As anyone living with microscopic colitis (MC) can attest,although the disease is often dismissed as a minor gastrointestinal issue, the reality is far more serious. A 2019 qualitative study published in The Journal of Clinical Nursing offers powerful insights into how deeply MC affects the daily lives of patients (Pihl Lesnovska, Münch, and Hjortswang, 2019).1 The lead author is an RN, and the other two authors are Mds who also hold a PhD. Through in-depth interviews, the study verifies how life with MC is not only physically taxing, but also emotionally and socially disruptive.

The study’s central theme,“struggling with an invisible, disabling disease”, describes what most of us have been through — the frustrating paradox of MC. Patients experience symptoms that are severe and life-altering, yet outwardly they appear healthy. This invisibility contributes to misunderstandings from employers, family, and healthcare providers, often leaving patients feeling isolated or invalidated.​

Through qualitative interviews with 15 individuals diagnosed with MC, researchers identified five key areas where the disease significantly disrupts life:​

1. Physical experience of bowel dysfunction

Patients described a relentless pattern of chronic or recurrent watery diarrhea, sometimes occurring multiple times per day. The urgency and frequency of bowel movements are difficult to control and often unpredictable. This can result in fecal incontinence, a deeply distressing symptom that undermines a person’s sense of dignity and autonomy.

2. Associated symptoms affecting quality of life

Beyond diarrhea, patients reported abdominal pain, fatigue, bloating, and sleep disturbances. These symptoms make it difficult to participate in normal daily activities. Fatigue, in particular, was noted as overwhelming and sometimes indistinguishable from the kind seen in other chronic inflammatory conditions.

3. Impact on everyday life

The consequences of MC extend far beyond the bathroom. Patients described having to plan their lives around toilet access, leading to reduced social engagement, work limitations, and avoidance of travel. Some felt compelled to stay close to home for fear of losing bowel control in public. This isolation contributes to emotional distress and loss of independence.

4. Disease-related worry

Participants expressed ongoing anxiety about the future, including fear of symptom escalation or progression to another disease. Uncertainty about effective treatment, flare unpredictability, and concerns about the long-term impact of chronic inflammation weighed heavily on their minds.

5. Strategies for managing daily life

Despite the challenges, patients adopted a variety of adaptive strategies to cope. These included strict dietary adjustments, carrying emergency supplies, mapping out bathrooms, and modifying work and social routines. However, many found that even with extensive lifestyle changes, their symptoms remained difficult to control.

The authors point out that this study highlights a critical gap in how microscopic colitis is perceived and managed. Although classified as a form of inflammatory bowel disease, MC is often under-recognized due to the absence of visible symptoms or positive imaging findings. As a result, patients feel dismissed or minimized, which exacerbates the psychological burden of the disease.​

The authors call for improved clinical awareness, more targeted quality of life assessments, and individualized care plans that acknowledge both the physical and emotional toll of MC.

1. Pihl Lesnovska, K., Münch, A., and Hjortswang, H. (2019). Microscopic colitis: Struggling with an invisible, disabling disease. The Journal of Clinical Nursing, 28(19-20). pp 3408-3415. Retrieved from https://pmc.ncbi.nlm.nih.gov/articles/PMC7328780/

Those of us who have histamine sensitivity issues eventually become willing to try almost anything to stop the symptoms. Whether the symptoms are associated with digestive issues, or a rash or hives on our skin, they can eventually become maddening, and dominate our thoughts. The most obvious remedy usually appears to be to stop eating high histamine foods, or at least minimize their consumption. But what do we do when this isn't enough to stop the symptoms? What if the problems are a result of more than just a sensitivity to high histamine foods?

This article discusses the basic types of histamine problems, how to identify the specific type of issue that's causing the symptoms, treatment options available, and how to resolve the symptoms by using and orderly, systematic approach.

tends to cause a chronic condition involving excessive histamine and other mediator release from mast cells throughout the body — not just the gut.

• At least two organs are affected (skin, gut, brain, cardiovascular, or respiratory).
• Skin symptoms can include flashing, hives, swelling, itching, and temperature sensitivity.
  
