Probiotics vs. Prebiotics: Which Is Better for Crohn’s?

Let’s start with the basics. There’s a bunch of bacteria in your intestines, both good and bad. When the good bacteria gets low, the bad bacteria can overgrow and contribute to symptoms like gas, bloating, diarrhea, constipation, or other mostly bathroom related difficulties.

That’s where probiotics come in. Probiotics are the good bacteria and are thought to help rebuild those friendly bacteria levels in the gut, and in turn, provide health benefits.

Consuming probiotics in food or supplements helps contribute to a more beneficial gut microbiome and potentially positive health outcomes, since the good bacteria can crowd out the bad, and prevent the bad from proliferating.

When you have a Crohn’s flare, it can affect the balance of good and bad bacteria which might make your symptoms of the disease worse. So striking the right balance of good and bad bacteria in the gut is important.

Increasing your probiotic intake (in supplement form or by eating probiotic-rich foods) can help boost good bacteria and hopefully reduce Crohn’s symptoms.

But should you bother with probiotics? Let’s look at how they may affect your health.

It’s a little hard to look at potential benefits of probiotics because research up to this point is largely inconclusively. Most studies around probiotics for IBD have been very small, so it’s not quite time to kick probiotics to the curb or start buying them en masse.

While more research needs to be done, here are some of the findings.

Since probiotics often help relieve bloating, pain, and diarrhea for people who aren’t living with a condition like Crohn’s, it would be natural to think they may improve these same GI symptoms in people with Crohn’s disease. But that doesn’t always seem to be the case.

One review showed that even though probiotics helped those with ulcerative colitis, another type of IBD, they had no significant effect on Crohn’s.

However, that doesn’t mean they simply don’t work. This could have happened because the probiotics weren’t properly absorbed or the wrong strains were given.

But it’s not all bad news. There’s also some evidence to show that probiotics *might* work for people in the very early stages of Crohn’s. Still more research is needed.

The scientific community is excited about the possibilities of probiotics for IBD because they’re easy to administer, relatively cheap, and could help relieve IBD symptoms.

As more research is done around probiotics for IBD, we may find more concrete evidence to support their benefits. For now, be sure to talk to your doctor before you lean into the probiotics trend.

Prebiotics seem to be a little more promising. Prebiotics, which are a form indigestible carbohydrate naturally found in a variety of fruits, vegetables, and other plant foods, act as fuel to feed the good bacteria in your gut and help them grow.

A small, 3-week study in people with Crohn’s found that 15 grams a day of oligofructose and inulin (prebiotic natural fibers) resulted in a significant reduction in the disease. While small, this study does show promise.

Synbiotics

Synbiotics are combo packs of prebiotics and probiotics. So, you’re taking in the good bacteria and the food to make them grow, all at the same time.

One preliminary study found synbiotics to be an effective treatment for Crohn’s, while another found that they didn’t really make a difference.

Meanwhile, in kids with Crohn’s, one study found that synbiotics were not an effective treatment.

So what does this all mean? Remember, all of these studies are small, and more research needs to be done. But so far, synbiotics have shown some promise for adults with Crohn’s.

Fecal transplants

Yes, some scientists are putting one person’s poop into another person’s body as a type of treatment. It sounds bizarre, but fecal transplants may be an easy way to bypass gastric acids (which can destroy bacteria before they ever get to the intestines) and get healthy bacteria into an unhealthy bowel.

Before you start asking your friends for their poop, know that this procedure is not yet approved by the FDA for treating IBD. But as research continues, it could one day be a viable option.

The study with the best results had people take a probiotic with Bifidobacterium longum and the prebiotic Synergy 1. This doesn’t mean it’s your only option, but it might be worth asking your doctor if there’s a synbiotic mix to try.

While you can take a probiotic supplement, many fermented foods contain probiotics. Naturally fermented kefir, yogurt, sauerkraut, kombucha, kimchi, and miso may contain these helpful bacteria.

Due to processing, many of these items that are packaged and sold at grocery stores may not actually contain high levels of probiotics. When these foods are processed, it can kill the good bacteria. So your typical yogurt cup isn’t necessarily going to be chock full of probiotics.

Instead, go for options with “live cultures” on the label, or ferment them yourself. Homemade yogurt can be a great option!

Natural prebiotics are easier to find in the grocery store. Chicory root, Jerusalem artichokes, garlic, onions, oats, apples, asparagus, and bananas are all good sources of the prebiotic fiber inulin. You can incorporate these into your regular diet to see if they have any beneficial effects.

Unfortunately, there’s some evidence that probiotics could make your Crohn’s worse. Since the digestive tract is already inflamed, adding any kind of bacteria could become a trigger.

A small study found that people with Crohn’s did better with a placebo than with probiotics. Some anecdotal evidence also found that probiotics could cause infection in people with very severe Crohn’s or those who are immunocompromised from Crohn’s medications.

All in all, the likelihood of probiotics hurting or helping you is low. That’s why it’s best to ask your doctor before giving a probiotics a try.

What about prebiotics? Since prebiotic fibers head to the colon undigested, they could contribute to gas, bloating, and pain. And if you’re following a low-FODMAP diet for Crohn’s, it will be very difficult to find natural prebiotics you can eat.

If you’re very familiar with your food triggers and can handle garlic, onions, and the like, then prebiotics should be safe to try. Again, just talk to your doctor first to be sure.

Though it would be lovely to say both prebiotics and probiotics do wonders for relieving Crohn’s, that just isn’t true.

Right now, there’s no conclusive evidence to show that probiotics help Crohn’s and there’s a very small chance they’ll make things worse. The evidence is slightly more positive for prebiotics or synbiotics.

Regardless, you should ask your doctor before you add any of these to your diet.

FYI: The FDA doesn’t test dietary supplements for safety and efficacy the way it does with food and drugs. It only sets guidelines for supplement companies to follow and can review products after they reach the market. So it’s always important to do your research and choose trusted, third-party tested supplement brands.