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Complementary & Alternative Medicine
Index of Herbal Medicines, Supplements and Therapies
The decision to use products containing or claiming to contain Lactobacillus should be carefully considered.
Lactobacillus GG (Lactobacillus casei)
Be aware that the U.S. Food and Drug Administration does not strictly regulate herbs and dietary supplements. There is no guarantee of strength, purity or safety of products containing or claiming to contain Lactobacillus GG. Decisions to use herbs or supplements should be carefully considered. Individuals using prescription drugs should discuss taking herbs or supplements with a pharmacist or health care professional before starting.
Lactobacillus GG is a microbe that lives in the human gut. It is one of several microbes that are called probiotics because they are believed to be helpful for some health conditions. Scientists have studied Lactobacillus GG for the following uses:
Multiple studies suggest that Lactobacillus GG is a safe and helpful treatment for diarrhea in infants and children caused by rotavirus infection. Other causes of diarrhea in children have also been studied, including antibiotics. Some results suggest that Lactobacillus GG works for these other causes, but more research is needed before a recommendation can be made.
Early research of Lactobacillus GG for diarrhea in adults caused by the bacteria Clostridium difficile is promising, but more study is needed. A few studies suggest that administration of Lactobacillus GG during the treatment of Helicobacter pylori may help in reducing the gastrointestinal side effects of the treatment, including diarrhea and taste disturbances. HIV-related diarrhea may be helped. However, studies are limited, and more information is needed before a conclusion can be drawn.
Several studies report that taking Lactobacillus GG may be helpful for preventing diarrhea in children. Further research is needed to determine what dose and timing will give the best results. Early study in adults supports the use of Lactobacillus GG to help prevent traveler's diarrhea. Further study is needed.
Improving or maintaining gut function
Lactobacillus GG may help in reducing the colonization of disease causing bacteria in infants. Further research is needed to confirm these results.
Lactobacillus GG has been studied to see if it could help prevent injury to the gut wall during therapy with the anti-inflammatory drug indomethacin. One small, randomized, controlled clinical trial reported positive results. However, Lactobacillus GG did not protect the intestine in this study. More studies are needed before firm conclusions can be drawn.
Lactobacillus GG may aid in the prevention of dental cavities However, study results are unclear, and further research is needed before a recommendation can be made.
Urinary tract infections
Early evidence suggests that Lactobacillus GG is not effective as a treatment for or prevention of urinary tract infections. Therefore, it should not be used for this purpose.
Probiotics, including Lactobacillus GG, may help in reducing the amount of disease-causing bacteria that reside in the nasal cavity, which may reduce the incidence of respiratory infections. Lactobacillus GG may also reduce the severity of respiratory infections. Well-designed research is needed to confirm these results.
Spread of bacteria from the gut
Lactobacillus GG has been studied to prevent the spread of bacteria from the gut into other areas of the body. However, early evidence suggests that it is not effective for this purpose and should not be used as treatment.
There have been studies of Lactobacillus GG to prevent respiratory diseases in children and to treat eczema, Crohn's disease, vaginitis, cystic fibrosis, and recurrence of bladder cancer. However, there is not enough research to make clear recommendations in any of these areas.
Lactobacillus GG has been suggested for many other uses, based on tradition or on scientific theories. However, these uses have not been thoroughly studied in humans, and there is limited scientific evidence about safety or effectiveness. Some of these suggested uses are for conditions that are potentially very serious and even life-threatening. You should consult a health care professional before using Lactobacillus GG for any unproven use.
|Alcoholic liver disease|
Food allergies or intolerance
Immune system stimulation
Vaginal yeast infection
People who are sensitive to lactose may have trouble digesting dairy products that contain Lactobacillus GG (for example, yogurt). Allergic reactions to Lactobacillus GG itself have not been reported.
Lactobacillus GG at recommended doses has had no serious side effects in studies of more than 2,000 children and adults. There are some reports of cramping when treatment is started. Lactobacillus GG should be avoided by people with immune system diseases (for example, HIV or AIDS) or some types of cancer.
Pregnancy And Breast-Feeding
There is no reliable research on Lactobacillus GG in pregnant women. In one study, a similar type of microbe called Lactobacillus acidophilus was found safe in vaginal suppositories given to treat vaginitis in pregnant women.
Interactions with drugs, herbs and other supplements have not been thoroughly studied. The interactions listed below have been reported in scientific publications. If you are taking prescription drugs, speak with a health care professional or pharmacist before using herbs or dietary supplements.
