Amy,
I apologize if I came across as insulting — I didn't mean to. And Kudos to your gastroenterologists for recommending diet changes to treat this disease. They obviously are not totally lost. But the fact is, microscopic colitis is not a rare disease. It might be considered uncommon, but certainly not rare. The incidence of MC is higher than any of the other IBD's. It's more common than ulcerative colitis. It's more common than Crohn's disease. And it's more common than celiac disease. Your doctors are not to blame. They're doing the best they can, and they're obviously learning on the job.
The primary problem with understanding and treating this disease appears to be associated with the medical schools. For some unfortunate reason, probably because those assigning the curriculum, and doing the teaching in medical schools don't understand the disease, doctors have traditionally been taught little more than a very few rudimentary basics about the disease in medical school. Since those schools don't provide a significant amount of training about the disease, graduates naturally assume that it must be a rare disease. The disease is not rare. Expertise in understanding and treating it is rare.
Pregnancies in MC patients typically follow two patterns:
1. Patients in remission typically relapse during pregnancy and lactation
2. Patients who are not in remission typically go into remission during pregnancy and lactation
Here's why:
MC is strongly affected by hormonal changes. For example, most MC patients cannot reach remission if they are using HRT, and in many cases, that also applies to hormonal contraceptives. MC patients who become pregnant follow 1 of 2 possible courses — about half of them go into remission which typically lasts until lactation ceases, and the other half suffer a relapse or intensifying symptoms. Unfortunately there is no official (based on medical research) way to predict which is the most likely outcome. I have a theory that is related to mast cell issues that predicts that patients whose MC is mast cell-driven (rather than T cell-driven) tend to go into remission with pregnancy. And conversely, those whose MC is T cell-driven tend to have worsening symptoms. This theory is based on the fact that diamine oxidase enzyme concentrations in the placenta can reach approximately 500 times normal levels during pregnancy.
In pregnancy, DAO is produced at very high concentrations by the placenta (119, 120), and its concentration may become 500 times that when the woman is not pregnant (120). This increased DAO production in pregnant women may be the reason why, in women with food intolerance, remissions frequently occur during pregnancy (14).
Histamine and histamine intolerance
But magnesium also plays an important role in this situation. For one thing, most people in this country are magnesium deficient, and anyone who has an IBD is especially likely to have a magnesium deficiency because the malabsorption issues associated with IBDs tend to cause various mineral and vitamin deficiencies, including magnesium. And in addition, many medications (especially antibiotics and corticosteroids) deplete magnesium. Why does that matter? Because unused histamine in the body is normally purged by diamine oxidase (DAO) enzyme. If unused histamine is not removed from circulation, it can build up to levels that trigger adverse reactions. And as I mentioned above, DAO levels increase to roughly 500 times the normal level during pregnancy in order to protect the fetus from bioactive histamine.
But unknown to the medical community (at least this remains unrecognized by the mainstream medical community), many/most of us have mast cell/histamine issues when our MC is active. The basic problem is mast cell activation disorder (MCAD), but of course the association of reduced DAO levels compounds the problem for many of us. IBDs are known to case DAO deficiencies and our experience on this discussion board shows that this certainly applies to MC. My personal theory is that the DAO decline and MCAD issues associated with MC are virtually always due to undiagnosed magnesium deficiency (because virtually no mainstream clinicians understand how to test for magnesium deficiency, so they always mistakenly order the useless blood tests, which virtually always incorrectly rule out a magnesium deficiency). The point is that those blood tests will only detect a magnesium deficiency after all of the muscle cells of the body have been purged of their magnesium reserves as the body struggles to maintain a normal serum magnesium level. The test results will be normal even though the body may be starved for magnesium.
As further evidence that my theory is correct, I note that despite the fact that taking a DAO supplement should resolve a DAO enzyme deficiency, to date at least, no one here who has taken a DAO supplement has had any noticeable success. My guess is that the reason for this response failure is a magnesium deficiency in virtually every case. And here's the clincher:
Magnesium deficiency has been shown to cause elevated histamine levels (associated with a drastic decline in DAO levels). Here's a reference based on rat responses to magnesium deficiency:
Specific change of histamine metabolism in acute magnesium-deficient young rats.
If your symptoms are mast cell-induced, rather than T cell-induced (as defined for classic MC inflammation), then boosting your magnesium intake significantly (topically-applied magnesium works well, also, if you use enough), and minimizing your intake of high histamine foods (and histamine-releasing foods), might provide significant benefits. You might find that a good daily H1 antihistamine for a week or so may also help to reduce your symptoms. An antihistamine will also help to reduce any nausea problems For many of us, a daily H1 antihistamine seems to provide about as much benefit (for reducing diarrhea) as budesonide, but of course, that doesn't work for everyone.
Tex