Colonoscopies Upset Your Microbiome

By Ross Pelton

Scientific Director, Essential Formulas

Ross Pelton is a pharmacist, nutritionist, author and a health educator who is widely recognized as the world’s leading authority on drug-induced nutrient depletions. He was named one of the top 50 most influential pharmacists in the United States by American Druggist magazine for his work in Natural Medicine.

Maintaining a healthy microbiome is now recognized as one of the most critical factors regarding overall health. Thus, whenever the microbiome is damaged or disrupted, steps should be taken as soon as possible to reestablish a healthy microbiome.

Until recently, commercial probiotic products were considered to be the best way to reestablish a healthy microbiome. Some microbiome scientists are now suggesting that directly delivering postbiotic metabolites is a faster and more effective method of accomplishing rapid microbiome restoration.i Postbiotic metabolites is the term that refers to the wide range of health-regulating compounds that bacteria produce and secrete in the intestinal tract when they digest and ferment the fiber content in the foods we eat.

Colonoscopies are universally recognized as the most accurate test for colorectal cancer and early detection saves lives. Colorectal cancer is the 2nd leading cause of cancer-related deaths in the U.S. and it is estimated that over 50,000 Americans will die from colorectal cancer in 2018.ii It is generally recommended adults aged 50–75, should have a colonoscopy every 10 years and approximately 15 million colonoscopies are performed in the U.S. each year.

Colonoscopies are promoted as a safe procedure when performed by doctors who have experience performing the procedure. However, recent studies are reporting that side effects from colonoscopies are more common than previously reported. It is hypothesized that some of these symptoms are related to alterations in gut microbiome that result from the procedure used to clean out the bowel in preparation for a colonoscopy.

Colonoscopies Disrupt Your Microbiome

The most common side effects following a colonoscopy are pain and abdominal swelling or bloating. A study published in 2015 reported that 20% of patients experience pain for two or more days following a colonoscopy. In this double-blind, placebo-controlled trial, patients who took probiotics after their colonoscopy had a 30% decrease in the number of post-colonoscopy days of pain.iii

Taking Probiotics Before Colonoscopy Can Help

In another double-blind, placebo-controlled trial, 104 patients with constipation were given probiotics or a placebo daily for two weeks before their pre-colonoscopy bowel prep procedure. Pre-treatment with probiotics resulted in more effective bowel cleansing, improved colonic mucosa visualization during the colonoscopy and reduction of intestinal distress symptoms following the colonoscopy.iv

Shopping for Probiotics Before Your Colonoscopy?

Probiotic supplements like Dr. Ohhira’s Original Formula are a good choice for improving digestive health before and after your next Colonoscopy!

Long-Term Microbiome Disruption Following Colonoscopy Bowel Prep

Polyethylene glycol (PEG) is one of the most commonly used agents to clean out the bowel prior to a colonoscopy. Fecal samples for microbiome analysis were collected from a group of patients 1 week before, the day of the colonoscopy after completion of the PEG bowel prep procedure, and again 30-days later. The results revealed that PEG bowel cleansing resulted in long-lasting changes in the microbiome. One month later, the participants in the study were found to have a significant decrease in beneficial strains of Lactobacilli and a significant increase Proteobacteria, which can cause diarrhea.v

Post-Colonoscopy Infections 100 x Higher Than Previously Thought

Results of a study published in the May 18, 2018 issue of the medical journal GUT reported that the rates of infections following a colonoscopies that are performed at ambulatory surgery centers (ASCs) were more than 100 times higher than

ASCs are outpatient facilities where patients can have minor procedures performed without going into a hospital. ASCs have been around for several decades, but their popularity has increased greatly in recent years as patients have looked for less expensive and more convenient alternatives to traditional hospital settings.

70+% of Immune System Resides in GI Tract

Scientists estimate that between 70 – 80% of the body’s immune cells are located in the gastrointestinal tract.vii,viii This part of the gut microbiota is a complex relationship and interaction between the lymphoid cells that reside in the lining of the GI tract, the bacteria in the intestinal tract and the postbiotic metabolites produced by the intestinal bacteria.

