Probiotics (VSL#3, E. coli Nissle, S. boulardii)
Also known as: VSL#3 · Escherichia coli Nissle 1917 · Saccharomyces boulardii · Lactobacillus GG · De Simone formulation
Beneficial bacteria that help rebalance the gut microbiome. Standout results in pouchitis and ulcerative colitis; Crohn’s results are still emerging.
Mixed clinical results. Strong results for specific strains in pouchitis and ulcerative colitis. Crohn’s maintenance studies so far have been small and have not shown a clear effect — strain selection appears critical.
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How it works
Probiotic organisms support a balanced microbiome by competing with less-friendly microbes for space and nutrients, reinforcing the tight junctions between gut-lining cells, and encouraging the regulatory immune cells and IL-10 signalling that keep inflammation in check. They also influence short-chain fatty acid production, the main fuel source for colon cells. Because dysbiosis — a disrupted microbiome — is one of the most consistent findings in Crohn’s, restoring microbial balance is a central goal of many holistic approaches.
Traditional use
Fermented foods such as kefir, yogurt, sauerkraut, kimchi and miso have been part of human diets for millennia. Nobel laureate Élie Metchnikoff first linked fermented milk to health and longevity in the early 1900s, launching the modern probiotic field.
Highlights
- VSL#3 (the De Simone formulation) has strong evidence for preventing and managing pouchitis.
- E. coli Nissle 1917 has performed comparably to 5-ASA medication in ulcerative colitis trials.
- In a post-surgical Crohn’s study, VSL#3 lowered inflammatory signalling in the gut lining.
- Crohn’s maintenance studies have been small and mixed — which strain, and for whom, is exactly the question community data can help answer.
- Very well tolerated; many people also use probiotics to support the gut during and after antibiotic courses.
What the research shows
Every study below links to its original publication so you can read it yourself. Many natural compounds have only been studied in small trials. That isn’t a verdict on them; it reflects how little funding exists for compounds that can’t be patented.
| Study | Design & population | Outcome |
|---|---|---|
| Cochrane probiotics No significant difference | Cochrane systematic review of randomised maintenance trials 7 small trials of variable quality · Crohn’s disease in remission | No demonstrated benefit of probiotics over placebo or standard maintenance therapy. |
| Bourreille 2013 No significant difference | Randomised, double-blind, placebo-controlled trial 165 patients · Crohn’s disease in remission after steroid or salicylate therapy | Saccharomyces boulardii did not prevent relapse compared with placebo. |
| Fedorak 2015 Mixed result | Randomised, double-blind, placebo-controlled post-operative trial 119 patients · Crohn’s disease after ileocolonic resection | VSL#3 did not significantly reduce endoscopic recurrence at 90 days, though mucosal inflammatory cytokines were lower in treated patients. |
Cochrane systematic review of randomised maintenance trials · 7 small trials of variable quality · Crohn’s disease in remission
No demonstrated benefit of probiotics over placebo or standard maintenance therapy.
Randomised, double-blind, placebo-controlled trial · 165 patients · Crohn’s disease in remission after steroid or salicylate therapy
Saccharomyces boulardii did not prevent relapse compared with placebo.
Randomised, double-blind, placebo-controlled post-operative trial · 119 patients · Crohn’s disease after ileocolonic resection
VSL#3 did not significantly reduce endoscopic recurrence at 90 days, though mucosal inflammatory cytokines were lower in treated patients.
Using it alongside conventional care
Probiotics are among the most popular gut-health supplements for people with IBD, and many use them alongside Entyvio, Mesalamine or other care to support a healthier microbiome. They can be particularly helpful during and after antibiotic courses, and alongside Prednisone. Results depend heavily on the specific strain, dose and person, which is why we are so interested in what our community reports. If you are significantly immunosuppressed or have a central line, check with your team first, since live organisms are not appropriate for everyone.
Medications mentioned
Entyvio (vedolizumab)
Gut-selective integrin blocker
Blocks α4β7 integrin, preventing lymphocyte trafficking into gut tissue.
Prednisone (prednisone / prednisolone)
Corticosteroid
Broad transcriptional suppression of inflammatory gene programmes.
Mesalamine (mesalazine / 5-ASA)
Aminosalicylate
Topically acting anti-inflammatory at the mucosal surface.
Never stop or change a prescribed medication without your gastroenterologist. Many people use natural support alongside conventional care, and your care team can help you do that safely.
Recommended sourcing
Where to buyWhat to look for in Probiotics
- Specific, named strains — ideally matching those in published research
- CFU count guaranteed at expiry, not just “at time of manufacture”
- Refrigerated or shelf-stable with verified stability data
- The De Simone formulation is now sold as Visbiome and Vivomixx
High-potency multi-strain formulas used in research deliver hundreds of billions of CFU per day — far more than typical retail probiotics.
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Amounts used in research
VSL#3 trials used 900 billion–3.6 trillion CFU/day. S. boulardii trials used 1 g/day. E. coli Nissle 1917 trials used 100–200 mg/day. Durations ran 6–12 months.
Good to know
- Well tolerated in general; bloating, gas and transient loose stools are common early on.
- Case reports of fungaemia with S. boulardii in patients with central venous catheters — avoid if you have a line or are significantly immunocompromised.
- Live-organism products warrant caution during severe flares, on high-dose immunosuppression, or with a compromised gut barrier.
- Product quality and viable CFU at end of shelf life vary widely between manufacturers.
Community experiences
Reported benefit
Typical dose
Time to notice
Common pairings
Real-world data for Probiotics is coming. When our Community Symptom Tracker launches, this section will show anonymised, aggregated experiences from people with Crohn’s who have tried Probiotics: how many noticed a difference, what they took, and what they paired it with.
Community data will always be labelled as self-reported, and it won’t replace the published research above.
Coming soon
Tried Probiotics? Your experience matters.
Our Community Symptom Tracker will let you log what you take and how you feel — and see what’s working for people like you. Alongside it, our wellness store will offer curated, third-party-tested protocols.
Sources
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Probiotics for maintenance of remission in Crohn’s disease
Rolfe VE, Fortun PJ, Hawkey CJ, Bath-Hextall F. · Cochrane Database of Systematic Reviews · 2006
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Saccharomyces boulardii does not prevent relapse of Crohn’s disease
Bourreille A, Cadiot G, Le Dreau G, et al. · Clinical Gastroenterology and Hepatology · 2013 · PMID 23376797
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Fedorak RN, Feagan BG, Hotte N, et al. · Clinical Gastroenterology and Hepatology · 2015 · PMID 25460016
Phase 2 — in development
Where traditional research stops, our community begins
Natural compounds can’t be patented, so they rarely get the multi-million-dollar trials that drugs receive. That leaves people with Crohn’s without answers to the questions that matter most: what actually helps, at what dose, and for whom? Our Community Symptom Tracker will crowdsource those answers from real people living with Crohn’s, and our upcoming wellness store will make it easy to find quality, third-party-tested products.
- Log your symptoms, supplements and doses in a private daily tracker
- See what’s working for people with the same disease location and medications
- Contribute to the largest real-world dataset on natural Crohn’s support
- Shop curated, third-party-tested protocols from our upcoming store
Be one of the first to join
Early access is opening soon. Bookmark this page and check back — we’ll announce sign-ups here first.