The Who, What, Where, When and Sometimes, Why.

Lactobacillus

Lactobacillus

What is it?

Lactobacillus is a type of bacteria. There are lots of different species of lactobacillus. These are “friendly” bacteria that normally live in our digestive, urinary, and genital systems without causing disease. Lactobacillus is also in some fermented foods like yogurt and in dietary supplements.

Lactobacillus is taken by mouth to treat and prevent diarrhea, including infectious types such as rotaviral diarrhea in children and traveler’s diarrhea. It is also taken to prevent and treat diarrhea linked with using antibiotics

Some people take lactobacillus by mouth for general digestion problems, irritable bowel syndrome (IBS), colic in babies, inflammatory bowel disease (IBD), inflammation of the colon, too much bacterial growth in the intestines, constipation, to improve outcomes after bowel surgery, and to prevent a serious gut problem called necrotizing enterocolitis (NEC) in babies born prematurely. Lactobacillus is also taken by mouth for infection with Helicobacter pylori, the type of bacteria that causes ulcers, and also for other types of infections including urinary tract infections (UTIs), vaginal yeast infections, to prevent the common cold and flu, to prevent and treat diabetes during pregnancy, to prevent ear infections in children, and to prevent respiratory infections in healthy children and adults, in athletes, and in children with cystic fibrosis. It is also taken by mouth for weight loss, eye fatigue, rheumatoid arthritis, dental cavities, dental plaque, gum disease, and mouth sores. It is also being tested to prevent serious infections in people on ventilators.

Lactobacillus is used for skin disorders such as fever blisters, canker sores, eczema (allergic dermatitis); and acne.

It is also used for high cholesterol, lactose intolerance, Lyme disease, hives, and to boost the immune system.

Women sometimes use lactobacillus suppositories to treat vaginal infections and urinary tract infections (UTIs).

There are concerns about the quality of some lactobacillus products. Some products labeled to contain Lactobacillus acidophilus actually contain no lactobacillus acidophilus, or they contain a different strain of lactobacillus such as Lactobacillus bulgaricus. Some products are contaminated with “unfriendly” bacteria.

Natural Medicines Comprehensive Database rates effectiveness based on scientific evidence according to the following scale: Effective, Likely Effective, Possibly Effective, Possibly Ineffective, Likely Ineffective, Ineffective, and Insufficient Evidence to Rate.

The effectiveness ratings for LACTOBACILLUS are as follows:

Possibly Effective for…

  • Hayfever. Taking 2 billion colony-forming units of lactobacillus daily for 5 weeks can improve quality of life by almost 18% in people with grass pollen allergy that doesn’t respond to the anti-allergy drug loratadine. In children with allergies that persist throughout the year, taking 10 billion colony-forming units of lactobacillus for 12 weeks seems to improve itchy eye symptoms. But taking lactobacillus during pregnancy doesn’t seem to prevent the infant from developing allergies.
  • Preventing diarrhea caused by antibiotics. Taking probiotics products containing lactobacillus strains helps prevent diarrhea caused by antibiotics in adults and children. The most well-studied strain of lactobacillus seems to reduce the chance of diarrhea by about 60% to 70% when started within 2 days of beginning antibiotic treatment and continued for at least 3 days after finishing the antibiotics.
  • Eczema (atopic dermatitis). Most research shows that taking lactobacillus products can reduce eczema symptoms in infants and children. Research also shows that lactobacillus can help PREVENT eczema from developing. When taken by a mother during the last month of pregnancy , lactobacillus probiotics can reduce the chance of the child developing eczema . But not all strains seem to work.
  • A condition associated with an increased risk for developing allergic reactions (atopic disease). Research shows that taking certain lactobacillus strains can prevent the development of allergic reactions, such as asthma, runny nose, and eczema, in infants with a family history of this condition. However, not all strains seem to work.
  • Treating vaginal infections caused by bacteria (bacterial vaginosis). Researchers have found that lactobacillus suppositories and vaginal tablets may be effective in treating bacterial vaginosis. Researchers have also found that eating yogurt or using vaginal capsules containing lactobacillus can help prevent these infections from occurring again.
  • Preventing diarrhea due to cancer treatment (chemotherapy). A chemotherapy drug called 5-fluorouracil can cause severe diarrhea and other gastrointestinal (GI) side effects. There is some evidence that patients with cancer of the colon or rectum have less severe diarrhea, less stomach discomfort, and shorter hospital care when they take lactobacillus.
  • Constipation. Taking lactobacillus probiotics for 4-8 weeks can reduce symptoms of constipation including stomach pain and discomfort, bloating, and incomplete bowel movements. It might also increase the number of bowel movements in some people.
  • Diabetes. Taking lactobacillus starting at the beginning of the second trimester of pregnancy helps to prevent diabetes during pregnancy, especially in mothers over 35 years of age and mothers that had diabetes during another pregnancy. In women who develop diabetes during pregnancy, taking lactobacillus seems to help control blood sugar.
  • Diarrhea. Giving lactobacillus to infants and children 1-36 months old when they are admitted to the hospital seems to reduce the risk of developing diarrhea. Also, lactobacillus can reduce the risk of diarrhea from all causes in undernourished children. But most research shows that giving lactobacillus to children who already have diarrhea does not help them to get better faster.
  • Stomach pain. Most research shows that taking lactobacillus short-term can help to reduce symptoms in children with stomach pain. Early research also shows that taking lactobacillus and bifidobacterium short-term can improve symptoms in women with stomach pain.
  • Helicobacter pylori (H pylori) infection. Research shows that taking lactobacillus probiotics along with “triple therapy” that consists of the prescription drugs clarithromycin, amoxicillin, and a proton-pump inhibitor helps treat stomach ulcers caused by H. pylori. About 7-11 patients with H. pylori infections need to be treated with lactobacillus plus “triple therapy” for one additional patient to achieve remission compared to what would be achieved with “triple therapy” alone. But taking lactobacillus probiotics does not help treat the infection when taken alone, with only an antibiotic, with other “triple therapies,” or with “quadruple therapy” that includes bismuth.
  • High cholesterol. Taking lactobacillus probiotics can lower total cholesterol by about 10 mg/dL and low-density lipoprotein (LDL or “bad”) cholesterol by about 9 mg/dL in people with or without high cholesterol. However, lactobacillus probiotics do not seem to improve high-density lipoprotein (HDL or “good”) cholesterol or fats called triglycerides.
  • Colic in babies. Some research shows that giving lactobacillus to nursing infants reduces daily crying time. Some research suggests that lactobacillus is more effective at reducing crying time than using the drug simethicone. But one large study shows that lactobacillus does not reduce crying. It’s possible that infants in the large study had more severe colic than those in the earlier research.
  • Inflamed mouth sores from cancer treatment (oral mucositis). Research shows that taking lozenges containing lactobacillus from the first day of radiation/chemotherapy treatment until one week after reduces the number of patients who develop severe mouth sores.
  • A complication from surgery for ulcerative colitis (pouchitis). Taking lactobacillus by mouth seems to help treat pouchitis, a complication of surgery for ulcerative colitis. Taking a probiotic containing lactobacillus, bifidobacterium, and streptococcus for one year seems to maintain remission in 85% of people with this condition. Taking a different formulation containing two lactobacillus species and bifidobacterium for 9 months seems to reduce pouchitis severity.
  • Airway infections. Some research shows that lactobacillus probiotics can help prevent airway infections in infants and children. Giving lactobacillus to infants and children seems to reduce the chance of upper airway infections . Also, children ages 1-6 years who attend daycare centers seem to get fewer and less severe airway infections when given milk containing lactobacillus . However, not all strains seem to work. In adults, drinking fermented milk that contains lactobacillus might help prevent airway infections and decrease how long the infections last.
  • Rheumatoid arthritis (RA). Research shows that taking lactobacillus for 8 weeks reduces tender and swollen joints in women with rheumatoid arthritis.
  • Traveler’s diarrhea . Traveler’s diarrhea is caused by bacteria, viruses, or parasites that the traveler has not been exposed to before. Taking lactobacillus seems to help prevent diarrhea in travelers. The effectiveness can vary a lot depending on the travel destination because of differences in bacteria in different locations.
  • A bowel condition called ulcerative colitis. Lactobacillus probiotics seem to increase remission in people with ulcerative colitis. The best evidence of benefit is for a multi-species probiotic containing lactobacillus, bifidobacterium, and streptococcus. Research shows that taking this product can increase remission rates by almost 2-fold when used with standard ulcerative colitis treatment. Taking a single strain of lactobacillus also seems to improve symptoms. But lactobacillus doesn’t seem to prevent ulcerative colitis relapse.

