Ulcerative Colitis VSL3

Probiotics & Colitis

Probiotics

Ulcerative Colitis Probiotics

Look in any of the Ulcerative Colitis groups/forums and you will find discussions about probiotics; how to take them; which are best; symptoms they've helped or caused etc.

In a nutshell, probiotics are specific strains of bacteria in a digestible form, and for many they can help maintain a balance of 'good' bacteria in the gut. This is important if you're taking antibiotics for example, where indiscriminate killing off of bacteria could cause an imbalance which may lead on to other issues.

Many UCers use probiotics as part of their daily routine; others use them during a flare-up or a course of antibiotics. Ulcerative Colitis - Kefir probiotics

Probiotics come in capsules, powders, liquids and naturally in fermented foods and drinks such as sauerkraut, kefir, yoghurt, kombucha, raw milk etc. As ever with Ulcerative Colitis, there isn't one particular type that works for all. Trial and error has worked for some, who eventually find a probiotic that has some benefits for their situation.

Because UCers can find themselves with sensitive digestive systems and unable to tolerate certain foods, they may also find that probiotics can be a little too extreme (they have caused UC symptoms such as bloating for some). However, trying smaller amounts and then slowly increasing has been the way some Ulcerative Colitis sufferers were able to build up a tolerance to enable them to take probiotics regularly.

Which type of probiotic is best

Ulcerative Colitis - Probiotic

There's no definitive answer to this - trial and error in each situation has meant that UCers are using different makes and types of probiotic with varying degrees of success. Probiotics with the highest bacteria count are more successful - one of the functions of stomach acid is to kill bacteria, so taking enough of the probiotic for a sufficient period of time to overcome this obstacle is important.

The bacteria cultures that appear to aid Colitis sufferers most are Lactobactillus and Bifidobacterium.

The probiotic I see discussed most are the natural ones found in food such as sauerkraut. Many UCers swear by them and use them as part of their daily routine. There are larger numbers of certain bacteria strains (Lactobactillus) in a typical helping of sauerkraut than in manufactured probiotics, although of course the total amount would depend on how much you eat/drink.

The bacteria names can be confusing, but if you simply look for Lactobactillus and Bifidobacterium, and their culture count (CFU), it makes it easier. It's worth remembering that the culture count is often determined at time of manufacture, but very few remain at full strength up to expiration date - looking for a probiotic that shows potency at time of expiration will give a better idea of quality.

VSL#3

The highest culture count found in a manufactured probiotic is 450 Billion - the brand is called VSL#3 (which you may have heard of if you've looked at any IBD groups or forums). It also seems to be the most used and talked about manufactured probiotic by UCers. This is probably because it's aimed specifically at IBD, unlike brands you find in health stores for example.

Some UCers have had success using VSL#3, and of course for others it made no difference. I note that some found the recommended dosage caused symptoms, but they were able to build up a tolerance to it by taking small amounts over a period of time.

I found one VSL#3 study that treated 30 patients with mild to moderate UC who were not responding to conventional therapy. The results showed a combined remission/response rate of 77% with no adverse events.

I feel I should point out that positive results have also been reported by Colitis sufferers using other brands. However, reports would suggest that VSL#3 can possibly play a role in achieving remission. General probiotics might be beneficial for maintenance of a healthy gut - as ever, trial and error!!

Note of caution: it's worth mentioning that some UCers experienced bloating, diarrhea and even a flare-up when taking VSL#3, so it isn't for everyone.

Reality check: we should also remember that at the end of the day, it's simply a probiotic that happens to contain more strains than other brands, it's not a miracle cure. In fact, I see that quite a few UCers found it helped their diarrhea, but they still had other UC symptoms such as urgency. In this case, we can say it might be complimentary to an existing protocol.

When is the best time to take probiotics

You will find much conflicting information about this on the internet! After looking at different information, those that specify probiotics should be taken at a certain time say optimal absorption is achieved on an empty stomach 30 mins before a meal - 'before breakfast' is often mentioned. However it appears that taking probiotics with a meal is also acceptable, but they shouldn't be taken afterwards because stomach acid will inhibit progress.

If you're taking probiotics to help balance antibiotics, the advice appears to be that after taking the antibiotics, you should wait 2 hours to allow them to pass through, before taking probiotics.

