Healthspan staff July 18, 2018

If you have Crohn’s disease, you’ve likely tried a number of different methods to try to relieve the discomfort and pain. From changes in diet to medication, there’s a plethora of advice out there that can quickly become overwhelming. One particular method that’s risen in popularity over recent times is to include probiotics, which contain healthy bacteria, in your diet and prebiotics that the healthy bacteria feed on. These bacteria live in your gut normally and it’s supposed that by adding them to your diet you can help to maintain a healthy gut. 

Another related, but often neglected, method of trying to deal with symptoms of Crohn’s is through the use of prebiotics to nourish the friendly bacteria, allowing them to flourish within the gut.

But what exactly are prebiotics? Here, we’ll take a closer look at prebiotics, and go into how they work and whether they can help to relieve the pain caused by Crohn’s.

What is Crohn’s disease?

Crohn’s disease is a condition that causes chronic inflammation of the digestive system. Inflammation most commonly occurs at the end of the small intestine and beginning of the large intestine (bowel), but can affect any part of the gastrointestinal tract. Typically, the symptoms will flare and then subside and may include:

  • Diarrhoea: varying from mild to severe, the diarrhoea of Crohn’s is commonly associated with urgency. A feeling of wanting to ‘go’, but not being able to pass anything is also common. In a few people with Crohn’s, constipation is also a problem.
  • Bleeding: sometimes a raw area of the gut may bleed. If this happens, you may see blood in the toilet pan when you pass stools.
  • Pain: this occurs in about 70% of people with Crohn’s.1 A common area for pain is the lower right side of the abdomen.
  • Generally feeling unwell: examples of this range from having a poor appetite and a high temperature, to feeling tired. Fatigue can also occur due to associated anaemia if you lose blood. Unintentional weight loss may also be a symptom.
  • Cracks in the skin around the anus: fissures around the back passage can also occur, along with skin tags — small, fleshy wart-like lumps.
  • Mouth ulcers: sores in the mouth can also be a common sign.

In addition to the physical aspects, these symptoms are also likely to affect you emotionally and psychologically. Not knowing what your symptoms are going to be like from day to day, or feeling like you always need to have a toilet nearby can take its toll. This stress doesn’t act as a cause for Crohn’s but it can aggravate or trigger its symptoms.

What are prebiotics?

Just like probiotics, prebiotics work by boosting the numbers of good gut bacteria in the gut — but the ways in which they do this differ. Prebiotics aren’t themselves living bacteria, but rather are a collection of indigestible fibres that act as fuel to the beneficial bacteria (in particular Bifidobacteria) already resident in the bowel, allowing it to multiply. This occurs as a result of the fibres selectively ‘feeding’ those bacteria. If you combine both prebiotics and probiotics you can keep the beneficial bacteria fed and healthy.

Can prebiotics help Crohn’s?

The research into the potential relationship between gut bacteria and Crohn’s disease is still in its infancy. However, many experts believe that alterations to the gut microbiota — the name given to the community of microbes living in your gut — does play some role in the development of the disease and could also be a key to helping treat it.2

One double-blind randomised controlled trial (considered to be the gold standard of trials), found that in 67 adults with Crohn’s disease, an inulin-based prebiotic improved the amount of beneficial Bifidobacteria longum in the gut, which ultimately correlated with some improvement in disease activity.3 However, although this is promising, a different study which looked at the effect of a prebiotic in 103 Crohn’s subjects showed no clinical benefit.4

More generally, it seems that the amount of prebiotic fibre contained in your food might well have an impact on your Crohn’s symptoms. One study found that those with Crohn’s had a lower dietary intake of prebiotic fibres in comparison to those without the condition.5 So increasing the amount of prebiotic fibres you consume, whether this is through food or supplements, might potentially help in subsiding your symptoms.

Getting enough prebiotics

As there’s no universally agreed upon consensus with regards to whether prebiotics do help to relieve Crohn’s symptoms, where does this leave us?

Overall, it seems like there’s no harm in increasing your intake of prebiotic fibres. In the worst case scenario, they might not help your Crohn’s symptoms — but in the best, they might help them to subside. If you do increase your intake of these fibres here are some useful pointers that you should know:

  • Know your prebiotic foods: the best natural food sources of prebiotics to get a good base amount in your diet include onions, garlic, asparagus, bananas, and Jerusalem artichokes. This, in addition to a healthy diet, is important not only to attempt to relieve your symptoms, but also for your general health and wellbeing.
  • Recognise prebiotic fibre on the label: look out of the terms inulin, galacto-oligosaccharides (GOS), fructo-oligosaccharides (FOS), Oligofructose (OF) or chicory fibre, as they are all key prebiotics that you can include into your diet.
  • Look for a dose of around 5g of prebiotic (such as inulin) a day: this is the broadly agreed upon amount recommended to have a stimulatory effect on gut bacteria.
  • Some prebiotics are marketed as helping constipation: This may be alarming if you have Crohn’s disease and your primary symptom is diarrhoea, but there’s no need to panic. Prebiotics work to regularise bowel motions by bulking out stools and shouldn’t make diarrhea symptoms worse. But if you are concerned, ask your GP or health specialist. Another good tip is to start with a lower dose and work up as prebiotics might make you a bit windy at first.

The bottom line

If you have Crohn’s disease, it’s important to eat a healthy, well-rounded diet and exercise regularly (to reduce stress) and lower the amount of alcohol that you consume.6 This, with the addition of increasing your prebiotic intake, can help to maintain the healthy bacteria in your gut and might help to reduce your symptoms. If you’re interested in learning more about how prebiotics can help wellbeing in general and what exactly you should look out for, then head over to our Gut Health advice centre.


References
1Ha, F., and Khalil, H. (2015). Crohn’s disease: a clinical update. Therapeutic Advances in Gastroenterology, 08(06).
2Guarner, F. (2007). Prebiotics in inflammatory bowel diseases. British Journal of Nutrition, 98(01).
3Joossens, M., et al. (2012). Effect of oligofructose-enriched inulin (OF-IN) on bacterial composition and disease activity of patients with Crohn's disease: results from a double-blinded randomised controlled trial. Gut, 61(06).
4Benjamin, J. L., et al. (2011). Randomised, double-blind, placebo-controlled trial of fructo-oligosaccharides in active Crohn’s disease. Gut, 60(07).
5Anderson, J. L., et al. (2015). Dietary intake of inulin-type fructans in active and inactive Crohn’s disease and healthy controls: a case-control study. Journal of Crohn’s and Colitis, 09(11).
6Hsu, T. Y., Shih, H. M., Wang, Y. C., et al. (2016). Effect of Alcoholic Intoxication on the Risk of Inflammatory Bowel Disease: A Nationwide Retrospective Cohort Study. PLOS ONE, 11(11).
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