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Lactobacillus GG (Lactobacillus rhamnosus)

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Also listed as: Lactobacillus rhamnosus, Lactobacillus casei subsp. rhamnosus
Related terms
Background
Evidencetable
Tradition
Dosing
Safety
Interactions
Attribution
Bibliography

Related Terms
  • Actimel®, ATCC 53103, fresh poi, GG, L. casei, L. casei DN114001, L. GG, LAB, lactic acid bacteria, lactic acid-producing bacteria, Lactobacillus casei 37, Lactobacillus casei 4646, Lactobacillus casei DN-114001, Lactobacillus casei strain GG, Lactobacillus casei subsp. rhamnosus, Lactobacillus rhamnosus, Lactobacillus rhamnosus 12L, Lactobacillus rhamnosus 19070-2, Lactobacillus rhamnosus GG, Lactobacillus strain GG, poi, probiotic, sour poi.

Background
  • Lactobacillus GG is a bacterium that naturally lives in the human gastrointestinal tract. Lactobacillus GG was named after its co-discoverers, Gorbach and Goldin. The scientific name for Lactobacillus GG is Lactobacillus rhamnosus.
  • Lactobacillus GG is a probiotic. Probiotics are sometime referred to as "friendly germs." These bacteria and yeast occur naturally in the human gastrointestinal tract, where they help maintain a healthy gut and aid in digestion. Lactobacillus GG is most commonly recommended to treat or prevent diarrhea. It is often prescribed during antibiotic treatment to restore "good" gut microbes killed by the antibiotic.
  • There is good evidence for the use of Lactobacillus GG in the prevention of diarrhea or acute infections in children. There is also good evidence for its use to treat or prevent other types of diarrhea, such as that associated with antibiotic therapy. However, Lactobacillus GG does not appear to be effective for prevention of atopic dermatitis or in maintaining remission of the inflammatory bowel disorder Crohn's disease.
  • The reported effects of Lactobacillus GG in clinical trials are based on studies using live and freeze-dried Lactobacillus GG, usually suspended in a liquid, such as a rehydration drink, milk, or water. Lactobacillus GG can also be obtained from some dairy products, including yogurt.

Evidence Table

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. GRADE *


Good evidence supports the use of Lactobacillus GG (Lactobacillus GG) in the treatment of acute diarrhea in children. Further study on dose and length of treatment period is required before stronger conclusions can be drawn.

B


Good evidence supports the use of Lactobacillus GG to prevent antibiotic-associated diarrhea in children. Future studies are needed to determine the timing of Lactobacillus GG therapy that will deliver maximum effectiveness.

B


Good evidence supports the use of daily Lactobacillus GG to prevent diarrhea in children. Further research is needed to determine the dose and timing that will generate the best results.

B


The results of studies investigating the effect of Lactobacillus GG on abdominal pain have been mixed. Further research is required to understand which patients with abdominal pain may be helped by Lactobacillus GG.

C


Preliminary research suggests that consumption of a fermented milk product containing Lactobacillus GG may decrease nasal congestion in patients with allergy to Japanese cedar pollen. Further research on the effect of Lactobacillus GG alone is required before conclusions can be made.

C


Available research suggests that a combination of Lactobacillus GG and lactulose lack benefit for treatment of constipation in children. Further research on the effect of Lactobacillus GG alone is necessary before conclusions can be drawn.

C


Preliminary evidence suggests that Lactobacillus GG may reduce periods of temporary worsening of lung function and hospital admission in children with cystic fibrosis. Further well-designed study is required before conclusions can be made.

C


Preliminary evidence suggests that Lactobacillus GG may help prevent dental cavities. However, further research is needed before a conclusion can be made.

C


Preliminary research suggests that Lactobacillus GG may help prevent diarrhea associated with chemotherapy. Further study is needed.

C


The use of Lactobacillus GG in recurrent or relapsing diarrhea caused by the bacterium Clostridium difficile has been investigated in preliminary research with promising results. However, further research is required before a conclusion can be made.

C


Limited study suggests that Lactobacillus GG is well tolerated in HIV-infected patients. Further trials are needed to determine if Lactobacillus GG is also effective in the treatment of HIV-associated diarrhea.

C


Preliminary research suggests that Lactobacillus GG may aid in the treatment of persistent diarrhea. Further study is needed before a conclusion can be made.

C


Available research suggests that Lactobacillus GG may help prevent travelers' diarrhea in adults. Additional research is needed before a conclusion can be made.

C


Preliminary evidence suggests that Lactobacillus GG may lack effect on gastrointestinal symptoms in the newborn but may increase infant growth. Further research is required before conclusions can be made.

C


Probiotics, including Lactobacillus GG, may help in reducing the amount of disease-causing bacteria that reside in the nasal cavity in healthy children. This, in turn, may reduce the incidence of respiratory infections. However, research findings are mixed. Additional studies are needed to determine if Lactobacillus GG is a safe and effective agent for infection prevention.

C


Preliminary research suggests that Lactobacillus GG has a lack of effect on rectal bleeding in breastfed infants of mothers who have reduced their intake of cow's milk. Further well-designed study is required before conclusions can be made in this area.