• Gut symptoms can be similar to histamine intolerance (diarrhea, bloating, pain, nausea, for example).
  
• Neurological symptoms can include brain fog, anxiety, irritability, for example.
  
• Cardiovascular symptoms can include dizziness, palpitations, low blood pressure, or near fainting.
  
• Respiratory symptoms can include nasal congestion, wheezing, throat tightness, for example.
  
• Triggers can include heat, stress, pressure (physical pressure can cause mast cell degranulation), exercise, foods, chemicals, insect stings, and even mosquito bites, for example.
  
• The onset of symptoms can be variable not always associated with food.
• Symptoms often improve in response to H1 and H2 antihistamines.
  
• The response to DAO supplements is often not enough, when used alone.
  
• Successful treatment may require antihistamines, mast cell stabilizers cromolyn sodium, or leukotriene blockers.

If histamine intolerance is the cause of symptoms, DAO supplements are readily available without a prescription, including online. In fact, a quick check shows that there are no DAO supplements that require a prescription. Just be sure to buy an enteric coated DAO supplement, because uncoated supplements will be degraded by stomach acid. While DAO supplements that are not enteric-coated may still be effective, enteric-coated supplements are typically significantly more effective, when they reach the small intestine, where they are needed.

and they may need to be developed under the supervision of a qualified healthcare provider. Developing a treatment plan for MCAS requires a step-by-step, layered approach, tailored to individual triggers, symptoms, and sensitivities. Similar to microscopic colitis (MC) there's no one-size-fits-all solution, but effective treatment generally involves a combination of avoidance, symptom control, stabilization, and nutritional support.
​

• After diagnosis, triggers should be identified, and avoided.
• Antihistamines should be introduced, by starting slowly, in order to avoid any undesirable reactions.
• H1 blockers, such as cetirizine, loratadine, fexofenadine, or hydroxyzine help to block itching, hives, and flashing.
• H2 blockers, such as famotidine help G.I. symptoms, nausea, and hypotension.Leukotriene blockers, such as montelukast zafirlukast help to prevent wheezing, brain fog, and GI system upset.

As most people are probably aware, sriracha goes through extended fermentation,, and is rather spicy. Not much time passed before I realized that every time I ate a significant amount of sriracha, I developed severe itching. It promptly dawned on me that I was having excess histamine issues. And as the problem continued to escalate, various other relatively high histamine foods (that never bothered me before) suddenly began to cause an itchy rash, and hives, that began on my ankles, or the tops of my feet, and spread up my legs to the rest of my body, during the next few days.

For a few years I controlled the problem by avoiding (or limiting) high histamine foods in my diet, and this seemed to work well, except during hay fever season (I've had seasonal allergy issues all my life), when I would have to follow additional restrictions of high histamine foods (and even medium histamine foods) in my diet, to avoid urticaria problems. I keep my vitamin D level (25[OH]D) up around 60 ng/mL (150 nmol/L, and I take 300 mg of magnesium glycinate daily, divided between right after breakfast, right after lunch, and just before bedtime.​

A few months ago, I began to have regular histamine reactions, and restricting my diet even more tightly, seemed to help sometimes, but didn't usually adequately resolve the problem. I eat breakfast early, and my normal routine included two big slices of bacon, with sausage and eggs (wrapped in corn tortillas), for breakfast, followed by 2 cups of coffee (to kick my brain into gear), and get me going in the morning. About every other day, I would have a bowl of gluten-free (Chex) cereal for breakfast, and a bowl of only slightly spicy chili for brunch (Wick Fowler's 2 alarm chili, minus the red pepper).

For lunch, I would have either a length of pork sausage wrapped in a corn tortilla, and tortilla chips and Fritos, or pork country ribs, and steamed rice (with sugar and cinnamon). Since bacon, the seasonings in chili, and coffee, are high histamine foods, I tried cutting my "doses" of bacon and coffee in half, and eliminated the chili, with no apparent benefit.

before every meal that contained any food that might cause histamine problems, and although I only developed slight areas of rash, the hives continued to appear daily and many of them were really aggravating. Some of them generated such intense itching that they would cause me to wake up in the wee hours of the morning, and make getting back to sleep, a difficult, and sometimes almost impossible, task.

