Effectiveness of Saccharomyces boulardii (a probiotic) for antibiotic-associated diarrhea and for C. difficile infection

A good recent review of the effectiveness of probiotics highlights especially the value of Saccharomyces boulardii for diarrhea associated with antibiotic treatments, and for C. difficile infections (a common, and often quite stubborn, gastrointestinal infection). This review, published in 2009, pools data from a number of studies to draw its conclusions. The author first focuses on antibiotic-associated diarrhea, which is a common side effect of many currently used antibiotics, occurring in up to a third of patients being treated. In the second place, the review looks at C. difficile infection and the clinical evidence for the effectiveness of probiotic treatments. In the case of both antibiotic-associated and C. difficile-associated diarrhea, the author concludes that Saccharomyces boulardii has shown effectiveness as a treatment. Among the other findings of this article: probiotic treatments have a very good safety profile and therefore can be recommended widely; and it is very important to treat using probiotics with documented high quality/potency standards in order to insure beneficial outcomes.

Read more about dosage and uses of Saccharomyces boulardii in the NYBC catalog, which now includes two different choices, both from high-quality producers:

Saccharomyces boulardii – Jarrow

and

Florastor – Biocodex

Reference:

McFarland, L. V. Evidence-based review of probiotics for antibiotic-associated diarrhea and Clostridium difficile infections. Anaerobe/Clinical microbiology 15 (2009) 274–280.
Accessed at http://www.idpublications.com/journals/PDFs/ANAE/ANAE_MostDown_1.pdf

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Florastor: a probiotic for many types of acute and chronic diarrhea

For many types of acute and chronic diarrhea, the probiotic Florastor can be recommended as the best natural approach. Florastor is the tradename of Saccharomyces boulardi lyo (lyo = freeze dried, the best means for preserving the effectiveness of this probiotic species; also means that Florastor is shelf-stable at room temperature).

Here are the main indications/conditions for which Florastor/Saccharomyces boulardii has been investigated:

Acute Diarrhea
A controlled study found a significant reduction in symptoms of diarrhea in adults taking 250mg of S. boulardii twice a day for five days or until symptoms were relieved.

Irritable Bowel Syndrome
A placebo-controlled study found that patients with diarrhea due mainly to irritable bowel syndrome (IBS) had a significant reduction in number and consistency of bowel movements.
Suggested dosage is 250mg twice daily.

Inflammatory Bowel Disease
Florastor benefits for inflammatory bowel disease (IBD) include: 1) prevention of relapse in Crohn’s disease patients currently in remission and 2) improvement for ulcerative colitis patients with moderate symptoms. Suggested dosage is three 250mg capsules a day.

Antibiotic-Associated Diarrhea
Some evidence for its usefulness in the prevention of antibiotic-associated diarrhea (AAD) in adults. Suggested dosage: 250mg twice a day with the standard antibiotic course.

HIV/AIDS-Associated Diarrhea
Saccharomyces boulardii was shown to significantly increase the recovery rate of stage IV AIDS patients suffering from diarrhea. On average, patients receiving S. boulardii gained weight while a placebo group lost weight over the 18 month study. There were no reported adverse reaction observed in these immunocompromised patients.

Recurrent Clostridium difficile Infection
Two 500mg doses per day of Saccharomyces boulardii when taken with one of two antibiotics (vancomycin or metronidazole) were found to significantly reduce the rate of recurrent Clostridium difficile (pseudomembranous colitis) infection. However, note that significant benefit was not found for prevention of an initial episode of Clostridium difficile-associated disease.

For more on Saccharomyces boulardii, see the NYBC entry:

Florastor

Note that non-member price is $30, but member price is NOW ONLY $29. (NYBC Membership costs $5, $10, or $25 per year, depending on income.)

