Can Probiotics Soothe Inflammatory Bowel Disease?

Exploring the Role of Gut Health and the Potential Benefits of Probiotics and Prebiotics for IBD

Inflammatory bowel disease affects millions of people around the globe. IBD refers to Ileal Crohn’s disease and colonic ulcerative colitis, both of which are characterized by one or repeated episodes of sustained inflammation in the gastrointestinal tract.

As with most IBDs, both UC and CD involve genetic inheritance, environmental influences and immune reactions.

Table of Contents

1. Introduction
2. The Healthy Microbiome

• Definition and Composition of the Gut Microbiome
• Role of Beneficial Bacteria in Gut Health

3. The Impact of an Unbalanced Microbiome

• Dysbiosis: Causes and Consequences
• Inflammation and Leaky Gut Syndrome
• World Health Organization’s (WHO) Perspective on Dysbiosis

4. Probiotics and IBD: Current Understanding

• What Are Probiotics?
• Evidence for Probiotics in Ulcerative Colitis
• Probiotics in Pouchitis Management
• Limited Evidence for Probiotics in Crohn’s Disease

5. Diet, Fiber, and Prebiotics in IBD Management

• Dietary Influence on the Microbiome
• Role of Fiber in Supporting Beneficial Gut Bacteria
• Prebiotics and the Mediterranean Diet

6. Challenges and Future Directions

• Limitations of Current Probiotic Research
• Personalized Probiotics: The Next Frontier
• Unanswered Questions and Research Opportunities

7. Conclusion

Today’s treatment for IBD entails the use of immunosuppressive that aims at controlling inflammation. That said, new research into the human microbiome might yield ways for researchers to tackle IBD more effectively. And some initial experiments on cells, animals, and people have explored the ability of what are known as “friendly” bacteria, or probiotics, to help IBD sufferers.

The healthy microbiome: Building a barrier

The human intestinal microbiome is defined as the complex arrangement of trillions of bacteria, viruses, fungi and other species living in the human gut. In an ideal world, the lining of the gut should act as a safety barricade that does not allow the bacteria or toxins to penetrate the body’s bloodstream.

The Sensitive Gut

Harvard Health Publishing’s The Sensitive Gut: A reference document on most prevalent gastrointestinal diseases. LEARN MORE

A favorable balance of organism assists this lining exclude pathogenic organisms while aiding in the existence of nutrients’ absorption. The beneficial bacteria in the microbiome ensure a good condition within the gut providing a suitable space for noxious bacteria to grow.

Recent investigations in cultures of human cells and in mice indicate that a balanced microbiota secretes compounds that support.com nourish the cells of colon mucous membrane so that they become tightly compacted layer which is hard for pathogenic microorganisms to get through.

With the appear­ance of ETE2, engage immune cells in the gut, decreasing inflammation. It cause gut lining to release mucus which forms an extra layer of protection against toxins and pathogenic organisms.

It was also established that one needs a healthy microbiome in animals for purposes of constructing a proper barrier. It has revealed that animals that were bred and or treated in laboratories with no microbiota or with dysfunctional microbiota due to exposure to antibiotics, possess thin intestinal tracts that get easily injured.

An unbalanced microbiome: Inflammation and damage

What is the consequence of having an unhealthy balance of the microbiome population to pathogenic bacteria and beneficial bacteria? The gut lining could become possibly more permeable. That may open a possibility for potentially pathogenic bacteria and its toxic products enter mucosa of the intestinal tract and then into the circulatory system causing inflammation of the gastrointestinal tract mucosa.

The condition where the microbial populations are in an improper ratio is called dysbiosis. And the inflammatory cascade which has been associated with dysbiosis is part of IBD.

Imbalance of these friendly microbes leads to dysbiosis which is dangerous to the body and most dangerous to the GI system. Microbiome comprises billions of symbiotic good and pathogenic bacteria which are mutually interdependent to support digestion, immune system and other facets of human body. When this balance is upset, the lining may become compromised and allow leaked through, a condition that some call leaky gut.

This increased permeability enables parasitic bacteria, and their poisonous by-products to invade the mucosas of the gut and probably the bloodstream. This leads to a rise in the manifestation of gut mucosa inflammation, which disrupts comfort, nutrient assimilation and results in chronic illness.

As per the World Health Organization (WHO), the state of microbiome is crucial to Ones health as any kind of disturbance with the imbalance of microbiome directly affects chronic conditions of the Gastrointestinal system inclusive of IBD (Inflammatory Bowel Disease).

