accrue until treatment isbegun,sothesoonerthattreatmentisinitiated, the smaller the amount ofdamagethatmustbehealed.
The amount of damage thathasaccruedTheamountoftimebeforetreatmentisstarted isn't the only determiningfactor in the amount of damage thataccrues.Thedegreeofexposuretothefoods that cause the most damage,and the relative sensitivity of the individual toward those foods are alsoimportant.
Whetherornotananti-inflammatorymedicationisusedWhile research shows that corticosteroids tend to slow down healing, theirabilitytodecreasetheinflammationlevelcansuppresstheclinicalsymptomswhile thedietchangesareaccomplishing theactualhealing, therebymakinglife a lot more pleasant during the recovery process. Suppressing theinflammation as quickly as possible can be very beneficial, not only for thecontrolof clinical symptoms,butalso for the stress reliefandpeaceofmindthatcomeswiththatsuppression.Somepatientsareabletorecoverwithouttheuseofmedications,whileinothercasesmedicationsmaybehelpfulintherecoveryprocess.
IndividualresponsetomedicationsFor unknown reasons (probably our genetics) some of us are much moreresponsive than others to certain medications or to medications in general.Thisobviouslymakesahugedifferenceinourresponsetomedications.
IndividualresponsetodietchangesLikewise,someofusrespondtodietchangesmorereadilythanothers.Thisissurelyrelatedtothenumberandseverityofoursensitivities,whethertheybefood,drugs,orsomethingelseinourenvironment.Oftenthosewhohavethehighestsensitivity levelarealsosensitivetolargernumbersoffoodsorotherissues.
Ourcommitment/complianceregardingdietrestrictionsWeall assume thatweare careful enough thatweare in100%compliancewiththediet.Butarewe?Researchshowsthat(dependingonwhichstudyyoureview)onlyabout50–75%ofceliacswhoclaimtobefollowingthegluten-freediet,areactuallyfollowingaglutenfreediet.Whetheracompromiseddietisintentionaloraccidental,it'sstillnon-compliance,andtheresultisthesame—damagetotheintestinaltract.Andthedietrestrictionsformicroscopiccolitisareusuallymuchmoredifficult to follow thana simplegluten-freediet. Notonlyisdietcomplianceaproblem,butfindingallofone'sfoodsensitivitiescanbeanevenbiggerprobleminsomecases.
TheamountofsleepwegetandoursleepqualityThebodyhealswhenitisatrest,anditdoesmostofthehealingwhileweareasleep.So,theamountandqualityofoursleepisimportantforhealing.Extrasleepandextraresthelp.
OurstresslevelsThe type of work we do usuallydetermines whether or not we areunder a condition of constant stressand the degree of stress to which weare exposed. But events in our livesthat happen away from work can bejust as crucial to ourhealth. The lossofafamilymember,adearfriend,orabeloved pet can be devastating. Whatever the source, chronic stresscan prevent any treatment programfromworkingasplanned.
Stress/relaxationmethodsUsingstress-relieftechniquesfrequentlycanbeverybeneficialforourrecovery.Thediseaseitselfisverystressful,andwemustcontrolstressinordertobeabletorecoveratanoptimumrate.
OurattitudeOur outlook on lifematters. Wewill bemore likely torecover and recover faster if we maintain a “can do”attitude rather than a defeatist attitude. When youbelievethat“Icandothis”,youverylikelycandoit.
OurageYoungpeopleheal fasterthanolderpeople. Soouragedefinitelyaffectsthemaximumrateatwhichweareabletoheal.
UnknownfactorsTherearesurelyotherfactorsthatenter intotheamountoftimerequiredforrecovery.Butthemainpointis,therearealotofreasonswhyrecoveryratescanbeextremelyvariablefromoneindividualtothenext.
Sohowlongdoesittaketorecover?Becauseofallthevariablesandlimitations,itcantakeanywherefromadayortwo to a year or two for any particular individual to recover. While somepeoplehaveactuallyexperienced theseextremes,mostof us findourselvessomewherewellinsidethoselimits.MostMCpatientswhoadoptthedietwillseesymptomsbegintoresolvewithinthetimeframeofbetweenaboutfourorsixweekstothreetosixmonths.Thosewhoareluckymaybegintoseereliefinhalfthattime(twotothreeweeks)andthosewhoarenotsofortunatemayrequiretwiceaslong(sixmonthstoayear).