Possibly Ineffective for…

  • Diarrhea caused by the bacterium Clostridium difficile. People who are treated for Clostridium difficile infections often experience recurrence. Although some conflicting results exist, most research shows that taking lactobacillus does not prevent recurrent episodes of Clostridium difficile diarrhea. Most research also shows that lactobacillus probiotics do not prevent first episodes of Clostridium difficile diarrhea.
  • Crohn’s disease. Taking lactobacillus probiotics does not prevent Crohn’s disease from becoming active again in people who are in remission or in those who have just had surgery for Crohn’s disease.
  • Dental plaque. Giving lactobacillus to pregnant women starting 4 weeks before delivery until birth, and then continuing in the infants until 12 months of age, does not seem to reduce dental plaque in the baby teeth of the child by the age of 9 years.
  • Exercise-induced respiratory infections. Research in trained athletes shows that taking lactobacillus probiotics does not reduce the risk of developing a respiratory infection. It also does not seem reduce the symptoms of respiratory infections in athletes.
  • Vaginal yeast infections . Taking lactobacillus by mouth or eating yogurt enriched with lactobacillus doesn’t prevent vaginal yeast infections in women that have used antibiotics. However, symptoms seem to improve if vaginal suppositories containing lactobacillus are used along with conventional treatment .

Insufficient Evidence to Rate Effectiveness for…

  • Acne. Early research shows that taking a probiotic containing lactobacillus and bifidobacterium along with minocycline improves acne.
  • Eye strain. Early research shows that taking lactobacillus does not reduce the strain on the eyes caused by monitors and screens. However, in some people who already have a lot of strain on the eyes, taking lactobacillus might help to reduce additional strain and redness.
  • Bipolar disorder. Taking a probiotic containing lactobacillus and bifidobacterium after being discharged from the hospital might reduce the chance that people with bipolar disorder will need to be readmitted due to worsening of symptoms.
  • Common cold. Early research shows that taking lactobacillus daily for 12 weeks reduces the risk of common cold by about 12% and reduces the number of days with symptoms from 8.6 to 6.2 in adults. Also, taking lactobacillus plus bifidobacterium for 3 months seems to reduce school absences due to cold symptoms. However, research is inconsistent. Taking some lactobacillus strains does not seem to reduce the risk of catching a cold or the number of cold/flu days.
  • Cystic fibrosis. Research suggests that taking lactobacillus daily for 6 months reduces the percentage of cystic fibrosis patients with lung complications from 37% to 3% and the percentage with upper respiratory tract infections from 20% to 3%.
  • Cavities. Giving lactobacillus to pregnant women starting 4 weeks before delivery until birth, and then continuing in the infants until 12 months of age, helps to prevent cavities in the child’s baby teeth. But giving lactobacillus to infants does not prevent cavities in teeth.
  • Flu. Taking a drink containing one strain of lactobacillus 5 days weekly for 8 weeks reduces the incidence of the flu in schoolchildren during flu season. Taking a different lactobacillus strain daily for 6 weeks does not reduce the number of cold/flu days in otherwise healthy adults.
  • Treating irritable bowel syndrome (IBS). Many studies have evaluated lactobacillus species for treating IBS. Some strains might reduce IBS symptoms including abdominal pain, bloating, and gas in some people. But other lactobacillus strains don’t seem to work in most people with IBS.
  • Trouble digesting lactose, the sugar in milk. Some research shows that drinking milk with lactobacillus still causes symptoms , like gas, in people with lactose intolerance. But other research shows that drinking a milk product containing lactobacillus reduces symptoms of lactose intolerance.
  • Necrotizing enterocolitis (NEC) in babies born prematurely. When results from multiple clinical studies are evaluated, giving lactobacillus to preterm infants seems to reduce the risk of severe NEC by 30% to 55%. But when results from individual clinical studies are considered, lactobacillus does not seem to prevent NEC. It’s possible that the individual clinical studies are too small to show benefit. It’s also possible that lactobacillus may be more beneficial when used along with other probiotics than when used as a single probiotic.
