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Saccharomyces boulardii or s boulardii has been used for the last 30 years or so to treat antibiotic associated diarrhea with pretty good results. It has also been used to treat diarrhea caused by Clostridium difficile and Traveler's diarrhea. Numerous clinical studies have been run to see if it works for Crohn's disease, helicobacter pylori, ulcerative colitis, irritable bowel syndrome, parasitic infections and HIV-related diarrhea. It's also been used to treat candida yeast infections and I am going to get into those results in a little bit.
Many classify it as a probiotic, which it is not. It is a yeast. Probiotics are typically various species of good bacteria. It was first isolated from lychee and mangosteen fruit in 1923 by French scientist Henri Boulard. Since then, it has been genome mapped and is now classified as a subspecies of the yeast Saccharomyces cerevisiae, with over a 99% genome relatedness. It is nearly identical to the Saccharomyces cerevisiae strains that are used to make wine and beer.1
Luckily, a comprehensive study was published in Therapeutic Advances in Gastroenterology in 2012 that we can refer too, to see just how effective s boulardii is for intestinal problems.
First up is antibiotic associated diarrhea, AAD, that often occurs when taking antibiotics. In 10 controlled trials, an 80% reduction in symptoms was observed among patients. It also demonstrated an ability to prevent AAD in 30% of adults and children.
It had a positive effect on acute and persistent diarrhea due to a variety of causes as well. The outcomes for children showed a 50% success rate in reducing the condition.
Travelers diarrhea is often associated with unsanitary food handling conditions in many of the third world countries. S boulardii achieved an 11% reduction in this illness in 12 clinical trials.
Sometimes taking antibiotics can trigger an over growth of Clostridium difficile, a pathogenic bacteria that often kills older adults. Saccharomyces boulardii was found in two clinical trials to reduce the chronic diarrhea that is associated with this infection up to 33%.
Fourteen clinical trials involving 1671 patients being treated for h pylori revealed an improvement in treatment related side effects and success rates. It decreased the risk of triple antibiotic associated diarrhea and induced cell death in the bacteria improving the success rate for treatment by 9%.
In patients with Crohn's disease, it helped reduce colon permeability and prevented a relapse after treatment in 38% of the patients.
A recent analysis of 20 clinical trials involving s boulardii and 1404 subjects with Irritable bowel syndrome, showed the quality of life was improved but it did not improve intestinal symptoms.
S Boulardii seems to have a beneficial effect in amebiasis, giardiasis and infection with Blastocystis homini. It helped enhance the clearance of amebic colitis when taken with antibiotics. It also helped reduce the patients diarrhea, abdominal pain and fever. It improved treatment success rates for giardia and Blastocystis hominis.
It improved diarrhea often associated with HIV positive patients by 61%.
The study also pointed out that there have been over 100 cases of infection by s boulardii in immunocompromised patients. Some of these patients took it by mouth; and some were infected through their iv catheters, they suspect infection occurred when opening the packet and the spores became airborne.2
Numerous studies have been carried out using saccharomyces boulardii and various species of candida including candida albicans and candida glabrata.3,4,5,6,7,8
All of these published scientific studies came to the same conclusion, s boulardii does not kill candida yeast.
It does however secrete capric acid like what is found in coconut oil. This prevents candida yeast from forming hyphae and building biofilms. It also helps reduce the spread of the candida colony by preventing it from adhering to epithilial cells. It helps reduce cytokine-mediated inflammatory host response and therefore reduces inflammation.
Lypholized preparations, which have to be refrigerated, performed much better in these clinical studies than freeze dried forms. Doses need to be at least 500mgs or more to have any success.
In 2003, an article was printed in the Journal of Clinical Microbiology describing outbreaks of Saccharomyces cerevisiae subtype boulardii in four hospitalized patients that were in the vicinity of patients that were treated with this yeast. All four were infected from the iv's that had been placed in their bodies. The suspected cause was that the yeast became airborne or the workers hands transferred the yeast to the patient in spite of repeated washing of their hands. All four patients recovered after being given 400mgs of fluconazole for various time frames.