Alcohol has long been associated with relaxation, with many people believing a "nightcap" can help them fall asleep more easily. However, recent research has revealed that while alcohol may induce sleep initially, it significantly disrupts sleep quality. An online medical Xpress article explores the effects of alcohol on sleep, why these disruptions occur, and healthier alternatives for improving sleep quality (Sweeney, and Pilkington-Cheney, 2025, January 20).1​

Alcohol increases GABA and adenosine activity, chemicals in the brain that promote sleepiness. However, these effects are short-lived, leading to a "rebound effect" where the body overcompensates, resulting in lighter, disrupted sleep.​

Alcohol delays the onset of REM (rapid eye movement) sleep, the critical stage associated with dreaming, memory consolidation, and emotional regulation. It also reduces the total amount of REM sleep achieved throughout the night.

Alcohol also increases the likelihood of waking up during the night, and causes lighter sleep during the latter half of the night. These disruptions can leave individuals feeling fatigued and less alert the next day. Even low doses of alcohol (around two standard drinks) consumed within three hours of bedtime can disrupt REM sleep and overall sleep quality.

Studies indicate that sleep disruptions may persist beyond a single night of drinking, potentially affecting sleep patterns even after alcohol consumption ceases. Alcohol interferes with the production of melatonin, a hormone that regulates sleep-wake cycles. It also affects body temperature regulation, further disturbing sleep.​

Alcohol relaxes airway muscles, exacerbating snoring and potentially causing disruptions for both the drinker and their partner. Its diuretic properties increase nighttime bathroom visits, further interrupting sleep.

Although research on long-term alcohol consumption and its effects on sleep is limited, existing studies suggest that sleep may take time to recover after prolonged drinking. For example, chronic disruption of REM sleep can impair memory, cognitive function, and emotional regulation.

1. Sweeney, E., and Pilkington-Cheney, F. (2025, January 20). Alcohol may help you fall asleep faster, but it leads to a worse night's rest overall—here's why. Medical Xpress, Retrieved from https://medicalxpress.com/news/2025-01-alcohol-fall-asleep-faster-worse.html

​Sleep offers substantial benefits to decision-making, problem-solving, and creativity. Through consolidation, insight formation, and hypnagogic inspiration, a well-rested mind becomes better equipped to approach complex decisions, solve challenging problems, and foster innovation. Above all, remember that sleep is not a luxury — it's a necessity.

1. Denis, D. (2024, November 11). Can you sleep your way to better decision making? Here's what the science says. Medical Xpress, Retrieved from https://medicalxpress.com/news/2024-11-decision-science.html?utm_source=nwletter&utm_medium=email&utm_campaign=daily-nwletter

A good night's sleep is often misunderstood as being continuous and unbroken, but according to the findings discussed in a recently published Medical Xpress article, this notion is a myth (Reynolds, et al., 2024, October 8).1 According to the article:

Adults typically move through five or six sleep cycles during the night, each lasting about 90 minutes. These cycles consist of different stages of sleep: lighter stages, deeper stages, and REM (rapid eye movement) sleep. Early in the night, deeper sleep stages are more common, while REM sleep, which is linked to dreaming, occurs more frequently later in the night. It's normal to wake up briefly at the end of each sleep cycle, meaning most people wake up several times during the night, even if they don’t remember it. This pattern is entirely healthy, especially as it becomes more common with age.​

A good night’s sleep typically involves falling asleep within around 30 minutes of getting into bed. While brief awakenings are normal, extended periods of wakefulness can disrupt sleep quality. Healthy sleep does not include long wakeful episodes in the night. The hallmark of good sleep is waking up feeling refreshed and energized, ready for the day. We shouldn't feel excessively sleepy during the day if we're getting around seven to nine hours of restful sleep per night.​

Conditions such as insomnia (which affects up to 25% of adults) and sleep apnea (20% of early adults and 40% of middle-aged people) can interfere with healthy sleep. These conditions may cause difficulty falling or staying asleep, or lead to excessive sleepiness during the day. Factors like noise, children, or pets waking us during the night can lead to more forced awakenings, making it harder to wake up refreshed. Chronic health issues (such as pain), medications, and irregular sleep schedules can negatively affect sleep quality. Waking up feeling unrested could also indicate that we’re not getting enough sleep, or that we need to consult a healthcare provider.

