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The Efficacy of Probiotics in Inflammatory Bowel Disease

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Ulcerative Colitis
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Posted 9/13/2017 1:44 PM (GMT 0)
Great new study on Mescape:
www.medscape.com/viewarticle/884985?src=wnl_edit_tpal (you may need to create an account to view it)

Conclusions VSL#3 may be effective in inducing remission in active UC. Probiotics may be as effective as 5-ASAs in preventing relapse of quiescent UC. The efficacy of probiotics in CD remains uncertain, and more evidence from RCTs is required before their utility is known.

Would love to be able to taper off expensive 5-ASAs and just use probiotics to maintain remission...
Posted 9/13/2017 4:37 PM (GMT 0)
Probiotics are expensive as well.

All you can do is try it if you are mentally driven to do so.....but 5ASA meds in conjunction with probiotics seem to be your best bet in my opinion and experience.

q
Posted 9/13/2017 4:40 PM (GMT 0)
I've seen mixed results in some probiotic studies with IBD.
Posted 9/13/2017 10:30 PM (GMT 0)
Yes, mixed results indeed. Most of the studies are too small or too poorly constructed to draw conclusions from, especially when there are other small, poorly constructed studies that contradict them.

There just aren't any really good, large, strong studies that show benefit - just as there aren't good large studies that prove definitively that there is no benefit.

So take em if you want and think they might help.
Posted 9/13/2017 11:40 PM (GMT 0)
It's like anything else... mixed results.

The pedi GI my son used to see (he aged out of her practice) had compelling stories about VSL helping when nothing else did, and I experimented with myself at one point and found it indeed reversed a flare.

But with new medical insurance and the price, I have let my use lapse. I take VSL from time to time as well as other probiotics. Maybe I'll seriously try again.....
Posted 9/13/2017 11:55 PM (GMT 0)
If I remember right, one of the studies with pretty sound design and numbers showed VSL#3 can help some people with pouchitis. It was one of the more compelling studies on probiotics. It might have even led to a lot of hype for VSL#3 for UC and Crohn's in general, despite the study being only for pouchitis.
Posted 9/14/2017 12:05 AM (GMT 0)
This work was a meta analysis, and did try to only include proper studies with randomization and control groups.

Probiotics in general did not help in a statistically significant way, but the subset of studies using VSL#3 there was a statistically significant benefit - although models.

They also misstate the findings a bit. They probotics comparable to mesalamine, but that just means they did not find a significant difference - likely because the meta analysis was underpowered to do so. Not finding something does not mean you can declare you *found* no difference. If I review this I would not allowed publication without rewording.

[url\https://www.ncbi.nlm.nih.gov/pubmed/28653751]/url]
Posted 9/14/2017 9:05 PM (GMT 0)

quincy said...
.but 5ASA meds in conjunction with probiotics seem to be your best bet in my opinion and experience.

Yes, that combo has worked beautifully for me, too. I am wondering if I drop the probiotics, if just the mesalamine would work solo? Hmmm.....it'd be a way to save $25-30 a month anyway.
Posted 9/15/2017 5:14 AM (GMT 0)
Your choice....i would never drop the probiotics, ever!

q😉
Posted 9/15/2017 12:20 PM (GMT 0)

quincy said...
Your choice....i would never drop the probiotics, ever!

q😉

In your mind are these probiotics working behind the scenes to provide a healthy digestive environment?

Are you reinoculating them in a permanent way because you think that----on their own-----they are unable to colonize?

Would you change your protocol upon proof that the new bacteria WERE able to proliferate in your digestive environment?

See......these are the things I hope we learn with all the micro-biome studies they are doing now.

And also I hope to learn more about the specific bacterial strains I am harvesting through my own homemade milk and water kefir. From what I've read these are RICH with bacteria.....and so fresh and alive compared to store bought probiotics.

If the testing becomes more affordable (and stable) I'd love to find these things out !

Edit: grammar issues as per usual rolleyes
Posted 9/15/2017 12:42 PM (GMT 0)

Eph said...
Would love to be able to taper off expensive 5-ASAs and just use probiotics to maintain remission

Eph, have you ever looked into making your own homemade water and/or milk kefir?

I was super intimidated by the process and so put it off for a year or two. Now that I am doing it every day I am embarrassed by how easy it is.

I am a beginner with this fascination process though and I have a lot to learn still smile

Edit: adding KEFIR 101....very interesting to know that kefir changes every day (like people do) !

https://www.fix.com/blog/countertop-culture/
Posted 9/15/2017 3:48 PM (GMT 0)
Marjie,

I have NOT tried making kefir, though love the taste of milk kefir products.

Do you make the milk version? Where did you buy your grains?
Posted 9/15/2017 4:38 PM (GMT 0)
@ Eph,

I make both milk kefir and water kefir every day. I bought both sets of grains on eBay from people who shipped live grains (two different sellers). And this was in the heat of the summer, too---I was shocked they not only survived but immediately thrived.

They say it takes a few batches before grains adapt to their new environment but mine started producing right away. And the milk kefir they produce is so good sometimes I drink it before adding berries or anything. I had been buying the Lifeway brand for several months so doing this just made sense.

Edit: these are the milk grains I purchased:
http://www.ebay.com/itm/Kefir-milk-grains-1-Tbs-instructions-included/162597592235?ssPageName=STRK%3AMEBIDX%3AIT&_trksid=p2057872.m2749.l2649
Posted 9/15/2017 7:29 PM (GMT 0)

MarjieKay said...

quincy said...
Your choice....i would never drop the probiotics, ever!

q😉

In your mind are these probiotics working behind the scenes to provide a healthy digestive environment?

Are you reinoculating them in a permanent way because you think that----on their own-----they are unable to colonize?

Would you change your protocol upon proof that the new bacteria WERE able to proliferate in your digestive environment?

See......these are the things I hope we learn with all the micro-biome studies they are doing now.

And also I hope to learn more about the specific bacterial strains I am harvesting through my own homemade milk and water kefir. From what I've read these are RICH with bacteria.....and so fresh and alive compared to store bought probiotics.

If the testing becomes more affordable (and stable) I'd love to find these things out !

Edit: grammar issues as per usual rolleyes

In my mind and butt....I don't really care. I don't. I can honestly say they have helped, Ive never had any issues of diarrhea related to infection, I can take antibiotics when I need (as in now sinus thingie), and they have helped others who have tried them for various issues.

I've been at this for over 30 years. I just wish I had known about them during the 2+ years of continual diarrhea before diagnosis. Not that it would have changed the diagnosis....just that it might have helped with the the initial and probable infection that should not have only been "treated" with Lomitil or opiate laced whatever bowel immobiliser med. All that gave me was an the best mellow stoned buzz ever (i had not one pain in my body) yet, continued diarrhea and weightloss when I stopped.

Im not much help to you..... you may believe you are driven to meet your predetermined outcome, but keep in mind you are and have vastly improved. Make your choices through your process as you need....but wisely of not dropping what is actually working.

q
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