Ulcerative colitis is a type of inflammatory bowel disease. A person might wonder: Can probiotics help manage the symptoms?

The human gut contains between 500 and 2,000 species of bacteria, some of which are helpful, while others are not. The balance of these bacteria, known as the gut microbiota or gut flora, is essential for maintaining gut health and may support health throughout the body.

Probiotics contain live bacteria that may help balance the gut microbiota. They occur in some foods and are also available as supplements.

Evidence is emerging that probiotics may help with a range of diseases, including ulcerative colitis (UC) and other types of inflammatory bowel disease (IBD).

Currently, it is not clear whether foods and supplements that contain probiotics can help manage UC, but some scientists are looking at the possibility of developing probiotics as a drug treatment for the condition.

Here, we explore why probiotics might help manage UC, but why it is essential to speak with a doctor before using them. We also look into sources of probiotics.

How is the microbiome different in someone with UC?

UC is a chronic gastrointestinal disease that involves inflammation in the gut. Symptoms include abdominal pain, bloating, diarrhea, and bleeding from the rectum. It can have a severe impact on a person’s quality of life.

Scientists believe that the following may play a role in the development of UC:

  • the intestinal immune response
  • the barrier function of the intestine’s lining
  • the balance of the gut microbiota, the “good” and “bad” bacteria in the gut

As UC appears to be a mucosal disease, experts believe that targeting the intestinal mucus may help manage symptoms.

The gut contains a diverse and complex community of helpful and harmful bacteria: the gut microbiota. These bacteria aid digestion and help keep the gut healthy.

An imbalance in the populations of these bacteria may contribute to the development of UC, and one theory is that increasing the number of good bacteria may help manage the symptoms.

Scientists also believe that genetic factors may play a role. One view is that a specific genetic feature allows “bad” bacteria to trigger a lasting inflammatory response in the mucus of the gut. In theory, changing the bacteria could make the gut flora less aggressive — less likely to trigger this response — and may also reduce UC symptoms.

For these reasons, researchers have investigated whether treatments involving probiotics might help manage UC. Also, people with the condition sometimes include probiotics in their diets to ease the symptoms.

Probiotics are similar or identical to helpful bacteria in the intestines. In theory, they may improve UC symptoms by helping to balance the gut flora.

According to one expert, probiotics can have the following effects:

  • Acting as a barrier, they line the gut and prevent other bacteria from stimulating the mucosal immune system.
  • Probiotics boost mucus production and change the consistency of mucus. This leads to a thicker mucus layer in the gut, which can offer protection from invasive bacteria.
  • Probiotics cause the mucosal immune system in the intestinal tract to produce protective immunoglobulins and other protective substances.
  • Probiotics change the function of the mucosal immune system so that it is more anti-inflammatory.

Through these mechanisms, probiotics can help prevent some types of bacteria from triggering and maintaining an inflammatory response in the intestines.

However, there is little specific evidence that probiotics can help relieve UC symptoms, and studies have arrived at mixed results. For example, a 2014 review describes the findings as “controversial” and calls for more research to clarify which antibiotics might help and how to use them effectively.

More recently, however, a 2018 review concluded that specific probiotics can help manage symptoms of IBD, and UC is one type of this disease.

Overall, if a person wants to use probiotics to treat UC, it is crucial to speak with a doctor first. They can provide the best guidance about which type to try — some types may help, but others may be ineffective or possibly harmful.

It is also important to use the best form and dosage of probiotic because stomach acid kills most bacteria before it reaches the gut. Over-the-counter supplements and dietary sources of probiotics may not deliver effective dosages.

A doctor can explain whether a suitable type and dosage of probiotic is available and, if so, where to find it.

Probiotics appear to be safe for healthy people, and they may help with UC. However, there is currently not enough evidence to show whether any specific type is safe or effective for this purpose.

Anyone interested in trying probiotics for UC should consult a doctor first.

Immune system reactions

Probiotics may not be safe for people with weakened immune systems, as they may increase the risk of infection.

The immune system may be weakened due to:

  • a health issue such as HIV
  • immunosuppressant drugs
  • chemotherapy
  • some types of cancer

Also, some prescription medications for UC can have this effect. This is one reason why it is important to contact a doctor before trying probiotics for UC management.

Worsening symptoms

Some people have experienced brain fog, gas, and bloating after using specific probiotics, possibly due to small intestinal bacterial overgrowth, according to a small study published in 2018.

Misleading expectations

Producers of probiotics may market them as the answer to UC, but be wary of false claims.