Dysbiosis = Immune Dysfunction

A healthy microbiome is generally thought to consist of approximately 85-90% beneficial bacteria and only 10-15% “bad” bacteria.ix,x Dysbiosis, or a pathogenic microbiome, causes immune dysfunction, which increases the risk of developing disease.xi Therefore, whenever the normal microbiome balance is upset or disturbed, quick action should be taken to reestablish the predominant abundance of beneficial probiotic bacteria and postbiotic metabolites. 

Don’t Avoid Your Colonoscopy

Colonoscopies are important screening procedures that help physicians detect colorectal cancer early. Consequently, screening colonoscopies decrease the risk of developing as well as dying from colorectal cancer.xii

The purpose of this article is NOT to frighten or suggest that people should avoid a colonoscopy, even if you have irritable bowel syndrome or chronic inflammatory bowel disease. Instead, the purpose of this article is to encourage gastroenterologists and the general public to take steps to maintain and/or reestablish a healthy microbiome following a colonoscopy. The studies reviewed in this article indicate that taking probiotics before and/or following a colonoscopy will help to reduce the incidence of side effects and enhance the immune system to prevent post-colonoscopy infections.The fastest and most effective method of reestablishing a healthy microbiome is to directly ingest a product that delivers a combination of probiotic bacteria and postbiotic metabolites, such as Dr. Ohhira’s Probiotics.

Do probiotics help the colon?

Yes, by lowering the pH levels in the colon stools are able to cleanly pass through.

Can you take probiotics during colonoscopy prep?

Yes, studies have shown that taking probiotic supplements before a colonoscopy can help keep the colon clean.

Probiotics After Colonoscopy

As discussed above, probiotics after colonoscopy can certainly help rebalance your microbiome and decrease or prevent post-colonoscopy issues.

Should I take probiotics After a Colonoscopy

Always consult your physician before taking any supplement. However, taking a well-formulated probiotic supplement can help rebalance your microbiome quickly, improve digestion, decrease complications, and may help prevent infections.

i Klemashevich C. et al. Rational identification of diet-derived postbiotics for improving intestinal microbiota functions. Current Opinion in Biotechnology. 2014 April;26:85-90.
ii Levin B, et al. Screening for Colorectal Cancer: A Comparison of 3 fecal Occult Blood Tests. JAMA Internal Medicine. 1997 May 12;157(9):970-976.
iii D’Souza B, et al. Randomized controlled trial of probiotics after colonoscopy. ANZ J Surg. 2015 July 17;87(9).
iv Lee H. A feasibility study of probiotics pretreatment as a bowel preparation for colonoscopy in constipated patients. Dig Dis Sci. 2010 Aug;55(8):2344-51.
v Drago L. Persisting changes of intestinal microbiota after bowel lavage and colonoscopy. Eur J Gastroehterol Hepatol. 2016 May;28(5):532-7.
vi Wang P. et al. Rates of infection after colonoscopy and osophagogastroduodenoscopy in ambulatory surgery centres in the USA. Gut. 2018 May 18;
vii Bengmark S. Pre-, pro- and synbiotics. Current Opinion in Clinical Nutrition and Metabolic Care. 2001 Nov;4(6):571-579.
viii Furness JB, et al. Nutrient tasting and signaling mechanisms in the gut. II. The intestine as a sensory organ: neural, endocrine, and immune responses. Am J Physiol. 1999 Nov;277(5 Pt 1):G922-8.
ix Hoffman R. Probiotics: twenty-first century support for healthy digestive and immune systems. Townsend Letter. Feb.-Mr. 2007:144.
x The Science of Probiotics. Nutrition Digest. Spring 2006;volume 38, No.2.
xi Shi N. et al. Interaction between the gut microbiome and mucosal immune system. Mil Med Res. 2017 Spr 27;4:14.
xii Umar SB, et al. The proof is in the pudding: improving adenoma detection rates reduces interval colon cancer development. Transl Gastroenterol Hepatol. 2017;2:99.


By Ross Pelton, RPh, PhD, CCN
Scientific Director, Essential Formulas

Ross Pelton is a pharmacist, nutritionist, author and a health educator who is widely recognized as the world’s leading authority on drug-induced nutrient depletions. He was named one of the top 50 most influential pharmacists in the United States by American Druggist magazine for his work in Natural Medicine.

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