CompletehealingofthedigestivesystemtakesalongtimeComplete healing of the intestines takes much longer than most people(includingmostgastroenterologists),realize.Kid'shealquickly,usuallywithinayear. Butadults require threeto fiveyears forcomplete intestinalhealing.Wewillreachremissionofsymptomslongbeforehealingiscompleted(withorwithoutmedications).
Medications may make life much morepleasantwhilerecovering.While it's true that corticosteroids slow down thehealing process, the time to remission of symptomscan be shortened dramatically by taking an anti-inflammatory medication. Budesonide is usually thedrugofchoice,andtakenconcurrentlywiththedietarytreatment program, it often brings remissionwithin aweekortwo.Whileit'susuallynotnecessarytotakea
medication in order accomplish remission of symptoms, taking an anti-inflammatory can speed up remission and thereby make life a lot morepleasantinmanycases.
Anti-inflammatorymedicationsbasedonmesalamineusuallytakeabouttwiceaslongtoworkasbudesonide,andtheymaynotbeaseffective,buttheyareanother option. In cases where clinical symptoms are severe, adding amedicationtothetreatmentprogrammayallowsomeonetocontinuetoworkwhen theymight otherwise be unable towork due to the symptoms. But ifbudesonideisused,thedosagemustbetaperedverygraduallyattheendofthetreatmentregimeninordertopreventarelapseofsymptomsduetomastcellrebound.
So perhaps the best answer to the
question“HowlongwillittakebeforeI begin to see improvements?” is,“Thatdepends—onalotofthings.”
WhatAreSomeoftheEarlySignsofImprovement?
Sometimes the signs of improvement are obvious andsometimestheyaresubtle.Theobvioussignsneednoelaboration,butsometimesthesignsaresosubtlethatwemightoverlookthemifwedon'trealizewhattheymean.Firstofallweneedtorecognizethatwhenwehavewaterydiarrhea(secretorydiarrhea),anyform of diarrhea more substantial is an improvement. Intermediate stagesbetween secretory diarrhea and normal stools on the path toward remissionmayincludebowelmovements intheformofthinribbonsorpartiallyformedclumpsandpossiblyotherformsinbetween.Buttheyareallimprovementsonthewaytomorenormalizedbowelmovements.
Inmanycasesas remission is approaching, the first bowelmovementof themorningmaybeanormally-formed(oralmostnormally-formed)stool,followedby subsequent bowel movements consisting of diarrhea or even waterydiarrhealaterintheday.Ratherthanbeingasignofpossibleproblems,thisisa very common stage of recovery and it usually indicates that healing is ontrackandrecoverymaybe“rightaroundthecorner”.
Othersymptomsshouldalsobenoted.Areachesandpainsdiminishing? Aremigrainesoccurring less frequentlyorless intensely? Is there lessbloating? Arethere fewertripstothebathroomeachday?Areyouableto“passgas”withoutriskingan“accident”?Doesyourabilitytothinkorconcentrateonaprojectseembetter?
Assessyourprogressonamonthlybasisratherthandaily.The recoveryprocessusually seems too slowand it'softendescribedas twostepsforwardandonestepbackward.Therewillbedailyupsanddowns.Inthattypeofsituation, it'susuallymuchmorepracticaltojudgeprogressonamonthlybasisratherthanadailybasis.It'smucheasiertoseeprogresswhenwecompareourcurrentsituationwithhowwefeltamonthago.
Takelifeadayatatime.Perhapssomeofthesoundestadviceduringrecoveryistotakelifeonedayatatime.Itiswhatitisandworryingaboutminordetailsiscounterproductive.Ifwewilljustacceptoursituationandstickwithourrecoveryplan,eventuallywewillawakenonemorningandrealizethat,“Hey! I feelbetterthanI’vefelt inyears!”
Inthenextnewsletter,wewillcomparesomeofthepopularanti-inflammatorydietssuchasFODMAP,AIP,SCDandPaleowithourrecommendeddietfortreatingmicroscopiccolitis.
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