Saccharomyces boulardii (S. boulardii) is a probiotic, a "friendly" organism, specifically a yeast and a strain of Saccharomyces cerevisiae. Unlike brewer's yeast and baker's yeast, it helps combat "bad" organisms that can cause diseases. It is used to treat and prevent diarrhea, including rotaviral diarrhea in children, acne, and digestive tract infections, although scientific evidence for these uses is limited. It is important not to confuse S. boulardii with other probiotics or fermented foods.
Uses and Effectiveness
Likely Effective
- Diarrhea: Oral intake of S. boulardii can shorten the duration of diarrhea in children. However, its effectiveness in adults or in children with longer-lasting diarrhea remains unclear.
- Antibiotic-Associated Diarrhea: S. boulardii taken orally can help prevent diarrhea in adults and children undergoing antibiotic treatment.
- Clostridioides difficile Infection: Oral administration of S. boulardii can prevent diarrhea from C. difficile infection. Combining it with antibiotics may also prevent recurrence of the infection.
- Helicobacter pylori Infection: When taken with standard H. pylori treatment, S. boulardii can help prevent side effects like diarrhea and nausea. However, it is uncertain whether it enhances the effectiveness of these treatments.
- Necrotizing Enterocolitis: Giving S. boulardii orally to preterm infants can prevent necrotizing enterocolitis (NEC).
- Rotavirus Diarrhea: S. boulardii can reduce the duration of diarrhea caused by rotavirus in children.
- Travelers' Diarrhea: Oral intake of S. boulardii can reduce the risk of developing diarrhea while traveling.
Possibly Ineffective
- Blood Infection (Sepsis): Giving S. boulardii orally to preterm infants does not prevent sepsis.
Currently, there is not enough reliable information available to support the use of S. boulardii for many other purposes.
Intestinal Barrier Function and Saccharomyces boulardii
The gastrointestinal tract represents the largest surface area in the human body exposed to the external environment. The intestinal epithelium serves as a barrier, preventing the entry of harmful substances while allowing the exchange of nutrients. This barrier is formed by epithelial cells interconnected via the apical junctional complex and desmosomes. Disruption of this barrier leads to increased intestinal permeability, known as "leaky gut syndrome," facilitating the translocation of luminal contents into the intestinal tissue and bloodstream.
Intestinal Permeability
The intestinal epithelium functions as a barrier, controlling the penetration of food and bacterial antigens into the tissue while allowing the translocation of nutrients. Intestinal permeability is mediated by two pathways: the transcellular pathway, associated with solute transport by specific transporters, and the paracellular pathway, associated with the transport of small molecules between epithelial cells. Permeability can be assessed using various techniques in vitro and in vivo.
Components of the Intestinal Barrier
The intestinal barrier comprises the microbiota, mucus, epithelial layer, and immune layer.
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- Microbiota: Bacteria, fungi, archaea, viruses, and protozoa compose the gut microbiota. Bacteria limit colonization by external bacteria, acting as modulators of intestinal permeability.
- Mucus: The mucus is a physical and chemical barrier that separates the lumen from the epithelium, containing antimicrobial peptides and trefoil peptides.
- Epithelial Layer: The epithelium is the physical boundary between the exterior and interior, regulated by apical TJs and AJs. TJs are multiprotein complexes that seal cells together, maintaining membrane polarity and regulating paracellular permeability. AJs participate in the integrity of the epithelial layer and cell-cell communication.
- Immune Layer: The lamina propria contains immune cells that contribute to protection against harmful molecules or pathogens while tolerating commensal bacteria.
Intestinal barrier disruption induces a systemic inflammatory response, causing increased permeability, functional impairment, and disease. Intestinal alkaline phosphatases (IAPs) protect intestinal tissue against luminal endotoxins by dephosphorylation. Loss of intestinal integrity plays a major role in the pathogenesis of multiple intestinal and extraintestinal disorders.
Factors Increasing Intestinal Permeability
Different factors can increase intestinal permeability, including genetic alterations, dysbiosis of microbiota, chronic inflammation, and iatrogenic treatments like antibiotics or NSAIDs. TJ alterations can lead to the relocalization of TJ proteins or to their disruption by phosphorylation state regulation.
Definition and Properties of S. boulardii
Saccharomyces boulardii CNCM I-745 (S. boulardii) is a non-pathogenic yeast widely used as a probiotic in the prevention and treatment of gastrointestinal disorders. It is distinct from bacterial probiotics due to its intrinsic resistance to antibiotic treatment. S. boulardii can adapt to and survive in the gastrointestinal tract because of its ability to grow at 37°C and its resistance to low gastric pH and bile acids. Once in the gastrointestinal tract, S. boulardii reaches a maximum concentration within 2 days and is cleared in the stools within 3-5 days after oral administration.
