Colonoscopy Results After NOT Following My Protocol for One Year | IBD Clinical Remission

My name is Kenny Honnas and I’ve been in clinical remission from a severe case of Ulcerative Colitis for several years now. Shortly after my diagnosis in 2014, I experienced a flare that was so bad I began filling toilet bowls with pure blood. After weeks of constant bloody diarrhea throughout the day and night, I was eventually hospitalized. I lost 30 lbs in two weeks, had four blood transfusions, and was just barely able to avoid having my colon surgically removed. After being released from the hospital, I eventually began studying nutrition. In 2016, after reading several articles and studies on pubmed, I learned that there seems to be a relationship between the pathogenesis of IBD and a dysbiotic gut microbiome (1). So I wondered what would happen if I optimized my gut microbiome and reversed the dysbiosis. I designed and began following my own gut microbiome optimizing diet which allowed me to finally achieve the level of health I was looking for- which was to be able to consume a full range of foods without bleeding, mucus, urgency or diarrhea; to have well-formed, solid bowel movements; and to be on no medication. In 2018, I released this video showing a healthy colon and the type of foods I ate to achieve clinical, endoscopic, and histologic remission with a total resolution of symptoms.

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Quick disclaimer

Just want to be explicitly clear that I am not a doctor, or a dietician, and that the information on this blog and in my videos is based on my personal opinion and should not be taken as medical advice. If you have, or suspect you have, a health condition, you should contact your doctor, or other healthcare practitioner. You should consult with your doctor before making any dietary changes with the intent to treat an illness. I recommend that you follow your doctor’s advice and take medication as prescribed.

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The purpose of this video/blog post is to analyze my colonoscopy from 2021, make some comparisons to my previous colonoscopies, and show you where my health is currently at. So, first to get our bearings let’s take a look at my original 2014 diagnostic colonoscopy. So as you can see here, my colon was very inflamed, especially the left side looking here at the descending colon and rectum. And right here you can see a pretty big polyp in the rectum. It was a few days after this colonoscopy that I had the really intense flare that landed me in the hospital. So this was the starting point.

2014 Colonoscopy Results

Now getting to my 2018 colonoscopy, this was performed after I had followed my gut microbiome optimizing diet for almost two years. When I was designing the program I really wanted to strike a good balance of dietary freedom and dietary discipline. So once I felt completely healthy, I incorporated the 80-20 rule which essentially is being disciplined 80% of the time and eating pretty much whatever I wanted 20% of the time. So I ate according to the gut microbiome optimizing principles for 80% of my meals each week and then for 20% of my meals I gave myself the freedom to eat whatever I wanted. This was a really great weekly routine that allowed me to consistently cultivate a healthy gut microbiome and enjoy the freedom of getting to go out to eat with my friends and family. In my experience, getting healthy and maintaining that level of health is an active process that requires consistency, which is why I’m a big fan of the 80-20 rule. It allowed me to be very consistent and disciplined and it gave me plenty of freedom which is really important to me.

So for those two years I really had the program dialed in, especially leading up to the procedure. I was following my four keys: drinking purified water, consuming prebiotics, consuming probiotics, and exercising very consistently. And it really paid off as you can see from the colonoscopy results. Healthy looking mucosa and no inflammation in the 2018 colonoscopy, and you can easily see a major difference in appearance compared to the 2014 colonoscopy. However, I did have a polyp once again in the 2018 colonoscopy, and this one was pretty big at 6 mm. Polyps can become cancerous, so that’s why it’s important to have colonoscopy screenings when appropriate and have any polyps that may be present removed. This was the second polyp I’ve had so I definitely wanted to keep my eye on further developments and continue getting screened. Overall, the colonoscopy and histology results were very good and confirmed clinical, endoscopic, and histologic remission.

