No more lymphocytic MC?

[Alohagirl]

Hi - I could use some input please. My dx of LC was done by colonoscopy & endoscopy 6-15. I had another colonoscopy 2 days ago. The new GI MD took multiple samples and finds no traces of LC now! I said to him 'great' but why am I starting to have symptoms again after stopping all of my supplements 1 week ago (magnesium, Vit A, B12, B6, D, molybdenum, butyric acid and probiotic). He said it was because of stopping the probiotic. I had breath test 3 years ago and was told by naturopath that I had SIBO and took 1 round of xifaxan back then (never took another med as I had more of the constipating type when when there was D I usually felt like I was going to pass out for 15 min). He says that there is no reliable test to dx SIBO so they go on symptoms. He is offering me a 14 day course of xifaxan with 1 optional 2nd round. I am starting to have some gas, rumbling tummy and tightness in my right mid abdomen like I did 3 years ago. I almost passed out last weekend due to having D and I did not eat anything that was not on my safe list (had been off supplements for 4 days) but have have had more white rice than usual. I restarted only the probiotic (lactobacillus acidophilus and plantarum and bifidobacterium longum) and butyric acid the day after the colonoscopy when the bloating started and it has helped so symptoms are minimal. I have had an extremely strict diet for the past 3 years. Does this really mean I do not have LC or that they just do not see evidence now since I have not been aggravating my gut? I am trying to figure out, now do I attack the SIBO? If so, how? Are the meds offered really likely to help? Of course I'd like to get the bacteria balanced better if that is possible. If not, what might be some options for next steps. My goal would be to gradually be able to expand my diet. Thanks in advance for any assistance!

[tex]

Hi,

The fact that no trace of MC was found during the colonoscopy confirms that you have indeed been following a safe diet and your colon has healed. It does not mean that you no longer have MC — MC is for life. It means that you no longer have active MC; it is in complete remission. Or rather, it was, before the colonoscopy.

Here's what probably actually happened. A colonoscopy is a very invasive procedure and it is very traumatic for the lining of the colon. The cleanout solutions used to prepare for a colonscopy are very caustic. They cause severe inflammation in some peoples' colon. Research has shown that they have caused many cases of MC in patients who did not have MC before having a colonoscopy. Some of those products have even been taken off the market by the FDA because they caused so many MC cases. If they can do that, surely they can trigger a relapse in a previous MC patient. In my opinion, your relapse is probably due to the cleanout solution used for the colonoscopy. Your GI doc is just trying to confuse the issue by blaming it on stopping the probiotic, so you won't be so likely to blame him.

Polly had exactly the same thing happen to her eight yeqars ago:

TA DAAA! My MC is GONE!

And then she promptly relapsed soon after the colonoscopy.

Going thru an emotional time

At the time we blamed it all on the emotional stress from losing a family pet, but now I'm not so sure. I have a hunch that the damage done to her colon by the cleanout solution probably set her up so that it was much more likely that the stress would cause a relapse.

Also, I think it might have been a mistake to discontinue taking vitamin D and magnesium. Without adequate vitamin D and magnesium our immune system cannot operate at full capacity to control inflammation, and a magnesium deficiency has been shown to actually cause inflammation.

But of course I'm just guessing that the cleanout solution was the primary cause. We can never prove what actually happened in situations such as these.

Hopefully, if you continue to eat a bland, safe diet (similar to what you ate in order to reach remission originally) the inflammation will recede and your remission will return in a few days or weeks.

Tex

[henrym]

Tex, can you please explain the SIBO? Is this something we need to have a look at? As I understand there is a specific antibiotic to treat it. Or is it also treated naturally by sticking to our diets?

[tex]

Hi Henry,

Here's my take on SIBO (copied from pages 177–179 of Understanding Microscopic Colitis:

Small intestinal bacterial overgrowth (SIBO)
SIBO is defined as an abnormally high number of bacteria in the small intestine (Dukowicz, Lacy, & Levine, 2007).202 It's frequently claimed to be the cause of chronic diarrhea and malabsorption, particularly by naturopathic practitioners. But in the real world, a shift in the balance among bacterial species is frequently considered to be SIBO. The reality is that species of bacteria and balances among those species in our intestines tend to change as our diet is changed and as our digestive abilities changes during the course of the disease.

Poor digestion leads to increases in population levels of certain opportunistic species that can benefit from the fermentation of partially-digested food. As the gut heals, and digestion improves, those species are “starved out” and replaced by some of the species of bacteria that were there originally. Likewise, as we change our diet to eat more protein and less carbohydrates, bacterial species that thrive on the altered diet tend to crowd out species that can't compete when fed that particular food. And as we heal, and gradually go back to eating some of the foods that were originally cut out of our diet, the bacterial balance among the various species of gut bacteria will shift again, to reflect the new diet.

Naturopaths often recommend testing for SIBO. And of course the testing almost always finds “SIBO” in patients with active microscopic colitis because SIBO has been found to be associated with many diseases.ii So they recommend treating the “SIBO”. But just because “SIBO” happens to be associated with a disease does not mean that it caused the disease. Fire trucks can be found near fires, but they are virtually never the cause of the fire. Is it really SIBO, or just a natural shift in the balances among the various bacterial species in response to diet changes or to loss of digestive efficiency as a result of the disease?

Digestive diseases create opportunities for bacteria, so they can hardly be blamed for for taking advantage of the situation. Logic suggests that SIBO is not the likely cause of all of the diseases attributed to it. It's much more likely that those diseases cause SIBO. Virtually every one of the diseases associated with SIBO is related to, or caused by a digestive system disorder. Digestive diseases naturally tend to cause poor digestion and poor digestion causes changes in gut bacteria populations as opportunistic bacteria take advantage of undigested or poorly-digested food to establish colonies that thrive under such conditions. So it's much more likely that digestive system problems cause SIBO than SIBO causes digestive system diseases. Consequently, there's little point in treating SIBO because that is simply treating a symptom— it's not treating the cause of the symptom. When the cause of the symptom is resolved, then the symptom will automatically disappear.

As the inflammation decreases, in response to proper diet changes, bacterial balances tend to realign to a more normal pattern in most patients, regardless of whether or not “SIBO” is treated. The point is, what may be interpreted as SIBO will usually be corrected automatically without any intervention, as the microscopic colitis is brought under control by stopping the inflammation with diet changes that avoid the inflammatory foods.

So in most cases, the “SIBO” tends to be a symptom of MC, rather than the MC being a symptom of SIBO. Except for truly pathogenic populations of certain species, treating a gut bacteria balance shift is usually pointless, because after the treatment, the balance among the various species populating the intestines is going to be determined by diet and the effectiveness of the digestive system at that point in time. So the population balance will tend to sort out according to those criteria after a few weeks. That said, if a true infection exists, it should be treated. Normally however, treating “SIBO” associated with MC appears to be a waste of time and money for many patients.

Here'e reference 202 from that quote:

Reference 202. Dukowicz, A. C., Lacy, B. E., & Levine, G. M. (2007). Small intestinal bacterial overgrowth. Gastroenterology & Hepatology, 3(2), 112–122. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3099351/

But remember, this is just my opinion of why and how SIBO is associated with MC.

Tex

[henrym]

Thanks Tex! It all seems logical

[Alohagirl]

Aloha - thanks so much for your help!