  • Skin rash caused by sun exposure (polymorphous light eruption). Early research shows that taking a supplement containing lactobacillus and other ingredients reduces how severe skin reactions are after sun exposure in people with a disorder called polymorphous light eruption.
  • Diarrhea in children caused by a certain virus (rotaviral diarrhea). Some small studies show that certain lactobacillus strains can help some children with rotaviral diarrhea get over their diarrhea up to 3 days sooner. But other research shows that giving lactobacillus to children with rotaviral diarrhea does not help them to get better faster. More research is needed to understand which strains, if any, can help with this condition. Also, more research is needed to determine if lactobacillus has different effects in children who have been given rotavirus vaccine compared with those who have not.
  • Growth of bacteria in the intestines. Some clinical research has evaluated lactobacillus for treating and preventing the growth of potentially harmful bacteria in the intestines. Some of this research shows slight improvements in symptoms such as stomach pain, bloating, and diarrhea . But other research has found no benefit in people with this condition. Lactobacillus does not seem to be helpful for preventing growth of harmful bacteria in the intestines.
  • Urinary tract infections (UTIs). There is some early evidence that taking lactobacillus by mouth or putting it on the vagina might be helpful for preventing UTIs . However, not all strains seem to work, and not all studies agree.
  • Pneumonia in people on breathing machines in the hospital. Early research shows that taking lactobacillus might reduce the incidence of pneumonia in people in the intensive care unit.
  • Weight loss. Research shows that taking lactobacillus does not reduce fat or weight in most obese adults. However, it might reduce body weight in women.
  • Boosting the immune system.
  • Cancer.
  • Canker sores.
  • Fever blisters.
  • Hives.
  • Lyme disease.
  • Other conditions.

More evidence is needed to rate lactobacillus for these uses.

Many bacteria and other organisms live in our bodies normally. “Friendly” bacteria such as lactobacillus can help us break down food, absorb nutrients, and fight off “unfriendly” organisms that might cause diseases such as diarrhea.

Lactobacillus is LIKELY SAFE for most people, including babies and children. Side effects are usually mild and most often include intestinal gas or bloating.

Lactobacillus is also LIKELY SAFE for women to use inside the vagina.

Special Precautions & Warnings:

Pregnancy and breast-feeding: Using lactobacillus during pregnancy and breast-feeding is POSSIBLY SAFE. Lactobacillus GG has been used safely in pregnant and breast-feeding women. But other types of lactobacillus have not been studied during pregnancy and breast-feeding, so their safety is unknown.

Weakened immune system: There is some concern that lactobacillus from supplements that contain live bacteria might grow too well in people whose immune systems are weakened. This includes people with HIV/AIDS or people who have taken medicines to prevent rejection of a transplanted organ. Lactobacillus has caused disease (rarely) in people with weakened immune systems. To be on the safe side, if you have a weakened immune system, talk with your healthcare provider before taking lactobacillus.

Short bowel syndrome: People with short bowel syndrome might be more likely than other people to develop lactobacillus infections. If you have this condition, talk with your healthcare provider before taking lactobacillus.

Antibiotic drugs

Interaction Rating = Moderate Be cautious with this combination.
Talk with your health provider.

Antibiotics are used to reduce harmful bacteria in the body. Antibiotics can also reduce friendly bacteria in the body. Lactobacillus is a type of friendly bacteria. Taking antibiotics along with lactobacillus can reduce the effectiveness of lactobacillus. To avoid this interaction, take lactobacillus products at least 2 hours before or after antibiotics.

