Probiotics…Do I need one for IBD?

What is a Probiotic?

Probiotics are tiny living things, or microorganisms, that have intended health benefits when you eat them or put them on your body. Probiotics are not the same as prebiotics, which are nondigestible food components intended to encourage the growth of bacteria. For the sake of today’s post, let’s focus on probiotics coming from food sources.

Let’s start with the good news first:
More high-quality clinical trials are coming! These studies are desperately needed. Until then, here’s an abbreviated summary of what we know when it comes to probiotic supplementation with IBD: 

In their 2023 review of research, The British consensus guidelines suggest that in some patients with mildly active ulcerative colitis, taking specific probiotics alongside prescribed medication (mostly 5-ASAs) may support induction of remission in cases of mild disease. Additionally, probiotics with specific strains may help maintain remission in chronic relapsing pouchitis in people who live with a j-pouch. However, there’s no evidence to suggest that the same is true for Crohn’s disease(1). Before you purchase a probiotic…

Here are 3 Important Considerations Before You Buy:

1: Mechanism Matters: What is the benefit claim of the probiotic in question?

1. Has the probiotic been shown in research to enhance host immunity? For example, is the article you’re reading referencing:

   • Influences on the immune system

   • Production of cell-signaling proteins (cytokines) that influence the immune system

   • Synthesis of antibodies (E.g., IgA)?

2. Is the probiotic performing metabolic functions, such as:

   • A substance that affects metabolism (metabolite)

   • Drug metabolism 

   • Calorie enhancement?

3. Or, has the probiotic been shown to help facilitate gut-brain communication?

   • Stress, anxiety, depression

   • Bacterial effects on brain function

Keeping these mechanisms in mind, this begs the question:
2. How were these conclusions about probiotic mechanisms explored through the research?

• Strain selection- did the scientists reference specific strains (E.g., Bifidobacterium bifidum strain Yakult)?

• Formulation- did the study provide a single probiotic? Or was this a cocktail of 2 or more? 

• Vehicle- was this given to research participants via a powder? Capsules? Fermented foods? How was this probiotic administered?

• Dosing- this would look something like, 109 to 1010 CFU/day for 5–10 days, for example. To date, studies are not consistent with dosing (2,3).

3. Lastly, what quality assurance measurements is this probiotic supplement company taking?
Is an independent organization reviewing the manufacturing process and verifying ingredient safety, label integrity, and shelf-life stability? Look for a label that reads “NSF” to be certain (4)

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In Summary…

There are a number of considerations in regards to how probiotics are being researched ranging from dosages to mechanism of actions to benefit claims, and more consistency in research trials is needed before we can draw hard and fast conclusions from the science for application. Consider using the dollars that you had planned for a probiotic supplement for food sources of probiotics instead, until the research is more conclusive in supporting safety and efficacy of probiotic supplementation for IBD. We aren’t there yet with the science. In the meantime, here are some probiotic foods to add into your rotation:

• Brown rice

• Cabbage

• Cassava

• Kimchi

• Millet

• Olives

• Pickles

• Sorghum

• Soybeans

• Yogurts (5)

Disclaimer: the above list or summary of the literature is not prescriptive, nor should it replace any advice of a trusted medical team. If you struggle to safely tolerate any of the aforementioned foods and feel you would benefit from an IBD-focused Registered Dietitian Nutritionist, please reach out for support, and we can discuss your individualized nutrition needs. 

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References

1. Lomer MCE, Wilson B, Wall CL. British Dietetic Association consensus guidelines on the nutritional assessment and dietary management of patients with inflammatory bowel disease. J Hum Nutr Diet. 2023;36(1):336-377. doi:10.1111/jhn.13054

2. National Sanitation Foundation International (NSF International) (2020). NSF International. Available online at: https://www.nsfsport.com/ (accessed September 22, 2022). 

3. Quigley EMM. Clinical Trials of Probiotics in Patients With Irritable Bowel Syndrome: Some Points to Consider. J Neurogastroenterol Motil. 2022;28(2):204-211. doi:10.5056/jnm22012

4. Quigley, E. (2022, May). Building Optimal Gut Health: Possibility or Pipe Dream? . Digestive Disease Week 2022. San Diego, CA. 

5. Min M, Bunt CR, Mason SL, Hussain MA. Non-dairy probiotic food products: An emerging group of functional foods. Crit Rev Food Sci Nutr. 2019;59(16):2626-2641. doi:10.1080/10408398.2018.1462760