Interactions With Drugs
Lactobacillus GG should be avoided by people taking drugs that weaken the immune system, such as corticosteroids, drugs used with organ transplants and some cancer treatments. Some antibiotics may kill Lactobacillus GG. It is sometimes recommended to take Lactobacillus GG three hours after antibiotics. In theory, Lactobacillus GG may break down the drugs sulfasalazine and chloramphenicol in the stomach and prevent them from working. Therefore, Lactobacillus GG should be taken separately. Alcohol may kill Lactobacillus GG and should not be taken at the same time.
Interactions With Herbs And Dietary Supplements
Some natural medicine textbooks report that taking two to three grams of fructo-oligosaccharides daily may stimulate the growth of lactobacilli and may increase the effectiveness of Lactobacillus GG. A similar report shows galacto-oligosaccharides may increase the amount of Lactobacillus as well.
The doses listed below are based on scientific research, publications or traditional use. Because most herbs and supplements have not been thoroughly studied or monitored, safety and effectiveness may not be proven. Brands may be made differently, with variable ingredients even within the same brand. Combination products often contain small amounts of each ingredient and may not be effective. Appropriate dosing should be discussed with a health care professional before starting therapy; always read the recommendations on a product's label. The dosing for unproven uses should be approached cautiously, because scientific information is limited in these areas.
For Diarrhea Treatment
Children (Younger Than 18)
Three to 5 billion organisms stirred into milk, formula, hydrating solution or water, taken by mouth twice daily for five days, has been used to treat diarrhea caused by rotavirus.
Ten billion organisms in one cup of liquid taken by mouth has been used in toddlers when the cause of diarrhea is not known.
Ten to 20 billion organisms taken by mouth one to two times daily with meals has been recommended for children with diarrhea caused by antibiotics. Treatment is continued for as long as the antibiotics are given. Note that Lactobacillus GG doses should not be taken at the same time as antibiotic doses.
A randomized, controlled clinical trial of 167 children using antibiotics for a respiratory infections studied the effects of Lactobacillus GG on diarrhea caused by the antibiotics. The children were given two capsules containing 10 colony-forming units in each capsule twice a day during the antibiotic treatment.
Another randomized, controlled clinical trial studied the effects of oral rehydration supplemented with Lactobacillus GG on children with acute diarrhea. A total of 140 children aged 1 month to 3 years were given an oral rehydration solution containing at least 10 colony forming units per 250 milliliters of Lactobacillus GG
For Diarrhea Prevention
Adults (Aged 18 Or Older)
One billion organisms mixed with water can be taken by mouth two times per day to prevent traveler's diarrhea. Start two days before leaving for a trip, and take it every day until the trip is over.
Children (Younger Than 18)
Five to 40 billion organisms stirred into milk, water, formula or other liquid can be taken by mouth one to two times per day.
For Gut Function
Adults (Aged 18 Or Older)
A dose of three cups per day of 8 to 10 billion organisms has been used for eight weeks. Please check with your pediatrician and pharmacist before using.
Children (Younger Than 18)
In a randomized, controlled clinical trial, the effects of Lactobacillus GG on the gut were studied in 71 preterm infants weighing less than 2,000 grams at birth. The infants were given a dose of Lactobacillus GG containing 10 colony-forming units twice a day for 21 or eight days depending on how much the infant weighed (less than 2,000 grams, 21 days; less than 1,500 grams, eight days).
For Dental Cavities
Adults (Aged 18 Or Older)
In one randomized, controlled clinical trial, 74 patients aged 18 to 35 years were given five 15-g pieces of cheese containing Lactobacillus GG a day for three weeks with unclear effects.
Lactobacillus GG is most commonly recommended for treating or preventing diarrhea. Scientific evidence supports its use for diarrhea in infants caused by rotavirus. Other uses have also been studied, but more research is needed before strong recommendations can be made. Lactobacillus GG appears to be safe in infants, children and women who are pregnant or breast-feeding. It should be avoided in individuals who have diseases that affect the immune system or who are taking drugs that weaken the immune system. Consult a health care professional immediately if you experience side effects.
The information in this monograph was prepared by the professional staff at Natural Standard, based on thorough systematic review of scientific evidence. The material was reviewed by the Faculty of the Harvard Medical School with final editing approved by Natural Standard.
- Natural Standard: An organization that produces scientifically based reviews of complementary and alternative medicine (CAM) topics
- National Center for Complementary and Alternative Medicine (NCCAM): A division of the U.S. Department of Health & Human Services dedicated to research
Selected Scientific Studies: Lactobacillus GG
Natural Standard reviewed more than 425 articles to prepare the professional monograph from which this version was created.
