 I am frequently asked if probiotics can help people who have IBD, which includes ulcerative colitis and Crohn’s disease.
Currently, the main therapies for IBD are medications that can suppress the inflammation of the intestinal lining. Unfortunately, these medications affect our immune system and do have potential adverse effects.
For the last 7-10 years, scientists have been interested in studying what role intestinal bacteria could have in triggering the intestinal inflammation in IBD (1).
If the triggering mechanism were known, then more targeted and potentially safer therapy could be used. By enhancing the intestinal tract with the good bacteria in probiotics, it may be possible to inhibit the inflammatory process.
IBD Clinical & Research Findings
Scientists have compared samples of the intestinal bacteria in healthy individuals and those with ulcerative colitis and Crohn’s disease (2).
Some studies have found a breakdown in the balance between the protective and harmful bacteria. When the harmful bacteria are present in sufficient number, they can stimulate the immune system, which can lead to chronic inflammation (2).
Other studies have identified genetic defects in the intestinal immune response. Some individuals with Crohn’s disease have an immune system that doesn’t recognize friendly bacteria and consequently mount an immune reaction resulting in chronic inflammation (2).
Researchers have also conducted studies in animals looking at the effect of bacteria on stimulating and suppressing the immune response. Based on these studies, a number of clinical investigations have been carried out using probiotics in patients with Crohn’s and ulcerative colitis (3,4).
Reviews of the clinical studies have demonstrated mixed results. A few have shown promise in treating active ulcerative colitis and also maintaining remissions. In another disorder called pouchitis, which occurs after surgery for ulcerative colitis, a mixture of probiotics proved very successful at treating active pouchitis and preventing relapses. Unfortunately, the clinical trials with probiotics in patients with Crohn’s disease have not been so successful (2,3).
It is the general opinion that probiotics have the potential to modify the inflammatory process in IBD. The studies done to date with probiotics have utilized various strain, dosages, and durations of therapy. Hopefully, with continued research, effective combinations of probiotics and dosage will be determined.
Do Intestinal Bacteria Play a Role in IBD?
In the meantime, the answer to the question is yes. Intestinal bacteria play a major role in activating the immune system in susceptible individuals who subsequently develop IBD.
The second question is whether probiotics are helpful for people with IBD. The answer is possibly; probiotics are more likely to be helpful for ulcerative colitis and pouchitis than for Crohn’s disease.
Here are the five top reasons to consider probiotics in individuals with IBD (3,5,6).
- Probiotics adhere to the intestinal lining cells and competitively inhibit the harmful bacteria from taking up residence.
- Probiotics suppress immune mediated inflammation by producing cytokines that inhibit the inflammatory process.
- Probiotics produce antimicrobial products that inhibit the survival of harmful bacteria.
- Probiotics enhance the intestinal lining cells health by tightening the junction between intestinal lining, thereby inhibiting the invasion by the harmful bacteria.
- Probiotics have been shown to inhibit immune cells responses, which would result in further inflammation.
Take Home Message
IBD is likely triggered by strains of bacteria that cause an immune mediated inflammatory response in genetically susceptible individuals. Taking a multi strain, multi species probiotic in high enough concentrations, such as EndoMune, may be beneficial as noted from the above findings.
Eat healthy and live well!
Dr. Larry Hoberman
(1) Mechanisms of action of probiotics: recent advances. Ng, S C / Hart, A L / Kamm, M A / Stagg, A J / Knight, S C : Inflammatory bowel diseases, 15 (2), p.300-310, Feb 2009
(2) Understanding why probiotic therapies can be effective in treating IBD;. Fedorak RN:J Clin Gastroenterol. 2008 Sep; 42 Suppl 3 Pt 1:S111-5. Review.
(3) Mechanisms of probiotic action: Implications for therapeutic applications in inflammatory bowel diseases.;Vanderpool C, Yan F, Polk DB: Inflamm Bowel Dis. 2008 Nov;14(11):1585-96. Review.
(4) Probiotics and their derivatives as treatments for inflammatory bowel disease. Prisciandaro L, Geier M, Butler R, Cummins A, Howarth G: Inflamm Bowel Dis. 2009 Apr 16.
(5) The pathogenic role of intestinal flora in IBD and colon cancer. Rescigno M: Curr Drug Targets. 2008 May; 9(5):395-403. Review
(6) Rationale for probiotic treatment strategies in inflammatory bowel disease. Schultz M, Lindström AL.Expert Rev: Gastroenterol Hepatol. 2008 Jun;2(3):337-55. Review
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