I still remember the first time I met Vicky. She walked into the clinic carrying a thick 1.5-inch binder of medical records and looked nervous. It was clear she wasn’t sure if I’d be just another doctor who couldn’t help her.
Vicky had been battling microscopic colitis for years. She went from someone who loved to travel to someone afraid to take extended trips because of her chronic diarrhea. Even simple things like attending concerts or going to places where restrooms weren’t easily accessible became stressful for her. This disease had taken a huge toll on her life, and sadly, she’s not alone.
Many people with microscopic colitis feel the same way—frustrated, anxious, and even depressed.
Microscopic colitis is actually a pretty common cause of chronic watery diarrhea, especially in adults over 65, and it’s more common in women. It’s often linked with other autoimmune conditions like Hashimoto’s or type 1 diabetes, but we still don’t fully understand how it develops.
What Causes Microscopic Colitis?
One leading theory of what causes microscopic colitis focuses on the gut microbiome—the ecosystem of microorganisms living and working together in our digestive system. When everything is in balance, our gut is healthy and keeps us feeling great. But when something throws off that balance—whether it’s a poor diet, antibiotics, steroids, or an intestinal infection—it can lead to disease.
Your gut microbiome is like a community, and what you eat feeds the “residents.” If your diet is high in refined sugar, saturated fats, artificial additives, or foods you’re intolerant to, it can encourage certain microbes to overgrow while others diminish.
Over time, this imbalance can cause problems.
Similarly, antibiotics and toxins released by infections can disrupt the microbiome, like a war or famine hitting a town—some microbes are wiped out, and the whole ecosystem changes. Usually, a healthy gut can recover from these disruptions in a few months, but in someone with microscopic colitis, the imbalance persists and often worsens.
When the gut microbiome is out of balance, the overgrown microbes produce metabolites that trigger your immune system, causing chronic low-grade inflammation in the GI tract.
Think of it like a constant, low-level battlefield—damage, debris, and casualties everywhere. This inflammation isn’t severe enough to cause issues like ulcers or bloody stools seen in conditions like inflammatory bowel disease, but it can definitely cause watery diarrhea, abdominal pain, urgency, and even fecal incontinence. It might interfere with nutrient absorption, leading to weight loss and fatigue. It’s exhausting, both physically and emotionally.
Microscopic Colitis Treatment
The go-to conventional treatment for microscopic colitis is bismuth subsalicylate—better known as Pepto-Bismol. While most people think of it as an anti-diarrhea medicine, it also helps break down biofilm and kill bacteria. Research shows that about 75% of people see improvement with bismuth, and roughly half of them go into remission after eight weeks.
But what about the other half—the ones who don’t see results?
You might wonder, “What about antibiotics?” While antibiotics can kill overgrowth, they might also be part of what caused the imbalance in the first place. That’s where a natural approach can make a real difference.
Naturopathic medicine offers stool testing to get a clearer picture of your microbiome. Herbal antimicrobials can help restore balance without being as harsh as conventional antibiotics. And don’t underestimate the power of diet—targeted dietary changes can play a huge role in healing and nurturing a healthy gut.
If you’re struggling with microscopic colitis, you don’t have to navigate this alone. It’s so important to work with trained professionals who can guide you through the process. Reach out to our staff to schedule a brief consultation with one of our providers. We are happy to talk with you about how we approach treating microscopic colitis.
Let’s work together to get you back to living your life fully and confidently—it is possible, and we’re here to help.
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Dr. Sherry Su, ND, FABNG
Naturopathic Doctor San Jose
408-356-1364
