How Do You Know if You are in Remission?

Crohn's and Colitis Gut

So… How do you know if you are in remission?

The topic of remission is rarely fully explained after a diagnosis of IBD so often people come to me with  many questions like:

How do I know if I’m in remission?

My doctor says I’m in remission, but I still have symptoms… What does this mean?

How do I know if I’m out of a flare?

Do these sound familiar?

They sure do for me, because I get questions like these on a weekly basis. 

What I’ve found is that if I can help you finally grasp a solid understanding of what remission truly is- it can actually provide a lot of relief and even improve your relationship with food.

Knowing that not every little sign of discomfort does not mean you are out of remission can really be a relief for many.

Reduced anxiety around food can help you take a big picture approach to your IBD nutrition plan by reducing foods we know are connected to flares and expanding your diet to include a more diverse diet. 

Next I’m going to identify the three types of remission, help you understand which you are in, and what to do next to ensure the best self-care.

 

Type 1: Clinical Remission

Clinical remission is confirmed through blood work that shows no signs of inflammation. 

Your provider might run markers like C-reactive protein, Sedimentation rate, Fecal Calprotectin or others to evaluate the state of your IBD. 

Keep in mind, even while in remission, you may still have “irritation” type symptoms like gas, bloating, diarrhea and constipation. 

Your Next Steps Are: 

  • Continue to support digestive health by eating a diverse diet (30+ unique plants weekly)
  • Expand the diet to things you would normally avoid in a flare
  • Monitor for deficiencies regularly
  • Work with a IBD Dietitian who can help get on a solid plan to reduce risk of flare
  • Continue to avoid foods identified as inflammatory for IBD
  • If symptomatic, working with a Dietitian can also help reduce “irritation” like symptoms
  • Try to incorporate “stress resilience” tools like meditation to reduce stress & flare risk

 

Type 2: Symptom Remission

Symptom remission is defined as the absence of irritation symptoms like gas, bloating, diarrhea and constipation. 

Approximately, half of those with Crohn’s and Ulcerative colitis have IBS or irritation symptoms despite being in clinical remission (no inflammation). 

Irritation symptoms can be managed well with a solid nutrition plan and lifestyle changes. 

However, just because symptoms are gone- it doesn’t mean there isn’t inflammation. 

It’s always a good idea to check in regularly with your providers to ensure there is no inflammation.

Your Next Steps Are:

  • Expand the diet to ensure you are getting a wide diversity of foods
  • Continue to avoid foods identified as inflammatory for IBD
  • Monitor labs regularly to check for inflammation
  • Monitor and replete deficiencies that are present to prevent flares
  • Work on avoiding eating in a “stressed state”- try 5-7-3 breathing before meals 

 

Type 3: Deep Remission

Deep remission is confirmed as being in clinical remission, with no signs of inflammation through blood work. This differs from clinical remission in that there are also signs of mucosal healing. 

Getting to deep remission can also mean there are no signs of disease which makes it less likely to have a relapse.

However, there is still a possibility of having relapse of disease activity or symptom activity.

Even in deep or histological remission, you can still have irritation or IBS like symptoms. 

Your Next Step Are:

  • Continue to monitor labs yearly check for inflammation
  • Run labs yearly to check for deficiencies like Vitamin D or Anemia
  • Work on expanding the diet to include a wide variety of plant foods
  • Unless a food is an allergy, you can continue to try out food triggers
  • Continue to avoid foods identified as inflammatory for IBD

 

Final Thoughts

Regardless of where you are at in the remission spectrum, the evidence is supportive of including a solid nutrition plan for Crohn’s and Colitis in helping to reduce the risk of having a flare and reducing the severity of flares.

If you aren’t sure where to start- I’ve got you covered. 

I’m continually working on resources to support you wherever you are at in your IBD journey

If you are curious about which of these resources or forms of coaching might be best for you, reach out and schedule a call here. Also, check out our IBD group program + course here.

 

P.S. If you are curious about the Differences between IBS & IBD check out my answer here.

If you don’t have IBD but you want to know how to better support your loved one with IBD- check out the blog I did it on here.

 

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