2. Resolution
We want the elimination phase to lead to: resolution of symptoms; and resolution of the underlying disease process.
Assessing the former is reasonably straightforward – everyday experience will indicate if the (properly applied) dietary approach is working. To get a figure on your symptoms you can use the Crohn’s Disease Activity Index (CDAI) or the Ulcerative Colitis Activity Index - these are not universally used measures but you may find them interesting.
One could assume that if the symptoms are resolving then the disease process is also resolving, this isn’t necessarily the case. To be more certain you would need to have a sigmoid or colonoscopy to confirm a return to gut health. Additionally, a biomarker test can indicate the absence of general inflammation. [Biomarker tests are not fool-proof in that absence of evidence is not evidence of absence. The future of biomarker disease identification promises to greatly advance the field of preventive health care – hopefully, with more sensitive and individualised tests, the false negative rate will virtually disappear].
We are assuming that Crohn’s Disease and Ulcerative Colitis are autoimmune inflammatory disorders as that’s what current medical science tells us. Unlike other IBD sites we are less interested in explanations per se, than we are in resolving the condition.
What is the timeline of resolution?
It’s possible that many CD/UC sufferers will experience some level of relief from symptoms within a day or two. Less stomach and back pain, less wind, less urgency to empty bowels, less visits to the toilet, less blood and mucus in the stools, less tiredness, and so on. EIMs may start clearing up. Every case is different, the speed and nature of symptom alleviation is individual and may also be dependent on the severity of the condition.
If all inflammatory agents have been successfully taken out, it seems that the last thing to resolve completely is blood in the stools - this could take a few weeks before all traces are gone. This makes sense in that healing of the gut lining takes time, in the way that a cut takes time to heal. Some while before this the main debilitating symptoms will have gone. It’s after this final stage that you need to have an ‘oscopy’ done.
By this time you’ll probably be sick of eating the same limited diet, and will want to start reintroducing other foods. It is a challenge to stick to an elimination diet, but this is only for the short term as opposed to the lifetime of challenges, complications, and limitations caused by chronic IBD, and from the medications used to treat it. It’s possible that all traces of blood in the stools are gone for a few days only to return for another week. This may happen a few times before complete cessation - it’s highly frustrating but stick with it. Ideally you shouldn’t start reintroducing foods until all symptoms are gone.
By this stage, fear of going out, travelling on public transport, being stuck in traffic in your car, or however your life has been limited by CD/UC, will (after a fragile psychological start) only be a memory. But the resolution of symptoms doesn’t yet mean you can eat what you like, drink alcohol and live a dietary spontaneous life; not unless you are prepared for a set-back. The resolution of symptoms and disease process needs to have the final part added to it, the reintroduction of other foods.