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Lactobacillus acidophilus

Also listed as: Bifidobacterium; L. acidophilus; Prebiotics; Probiotics

• Overview
• Uses
• Dietary Sources
• Available Forms
• How to Take It
• Precautions
• Possible Interactions
• Supporting Research

Overview

Lactobacillus acidophilus ( L. acidophilus ) is the most commonly used probiotic, or "friendly" bacteria. Such healthy bacteria inhabit the intestines and vagina and protect against the entrance and proliferation of "bad" organisms that can cause disease. This is accomplished through a variety of mechanisms. For example, the breakdown of food by L. acidophilus leads to production of lactic acid, hydrogen peroxide, and other byproducts that make the environment hostile for undesired organisms. L. acidophilus also produces lactase, the enzyme that breaks down milk sugar (lactose) into simple sugars. People who are lactose intolerant do not produce this enzyme. For this reason, L. acidophilus supplements may be beneficial for these individuals.

Other potential probiotics include a variety of Lactobacillus species (spp.), such as the caseiGG , rhamnosus , NCFM, DDS-1, and johnsonii strains, Bifidobacterium longum , Bifidobacterium bifidum , Streptococcus thermophilus , Enterococcus faecium , Saccharaomyces boulardii , Bacillus spp., and Escherichia coli .

Prebiotics refers to the soluble fiber component found in certain foods or supplements that stimulate the growth of probiotics in the gastrointestinal tract.

Uses

Probiotics offer a variety of potential therapeutic uses. These include the following:

• Replacing the "friendly" intestinal bacteria destroyed by antibiotics.
• Aiding digestion and suppressing disease-causing bacteria.
• Preventing and treating diarrhea, including infectious diarrhea, particularly from rotavirus (a virus that commonly causes diarrhea in children).
• Treating overgrowth of "bad" organisms in the gastrointestinal tract (a condition that tends to cause diarrhea and may occur from use of antibiotics).
• Alleviating symptoms of irritable bowel syndrome and, possibly, inflammatory bowel disease (such as Crohn's disease and ulcerative colitis).
• Preventing and/or reducing the recurrence of vaginal yeast infections, urinary tract infections, and cystitis (bladder inflammation). The best scientific evidence exists for vaginal infections.
• Improving lactose absorption digestion in people who are lactose intolerant
• Enhancing the immune response. Studies have suggested that consumption of yogurt or milk that contains specific strains of Lactobacillus or supplements with Lactobacillus or Bifidobacterium may improve the natural immune response. Further research is needed to confirm these early findings and to best understand how the improved immune function may or may not help in warding off infections.
• Aiding the treatment of respiratory infections such as sinusitis, bronchitis, and pneumonia. More research is needed in this area.
• Lowering risk of allergies. Examples include asthma, hay fever, food allergies to milk, and skin reactions such as eczema.
• Helping to treat high cholesterol. More research is needed.
• Reducing the risk of recurring bladder tumors once this cancer has been treated. Much more research is needed in this area.
• Other conditions under investigation for use of probiotics include colon cancer, HIV related diarrhea, and Helicobacter pylori, an organism that can lead to development of ulcers.

Dietary Sources

The primary dietary sources of L. acidophilus include milk enriched with acidophilus, yogurt containing live L. acidophilus cultures, miso, and tempeh.

Prebiotics are found in breast milk, onions, tomatoes, bananas, honey, barley, garlic and wheat.

Available Forms

L. acidophilus preparations consist of dried or liquid cultures of living bacteria. These cultures are usually grown in milk but can sometimes be grown in milk-free cultures. L. acidophilus is available in the following forms:

• Freeze-dried granules
• Freeze-dried powders
• Freeze-dried capsules
• Liquid L. acidophilus preparations (which must be kept refrigerated)

Prebiotics occur naturally in foods, but supplements provide a more concentrated source of this substance. Prebiotics are oligosacchrides, chains of sugar units linked together. Inulin is a long-chain oligosacchride (from 2-60 sugars) and fructooligosaccharides (FOS) are short-chain oligosaccharides (from 2-7 sugars). It is not clear at this time which type of prebiotic is most effective.