C


Preliminary evidence does not support the use of oral Lactobacillus GG to prevent recurrence of urinary tract infection. Further research is needed in this area.

C


Early data support the use of Lactobacillus GG in the treatment of vaginitis. Further research into this use of Lactobacillus GG is needed before conclusions can be made.

C


Preliminary evidence is inconclusive regarding the effects of prenatal maternal use of Lactobacillus GG, followed by supplementation in infants, on the development of atopic dermatitis. Lactobacillus GG appears to have a lack of effect on symptoms in children already showing evidence of atopic dermatitis. Additional research is needed.

D


Scientific evidence to support the use of Lactobacillus GG to maintain remission of Crohn's disease is lacking. Further research is required.

D
* Key to grades

A: Strong scientific evidence for this use
B: Good scientific evidence for this use
C: Unclear scientific evidence for this use
D: Fair scientific evidence for this use (it may not work)
F: Strong scientific evidence against this use (it likley does not work)


Tradition / Theory

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.


Dosing

Adults (18 years and older)

  • For diarrhea (Clostridium difficile), doses of up to 1010 live bacteria have been taken by mouth for up to 7-10 days.
  • For diarrhea (HIV-related), 1-5 x 1010 colony-forming units (CFU) of Lactobacillus GG has been taken by mouth twice daily for two weeks.
  • For diarrhea in adults (travelers' diarrhea), 2 x 109 colony-forming units (CFU) of Lactobacillus GG has been mixed with water and taken by mouth daily, beginning two days prior to departure and continuing during the trip.
  • For urinary tract infection, 100 milliliters of Lactobacillus GG in liquid has been taken by mouth five days weekly for one year.
  • For vaginitis, glycerol suppositories containing 109Lactobacillus GG, have been applied externally once or twice daily for seven days.

Children (under 18 years old)

  • For abdominal pain, 3 x 109 Lactobacillus GG has been taken by mouth twice daily for four weeks.
  • For cystic fibrosis, 6 x 109 colony-forming units (CFU) Lactobacillus GG has been dissolved in a rehydration drink and taken by mouth daily for six months.
  • For Crohn's disease, 1010 Lactobacillus GG has been taken by mouth twice daily for up to two years.
  • For dental cavities, Lactobacillus GG has been taken by mouth in milk five days weekly for seven months.
  • For diarrhea (acute infections), often caused by rotavirus in infants and toddlers, doses of 109 to 1011 colony-forming units (CFU) of Lactobacillus GG per milliliter has been resuspended in milk, formula, oral rehydration solution, or water and taken by mouth twice daily or ad libitum (on demand) in formula by infants for up to seven days or upon release from the hospital.
  • For diarrhea (antibiotic-associated in children), 2 x 1010 colony-forming units (CFU) of Lactobacillus GG per capsule has been taken by mouth twice daily, simultaneously with antibiotic therapy, for 7-10 days. Children weighing less than 12 kilograms have taken by mouth a dose of one capsule, containing 10 billion colony-forming units (CFU) of Lactobacillus GG, and those weighing greater than 12 kilograms have taken twice that amount by mouth once daily with a meal. Lactobacillus GG (2 x 1010 CFU) has been taken by mouth daily for 14 days.
  • For diarrhea (Clostridium difficile), 5 x 109 live Lactobacillus GG bacteria per gram of freeze-dried powder has been taken by mouth in a dose of 125 milligrams twice daily for two weeks.
  • For diarrhea prevention (children), 3.7 x 1010 colony-forming units (CFU) of Lactobacillus GG has been resuspended in liquid and taken by mouth six days weekly for 15 months. Lactobacillus GG (6 x 109 colony-forming units [CFU]) has been taken by mouth twice daily for the duration of the hospital stay.
  • For infant development/neonatal care, Lactobacillus GG-supplemented formula has been taken by mouth for six months.
  • For infection prevention, 5-10 x 105 colony-forming units (CFU) Lactobacillus GG strain ATCC 53103 per milliliter in 1% fat milk has been taken by mouth in an average daily amount of 260 milliliters, divided into three doses, five days weekly for seven months.
  • For rectal complaints (bleeding in infants), 3 x 109 colony-forming units (CFU) Lactobacillus GG has been taken by mouth by breastfed infants twice daily for four weeks when cow's milk was restricted in the mother's diet.

Safety

The U.S. Food and Drug Administration does not strictly regulate herbs and supplements. There is no guarantee of strength, purity or safety of products, and effects may vary. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy. Consult a healthcare provider immediately if you experience side effects.

Allergies

  • Avoid with known allergy or sensitivity to dairy products, if Lactobacillus GG (Lactobacillus GG) is taken as part of a dairy product.

