Lactobacillusacidophilus (L. acidophilus) is the most commonly used probiotic, or "friendly" bacteria. Many healthy bacteria live in the intestines and vagina, where they protect against "bad" bacteria that can cause disease. They do this in a couple of ways: for example, when L. acidophilus breaks down food in the intestine, several substances are formed (such as lactic acid and hydrogen peroxide) that create an unfriendly environment for “bad” bacteria. Probiotics are often suggested as a supplement when you take antibiotics. Antibiotics kill bacteria, but don’t discriminate between “friendly” and “unfriendly” organisms, so the balance between good and bad bacteria in the intestines can be upset. It is thought that taking probiotics helps restore the healthy balance of bacteria.
Other probiotics include several Lactobacillus species (spp.), such as L. bulgaricus, L. casei, and L. reuteri, Lactobacillus GG,Bifidobacterium longum, Bifidobacterium bifidum, Streptococcus thermophilus, and Saccharaomyces boulardii (a kind of yeast).
In addition to probiotics, some health care providers suggest taking “prebiotics.” These are the soluble fiber found in some foods or supplements that help prebiotics thrive in the intestine. Examples include fructooligosaccharides (FOS), a carbohydrate found in some fruits and vegetables.
Probiotics may be used for the following:
Several clinical studies suggest that using L. acidophilus vaginal suppositories can help treat bacterial vaginosis. A small number of clinical studies suggests that eating yogurt with L. acidophilus cultures may also help. Some people also use L. acidophilus to treat or prevent vaginal yeast infections, although the evidence about whether it is effective is mixed. Additional clinical research is needed.
The evidence for using Lactobacillus to prevent diarrhea is mixed. Some clinical research suggests Lactobacillus acidophilus may be effective when used to prevent traveler’s diarrhea (caused by eating contaminated food). Other studies have found that Lactoabcillus GG was effective. A mix of probiotics (Saccharomyces boulardii and a mixture of Lactobacillus acidophilus and Bifidobacterium bifidum) helped treat traveler’s diarrhea in one study.
Probiotics, especially Lactobacillus GG, may help prevent or treat infectious diarrhea in children and adults, although the evidence is mixed. Studies seem to show probiotics are most effective in treating rotavirus in children. Diarrhea in children can be serious, and you should call your doctor if it lasts more than a day or your child seems dehydrated.
Other studies have found that probiotics, taken regularly, may help prevent gastrointestinal infections in adults.
Several studies suggest that probiotics, especially Lactobacillus GG and S boulardi, may help prevent diarrhea associated with taking antibiotics. Antibiotic-related diarrhea can be serious, so you should tell your doctor about it.
Lactobacillus and other probiotics have been suggested for a number of conditions, although evidence in most cases is preliminary or mixed:
- Replacing the "friendly" intestinal bacteria destroyed by antibiotics
- Helping digestion and suppressing disease causing bacteria
- Treating chronic constipation
- Treating symptoms of irritable bowel syndrome and inflammatory bowel disease (such as Crohn's disease and ulcerative colitis)
- Improving lactose tolerance in people who are lactose intolerant
- Enhancing the immune system. Studies have suggested that consuming yogurt or milk that contains specific strains of Lactobacillus or taking supplements with Lactobacillus or Bifidobacterium may improve the body’s natural immune response. One study found that supplementation for 6 months was a safe, effective way to reduce fever, cough, and duration of antibiotic treatment, as well as number of missed school days for children 3 - 5 years of age
- Lowering risk of pollen allergies
- Reducing the risk of childhood eczema
- Helping to treat high cholesterol
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.
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
- Yogurt enhanced with probiotics
- Vaginal suppositories
Refrigerate L. acidophilus supplements for best quality. Some preparations are in a form that does not break down under normal temperatures and may be convenient for travelers who can’t refrigerate their supplements. Check the package label for storage instructions.
Marketed probiotics are highly variable, with some products containing single microbes while others comprise multiple distinct microbes. Studies to verify the composition of probiotic formulations have found that discrepancies are common between the stated and actual number of viable organisms in any given product.
Prebiotics occur naturally in foods, but supplements provide a more concentrated source. Prebiotics are oligosaccharides -- chains of sugar units linked together -- and include inulin and fructooligosaccharides (FOS). Fructoligosaccarhides (FOS) are the most commonly used.
How to Take It
Newborns and Infants (0 - 1 year): Always check with your pediatrician before giving dietary supplements to an infant or child. Topical forms are available that may be used for diaper rash. If your infant is taking antibiotics, ask your doctor if a probiotic supplement might be appropriate as well.
Recommended doses of L. acidophilus vary depending on the health condition being treated. Check the specific dosage recommendations on the product label. The following lists guidelines for the most common uses:
For prevention or treatment of diarrhea: Take 1 - 2 billion colony forming units or CFUs per day. Some health care providers may recommend up to 10 - 15 billion cells per day.
For vaginal infections: Some supplement manufacturers offer a probiotic suppository for vaginal use. Many people recommend inserting regular probiotic capsules vaginally as well. However, oral medications should be taken orally and those seeking a vaginal application should look for formulas specifically designed for vaginal use. Many practitioners rely on the oral use of probiotics to treat and prevent vaginal infections without using any sort of vaginal application of probiotics. You should never insert prebiotics vaginally. Speak with your physician.
For maintaining intestinal health: Take 1 - 15 billion CFUs daily in healthy adults. If for the prevention of antibiotic related diarrhea, some health care providers recommend taking it 2 - 3 hours after the antibiotic.
If diarrhea occurs, decrease the dosage or stop taking the product and talk with your health care provider.
