Prebiotics for Ulcerative Colitis; Should You Take Them?

Prebiotics play a role as food for useful bacteria in the guts, prebiotics contribute to the overall health of the digestive system. Prebiotics for ulcerative colitis, are they worth consuming?

If you are living with ulcerative colitis (UC), chances are you must have heard of (and may even be using) probiotics — supplements of healthy bacteria that promotes healthy digestive system and general well-being. But you may not have heard of probiotics’ counterpart, prebiotics.

Prebiotics are elements found in food or supplements that support the growth of probiotics in the digestive system. While they may not get as much popularity as the bacteria they support, prebiotics plays a vital role in building and maintaining a diverse and balanced population of gut bacteria — which may be especially important in people with ulcerative colitis.

Prebiotics are mainly varieties of dietary fiber, which the body’s own digestive juices and enzymes can’t efficiently break down — leaving bacteria in the colon to do the job instead.

“Your gut is like a garden,” says William R. DePaolo, PhD, the head of the Center for Microbiome Sciences and Therapeutics at the University of Washington School of Medicine in Seattle. “If you want to spread and grow something, you plant seeds. Those seeds would be the probiotics.”

Prebiotics, in comparison, “act as the fertilizer you put on that garden,” says Dr. DePaolo. They help healthy bacteria grow and thrive and maintain a stable population in your gut.

The Relationship Between Gut Bacteria and UC

Our intestines houses up to 100 trillion microorganisms, which include bacteria, fungi, and other microbes — known collectively as your gut microbiome. Some types of bacteria (such as lactobacilli and bifidobacteria) are considered positive and helpful, while others (like proteobacteria) can have negative health effects if they become too dominant.

While the role of gut bacteria in UC not fully understood, it’s clear that people with UC tend to have a different profile of bacteria in their intestines, and that certain differences and changes in the composition of gut bacteria can help predict the course of the disease.

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In a study published in June 2017 in the journal Inflammatory Bowel Diseases,researchers found that in people with newly diagnosed and untreated UC, the composition of gut bacteria helped predict whether the disease would be mild or more severe in the subsequent three years.

How can Prebiotics Help?

According to DePaolo, people with an IBD like ulcerative colitis are more likely to have an out-of-balance microbiome, a condition known as dysbiosis. This may contribute to disease activity in UC because of the deficiency of compounds produced by healthy bacteria called short-chain fatty acids (SCFAs).

“Short-chain fatty acids are one of the major molecules that regulate inflammation,” says DePaolo, both within the gut and in the body at large. They do this by enhancing the effects of a type of immune system cell — known as a regulatory T cell — that helps regulate other pro-inflammatory T cells.

If you have fewer SCFAs in your body, “you’re going to have less regulation,” says DePaolo, “and that’s going to allow inflammation to be worse.” By helping healthy bacteria grow, prebiotics can help increase SCFAs and reduce inflammation.

While many differences in gut bacteria in people with ulcerative colitis have been found in scientific studies, it’s less clear what effect prebiotics have on these differences, or on disease outcomes.

In a study published in December 2016 in the Scandinavian Journal of Gastroenterology, researchers examined 17 previous studies of different prebiotics in people with UC. They found that six of these studies showed a clinical response from taking prebiotics, while two showed a response in a colonoscopy and four showed indirect effects that might be of some benefit.

review of studies published in February 2016 in the journal Best Practice and Research Clinical Gastroenterology emphasizes the difficulty in drawing conclusions from studies involving probiotics and prebiotics in people with UC. While some results have been promising, the researchers write, most studies have been small, and they often have large differences in their design. And since some have evaluated a combination of probiotics and prebiotics — known as synbiotics — it’s sometimes unclear what effect prebiotics by themselves would have had.

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Sources of Prebiotics

A series of different chemical compounds, all of which are indigestible forms of carbohydrate, are known to have prebiotic effects. These include a category of compounds called oligosaccharides, as well as inulin, a form of dietary fiber. The two compounds can be found in various foods, including:

Legumes These include chickpeas, lentils, kidney beans, navy beans, and soybeans.

Whole grains Good sources include wheat (especially wheat bran), corn, barley, rye, and oats.

Fruit Fruit sources include apples, peaches, nectarines, grapefruit, watermelon, pomegranates, persimmons, dates, and figs. But if fruit seeds or skins irritate your digestive system, remove these parts of the fruit.

Certain vegetables While most vegetables contain some amount of prebiotics, the best include artichokes, onions, leeks, shallots, garlic, asparagus, sweet corn, beets, and cabbage.

Some vegetables, DePaolo says, have the greatest prebiotic content when they’re consumed raw — including onions, garlic, and leeks. But if raw vegetables irritate your digestive tract, you can help preserve their prebiotic effects by gently steaming them or cooking them as lightly as possible.

Nuts and seeds Almost all nuts and seeds are good sources of prebiotics, including cashews, pistachios, almonds, walnuts, sunflower seeds, and pumpkin seeds. Since many people with UC don’t tolerate whole nuts and seeds well, consider trying nut and seed butters to see if these are easier on your digestive system

Many Americans consume about 50 percent less fiber than is recommended, so DePaolo recommends including as many fiber-rich foods in your diet as possible, as long as you tolerate them well. “Getting [prebiotics] from different sources is good, because there are different types of fiber,” he says. “Variation really covers all your bases.”

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If you have trouble tolerating many food sources of prebiotics, it may be worthwhile to try a prebiotic supplement.

An article published in June 2016 in the International Journal of Molecular Sciences reported that in several different studies involving prebiotic supplements for people with IBD — in which the supplements were often derived from chicory root — participants saw not only improved digestive symptoms, but also better gut immune function, reduced inflammation, and a healthier variety of gut bacteria.

Chicory-based supplements may be a good place to start. These products — which include dried chicory, chicory root extract, and inulin (fiber) supplements derived from chicory — tend to contain a mix of both inulin and a type of molecule called oligofructoses, in varying proportions.

Pairing a prebiotic-rich diet or prebiotic supplement with a probiotic supplement may be an even better approach than one or the other, DePaolo says. It may take some time, though, to find a combination of foods and supplements that help relieve your digestive symptoms and make you feel better, so be prepared for some trial and error.

If you choose to explore adding a prebiotic (or probiotic) supplement to your diet, consult your doctor first to discuss any specific recommendations or reasons why you shouldn’t take such a supplement.

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