Probiotics and inflammatory bowel disease (IBD) - Crohn's disease and ulcerative colitis

Our gut bacteria is currently a hot topic among researchers and doctors alike. We are only just starting to understand the relationship between having a balanced microbiome (our collective gut bacteria) and our health. New studies and discoveries are happening all the time and as a digestive condition inflammatory bowel disease (IBD) is frequently talked about in relation to our microbiome.

As a result of all this dozens of probiotic supplements and foods - which when ingested aim to populate your gut with friendly bacteria that you might be lacking in - have come onto the market and many of them are targeting people with IBD.

In this section we examine what probiotics are available and present the current evidence available in relation to IBD and the use of probiotics.

What are probiotics?

Probiotics are supplements or foods containing ‘probiotic’ bacteria which is naturally found in our guts. It is believed that many people (not just those with IBD) have unbalanced gut bacteria - which may be due to a number of reasons. Some of these reasons include:

  • Overuse of antibiotics and other medication
  • Stress
  • Diet
  • Illness and chronic disease

When taken - usually as a drink, capsule or a food - probiotics are meant to repopulate your gut with some of the friendly bacteria that we might be missing. You can learn more our gut microbiome in this article.

Most people buy their probiotic products or foods, but some people make their own - usually done through a fermenting process. You can learn more about probiotic foods in this article.

When buying probiotic products it’s important to understand that not all probiotics are the same. They do not all contain the same strains of bacteria, they have all been manufactured differently and they all deliver the bacteria to the gut in different ways.

It’s not known exactly how many different strains of bacteria live in our guts - but it’s a lot (we are talking trillions!). Manufactured probiotic supplements and food tend to focus their products on just one or a few strains they believe will be the most beneficial for us.

When making a probiotic the manufacturer has to grow the strains of bacteria they want in their product (or buy them from another manufacturer that does this). This can be a very complicated process. Once grown the bacteria needs to be prepared for the probiotic. In general the bacteria in capsule probiotics is freeze-dried, leaving a powder which can be encapsulated. As bacteria are delicate and sensitive to extreme conditions special steps have to be taken during this process to ensure the bacteria isn’t damaged. Steps also have to be taken to ensure the bacteria will survive once encapsulated and also survive the harsh environment of our digestive system to make it into the small intestine. Probiotic companies often do this by mixing the bacteria with digestive enzymes and soluble fibre.

For liquid probiotics the bacteria, once cultivated, is added to the liquid (usually water or dairy) rather than being encapsulated.

Do probiotics help ulcerative colitis and Crohn's disease?

Researchers are starting to think that imbalances in our gut microbiome are linked to many diseases, ailments and even our mental health.

There is increasing evidence that suggests intestinal microbiota plays a role in initiating, maintaining and determining the characteristics and development of IBD1, 2. And, some people with IBD do report that taking probiotics can help with easing some of their symptoms.

However, studies into the effectiveness of probiotics on people with IBD are limited. There have been a few studies into specific strains of bacteria and their effect on IBD and even fewer studies specifically testing probiotic products on IBD.

Some of these studies include:

Probiotic product specific

VSL#3 and pouchitis. The study concluded that ‘high doses of the probiotic VSL#3 are effective in the treatment of mild pouchitis’3.

VSL#3 and ulcerative colitis. The study ‘demonstrated that VSL#3 is effective in achieving clinical responses and remissions in patients with mild-to moderately active UC’4.

Some studies have also been carried out into Crohn's disease and microscopic colitis.

Symprove and ulcerative colitis. The study found that 76% of those with ulcerative colitis taking part in the study had significant reductions in faecal levels of calprotectin5.

Bacteria strain specific

Saccharomyces boulardii and Crohn’s disease. Results suggested that ‘Saccharomyces boulardii may represent a useful tool in the maintenance treatment of Crohn’s disease’6.

Saccharomyces boulardii and ulcerative colitis. The study’s ‘preliminary results suggest that S. boulardii can be effective in the treatment of ulcerative colitis’7.

OpticBac Probiotics have a product which just includes Saccharomyces boulardii.

Will probiotics cure my IBD?

No. Unfortunately there is currently no cure for IBD.

However, some people have found that some probiotics assist in alleviating some symptoms of their IBD. If you choose to take a probiotic it is recommended you do so alongside any other treatment you are undergoing and that you discuss taking it with your doctor before starting.

People who report success with probiotics have found a reduction in symptoms such as bloating, diarrhoea, fatigue, skin conditions (such as eczema) and constipation. Probiotics are increasingly being recognised to help people who have irritable bowel syndrome. Many people with IBD suffer from IBS too.

The success rate varies from person to person and a probiotic that may produce results for one person may not do the same for another.

How will I feel taking probiotics?

Again, this really varies from person to person. Some people who take probiotics - whether they have IBD or not - report feeling bloated and gassy or have a short bout of diarrhoea at the beginning. This may be a reaction to the changes in bacteria in your gut. To help prevent this some probiotic companies recommend you start by taking a small dosage and build up to taking the full dose to allow your body to adjust. If you are concerned, or these symptoms persist, you should stop taking the probiotic and speak to your doctor.

Which probiotic should I take?

Unfortunately there isn't one probiotic that works for all. It is very individual as to whether probiotics will make a difference to you, although there is increasing research showing that people with IBD do have an imbalance of gut bacteria.

