Saccharomyces boulardii

Category

Herbs & Supplements

Synonyms

Brewer's yeast, Florastor®, Florastor® Kids, Hansen CBS 5926, Lactobacillus, Lactobacillus acidophilus, Lactobacillus bulgaricus, Lactobacillus gasseri, Lactobacillus GG, Lactobacillus plantarum, Perenterol®, probiotic, S. boulardii, Saccharomyces cerevisiae, Saccharomyces salivarius, Saccharomyces thermophilus, Saccharomycetaceae (family), Ultra-Levure®, yeast.

Note: There is debate as to whether Saccharomyces boulardii is a subspecies of Saccharomyces cerevisiae or a separate entity. Traditional techniques cannot distinguish the two, but manufacturers of Saccharomyces boulardii claim that the two yeasts are separate species.

Background

Saccharomyces boulardii is a non-pathogenic yeast strain that has been used for treatment and prevention of diarrhea. Saccharomyces boulardii is classified as a "probiotic," or a microorganism that when ingested may have a positive influence on the host's health. Probiotics may exert their effects on the gastrointestinal system directly, or may modulate the immune system in a larger scope.

Human studies indicate Saccharomyces boulardii may prevent antibiotic-associated diarrhea, Clostridium difficile diarrhea in combination with antibiotic therapy, diarrhea associated with tube feeds, and acute childhood diarrhea. Promising initial studies have shown that Saccharomyces boulardii may be beneficial in treating diarrhea associated with HIV.

The German Commission E has approved the use of Saccharomyces boulardii for symptomatic treatment of acute diarrhea, prophylactic and symptomatic treatment of diarrhea during travel, treatment of diarrhea occurring while tube feeding, use as an adjuvant for chronic acne, for a dietary supplementation, and for a source of B vitamins and protein.

Evidence

DISCLAIMER: These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.

Diarrhea (antibiotic associated): There is good evidence that concurrent use of Saccharomyces boulardii with antibiotic therapy reduces the incidence of developing antibiotic-associated diarrhea (AAD) (Clostridium difficile and other). In general, positive results occur only when Saccharomyces boulardii is continued for several days to several weeks after the course of antibiotics is stopped. Duplication of these results should still be attempted to confirm these findings.
Grade: A

Diarrhea in children: Several trials suggest efficacy of Saccharomyces boulardii in the treatment of diarrhea in childhood. Further studies are still required. Use of Saccharomyces boulardii may be advantageous in both the reduction of stool frequency per day and the duration of diarrhea in this age group.
Grade: B

Antibacterial (amebiasis): Evidence from one clinical trial supports improvement of symptoms and in patients with amebiasis treated with Saccharomyces boulardii, in addition to standard therapy. Further clinical trials are required before a firm recommendation can be made.
Grade: C

Crohn's disease: Evidence supports mild improvement of symptoms and quality of life in patients with Crohn's disease who use Saccharomyces boulardii. More clinical trials are required before a firm recommendation can be made in this area.
Grade: C

Diarrhea (Clostridium difficile): With the introduction of broad-spectrum antibiotics into clinical practice, Clostridium difficile infection has become a common cause of infectious diarrhea in hospitalized patients. For treatment of recurrent Clostridium difficile-associated diarrhea, Saccharomyces boulardii may decrease recurrences by about 50%, especially when combined with high-dose vancomycin. Further studies are still required.
Grade: C

Diarrhea (HIV associated): While only small studies have been performed, treatment with Saccharomyces boulardii may improve quality of life for AIDS patients with chronic diarrhea. As fungemia has been associated with Saccharomyces boulardii administration in patients with central lines, care should be exercised in treating these patients.
Grade: C

Diarrhea (prevention during tube feeding): Preliminary evidence supports the use of Saccharomyces boulardii for this indication. However, the role of antibiotics in the results is unclear. More studies should be performed before a strong recommendation can be made.
Grade: C

Diarrhea (traveler's): Although evidence supports the use of Saccharomyces boulardii for other forms of diarrhea, little evidence exists to support standard treatment with Saccharomyces boulardii for traveler's diarrhea. More studies need to be performed.
Grade: C

Irritable bowel syndrome (IBS): One clinical trial exists to support treatment with Saccharomyces boulardii for irritable bowel syndrome. Additional study is required before a firm recommendation can be made.
Grade: C

Nutritional support (premature infants): One clinical trial exists investigating the addition of Saccharomyces boulardii to nutritional support for premature infants. No evidence was found for lipid gut absorption or increased weight gain. A benefit was noted on gut flora. Additional study is needed.
Grade: C

Tradition

WARNING: DISCLAIMER: The below uses are based on tradition, scientific theories, or limited research. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider. There may be other proposed uses that are not listed below.
Acne, aging, allergies, anorexia, autism, cancer, Candidal infection, cholera, colitis (inflamed colon), constipation, cystic fibrosis, depression, diabetes, digestive disorders (Hirschsprung's disease), fatigue, fever, flatulence (gas), food allergies, H. pylori infection (children), herpes, hyperlipidemia (high cholesterol), lactose intolerance, mood changes (irritability), nutrition, osteoporosis (prevention), premenstrual syndrome (pms), seborrheic dermatitis (inflamed skin), skin disorders, stress, ulcerative colitis, ulcers, urinary tract infections (UTIs), weight loss.

