i just started the diet. how long will it take before i begin to see ...€¦ · diet, are actually...

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.