What to Eat for Microscopic Colitis: Diet and Nutrition

Microscopic Colitis is a type of inflammatory bowel disease that affects the colon. During a flare-up, people experience pain, discomfort, and watery stools. Spending time out of the house (away from a reliable bathroom) can be scary, and quality of life can decline. 

Fortunately, dietary changes can significantly improve symptoms and help you return to your everyday routine. This article will teach what microscopic colitis is, how to recognize symptoms, and how to follow a microbic colitis diet looks like!  

What Is Microscopic Colitis?

Microscopic colitis (MC) is an inflammatory condition affecting the colon, the longest part of your intestines. The colon's primary function is to absorb liquids, some electrolytes, and nutrients to create a solid stool. The stool is passed into the rectum and pushed out through a bowel movement.^1,2 

Any type of upset in the colon can lead to diarrhea. While inflamed, it can’t fully absorb liquid, and the stool becomes loose and watery. These bouts of diarrhea can last for a few days or, in extreme scenarios, a few weeks. Anyone having diarrhea for more than three days should consult a medical professional. 

There are two major subgroups of MC:³ 

• Lymphocytic colitis - the higher presence of white blood cells, lymphocytes, in the colon tissues.
• Collagenous colitis - a thick collagen layer in the colon tissues.  

The symptoms, treatment, and long-term management of these forms of MC are the same.³ Knowing what type of MC you have can give your healthcare team a clearer snapshot of how your digestive system functions. As technology advances, this data could become more important and lead to more personalized treatments.³   

Many people with MC will need medication to heal fully after a flare-up. Focusing on diet changes can significantly improve symptoms and even provide instant relief. People who heal the fastest take a two-pronged approach and use medication and dietary strategies. 

Microscopic Colitis Symptoms

• Watery diarrhea. 
• Nocturnal stool (having diarrhea overnight). 
• Bathroom urgency. 
• Abdominal pain.
• Dehydration. 
• Weight loss.

These symptoms can be similar to other digestive diseases. It’s recommended to get tested to rule out other conditions. 

Having an official diagnosis can help you build a sustainable treatment plan that considers all areas of your health. For example, people with MC are at higher risk for iron deficiency. Standard bloodwork should include an iron level assessment to monitor for low levels of microcytic anemia. ⁴

Who Is At Risk?  

• Age (50-70-year-olds).  
• Female sex. 
• Presence of other autoimmune disorders. 
• Genetic links. 
• Smokers.

People diagnosed with Celiac Disease are at a 50% higher risk of developing MC. If you have Celiac’s and follow a strict gluten-free diet but still have the symptoms listed above, you should be assessed for MC.²

Microscopic Colitis Diet 

Changes to your diet can lessen your symptoms and improve your quality of life. While your gut is inflamed, you want to choose gentle foods that are easy to break down. This gives your gut a chance to heal and decreases the chances of a second flare-up. 

Foods To Limit  

Prioritize decreasing your intake of foods that can exacerbate diarrhea. 

• Caffeinated beverages, including coffee and sodas. 
• Products with sugar alcohols (xylitol, mannitol, sorbitol). 
• Animal dairy products if you are lactose intolerant. 
• Alcohol. 
• Spicy foods.
• Fried and fatty foods. 

Other dietary changes include drinking more water to prevent dehydration. Also, decrease your intake of insoluble fiber and high-fat foods. Insoluble fiber adds bulk to your stool and can race through your digestive tract. 

Examples of these foods include nuts and seeds and raw fruits and vegetables. Instead of salads, eat cooked vegetables with little to no added fat or oils. 

Sample Microscopic Colitis Diet Plan

Here is a three-day sample diet plan you can follow if you suffer from an MC flare-up. You can add herbal tea to any meal. 

Day 1

• Breakfast - Scrambled eggs with white toast (because it is low in fiber). Add melon slices for a fresh side.  
• Lunch - Chicken soup with soft noodles and boiled carrots. 
• Dinner - Lean pork loin baked with garlic, your favorite seasonings, and applesauce. Serve over steamed rice and boiled string beans. 

Day 2

• Breakfast - Baked peach with oatmeal and cinnamon. Add a hard-boiled egg on the side for protein. 
• Lunch - Elbow macaroni salad with olive oil, light tuna, peas, sundried tomatoes, and fresh basil. 
• Dinner - Roasted chicken thighs with your favorite herbs. Serve with mashed squash and a side of Mediterranean salad cucumber tomato salad. 

Day 3

• Breakfast - Toasted English muffin with conservative portions of smooth nut butter. Add apple slices on the side. 
• Lunch - Pureed butternut squash soup with low-fat dairy to garnish. 
• Dinner - Baked salmon with lemon and fresh dill. Serve with boiled sweet potatoes and a side of pureed spinach. 

General Lifestyle Tips

Smoking can increase your risk of digestive health issues, cancers, and other health problems. If you currently smoke (cigarettes or e-cigarettes), consider quitting right away. It is one lifestyle change that can have the biggest impact on your health.⁵

Managing a flare-up will look different for everybody. Two people suffering from the same symptoms can find relief by making different unrelated changes. Track your symptoms and include which dietary changes are the most impactful at lowering their intensity. Don’t compare yourself to what others are doing; focus on the changes that work for you!

Work With A Registered Dietitian

People suffering from microscopic colitis may feel overwhelmed in choosing the right foods to eat. A crohn's and colitis dietitian specializing in digestive health can teach you what to include in your diet to manage microscopic colitis best.

Nourish offers remote appointments with registered dietitians who are covered by insurance. All the providers on our team are compassionate, expertly trained, and want to help you feel better. Click here to get started! 

References: 

1. Tome, J., Kamboj, A. K., & Pardi, D. S. (2021). Microscopic Colitis: A Concise Review for Clinicians. 
2. NCI Dictionary of Cancer Terms. (n.d.). National Cancer Institute.  
3. Pardi D. S. (2017). Diagnosis and Management of Microscopic Colitis. 
4. Lugg, S., Beal, F., Nightingale, P., Bhala, N., & Iqbal, T. (2014). Iron treatment and inflammatory bowel disease: what happens in real practice?. 
5. Gui, X., Yang, Z., & Li, M. D. (2021). Effect of Cigarette Smoke on Gut Microbiota: State of Knowledge.

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