It’s important to note that not all probiotic supplements are alike. There are many strains, and one may not have the same effect as another. They can vary widely in their CFUs and overall quality. Researchers aren’t yet sure which probiotics are helpful — and which are not — for ulcerative colitis (UC) or other health conditions. But according to a study published by PLoS One in March 2020, probiotic foods or supplements containing a probiotic called VSL#3 may help people manage UC. “Patients with UC have an imbalance in their gut bacteria,” says David Hudesman, MD, the codirector of the inflammatory bowel disease center at New York University’s Langone Health in New York City. And yet, “we don’t have a great understanding of how to apply that clinically,” he says. In other words, more studies on probiotics and UC need to be done to assess which types of probiotics may help and how. Probiotics may still have a place in your treatment plan as long as you know what they can do for you. But if you have noticeable symptoms such as gas, bloating, and loose bowel movements, probiotics might help you find some relief. Foods that bring probiotics into your diet include:
Yogurt that advertises live, active cultures on the labelKefir, a fermented milk drinkKimchi, a Korean side dish of salted and fermented vegetables
If you’re interested in taking a probiotic supplement, talk to your doctor first. Whether in food or supplement form, probiotics should be used only to complement other treatments for UC. If your doctor has prescribed medication for your UC, don’t stop taking it. “Use probiotics with your usual medical therapy, if needed,” Hudesman says. There’s strong evidence, published in January 2017 in the Journal of Crohn’s and Colitis, for using probiotics, specifically VSL#3, to prevent pouchitis in those who no longer have a colon. Pouchitis occurs when the lining of the pouch becomes inflamed after ulcerative colitis surgery. Hudesman says he routinely recommends VSL#3 for patients who have had more than one bout of pouchitis. VSL#3 contains eight different probiotic strains and is available in three potencies. If you’ve had pouchitis, ask your doctor whether VSL#3 and is worth trying, and which potency might work for you.
The Downside of Probiotics for Ulcerative Colitis
Probiotics could make symptoms worse depending on your gut microbiome, which contains 10 to 100 trillion bacteria. “Certain probiotics for certain people can also lead to more gas, more bloating, and looser stools,” Hudesman says. “We see that a lot.” “We know the intestinal flora is very important to the development of IBD,” says Jessica Philpott, MD, PhD, a gastroenterologist who specializes in IBD at the Cleveland Clinic in Ohio. “But more research is needed to have a better understanding of how to adjust the intestinal flora — either with probiotic supplements, medications, or foods — to treat or even prevent IBD.” Probiotics could even make your UC worse. “If you’re very sick with severe colitis and use probiotics rather than known, effective therapies, you might incur some harm in delaying to treat the colitis,” Dr. Philpott says. Another downside: Probiotics are sold as dietary supplements, which are regulated by the U.S. Food and Drug Administration (FDA) as food, not drugs, even though dietary supplements may contain ingredients that conflict with medicines. The FDA has not approved probiotics to prevent or treat any health condition. “There are numerous probiotic therapies with many different types of bacteria, numbers, and delivery agents,” Philpott says. “One probiotic may provide health benefits in a certain environment, while another probiotic strain may not.” In 2019, the FDA conducted a study to improve methods of determining the purity of probiotic products, but there hasn’t been any follow-up. Perhaps in the near future, when (and if) probiotics are deemed ready for prime-time clinical use, doctors may be able to check your stool and prescribe the right probiotic or diet for you. Until then, don’t take using a probiotic lightly. “When I talk with UC patients about probiotics, nutrition, and diet, I have them see a nutritionist who specializes in IBD as needed,” Hudesman says. Philpott takes a similar approach. “Before taking a probiotic, I recommend talking with your healthcare provider to evaluate the pros and cons and make an informed decision.” You should also talk to your doctor about which type of probiotic you want to take — just in case it triggers any side effects. Additional reporting by Zachary Smith.