How to Take It

Pediatric

Newborns and Infants (0 to 1 year)

• Liquid preparations may be used as a lotion and applied topically to diaper area for yeast infections and diaper rashes.
• If the child is on antibiotic therapy, ¼ tsp or ¼ capsule can be taken orally 2 hours after each dose of antibiotics to replace beneficial bacteria.
• Add ¼ tsp or ¼ capsule to water for the treatment of oral infections.

Children (1 to 12 years)

• Refer to recommended dosage on product label

Adult

Recommended doses of L. acidophilus vary depending on the health condition being treated. Check the specific dosage recommendations on the product label. The following list provides guidelines for the most common uses:

• Prevention or treatment of diarrhea: 1 to 2 billion viable cells per day (some experts may recommend up to ten billion cells per day)
• Vaginal infections: 8 ounces of yogurt (with live active cultures containing one of the Lactobacillus or Bifidobacterium strains listed above) daily or an oral daily supplement containing at least 1 to 2 billion live organisms. Clinical experience also suggests that placing yogurt with live acidophilus cultures directly to the vaginal area, using a disposable spatula and wearing a sanitary pad, helps to relieve itching and inflammation. Similarly, lactobacillus capsules or tablets may be inserted directly into the vagina.
• Cystitis: 1 to 2 capsules or tablets inserted into the vagina nightly for two weeks
• Maintaining normal intestinal flora: 1 to 10 billion viable cells per day

Precautions

Because of the potential for side effects and interactions with medications, dietary supplements should be taken only under the supervision of a knowledgeable healthcare provider.

Mild gastrointestinal upset may occur in some individuals (not on antibiotic therapy) who take more than 1 to 2 billion L. acidophilus cells per day.

There has been one report of anaphylaxis (a serious allergic reaction accompanied by shortness of breath and loss of consciousness) in a person taking inulin, a type of prebiotic.

Possible Interactions

If you are currently being treated with any of the following medications, you should not use Lactobacillus or other probiotics without first talking to your healthcare provider.

Sulfasalazine
A laboratory study suggests that L. acidophilus speeds up metabolism of sulfasalazine, a medication used to treat ulcerative colitis. The significance of this information is unknown at this time.

Supporting Research

Alvarez-Olmos MI. Probiotic agents and infectious diseases: a modern perspective on a traditional therapy. Clin Infect Dis . 2001;32(11):1567-1576.

Cunningham-Rundles S, Ahrne S, Bengmark S, et al. Probiotics and immune response. Am J Gastroenterol . 2000;95(1 Suppl):S22-25.

de Roos NM, Katan MB. Effects of probiotic bacteria on diarrhea, lipid metabolism, and carcinogenesis: a review of papers published between 1988 and 1998. Am J Clin Nutr . 2000;71(2):405-411.

Donnet-Hughes A, et al. Modulation of nonspecific mechanisms of defense by lactic acid bacteria: effective dose. J Dairy Sci . May 1999; 82(5):863-869.

Elmer GW, Surawicz CM, McFarland LV. Biotherapeutic agents. A neglected modality for the treatment and prevention of selected intestinal and vaginal infections. [Review]. JAMA . 1996;275(11):870-876.

Favier C, Neut C, Mizon C, Cortot A, Colombel JF, Mizon J. Fecal ß-D-galactosidase production and Bifidobacteria are decreased in Crohn's disease. Dig Dis Sci . 1997;42(4):817-822.

Friedrich MJ. A bit of culture for children: probiotics may improve health and fight disease. JAMA . 2000;284(11):1365-1366.

Gill HS, Rutherford KJ, Cross ML. Dietary probiotic supplementation enhances natural killer cell activity in the elderly: an investigation of age-related immunological changes. J Clin Immunol. 2001;21(4):264-271.

