The market for prebiotics and probiotic supplements has grown rapidly, largely supported by the emerging evidence of their benefits to digestive health. But for those with IBD, using natural supplements to manage the condition can be a hit or a miss.
Here’s what you need to know about probiotics and prebiotics when it comes to IBD.
Probiotics for IBD
Probiotics are live microorganisms and yeasts that are especially beneficial for the digestive system, and therefore the health of the entire body. The word itself stems from the Latin “pro”, meaning “supporting”, and the ancient Greek word, “bios”, meaning “life”.
Probiotics support the trillions of bacteria within the human body known collectively as the microbiome, and a balanced, thriving microbial environment is essential for healthy gut and immune function. Probiotics are found naturally in fermented foods like kimchi, yogurt, and sauerkraut. They can also be taken as supplements.
As some probiotics have been found to reduce inflammation, restore balance to the microbiome, support the synthesis of nutrients, and perhaps exert a protective influence on the intestinal mucosa, researchers have posited their potential benefit for the management of IBD.
Are Probiotics Safe with IBD?
As is often the case with supplements for medical conditions, it’s complicated. Firstly, there are numerous probiotics with different strains of bacteria, and while one type of probiotic may be beneficial in a particular environment, others may not.
IBD patients with active disease should be aware that some probiotics may exasperate their digestive symptoms, such as stomach upset, bloating, and diarrhea. Although these are considered a normal reaction to new bacteria in the gut, experts suggest shelving probiotics while experiencing a flare-up.
Can Probiotics Help Manage IBD?
In 2021, the American Gastroenterological Association (AGA) conducted a technical review of probiotics studies for the management of gastro-disorders.
They reviewed 12 studies investigating different probiotics for Crohn’s disease but found poor evidence to back their use as a therapy. Of the 11 studies reviewed for ulcerative colitis, only one showed a “potential for benefit”, and it was declared uncertain.
While these results are admittedly underwhelming, this may be due to the inherent difficulty of collecting data on probiotics, as most trials use different strains, doses, treatment durations, and adjunct therapies.
As the matter stands, the World Gastroenterology Organisation (WGO) advises avoiding probiotic use for those with compromised immune function or other serious health conditions unless sufficient efficacy has been proven.
If you have IBD and are interested in taking probiotics, it’s best to consult with your physician regarding the specific strain, dose, and duration for your individual situation.
Prebiotics for IBD
Prebiotics are fermentable carbohydrates that can’t be broken down by the digestive system. Instead, they travel to the colon to essentially feed the probiotic bacteria. If you picture the gut as a garden, the probiotics act as seeds whereas prebiotics act like fertilizer to help those seeds grow and flourish in the gut.
Prebiotics occur naturally in a large range of foods, including:
- Jerusalem Artichokes
- Dandelion Greens
The Health Benefits of Prebiotics
When the intestinal microbiota ferments prebiotics, they produce short-chain fatty acids (SCFA). These are absorbed into the bloodstream, where they interact with proteins and affect the organs, including the gastrointestinal tract.
SCFA has been found to improve gut barrier integrity and function, modulate the immune system, alter the composition of the gut microbiome, and regulate the inflammatory response. They do this by enhancing regulatory T cells, which are immune system cells involved in the regulation of pro-inflammatory T cells.
These effects seem clearly beneficial for IBD patients, who suffer from compromised gut barrier integrity and often show an imbalance of gut bacteria. Still, the data on prebiotics in IBD patients is limited.
A 1991 trial found that the prebiotic psyllium husk could alleviate gastrointestinal symptoms in UC patients already in remission. A later trial in 2007 tested oligofructose-enriched inulin (a common type of prebiotic) on patients with mild to moderate UC. Compared to the placebo group, the inulin group showed a significant decrease in fecal calprotectin, as well as a decrease in dyspeptic symptoms (chronic indigestion).
Currently, researchers beleive that prebiotics may be useful in patients with low disease activity, but recommend against using prebiotics for inducing and actually maintaining remission due to the lack of data.
All in all, researchers have not been able to confirm or deny the benefits of prebiotics and probiotics for IBD. Although some trials have been promising, the results are still too inconsistent to be conclusive. Certainly, neither should be used as a sole therapy.
That said, there seems to be little harm in IBD patients taking a small amount of prebiotics, especially once in remission. On the other hand, probiotics should be used with caution – especially in those with a compromised immune system or patients taking long-term or high-dose corticosteroids.