Volume 6, Issue 2
February 2020
Happy Valentine's Day

February brings Valentine's Day, and like many holidays it has a way of reminding us of the accommodations we have had to make because of our MC and the associated fatigue and diet restrictions.  For example, a common Valentine's Day celebration often involves the woman getting chocolates and flowers and going out to a romantic dinner.   We can find workable substitutes, but  we can also look on holidays as an opportunity to branch out and establish new traditions that are enjoyable and work with our limitations.

Let's take a look at an example.  If you just want chocolate free of many food sensitivities, there are a number of companies that produce chocolate bars that are gluten, dairy and soy free.  One of my favorites is Theo Chocolate, based in Seattle.  They make organic  chocolate from scratch, using beans sourced ethically from from small  cocoa farmers.  It is available in stores like Whole Foods and other regional grocery stores that specialize in organic foods.  And of course you can always order on-line.
Anything beyond basic chocolate bars is somewhat iffy. For that romantic heart-shaped box of chocolates, I found a selection of truffles at No Whey Foods that are gluten, dairy and soy free. However, they include other legume-based ingredients such as pea protein, and of course the "natural flavors", which sometimes contain undeclared soy oil. So it can be a challenge to find a safe product, as we each have our unique sensitivities.

That is why finding non-food related romantic ways to celebrate Valentine's Day is important.  It can be as simple as planning a movie night.  And if you are fatigued or worried about finding a bathroom, a movie night at home with some special effects like candles and flowers can make it feel more special.  So rather than focus on what we can't do because of our MC, look to other ways to celebrate and look forward to holidays like Valentine's Day.

Of course, not everyone celebrates Valentine's Day, but if you want, concentrate on being kind to yourself and doing something meaningful to you! 
Looking at Bile Acids From Another Angle

In the past, we've mostly looked at bile acids in the context of bile acid malabsorption (BAM).  BAM is a common cause of diarrhea in microscopic colitis (MC) patients who don't respond to any of the treatments that are usually effective.  But some interesting research demonstrating that bile acids appear to help regulate gut immunity and inflammation has recently been published. (1)

Basically, the study showed that bile acids are modified by gut bacteria to regulate certain types of immune cells that in turn, regulate inflammation.  The gallbladder dribbles bile acids into the common bile duct in the duodenum to help dissolve fats in the diet.  Farther down the gastrointestinal tract, gut bacteria convert bile acids into two types of immune cells by creating certain metabolites that favor the promotion of T cells (Tregs) and helper T cells (Th17 cells).  T cells suppress inflammation, while Th17 cells promote inflammation.

Normally, the T cells and Th17 cells are balanced so that stability is maintained in the intestines.  If some type of insult causes intestinal damage (such as a non-IBD issue), then normally the cellular damage is healed by first utilizing Th17 cells to initially promote inflammation (which allows various white cells from the immune system to destroy any invaders and damaged cells).  After the damaged cells and any other foreign matter are removed, then T cells replace the Th17 cells, to suppress inflammation and allow the healing process to be completed.

But as we know, when MC is untreated, the damage never ends (because the dietary insults never end), so healing can never be completed and the inflammation is perpetuated.  This leads to altered gut bacteria population profiles because of the resulting compromised digestion.  It's likely that this effect might favor increases in Th17 numbers, thus promoting inflammation, just as the research suggests.  But because healing can never be completed (without treatment intervention), it's unlikely that a condition would ever be reached where Tregs would be promoted by the process.  This suggests that MC patients would still be better off by getting rid of (sequestering) as much bile acid as possible, simply because the net total effects of bile acids on MC appear to be predominantly negative.

After all, just because T cell regulation is normally within the scope of influence of bile acids doesn't mean that bile acids will be helpful in the treatment of MC (or any other IBD). It appears that this research merely confirms what we already knew (that Tregs are suppressed, and pro-inflammatory T cells are promoted) whenever an IBD develops, or an existing case becomes active.  However, the research does make a novel contribution to the knowledge base by verifying a mechanism (gut bacteria acting on bile acids) to explain how the perpetuated inflammation may occur.

1. Harvard Medical School. (2020, January 3). Bile acids may help regulate gut immunity and inflammation. Retrieved from: https://www.sciencedaily.com/releases/2020/01/200103141047.htm