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 and UC
Probiotics are live microorganisms that may help support a healthy balance of bacteria in your gut. They are found in foods such as yogurt, kefir, sauerkraut, kimchi, miso, and tempeh, and are also available as dietary supplements.
Researchers are studying whether probiotics can help manage UC. They may help strengthen the intestinal barrier, improve the balance of gut bacteria, and reduce inflammation. However, it isn’t clear whether these effects improve UC symptoms or remission.
Two probiotic products have been studied more than others:
- E. coli Nissle (Mutaflor) is a non-disease-causing strain of E. coli. Some studies suggest that it may help maintain remission in people with UC.
- VSL#3 is a combination of several probiotic strains. Some studies of the original formulation suggest that it may help induce or maintain remission.
Overall, researchers have conducted only small studies, and the evidence isn’t strong enough to support probiotics as a routine UC treatment. Current guidelines generally recommend using them only in clinical trials, with pouchitis as the main exception. Talk with your UC doctor before taking a probiotic supplement.
How to Take Probiotics
When you take probiotics for UC, there are two key things to know.
How long you take a probiotic and how much you need depend on the specific product and probiotic strain. Studies of probiotics for UC have used different doses and treatment periods, so researchers haven’t established a standard dose or duration. Ask your doctor whether a probiotic is appropriate for you and follow the product’s instructions.
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.
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 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.
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.
What Are Synbiotics?
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.
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