Any benefits of probiotics in their most available forms — in foods or supplements — are likely to be small. Most will not reach the gut, and a person requires a specific type of probiotic to meet specific health needs. It is unlikely that a food or supplement happens to contain the right type.

Anyone using probiotics for UC should have the go-ahead from their doctor and also be using other treatment strategies, involving dietary changes and medications, for example.

Some foods contain probiotics. They may occur naturally or be added by the manufacturer. These products include some types of:

  • fermented milk
  • cheese
  • ice cream
  • buttermilk
  • milk powder
  • yogurts
  • soy-based products, including nutrition bars
  • juices
  • sauerkraut
  • kimchi
  • miso
  • tempeh

Probiotics are also available in a range of over-the-counter supplements. Commonly available types include species of Lactobacillus and Bifidobacterium bacteria. It is important to remember that different types can have different effects.

The Food and Drug Administration (FDA) do not regulate supplements or probiotics. As a result, the producers can vary the ingredients and make claims that are not true. The quality and contents of supplements can vary widely, and marketing claims may not be based on scientific evidence.

Anyone interested in trying probiotics should first consult a doctor. Next, research suppliers thoroughly to be sure that they sell reliable products. Before making a purchase, check that it provides the specific type of probiotic that the doctor recommended.

It is also worth remembering that no over-the-counter product is likely to have the same effect as the specifically targeted and pharmaceutical-grade probiotics used in clinical trials.

Learn about the best sources of probiotics here.

Prebiotics are fermentable fibers that the body does not digest. They may help change the gut microbiota in a way that benefits people with UC.

To be a prebiotic, a substance must:

  • remain unabsorbed as it passes through the small intestine
  • become selectively fermented by bacteria in the intestine
  • be able to make the gut microbiota healthier

Fibers that have these properties are present in:

  • wheat
  • chicory
  • bananas
  • onions, garlic, and leeks
  • asparagus

Food manufacturers also extract prebiotics from chicory roots and add them to other products, such as candies, baked goods, fruit juices, and spreads.

Prebiotics can stimulate the gut to produce healthy bacteria. They may also prevent unhealthy bacteria from multiplying.

However, they may also increase the risk of flatulence, bloating, diarrhea, and abdominal pain, which may be especially problematic for people with UC.

Learn more about the difference between probiotics and prebiotics

Probiotics appear to be safe overall, though there is limited evidence to support or refute this.

Possible adverse effects may include:

  • an increased risk of infection, especially for people with weakened immune systems
  • the transfer of antibiotic-resistant genes
  • a reaction to other ingredients in a product
  • a rash or nausea, according to one 2018 review

Check with a doctor before taking probiotics or adding probiotic-rich food to the diet. Some medications for UC suppress the immune system, and using probiotics may increase the risk of infection.

Meanwhile, it is still unclear how specific probiotics may interact with medications.

Also, some foods that contain probiotics, such as cheese, may not be suitable for people with UC — dairy products and high-fat foods may make the symptoms worse.

Here, learn more about the possible adverse effects of probiotics.

After diagnosing UC, a doctor may recommend one or more of the following types of drugs:

  • biologics, such as infliximab (Remicade)
  • immunomodulators, such as Janus kinase inhibitors
  • aminosalicylates, such as sulfasalazine (Azulfidine)
  • corticosteroids, such as prednisone (Deltasone)

Biologics, immunomodulators, and aminosalicylates are for long-term use and can help prevent symptoms from flaring up. Corticosteroids are usually for short-term use, due to the risk of significant side effects.

Learn more about drugs that treat UC.

The Crohns and Colitis Foundation note that the following may trigger a flare-up:

  • foods that are insoluble or otherwise hard to digest, such as raw vegetables
  • spicy foods
  • high-fat foods
  • lactose, which is present in dairy products
  • sugar substitutes, such as sorbitol or mannitol
  • alcohol
  • caffeinated drinks, such as coffee or cola

Keeping a food and symptom diary can help a person identify their UC triggers. A person may need to alter their diet when symptoms are flaring up.

Find out more about foods to eat and avoid with UC.

Some scientists believe that probiotics may help treat UC, but researchers have yet to identify an effective probiotic-based treatment.

Evidence for using supplements or eating foods that contain probiotics is limited. Also, probiotics may increase the risk of infection and have negative effects on people with UC.

Speak with a doctor before trying probiotic supplements or adding probiotic-rich foods to the diet. As for detailed guidance about which type and dosage of probiotic might help.

Read the article in Spanish.