Updated on February 2, 2023
Nearly one million U.S. adults suffer from ulcerative colitis (UC) and experience a host of symptoms that can significantly diminish quality of life. In severe cases, UC can even be life-threatening. With no known cure and an unclear etiology, UC presents major challenges, and many patients struggle to find durable relief from symptoms.
Although current ulcerative colitis therapies include traditional small molecule drug therapies, biologics and biosimilars, nutritional supplements, and lifestyle modifications, the relative effectiveness of each option varies depending on the patient. Additionally, most conventional drug therapies for ulcerative colitis are designed to address only the symptoms of UC—and many come along with debilitating side effects—while leaving its root mechanisms unaddressed. However, in recent years, there has been increasing research interest in potential therapies that directly target the underlying causes of UC symptoms to more fully alleviate gastrointestinal distress. As a result of these investigations, in early 2017 a team of Australian researchers introduced multidonor fecal microbiota transplantation (FMT) as a novel therapy. The research team’s paper provides insight into the effectiveness of this intriguing UC supportive therapy, as well as shedding new light on why certain nutritional supplements might also be effective.
In March 2017, a group of researchers from the University of South Wales in Australia published a groundbreaking study in The Lancet on multidonor FMT, in which fecal samples from multiple healthy patients were transplanted into the colon of patients with active ulcerative colitis. The impetus for the study was the growing recognition of the role of microbiome composition in the pathogenesis of ulcerative colitis. The researchers hypothesized that transplanting fecal microbiota from multiple donors might alter the gut microbiota of patients with ulcerative colitis, which would ideally have measurable functional effects. In a randomized, placebo-controlled study of a sample population of 85 patients at three Australian hospitals, the researchers successfully demonstrated that multidonor FMT could accomplish both aims: changing the composition of the gut microbiome and increasing the likelihood of remission.
After the transplantations, the researchers used shotgun metagenomics to analyze the microbial composition of the patients’ gastrointestinal tracts. Not only did they find a significant rise in the diversity of the gut microbiota in the treatment group compared to the control group (who had received a placebo), there were also noticeable shifts in the prevalence of certain bacterial taxa. Significantly, a number of these changes were clearly correlated with clinical outcomes.
One of the study’s key findings was that multidonor FMT results in a shift in the dominant bacteria in the gut microbiome from the genus Bacteroides to Prevotella. These are both genera of bacteria normally present in the gut, although their prevalence can vary. Although the implications of this shift after multidonor FMT are not fully clear, it opened an exciting new avenue for exploration. The authors also observed that the presence of bacteria from the phylum Firmicutes were loosely correlated with symptom remission. This included bacteria from the genus Lachnospiraceae, a genus that other studies have associated with the production of butyrate, a substance that plays a wide range of essential roles in the body. There were also several bacterial genera correlated with a lack of remission. Although it is unclear why these specific genera are not associated with remission, the researchers did note that many are involved in heme biosynthesis.
It is well-understood that the metabolic activities of gut bacteria play a key role in the functioning of the gastrointestinal tract, having both positive and negative impacts. Notably, the researchers found that changes in global bacterial metabolic function after FMT are also correlated with remission or lack thereof. Specifically, the results indicate that a rise in bacterial heme biosynthesis after FMT is associated with a lack of remission, while starch degradation activity and short-chain fatty acid production are correlated with benefits for ulcerative colitis patients.
Multidonor FMT is not among the ulcerative colitis supportive therapy options widely available today. However, the results of the Australian study provide insight into some of the options that are available, including multiple nutritional supplementation options. Of particular interest is the key finding that symptom relief is associated with microbiome changes that facilitate short-chain fatty acid production. Although the breakdown of fibers by bacteria is the main source of short-chain fatty acid production in the gut, they can also be introduced in supplement form. In recent years, anecdotal evidence for the effectiveness of short-chain fatty acid supplements like butyrate has been growing, and they have become increasingly popular among patients. The results of this study provide rigorous evidence that the presence of butyrate in the gut is associated with beneficial impacts on symptoms, which builds a stronger evidence-based case for the effectiveness of butyrate supplements.
Omega-3 fatty acid supplementation is another ulcerative colitis supportive therapy that patients may want to consider. In multiple research studies, omega-3 fatty acid supplements have been associated with some of the same benefits the Australian research team found in patients who achieved remission after multidonor FMT, including an overall rise in microbial diversity and a shift in the prevalence of bacterial genera involved in butyrate production, such as Lachnospiraceae. Additionally, omega-3 fatty acid supplementation is associated with a decline in the prevalence of bacterial species within the genus Faecalibacterium, which are suspected to be involved in the exacerbation of UC symptoms.
In addition to butyrate and omega-3 fatty acids, probiotics and prebiotic supplements also help maintain the health of the gut microbiome. Like multidonor FMT, a probiotic supplement enhances the bacterial composition of the microbiome in UC patients. Meanwhile, prebiotic fiber supplements support the gut microbiome by introducing fibers that feed the “good” bacteria in the gut, giving them fuel to create beneficial metabolites like butyrate.
When considering nutritional supplements as a potential ulcerative colitis supportive therapy, it is essential to recognize the relevance of supplement bioavailability. Recent research indicates there is a wide range of factors that affect the bioavailability of supplements and therefore their efficacy. For individuals taking an omega-3 supplement, for instance, improper dosage and timing of intake might limit bioavailability, whereas bioavailability can be optimized when formulators alter lipid oxidation levels or add omega-3 fatty acids to supplements and functional foods in an emulsified form. For UC patients, finding a highly bioavailable supplement is particularly important because ongoing gut inflammation can interfere with nutrient absorption.
Despite the fact that ulcerative colitis remains poorly understood, it is clear from the latest research breakthroughs that the future is promising. Not only does the Australian study on multidonor FMT present a novel way to support remission in UC patients, it also sheds light on some of the nutritional supplements most commonly used by patients, helping to build on the anecdotal evidence by solidifying the research foundation for supplementation as a viable supportive therapy for UC. As researchers continue to investigate potential future therapies, particularly those aimed at manipulating the gut microbiome, patients and practitioners can take advantage of insights like these when considering the currently available therapies. Already, cutting-edge supplement manufacturers are developing more bioavailable supplements to allow UC patients to explore their potential therapeutic benefits. As a result, patients now have more and better options for creating well-tolerated multidisciplinary therapies and experiencing more relief from symptoms.
The power of Tesseract supplements lies in enhancing palatability, maximizing bioavailability and absorption, and micro-dosing of multiple nutrients in a single, highly effective capsule. Visit our website for more information about how Tesseract’s products can help support your gastrointestinal health.*
Constantini L, Molinari R, Farinon B, Meredino N. 2017. International Journal of Molecular Sciences. 18(2):2645.
Garud S, Peppercorn, M. 2009. Therapeutic Advances in Gastroenterology. 2(2):99-108.
Ghasemifard S, Sinclair AJ, Kaur G, Lewandowski P, Turchini GM. 2015. Nutrients. 7(7):5628-45.
Noriega BS, Sanchez-Gonzalez MA, Salyakina D, Coffman J. 2016. Case Reports in Medicine.
Ottestad I, Nordvi B, Vogt G, Holck M, Halvorsen B et al. 2016. Journal of Nutritional Science. 5:e43.
Owczarek D, Rocacki T, Domagala-Rodacka R, Cibor D, Mach T. 2016. World Journal of Gastroenterology. 22(3):895-905.
Parmasothy S, Kamm MA, Kaakoush NO, Walsh AJ, van den Bogaerde J et al. 2017. The Lancet. 389(10075):1218-28.