probiotics

Last week a startling headline appeared in my Google news alert: “Probiotics Have No Impact on Crohn’s Disease Remission.” The study, published this month in Clinical Gastroenterology and Hepatology, was a 52-week, randomized, double-blind, placebo-controlled trial conducted at 32 centers and looked at whether or not a specific yeast probiotic, saccharomyces boulardii, prevented relapse of Crohn’s disease after remission was achieved via conventional medications (steroids and aminosalicylates). As the headline states, the findings of the study were that it has no statistically significant effect (47.5% of those taking the probiotic had a relapse, compared to 53.2% in the placebo group).

This story was of personal interest to me because it appeared right about the same time I was starting to feel really good after going on the paleo autoimmune protocol (AIP) and wondering whether or not I really needed to keep taking the various supplements I’ve been on for the last few months, including a couple probiotics. After all, taking pills is no fun and can be hard to keep up on, especially annoying with probiotics that need to be kept refrigerated. And they are an extra monthly expense that I’d love to drop and instead put the money toward buying high quality food.

So I decided to do a little self experiment and when I went out of town for a couple days last week, I just left the probiotics behind in the refrigerator at home. I felt quite good while I was traveling. I never once worried about finding a bathroom, had no significant gas, slept great, and overall felt really good. I was feeling quite proud of myself and even cancelled my next Amazon order of probiotics, deciding that clearly I had no need for it after all now that I had my diet all figured out.

And then I realized my celebration was premature. The day after I got home (which was day 4 without the probiotics), I noticed my bathroom visits increasing. Then I started getting some extra gas. The next night I had to get up in the middle of the night to use the restroom. Nothing really dramatic and still a big improvement from just a few weeks ago, before I went on AIP, but enough to concern me. I really can’t say if it was a result of eliminating the probiotics, some residual effect of the stress of travel, or just pure coincidence, but I quickly decided to get back on both the saccharomyces boulardii supplement  three times a day (I use Nutricology Saccharomyces Boulardii) and an other multi-strain probiotic once a day. After two days now of being back on the probiotics, I’m seeing my bowel movements firming up and the gas diminishing. Is this caused by the probiotics? I’m not sure, but my diet has been squeaky clean this whole time and I haven’t changed anything else, so I tend to think it is.

While this most recent study seems to show that this particular probiotic has no effect on preventing relapse of Crohn’s disease, animal models like this 2009 study on rats that showed saccharomyces boulardii reduced colonic inflammation and regulated inflammatory gene expression and earlier pilot studies, such as this 2008 study that showed saccharomyces boulardii improved intestinal permeability (“leaky gut”) in patients with Crohn’s disease, suggested that it could have therapeutic benefits. This seems particularly relevant to me because my sensitivity to gluten and my experiences with food allergies suggest that increased intestinal permeability has been a significant and long overlooked manifestation of my disease.

A study conducted way back in 1993 looked at the effects of saccharomyces boulardii on patients with “mild residual symptoms in a stable phase of Crohn’s disease” in combination with basic pharmacological treatment, which in 1993 would have been mesalamine (the well known biologics such as Remicade and Humira had not yet been developed). This small study looked at just 20 patients and focused specifically on chronic diarrhea. All patients took the probiotic for the first two weeks and reported modest reduction in number of bowel movements. The patients were then randomized and the control group got a placebo while the test group got the probiotic for another 7 weeks. After 10 total weeks of treatment, the test group was reporting a significant decrease in the number of bowel movements from a baseline average of 5.0 per day to an average of 3.3. In contrast, the number of bowel movements reported by the control group steadily rose and ended up back near the baseline at 4.6 per day.

I am not a scientist, but it seems to me that this study looked at a very different question. The 2013 study asked whether or not the probiotic would prevent relapse when the patient is experiencing no symptoms, but the smaller 1993 study was looking at whether or not it could reduce residual symptoms in patients whose disease is relatively well controlled, but not necessarily in remission.

Bottom line: If you are in remission, you may be just wasting your money if you keep taking saccharomyces boulardii.

But if you are like many people with Crohn’s disease who really never reach that elusive state of perfect digestion and complete remission, it may be very beneficial in helping reduce your lingering symptoms. Maintaining remission may also depend on the severity of your disease to begin with. As the authors of a cleverly titled editorial about the recent study, “To Yeast or Not to Yeast: A Probiotic Question,” point out; the patients in this study achieved remission through steroid treatment, which suggest that they have a particularly severe disease. It could be that patients with a milder form will see a greater benefit from probiotics.

Little is known about how bacteria in the gut actually work both in people with inflammatory bowel diseases and otherwise healthy people. Perhaps the key to success in the 1993 study was that it was combined with another treatment and provided a necessary boost to the effect of that medication. To my knowledge, no one has done a study of the effects of any probiotics in combination with an autoimmune protocol diet.

(Please note: I am not a doctor and this is not medical advice. I am just an ordinary person dealing with Crohn’s disease and sharing something that works with me. You should not stop or start any medication or supplement without consulting a health care provider.)

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