Should You Be Taking Probiotics for Crohn's Disease?
If you have Crohn’s disease, a form of inflammatory bowel disease (IBD), you may wonder if taking probiotic supplements could help manage your symptoms, or even help you reach or maintain remission.
Studies have shown that people with IBD have less diversity in their gut microbiome. But strong evidence is lacking when it comes to the benefits of taking probiotic supplements for Crohn’s disease.
Here’s how probiotics could potentially help, and what to look out for when deciding if you should take them.
Probiotics are dietary supplements that contain potentially beneficial bacteria and sometimes other microorganisms, such as fungi.
It’s not exactly clear how helpful probiotics may be for Crohn’s disease, according to Berkeley Limketkai, MD, PhD, a gastroenterologist and director of clinical research at the UCLA Center for Inflammatory Bowel Diseases in Los Angeles.
“Unfortunately, probiotics have not been shown to be helpful for Crohn’s disease directly, for either induction of remission or maintenance of remission,” he says, in part due to a lack of robust studies. For that reason, Dr. Limketkai doesn’t typically recommend probiotics for his patients with Crohn’s.
One research review, coauthored by Limketkai, turned up only two small studies that investigated probiotics for the remission of Crohn’s disease. After six months, the treatment showed no difference in inducing remission when compared with taking a placebo (inactive pill).
Probiotics for Crohn’s vs. for Ulcerative Colitis
Compared with Crohn’s disease, there is greater evidence that taking probiotics may be helpful for ulcerative colitis (UC), a form of IBD that mainly affects the large intestine (colon) by causing ulcers to form.
A research review found that in 21 out of 25 studies, probiotics were found to be somewhat effective at inducing or maintaining remission of ulcerative colitis, while the same was true for Crohn’s disease in only 4 out of 11 studies. Notably, the quality of studies vary so probiotics supplementation are not recommended in clinical guidelines.
Evidence of the Benefits of Probiotics for Crohn’s
However, there is research suggesting that certain probiotics may help with a subset of patients with Crohn’s disease. In one small study, people with mildly active Crohn’s were randomly assigned to take only the drug mesalamine (Lialda), or mesalamine along with a probiotic containing Bifidobacterium longum,Lactobacillus acidophilus, and Enterococcus faecalis species of bacteria.
After four weeks, participants who took the probiotic had better results in measures of inflammation and function of the gut mucosal barrier (cells that play a key role in absorbing nutrients).
Even though research hasn’t conclusively linked probiotics with remission in Crohn’s disease, that doesn’t mean they can’t be helpful for people with Crohn’s.
“Probiotics have been shown to be helpful for gut health in general,” says Limketkai, and Crohn’s can cause downstream digestive issues.
“When someone has Crohn’s disease, while inflammation is one factor that drives their symptoms, inflammation itself is an injury process,” he says. “And so it also then gives rise to other kinds of digestive issues” like irritable bowel syndrome (IBS), which probiotics may be able to improve.
The big takeaway, says Limketkai, is that if someone with Crohn’s is dealing with symptoms typical of a gut microbiome imbalance, it probably can’t hurt to try taking probiotics. “The risk profile is low,” he says. “It's generally helpful for the gut microbiome. That’s why it’s [sold] over the counter,” rather than by prescription. While there is a small risk of diarrhea, that’s true for anyone starting probiotics, not just people with Crohn’s, he says.
In an analysis of 43 clinical studies involving over 5,500 people with irritable bowel syndrome, researchers found that one particular species of bacteria, known as Bacillus coagulans, was most likely to improve overall symptoms as well as abdominal pain, bloating, and straining during bowel movements. Benefits were greatest when the probiotic was taken for eight weeks.
Another analysis, involving 82 clinical studies with over 10,000 participants with irritable bowel syndrome, found with moderate certainty that strains of Escherichia bacteria helped reduce symptoms, but only with low or very low certainty that certain other strains could be helpful. On the other hand, there was no overall increase in adverse events (such as worsening of symptoms) linked to taking probiotics.
If you’re considering taking a probiotic supplement, talk to your doctor first about the potential risks and benefits.
While your doctor may give you general guidance about choosing a supplement, there isn’t much evidence to recommend one product over another. “I'd love to be able to tell people, ‘Take X amount of Y strain and that should help your symptoms.’ Unfortunately, we're not there yet,” says Kelly Kennedy, RDN, a former staff nutritionist with Everyday Health.
In some studies, supplements with multiple probiotic strains have been shown to be more helpful in alleviating gastrointestinal (GI) symptoms than single-strain products, according to Limketkai. But it’s important to note that those studies were done in people with ulcerative colitis or irritable bowel syndrome, not Crohn’s disease.
These foods typically contain a variety of beneficial types of bacteria, with the added benefit of nutrients that aren’t found in probiotic supplements. Look for products that are refrigerated, rather than stored in jars or cans at room temperature, as the canning process can make bacteria inactive.
Both Limketkai and Kennedy say that if you’re going to get any benefit from probiotics, whether supplements or foods, you should start seeing improvements within three to four weeks. If you don’t notice any difference after that, or if your symptoms seem to get worse, discontinue using them. You may notice symptoms like gas or bloating when you start taking probiotics, but these issues typically resolve within a few days.
Some probiotic supplements may be beneficial for Crohn’s disease, but there is no strong evidence linking them to Crohn’s remission in most people.
Certain bacterial strains in supplements may be more effective than others at relieving GI symptoms like abdominal pain, bloating, and straining.
Both supplements and certain foods can provide beneficial probiotics, including yogurt, kefir, kombucha, and kimchi.
Talk to your doctor if you’re unsure whether probiotic supplements may be right for you.