Interestingly if you look at the VSL#3 website, they say you can take their probiotics with any food you would ordinarily eat, the time of day you take them is not important and that you can take them with antibiotics but it may reduce their effects.

How long should you take probiotics for

This is a difficult question because it depends on the individual case. Adjustment and balancing of intestinal flora can take anything from a few days up to a few weeks, so approximately a month would appear to be a generally accepted course.

I found the question, 'how long should I take probiotics to maintain a healthy gut balance?' asked a few times on various websites and forums; the general consensus is 'indefinitely'. So basically there is no time limit, but the amount of probiotics should be dropped if you were taking a higher amount during a flare-up for example.

How much should I take

All manufactured probiotics will have suggested dosage amounts. If you're coming out of a flare and wondering what you should do about the dosage; maintenance with probiotics for most Ulcerative Colitis sufferers simply means reducing the dose.

For example:

  • The maintenance dose suggested by VSL#3 is half the treatment dose e.g. they suggest 2 sachets per day when trying to balance the gut bacteria, then 1 sachet per day once balanced.

I guess this method can also be used for other probiotics.

Fermented food

Ulcerative Colitis Fermented food

Fermented food such as sauerkraut is a great source of probiotics (there are various strains of Lactobacillus) but it can be too harsh for some. The protocol of starting small is something I would recommend for those thinking about trying fermented foods for their probiotics.

As little as a teaspoon of sauerkraut is enough to begin with for the first couple of weeks - even this amount can cause reactions for some. For those that have a reaction to small amounts, I've heard that some let the symptoms subside (can take a couple of weeks), and then try another teaspoon with more success. This is similar to juicing raw fruit/veg for some UCers, where the body initially reacts as it adjusts.

The good thing about fermented food is that it's easy and cheap to make. In ref to sauerkraut: a glass jar, water, salt and cabbage is literally all you need; along with the timings. It's easy to find simple sauerkraut recipes and instructions on the internet.

Recently there was an unoffical 4 week study of 3 different groups of 10 people who ate different types of probiotic/prebiotic food and drinks. The prebiotic vegetables (onion, garlic, leek, artichoke etc.) group saw a significant change in a genus of bacteria called Faecalibacterium. These bacteria produce a metabolite called Butyrate (page on the UCer website that covers Butyrate - fibre) which feeds the cells of the colon and helps to keep them healthy. Research suggests that this is helpful for inflammatory bowel diseases.

Fermented drinks

The most well known probiotic drinks are probably kefir and kombucha. Although also well known is a fairly long list of supermarket yoghurt drinks - normally in a small pot, and heavily advertised on TV. However, there's not much evidence to show that they have much effect, and it would appear that the natural choices (kefir, kombucha etc.) are far more beneficial to the gut.

Kefir is a popular choice of drink for those interested in replenishing the gut with beneficial bacteria. In a recent small, unoffical 4 week study of 3 different groups of 10 people (mentioned above), kefir showed the most beneficial change out of the small supermarket probiotic yoghurt drinks and prebiotic vegetables. Volunteers saw a rise in a whole family of bacteria called Lactobacillales which are thought to be good for general gut health

Studies

There is a growing number of research into the benefits of probiotics on Ulcerative Colitis, and those that I have found are cautiously optimistic, with some promising results.

Some controlled studies support the idea that probiotics may be as effective as mesalamine in maintaining remission in short-term trials, which is encouraging to know.

American Gut Project

It's worth noting that very recently I stumbled across a large, scientific experiment called the American Gut project. Funded by donations and using leading researchers, their goal is to compare the bacteria in the guts of as many different people as possible across the world. It has already become the largest survey ever done and continues to grow (for a small donation, anyone can take part, send a sample and receive details about their gut).

They've already released some results of their findings, revealing that there appears to be 2 dominant types of bacteria in our guts - Firmicutes and Bacteroidetes:

  • Firmicutes include Clostridium and Lactobacillus species and many producers of the short-chain fatty acid butyrate
  • Bacteroidetes includes Bacteroides and Prevotella, both of which break down polysaccharides (big sugars)

Hopefully through the sheer volume of knowledge they are collecting, information will be revealed that can help sufferers of Colitis, who by the way, are welcome to take part in the survey as well.