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Probiotics probably aren’t the cure-all that manufacturers make them out to be. In fact, there’s limited research on their effectiveness for treating symptoms of ulcerative colitis and other inflammatory bowel diseases (IBD).

What we do know is that UC is characterized by an imbalance of good and bad bacteria in the large intestine. The right kinds of probiotics show promise for correcting the imbalance while improving the symptoms of UC.

Among the estimated 100 trillion microbes living in your gut, there are some really helpful bacteria. They break down stuff like fiber into nutrients that your body then uses for energy and as a weapon against everything from cardiovascular disease to cancer.

Bottom line

The “pro” in probiotics refers to good bacteria that you can ingest as food or in tablet form, among other methods. If the good bacteria survive the journey through your digestive system into your gut, they will settle in and colonize it, eventually driving out the bad guys.

Multiple studies have concluded that certain strains of bacteria (including lactobacillus, saccharomyces boulardii, and Bifidobacterium) can help prevent a relapse of ulcerative colitis symptoms.

The right combination of strains, such as those found in VSL#3, might even help people go into remission during a flare-up.

More research is needed though, because the word ‘probiotics’ refers to countless species of bacteria. Evaluating each of them and their myriad combinations requires a great deal of testing to figure out how best to deploy them for each unique case of IBD.

Probably not. For most, the worst thing that could happen when taking probiotics is nothing at all.

But in some people with underlying medical problems, probiotics have been linked to dangerous infections. It’s always a good idea to consult your doctor before making any dietary changes.

The species of bacteria that come up again and again in positive studies are lactobacillus and Bifidobacterium.

Interestingly enough, while we normally don’t want to mess with E. coli, a strain called Escherichia coli Nissle 1917 has tested well for keeping UC symptoms at bay.

Another species called Saccharomyces boulardii is known for its treatment of diarrhea, but it has less conclusive results for UC specifically. Many probiotic supplements will provide some combination of these, plus others.

Some popular and recommended brands of probiotics are:

  1. VSL#3, which has been shown to maintain UC remission and even to calm flare-ups, contains eight different strains. Some versions are available only with a prescription.
  2. Align, an over-the-counter probiotic, contains Bifidobacterium 35624, which has been shown to treat inflammation.
  3. Florastor, a popular brand of OTC Saccharomyces boulardii, has not yet proven itself for ulcerative colitis in the laboratory, but it looks promising.
  4. Renew Life Ultimate Flora Probiotic contains both lactobacillus and Bifidobacterium strains in shelf-stable capsules.

Probiotics found in common food items are also a good source of healthy bacteria for your gut.

You never know which foods might trigger a UC flare though, so start out slowly and keep a food diary to record when you decide to introduce new items to your diet.

Some good probiotic-rich foods to try are:

  • Yogurt
  • Other fermented milk products such as kefir or Yakult — a great source of calcium for the lactose intolerant
  • Sauerkraut
  • Kimchi
  • Other fermented foods you can make at home
  • Tempeh and miso (made from fermented soybeans), which are also good sources of protein

A lot of yogurts you’ll find in the grocery store are overheated during production, which kills healthy bacteria. To get the most from a yogurt, look for one that contains the ‘live and active cultures’ seal and includes lactobacillus and/or Bifidobacterium.

Everyone’s UC triggers are different, and some of these recommended probiotic foods might be a no-go for you.

We can’t stress enough that it’s a good idea to visit a doctor and/or a registered dietitian before taking something new to treat ulcerative colitis.

They may have some advice about which probiotic to take and what dosage might be right for you.

Probiotic dosage for ulcerative colitis is not an exact science. The dosages found to be effective in various studies usually range from 2 billion to 25 billion colony-forming units (CFUs). The more bacteria, the merrier.

Check the expiration date and make sure to store them properly, refrigerating them if recommended on the packaging. These are living organisms that require a little TLC, and they die out over time if not used.

As unpleasant as it may sound, you can choose to directly apply probiotics to your colon via an enema.

The advantage is that the good bacteria don’t have to go through the harsh environment of your digestive system to reach the colon. Around 60 percent don’t survive that stomach acid waterslide.

More research is needed on the effectiveness of this treatment for UC, but one 2010 study called it a “well-tolerated treatment alternative.”

A 2011 study found that administering some strains with an enema in combination with oral medication may be beneficial for children with UC.

In the U.S., probiotics are marketed as dietary supplements, so they haven’t gone through the same rigorous FDA testing as drugs.

This means we have no way of knowing for certain if a product has the bacterial strains or the concentration of bacteria that its label claims.

The higher-ups at the FDA are hoping to change this soon, but for now, we have to go by our own experience and hope for the best.

Think of probiotics as the flowers you’re planting in the garden of your gut, and prebiotics as the fertilizer that encourages those flowers to grow.

Prebiotics are soluble fibers, the kind our bodies can’t digest without the support of good gut bacteria to ferment it and break it down into useful short-chain fatty acids like butyrate, acetate, and propionate.

Prebiotics work together with probiotics to encourage the growth of good gut bacteria.

Sources of prebiotics:

  • Jerusalem artichokes
  • leeks
  • onions
  • bananas
  • barley

Unfortunately, these are all also potential triggers for ulcerative colitis for the very same reason. As bacteria break down those foods, it can result in painful gas for anyone with inflammatory bowel disease.

Many of the foods considered to contain prebiotics are ones that a low-FODMAP diet discourages.

Prebiotic supplements may be a good solution to this problem. Studies have shown that supplements derived from chicory root or germinated barley foodstuff lead to fewer UC symptoms in patients.

You might consider taking a supplement that combines probiotics and prebiotics, such as Align’s DualBiotic.

Takeaway

Overall, more conclusive evidence is needed to support probiotics and prebiotics as an effective treatment for ulcerative colitis and other types of IBD.

However, the probiotic strains lactobacillus, Saccharomyces boulardii, and Bifidobacterium, as well as the supplement VSL#3, are thought to be beneficial in the treatment of UC and worth discussing with your doctor.

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