Intestinal Permeability Alterations Due to Enteric Pathogens and Corrective Effects of S. boulardii
IECs act as a physical barrier via TJs to protect tissue from invasion by pathogens. Bacterial recognition occurs through pattern recognition receptors like Toll-like receptors (TLRs). During invasion, enteric pathogens use TJs as receptors to attach to the cell membrane in order to become internalized, or they disrupt the TJ first before penetrating into the tissue. Alterations in TJs are implicated in diarrhea through a “leaky flux” mechanism.
S. boulardii owes its clinical efficacy to a wide variety of actions counteracting numerous pathogen-induced deleterious effects. The modes of action of S. boulardii can be summarized as follows:
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- Luminal action: antitoxinic effect, antimicrobial activity, modulation of intestinal flora and metabolic activity.
- Trophic action at the villi: secretion of digestion-enhancing enzymes and induction of host digestive enzymes.
- Mucosal action: anti-inflammatory activity.
These modes of action work together to counteract infections and support barrier function and regeneration of damaged intestinal tissue.
Deleterious Actions of Pathogens in the Gut and Beneficial Effects of S. boulardii
Enteropathogenic E. coli (EPEC) and enterohemorrhagic E. coli (EHEC) are pathogenic strains that cause intestinal barrier disruption and permeability alterations. Pathogenic effector proteins delivered into enterocytes have caused TJ disruption by MLCK and PKC activation, and increased intestinal permeability. IECs treated with S. boulardii before infection by EPEC display a reduced level of secreted pro-inflammatory cytokines and a preserved TJ structure due to the abolition of MLC phosphorylation.
Side Effects
When taken by mouth, S. boulardii is likely safe for up to 15 months. Some people may experience gas.
Special Precautions and Warnings
- Pregnancy and Breast-feeding: There is insufficient reliable data on the safety of S. boulardii during pregnancy and breast-feeding; it is best to avoid use.
- Children: S. boulardii is possibly safe for most children when taken orally and appropriately. However, diarrhea in children should be evaluated by a healthcare professional before using S. boulardii. There is insufficient reliable information on the safety of S. boulardii for very small premature infants.
- Elderly: Older adults may have an increased risk of fungal infection when taking S. boulardii; it is best to avoid use.
- Digestive Tract Disease: S. boulardii has caused fungal infections in people with diseases of the digestive tract. Consult a healthcare provider before taking S. boulardii if you have a digestive tract disease.
- Weakened Immune System: S. boulardii has caused fungal infections in people with weakened immune systems, often due to catheter contamination. Consult a healthcare provider before taking S. boulardii if you have a weakened immune system.
- Yeast Allergy: People with yeast allergies may be allergic to products containing S. boulardii; it is best to avoid these products.
Interactions
- Minor Interaction: S. boulardii is a fungus. Medications for fungal infections help reduce fungus in and on the body. Taking S. boulardii with medications for fungal infections can reduce the effects of S. boulardii.
Dosing
In adults, S. boulardii has most often been taken by mouth in doses of 500-1000 mg (about 10-20 billion colony-forming units) daily for 4 weeks. In children, S. boulardii has most often been taken by mouth in doses of 250-500 mg (about 5-10 billion colony-forming units) for up to 4 weeks. Consult a healthcare provider to determine the best dose for a specific condition.
Additional Information
Saccharomyces Boulardii+MOS is likely effective in alternative medicine as an aid in preventing diarrhea caused by taking antibiotics, or by using a feeding tube. Saccharomyces Boulardii+MOS has been used as a possibly effective aid in preventing the recurrence of diarrhea caused by Clostridium difficile (C. difficile). However, this product may not be effective in treating the first episodes of this type of diarrhea.
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It is not certain whether Saccharomyces Boulardii+MOS is effective in treating any medical condition. Medicinal use of this product has not been approved by the FDA. Saccharomyces Boulardii+MOS is often sold as an herbal supplement. There are no regulated manufacturing standards in place for many herbal compounds and some marketed supplements have been found to be contaminated with toxic metals or other drugs.
How to Use
Follow all directions on the product label and package. Do not give any herbal/health supplement to a child without medical advice.
You may swallow the capsule whole, or open it and sprinkle the contents directly onto your tongue. To use the oral powder, tear open the packet and empty the entire contents into at least 4 ounces of water, juice, or milk. Stir this mixture and drink all of it right away. To make swallowing easier, you may also sprinkle the medicine from a capsule or from the powder packet into a spoonful of yogurt or applesauce. Swallow right away without chewing. Do not save the mixture for later use.
Storage
Store this product at room temperature away from moisture and heat. Keep all drugs in a safe place. Throw away unused or expired drugs. Do not flush down a toilet or pour down a drain unless you are told to do so.
Missed Dose
Skip the missed dose if it is almost time for your next scheduled dose.
Interactions with Other Drugs
Other drugs may affect Saccharomyces Boulardii+MOS, including prescription and over-the-counter medicines, vitamins, and herbal products. Consult with a licensed healthcare professional before using any herbal/health supplement.