As we saw last month:

1. Ulcerative colitis (UC) is considered incurable.
2. Medical approaches involve pharmacotherapy – antibiotics, anti-inflammatory and/or immunosuppressive drugs; surgical intervention (sometimes extensive).
3. These are supportive, not curative; may have side effects requiring discontinuation.
4. 20-30% of patients don’t respond/are forced off medication, leading to colectomy.
5. Human UC patients have alterations in gut microbial composition.
6. Inappropriate gut flora may be a contributor to UC disease.

We’ve previously examined various microbial UC treatments:

1. Single strain probiotics (Mutaflor),
2. Transplantation of donor stool alone (FMT)
3. FMT plus diet modifications

Open-labelled and randomised double-blind placebo-controlled trials (RCT) have also been conducted using a probiotic containing 8-bacteria, namely:

• Streptococcus thermophilus
• Bifidobacterium breve
• Bifidobacterium longum
• Bifidobacterium infantis
• Lactobacillus paracasei
• Lactobacillus delbrueckii subsp. Bulgaricus
• Lactobacillus acidophilus
• Lactobacillus plantarum

Bibiloni et al (2005), studied 34 adult active-UC patients (while on steroids or mesalazine) given 2 sachets of probiotics morning and night for 6 weeks. 53% of these UC patients achieved remission, 24% a significant clinical response, 9% no response, 9% a worsening of symptoms. In total, 77% of patients’ symptoms improved on multi-strain probiotics.

Lee et al, (2012) studied 24 adult patients with active UC (concomitant medications not specified) given 2 sachets of probiotics morning and night for 8 weeks. 46% of UC patients achieved remission, 21% significant clinical response, 25% had either no response or some symptom-worsening. In total, 67% of patients improved on multi-strain probiotics.

Sood et al (2009) conducted an RCT involving 147 adults with active UC (not on steroids; but with oral mesalazine, azathioprine or 6-mercaptopurine allowed) given 2 sachets of probiotics morning and night, or placebo for 12 weeks:

After 6 weeks:

1. 33% of the probiotic’s patients, only
2. 10% of placebo patients halved their symptom scores.

After 12 weeks:

42. 42.9% of probiotics patients achieved remission, only 15.7% on placebo.
43. 52% of probiotics patients achieved significant symptom scores decreases, only 19% on placebo.

• Symptom decrease-magnitudes were significantly greater for those on probiotics.

These studies clearly show that multi-strain probiotics are a generally safe and effective adjunctive treatment for achieving clinical response and remission in UC.

In non-responsive cases, alternative probiotics such a Saccharomyces boulardii, ‘E coli Nissle 1917’, Bifidobacterium fermented milk yoghurt, and even Faecal microbial transplant methods may be considered.

The key point to note here is that none of the above studies have given any consideration to other aspects of patient environments that may positively influence treatment efficacy. For example:

1. Modulation of diet. Diet is one of the major determinants of the gut microbiome and has been associated with risk as well as disease course of IBD.
2. Sleep quality or quantity was not considered, even though:
   1. Sleep, if insufficient or excessive, is associated with increased risk of UC and
   2. Animal studies clearly show that acute and chronic sleep deprivation results in worsening severity of colitis and a delayed recovery from colonic injury.
3. Alcohol consumption was not addressed but is associated with IBD flare-ups and worsening of symptoms.

Treating UC successfully will not just require inflammation management, or the simple provision of probiotics. More likely, it will require the appropriate modulation of all the complex stress-factors that influence and affect the lives of UC patients, because it is these which together in an orchestrated fashion eventually lead to altered physiological function, and finally disease. Thus, to increase the likelihood of successful intervention and cure, we would likely require complete assessment of all the complex and multifaceted factors contributing to disease and provide comprehensive interventions that addresses these.

Article Written + Submitted by:

Andreas Klein Nutritionist + Remedial Therapist from Beautiful Health + Wellness
P: 0418 166 269