Probiotics and Prebiotics in IBD

Probiotics and prebiotics are hot topics in the world of gut health. You’ve probably heard of them before and may be wondering if they play a role in inflammatory bowel disease (IBD).  

In this blog, we’ll review the evidence for probiotics and prebiotics in IBD and talk about where you can find them in your diet. But first, let’s review some basics.  

Probiotics are “live microorganisms that are intended to have health benefits when consumed or applied to the body”(1). Probiotics are naturally present in certain fermented foods and can also be found in supplements.  

Prebiotics are “are nondigestible food components that selectively stimulate the growth or activity of desirable microorganisms”(1). Prebiotics are found in certain fibre rich foods but can also be found in supplements.  

When probiotics and prebiotics are packaged together in a product it’s called synbiotics. 

What are the benefits of Probiotics and Prebiotics?

It is thought that probiotics may help support the community of microorganisms in your gut and inhibit the growth of pathogenic bacteria2. Probiotics may also help produce helpful substrates, such as short chain fatty acids, and help maintain a healthy immune system(1,2).  

We don’t know exactly how probiotics work but there is evidence that they are helpful in several situations such as antibiotic-associated diarrhea, irritable bowel syndrome and infant colic(1).

Prebiotics are substrates that feed the helpful microorganisms in our gut and can influence which microorganisms thrive3. When prebiotics are consumed and fermented by our gut microbes, they produce short chain fatty acids (SCFAs). SCFAs have been shown to have beneficial effects on the body such as supporting immune function and intestinal integrity(3).

What’s the evidence for probiotic use in IBD?

There is evidence to support the use of probiotics in those with ulcerative colitis (UC) and pouchitis. However, there is no evidence for probiotic use in Crohn’s Disease and it is not recommended at this time(4).

When it comes to probiotics for UC and pouchitis, it’s important to get the right one. Probiotics are strain specific meaning they have very specific “recipes” of microorganisms that have been studied for a very specific purpose. The European Society of Parenteral and Enteral Nutrition (ESPEN) recommends the VSL#3 probiotic (or Visbiome™ in Canada) for those with UC and pouchitis.

ESPEN’s recommendations for VSL#3 probiotic use include(4):  

• To induce remission and support maintenance in those with UC 
• In pouchitis if antibiotic treatment has failed 
• For primary and secondary prevention of pouchitis in patients with UC who have undergone a colectomy  

Other probiotics including Echerichia coli Nissle 1917  (Mutaflor ®) and Saccharomyces boulardii (Florastor ® & FlorastorMAX ®) have also been shown to be helpful for those with ulcerative colitis(5). The evidence for these probiotics isn’t as strong as the evidence for VSL#3, however, these products may be easier to access.  

Some people with IBD may also benefit from probiotics for Irritable Bowel Syndrome (IBS) if their doctor thinks they also have IBS.  

Visit Probiotic Chart (probioticchart.ca) to learn more about evidence based probiotic supplements and talk to your health care provider if you are interested in trying one.

 What’s the evidence for prebiotic use in IBD?

Similar to studies on probiotics, most of the research on prebiotics has been in those with UC. Certain prebiotics such as inulin and germinated barley have been shown to lower fecal calprotectin, decrease disease activity scores and maintain remission in the those with UC5. Plantago ovata has also been shown to improve symptoms in UC, however side effects of increased gas and constipation have been reported(5).  

Prebiotics in IBD are not as well studied as probiotics but there is a lot of interest in their potential, which means we will likely be hearing more about prebiotics and IBD in the future.

How can I add probiotics and prebiotics to my diet?

Supplements aren’t the only way to get prebiotics and probiotics. There are many foods that you can incorporate into your diet on a regular basis that contain prebiotics and probiotics.  

Probiotics can be found in many fermented foods but, not all fermented foods have probiotics. Choose refrigerated fermented foods (yogurt) rather than shelf stable items (jar of pickles) as refrigerated options are more likely to contain live cultures.  

Good sources of probiotics include yogurt, miso, sauerkraut, kefir, kombucha, tempeh, kimchi and some cheeses(6).  

Prebiotics can be found in fibre containing food, but not all fibre rich foods are prebiotics! Some prebiotics may increase gas and bloating if you aren’t used to eating them. To reduce this, slowly introduce these foods into your diet overtime.  

Good sources of prebiotics include onions, garlic, beets, asparagus, green peas, chickpeas, lentils, soybeans, nectarines, dried fruit, watermelon, barley, oats and cashews(7).

Take-Away Points

• Probiotics and prebiotics can have beneficial impacts on the gut such as supporting the helpful microorganisms in the gut thrive and producing short chain fatty acids.  
• Certain probiotic supplements may be helpful for specific health conditions. At this time, probiotics are recommended for Ulcerative Colitis and pouchitis but not for Crohn’s disease.  
• Probiotics and prebiotics are available in supplement form but can also be found in a variety of food including fermented and fibre rich food.

 

References

1. National Institutes of Health. Probiotics: What you need to know [Internet]. [Updated 2019 Jul, cited 2021 Nov 1]. Available from: https://www.nccih.nih.gov/health/probiotics-what-you-need-to-know 
2. Varney, J. Prebiotics and probiotics: What are they and should I be including them on a low FODMAP diet? [Internet]. [Updated 2016 Jan 3, cited 2021 Nov 1]. Available from: https://www.monashfodmap.com/blog/prebiotics-and-probiotics-what-are-they/  
3. Davani-Davari D, Negahdaripour M, Karimzadeh I, Seifan M, Mohkam M, Masoumi SJ, Berenjian A, Ghasemi Y. Prebiotics: definition, types, sources, mechanisms, and clinical applications. Foods. 2019 Mar;8(3):92. 
4. Bischoff SC, Escher J, Hébuterne X, Kłęk S, Krznaric Z, Schneider S, Shamir R, Stardelova K, Wierdsma N, Wiskin AE, Forbes A. ESPEN practical guideline: Clinical Nutrition in inflammatory bowel disease. Clinical Nutrition. 2020 Mar 1;39(3):632-53. 
5. Corner CA. Nutraceutical supplements for inflammatory bowel disease. Nutrition in Clinical Practice. 2015 Aug;30(4):551-8. 
6. Harvard Health Publishing. How to get more probiotics [Internet]. [Updated 2020 Aug 24, cited 2021 Nov 1]. Available from: https://www.health.harvard.edu/staying-healthy/how-to-get-more-probiotics 
7. Monash University. Prebiotic Diet – FAQs [Internet]. [Cited 2021 Nov 24]. Available from: https://www.monash.edu/medicine/ccs/gastroenterology/prebiotic/faq