Some references (there are many more, since Saccharomyces boulardii is among the most-studied probiotics):
–Höcher W, Chase D, Hagenhoff G (1990). “Saccharomyces boulardii in acute adult diarrhoea. Efficacy and tolerance of treatment”. Münch Med Wochenschr 132: 188–92. 
–McFarland L, Surawicz C, Greenberg R (1994). “A randomised placebo-controlled trial of Saccharomyces boulardii in combination with standard antibiotics for Clostridium difficile disease”. J Am Med Assoc 271: 1913–8. 
–Maupas J, Champemont P, Delforge M (1983). “Treatment of irritable bowel syndrome with Saccharomyces boulardii: a double blind, placebo controlled study”. Medicine Chirurgie Digestives 12(1): 77–9. 
–Guslandi M, Mezzi G, Sorghi M, Testoni PA (2000). “Saccharomyces boulardii in maintenance treatment of Crohn’s disease”. Dig. Dis. Sci. 45 (7): 1462–4. PMID 10961730. 
–Guslandi M, Giollo P, Testoni PA (2003). “A pilot trial of Saccharomyces boulardii in ulcerative colitis”. Eur J Gastroenterol Hepatol 15 (6): 697–8. doi:10.1097/01.meg.0000059138.68845.06. PMID 12840682. 
–Saint-Marc T, Blehaut H, Musial C, Touraine J (1995). “AIDS related diarrhea: a double-blind trial of Saccharomyces boulardii”. Sem Hôsp Paris 71: 735–41. 

Saccharomyces boulardii: When a Yeast is Good

Here’s a testimonial about the probiotic Saccharomyces boulardii that we recently came across on the website http://www.florastories.com/. No doubt there’s a connection between the site and the product tradenamed Florastor, but nonetheless this is an important clarification for those wondering about the relationship between other yeasts and the probiotic Saccharomyces boulardii.

Note that the NYBC purchasing co-op has stocked Florastor for several years, and its predecessor DAAIR imported a similar product from Europe for a decade longer. So we have accumulated a store of knowledge about its usefulness and do have confidence in the reliability of its formulation. (By the way, a Consumer Labs review last year gave Florastor good marks, confirming our view.)

Here’s the clarification about “yeast” and Saccharomyces boulardii:

Yeast. It’s a word that makes many women cringe.

And it comes as no surprise, according to Patricia Raymond, MD, board-certified gastroenterologist, author and assistant professor at Eastern Virginia Medical School. For many women, the thought of yeast conjures up bad thoughts of yeast infections.

“Before I was a gastroenterologist, I was a physician,” says Dr. Raymond. “Before I was a physician, I was a medical student. Before I was a medical student, I was a regular woman and frankly, yeast was not my friend. Anything that causes you to lose your self-confidence, lowers your self-image and destroys your sex life is not a friend.”

What many people don’t know is that there are different varieties of yeast. Candida albicans is the yeast infection-causing yeast that many women have learned to hate, while Saccharomyces is a beneficial yeast that can be broken down into different types.

For example, Saccharomyces cerevisiae is a brewer’s yeast that’s used in making wine, bread and beer, while Saccharomyces boulardii is a powerful probiotic that’s been clinically shown to maintain and restore the natural flora in our small and large intestines.

“For those women who have never had a positive relationship with yeast, fear not – pharmaceutical yeast doesn’t equal yeast infection,” Dr. Raymond reports. “In the last several years, there have been more and more studies – clinical trials on humans – using yeast, using specifically Saccharomyces boulardii, and, as a practicing gastroenterologist, I have come to the conclusion that yeast is, in fact, good.”

This website entry then goes on to detail some of the main applications of Saccharomyces boulardii: preventing antibiotic-associated diarrhea; managing traveler’s diarrhea; treating recurrence of C. diff (Clostridium difficile).

For more information, see the NYBC entry:

Florastor,

Saccharomyces boulardii lyo: indications and dosage suggestions

NYBC stocks the probiotic Florastor, which is Saccharomyces boulardi lyo (lyo = freeze dried, the best means discovered for preserving the effectiveness of this agent). Saccharomyces boulardii, a yeast first investigated by French microbiologist Henri Boulard in Indochina in the 1920s, has been widely researched and distributed over the last fifty years, though it has a longer history of use in Europe than in the US.

We’re glad that Florastor has become available in the United States in the last five years, since before that we were obliged to import this pharmaceutical grade probiotic from Europe; the US versions of Saccharomyces boulardii often seemed quite a bit less effective, perhaps because the European production techniques were more advanced.

Here are the main indications/conditions for which Saccharomyces boulardii has been investigated:

Acute Diarrhea
A controlled study found a significant reduction in symptoms of diarrhea in adults taking 250mg of S. boulardii twice a day for five days or until symptoms were relieved.

Irritable Bowel Syndrome
A placebo-controlled study found that patients with diarrhea due mainly to irritable bowel syndrome (IBS) had a significant reduction in number and consistency of bowel movements.
Suggested dosage is 250mg twice daily.