Gill HS, Rutherford KJ, Cross ML, Gopal PK. Enhancement of immunity in the elderly by dietary supplementation with the probiotic Bifidobacterium lactis HN019. Am J Clin Nutr . 2001;74(6):833-839.

Gionchetti P, Rizzello F, Venturi A, Campieri M. Probiotics in infective diarrhea and inflammatory bowel diseases [Review]. J Gastroenterol Hepatol . 2000;15:489-493.

Gismondo MR, Drago L, Lombardi A. Review of probiotics available to modify gastrointestinal flora. Int J Antimicrob Agents. 1999;4:287-292.

Gorbach SL. Probiotics in the third millennium. Dig Liver Dis. 2002;34 Suppl 2:S2-S7.

Hatakka K, Savilahti, Ponka A, et al. Effect of long term consumption of probiotic milk on infections in children attending day care centers: double-blind, randomized trial. BMJ . 2001;322(7298):1327.

Hilton E, Isenberg HD, Alperstein P, France K, Borenstein MT. Ingestion of yogurt containing Lactobacillus acidophilus as prophylaxis for candidal vaginitis. Ann Intern Med. 1992;116(5): 353-357.

Hilton E, Kolakowski P, Singer C, Smith M. Efficacy of Lactobacillus GG as a diarrheal preventive in travelers. J Travel Med . 1997;4(1):41-43.

Hove H, Norgaard H, Mortensen PB. Lactic acid bacteria and the human gastrointestinal tract [Review]. Eur J Clin Nutr . 1999;53(5):339-350.

Jang T, Saviano DA. In vitro fermentation by human colonic bacteria is modified by Lactobacillus acidophilus supplementation. J Nutr . 1997;127(8):1489-1495.

Kalliomaki M, Salminen S, Arvilommi H, Kero P, Koskinen P, Isolauri E. Probiotics in primary prevention of atopic disease: a randomized placebo controlled trial. Lancet . 2001;357(9262):1076-1079.

Kontiokari T, Sundqvist K, Nuutinen M, Pokka T, Koskela M, Uhari M. Randomised trial of cranberry-lingonberry juice and Lactobacillus GG drink for the prevention of urinary tract infections in women. BMJ . 2001;322:1571-1573.

Malin M, Suomalainen H, Saxelin M, Isolauri E. Promotion of IgA immune response in patients with Crohn's disease by oral bacteriotherapy with Lactobacillus GG . Ann Nutr Metab. 1996;40:137-145.

Marteau PR, de Vrese M, Cellier CJ, Schrezenmeir J. Protection from gastrointestinal diseases with the use of probiotics. Am J Clin Nutr . 2001;73(2 Suppl):430S-436S.

Meydani SN, Ha WK. Immunologic effects of yogurt. Am J Clin Nutr . 2000;71(4):861-872.

Michetti P, Dorta G, Wiesel PH, et al. Effect of whey-based culture supernatant of Lactobacillus acidophilus ( johnsonii ) La1 on Helicobacter pylori infection in humans. Digestion . 1999;60(3):203-209.

Murray MT, Pizzorno JE. Probiotics. In: Pizzorno JE, Murray MT, eds. Textbook of Natural Medicine. Vol 1. 2nd ed. Edinburgh: Churchill Livingstone; 1999: 893-898.

Pradhan A, Majumdar MK. Metabolism of some drugs by intestinal lactobacilli and their toxicological considerations. Acta Pharmacol Toxicol (Copenh). 1986;58(1):11-15.

Rani B, Khetarpaul N. Probiotic fermented food mixtures: possible applications in clinical anti-diarrhea usage. Nutr Health . 1998; 12(2): 97-105.

Reid G. Probiotic agents to protect the urogenital tract against infection. [Review]. Am J Clin Nutr . 2001;73(2 Suppl):437S-443S.

