Ulcerative Colitis, Probiotics, and Prebiotics

Ulcerative colitis is a lasting disease that causes inflammation and sores called ulcers in the colon. Experts believe that the cause is a genetic mutation that allows 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 and UC

Probiotics are live microorganisms that help “good” bacteria to grow in your intestine. They’re found in foods such as yogurt, kefir, sauerkraut, kimchi, miso, and tempeh. They’re also available as a dietary supplement.

How do probiotics help with UC? Probiotics act as a barrier. They line your bowels so bad bacteria don't reach the intestinal wall. They also change the makeup of your gut biome, adding good bacteria to balance out the bad. This lowers inflammation and helps calm the reaction.

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

1.Escherichia coli Nissle (Mutaflor) is a strain of E. coli that is nonpathogenic. That means it won’t make you sick. Studies show that it can bring UC patients into remission for at least a year.

2. VSL#3 is a combination of eight different probiotics. Studies show that it has brought UC patients into remission for at least 24 weeks.

How to Take Probiotics

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

  1. You'll likely 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. You need millions and millions -- possibly billions -- to start relieving UC symptoms.

To keep up the benefits, you have to keep taking them. If you stop, the balance of bacteria in your colon will change and a flare-up may occur. 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.

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Prebiotics and UC

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.

How They Compare to Other UC Treatments

The most common prescription medication for UC is mesalamine. This is a nonsteroidal anti-inflammatory drug (NSAID). Several large studies looked at how well E. coli Nissle worked compared to mesalamine. They found that the treatments were equally effective against UC.

No studies have compared VSL#3 to mesalamine head-to-head, but experts think the probiotic’s effects on UC are similar.

Can Probiotics Treat Other GI Issues?

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.

WebMD Medical Reference Reviewed by Melinda Ratini, DO, MS on May 21, 2019

Sources

SOURCES:

National Institute of Diabetes and Digestive and Kidney Diseases: "Ulcerative Colitis."

Academy of Nutrition and Dietetics: “Prebiotics and Probiotics: Creating a Healthier You.”

ClinicalTrials.gov: "Ulcerative Colitis Relapse Prevention by Prebiotics."

Gastroenterology Hepatology: "Probiotics in the Management of Ulcerative Colitis."

Columbia University Irving Medical Center Department of Surgery: “What You Need to Know About Prebiotics.”

Mayo Clinic: "What are probiotics and prebiotics?"

Current Pharmaceutical Design: "Can Probiotics Cure Inflammatory Bowel Diseases?"

Gut: "Probiotics for Crohn's disease: what have we learned?"

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