Medications that decrease the immune system (Immunosuppressants)

Interaction Rating = Moderate Be cautious with this combination.
Talk with your health provider.

Lactobacillus contains live bacteria and yeast. The immune system usually controls bacteria and yeast in the body to prevent infections. Medications that decrease the immune system can increase your chances of getting sick from bacteria and yeast. Taking lactobacillus along with medications that decrease the immune system might increase the chances of getting sick.

Some medications that decrease the immune system include azathioprine (Imuran), basiliximab (Simulect), cyclosporine (Neoral, Sandimmune), daclizumab (Zenapax), muromonab-CD3 (OKT3, Orthoclone OKT3), mycophenolate (CellCept), tacrolimus (FK506, Prograf), sirolimus (Rapamune), prednisone (Deltasone, Orasone), corticosteroids (glucocorticoids), and others.

Iron 
Some lactobacillus seems to increase the absorption of iron when taken at the same time. It’s possible that taking this lactobacillus species along with iron supplements might cause some people to get too much iron. But this has not been reported in humans.

Iron
Some lactobacillus seems to increase the absorption of iron from food when taken at the same time. It’s possible that taking this lactobacillus along with iron supplements might cause some people to get too much iron. But this has not been reported in humans.

The strength of lactobacillus products is usually indicated by the number of living organisms per capsule. Typical doses range from 1 to 10 billion living organisms taken daily in 3-4 divided doses.

The following doses have been studied in scientific research:

BY MOUTH:

  • For children with rotaviral diarrhea: 5 to 10 billion live Lactobacillus GG in a solution that replaces lost water.
  • For treating babies and children with diarrhea:
    • 10 to 100 billion live Lactobacillus reuteri daily for up to 5 days. Lower doses may not be effective.
    • Also, combination of Lactobacillus rhamnosus and Lactobacillus reuteri, 10 billion live cells of each strain, twice daily for 5 days.
  • For preventing antibiotic-associated diarrhea in children: A specific strain of Lactobacillus rhamnosus, Lactobacillus GG (Culturelle) containing 20 billion live organisms daily has been used during treatment with antibiotics. A specific beverage containing Lactobacillus casei, Lactobacillus bulgaricus, and Streptococcus thermophilus (Actimel, Danone) 97 mL twice daily also has been used.
  • For preventing diarrhea in infants and children ages 1 to 36 months:
    • 6 billion live Lactobacillus GG twice daily.
    • A fermented milk product containing a specific Lactobacillus casei strain DN-114 001 (DanActive, Dannon) in doses of 100 grams, 125 grams, or 250 grams daily has also been used.
  • For preventing and shortening the duration of diarrhea in newborns within the first year of life in rural areas of developing countries: 100 million live Lactobacillus sporogenes have been given daily for one year.
  • For preventing respiratory infections in children attending day-care centers: 260 mL milk with 500,000 to 1 million colony-forming units of Lactobacillus GG per mL. A milk product containing 5 billion colony forming units each of Lactobacillus acidophilus and Bifidobacterium (HOWARU Protect, Danisco) in 120 mL of milk twice a day has also been used. A milk product containing Lactobacillus 5 billion colony forming units in 120 mL of milk twice a day has also been used.
  • For treating recurrent diarrhea caused by Clostridium difficile: 1.25 billion live Lactobacillus GG in two divided doses for 2 weeks.
  • For ulcerative colitis: a combination product containing living freeze-dried bacteria species including lactobacillus, bifidobacteria, and streptococcus (VSL#3) 3 grams twice daily has been used for maintenance therapy.
  • For patients with active mild-to-moderate ulcerative colitis: VSL#3 three grams once or twice daily in combination with conventional treatment.
  • For children with moderate-to-severe ulcerative colitis: VSL#3 450-1800 billion bacteria once a day in combination with mesalamine.
  • For preventing traveler’s diarrhea: Lactobacillus GG, 2 billion organisms daily.
  • For diarrhea due to chemotherapy: a specific strain of Lactobacillus rhamnosus, Lactobacillus GG (Culturelle) containing 10-20 billion live organisms daily.
  • For atopic dermatitis: a specific strain of Lactobacillus rhamnosus, Lactobacillus GG (Culturelle). Lactobacillus reuteri 100 million live bacteria daily, or Lactobacillus sakei 5 billion live bacteria twice daily have also been used.
  • For irritable bowel syndrome (IBS): 10 billion heat-killed Lactobacillus acidophilus (Lacteol Fort) twice daily for 6 weeks. A specific lactobacillus combination probiotic containing viable lyophilized bacteria species including lactobacillus, bifidobacteria, and streptococcus (VSL#3) containing 450 billion viable lyophilized bacteria twice daily. A specific beverage containing Lactobacillus plantarum 299v (ProViva, Skanemejerier, Sweden) taken twice daily.
  • For preventing the common cold in adults: a mixture of Lactobacillus plantarum and Lactobacillus paracasei, 1 billion live bacteria daily.
  • For colic in babies: A specific Lactobacillus reuteri product (Probiotic Drops, BioGaia AB) 100 million CFUs once daily 30 minutes after a feeding.
  • For preventing the serious gut condition called necrotizing enterocolitis (NEC) in babies born prematurely: Lactobacillus rhamnosus GG 6 billion live bacteria daily.
  • For preventing serious lung infections in adults on ventilators: Lactobacillus rhamnosus GG (Amerifit Brands Nutrition), 2 billion live bacteria twice daily.

