Hi all,
"If my body reacts differently to one food than your body does, the food cannot per definition be as good for me as it is for you, or vice versa. We have different gut bacteria that react differently to certain foods".
Well, I think we have agreed on that one!
http://www.abc.net.au/news/2015-11-20/d ... dy/6956436
The study:
http://www.cell.com/cell/abstract/S0092 ... all%3Dtrue
Lilia
Personally Tailored Diet
Moderators: Rosie, Stanz, Jean, CAMary, moremuscle, JFR, Dee, xet, Peggy, Matthew, Gabes-Apg, grannyh, Gloria, Mars, starfire, Polly, Joefnh
Personally Tailored Diet
Collagenous Colitis diagnosis in 2010
Psoriasis in 1973, symptom free in 2014
GF, CF and SF free since April, 2013
Psoriasis in 1973, symptom free in 2014
GF, CF and SF free since April, 2013
the top link didn't work for me, but when I first began my journey with dealing with MC, I worked on improving my gut microbes. I must have read the old SCD diet book material for IBD diseases but don't remember for sure if that is what is was, with avoiding sugars that feed bad bacteria growth, and eating a diet rich in probiotics. Improving gut microbes and taking probiotics never worked for me unfortunately. It wasn't for a lack of trying though.
It makes sense that the gut bacteria has some important use for the body. I've thought of it as possibly being similar to bacteria found in the soil that help feed crops growth. I'm not a farmer, or much of a gardner, but at least that is what I've read about the importance of soil bacteria for breaking down nutrients for crops. I wondered if something similar was going on with humans and animals.
With allergies I've found transplants, where an organ is transplanted from one person to another and with that the allergy goes with the organ fascinating. Looking at the internet I see mention of this happening with liver and lung transplants. If that is true, one article on the lung transplant mentions a peanut allergy showed up in the recipient. The donor had a peanut allergy. The severe peanut allergy lasted for around a year the article mentioned but eventually went away. I know our body is constantly breaking down and rebuilding. Each organ has a different regrowth rate, with some organs breaking down and growing faster than others, such as the gut which I believe is replaced once a week (I might be wrong about that) but a lung could take up to a year. That is my guess on what might be going on.
Anyway, it is nice to see the resurgence of interest in gut microbes and their importance for health. It wouldn't be nice if allergies could be controlled that way, improving gut bacteria, but if that is the case seems more details need to be worked out in my opinion.
It makes sense that the gut bacteria has some important use for the body. I've thought of it as possibly being similar to bacteria found in the soil that help feed crops growth. I'm not a farmer, or much of a gardner, but at least that is what I've read about the importance of soil bacteria for breaking down nutrients for crops. I wondered if something similar was going on with humans and animals.
With allergies I've found transplants, where an organ is transplanted from one person to another and with that the allergy goes with the organ fascinating. Looking at the internet I see mention of this happening with liver and lung transplants. If that is true, one article on the lung transplant mentions a peanut allergy showed up in the recipient. The donor had a peanut allergy. The severe peanut allergy lasted for around a year the article mentioned but eventually went away. I know our body is constantly breaking down and rebuilding. Each organ has a different regrowth rate, with some organs breaking down and growing faster than others, such as the gut which I believe is replaced once a week (I might be wrong about that) but a lung could take up to a year. That is my guess on what might be going on.
Anyway, it is nice to see the resurgence of interest in gut microbes and their importance for health. It wouldn't be nice if allergies could be controlled that way, improving gut bacteria, but if that is the case seems more details need to be worked out in my opinion.
Copy and paste:
Diets should be personally tailored to your gut microbiome, study says
ABC Science By Bianca Nogrady
Updated 20 Nov 2015, 1:12am
A man and woman eating apples
PHOTO: Different people metabolise the same food differently (Getty Images)
EXTERNAL LINK: Road-testing intermittent fasting RELATED STORY: Low-fat diets no better for reaching skinny goals than other dietingRELATED STORY: 'Slow metabolism' causing weight gain? What really affects metabolism
MAP: Israel
Even if we all ate the same meal, everyone would metabolise it differently, according to a new study that suggests that there is no such thing as one-size-fits-all dietary advice.
Rather diets should be tailored to an individual's gut microbiome, or combination of gut bacteria, Israeli scientists said.
