Inflammatory Bowel Disease and Probiotics
What Is Inflammatory Bowel Disease
Inflammatory bowel disease (IBD) is a disease that causes chronic inflammation in the digestive tract. The symptoms of IBD include pain, fatigue, diarrhea, weight loss, and loss of appetite.
IBD is a chronic disease. It has periods of remission, followed by flare-ups, during which the symptoms get worse. IBD can be debilitating and sometimes leads to serious complications.
There are 2 main types of IBD: ulcerative colitis and Crohn's disease. Both are characterized by chronic inflammation. The difference is that Crohn’s disease can affect any part of the digestive symptoms (from mouth to anus); while ulcerative colitis is limited to the colon and rectum.
Inflammatory bowel disease falls in group of autoimmune disease. This means that it is marked by an abnormal response of the body’s immune system, which mistakes benign cells and bacteria for harmful substances. It reacts in a way that damages the gastrointestinal tract and leads to chronic inflammation and symptoms of IBD.
How Do Probiotics Work For Inflammatory Bowel Disease?
Probiotics are live organisms (bacteria and yeast) that have beneficial effect on health. They are found in many food sources, such as yogurt, kefir, many cheeses, miso, sauer kraut and other fermented vegetables.
Probiotics are also part of the healthy intestinal flora. Studies, related to inflammatory bowel disease, have discovered that people with IBD often have a disrupted gut flora. This is where the probiotics come into play – the theory is that probiotics may help shift the gut flora from pro-inflammatory to anti-inflammatory.
3 Ways in Which Probiotics Help With IBD:
- Probiotics help to calm down the inflammation in the gut by suppressing pro-inflammatory substances
- Probiotics produce chemicals that enhance and stabilize the gut barrier function
- Probiotics fight pathogenic (disease causing) bacteria by producing antimicrobial substances and preventing pathogens from adhering to the intestinal lining
Various studies have been made that attempted to change the gut flora with the help of probiotics. They show promising results for people with IBD.
Probiotics seem to be most helpful for patients with ulcerative colitis and pouchitis that developed after an ileo-pouch procedure.
Clinical Trials Of Probiotics and IBD Have Shown:
- Lower relapsed rate and longer remission periods
- Reduced severity of the symptoms
- Decreased inflammatory activity in the intestinal lining
- Normalized gut barrier function
Clinical studies haven’t shown such positive results for Crohn’s disease; although the research is still underway.
Currently, few studies have included enough subjects for the researchers to reach conclusive findings. Also, there are many different types of probiotic bacteria and each needs to be tested to see if it may provide health benefits for people with Crohn’s.
Although, clinical studies have not conclusively supported the use of probiotics for Crohn's disease, anecdotal evidence seems to be promising. That is why many health care professionals already routinely recommend patients with Crohn’s disease to try a course of probiotics.
The Following Probiotic Strains Have Been Proven Helpful for IBD:
- L. salivarius UCC118
- Lactobacillus plantarum 299v
- L. reuteri (R2LC)
- L. casei GG
- Saccharomyces boulardii (a type of yeast)
- E.coli Nissle 197
VSL## is a blend of several probiotic strains, including:
- Bifidobacterium breve
- Bifidobacterium longum
- Bifidobacterium infantis
- Lactobacillus acidophilus
- Lactobacillus plantarum
- Lactobacillus paracasei
- Lactobacillus bulgaricus
- Streptococcus thermophilus
How to Take Probiotics For IBD?
There are many probiotic supplements available on the market. If you are taking probiotics for IBD, you will need to take fairly high doses.
VSL#3 manufacturer recommends the following doses of probiotic bacteria per day:
Ulcerative colitis 450 to 900 billion
Pouchitis 900 to 1800 billion
Ulcerative colitis (active and not responding to conventional therapy) 1800 to 3600 billion
Probiotic in such high concentrations need to be taken under medical supervision.
It is hard to find probiotic supplements that come near these numbers; almost all supplements, which are available over the counter deliver below 100 billion bacteria per serving.
You might want to decide to start with lower dose. In this case, you can take a look at our article, which describes different types of probiotic supplements and see if you find any that sounds right for you (take a look at the supplements in the gastrointestinal problems section at Top probiotic supplements).
Whatever you decide, it is a good idea to keep a diary of your symptoms and adjust the dose over a period of time until you find the dose that works best for you.
The best time to take probiotics is during or just after a meal. The reason for this is that probiotic bacteria are often vulnerable to digestion juices (stomach acid and bile). Food offers some protection against the harsh environment in the digestion tract.