Because of the potential for side effects and interactions with medications, dietary supplements should be taken only under the supervision of a knowledgeable health care provider.
Lactobacillus acidophilus is generally considered safe for most people. Gas, upset stomach, and diarrhea are potential side effects in some people (not on antibiotic therapy) who take more than 1 - 2 billion L. acidophilus cells daily.
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.
People with weakened immune systems (such as those receiving chemotherapy or drugs that suppress their immune systems) should ask their doctor before taking probiotics.
People with artificial heart valves should not take L. acidophilus because of the rare chance of bacterial infection.
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 health care provider.
Sulfasalazine -- A laboratory study suggests that L. acidophilus speeds up metabolism of sulfasalazine, a medication used to treat ulcerative colitis.
Antibiotics -- Antibiotics may kill acidophilus bacteria. Take antibiotics at least 2 hours before or after you take this remedy.
Alvarez-Olmos MI. Probiotic agents and infectious diseases: a modern perspective on a traditional therapy. Clin Infect Dis. 2001;32(11):1567-1576.
Ataie-Jafari A, Larijani B, Alavi Majd H, Tahbaz F. Cholesterol-lowering effect of probiotic yogurt in comparison with ordinary yogurt in mildly to moderately hypercholesterolemic subjects. Ann Nutr Metab. 2009;54(1):22-7.
Chitapanarux I, Chitapanarus T, Traisathit P, et al. Randomized controlled trial of live lactobacillus acidophilu plus bifidobacterium bifidum in prophylaxis of diarrhea during radiotherapy in cervical cancer patients. Radiat Oncol. 2010; 5:31.
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.
de Vrese M, Marteau PR. Probiotics and prebiotics: effects on diarrhea. J Nutr. 2007;137(3 Suppl 2):803S-11S.
Ewaschuk JB, Dieleman LA. Probiotics and prebiotics in chronic inflammatory bowel diseases. World J Gastroenterol. 2006;12(37):5941-50.
Fedorak RN, Madsen KL. Probiotics and the management of inflammatory bowel disease. Inflamm Bowel Dis. 2004;10(3):286-299.
Friedrich MJ. A bit of culture for children: probiotics may improve health and fight disease. JAMA. 2000;284(11):1365-1366.
Gao XW, Mubasher M, Fang CY, Reifer C, Miller LE. Dose-response efficacy of a proprietary probiotic formula of Lactobacillus acidophilus CL1285 and Lactobacillus casei LBC80R for antibiotic-associated diarrhea and Clostridium difficile-associated diarrhea prophylaxis in adult patients. Am J Gastroenterol. 2010; 105(7):1636-41.
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.
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.
Ishida Y, Nakamura F, Kanzato H, et al. Effect of milk fermented with Lactobacillus acidophilus strain L-92 on symptoms of Japanese cedar pollen allergy: a randomized placebo-controlled trial.Biosci Biotechnol Biochem. 2005;69(9):1652-60.
Leyer GJ, Li S, Mubasher ME, Reifer C, Ouwehand AC. Probiotic effects on cold and influenza-like symptom incidence and duration in children. Pediatrics. 2009; 124(2):e172-9.
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.
Kaur IP, Kuhad A, Garg A, Chopra K. Probiotics: delineation of prophylactic and therapeutic benefits. J Med Food. 2009 Apr;12(2):219-35.
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.
Kopp MV, Salfeld P. Probiotics and prevention of allergic disease. Curr Opin Clin Nutr Metab Care. 2009 May;12(3):298-303. Review.
Lin PP, Hsieh YM, Tsai CC. Antagonistic activity of Lactobacillus acidophilus RY2 isolated from healthy infancy feces on the growth and adhesion characteristics of enteroaggregative Escherichia coli. Angerobe. 2009; 15(4):122-6.
McFarland LV. Meta-analysis of probiotics for the prevention of traveler's diarrhea. Travel Med Infect Dis. 2007;5(2):97-105.
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.
Martinez RC, Franceschini SA, Patta MC, Quintana SM, Candido RC, Ferreira JC, De Martinis EC, Reid G. Improved treatment of vulvovaginal candidiasis with fluconazole plus probiotic Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14. Lett Appl Microbiol. 2009 Mar;48(3):269-74.
Meydani SN, Ha WK. Immunologic effects of yogurt. Am J Clin Nutr. 2000;71(4):861-872.
Mukerji SS, Pynnonen MA, Kim HM, Singer A, Tabor M, Terrell JE. Probiotics as adjunctive treatment for chronic rhinosinusitis: a randomized controlled trial. Otolaryngol Head Neck Surg. 2009 Feb;140(2):202-8
Rabizadeh S, Miller M, Sears C. Mandell: Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases, 7th ed. Philadelphia, PA: Churchill Livingstone, An Imprint of Elsevier; 2009.
Reid G. Probiotic agents to protect the urogenital tract against infection. [Review]. Am J Clin Nutr. 2001;73(2 Suppl):437S-443S.
Rohde CL, Bartolini V, Jones N. The use of probiotics in the prevention and treatment of antibiotic-associated diarrhea with special interest in Clostridium difficile-associated diarrhea. Nutr Clin Pract. 2009 Feb-Mar;24(1):33-40. Review.
Rolfe RD. The role of probiotic cultures in the control of gastrointestinal health. J Nutr. 2000;130(2S Suppl):396S-402S.
Sazawal S, Hiremath G, Dhingra U, Malik P, Deb S, Black RE. Efficacy of probiotics in prevention of acute diarrhoea: a meta-analysis of masked, randomised, placebo-controlled trials. Lancet Infect Dis. 2006;6(6):374-82.
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.
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.
Bifidobacterium; L. acidophilus; Prebiotics; Probiotics