Probiotics help for bowel disease

Health24's DietDoc, Dr Ingrid van Heerden, recently attended a lecture on probiotics and inflammatory bowel disease, which was presented by Dr Ela Johannsen, one of the leading microbiologists in South Africa. Here are some highlights from the lecture.

Inflammatory bowel disease
Inflammatory conditions that affect the bowel include Crohn's disease, ulcerative colitis and pouchitis, or inflammation of the pouch made by surgeons when the entire colon is removed.

These conditions are usually chronic and patients experience fever, bleeding, bloating and pain. These symptoms can be severe and may lead to hospitalisation. In up to 40% of cases, the inflammation affects the entire colon.

Contributing factors
People with inflammatory bowel disease generally have some, or all, of the following characteristics:

• A genetic disposition. These conditions often occur in certain families.
• Permeability of the bowel mucosa and/or a weakened mucosal barrier. Instead of presenting a barrier to infections and harmful microorganisms, the lining or mucosa of the gut allows these vectors to enter the digestive system.
• Increased immunological sensitivity - a tendency to overreact to negative stimuli.
• A higher load of pathogenic bacteria occurring in the gut.
• A higher number of potent inflammatory bacteria are present in the gut.

All these factors lead to chronic inflammation, which in turn further weakens the mucosal barrier and allows more harmful bacteria access to the intestines, thus creating a vicious cycle.

Characteristics of suitable probiotics
Studies are starting to show that probiotics, or beneficial microorganisms, may be able to improve symptoms of chronic inflammatory bowel disease.

According to Johannsen, probiotics should have the following characteristics if they're to be used for this purpose:

• The microorganisms must be of human origin. Using probiotics produced from microorganisms that occur in soil or animals can be dangerous.
• The microorganisms must be present in adequate quantities.
• The microorganisms must be viable, in other words alive (it's no use taking large doses of probiotics that are dead).
• The ideal microorganisms for the human gut belong to the Bifidobacteria and Lactobacillus families.

What do probiotics do?
Probiotics act on two levels in the human gut:

• They restore and maintain the correct microbiological balance on the mucosal surfaces of the gut.
• They inhibit the production of microbial toxins and produce antibacterial compounds such as hydrogen peroxide and acids to kill and neutralise harmful toxins produced by pathogens in the gut.
• They stimulate immunity.
• They suppress inflammatory reactions by producing interleukin-10, which counteracts inflammation.
• Bifidobacteria are capable of producing butyric acid that nourishes the so-called colonocytes, which can in turn help to prevent colon cancer.

Who needs probiotics?

• Newborn babies born by Caesarian section who don't acquire natural probiotics from their mothers during the normal birth process.
• Older people - our natural beneficial gut microorganisms tend to decrease as we get older.
• Anyone with suppressed immunity.
• People with inflammatory bowel disease.

Dosage
If you have inflammatory bowel disease, you should introduce suitable probiotics very slowly to your diet. For example, Johannsen advised that people who have ulcerative colitis should start treatment with only half a capsule of probiotics a day.

She also mentioned that it may be a good idea to remove the hard gelatine capsule, as hard gelatine may be difficult to digest. This may cause pain and bloating.

Just sprinkle the probiotic powder inside the capsule over your breakfast porridge or cereal, or stir it into water or fruit juice.

Doses that are too high can also cause pain and bloating and may discourage you from using probiotics. So, stick to a tiny dose until your system is used to probiotics, and then have one dose a day.

So far, the best probiotic treatment results have been obtained with pouchitis and ulcerative colitis, while Crohn’s disease is not giving such positive results as yet.

In one study, researchers found that 77% of people with ulcerative colitis went into remission after six weeks of treatment with suitable probiotics.

Probiotics can be taken with a small amount of liquid or a meal, but be careful not to take them with oils or fatty foods as these will render the beneficial microorganisms ineffective.

Probiotics can be taken with antibiotics intended to kill Gram-positive pathogens, but it's useless to take probiotics with broad-spectrum antibiotics, because these antibiotics don't only kill the pathogens, but also the good micro-organisms in the probiotics.

If your doctor prescribes broad-spectrum antibiotics (you might have to ask to be sure), only start taking your probiotics after you've completed the course.

Probiotic range
Johannsen was responsible for developing a range of suitable probiotics for the treatment of inflammatory bowel disease, the enhancement of immunity and restoration of gut health.

The following products are available in the Bioflora range:

• Acidoflora (Lactobacilli)
  Recommended specifically for the treatment of small intestine disorders and the control of Candida overgrowth.
• Bifidoflora (Bifidobacteria)
  Recommended specifically for the treatment of disorders of the colon (large intestine).
• Intestiflora (Lactobacilli & Bifidobacteria)
  Recommended for adults to restore the intestinal flora (e.g. after antibiotic treatments).
• Infantiflora (Bifidobacteria)
  Recommended for infants younger than 12 months.
• Kiddie-forte (Lactobacilli & Bifidobacteria)
  Recommended for toddlers and children up to the age of 14 years.
• Vagiforte Plus (Lactobacilli & Bifidobacteria)
  Recommended for the restoration of vaginal microflora and for the treatment of thrush caused by Candida.

These probiotics can be obtained from dieticians and health shops.

If you're considering the use of probiotics to alleviate the symptoms of inflammatory bowel disease, then do this in conjunction with the correct diet and the help of your dietician.

(Dr I.V. van Heerden, DietDoc, March 2009)

Any questions? Ask DietDoc.