By Dr. Jordan Robertson ND

In the recent years, we have come to recognize some unique characteristics about Ulcerative Colitis that separates this autoimmune condition from others. Like other autoimmune diseases, the broad themes of inflammation, immune system disregulation and Vitamin D deficiency, which helps guide our initial treatments of this disease.

Not all probiotics have positive research for use with UC. The effect we are looking for can only be achieved with specific strains, at a specific dose. – Dr. Jordan Robertson ND.

The unique characteristic about UC is what the immune reaction is directed against. In most autoimmune conditions, the immune system has lost tolerance for a particular tissue which causes inflammation and tissue destruction. In UC, the immune system has lost tolerance to the bacteria inside the gut, not the host (patient). Given this underlying pathology, it’s no wonder we look to probiotics to help us manage this condition, with overwhelming evidence that we can support patients at all stages of UC to improve their outcomes.

Inside the gut of healthy patients, bacteria, healthy mucous (mucin) and the immune system stay in a healthy balance. Food rarely contacts the immune system because of this barrier of support, and bacteria and the immune system communicate with each other in a healthy fashion. In UC, this protective layer doesn’t exist (which may actually be genetic (1)). Without this protective layer, food, bacteria and the immune system start to interact, causing inflammation, tissue destruction and the characteristic lesions in UC (2).

Probiotics have been widely studied for various stages of UC. In general, specific strains and doses have been shown to be effective (3–6), while ‘run of the mill’ probiotics have not (7). Probiotics have been shown to reduce symptoms in as little as 6 weeks, while helping achieve remission in as little as 12 weeks(4). We expect upwards of a 40-60% relapse rate in UC even with medication, and probiotics have been shown to improve these numbers significantly, helping patients stay off more aggressive medications and avoid hospital time. Probiotics have also been well studied post surgery in patients with UC, and to avoid pouchitis – a common complication of standard UC care (8,9).

Curiously, we are also starting to recognize that probiotics may help other symptoms we find in UC beyond diarrhea and blood stools. Patients with UC who take the right probiotic also report an improvement in joint pain (10), and developing literature suggests that probiotics may have a positive impact on depression – a condition often associated with digestive disease (11).

As noted above, most probiotics do not have the correct strain, or dose to achieve these impressive outcomes in UC. A prescription from one of our Naturopathic Doctors can target your symptoms specifically, and help you achieve the results we expect.

  1. Serban DE. Microbiota in Inflammatory Bowel Disease Pathogenesis and Therapy: Is It All About Diet? Nutr Clin Pract Off Publ Am Soc Parenter Enter Nutr. 2015 Dec;30(6):760–79.
  2. Michielan A, D’Incà R. Intestinal Permeability in Inflammatory Bowel Disease: Pathogenesis, Clinical Evaluation, and Therapy of Leaky Gut. Mediators Inflamm. 2015;2015:628157.
  3. Tursi A, Brandimarte G, Papa A, Giglio A, Elisei W, Giorgetti GM, et al. Treatment of relapsing mild-to-moderate ulcerative colitis with the probiotic VSL#3 as adjunctive to a standard pharmaceutical treatment: a double-blind, randomized, placebo-controlled study. Am J Gastroenterol. 2010 Oct;105(10):2218–27.
  4. Sood A, Midha V, Makharia GK, Ahuja V, Singal D, Goswami P, et al. The probiotic preparation, VSL#3 induces remission in patients with mild-to-moderately active ulcerative colitis. Clin Gastroenterol Hepatol Off Clin Pract J Am Gastroenterol Assoc. 2009 Nov;7(11):1202–9, 1209.e1.
  5. Miele E, Pascarella F, Giannetti E, Quaglietta L, Baldassano RN, Staiano A. Effect of a probiotic preparation (VSL#3) on induction and maintenance of remission in children with ulcerative colitis. Am J Gastroenterol. 2009 Feb;104(2):437–43.
  6. Mardini HE, Grigorian AY. Probiotic mix VSL#3 is effective adjunctive therapy for mild to moderately active ulcerative colitis: a meta-analysis. Inflamm Bowel Dis. 2014 Sep;20(9):1562–7.
  7. Mallon P, McKay D, Kirk S, Gardiner K. Probiotics for induction of remission in ulcerative colitis. Cochrane Database Syst Rev. 2007;(4):CD005573.
  8. Gionchetti P, Rizzello F, Morselli C, Poggioli G, Tambasco R, Calabrese C, et al. High-dose probiotics for the treatment of active pouchitis. Dis Colon Rectum. 2007 Dec;50(12):2075–82; discussion 2082–4.
  9. Gionchetti P, Rizzello F, Helwig U, Venturi A, Lammers KM, Brigidi P, et al. Prophylaxis of pouchitis onset with probiotic therapy: a double-blind, placebo-controlled trial. Gastroenterology. 2003 May;124(5):1202–9.
  10. Karimi O, Peña AS, van Bodegraven AA. Probiotics (VSL#3) in arthralgia in patients with ulcerative colitis and Crohn’s disease: a pilot study. Drugs Today Barc Spain 1998. 2005 Jul;41(7):453–9.
  11. Akkasheh G, Kashani-Poor Z, Tajabadi-Ebrahimi M, Jafari P, Akbari H, Taghizadeh M, et al. Clinical and metabolic response to probiotic administration in patients with major depressive disorder: A randomized, double-blind, placebo-controlled trial. Nutr Burbank Los Angel Cty Calif. 2015 Sep 28;