As you know from my previous articles on ulcerative colitis (UC), the occurrence of UC is influenced by alterations in intestinal microbiota composition (Ohkusa & Koido, 2015; Wang et al., 2019). The human gut doesn’t only contain bacteria. It also contains other microbes that can influence gut health, including probiotic yeasts such as Saccharomyces boulardii (S. boulardii).

1. boulardii can be found in our food, on fruits such as lychees, mangosteen, and in higher numbers in probiotic foods such as natural kombucha, and milk-kefir (Ansari et al, 2023).

Mouse models of UC show that S. boulardii supplementation beneficially alters intestinal microbial composition, to reduce intestinal inflammation (TNF-α and IL-6), which then helps prevent intestinal cancers (Wang et al., 2019).

In humans, presence of S. boulardii in our intestines can:

1. Kill pathogenic bacteria (Ansari et al., 2023).
2. Push intestinal microbiota toward a healthier composition.
3. Destroy many of the toxic substances secreted by pathogenic bacteria.
4. Prevent pathogenic bacteria binding to intestinal cells (Im & Pothoulakis, 2010).
5. Increase intestinal cell secretion of protective antibodies which can bind and remove pathogenic microorganisms in stool.
6. Re-establish microbial production of beneficial short chain fatty acids (Ansari et al., 2023)
7. Stimulate intestinal-cell metabolism (after uptake by intestinal cells of secreted polyamines – spermidine and spermine).
8. Regenerate damaged intestinal lining cells
9. Re-establish intestinal cell barrier function by ensuring joins between intestinal lining cells are intact and strong (stops intestinal contents including bacteria & toxins leaking into the body).
10. Lower intestinal inflammation by:
    1. blocking proinflammatory immune responses (lowers TNF-α, →NFKB, → IL-1β, IL-6)
    2. promoting ant-inflammatory immune pathways (PPAR-γ pathways)
    3. sending inflammatory INFγ secreting T-cells from the intestinal wall back to lymph nodes
11. Help reduce the risk of colon cancer (Im & Pothoulakis, 2010) – intestinal cancers represent 10%-15% of all deaths in UC & Crohn’s disease (Lakatoos & Lakatos, 2008).

Based on these effects, S. boulardii (officially Saccharomyces cerevisiae var. boulardii) was studied and found beneficial as a treatment for Crohn’s disease (Guslandi et al, 2000).

The same researchers then studied S. boulardii supplementation as a treatment for UC. They took 25 patients who had been on high dose mesalazine maintenance therapy for UC (1g tds for at least 3

months), who were nevertheless suffering mild-moderate UC flare-ups (i.e., mesalazine had failed to

induce/maintain clinical remission in these patients). These patients were continued on mesalazine but were given an additional 250mg S. boulardii 3 x daily, for 4 weeks.

After 4 weeks, 68% (17/25) patients achieved clinical remission (defined as a clinical Rachmilewitz score of ≤5). Each patient also underwent an endoscopic examination to confirm that their bowel wall had healed (Guslandi. et al, 2003).

This study was a small, open-labelled, and not placebo-controlled, so definite conclusions cannot be drawn, and larger controlled trials should be done. However, given S. boulardii was able to restore remission in most patients who had failed to remain in remission on mesalazine alone, the result is

highly encouraging. Given this, the inclusion of appropriate S. boulardii probiotics or probiotic foods into the diet, as an intervention for people suffering from UC seems a simple, low cost, accessible, and sensible intervention, with a reasonable likelihood of beneficial outcomes, and low likelihood of harm.

Notes:

1. The remission rate of S. boulardii treatment in this trial is equivalent to the remission rates achieved for UC by mesalazine (& sulphasalazine) in the seminal trial examining the use of mesalazine for treatment of UC conducted by Rachmilewitz in 1989 (Rachmilewitz, 1989)
2. Rachmilewitz (Division of Gastroenterology, Tel Aviv Sourasky Medical Center, Israel), defines the different degrees of clinical and endoscopic activity of UC as follows: Clinical Activity Index (range 0-29 points): inactive (remission) 0-4, mild activity 5-10, moderate activity 11-17, and high activity ≥18 points (Rachmilewitz, 1989; Schoepfer et al, 2009)

Article Written + Submitted by:

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