The glycaemic index is used by doctors and nutritionists to develop healthy diets based on how different foods affect glucose levels in the blood.
But the study, published today in Cell, shows different people can have a very different glycaemic response to a food.
"If my and your response to the same food are opposite then by definition a similar diet cannot be effective for both of us," said co-author Dr Elan Elinav, from the Immunology Department at the Weizmann Institute of Science.
What is the glycaemic index (GI)?
The glycaemic index scale ranks carbohydrate foods based on their effect on glucose levels in the blood over a period of two hours.
Carbohydrate foods are compared gram for gram against glucose or white bread, which have a GI score of 100.
High-GI foods such as baked potato with a score more than 70 break down quickly, causing a spike in blood glucose levels.
Low GI foods such as oats, lentils, beans and nuts release with a score of 55 or less release glucose gradually into the blood.
The team found that an individual's gut bacteria was a key factor influencing whether a food delivers a long, slow rise in blood sugar, or a short, sharp spike.
In the first part of the study, 800 volunteers — some healthy, some with pre-diabetes — were hooked up with devices that continually monitored their blood sugar levels, and equipped with an app to record their every move and meal.
Over one week, this revealed dramatic differences in each person's blood sugar response to different foods.
"We would expect that in average people, their blood sugar would spike more on ice-cream than rice," Dr Elinav said.
"What we found in this really large cohort is that some people did exactly that but others did exactly the opposite.
"They were not responsive to ice-cream at all, and actually close to 70 per cent of the study population did not even spike on ice-cream."
At the same time, researchers took blood and sampled each individual's gut bacteria, looking not only at the makeup of their gut bacteria but also the functional profile of the microbiome.
Algorithm predicts individual's glycaemic response
Using all this data, the group developed an algorithm to predict an individual's glycaemic response to a food, based on factors such as their microbiome, daily activity, blood parameters such as cholesterol, and food content.
When they applied this algorithm to a separate group of 100 people who had participated in the week-long monitoring, they found the algorithm accurately predicted what each individual's blood glucose response would be to each meal.
Some of the food ingredients that were included in some of these people's good diets were included in other people's bad diets, so it was completely individualised.
Dr Elan Elinav
"This told us that we had a very useful tool that could utilise this huge amount of data to do something predictive at the individual level, but the third phase of our study was an interventional study in which we put ourselves to the test," Dr Elinav said.
When they pitted the algorithm against the tailored advice of experienced dieticians, in a group of people with pre-diabetes, the algorithm proved better at devising a diet that would improve these at-risk people's blood sugar profile.
"What was interesting was that some of the food ingredients that were included in some of these people's good diets were included in other people's bad diets, so it was completely individualised," he said.
Variation averages out over time
Commenting on the study, Professor Jennie Brand-Miller, director of the Sydney University Glycemic Index Research Service, said it was well known that individuals would respond differently to different foods, because the response was influenced by factors such as exercise and sleep and stress.
You may also like ...
Questioning the low-GI diet
High-carb diet could 'equal calorie restriction'
However, she said, this day-to-day variation within an individual did average out over time to the established glycaemia index values for foods, and pointed out that the study only followed individuals for one week.
Dr Elinav said there are now plans to extend the study and see if the algorithm-tailored diet held up against gold standard diabetes diets over longer periods of time.
Diets should be personally tailored to your gut microbiome, study says
ABC Science By Bianca Nogrady
Updated 20 Nov 2015, 1:12am
A man and woman eating apples
PHOTO: Different people metabolise the same food differently (Getty Images)
EXTERNAL LINK: Road-testing intermittent fasting RELATED STORY: Low-fat diets no better for reaching skinny goals than other dietingRELATED STORY: 'Slow metabolism' causing weight gain? What really affects metabolism
MAP: Israel
Even if we all ate the same meal, everyone would metabolise it differently, according to a new study that suggests that there is no such thing as one-size-fits-all dietary advice.
Rather diets should be tailored to an individual's gut microbiome, or combination of gut bacteria, Israeli scientists said.
The glycaemic index is used by doctors and nutritionists to develop healthy diets based on how different foods affect glucose levels in the blood.
But the study, published today in Cell, shows different people can have a very different glycaemic response to a food.
"If my and your response to the same food are opposite then by definition a similar diet cannot be effective for both of us," said co-author Dr Elan Elinav, from the Immunology Department at the Weizmann Institute of Science.