Some of the more recent studies are listed below:
- Agarwal R, Sharma N, Chaudhry R, et al. Effects of oral Lactobacillus GG on enteric microflora in low-birth-weight neonates. J Pediatr Gastroenterol Nutr 2003;Mar, 36(3):397-402.
- Ahola AJ, Yli-Knuuttila H, Suomalainen T, et al. Short-term consumption of probiotic-containing cheese and its effect on dental caries risk factors. Arch Oral Biol 2002;Nov, 47(11):799-804.
- Armuzzi A, Cremonini F, Bartolozzi F, et al. The effect of oral administration of Lactobacillus GG on antibiotic-associated gastrointestinal side-effects during Helicobacter pylori eradication therapy. Aliment Pharmacol Ther 2001;Feb, 15(2):163-169.
- Armuzzi A, Cremonini F, Ojetti V, et al. Effect of Lactobacillus GG supplementation on antibiotic-associated gastrointestinal side effects during Helicobacter pylori eradication therapy: a pilot study. Digestion 2001;63(1):1-7.
- Arvola T, Laiho K, Torkkeli S, et al. Prophylactic Lactobacillus GG reduces antibiotic-associated diarrhea in children with respiratory infections: a randomized study. Pediatrics 1999;104(5):e64.
- Banaszkiewicz A, Szajewska H. Ineffectiveness of Lactobacillus GG as an adjunct to lactulose for the treatment of constipation in children: a double-blind, placebo-controlled randomized trial. J Pediatr 2005;Mar, 146(3):364-369.
- Bauer TM, Fernandez J, Navasa M, et al. Failure of Lactobacillus spp. to prevent bacterial translocation in a rat model of experimental cirrhosis. J Hepatol 2002;Apr, 36(4):501-506.
- Biller JA, Katz AJ, Flores AF, et al. Treatment of recurrent Clostridium difficile colitis with Lactobacillus GG. J Pediatr Gastroenterol Nutr 1995;21(2):224-226.
- Cremonini F, Di Caro S, Covino M, et al. Effect of different probiotic preparations on anti-Helicobacter pylori therapy-related side effects: a parallel group, triple blind, placebo-controlled study. Am J Gastroenterol 2002;Nov, 97(11):2744-2749.
- Cremonini F, Di Caro S, Santarelli L, et al. Probiotics in antibiotic-associated diarrhoea. Dig Liver Dis 2002;Sep, 34(Suppl 2):S78-S80.
- Dani C, Biadaioli R, Bertini G, et al. Probiotics feeding in prevention of urinary tract infection, bacterial sepsis and necrotizing enterocolitis in preterm infants: a prospective double-blind study. Biol Neonate 2002;Aug, 82(2):103-108.
- De Groote MA, Frank DN, Dowell E, et al. Lactobacillus rhamnosus GG bacteremia associated with probiotic use in a child with short gut syndrome. Pediatr Infect Dis J 2005;Mar, 24(3):278-280.
- Elmadfa I, Heinzle C, Majchrzak D, Foissy H. Influence of a probiotic yoghurt on the status of vitamins B(1), B(2) and B(6) in the healthy adult human. Ann Nutr Metab 2001;45(1):13-18.
- Gluck U, Gebbers JO. Ingested probiotics reduce nasal colonization with pathogenic bacteria (Staphylococcus aureus, Streptococcus pneumoniae, and beta-hemolytic streptococci). Am J Clin Nutr 2003;Feb, 77(2):517-520.
- Guandalini S, Pensabene L, Zikri MA, et al. Lactobacillus GG administered in oral rehydration solution to children with acute diarrhea: a multicenter European trial. J Pediatr Gastroenterol Nutr 2000;30(1):54-60.
- Guarino A, Canani RB, Spagnuolo MI, et al. Oral bacterial therapy reduces the duration of symptoms and of viral excretion in children with mild diarrhea. J Pediatr Gastroenterol Nutr 1997;Nov, 25(5):516-519.
- Guerrero ML, Moreno-Espinosa S, Tuz-Dzib F, et al. Breastfeeding and natural colonization with Lactobacillus spp as protection against rotavirus-associated diarrhea.
- Gupta P, Andrew H, Kirschner BS, Guandalini S. Is Lactobacillus GG helpful in children with Crohn's disease? Results of a preliminary, open-label study. J Pediatr Gastroentrol Nutr 2000;Oct, 31(40):453-457.