Dosing

Adults (18 years and older):

In large multicenter trials, few (if any) side effects have been noted in patients taking Saccharomyces boulardii for up to 15 months. Regardless of diarrhea type, Saccharomyces boulardii is often taken in doses of 500-2,000 milligrams in divided daily doses (three or four times daily). The brand name product, Ultra-Levure®, has been studied in doses of 2-4 capsules daily for up to eight months. For antibiotic-associated diarrhea, 1 gram daily for three days following completion of antibiotics has been used. Two sachets per day containing 5x10⁹ colony forming units (CFU) per sachet has also been used for four weeks. One capsule twice daily has been used; duration was not noted. 250-500mg twice daily for up to two weeks following antibiotics has been used. Four capsules Ultra-Levure® daily for eight months has been used.

Children (younger than 18 years):

The most commonly used dose for Saccharomyces boulardii in children for the treatment of diarrhea is 250-600 milligrams daily for up to five days. This has been given alone and in combination with antibiotics.

Safety

DISCLAIMER: Many complementary techniques are practiced by healthcare professionals with formal training, in accordance with the standards of national organizations. However, this is not universally the case, and adverse effects are possible. Due to limited research, in some cases only limited safety information is available.

Allergies

Avoid in individuals with a known allergy or hypersensitivity to yeast, Saccharomyces boulardii, Saccharomyces cerevisiae, or other species in the Saccharomycetaceae family. Saccharomyces boulardii use may be associated with itching, urticaria ("hives"), and generalized skin eruptions.

Side Effects and Warnings

Saccharomyces boulardii has been generally well tolerated in human studies for treatment of various diarrheal disorders. Symptoms of Saccharomyces cerevisiae infection included septic shock in more than one patient and fever in another. Symptoms of sepsis (infection) included increased white blood cell count, abdominal meteorism (swelling from gas), and respiratory insufficiency. In general, contamination occurred in patients with an indwelling vascular catheter.

Constipation, increased thirst, flatulence (gas), and bloating have been associated with Saccharomyces boulardii use. Use cautiously in patients with constipation.

Saccharomyces boulardii fungemia (fungal infection) has occurred. Avoid in patients with a yeast infection. Symptoms included septic shock in more than one patient and fever in another. Symptoms of sepsis include white blood cell count increase, abdominal meteorism, and respiratory insufficiency. In general, contamination occurred in patients with an indwelling vascular catheter.

Saccharomyces boulardii use may also cause Quincke's edema (swelling) or increases or decreases in blood pressure when used with MAOIs.

Pregnancy and Breastfeeding

Saccharomyces boulardii is not recommended in pregnant or breastfeeding women due to a lack of available scientific evidence.

Interactions

Interactions with Drugs

Concomitant antibiotic treatment may change gastrointestinal flora, subsequently increasing steady state levels of Saccharomyces boulardii in humans. According to various clinical trials, use of Saccharomyces boulardii in combination with antibiotics decreases the frequency and duration of diarrhea. Caution is also advised when taking Saccharomyces boulardii with other antidiarrheal agents due to additive effects.

Use of antifungal agents may result in decreased efficacy of Saccharomyces boulardii.

Use of metronidazole plus iodoquinol plus Saccharomyces boulardii was more effective than metronidazole plus iodoquinol alone for reducing diarrhea associated with amebiasis (intestinal infection). Similarly, use of mesalamine plus Saccharomyces boulardii may be more effective than mesalamine alone for reducing diarrhea associated with Crohn's disease. These may be examples of positive interactions.

Saccharomyces boulardii taken in combination with monoamine oxidase inhibitors (MAOIs) may lower blood pressure.

Interactions with Herbs and Dietary Supplements

Concomitant antibiotic treatment with herbs or supplements may change gastrointestinal flora, subsequently increasing steady state levels of Saccharomyces boulardii in humans. According to various clinical trials, use of Saccharomyces boulardii in combination with antibiotics decreases the frequency and duration of diarrhea.

Caution is also advised when taking Saccharomyces boulardii with other antidiarrheal herbs or supplements due to additive effects.

Use of antifungal herbs or supplements may result in decreased efficacy of Saccharomyces boulardii.