What is the glycaemic index (GI)?
The glycaemic index scale ranks carbohydrate foods based on their effect on glucose levels in the blood over a period of two hours.
Carbohydrate foods are compared gram for gram against glucose or white bread, which have a GI score of 100.
High-GI foods such as baked potato with a score more than 70 break down quickly, causing a spike in blood glucose levels.
Low GI foods such as oats, lentils, beans and nuts release with a score of 55 or less release glucose gradually into the blood.
The team found that an individual's gut bacteria was a key factor influencing whether a food delivers a long, slow rise in blood sugar, or a short, sharp spike.
In the first part of the study, 800 volunteers — some healthy, some with pre-diabetes — were hooked up with devices that continually monitored their blood sugar levels, and equipped with an app to record their every move and meal.
Over one week, this revealed dramatic differences in each person's blood sugar response to different foods.
"We would expect that in average people, their blood sugar would spike more on ice-cream than rice," Dr Elinav said.
"What we found in this really large cohort is that some people did exactly that but others did exactly the opposite.
"They were not responsive to ice-cream at all, and actually close to 70 per cent of the study population did not even spike on ice-cream."
At the same time, researchers took blood and sampled each individual's gut bacteria, looking not only at the makeup of their gut bacteria but also the functional profile of the microbiome.
Algorithm predicts individual's glycaemic response
Using all this data, the group developed an algorithm to predict an individual's glycaemic response to a food, based on factors such as their microbiome, daily activity, blood parameters such as cholesterol, and food content.
When they applied this algorithm to a separate group of 100 people who had participated in the week-long monitoring, they found the algorithm accurately predicted what each individual's blood glucose response would be to each meal.
Some of the food ingredients that were included in some of these people's good diets were included in other people's bad diets, so it was completely individualised.
Dr Elan Elinav
"This told us that we had a very useful tool that could utilise this huge amount of data to do something predictive at the individual level, but the third phase of our study was an interventional study in which we put ourselves to the test," Dr Elinav said.
When they pitted the algorithm against the tailored advice of experienced dieticians, in a group of people with pre-diabetes, the algorithm proved better at devising a diet that would improve these at-risk people's blood sugar profile.
"What was interesting was that some of the food ingredients that were included in some of these people's good diets were included in other people's bad diets, so it was completely individualised," he said.
Variation averages out over time
Commenting on the study, Professor Jennie Brand-Miller, director of the Sydney University Glycemic Index Research Service, said it was well known that individuals would respond differently to different foods, because the response was influenced by factors such as exercise and sleep and stress.
You may also like ...
Questioning the low-GI diet
High-carb diet could 'equal calorie restriction'
However, she said, this day-to-day variation within an individual did average out over time to the established glycaemia index values for foods, and pointed out that the study only followed individuals for one week.
Dr Elinav said there are now plans to extend the study and see if the algorithm-tailored diet held up against gold standard diabetes diets over longer periods of time.
Collagenous Colitis diagnosis in 2010
Psoriasis in 1973, symptom free in 2014
GF, CF and SF free since April, 2013
Psoriasis in 1973, symptom free in 2014
GF, CF and SF free since April, 2013
Hi Lilia,
The claim that we should tailor our diet to match our gut bacteria profile sounds logical (if you happen to be a gut bacteria worshiper). But the problem is, that claim is based on a flawed study. The study on which that claim was made lasted exactly 1 week. That makes the data worthless. Here's why:
It doesn't take a rocket scientist to figure out that gut bacteria will respond best to a diet that is custom tailored for them. But so what? That's irrelevant, because given enough time, our gut bacteria population profile will adjust to match our diet. That's what it's all about. But it takes much longer than a week for the microbiome to change, and homeostasis to occur.
When we change our diet, certain species of bacteria will no longer receive the nourishment they need, so they will slowly die off and they will be replaced by species that thrive on our new diet. The gut microbiome is dynamic, and it changes almost constantly as our diet changes and as our digestion changes. If we experience an MC flare, that will change our gut bacteria profile, provided the flare lasts long enough to kill off certain species, and allow certain other species to thrive on the partially-digested food. When we reach remission from an MC flare, our gut bacteria profile will evolve to match our new digestive efficiency.