As WHO puts it, “Dysbiosis, or changes in the composition of the microbiota have been associated with many inflammatory diseases, including IBD, which involves a persistent inflammation of the gastrointestinal tract.”

Dysbiosis also promotes a chain reaction in inflammation which affects the immune system and compromises better gut health, therefore proving that the bacterial flora is essential in holding the gut health and disease at bay.

In addition, studies show that imbalances of microbes have effects on other regions of the body and can affect systemic inflammation. The WHO points out that “Although the concept is still rapidly developing, it is undeniable that the gut microbiome is involved in regulating inflammation systematically, and its imbalance leads to chronic diseases.”

This call for dietary an lifestyle changes emphasizes importance of Microbiome balance. One can then take measures which include taking probiotics, prebiotics, as well as fiber, which will enhance the former microbial diversity and thus combat inflammation for better gut and overall health.

Probiotics: More promise than evidence

I investigated whether probiotics recommended as soothing healing agents in IBD bear any truth to them — given that they are live microorganisms in supplement form or consumed from foods like kombucha, kefir, yogurt or sauerkraut. The premise is, if you want to fix and support unfavorable gut microbiome, reduce inflammation and improve the gut barrier you should take beneficial bacteria by consuming probiotics.

But what do the findings show?

To the best of my knowledge, there is no standard probiotic treatment for IBD yet. Randomized small-scale studies have also been done to compare the effect of certain probiotics with standard immunosuppressive treatments for IBD. The studies assessed IBD symptoms, response or remission, or patient’s quality of life. Results were mixed at best:

• Ulcerative colitis: Bifidobacteria and Lactobacilli probiotics have been found to have mild efficacy in dealing with ulcerative colitis in some research by bringing down symptoms, developing remission and enhancing the quality of life. Nevertheless these effects are relatively minor compared with conventional treatments and, in any case, probiotics have not demonstrated sufficient efficacy to gain endorsement in clinical medicine.
• Pouchitis: Sometimes people with IBD will require a colectomy — the removal of the colon or large intestine. This can result to inflammation of the small intestines and what is left of it is shaped like a J, anastamosed to the anus. However, from 25% to 45% of all the patients who undergo J-pouch reconstruction subsequently get inflammation of the pouch referred to as pouchitis. Three research find that when standard pharmacology is administered with a particular probiotic combination known as VSL#3, it does well to calm pouchitis’ symptoms and inflammation. There are eight strains of bacteria in VSL#3. It is used in chronic pouchitis which is the only applicable probiotics in practice for IBD.
• Crohn’s disease: However, probiotics were assessed in Crohn’s disease less intensively than in ulcerative colitis. Nearly all of the small number of trials demonstrated that probiotics have no greater effectiveness than a placebo in alleviating symptoms or achieving remission.

Diet, fiber, and prebiotics: A role in IBD?

It is now understood that diet can change the makeup and activity of our microbiomes. That is always the case, even if the foods you eat are not such ‘probiotic royalty’ as the likes of kombucha, yogurt, kefir or other fermented foods.

There are plenty of gut bacteria that are involved in the fermentation of dietary fiber, and are therefore beneficial. This type of bacteria improves with a high-fiber diet and its desired benefits for the healthy bacteria and anti-inflammatory properties.

Prebiotics are food ingredients that are not digested in the gut but are rather, fermented by the gut bacteria. Unfortunately, we have few — but favorable — studies on prebiotics in human IBD. At the present time, there are no well-studied individual prebiotic food products or supplements that are recommended as standard of care.

However, the Mediterranean diet with fiber containing vegetables, whole grains and legumes may cause small improvements in symptoms and inflammation in IBD. Despite such effects, the latter augments general well-being in patients with, or even without IBD owing to the Mediterranean diet. For this reason the American Gastroenterology Association advises it among people who have be diagnosed with IBD.

Concluding Remarks

That means that probiotics might help as well as even perhaps prebiotics, too. However, we still have limited ways of optimally using the newly-discovered biomarkers in managing IBD. Even though current research points towards the possibility of using probiotics to effectively intervene in IBD some day, it is unlikely that a single type of probiotic can be effective in the context of the many branched microbiome.

Many questions remain: Which subpopulations of the gut bacteria should we target for research? How do we decide on the right probiotics cocktail for us to gain the most benefits out of them? Since each person has a unique gut microbiota make up, is the idea of personalized probiotics the correct approach? What is the perfect dosage and form of probiotics?

The delivery method (capsules, powders, foods), the dosage and period on the treatment are still areas of inadequacy. Until these questions are answered, probiotics and prebiotics are adjunctive approaches to managing IBD while patients are receiving standard immunosuppressive medications.