Probiotics and IBD - Mythbuster
The Myth: Probiotics can cure IBD
The Truth: Probiotics may be helpful for some people with Ulcerative Colitis, Pouchitis or with IBS when in remission, but generally haven’t been shown to be helpful in Crohn’s Disease.
What is a probiotic?
The definition of a probiotic is ‘a live microorganism that, when administered in adequate amounts, confers a health benefit on the host’ (1). Probiotics can help support the bacteria that live within us, especially when our bacteria are challenged, for example by antibiotics, poor diet or traveling.
Probiotics are known by their genus, species and strain (for example, Lactobacillus rhamnosus GG). Probiotics can be likened to breeds of dogs; all dogs come from the same species, but breeds vary in size, shape, strength and what they can do. The same way we use different breeds of dogs for different jobs, we use different strains of bacteria for different medical conditions and goals. For example, you wouldn’t use a chihuahua for crowd control, you’d need a German shepherd. Similar with probiotics, we need to make sure we are using the right bacterial strains for the specific condition or IBD.
Probiotics and IBD
Probiotics may be helpful for some people with Ulcerative Colitis, Pouchitis or with IBS which can happen alongside IBD when in remission, but generally haven’t been shown to be helpful in Crohn’s Disease.
In fact, there are two strains of probiotics that have been shown to potentially have a negative impact in Crohn’s Disease – these are Lactobacillus rhamnosus GG (2, 3) and Lactobacillus johnsonii LA1 (4, 5).
There are thousands of probiotics on the market today each claiming to help your gut health (some using frankly unethical ways or doing so but that’s a story for another day!) but there are only a very small number which actually have clinical trials to show they may have some benefit.
Should I take a probiotic for my Crohn’s Disease or Ulcerative Colitis?
The short answer is if you have Crohn’s Disease probably not, but it depends on you - the condition you are living with, where you are in the cycle of disease (remission or flare), and what we want to achieve.
Here is a checklist that might be useful when choosing a probiotic - think SAS – strain, amount, safety:
Strain - Chose a strain that has been shown to be effective in studies for the specific condition you are dealing with.
Amount – If you are not using the exact product that was used in the study, be sure the product you are buying contains at least the level of probiotics that was used in the study. These are shown as CFU (colony forming units - the number of viable bacteria in the product). Most successful probiotic research has used 9 billion or more CFU per dose.
Safety - Probiotics are safe for most people but please talk to your doctor before trying probiotics if you are experiencing a flare, or if you are on immunosuppressant medications like azathioprine or methotrexate, or biologics like vedolizumab.
I have written a longer article with more information on probiotics if you’re interested you can read it here.
References
Jakubczyk D, Leszczyńska K, Górska S. The Effectiveness of Probiotics in the Treatment of Inflammatory Bowel Disease (IBD)-A Critical Review. Nutrients. 2020;12(7):1973. Published 2020 Jul 2. doi:10.3390/nu12071973
Prantera, C., Scribano, M. L., Falasco, G., Andreoli, A. & Luzi, C. 2002. Ineffectiveness of probiotics in preventing recurrence after curative resection for Crohn's disease: a randomised controlled trial with Lactobacillus GG. Gut,51,405-9. PMID 12171964
Schultz, M., Timmer, A., Herfarth, H. H., Sartor, R. B., Vanderhoof, J. A. & Rath, H. C. 2004. Lactobacillus GG in inducing and maintaining remission of Crohn's disease. BMC Gastroenterol,4,5. PMID 15113451
Marteau, P., Lemann, M., Seksik, P., Laharie, D., Colombel, J. F., Bouhnik, Y., Cadiot, G., Soule, J. C., Bourreille, A., Metman, E., Lerebours, E., Carbonnel, F., Dupas, J. L., Veyrac, M., Coffin, B., Moreau, J., Abitbol, V., Blum-Sperisen, S. & Mary, J. Y. 2006. Ineffectiveness of Lactobacillus johnsonii LA1 for prophylaxis of postoperative recurrence in Crohn's disease: a randomised, double blind, placebo controlled GETAID trial. Gut,55,842-7. PMID 16377775
Van Gossum, A., Dewit, O., Louis, E., De Hertogh, G., Baert, F., Fontaine, F., Devos, M., Enslen, M., Paintin, M. & Franchimont, D. 2007. Multicenter randomized-controlled clinical trial of probiotics (Lactobacillus johnsonii, LA1) on early endoscopic recurrence of Crohn's disease after lleo-caecal resection. InflammBowel Dis,13,135-42. PMID 17206696
I have written a free e-book to help you find a way forward for your everyday life with Inflammatory Bowel Disease. Whether you are right at the beginning of your journey with IBD or have been living with your condition for years and feel like you have tried almost everything, there are things you can do everyday, beyond the medication you are taking, to help you take back control and feel better.
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We are all wonderfully unique and what works for one person may not work for another so please seek help and advice before changing your diet to work out the right way forward for you.