Catering to gut bacteria is a lot like being owned by a cat. Cats are very independent creatures, and we can't really "own" one. They will display affection and all that good stuff, but it's just a ploy to win our trust and devotion, so that we will cater to their needs, and satisfy their need to feel dominant. In reality, they "own" us. And if we were to cater to their every whim, we would be feeding them many times a day, because they are always ready to pretend to be hungry, in order to entice us to demonstrate our affection for (subservience to) them. But if we feed the cat on our own schedule, using our best judgment (rather than allowing the cat to dictate the feeding schedule) not only will we save beau coups of time, but the cat will be much healthier (because in the wild, cats don't eat every hour, all day long).
Likewise, rather than to cater to gut bacteria, as if they are some sort of treasured pets, if we force the little parasites to adapt to our diet preferences, not only will the little freeloaders do just fine, but so will we. And we'll be just as healthy as those foolish researchers who are afraid to eat what they prefer, because it might upset their precious gut barnacles.
And that's why I view that sort of research as worthless. Those researchers should know better, but they're in it for the money, not to further medical knowledge. At least that's how I see it.
Tex
The claim that we should tailor our diet to match our gut bacteria profile sounds logical (if you happen to be a gut bacteria worshiper). But the problem is, that claim is based on a flawed study. The study on which that claim was made lasted exactly 1 week. That makes the data worthless. Here's why:
It doesn't take a rocket scientist to figure out that gut bacteria will respond best to a diet that is custom tailored for them. But so what? That's irrelevant, because given enough time, our gut bacteria population profile will adjust to match our diet. That's what it's all about. But it takes much longer than a week for the microbiome to change, and homeostasis to occur.
When we change our diet, certain species of bacteria will no longer receive the nourishment they need, so they will slowly die off and they will be replaced by species that thrive on our new diet. The gut microbiome is dynamic, and it changes almost constantly as our diet changes and as our digestion changes. If we experience an MC flare, that will change our gut bacteria profile, provided the flare lasts long enough to kill off certain species, and allow certain other species to thrive on the partially-digested food. When we reach remission from an MC flare, our gut bacteria profile will evolve to match our new digestive efficiency.
Catering to gut bacteria is a lot like being owned by a cat. Cats are very independent creatures, and we can't really "own" one. They will display affection and all that good stuff, but it's just a ploy to win our trust and devotion, so that we will cater to their needs, and satisfy their need to feel dominant. In reality, they "own" us. And if we were to cater to their every whim, we would be feeding them many times a day, because they are always ready to pretend to be hungry, in order to entice us to demonstrate our affection for (subservience to) them. But if we feed the cat on our own schedule, using our best judgment (rather than allowing the cat to dictate the feeding schedule) not only will we save beau coups of time, but the cat will be much healthier (because in the wild, cats don't eat every hour, all day long).
Likewise, rather than to cater to gut bacteria, as if they are some sort of treasured pets, if we force the little parasites to adapt to our diet preferences, not only will the little freeloaders do just fine, but so will we. And we'll be just as healthy as those foolish researchers who are afraid to eat what they prefer, because it might upset their precious gut barnacles.
And that's why I view that sort of research as worthless. Those researchers should know better, but they're in it for the money, not to further medical knowledge. At least that's how I see it.
Tex
It is suspected that some of the hardest material known to science can be found in the skulls of GI specialists who insist that diet has nothing to do with the treatment of microscopic colitis.
Oh, I jumped the gun with reaction and thinking foods and allergy! I'm going to blame it on my thanksgiving guests tiring me out today. I've seen that before with mention that gut microbes can be helpful with controlling blood sugar spikes. It is interesting. Running in my mind on this though is whether it is helpful or not - what would be interesting to see is if a tailored diet prevents type 2 diabetes common outcomes, such as poor circulation, blindness, heart disease, nerve damage, etc. I imagine it can as some long time low carb followers that avoid grains and sugar mention the diet helping prevent complications.
Oddly though, there was the ACCORD study that found lowering blood sugar levels in type 2 diabetics increased the rate of death. Some of this can be read at:
http://drmalcolmkendrick.org/2015/08/04 ... side-down/
There was also the work by Walter Kempner at Duke university that found a high carb rice and sugar diet, which would have spiked glucose levels to some degree in all on it, prevented type 2 diabetes complications in around 70% of patients.
http://rawfoodsos.com/2015/10/06/in-def ... ht-part-1/
What confusing me some on type 2 diabetes or pre-diabetes also is the definition of it. It's changing, or the standards are lowered making more people within that range, and in need of treatment, whether the treatment helps or not.