APPLIED INSIDE THE VAGINA:

  • For treating vaginal infections caused by bacteria:
    • 1-2 vaginal tablets (Gynoflor, Medinova, Switzerland) daily containing living Lactobacillus acidophilus (10 million colon-forming units/tablet) and 0.3 mg estriol for 6 days.
    • Intravaginal suppositories containing 100 million to 1 billion colony forming units of Lactobacillus acidophilus (Vivag, Pharma Vinci A/S, Denmark) given twice daily for 6 days has also been used.
    • Vaginal capsules containing Lactobacillus gasseri and Lactobacillus rhamnosus, 100 million to 1 billion colony-forming units of each strain per capsule (EcoVag Vaginal Capsules, Bifodan A/S, Denmark), following usual treatment, for 10 days in three menstrual cycles following the infection has also been used.

Acidophilus, Acidophilus Bifidus, Acidophilus Lactobacillus, L. Acidophilus, L. Amylovorus, L. Brevis, L. Bulgaricus, L. Casei Immunitas, L. Casei, L. Crispatus, L. Delbrueckii, L. Fermentum, L. Gallinarum, L. Helveticus, L. Johnsonii, L. Johnsonii LC-1, L. Lactis, L. Plantarum, L. Reuteri, L. Rhamnosus, L. Salivarius, L. Sporogenes, Lacto Bacillus, Lactobacille, Lactobacilli, Lactobacilli Acidophilus, Lactobacilli Bulgaricus, Lactobacilli Plantarum, Lactobacilli Rhamnosus, Lactobacilli Salivarium, Lactobacillus acidophilus, Lactobacillus amylovorus, Lactobacillus brevis, Lactobacillus bulgaricus, Lactobacillus casei, Lactobacillus casei sp. rhamnosus, Lactobacillus crispatus, Lactobacillus delbrueckii, Lactobacillus delbrueckii ssp. bulgaricus, Lactobacillus fermentum, Lactobacillus gallinarum, Lactobacillus Gasseri, Lactobacillus GG, Lactobacillus Helveticus, Lactobacillus johnsonii, Lactobacillus Lactis, Lactobacillus Paracasei, Lactobacillus plantarum, Lactobacillus reuteri, Lactobacillus Rhamnosus GG, Lactobacillus rhamnosus, Lactobacillus sakei, Lactobacillus Salivarium, Lactobacillus salivarius, Lactobacillus sporogenes, Lactobacilo, Lactospores, LC-1, Probiotics, Probiotiques.


 

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