Butyrate & Inulin Supplementation Improves Ulcerative Colitis Symptoms
Evidence linking the microbiome to a plethora of immune system-mediated diseases (such as IBD, IBS, type 2 diabetes, etc.) continues to mount.
One of the primary features in individuals with these conditions is microbiome dysbiosis, specifically leading to a lack of bacteria that produce healthy short-chain fatty acids (acetate, butyrate, and propionate).
In response to such findings, scientists have turned to supplementation with oral short-chain fatty acids (predominantly sodium butyrate) and prebiotics (mainly inulin) in an attempt to balance the lack of short-chain fatty acids and promote the bacteria that produce them.
In a pilot study published in the Journal of Crohn’s and Colitis, researchers report the successful use of oral sodium butyrate and inulin supplementation to improve the symptoms of ulcerative colitis.
The researchers analyzed the gut microbiomes of 37 patients with mild-to-moderate active UC and 38 healthy controls.
They found that the ability of the gut microbiome to make butyrate was significantly lower in the UC group as compared to the healthy controls.
UC patients also had significantly lower Faecalibacterium prausnitzii bacteria (an important bacterial species in healthy microbiomes) than healthy controls, and Bacteroides thetaiotaomicron was also detected less frequently.
Subsequently, 40 mild-to-moderate active left-sided UC patients were enrolled in an open study and randomized to receive either oral butyrate plus inulin as a supplement to oral mesalazine or mesalazine alone for 28 days.
The research team found that oral butyrate plus inulin significantly enhanced the butyrate-producing bacteria, and lowered serum pro-inflammatory biomarkers while being safe and well tolerated. In the butyrate and inulin-treated group of UC patients, 85% demonstrated significant improvements in both rectal bleeding and stool frequency by Day 14, compared to only 55% in the mesalazine alone group.
The addition of butyrate and inulin to the standard ulcerative colitis treatment had a clinically relevant benefit in this pilot trial.
As butyrate is an important energy source for colonic epithelial cells, maintains the integrity of the intestinal barrier, and exerts anti-inflammatory effects, the researchers believe that it is useful both to reconcile the butyrate deficiency and to restore the butyrate-producing gut bacteria.
Larger studies will now be required to confirm these benefits.
Laserna-Mendieta et al. (2017) Determinants of Reduced Genetic Capacity for Butyrate Synthesis by the Gut Microbiome in Crohn’s Disease and Ulcerative Colitis. Journal of Crohn's and Colitis, 2018, 204–216 doi:10.1093/ecco-jcc/jjx137
Sotkin et al. (2018) How to Increase the Butyrate-producing Capacity of the Gut Microbiome: Do IBD Patients Really Need Butyrate Replacement and Butyrogenic Therapy? Journal of Crohn's and Colitis, jjy033, https://doi.org/10.1093/ecco-jcc/jjy033