2018 Colonoscopy Results

2018 Histology Results

This brings us to my 2021 colonoscopy. There are two reasons I decided to have this procedure performed so soon after my 2018 colonoscopy. Number one, I wanted to get screened for polyps since I’ve already had two in the past. And reason number two, I wanted to update everyone on my level of health and continue documenting the process. I felt very good going into the procedure, no symptoms, normal BMs, et cetera. Now the results of this colonoscopy are particularly interesting because I was not following my protocol the way I should have been during the year leading up to this procedure. I really just did not do a good job of making it a priority to eat the stuff I know I needed to eat and exercise as much as I know I needed to exercise. Life gets busy and hectic for everyone and when that happens for me the first thing that usually takes a hit is my discipline with diet and exercise. So that is definitely something I’m working on. Anyway, I started significantly relaxing the 80-20 rule towards the end of 2019 and the beginning of 2020. This eventually evolved into more of a “eat-generally-healthy most of the time and drink clean water” rule. I was going out to eat several times per week, I was not consuming adequate amounts of prebiotics or probiotics on a daily basis, and I was not consistently exercising. So in reality, I wasn’t following my own gut microbiome optimizing protocol, and I was using different stressors in my life as an excuse to justify my lack of discipline to myself. Can anyone else relate?

While the majority of my diet was generally healthy and did include eubiotic elements, it wasn’t geared towards gut microbiome optimization overall. For instance, I followed principle number one and drank clean water every day. And my diet did include daily prebiotics, just not in an optimal quantity or variety. As for principle number three, my diet was pretty much devoid of probiotics except for a few sporadic weeks here and there. And for principle number four, exercise was very inconsistent, I sometimes took weeks or months off at a time. So, for the last year I really only followed 1 and a ½ of my four gut microbiome optimization principles, which is not following my gut microbiome optimizing protocol. Following 1 and a ½ of my own principles is better than nothing, but I was definitely doing less than the bare minimum, which is obviously not the way to get optimal results. Anyway, despite my lack of discipline, I still felt great and had no symptoms. I was having a standard 1-3 solid bowel movements per day, no blood, no diarrhea, and no urgency or mucus.

Okay, before we dive into the 2021 colonoscopy results, I want to give you a big picture view by showing a side by side comparison of all three colonoscopies. So here are the colonoscopies from 2014, 2018, and 2021.

So again you can see that 2014 shows significant inflammation in the colon and a large polyp. Then after four years of nutritional experimentation, with the last two of those years following my gut microbiome optimizing protocol, which includes consistent exercise, we have the 2018 colonoscopy showing a healthy colon with no inflammation (confirmed by histology) but still with another large polyp. Then finally, here is the 2021 colonoscopy after a year of eating generally healthy most of the time, but not actually following the gut microbiome optimizing protocol the way that I should have or the way that I did in the past. And as you can see, it looks pretty much the same as the 2018 colonoscopy. However, there were two important differences. Number 1, there were no polyps which, I was very excited about, that’s a good sign and something I was hoping for. Number 2, they did find small areas in the cecum and in the ascending colon that had very mild inflammation, and this was confirmed with histology.

2021 Colonoscopy Results

Besides the lack of polyps in the 2021 colonoscopy, I would not have noticed that there was any difference between my 2018 and 2021 colonoscopies if my gastroenterologist had not told me. Which overall is something I’m really pleased with, I definitely think it’s a net positive, seeing as I was able to maintain clinical remission after doing less than the bare minimum for my gut microbiome the year leading up to the procedure. And there were no polyps, and my colonoscopy looks nearly identical to my 2018 colonoscopy when I was at the peak of my protocol. I clearly have some work to do because my goal is to maintain clinical, endoscopic, and histologic remission, not just clinical remission.

Maintaining endoscopic and histologic remission would have been way better, however, I think my 2021 colonoscopy actually shows two really important points that I’ve tried to communicate for a long time. Gut health, and health in general, is a dynamic, active process, it’s not static. It changes based on what we eat and how we exercise, and how consistently we eat certain things and how consistently we exercise. The two years leading up to my 2018 colonoscopy I consistently chose to promote the health of my gut microbiome with eubiotic foods and appropriate exercise. I did this for 80% of each week, and gave myself complete dietary freedom 20% of each week. This gave me awesome results and I checked all the boxes for the 2018 colonoscopy- clinical, endoscopic, and histologic remission. The year leading up to my 2021 colonoscopy, I did not consistently choose to promote the health of my gut microbiome with eubiotic foods and exercise the way that I needed to. I was still able to keep my gut microbiome healthy enough to maintain clinical remission, but my lack of discipline and substandard diet in terms of gut microbiome optimization were reflected in the two abnormal areas of my colonoscopy and histology results.

