Limited research suggests that probiotics may help to prevent ulcerative colitis flareups, but you may want to avoid them if you have a weakened immune system.

Probiotics are microorganisms that we take into our bodies to support our health. Typically, they’re strains of bacteria that can help improve our digestion, or so-called “good bacteria.” Probiotic products are intended to supply healthy, gut-friendly bacteria to populate the intestinal wall.

Probiotics are found in certain foods. They also come in supplements, which are available in a variety of forms, including tablets and capsules.

UC is an inflammatory disease of the large intestine that can cause diarrhea that may be bloody, cramping, and abdominal pain. The disease is relapsing and remitting, which means there are times when the disease is quiet and other times when it flares up, causing symptoms.

Standard medical treatment for UC has two components: treating active flare-ups and preventing flare-ups. With traditional treatment, active flare-ups are often treated with corticosteroids such as prednisone. Flare-ups are prevented with maintenance treatment, which means using certain drugs long-term.

Let’s look at whether probiotics can help with either of these treatment needs.

Can probiotics help stop flare-ups?

The answer to this question is likely no. An older 2010 studyTrusted Source showed that using probiotics provided no additional benefit in inducing remission of UC.

That said, a 2022 studyTrusted Source found that a combination of antibiotics and probiotics was effective in inducing remission in people with pouchitis (which is a complication of UC).

The National Center for Complementary and Integrative Health (NCCIH)Trusted Source also reports that there is promise with the use of probiotics for UC remission induction. However, in most instances, it’s still not known which probiotics are helpful and which are not. It’s also unknown how much of the probiotic people would have to take or who would be most likely to benefit.

Can probiotics help prevent flare-ups?

The use of probiotics for this purpose shows more promise.

Several studies have shown that probiotics may be as effective as traditional UC medications, including the gold-standard treatment mesalazine.

A 2004 German study followed a group of 327 patients with a history of UC, giving half of them mesalazine and the other half probiotics (Escherichia coli Nissle 1917). After one year of treatment, the average time to remission (time without a flare-up) and safety profile and tolerability were very good for both groups and were not different.

Similar results have been seen in other studiesTrusted Source. And another probiotic, Lactobacillus GGTrusted Source, may also be helpful in sustaining remission in UC.

How probiotics may help treat ulcerative colitis

Probiotics may help in treating UC. There are different theories and hypotheses about the cause of the condition.

UC may be caused by problems with the immune system in the intestines. Your immune system helps your body fight disease, but it can sometimes lash out and target your own body in an effort to protect it from a perceived danger. When this happens, it’s called an autoimmune disease.

Some researchersTrusted Source think an imbalance of bacteria in the large intestine is thought to be the perceived danger that prompts the immune system to respond and that probiotics may restore this balance to the gut.

Probiotics may help by providing good bacteria that help restore the bacterial balance in the intestine.

As we stated previously, probiotics may also helpTrusted Source increase the time between flare-ups and may make the symptoms of a flare-up less severe.

Plus, probiotics may also protect againstTrusted Source other bowel problems such as Clostridium difficile colitis and travelers’ diarrhea.

There are a lot of benefits, but there are a few cons when using probiotics with UC.

The main one is that people should use them cautiously. Probiotics contain living bacteria, so they may increase infection risk in people with compromised immune systems (such as those taking long-term or high dose corticosteroids). This is because a weakened immune system might not be able to keep the live bacteria in check, and an infection may result.

Pros of probiotics for UC

  • may help prevent UC flare-ups
  • may reduce symptoms during flare-ups
  • no serious side effectsTrusted Source shown to date
  • may protect against other bowel diseases, such as C. difficile infection

Cons of probiotics for UC

There are countless types of probiotic products available and many strains of microorganisms that may be used in them. Two of the most commonTrusted Source types of bacteria used are Lactobacillus and Bifidobacterium.

You can get probiotics from a range of sources. You can find them in foods such as yogurt, kefir (a fermented drink made from cow’s milk), and even sauerkraut.

You can also take them as supplements in forms such as capsules, tablets, liquids, or gummies. Your local pharmacy likely has several options available.

If you’re thinking of using probiotics, you should keep in mind that supplements are not regulated by the Food and Drug Administration (FDA)Trusted Source in the same way as prescription drugs. This means the FDA doesn’t check whether supplements are safe or effective before they go on the market.

If you would like guidance on finding a high quality probiotic, talk with your doctor.

Prebiotics are carbohydrates that are the “food” for certain groups of bacteria. Consuming prebiotics can help boost the population of your own gut probiotics for this reason. Some natural sources of prebiotics includeTrusted Source:

  • garlic
  • onion
  • asparagus
  • artichoke
  • banana
  • chicory root

So far, no serious side effects have been linked withTrusted Source prolonged use of probiotics for UC.

That said, people with severe illnesses or weakened immune systems face an increased riskTrusted Source of adverse reactions to probiotics.

Other possible harmful effects of probiotics include infections, production of harmful substances by the probiotic microorganisms, and transfer of antibiotic resistance genes from probiotic microorganisms to other microorganisms in the digestive tract.

However, few studies have looked at the safety of probiotics in detail, so more research needs to be done on this topic.

While taking probiotics may help with your UC, your doctor may also prescribe medications to help induce or maintain remission. These medications fall into four main categories, which include:

  • aminosalicylates
  • corticosteroids
  • immunomodulators
  • biologics
  • targeted synthetic small molecules

Should I take probiotics during a ulcerative colitis flare?

According to the National Center for Complementary and Integrative Health (NCCIH)Trusted Source, probiotics have shown promise for remission induction in UC. However, you should talk with your doctor before adding them to your UC treatment plan.

How do I heal my gut ulcerative colitis?

There is no cure for UC. Therefore, the goal of treatment is to heal the lining of the colon, reduce symptoms, and stay in remission.

According to the National Health Service (NHS) in the UK, this may be achieved through:

  • aminosalicylates
  • corticosteroids
  • immunomodulators
  • biologic

Managing stress levels with exercise and relaxation techniques may also help.

Even though probiotics are easy to get and may haveTrusted Source risks and benefits, you should talk with your doctor before adding them to your UC treatment plan. This is especially important if you have a compromised immune system or are on high dose corticosteroids.

And definitely don’t use probiotics to replace any UC medications or treatment your doctor has advised without confirming with your doctor first.

But if you and your doctor think probiotics are the next option to consider for your UC treatment plan, ask your doctor for help in finding the best probiotic for you. You’ve likely got nothing to lose — except possibly some UC flare-ups.