- Hamilton-Miller JM. The role of probiotics in the treatment and prevention of Helicobacter pylori infection. Int J Antimicrob Agents 2003;Oct, 22(4):360-366.
- Hatakka K, Savilahti E, Ponka A, et al. Effect of long term consumption of probiotic milk on infections in children attending day care centres: double blind, randomised trial. BMJ 2001;Jun 2, 322(7298):1327. Comment in Br Med J 2001;Jun 2, 322(7298):1318-1319.
- Hilton E, Kolakowski P, Singer C, Smith M. Efficacy of Lactobacillus GG as a diarrheal preventive in travelers. J Travel Med 1997;Mar 1, 4(1):41-43.
- Hilton E, Rindos P, Isenberg HD. Lactobacillus GG vaginal suppositories and vaginitis. J Clin Microbiol 1995;33(5):1433.
- Kaila M, Isolauri E, Saxelin M, et al. Viable versus inactivated Lactobacillus strain GG in acute rotavirus diarrhoea. Arch Dis Child 1995;72(1):51-53.
- Land MH, Rouster-Stevens K, Woods CR, et al. Lactobacillus sepsis associated with probiotic therapy. Pediatrics 2005;Jan, 115(1):178-181.
- Lee SY, Chang CT, Lee MH, Wu MS. Lactobacillus peritonitis: a rare cause of peritonitis in peritoneal dialysis patients. Ren Fail 2004;Jul, 26(4):419-423.
- Ozkinay E, Terek MC, Yayci M, et al. The effectiveness of live lactobacilli in combination with low dose oestriol (Gynoflor) to restore the vaginal flora after treatment of vaginal infections. BJOG 2005;Feb, 112(2):234-240.
- Parra MD, Martinez de Morentin BE, Cobo JM, et al. Daily ingestion of fermented milk containing Lactobacillus casei DN114001 improves innate-defense capacity in healthy middle-aged people. J Physiol Biochem 2004;Jun, 60(2):85-91.
- Pensabene I, Mancuso M, Contaldo A, et al. A multicenter European trial on the use of Lactobacillus GG in children with acute-onset diarrhea. Ital J Gastroenterol Hepatol 1998;30 Suppl 1(Abstr 6):A25.
- Pereg D, Kimhi O, Tirosh A, et al. The effect of fermented yogurt on the prevention of diarrhea in a healthy adult population. Am J Infect Control 2005;Mar, 33(2):122-125.
- Pirotta M, Gunn J, Chondros P, et al. Effect of lactobacillus in preventing post-antibiotic vulvovaginal candidiasis: a randomised controlled trial. BMJ 2004;Sep 4, 329(7465):548. Epub 2004;Aug 27.
- Plummer S, Weaver MA, Harris JC, et al. Clostridium difficile pilot study: effects of probiotic supplementation on the incidence of C. difficile diarrhoea. Int Microbiol 2004;Mar, 7(1):59-62.
- Rosenfeldt V, Benfeldt E, Valerius NH, et al. Effect of probiotics on gastrointestinal symptoms and small intestinal permeability in children with atopic dermatitis. J Pediatr 2004;Nov, 145(5):612-616.
- Salminen MK, Tynkkynen S, Rautelin H, et al. The efficacy and safety of probiotic Lactobacillus rhamnosus GG on prolonged, noninfectious diarrhea in HIV patients on antiretroviral therapy: a randomized, placebo-controlled, crossover study. HIV Clin Trials 2004;Jul-Aug, 5(4):183-191.
- Sherman MP, Bennett SH, Hwang FF, Yu C. Neonatal small bowel epithelia: enhancing anti-bacterial defense with lactoferrin and Lactobacillus GG. Biometals 2004;Jun, 17(3):285-289.
- Szajewska H, Kotowska M, Mrukowicz JZ, et al. Efficacy of Lactobacillus GG in prevention of nosocomial diarrhea in infants. J Pediatr 2001;138(3):361-365.
- Thomas MR, Litin SC, Osmon DR, et al. Lack of effect of Lactobacillus GG on antibiotic-associated diarrhea: a randomized, placebo-controlled trial. Mayo Clin Proc 2001;76(9):883-889.
- Vanderhoof JA, Whitney DB, Antonson DL, et al. Lactobacillus GG in the prevention of antibiotic-associated diarrhea in children. J Pediatr 1999;135(5):564-568.
Last updated July 12, 2005
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