Oddly though, there was the ACCORD study that found lowering blood sugar levels in type 2 diabetics increased the rate of death. Some of this can be read at:
http://drmalcolmkendrick.org/2015/08/04 ... side-down/
There was also the work by Walter Kempner at Duke university that found a high carb rice and sugar diet, which would have spiked glucose levels to some degree in all on it, prevented type 2 diabetes complications in around 70% of patients.
http://rawfoodsos.com/2015/10/06/in-def ... ht-part-1/
What confusing me some on type 2 diabetes or pre-diabetes also is the definition of it. It's changing, or the standards are lowered making more people within that range, and in need of treatment, whether the treatment helps or not.
You're referring to the GF diet. For most people, the GF diet will help prevent type 2 diabetes, because type 2 diabetes is a side effect of untreated gluten sensitivity:Blueberry wrote:what would be interesting to see is if a tailored diet prevents type 2 diabetes common outcomes, such as poor circulation, blindness, heart disease, nerve damage, etc.
Diabetes: “Cured by Wheat Belly”
The drug reps encourage doctors to widen treatment ranges by talking them into treating "pre-diabetes" or "pre-hypertension" or "pre-whatever". It's great for business and it brings in billions of dollars of added income for both Big Pharma and the medical community. And no one (except for Dr. Briffa in GB) seems to notice that it's unscrupulous to treat a disease that doesn't even exist. Of course most doctors are probably so used to treating "IBS" that by now most of them probably have forgotten the distinction between real disease and fabricated disease.Blueberry wrote:What confusing me some on type 2 diabetes or pre-diabetes also is the definition of it. It's changing, or the standards are lowered making more people within that range, and in need of treatment, whether the treatment helps or not.
Tex
It is suspected that some of the hardest material known to science can be found in the skulls of GI specialists who insist that diet has nothing to do with the treatment of microscopic colitis.
Yeah, I suspect that to be the case also about wheat/gluten & maybe even yeast for type 2 diabetes, and largely believe that due to the indigenous peoples that would eat a western diet, develop diabetes at a high rate, yet when the indigenous returned to their native diet void of western grains such as wheat, their type 2 diabetes and complications would often go away. What can confuse me with diabetes type 2 is articles bringing up glucose, insulin and glucagon considering the ACCORD study along with a few other studies that found similar.tex wrote:You're referring to the GF diet. For most people, the GF diet will help prevent type 2 diabetes, because type 2 diabetes is a side effect of untreated gluten sensitivity:Blueberry wrote:what would be interesting to see is if a tailored diet prevents type 2 diabetes common outcomes, such as poor circulation, blindness, heart disease, nerve damage, etc.
Diabetes: “Cured by Wheat Belly”
The drug reps encourage doctors to widen treatment ranges by talking them into treating "pre-diabetes" or "pre-hypertension" or "pre-whatever". It's great for business and it brings in billions of dollars of added income for both Big Pharma and the medical community. And no one (except for Dr. Briffa in GB) seems to notice that it's unscrupulous to treat a disease that doesn't even exist. Of course most doctors are probably so used to treating "IBS" that by now most of them probably have forgotten the distinction between real disease and fabricated disease.Blueberry wrote:What confusing me some on type 2 diabetes or pre-diabetes also is the definition of it. It's changing, or the standards are lowered making more people within that range, and in need of treatment, whether the treatment helps or not.
Tex
Ugh, don't get me going on the pharmaceutical companies and health care field! It really comes across to me as more of a religion in many ways. I almost want to say we're all to often nations of hypochondriacs, with a health care field more than willing to market "cures". It's not that simple but in some respects it is. Along those lines I'm currently reading informative but disturbing former NEJM editor Marcia Angell's book:
The Truth About the Drug Companies: How They Deceive Us and What to Do About It
http://www.amazon.com/The-Truth-About-D ... BVKSFKEZV7
after that I'll be reading Peter Gotzsche's book Deadly Medicines and Organised Crime: How Big Pharma Has Corrupted Healthcare. And I'm tell my vacationing relatives what I read! I haven't been told to eat on the other side of the room yet, so far so good.
