All kinds of things can lead to an imbalance in our gut microbiomes, from overexposure to antibiotics in childhood to a diet insufficient in fiber, according to Kelly Kennedy, RDN, staff nutritionist with Everyday Health. Probiotic supplements, then, are intended to restore balance to that system. If you live with Crohn’s disease, an inflammatory bowel disease (IBD) with GI symptoms including diarrhea, cramping, and rectal bleeding, it can definitely feel like your system is out of whack. In fact, studies have shown that people with IBD have lower microbial diversity and less anti-inflammatory bacteria compared with people without IBD, according to a review published in January 2020 in The Journal of Allergy and Clinical Immunology. But can probiotics offer any relief for Crohn’s symptoms?
The Benefits of Probiotics for Inflammatory Bowel Diseases
The answer is complicated, according to Berkeley Limketkai, MD, PhD, an associate professor of medicine at UCLA and the director of clinical research at the school’s Center for Inflammatory Bowel Diseases. “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, partially due to a lack of robust studies. A review co-authored by Dr. Limketkai published in July 2020 in The Cochrane Database of Systematic Reviews turned up only two studies that investigated probiotics for the remission of Crohn’s, and after six months, the treatment showed no difference compared with placebo. A previous review, published in the journal Clinical and Experimental Gastroenterology, included 14 studies on Crohn’s and 21 studies on ulcerative colitis; it found that while probiotics were a beneficial addition to conventional treatment for ulcerative colitis, no such benefit was found for patients with Crohn’s compared with a placebo. For that reason, Limketkai doesn’t typically recommend probiotics for his patients with Crohn’s disease. That doesn’t mean probiotics aren’t helpful for Crohn’s — just that enough research hasn’t been done yet to prove or disprove their efficacy. “On the other hand, you know, probiotics have been shown to be helpful for gut health in general,” he says, and Crohn’s can cause downstream digestive woes. “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 begets other kinds of digestive issues,” like irritable bowel symptoms, 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 gut imbalance, it couldn’t hurt to try probiotics. “The risk profile [of probiotics] is low,” he says, adding “it’s generally helpful for the gut microbiome. That’s why it’s over the counter.” There is a small risk of diarrhea, but that’s true for anyone starting probiotics, not just people with Crohn’s, he says. In terms of what to look for in a probiotic supplement, there isn’t enough 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 Kennedy. Supplements with multiple probiotic strains were shown to be more helpful in alleviating 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 and IBS, not Crohn’s. Alternatively, you can try incorporating probiotics into your diet by consuming things like yogurt, kefir, and kombucha, as well as fermented foods like kimchi, miso, and sauerkraut. Both Limketkai and Kennedy say that if you’re going to get any benefit from probiotics, 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, you should discontinue using them.
