Ulcerative Colitis is an Inflammatory Bowel Disease that mainly affects the large intestine. There are two stages of Ulcerative Colitis, active flare and remission. During an active flare, symptoms such as abdominal pain, cramping, and urgent and painful bowel movements are common. The goal is to achieve and maintain remission, which can be accomplished using a variety of treatments, including the use of probiotics.
Probiotics are live microorganisms that can help to balance the microbiome in your gut. The bacteria contained in probiotics are commonly referred to as “good” bacteria. These bacteria live in the gut and support overall health. Probiotics are found in foods such as yogurt, kefir, sauerkraut, kimchi, miso, tempeh, kombucha, and other fermented foods. Supplements containing various strains of probiotics are also widely available.
Probiotics and Ulcerative Colitis
The balance of "good” and “bad” bacteria within the gut likely plays a role in the development of Ulcerative Colitis. The beneficial bacteria within your gut help with digestion and maintaining colon health. The detrimental bacteria trigger the body’s immune system to send immune cells to the intestine. The constant presence of these immune cells in the intestine leads to chronic inflammation, which is associated with Ulcerative Colitis symptoms. This is where probiotics come in.
Probiotics may help relieve Ulcerative Colitis symptoms by restoring a healthy balance of bacteria within your intestine. When beneficial bacteria are added to the gut and balance is achieved, the immune system no longer needs to send cells to the area and the inflammation resolves along with your Ulcerative Colitis symptoms.
As previously mentioned, Ulcerative Colitis has two stages, and the treatment goal is to achieve and maintain remission. Research shows that probiotics can be used during remission to help prevent future flares. Some studies even suggest that probiotics may be as effective as prescription medications in preventing flares. Probiotics have also been shown to reduce Ulcerative Colitis flare severity when they do occur. Unfortunately, probiotics do not seem to have any effect on flare duration once it starts.
While there are many different strains of bacteria that are considered probiotics, two have specifically been shown to alleviate UC symptoms.
- Escherichia coli Nissle is a nonpathogenic strain of E. coli, which means it will not cause infection. This strain has been shown to help maintain remission for at least one year and is just as effective as mesalazine, one of the most common medications used to treat Ulcerative Colitis
- VSL#3 contains eight probiotic strains and has been shown to maintain remission for at least 24 weeks by balancing the gut bacteria, strengthening the intestinal barrier, and reducing inflammation caused by the immune response to harmful bacteria
How To Include Probiotics
As you previously learned, probiotics are found in various foods, specifically fermented foods, as well as in many supplements. Probiotic supplements come in capsule, tablet, liquid, and gummy form and are available at most pharmacies. Your doctor or dietitian can help you identify the best supplement for you.
If you do begin taking a probiotic supplement, it may not have an immediate effect on your Ulcerative Colitis symptoms. You will need to take a probiotic supplement for at least seven to ten days to begin to build up the good bacteria in your gut. Additionally, to continue to see their benefits, you will need to continue to take the probiotics. Stopping the supplement may even shift the balance of bacteria in a negative way and trigger a flare.
Although the most common way to take probiotics is by mouth, there is another avenue that may be even more effective. Lower-dose probiotics taken rectally may be more effective than oral probiotics. This is because the acid in the stomach kills most bacteria, good or bad, that enters the upper GI tract. Rectal probiotics have a much better chance of reaching the intestines and shifting the balance of your microbiome.
Seeking Professional Help
As with any medication or supplement, it is best to talk to your doctor before starting a probiotic supplement for Ulcerative Colitis. One factor to consider is that the live bacteria found in probiotics may increase the risk of infection in individuals with a compromised immune system. More specifically, individuals taking long-term high-dose steroids or immunosuppressants should specifically speak with their doctor about the pros and cons of supplementing with probiotics.
The Bottom Line
Probiotics can help to balance the bacteria in the gut and reduce inflammation in the intestines. This can help decrease the risk of a flare and improve quality of life in individuals with UC.
Kaitlyn Willwerth is a Registered Dietitian at OnPoint Nutrition. Kaitlyn's work focuses on providing individualized health and lifestyle coaching and, most importantly, support. She is a Certified LEAP Therapist and has also completed the Monash University 'Low FODMAP Diet for IBS' online training course for health professionals.