The article points out that "Fungemias are not limited to immunocompromised patients and for this reason, S. cerevisiae subtype boulardii should be considered a potentially dangerous microorganism." 9
In 2016, an article was published in Frontiers of Microbiology that talks about the potential risks of opportunistic strains of Saccharomyces cerevisiae in food products. They admit that S. cerevisiae has an impeccably good food safety record but the large amounts of this yeast that people are consuming these days is cause for concern.
They say that s boulardii is nothing other than the commercialized name for S. cerevisiae and that S. cerevisiae has been related to a wide variety of infections, which range from vaginitis infections in healthy patients and cutaneous infections, to systemic bloodstream infections and infections of essential organs in immunocompromised and critically ill patients.10
Occasionally I do see very high levels on stool test results for Saccharomyces cerevisiae with no other yeasts present. These people are infected and are not immunocompromised laying in a bed in an Intensive Care Unit. Just the fact that the article in Frontiers of Microbiology mentions, "vaginitis infections in healthy patients", would keep me from taking it. Especially when you consider that it does not kill candida! Yes, it keeps it from spreading but so does gymnema sylvestre, which also has the ability to cause hypheal forms of yeast to shift back to a spore form which is easier to kill. And, because the effective agent it secretes, capric acid, is also in coconut oil, why not remove the risk and just take coconut oil?
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1. Sci Rep. 2017; 7: 371. PMCID: PMC5428479. Complete genome sequence and comparative genomics of the probiotic yeast Saccharomyces boulardii
2. Therap Adv Gastroenterol. 2012 Mar; 5(2): 111–125. Efficacy and safety of the probiotic Saccharomyces boulardii for the prevention and therapy of gastrointestinal disorders
3. J Infect Dis. 1993 Nov;168(5):1314-8.Inhibition of Candida albicans translocation from the gastrointestinal tract of mice by oral administration of Saccharomyces boulardii.
4. FEMS Microbiology Letters, Volume 310, Issue 1, 1 September 2010, Pages 17–23, https://doi.org/10.1111/j.1574-6968.2010.02037. The effect of Saccharomyces boulardii on Candida albicans-infected human intestinal cell lines Caco-2 and Intestin.
5. Plos One. Published: August 10, 2010. Capric Acid Secreted by S. boulardii Inhibits C. albicans Filamentous Growth, Adhesion and Biofilm Formation.
6. Med Mycol. 2007 Dec;45(8):691-700. Saccharomyces boulardii decreases inflammation and intestinal colonization by Candida albicans in a mouse model of chemically-induced colitis.
7. Med Mycol. 2016 Nov 1;54(8):835-45. doi: 10.1093/mmy/myw026. Epub 2016 Jun 1.
Probiotic yeast Saccharomyces boulardii (nom. nud.) modulates adhesive properties of Candida glabrata.
8. FEMS Yeast Res. 2009 Dec;9(8):1312-21. 2009 Aug 5. The antagonistic effect of Saccharomyces boulardii on Candida albicans filamentation, adhesion and biofilm formation.
9. J. Clin. Microbiol. November 2003. Outbreak of Saccharomyces cerevisiae Subtype boulardii Fungemia in Patients Neighboring Those Treated with a Probiotic Preparation of the Organism.
10. Front Microbiol. 2015; 6: 1522. Published online 2016 Jan 8. Opportunistic Strains of Saccharomyces cerevisiae: A Potential Risk Sold in Food Products
Intensive Care Med. 2002 Jun;28(6):797-801. Epub 2002 May 10.
Seven cases of fungemia with Saccharomyces boulardii in critically ill patients.
Medical Mycology Case Reports, Volume 18, December 2017, Pages 15-17. Saccharomyces cerevisiae var. boulardii fungemia following probiotic treatment.
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