Ulcerative Colitis, Probiotics, and Prebiotics

Medically Reviewed by Sabrina Felson, MD on May 29, 2024
3 min read

Ulcerative colitis (UC) is a long-term disease that causes inflammation and sores called ulcers in the colon. Experts think a genetic mutation can make someone susceptible to triggers (infection, environmental exposure, antibiotics that change the bowel microbiome) that allow bad bacteria to irritate your intestines. This causes a never-ending reaction.

It's treated with medication or surgery, but there’s no cure. Flare-ups can happen even after treatment.

Some people turn to probiotics and prebiotics to help. But do they really work?

Probiotics are live microorganisms that help “good” bacteria grow in your intestine. You can get them from foods like yogurt, kefir, sauerkraut, kimchi, miso, and tempeh. They’re also available as a dietary supplement. It is not common to use probiotics to treat UC. 

How do probiotics help with UC? They act as a barrier. They line your bowels so bad bacteria don't reach the intestinal wall. They also add good bacteria to your gut to balance out the bad. This lowers inflammation and helps calm your body’s reaction.

Not all probiotics are equal when it comes to treating UC. Several studies have shown two specific probiotics to work:

1.E. coli Nissle (Mutaflor) is a strain of E. coli that is “non-pathogenic.” That means it won’t make you sickStudies show that it can bring people with UC into remission for at least a year. Remission means you have few or no symptoms.

2. VSL#3 is a combination of eight probiotics. Some studies show that it has brought people with UC into remission for at least 24 weeks.

Overall, though, studies into how well probiotics work for UC have been small. Talk to your ulcerative colitis doctor before you try a probiotic supplement.

When you take probiotics for UC, there are two key things to know.

  1. You'll probably need to take them for a while. Your stomach acid kills bacteria, whether good or bad. Experts suggest that you take the probiotics for at least 7 to 10 days to get enough good bacteria. Studies have treated people with probiotics for up to 6 to 8 weeks. You need millions and millions -- possibly billions -- of good bacteria to start relieving UC symptoms.

To keep up the benefits, you have to keep taking the probiotics. If you stop, the balance of bacteria in your colon will change and you may get a flare-up. Talk to your doctor about a long-term probiotic plan.

  1. Taking them by mouth may not be best. Although it may not seem pleasant, there may be some advantages to taking probiotics rectally. A smaller dose may be possible because the probiotics skip the stomach acid. This lets more of the good bacteria reach the intestines. But for obvious reasons, most people find it easier to just swallow a pill.

Prebiotics are foods that aid the good bacteria in your colon. They come from the fibrous parts of food that you can’t digest. Prebiotic fibers give energy to the cells that line the walls of your gut so they can build protective layers against bad bacteria.

Prebiotic foods include fruits, vegetables, and whole-grain foods such as:

  • Bananas
  • Onions
  • Garlic
  • Leeks
  • Asparagus
  • Artichokes
  • Soybeans
  • Oats

While prebiotics may help people with UC, they’re not for everyone. They may make symptoms worse for people with other conditions. These include irritable bowel syndrome, small intestinal bacterial overgrowth, and FODMAPs intolerance.

Side effects of probiotics or prebiotics are rare. They're usually safe for most adults. Check with your doctor before you take either one to make sure they’re right for you.

Studies show that probiotics help with symptoms of inflammatory bowel disease. But more research to form a standard treatment goes on.

Research into whether probiotics may help people with Crohn’s disease is less clear. The studies have been small, and we need more research into what types of probiotics might work. Because of this, doctors aren't likely to recommend probiotics to people with Crohn’s disease.

They’re supplements that have a mix of probiotics and prebiotics. Prebiotics might give probiotics a better chance of surviving the journey into your gut.

But a 2021 study found no proof that taking synbiotics could change the course of inflammatory bowel disease, which includes UC and Crohn’s. The researchers said that past studies on these supplements were small and had results that were hard to compare.

Don’t try synbiotics or any other new supplement for UC unless you check with your doctor first.