When active, microscopic colitis (MC) offers a variety of symptoms to interfere with sleep. Those who usually sleep on their stomach, such as me, soon learn to sleep on their back because of the severe bloating associated with MC. Although not everyone experiences pain with MC, those of us who do, tend to find it extremely difficult to lie in a comfortable position. No matter how we position ourselves, within a few minutes (or less) we feel compelled to move into a new position, which of course doesn't remain comfortable very long.

And some of us have headaches, nausea, migraines, or other issues. During some nights, when my symptoms were at their worst, my nausea and migraines were so severe that I occasionally even had hallucinations during the night. Whether they were actually hallucinations or nightmares is debatable, because after a while, some of us become so sleep deprived, and our brains so groggy, that it's almost impossible for us to tell the difference. When my symptoms were that bad, even if I managed to get a little sleep during the night, in the morning when I dragged my aching body out of bed in order to rush to the bathroom in time, I felt as though I had literally been hit by a truck.​

Fortunately, after reaching remission, I could sleep normally, again. But when MC is active, all the knowledge in the world regarding quality sleep, is irrelevant for many of us, and that's probably true for many autoimmune diseases.

Although sleep is an essential pillar of good health, many people don't treat sleep with the priority it deserves. A study from Flinders University, published in Sleep Health, illustrates this counterproductive trend and its potential health consequences (Scott, et al., 2023).2 The study analyzed data from nearly 68,000 adults using in-home sleep trackers over nine months, and the data showed that:

• 31% of adults averaged sleep durations outside the recommended seven to nine hours per night.
• Among those who achieved an average of seven to nine hours, 40% of nights fell outside this ideal range.
• Only 15% of participants consistently slept between seven and nine hours for at least five nights a week.

These findings point to widespread irregular sleep patterns, even among those meeting the recommended average sleep duration.

One of the most persistent symptoms of MC is fatigue. And due to the slow healing characteristic of inflammatory bowel disease (IBD), in general, the fatigue often lasts as long as two years, or more.

Back when my symptoms first became active, and slowly became more severe, I was trying to manage a business. The only times I ever took a nap during the day, were when I had a migraine that was so severe that it caused nausea, and I couldn't work until it subsided. Other than that, I never considered taking a nap. But maybe I should have, because I was always short of sleep.

According to a recent online medical Xpress article, daytime naps can benefit almost anyone (Rath, 2025, January 13).3 Note that this article was not written for MC patients — it was written for the general public.​

1. Reynolds, A., Dunbar, C., Micic, G., Scott, H., and Lovato, N. (2024, October 8). An unbroken night's sleep is a myth. Here's what good sleep looks like. Medical Xpress, Retrieved from https://medicalxpress.com/news/2024-10-unbroken-night-myth-good.html?utm_source=nwletter&utm_medium=email&utm_campaign=daily-nwletter

2. Scott, H., Naik, G., Lechat, B., Manners, J., Fitton, J., Nguyen, D. P., . . . Eckert, D. J. (2023). Are we getting enough sleep? Frequent irregular sleep found in an analysis of over 11 million nights of objective in-home sleep data, Sleep Health, ISSN 2352-7218 https://www.sciencedirect.com/science/article/pii/S235272182300253X?via%3Dihub

3. Rath, S. (2025, January 13). How napping can boost your day, Medical Xpress, Retrieved from https://medicalxpress.com/news/2025-01-napping-boost-day.html?utm_source=nwletter&utm_medium=email&utm_campaign=daily-nwletter