Saccharomyces boulardii taken in combination with herbs or supplements with monoamine oxidase inhibitor-like activity may lower blood pressure.

Attribution

This information is based on a systematic review of scientific literature, and was peer-reviewed and edited by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com): Ethan Basch, MD (Memorial Sloan-Kettering Cancer Center); Julie Conquer, PhD (RGB Consulting); Elizabeth Copeland, MD (Boston Medical Center); Molly Davis, PharmD (University of Rhode Island); Bonnie Diamond (Harvard Medical School); Nicole Giese, MS (Natural Standard Research Collaboration); Sooyoun Kang, PharmD (Massachusetts College of Pharmacy); Shaina Tanguay-Colucci, BS (Natural Standard Research Collaboration); Catherine Ulbricht, PharmD (Massachusetts General Hospital); Mamta Vora, PharmD (Northeastern University); Wendy Weissner, BA (Natural Standard Research Collaboration).

Bibliography

DISCLAIMER: Natural Standard developed the above evidence-based information based on a thorough systematic review of the available scientific articles. For comprehensive information about alternative and complementary therapies on the professional level, go to www.naturalstandard.com. Selected references are listed below.

Akil I, Yilmaz O, Kurutepe S, et al. Influence of oral intake of Saccharomyces boulardii on Escherichia coli in enteric flora. Pediatr Nephrol. 2006;21(6):807-810.

Bleichner G, Blehaut H, Mentec H, et al. Saccharomyces boulardii prevents diarrhea in critically ill tube-fed patients. A multicenter, randomized, double-blind placebo-controlled trial. Intensive Care Med 1997;23(5):517-523.

Can M, Besirbellioglu BA, Avci IY, et al. Prophylactic Saccharomyces boulardii in the prevention of antibiotic-associated diarrhea: a prospective study. Med Sci Monit. 2006;12(4):I19-I22.

Chouraqui JP, Dietsch J, Musial C, et al. Saccharomyces boulardii (SB) in the management of toddler diarrhea: a double-blind-placebo controlled study [abstract]. J Pediatr Gastroenterol Nutr 1995;20(4):463.

Dalmasso G, Loubat A, Dahan S, et al. Saccharomyces boulardii prevents TNF-alpha-induced apoptosis in EHEC-infected T84 cells. Res Microbiol 2006;157(5):456-465.

De Preter V, Vanhoutte T, Huys G, et al. Effect of lactulose and Saccharomyces boulardii administration on the colonic urea-nitrogen metabolism and the bifidobacteria concentration in healthy human subjects. Aliment.Pharmacol Ther 4-1-2006;23(7):963-974.

Facchinetti F, Nappi RE, Sances MG, et al. Effects of a yeast-based dietary supplementation on premenstrual syndrome. A double-blind placebo-controlled study. Gynecol Obstet Invest 1997;43(2):120-124.

Geyik MF, Aldemir M, Hosoglu S, et al. The effects of Saccharomyces boulardii on bacterial translocation in rats with obstructive jaundice. Ann R.Coll Surg Engl. 2006;88(2):176-180.

Kollaritsch H, Holst H, Grobara P, et al. [Prevention of traveler's diarrhea with Saccharomyces boulardii. Results of a placebo controlled double-blind study]. Fortschr.Med 3-30-1993;111(9):152-156.

Kotowska M, Albrecht P, Szajewska H. Saccharomyces boulardii in the prevention of antibiotic-associated diarrhoea in children: a randomized double-blind placebo-controlled trial. Aliment.Pharmacol.Ther. 3-1-2005;21(5):583-590.

McFarland LV. Meta-analysis of probiotics for the prevention of antibiotic associated diarrhea and the treatment of Clostridium difficile disease. Am J Gastroenterol. 2006;101(4):812-822.

McFarland LV, Surawicz CM, Greenberg RN, et al. A randomized placebo-controlled trial of Saccharomyces boulardii in combination with standard antibiotics for Clostridium difficile disease. JAMA 6-22-1994;271(24):1913-1918.

Potts L, Lewis SJ, Barry R. Randomised double blind placebo controlled study of the ability of Saccharomyces boulardii to prevent antibiotic related diarrhoea. Gut 1996;38 (suppl 1):A61.

Sougioultzis S, Simeonidis S, Bhaskar KR, et al. Saccharomyces boulardii produces a soluble anti-inflammatory factor that inhibits NF-kappaB-mediated IL-8 gene expression. Biochem Biophys.Res Commun. 4-28-2006;343(1):69-76.

Szajewska H, Ruszczynski M, Radzikowski A. Probiotics in the prevention of antibiotic-associated diarrhea in children: a meta-analysis of randomized controlled trials. J Pediatr 2006;149(3):367-372.

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.