Collagenous Colitis: Five Nutritional Approaches To Help Manage Symptoms

Collagenous colitis occurs when a collagen band forms due to inflammation of the colon lining.  The severity of this appears to correlate with the severity of the symptoms.  The band can be identified using a biopsy.  This gut health problem appears to be more prevalent amongst women in their 60s than other demographics.

Unfortunately, collagenous colitis tends to be a recurring condition.

The main symptom of this gut condition is diarrhoea.  Other symptoms may include:

• Abdominal pain
• Weight loss
• Bloating
• Dehydration
• Nausea
• Fatigue or weakness
• Joint pain

Understanding the causes, or potential causes, of a condition can help us to reduce our risk of developing it.  However, in the case of collagenous colitis, the definitive cause is not known.  There are of course theories about it, including:

• Immune system problems

Collagenous colitis may be related to an autoimmune condition.  It has been associated with Coeliac’s Disease, autoimmune thyroid conditions, Sjögren syndrome, diabetes mellitus and others.

It is possible that substances in the gut that trigger the immune system contributing to IBD and IBS conditions, may play a role.  These substances may include dietary allergens, bile acids or products produced by gut bacteria.

• Pathogenic bacteria

The microbiome in our gut has a significant influence on our health.  It is important to have a variety of bacteria present and we can support this by eating a varied diet, rich in plants.

In the case of collagenous colitis, studies have suggested that individuals may have insufficient levels of clostridiales, akkermansia and ruminococcus bacteria.  These strains are known to have roles in the protection of our health.  However, individuals affected may also have high levels of prevotella, and/or campylobacter concisus may be present.  The risk of the latter being present may be increased by smoking or certain medications.

If you would like to check the bacterial balance in your gut, stool tests are available.  These tests may be carried out by your medical team if you are experiencing symptoms.  If not, you can obtain stool tests privately.  As a Nutritional Therapist I am able to co-ordinate stool tests, however this will only be done for Nutritional Therapy clients, as part of their chosen service package (additional costs will apply).

• Medication

Various medications have been identified as potential causes of the condition, but none are proven.  The list of medications includes anti-inflammatories, anti-reflux medications, medications for cholesterol and high blood pressure, diabetes treatments and medications for depression.

Details of the side-effects of medications can be found on the patient leaflets.  Do not stop taking any medication without discussing your concerns with your doctor who can advise you regarding your personal health risks and any alternative medications or treatments.

• Smoking

• Genetics

Studies suggest that you may be at greater risk of collagenous colitis if you have certain genetic variations.  Other genetic variations may be protective.

There are two nutritional approaches that may help sufferers feel better: removing triggers, and adding in nutritional support.  Here are five nutritional approaches that may help you manage your symptoms:

• Keep hydrated

It is important that you keep yourself hydrated when experiencing the symptom of diarrhoea.  Reducing your caffeine intake and ensuring you have sufficient water can help with this.  Checking that your urine is a pale yellow colour will give you an indicator of your hydration level – if it is darker, it is likely that you need additional fluids.

• Cut the coffee – even decaf

While the specific component of coffee responsible has not yet been identified, coffee is associated with an increased movement of fecal matter through the intestines.  Interestingly, decaffeinated has been found in studies to have this affect as well as the normal stuff.  Therefore, when experiencing diarrhoea it is worth trying to avoid coffee to try to help reduce the symptom.

• Reduce dairy products

Dairy contains a sugar called lactose for which we need the enzyme lactase to break it down.  Individuals with lactose intolerance are lacking this enzyme, and this can happen as temporary consequence of intestinal problems like diarrhoea.  This can then make the diarrhoea symptom worse as the lactose remains in the bowels fermenting.

Temporarily removing dairy products from your diet may help manage the diarrhoea.  It is important to remember that lactose may be added to other foods and medications as an ingredient, so if this does seem to be a problem for you, make sure you check ingredient lists.

• Increase your glutamine and fibre intake

You’re no doubt family with the term fibre, but may be not so familiar with glutamine.  This is an amino acid (building block of protein) which supports the intestinal lignin and the absorption of salts and water.  While the body can make its own glutamine, we can get it from food as well.

Good sources of glutamine include: eggs, beef, tofu, white rice, and corn

Good sources of fibre include: beans, brassicas, avocados, sweet potatoes, fruit, carrots, seeds, hazelnuts, oats and barley.

When changing your diet in response to illness, it is worth monitoring the effects of those foods.  If any foods appear to exasperate the problem, remove them from your diet.  Keeping a food and symptom diary may be helpful.

• Supplements

While the soluble fibre psyllium husk is often  used to relief constipation, it may be helpful to reduce diarrhoea as it helps to absorb water in the colon.  In addition, the probiotic saccharomyces boulardii has been found to be effective in reducing the severity of persistent diarrhoea.

**It is important that you only use supplements after consultation with a suitably qualified professional to ensure they are appropriate for you.

Microscopic colitis: an update – Farcas, Grad and Dumitrascu (2022) – https://pmc.ncbi.nlm.nih.gov/articles/PMC9694749/

Microscopic colitis: etiopathology, diagnosis, and rational management – Nielsen, et al (2022) – https://elifesciences.org/articles/79397#:~:text=More%20recently%2C%20a%20team%20of,et%20al.%2C%202019).

Effects of coffee and its components on the gastrointestinal tract and the brain-gut axis  – Iriondo-DeHond, et al (2020) – https://pmc.ncbi.nlm.nih.gov/articles/PMC7824117/