What lifestyle and dietary modifications should I recommend to patients with microscopic colitis?

For patients with microscopic colitis, lifestyle and dietary modifications should focus on symptom management and overall bowel health. Encourage patients to maintain regular meal patterns, avoiding long gaps between eating, which can help stabilise bowel function. They should be advised to drink at least 8 cups of fluids daily, prioritising water and non-caffeinated drinks such as herbal teas, while limiting tea and coffee to no more than 3 cups per day to reduce potential bowel irritation.

Alcohol and fizzy drinks intake should be reduced as these can exacerbate symptoms. Patients may benefit from limiting high-fibre foods, particularly those high in insoluble fibre such as wholemeal breads, bran cereals, and whole grains, as these can worsen diarrhoea and abdominal discomfort.

It is also advisable to limit intake of resistant starches found in processed or re-cooked foods, and to restrict fresh fruit consumption to about 3 portions per day (approximately 80 g per portion) to avoid excessive fermentable substrates that may aggravate symptoms.

Additionally, patients should be supported to identify and avoid specific dietary triggers that worsen their symptoms, as individual responses can vary. Encouraging physical activity and relaxation techniques may also help improve overall wellbeing and symptom control.

While UK guidelines for irritable bowel syndrome provide these general dietary and lifestyle recommendations applicable to microscopic colitis due to symptom overlap, recent literature on microscopic colitis (Silva et al., 2024) emphasises the importance of tailored dietary advice and symptom-targeted management, highlighting that no single diet fits all and that patient education on self-management is crucial.