Louise Chang, MD
A growing number of people with ulcerative colitis are reaching for
probiotics -- products containing so-called "friendly" bacteria that populate
Why? Researchers don't yet know what causes ulcerative colitis and other
inflammatory bowel diseases (IBD). So finding effective treatments has been a
challenge. Several kinds of medications can help reduce inflammation, improve
symptoms, and achieve remission. But many people with IBD also want to use more
natural methods to ease their discomfort.
Two out of five patients with inflammatory bowel disease use probiotics
regularly, recent surveys suggest. Children with IBD are also frequently
given probiotics by their parents.
But do they really work?
"I'm a great believer in probiotics," says Walter J. Coyle, MD, director of
the Gastrointestinal Program at Scripps Clinic Medical Center in La Jolla,
Calif. "I definitely recommend them for irritable bowel syndrome,
regulation, and bloating. But frankly, when it comes to inflammatory bowel
diseases like ulcerative colitis, we have almost no scientific evidence that
they are beneficial."
In theory, at least, the approach makes sense. Ulcerative colitis and other
IBDs may occur when bad bacteria outnumber the beneficial bacteria that
normally reside in the gut. Recent research suggests that a lack of certain
beneficial bacteria may also be a cause of the diseases. If that's true,
introducing more friendly bugs would certainly seem to help.
Researchers have discovered probiotic bacteria can influence the activity of
immune cells and the cells that line the intestines. Specifically, these
friendly bacteria appear to block disease-causing bacteria from sticking to the
lining of the intestines. There's also evidence that the good bugs block
chemical factors involved in inflammation.
"It's clear that the effects of probiotic organisms could be helpful in
treating the pathogenic mechanisms of inflammatory bowel disease," notes
University of Alberta gastroenterologist Richard Neil Fedorak, MD, who recently
published a review of current research findings on probiotics.
Still, researchers acknowledge that they're only just beginning to explore
the complex populations of bacteria -- friendly and unfriendly -- that reside
in the gut. So far, clinical studies designed to test whether probiotics help
either to maintain remissions or to resolve flare-ups have produced murky
For example, a randomized controlled trial with 90 volunteers found
significantly higher remission rates in people with ulcerative colitis who were
given the beneficial bacteria E. coli Nissle. The higher the dose, the longer
their remission -- good evidence that the friendly bacteria were
But other studies that looked at other bacteria haven't shown any benefits
compared to placebos. A 2006 study of 157 ulcerative colitis patients found no
difference between the placebo group and those given one of three different
beneficial bacteria, although the findings did suggest that probiotics may have
prolonged the length of remission.
Even if probiotics help, Fedorak points out, the evidence strongly suggests
they're likely to offer only small benefits, certainly not a cure. For that
reason, probiotics are not a replacement for conventional medication. They can
be used along with prescription drugs, however. And there's certainly no
evidence that they pose any risk at all -- except to your wallet. Since
probiotic-containing products are not covered by health insurance, most
ulcerative colitis patients end up paying out of pocket.
To make sure they're worth the expense, consider starting a food and symptom
diary before you begin using probiotics. Then keep track of how you feel before
and after you start taking them. After several weeks, try going off the
product. If you notice an increase in symptoms, the probiotic may be helping.
Begin using it again to see if you feel better.
Experts can offer little help on which products to choose. Unfortunately,
there's no regulation of probiotics, so it's very hard to know what you're
actually getting when you buy one. "I tell people to use a product that's
refrigerated, which may give you a better chance at getting something with live
culture," says dietitian Tracie Dalessandro, RD, author of What to Eat With
Whatever you choose to try, tell your doctor if you're using probiotics.
It's important to discuss with your doctor any and all complementary remedies
you're taking. "Most of us want to know what works and doesn't work for you,"
says Coyle. "So if you're using something and it's helping, tell your
SOURCES:Fedorak, R. Journal of Clinical Gastroenterology, September 2008; vol
42: pp S111-S115.Fedorak, R. and Dieleman, L. Journal of Clinical Gastroenterology,
July 2008; vol 42: pp S97-S103.Richard Neil Fedorak, MD, professor of medicine, division of
gastroenterology, University of Alberta, Edmonton, Canada.Walter J. Coyle, MD, director, gastrointestinal program, Scripps Clinic
Medical Center, La Jolla, Calif.Tracie Dalessandro, RD, author, What to Eat with IBD: A Comprehensive
Nutrition and Recipe Guide for Crohn's Disease and Ulcerative Colitis.Crohn's & Colitis Foundation of America.
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