Now while gut health is dynamic and it fluctuates based on nutrition and exercise, in my experience it’s been much easier to maintain good gut health, and thus clinical remission, than it was to initially achieve it. And I think my 2021 colonoscopy really helps to paint this much larger picture. Let me show you. So it was really difficult to get my colon from 2014, at which time I was experiencing severe bleeding, mucus, urgency, diarrhea, and 10 BMs per day to look the way it did in 2018 where I had zero symptoms and was in clinical, endoscopic, and histologic remission. But it’s been really easy to keep my colon looking almost exactly the same as it did in the 2018 colonoscopy. Still with zero symptoms and feeling just as good digestively. And when I say it’s been really easy, I’m referring to the fact that I did less than the bare minimum for my gut microbiome over the year leading up to this colonoscopy.

Now why are these two points important? I think these two points are important because they show possibility. The first point shows that with consistency, it’s possible to significantly improve gut health with eubiotic nutrition and exercise. And the second point shows that in my experience, while it’s hard to achieve that initial improvement, it becomes much easier to maintain. Meaning, it’s possible to live a relatively normal life without being confined to strict, rigid dietary rules while still maintaining clinical remission. To have the freedom to go out and eat your favorite foods with your friends and family. When I was sick, there were many times I just wanted to get through a single day without soiling myself, without being in severe pain, and without passing blood. And I wanted to be able to eat my favorite foods, specifically spicy buffalo wings, without causing all of those things to happen, seemingly immediately and all at the same time. I wanted to not live in fear. I wanted to be normal. I wanted to be able to consume a full range of foods without bleeding, mucus, urgency or diarrhea; to have well-formed and solid bowel movements. This is the level of health I have been living at since the end of 2016. And I think that my colonoscopy progression from 2014 to 2021 shows that it’s possible to get to this level of health and that it gets easier to maintain this level of health.

2014 (left) and summer of 2016 (right)

And just to be clear, this is not an encouragement to do less than the bare minimum. This is meant to be an encouragement by highlighting the freedom and improved quality of life that consistent eubiotic nutrition and exercise can potentially bring. Consistency can produce a more resilient gut microbiome that does not require the same amount of upkeep or effort that it initially took to maintain a high level of eubiosis. So consistency and discipline are very important. And best practice is not doing what I just did and essentially taking a year off. I personally think it’s fine to take periods of time off within reason, enjoy times of rest, to recharge, and reset. But, best practice is to continually work towards optimization through eubiotic nutrition and exercise. Even though it’s gotten easier to maintain a high level of eubiosis in my experience, the gut microbiome still very much has a dynamic nature and will trend towards dysbiosis or eubiosis depending on our diet and exercise. That’s why I think the 80-20 rule is so awesome. It strikes such a great balance of discipline and freedom. It allows the consistent cultivation of a eubiotic gut microbiome 80% of the time and complete dietary freedom 20% of the time. Getting to go out and eat with friends and family. The 80-20 rule is what I follow and how I apply my gut microbiome optimizing principles unless I’m traveling, visiting friends and family, or otherwise taking time off. Kind of like the year that I should not have taken off.

So anyway, that’s my colonoscopy update for 2021. I still feel great with no symptoms. I’m excited to recalibrate and improve in the areas I have to improve, and continue chronicling, researching, and breaking the limits of what’s typically thought to be possible after an IBD diagnosis.

2020 - Kara, Goose, and I (right to left)

Sources

1. Brown K, DeCoffe D, Molcan E, Gibson DL. Diet-Induced Dysbiosis of the Intestinal Microbiota and the Effects on Immunity and Disease [published correction appears in Nutrients. 2012 Oct;4(11)1552-3]. Nutrients. 2012;4(8):1095-1119. doi:10.3390/nu4081095 Link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3448089/