What Else Should You Know About Taking Probiotics?
Probiotics are considered as generally safe. There are some groups of people that should not take probitics; especially people with weakened immune system and critically ill patients. Read about precautions, side effects, possible interactions, and correct storage conditions here:
You might also want to read an article that discusses the things you need to consider when looking for probiotic supplement:
You might also be interested in an overview of popular high-quality probiotic supplements:
- Inflammatory Bowel Disease. Mayo Clinic. http://www.mayoclinic.org/diseases-conditions/inflammatory-bowel-disease/basics/causes/con-20034908
- What are Crohn's and Colitis? http://www.ccfa.org/what-are-crohns-and-colitis/
- Inflammatory Bowel Disease Health Center at WebMD. http://www.webmd.com/ibd-crohns-disease/
- Crohn's and Colitis UK. http://www.crohnsandcolitis.org.uk/information-and-support/information-about-ibd/what-is-IBD
- Probiotics & IBD. Today's Dietitian. http://www.todaysdietitian.com/newarchives/040113p34.shtml
- Probiotic Effects on Inflammatory Bowel Disease. Journal of Nutrition. http://jn.nutrition.org/content/137/3/819S.full
- Probiotics in the Management of Irritable Bowel Syndrome and Inflammatory Bowel Disease. Current Opinion in Gastroenterology. 2013. http://www.medscape.com/viewarticle/779778
- Lactobacillus plantarum 299V in the treatment and prevention of spontaneous colitis in interleukin-10-deficient mice. Schultz M, Veltkamp C, Dieleman LA, Grenther WB, Wyrick PB, Tonkonogy SL, Sartor RB. Inflammatory Bowel Diseases. 2002 Mar. http://www.ncbi.nlm.nih.gov/pubmed/11854603
- The effects of Lactobacillus strains and oat fiber on methotrexate-induced enterocolitis in rats. Mao Y, Nobaek S, Kasravi B, Adawi D, Stenram U, Molin G, Jeppsson B. Gastroenterology. 1996 Aug. http://www.ncbi.nlm.nih.gov/pubmed/8690198
- Lactobacillus species prevents colitis in interleukin 10 gene-deficient mice. Madsen KL, Doyle JS, Jewell LD, Tavernini MM, Fedorak RN. Gastroenterology. 1999 May. http://www.ncbi.nlm.nih.gov/pubmed/10220502
- Probiotic impact on microbial flora, inflammation and tumour development in IL-10 knockout mice.
- O'Mahony L, Feeney M, O'Halloran S, Murphy L, Kiely B, Fitzgibbon J, Lee G, O'Sullivan G, Shanahan F, Collins JK. Alimentary Pharmacology & Therapeutics. 2001 Aug. http://www.ncbi.nlm.nih.gov/pubmed/11472326
- Inflammatory bowel disease: lessons from the IL-10 gene-deficient mouse. Madsen KL. Clinical and investigative medicine. 2001 Oct. http://www.ncbi.nlm.nih.gov/pubmed/11603509
- Promotion of IgA immune response in patients with Crohn's disease by oral bacteriotherapy with Lactobacillus GG. Malin M, Suomalainen H, Saxelin M, Isolauri E. Annals of Nutrition and Metabolism. 1996. http://www.ncbi.nlm.nih.gov/pubmed/8862696
- Is lactobacillus GG helpful in children with Crohn's disease? Results of a preliminary, open-label study. Gupta P, Andrew H, Kirschner BS, Guandalini S. Journal of Pediatric Gastroenterology and Nutrition. 2000 Oct. http://www.ncbi.nlm.nih.gov/pubmed/11045848
- Saccharomyces boulardii in maintenance treatment of Crohn's disease. Guslandi M, Mezzi G, Sorghi M, Testoni PA. Digestive Diseases adn Sciences. 2000 Jul. http://www.ncbi.nlm.nih.gov/pubmed/10961730
- Impact on the composition of the faecal flora by a new probiotic preparation: preliminary data on maintenance treatment of patients with ulcerative colitis. Venturi A, Gionchetti P, Rizzello F, Johansson R, Zucconi E, Brigidi P, Matteuzzi D, Campieri M. Alimentary Pharmacology and Therapeutics. 1999 Aug. http://www.ncbi.nlm.nih.gov/pubmed/10468688
- Crohn's disease and Escherichia coli. A new approach in therapy to maintain remission of colonic Crohn's disease? Malchow HA. Journal of Clinical Gastroenterology. 1997 Dec. http://www.ncbi.nlm.nih.gov/pubmed/9451682