What are probiotics? Probiotics are microorganisms that we take into our bodies to support our health. Typically, they’re strains of bacteria that can help improve our digestion, or so-called “good bacteria.” Probiotic products are intended to supply healthy, gut-friendly bacteria to populate the intestinal wall. Probiotics are found in certain foods. They also come in supplements, which are available in a variety of forms, including tablets and capsules. While many people take probiotics to support their general digestive health, they’ve also been used to treat certain intestinal problems such as gastroenteritis and a condition called pouchitis. But can these good bacteria also be used to treat ulcerative colitis (UC)?

Should I take probiotics for UC? UC is an inflammatory disease of the large intestine that causes bloody diarrhea, cramping, and bloating. The disease is relapsing and remitting, which means there are times when the disease is quiet, and other times when it flares up, causing symptoms. Standard medical treatment for UC has two components: treating active flare-ups and preventing flare-ups. With traditional treatment, active flare-ups are often treated with corticosteroids such as prednisone. Flare-ups are prevented with maintenance treatment, which means using certain drugs long term. Let’s look at whether probiotics can help with either of these treatment needs. Can probiotics help stop flare-ups? The answer to this question is likely no. A 2007 review of clinical studies on the use of probiotics for UC flare-ups found that probiotics do not shorten the duration of a flare-up when added to regular treatment. However, the people in the studies taking probiotics reported fewer symptoms during the flare-up, and these symptoms were less severe. In other words, while probiotics did not end the flare-up faster, they seemed to make the symptoms of the flare-up less frequent and less severe. Can probiotics help prevent flare-ups? The use of probiotics for this purpose shows more promise. Several studies have shown that probiotics may be as effective as traditional UC medications, including the gold-standard treatment mesalazine. A 2004 German study followed a group of 327 patients with a history of UC, giving half of them mesalazine and the other half probiotics (Escherichia coli Nissle 1917). After one year of treatment, the average time to remission (time without a flare-up) and the quality of remission was the same for both groups. Similar results have been seen in other studies. And another probiotic, Lactobacillus GG, may also be helpful in sustaining remission in UC.

How do probiotics help treat ulcerative colitis? Probiotics may help in treating UC because they address the actual cause of the condition. UC is thought to be caused by problems with the immune system in the intestines. Your immune system helps your body fight disease, but it can sometimes lash out and target your own body in an effort to protect it from a perceived danger. When this happens, it’s called an autoimmune disease. In the case of UC, an imbalance of bacteria in the large intestine is thought to be the perceived danger that prompts the immune system to respond.

Can probiotics make UC worse? Probiotics may help by providing good bacteria that help restore the bacterial balance in the intestine, eliminating the problem to which the immune system is responding. With the perceived danger gone, the immune system may soften or stop its attack. As we stated previously, probiotics may help increase the time between flare-ups and may make the symptoms of a flare-up less severe. Also, probiotics are likely less expensive than typical UC medications, and they may be safer over long periods. Probiotics may also protect against other bowel problems such as Clostridium difficile colitis and travelers’ diarrhea. There are a lot of benefits, but there are a few cons when using probiotics with UC. The main one is that they’re probably not useful in causing a faster remission during a flare-up of UC. Another con is that certain people should use them cautiously. Probiotics contain living bacteria, so they may increase infection risk in people with compromised immune systems (such as those taking long-term or high-dose corticosteroids). This is because a weakened immune system might not be able to keep the live bacteria in check, and an infection may result. Pros of probiotics for UC May help prevent UC flare-ups

May reduce symptoms during flare-ups

No serious side effects shown to date

Less expensive than other UC medications

Possibly safer for long-term use than other UC medications

May protect against other bowel diseases, such as C. difficile infection Cons of probiotics for UC Don’t stop flare-ups in process

Should be used with caution in people with weakened immune systems

Where can I get probiotics? There are countless types of probiotic products available and many strains of microorganisms that may be used in them. Two of the most common types of bacteria used are Lactobacillus and Bifidobacterium. You can get probiotics from a range of sources. You can find them in foods such as yogurt, kefir (a fermented drink made from cow’s milk), and even sauerkraut. You can also take them as supplements, in forms such as capsules, tablets, liquids, or gummies. Your local pharmacy likely has several options available. If you’re thinking of using probiotics, you should keep in mind that unlike prescription drugs, probiotic supplements are not regulated by the U.S. Food and Drug Administration (FDA). This means the FDA doesn’t check whether supplements are safe or effective before they go on the market. If you would like guidance on finding a high-quality probiotic, talk to your doctor.

Prebiotics Prebiotics are carbohydrates that are the “food” for certain groups of bacteria. Consuming prebiotics can help boost the population of your own gut probiotics for this reason. Some natural sources of prebiotics include: garlic

dandelion greens

onion

asparagas

artichoke

banana

leek

chicory root These foods should be consumed raw for the maximum prebiotic benefit.

Side effects So far, no serious side effects have been linked with prolonged use of probiotics for UC. In a review of studies, the rate of side effects was about the same (26 percent vs. 24 percent) in probiotics users as in those taking mesalazine.

Other medications While taking probiotics may help with your UC, your doctor may also prescribe medications to help induce or maintain remission. These medications fall into four main categories, which include: aminosalicylates

corticosteroids

immunomodulators

biologics