Probiotics & Prebiotics

The human gastrointestinal tract is home to about 100 trillion microorganisms, most of them bacteria and most of them residing in the large intestine. Over a thousand different species have been identified.People with IBD have abnormal populations of bacteria in their gastrointestinal tracts. IBD may start because the populations of the bacteria residing in the small and large intestine have been disrupted. Instead of coexisting with the person’s gut, the altered populations cause inflammation and its symptoms.Probiotics are live bacteria, usually taken orally. They are taken in hopes that IBD can be treated by putting the bacteria residing in the gastrointestinal tract back into a healthful balance that doesn’t cause inflammation.

How do they work?
Probiotics work by favorably altering the balance of bacteria and other microorganism living in the small and large intestine. In people with IBD, normal, healthy populations of bacteria may be overrun by populations of varieties that cause inflammation or normal populations have fallen out of balance, also resulting in inflammation.Probiotics deliver bacteria to the intestines in hopes of seeding healthy bacteria there while inhibiting the growth of the harmful varieties.

Pouchitis is inflammation of the J pouch formed after the large intestine has been removed. Several well-designed studies have shown that probiotics prevent pouchitis and can keep it in remission if it occurs. Some of the important studies of probiotics and pouchitis have used a probiotic formulation called VSL #3, which consists of four strains of lactobacilli, three strains of Bifidobacterium, and one strain of Streptococcus salivarius.

Where can I get probiotics?
Yogurt that contains “live cultures” is a common, readily available food that contains probiotics. Other foods that contains healthy bacteria include kefir, miso, and tempeh. Probiotics are also being added to many foods. Heat-treated yogurt may contain few if any bacteria. Look for the “live and active culture” seal to find a variety that contains live bacteria.

Prebiotic Foods Probiotic Foods
Asparagus, bananas, chicory root, Jerusalem artichokes, garlic, honey, oats, onions Aged cheeses, dark chocolate, kefir, miso soup, pickles, sauerkraut, yogurt

Many varieties of capsules, tablets, and powders are available. Some brand-name products are Accuflora, Align, and Culturelle. They are typically available at health stores and many supermarkets and drug stores.

How are probiotics administered? 

Probiotics often come in pill, capsule or tablet form. There’s no consensus on the right amount or dose of probiotics. One recommendation is to take 50 billion bacteria a day. Many of the probiotic capsules contain 10 billion bacteriaProducts with multiple types of bacteria may be preferable to those with just one type.

Here are few tips on taking and storing your probiotics:

  • Store probiotics in the refrigerator. That may keep the bacteria alive longer.
  • Don’t take probiotics with acidic food or beverages
  • Don’t take probiotics with hot food and beverages
  • Don’t take probiotics with antibiotics. The antibiotics may kill the bacteria that the probiotics are supplying.

When will I feel better?
If probiotics are effective, it usually takes one to two weeks before people notice a significant benefit.

While the concept of probiotics is very appealing, studies of probiotics haven’t produced strong evidence that they work to treat or control Crohn’s disease or ulcerative colitis. The strongest data for probiotics is as a treatment for pouchitis after surgery for ulcerative colitis.

Still, many people with IBD experience some benefit from taking probiotics, and there’s little, if any, evidence that they cause harm.

Side effects
The side effects of probiotics tend to be mild. Gas and some bloating are possible. They usually go away after the intestines adjust.
Taking probiotics while Pregnant
Most probiotics are probably safe to take if you are pregnant. Still, women who are pregnant or planning to become pregnant and who are taking probiotics should discuss them with their care team.