Side Effects and Warnings

  • LactobacillusLactobacillus GG (Lactobacillus GG) has been well tolerated in general. Lactobacillus GG is likely safe when taken by mouth by adults at recommended doses for up to one year. Lactobacillus GG is possibly safe when used during pregnancy, six months before delivery, and during breastfeeding for up to six months.
  • Lactobacillus GG may cause abdominal cramping, abscesses in the liver, bloating, diarrhea, constipation, cramping, epigastric pain, infections associated with hospital/treatment facilities, infectious endocarditis (inflammation of the inside lining of the heart), meningitis, nausea, peritonitis (infection of the abdominal wall), sepsis (severe systemic immune reaction to infection), or vomiting.
  • Use cautiously in pregnant mothers and infants at risk for developing atopic dermatitis (eczema), due to the risk of the children developing wheezing bronchitis.
  • Avoid in patients with intestinal mucosal injury, due to the potential for bacterial infection of the blood.
  • Avoid in patients who have compromised immune function, as Lactobacillus GG may cause infection in these individuals.
  • Avoid with known allergy or sensitivity to dairy products, if Lactobacillus GG is taken as part of a dairy product.

Pregnancy and Breastfeeding

  • Lactobacillus GG is possibly safe when used during pregnancy, six months before delivery, and during breastfeeding for up to six months.
  • Use caution in pregnant mothers and infants at risk of development of atopic dermatitis, due to the risk of the children developing wheezing bronchitis.

Interactions

Interactions with Drugs

  • Lactobacillus GG (Lactobacillus GG) may interact with alcohol, antibiotics, antidiarrheals, anti-inflammatory agents, antiulcer agents, estrogens, agents that affect the immune system, immunoglobulins, lactulose, or laxatives.

Interactions with Herbs and Dietary Supplements

  • Lactobacillus GG (Lactobacillus GG) may interact with antibacterials, antidiarrheals, anti-inflammatory herbs and supplements, antiulcer herbs and supplements, herbs and supplements that affect the immune system, laxatives, oligosaccharides, omega-3 fatty acids, phytic acid, phytic acid-containing foods, phytoestrogens, prebiotics, prebiotic-containing foods, probiotics, probiotic-containing foods, rye bread, soy, soy isoflavones, or vitamin K.

Attribution
  • This information is based on a systematic review of scientific literature edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

Bibliography
  1. Banaszkiewicz A, Szajewska H. Ineffectiveness of GG as an adjunct to lactulose for the treatment of constipation in children: a double-blind, placebo-controlled randomized trial. J Pediatr 2005;146(3):364-369.
  2. Forsyth CB, Farhadi A, Jakate SM, et al. GG treatment ameliorates alcohol-induced intestinal oxidative stress, gut leakiness, and liver injury in a rat model of alcoholic steatohepatitis. Alcohol 2009;43(2):163-172.
  3. Gotteland M, Cruchet S, Verbeke S. Effect of ingestion on the gastrointestinal mucosal barrier alterations induced by indometacin in humans. Aliment Pharmacol Ther 2001;15(1):11-17.
  4. Lam EK, Tai EK, Koo MW, et al. Enhancement of gastric mucosal integrity by GG. Life Sci 2007;80(23):2128-2136.
  5. Malin M, Suomalainen H, Saxelin M, et al. Promotion of IgA immune response in patients with Crohn's disease by oral bacteriotherapy with GG. Ann Nutr Metab 1996;40(3):137-145.
  6. Nase L, Hatakka K, Savilahti E, et al. Effect of long-term consumption of a probiotic bacterium, GG, in milk on dental caries and caries risk in children. Caries Res 2001;35(6):412-420.
  7. Ozkinay E, Terek MC, Yayci M. The effectiveness of live lactobacilli in combination with low dose oestriol (Gynoflor) to restore the vaginal flora after treatment of vaginal infections. BJOG 2005;112(2):234-240.
  8. Pant N, Marcotte H, Brussow H, et al. Effective prophylaxis against rotavirus diarrhea using a combination of GG and antibodies. BMC Microbiol 2007;7:86.
  9. Pelto L, Isolauri E, Lilius EM, et al. Probiotic bacteria down-regulate the milk-induced inflammatory response in milk-hypersensitive subjects but have an immunostimulatory effect in healthy subjects. Clin Exp Allergy 1998;28(12):1474-1479.
  10. Piirainen L, Haahtela S, Helin T, et al. Effect of GG on rBet v1 and rMal d1 specific IgA in the saliva of patients with birch pollen allergy. Ann Allergy Asthma Immunol 2008;100(4):338-342.
  11. Piirainen L, Kekkonen RA, Kajander K. In school-aged children a combination of galacto-oligosaccharides and GG increases bifidobacteria more than GG on its own. Ann Nutr Metab 2008;52(3):204-208.
  12. Rautava S, Arvilommi H, Isolauri E. Specific probiotics in enhancing maturation of IgA responses in formula-fed infants. Pediatr Res 2006;60(2):221-224.
  13. 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.
  14. Szajewska H, Skorka A, Ruszczynski M, et al. Meta-analysis: GG for treating acute diarrhoea in children. Aliment Pharmacol Ther 2007;25(8):871-881.
  15. Viljanen M, Kuitunen M, Haahtela T,et al. Probiotic effects on faecal inflammatory markers and on faecal IgA in food allergic atopic eczema/dermatitis syndrome infants. Pediatr Allergy Immunol 2005;16(1):65-71.

Copyright © 2011 Natural Standard (www.naturalstandard.com)


The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.

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