Inflammatory Bowel Disease
Additional benefits to inflammatory bowel disease (IBD) patients may be found in 1) prevention of relapse in Crohn’s disease patients currently in remission and 2) benefits to ulcerative colitis patients with moderate symptoms. Suggested dosage is three 250mg capsules a day.

Antibiotic-Associated Diarrhea
Some evidence for its use in the prophylaxis (prevention) of antibiotic-associated diarrhea (AAD) in adults. Suggested dosage: 250mg twice a day with the standard antibiotic course.

HIV/AIDS-Associated Diarrhea
Saccharomyces boulardii was shown to significantly increase the recovery rate of stage IV AIDS patients suffering from diarrhea versus placebo. On average, patients receiving S. boulardii gained weight while the placebo group lost weight over the 18 month study. There were no reported adverse reaction observed in these immunocompromised patients.

Recurrent Clostridium difficile Infection
Two 500mg doses per day of Saccharomyces boulardii when taken with one of two antibiotics (vancomycin or metronidazole) were found to significantly reduce the rate of recurrent Clostridium difficile (pseudomembranous colitis) infection. However, note that significant benefit was not found for prevention of an initial episode of Clostridium difficile-associated disease.

For more on Saccharomyces boulardii, see the NYBC entry:

Florastor
Note that non-member price is $30, but member price is ONLY $29. (NYBC Membership costs $5, $10, or $25 per year, depending on income.)
Some citations (there are many more, since Saccharomyces boulardii is among the most-studied probiotics):

–Höcher W, Chase D, Hagenhoff G (1990). “Saccharomyces boulardii in acute adult diarrhoea. Efficacy and tolerance of treatment”. Münch Med Wochenschr 132: 188–92. 
–McFarland L, Surawicz C, Greenberg R (1994). “A randomised placebo-controlled trial of Saccharomyces boulardii in combination with standard antibiotics for Clostridium difficile disease”. J Am Med Assoc 271: 1913–8. 
–Maupas J, Champemont P, Delforge M (1983). “Treatment of irritable bowel syndrome with Saccharomyces boulardii: a double blind, placebo controlled study”. Medicine Chirurgie Digestives 12(1): 77–9. 
–Guslandi M, Mezzi G, Sorghi M, Testoni PA (2000). “Saccharomyces boulardii in maintenance treatment of Crohn’s disease”. Dig. Dis. Sci. 45 (7): 1462–4. PMID 10961730. 
–Guslandi M, Giollo P, Testoni PA (2003). “A pilot trial of Saccharomyces boulardii in ulcerative colitis”. Eur J Gastroenterol Hepatol 15 (6): 697–8. doi:10.1097/01.meg.0000059138.68845.06. PMID 12840682. 
–Saint-Marc T, Blehaut H, Musial C, Touraine J (1995). “AIDS related diarrhea: a double-blind trial of Saccharomyces boulardii”. Sem Hôsp Paris 71: 735–41. 

Saccharomyces boulardii info sheet on www.thebody.com

We noticed that our friends at www.thebody.com are still posting an old info sheet on Saccharomyces boulardii produced by one of the New York Buyers’ Club’s predecessor organizations, the PWA Health Group. Much of the scientific information displayed is still valid, though the Biocodex product, once available in the US only through convoluted importation processes (pioneered by PWAHG and others), is now readily available here under the tradename Florastor.

See also NYBC’s  Florastor description in our online purchasing co-op.

Here’s the introduction of the info sheet on www.thebody.com:  

Saccharomyces boulardii (SB) is a live yeast packaged in capsules and sold over the counter in Europe to treat diarrhea. Studies suggest that SB protects the gut from amebas and cholera, may keep candida from spreading, alleviates diarrhea caused by c. difficile, Crohn’s disease and diarrhea of unknown cause in PWAs, and traveller’s diarrhea.

We’ll add the capsule summary of Florastor’s utility from the NYBC website:

This “friendly” yeast has a proven ability to increase the immune response in the GI tract and has helped to control chronic diarrhea in some PWAs. Part of the way this works is to replenish vital intestinal flora that have the added benefit of competing for the site of other infections. It may be a good idea to use this product if you are taking antibiotics. One problem with chronic, long-term antibiotic use is that it can cause the eruption of a bacterial infection known as clostridium (C. difficile) which can cause serious diarrhea.