Prebiotics

Inflammatory bowel disease (IBD), which encompasses Crohn’s disease (CD) and ulcerative colitis (UC), creates chronic inflammation in the digestive tract and can cause symptoms like abdominal pain, diarrhea, nausea and fatigue. Several medications are available to help manage the disease and reduce its symptoms, including aminosalicylates, immunomodulators, corticosteroids, antibiotics, and biologic therapies.

Some people with IBD also choose to supplement their medications with alternative or complementary therapies. Unlike prescribed medications, these therapies have not been scientifically proven to have an effect on IBD or its symptoms. Some people may find that they experience some symptom relief from alternative therapies, but it is very important to understand that these alternative therapies are not recommended to be used in place of prescribed IBD medications. One form of alternative therapy is prebiotic supplementation. As with any form of alternative therapy, patients should consult their healthcare provider before starting any additional treatments.

What are prebiotics?

Prebiotics are certain types of non-digestible foods that help to stimulate the growth of beneficial bacteria in the digestive tract. Specifically, prebiotics are carbohydrates that fuel and feed health-promoting bacteria that live in the intestines. Prebiotics are different from probiotics, which are supplements that contain one or more strains of helpful bacteria.1

The specific carbohydrates found in prebiotics are inulin and oligofructose. While both inulin and oligofructose are thought to have a variety of health benefits and uses, they are best known for their ability to stimulate and promote bifidobacteria growth in the intestines. Bifidobacteria is a form of beneficial bacteria that normally resides in human intestines. Bifidobacteria is thought to help control levels of potentially harmful forms of bacteria and promote intestinal health.2

When prebiotics and probiotics are taken at the same time they are considered symbiotic, meaning they are working together to form a synergistic relationship that is more effective than either of them alone. That is, the use of probiotics alongside prebiotics is considered to be more effective than probiotics alone. Studies have suggested that high-doses of probiotics and prebiotics may be effective in some people with active IBD.2,3

How might prebiotics have an effect on IBD symptoms?

The chronic inflammation of the digestive tract in IBD can cause symptoms including diarrhea, nausea, abdominal pain, and fatigue. The use of both prebiotics and probiotics is beginning to be studied more as a potential aid in helping to reduce IBD symptoms.

Research suggests that the types and amounts of bacteria are altered in people with IBD, and this imbalance may contribute to the disease.2,4

The theory is by replacing the healthy bacteria with probiotics, and supporting the growth of those healthy bacteria with prebiotics, the digestive system would be improved and it may have a benefit on symptom management. Some small research trials have been conducted studying the effects of prebiotics on people with Crohn’s disease and ulcerative colitis, and initial data suggests that prebiotics may have a beneficial effect on the inflammation caused by IBD. However, additional research is needed to confirm the effects.2

What are potential risks associated with taking prebiotics?

The use of prebiotics as a supplement is generally considered safe, and side effects are uncommon.5 As with any supplementation or alternative therapy, consult your healthcare provider before beginning treatment. Make sure your healthcare provider is aware of all medications and supplements you are currently taking, in order to help avoid harmful drug interactions.

Written by: Anna Nicholson and Emily Downward | Last Reviewed: January 2018.
View References
  1. Guo M. Prebiotics and Probiotics. J Prob Health. 2015;3:e120. doi: 10.4172/2329-8901.1000e120
  2. Guarner F. Prebiotics in inflammatory bowel diseases. British Journal of Nutrition. 2007;98(1):S85-S89.
  3. Fujimori S, Tatsuguchi A, Gudis K, et al. High dose probiotic and prebiotic cotherapy for remission induction of active Crohn’s disease. J Gastroenterol and Hepatol. 2007 Aug;22(8):1199-1204.
  4. Sartor RB. Therapeutic manipulation of the enteric microflora in inflammatory bowel diseases: antibiotics, probiotics, and prebiotics. Gastroenterology 2004;126(6):1620-1633.
  5. Do I need to include probiotics and prebiotics in my diet? Mayo Clinic. Available at http://www.mayoclinic.org/healthy-lifestyle/consumer-health/expert-answers/probiotics/faq-20058065. Accessed 1/1018.