First you need to decide if you want to try to make your own probiotic foods or if you would prefer to buy a commercially made probiotic. Making your own probiotic foods can be cheaper than buying probiotics, however the levels and type of bacteria in homemade foods varies greatly and it isn't possible to test them.

There are dozens of probiotics available to buy. They are all of varying quality and some are brought from a common distributor and rebranded by the company selling them. Some brands of probiotic have clinical research available into their finished products in relation to IBD.

Probiotics can be expensive so it’s worth spending some time doing research into them - the claims they make and the clinical research behind their product - before buying them. You may also find the experiences of other people with Crohn's disease and ulcerative colitis who use probiotics useful in making your choice.

The success you have with probiotics will be very individual and if you find that one product doesn't work for you it doesn't mean that none of them will. Unfortunately you may have to go through a process of trial and error to see if they are of benefit to you.

What are the different types of manufactured probiotics?

Manufactured probiotics available generally fall into two types:

  • Drinks
  • Capsules
  • Sachets

We have taken an in depth look at some of the brands available in the articles below. We will also be adding more brands in the coming months...

How do I tell what’s in a probiotic?

Probiotics must list on their labels what’s in them, including the strains and any other ingredients added.

A probiotic strain will be listed as a long name followed by a series of letters and sometimes numbers too.

The first part of the name (for example Lactobacillus, or sometimes just referred to as L.) is the genus. The second part of the name (for example rhamnosus) is the species and the letters and numbers at the end are the strain designation.

If you know what the name of each strain in the probiotic is you can link it to any research that’s been done into the strain.

Some companies produce a Trademarked name for strains of bacteria in their products. This can be for marketing purposes and isn’t an indication of one strain being better than another. If a product contains a Trademarked strain the packaging must still list the scientific name for the strain.

How are probiotic products regulated?

In the UK most probiotics are governed under the same laws as foods, not medicines, and governing bodies include the European Food Safety Authority (EFSA),  the Food Safety Authority (FSA) and the Advisory Committee on Borderline Substances.

These bodies issue guidelines around what probiotic companies can say in relation to their product and health claims they can make. Even if a probiotic has medical evidence to support its use for a certain condition they cannot publicise this unless they go through strict medical testing - a very expensive and lengthy process. 

This is why you will often find that probiotic companies do not mention specific health conditions on their website and marketing material. Guidelines have also been issued to say that the term probiotic may no longer be used in the promotion of supplements by the companies. The Advertising Standards Authority also has oversight regarding claims made and any complaints arising. In general the industry is self-regulated so some companies choose to ‘bend’ the rules around making health claims in relation to their product.

Can I get the same bacteria through the food I eat?

There are many foods that are considered to be probiotic foods and some people even ferment their own foods to culture these bacteria.

Common food sources of probiotic bacteria include:

  • Yogurt
  • Kefir
  • Kimchi
  • Pickles
  • Kombucha
  • Sauerkraut
  • Sourdough bread
  • Miso

Learn more about getting probiotic bacteria from food in these articles....


What are prebiotics?

Prebiotics are naturally occurring foods in our diet which can’t be broken down by the body. But the probiotic bacteria can break them down. Prebiotics act as food for the probiotic bacteria to feed on and grow. Prebiotic foods include:

  • Raw Jerusalem artichokes
  • Raw Garlic
  • skin of apples
  • Bananas
  • Raw Chicory
  • Onions
  • Cabbage
  • Beans

There are also prebiotic supplements available to buy.

Some people find that they don’t tolerate prebiotic foods very well - if you find you are one of these people then you may want to consider a prebiotic supplement (but start small and work your way up to a full dose).

References

  1. Sartor RB. Microbial influences in inflammatory bowel diseases. Gastroenterology 2008;134:577–594. | Article | PubMed | ISI | CAS
  2. Sartor RB. Genetics and environmental interactions shape the intestinal microbiome to promote inflammatory bowel disease versus mucosal homeostasis. Gastroenterology 2010;139:1816–1819. | Article | PubMed | ISI |
  3. Gionchetti P, Rizzello F, Morselli C, Poggioli G, Tambasco R, Calabrese C, Brigidi P, Vitali B, Straforini G, Campieri M. High-dose probiotics for the treatment of active pouchitis. Dis Colon Rectum. 2007 Dec;50(12):2075-82; discussion 2082-4. Epub 2007 Oct 13. PMID: 17934776
  4. Lee JH, Moon G, Kwon HJ, Jung WJ, Seo PJ, Baec TY, Lee JH, Kim HS. Effect of a probiotic preparation (VSL#3) in patients with mild to moderate ulcerative colitis. Korean J Gastroenterol. 2012 Aug;60(2):94-101. PMID: 22926120
  5. Assessment of a Multi Strain Probiotic (Symprove) in IBD. Guy Sisson, Bu Hayee, Ingvar Bjarnason. Gastroenterology, April 2015 Volume 148, Issue 4, Supplement 1, Page S-531
  6. Guslandi, M. et al. (2000) Saccharomyces boulardii in Maintenance Treatment of Crohn's Disease. Digestive Diseases & Sciences. Vol 45, 7, 1462 - 1464
  7. Guslandi M, Giollo P, Testoni PA. A pilot trial of Saccharomyces boulardii in ulcerative colitis. Eur J Gastroenterol Hepatol. 2003 Jun;15(6):697-8. PMID:12840682

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