Two amateur cooks explore the world of cooking for a Crohn's and Colitis diet

Probiotics can lead to a happy gut!

There are many therapies that have been touted for Crohn’s Disease and Ulcerative Colitis, but only a few have proven to be truly effective.  The usual medications and lifestyle adjustments are well-known, but somewhere in the midst of all the traditional therapies are the lesser-known complementary therapies, such as probiotics.  The role of bacterial flora has been postulated as a potential contributor to the cause of IBD — it is now generally accepted that the intestinal bacterial flora contributes significantly to the pathogenesis of IBD[1].   The inflammation caused by Crohn’s Disease can also disrupt the natural balance of microorganisms, which can allow harmful organisms to potentially worsen the inflammation.

For those new to probiotics, here is a quick overview:

The human gastrointestinal tract is home to more than 400 types of live ‘friendly’ bacteria, known as probiotics.  These good bacteria improve the intestinal balance of one’s GI system, protect us from harmful microorganisms, and improve immune system function.  Other benefits of probiotics include improved digestion (due to the production of enzymes that help break down and digest food) and nutrient absorption.

At this point in time, the efficacy of probiotics has not been shown in high quality trials; therapeutic probiotic bacteria that promote a balance of appropriate intestinal flora have shown mixed results[2].  Individuals vary in terms of their collection of gut microbes, but we do not yet know the exact effects of dosing and which strains are most beneficial.[3]  One well-known study showed that certain probiotics (such as Lactobacillus casei or Lactobacillus bulgaricus) contribute to anti-inflammatory processes by reducing the inflammatory response induced by harmful bacteria from Crohn’s Disease affected intestinal tissues[4].

After infancy, different strains of probiotics are supplied to us by some raw foods, lactic acid bacteria-fermented foods and probiotic supplements (in the form of capsules, tablets, liquids, and powders).  The yogurt aisle is the most common place to find foods that contain probiotics, but navigating the probiotic world can be very confusing.  Be sure to purchase your probiotics from a reputable company that ensures the potency and efficacy of their products. You can try contacting these companies for documentation providing viable research studies using the strains in their formulas.  The number of bacteria in a dose is not necessarily the most important aspect of the probiotic; the number of different probiotic strains and the type of strains are probably more important.

Some IBD patients turn to probiotics as part of their treatment. There are a few probiotics that have been shown to have positive effects on individuals with Crohn’s Disease or Ulcerative Colitis.  Regardless, it is important to remember that no treatment plan works the same for every patient.  Just because a certain probiotic tends to work for patient A does not mean that it will also work for patient Bl.  Marnina has experimented with two over-the-counter probiotics—Florastor and VSL#3.  Florastor is made up of a type of yeast (Saccharomyces boulardii lyo) and has been used to maintain normal bowel function and promote intestinal health[5].  VSL#3 is a probiotic that has 450 billion live bacteria per pill or packet.  It is generally used for the “dietary management of patients with Ulcerative Colitis (UC), an ileal pouch (IP), and irritable bowel syndrome (IBS).[6]

Marnina has taken VSL#3 (suggested by her GI) as a supplement to her current Crohn’s management plan. She hasn’t ever been able to say whether or not taking probiotics does in fact help her Crohn’s, but she has found that if she starts taking VSL#3 religiously for 1-2 weeks before a  big holiday (which will pose a risk for overeating), she tends to recover better from the large meals. She doesn’t know if the VSL#3 actually helps her gut or if it is all psychological.  She will also take Florastor or VSL#3 (whichever she has on hand) when she is “on the edge” and feels like her Crohn’s is starting to act up.  Regardless Marnina does not feel like she relies heavily on probiotics for her Crohn’s maintenance.  She will take them if she has them but will not go out of her way to purchase them. They tend to be expensive (especially VSL#3) and if she doesn’t actively need them to maintain her health, then she doesn’t feel the need to make the investment.  That being said, she eats yogurt frequently and it is one of the first foods she reintroduces into her diet when recovering from a minor flare (after graduating from the bananas, white rice, apple sauce and rice cakes diet).

Remember that unlike other prescription medications used to treat IBD, probiotics have NOT been approved by the U.S. Food and Drug Administration (FDA).  In the U.S. medical products must undergo FDA approval before they can be marketed. FDA’s premarketing review involves (1) developing criteria for the evidence of product safety and effectiveness that manufacturers must submit to FDA, and (2) evaluating the data manufacturers submit to see if the product meets the statutory standard for market approval. So far, the FDA has not approved any specific health claims for probiotics.  Studies have found that the benefits of probiotics vary by strain and condition. [7]  This does not mean that you should avoid probiotics at all costs. Speak to your doctor if you are interested in pursuing probiotic supplements.

Suggestions:

1.  Don’t use probiotics in replacement of your normal IBD medicine regimen. Talk to your doctor if you are unhappy about your medications or want to try probiotics.  Probiotics should only supplement your IBD maintenance regimen, not replace it.

2.  If you can tolerate dairy, eat lots of yogurt and cheese as they are rich in probiotics.

3.   Don’t fall for the “added probiotic” yogurt scam. Yes, yogurt contains probiotics, but don’t go out of your way to buy products, such as Activia and DanActive, that claim that they have more probiotics than the normal brand.  In fact, Dannon is being sued for making claims that its products have been “clinically” and “scientifically” proven to regulate digestion and boost immune systems.  The company has been making claims that have not yet been proven. To read more, click here.

If you are interested in learning more about probiotics, visit www.PubMed.gov and search ‘Probiotics.’

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