With that lineup of books in the queue, you're really a glutton for punishment, aren't you. You're tougher than I am. I won't be reading those books because I like my blood pressure right where it is — low. 
Tex
You're tougher than I am. I won't be reading those books because I like my blood pressure right where it is — low. Tex
It is suspected that some of the hardest material known to science can be found in the skulls of GI specialists who insist that diet has nothing to do with the treatment of microscopic colitis.
Hi Tex,
So, what you are saying is that there is no point in trying to improve or alter the gut bacteria flora for us MC-people.
MC can only be controlled through diet?
I'm trying to understand
Lilia
So, what you are saying is that there is no point in trying to improve or alter the gut bacteria flora for us MC-people.
MC can only be controlled through diet?
I'm trying to understand
Lilia
Collagenous Colitis diagnosis in 2010
Psoriasis in 1973, symptom free in 2014
GF, CF and SF free since April, 2013
Psoriasis in 1973, symptom free in 2014
GF, CF and SF free since April, 2013
Hi Lilia,
Yes, that's correct. Take care of yourself and your gut bacteria will take care of themselves. Your gut bacteria profile will be whatever it is going to be, based on your diet. When you change your diet, that will lead to a change in your gut bacteria profile, by the process of natural selection. There's nothing mysterious about the process.
Gut bacteria are not Santa Claus. They are not living in our gut in order to enhance our health. They are parasites, living off nutrition that we provide (or rather, nutrition that they steal from us). Despite all the glowing claims about their alleged "benefits", they exist in our gut strictly for their own benefit, and any benefits that we "think" we derive from their presence, are strictly accidental.
Our relationship with gut bacteria is a lot like the relationship between plant aphids and "aphid-herding" ants. Certain species of ants control colonies of aphids by releasing chemicals from their feet. The chemicals subdue and tranquilize the aphids, and the ants protect their herd from outside invaders. Then the ants eat the honeydew excreted by the aphids. The aphids may appear to benefit from the protection provided by the ants, but the ants are only interested in their own benefits. And the aphids would certainly be better off without the freeloading ants. Here's some information on that arrangement if you're not already familiar with it:
http://www.sciencedaily.com/releases/20 ... 212548.htm
Unfortunately, in the human/gut bacteria arrangement, we play the role of the aphids, and our gut bacteria play the role of the ants.
Now I'll grant you, at the moment I may be the only one on the planet who sees our gut parasites for what they actually are, but I have high hopes that some day humans will advance their knowledge and understanding sufficiently to be able to recognize that gut bacteria are nothing more than pesky parasites that we would be much better off without.
Tex
Yes, that's correct. Take care of yourself and your gut bacteria will take care of themselves. Your gut bacteria profile will be whatever it is going to be, based on your diet. When you change your diet, that will lead to a change in your gut bacteria profile, by the process of natural selection. There's nothing mysterious about the process.
Gut bacteria are not Santa Claus. They are not living in our gut in order to enhance our health. They are parasites, living off nutrition that we provide (or rather, nutrition that they steal from us). Despite all the glowing claims about their alleged "benefits", they exist in our gut strictly for their own benefit, and any benefits that we "think" we derive from their presence, are strictly accidental.
Our relationship with gut bacteria is a lot like the relationship between plant aphids and "aphid-herding" ants. Certain species of ants control colonies of aphids by releasing chemicals from their feet. The chemicals subdue and tranquilize the aphids, and the ants protect their herd from outside invaders. Then the ants eat the honeydew excreted by the aphids. The aphids may appear to benefit from the protection provided by the ants, but the ants are only interested in their own benefits. And the aphids would certainly be better off without the freeloading ants. Here's some information on that arrangement if you're not already familiar with it:
http://www.sciencedaily.com/releases/20 ... 212548.htm
Unfortunately, in the human/gut bacteria arrangement, we play the role of the aphids, and our gut bacteria play the role of the ants.
Now I'll grant you, at the moment I may be the only one on the planet who sees our gut parasites for what they actually are, but I have high hopes that some day humans will advance their knowledge and understanding sufficiently to be able to recognize that gut bacteria are nothing more than pesky parasites that we would be much better off without.
Tex
It is suspected that some of the hardest material known to science can be found in the skulls of GI specialists who insist that diet has nothing to do with the treatment of microscopic colitis.