Rembacken BJ, Snelling AM, Hawkey PM, Chlamers DM, Axon ATR. Non-pathogenic Eschericia coli versus mesalazine for the treatment of ulcerative colitis: a randomized trial. Lancet . 1999;354:635-639.

Rolfe RD. The role of probiotic cultures in the control of gastrointestinal health. J Nutr. 2000;130(2S Suppl):396S-402S.

Scarpignato C, Rampal P. Prevention and treatment of traveler's diarrhea: a clinical pharmacological approach. [Review]. Chemotherapy . 1995;41 Suppl 1:48-81.

Schiffrin EJ, Brassart D, Servin AL, Rochat F, Donnet-Hughes A. Immune modulation of blood leukocytes in humans by lactic acid bacteria: criteria for strain selection. Am J Clin Nutr. 1997;66(2):515S-520S.

Shalev E, Battino S, Weiner E, Colodner R, Keness Y. Ingestion of yogurt containing Lactobacillus acidophilus compared with pasteurized yogurt as prophylaxis for recurrent candidal vaginitis and bacterial vaginosis. Arch Fam Med . 1996;5(10):593-596.

Shanahan F. Probiotics and inflammatory bowel disease: is there a scientific rationale? Inflamm Bowel Dis . 2000;6(2):107-115.

Sheih YH. Systemic immunity-enhancing effects in health subjects following dietary consumption of the lactic acid bacterium Lactobacillus rhamnosus HN001. J Am Coll Nutr. 2001;20(2):149-156.

Szajewska H, Kotowska M, Mrukowicz JZ, Armanska M, Mikolajczyk W. Efficacy of Lactobacillus GG in prevention of nosocomial diarrhea in infants. J Pediatr . 2001;138(3):361-365.

Szajewska H, Mrukowicz JZ. Probiotics in the treatment and prevention of acute infectious diarrhea in infants and children: a systematic review of published randomized, double-blind, placebo-controlled trials. J Pediatr Gastroenterol Nutr . 2001;33 Suppl 2;S17-S25.

Tejada-Simon MV, Lee JH, Ustunol Z, Pestka JJ. Ingestion of yogurt containing Lactobacillus acidophilus and Bifidobacterium to potentiate immunoglobulin A responses to cholera toxin in mice. J Dairy Sci . 1999;82(4):649-660.

Van Niel CW, Feudtner C, Garrison M, Christakis DA. Lactobacillus thearpy for acute infections diarrhea in children: a meta-analysis. Pediatrics. 2002;109(4):678-684.

Vanderhoof JA, Whitney DB, Antonson DL, Hanner TL, Lupo JV, Young RJ. Lactobacillus GG in the prevention of antibiotic-associated diarrhea in children. J Pediatr . 1999;135(5):564-568.

• Review Date: 4/1/2002
• Reviewed By: Participants in the review process include: Ruth DeBusk, RD, PhD, Editor, Nutrition in Complementary Care, Tallahassee, FL; Jacqueline A. Hart, MD, Department of Internal Medicine, Newton-Wellesley Hospital, Harvard University and Senior Medical Editor Integrative Medicine, Boston, MA; Gary Kracoff, RPh (Pediatric Dosing section February 2001), Johnson Drugs, Natick, Ma; Steven Ottariono, RPh (Pediatric Dosing section February 2001), Veteran's Administrative Hospital, Londonderry, NH. All interaction sections have also been reviewed by a team of experts including Joseph Lamb, MD (July 2000), The Integrative Medicine Works, Alexandria, VA;Enrico Liva, ND, RPh (August 2000), Vital Nutrients, Middletown, CT; Brian T Sanderoff, PD, BS in Pharmacy (March 2000), Clinical Assistant Professor, University of Maryland School of Pharmacy; President, Your Prescription for Health, Owings Mills, MD; Ira Zunin, MD, MPH, MBA (July 2000), President and Chairman, Hawaii State Consortium for Integrative Medicine, Honolulu, HI.

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