Lacticaseibacillus rhamnosus GG
Also known as: LGG, Lactobacillus rhamnosus GG, Lacticaseibacillus rhamnosus GG
Overview
Lacticaseibacillus rhamnosus GG (LGG) is a widely recognized and extensively researched probiotic strain, originally isolated from the human gut. It is commonly utilized as a dietary supplement to support gut health and modulate the immune system. LGG is naturally present in various fermented dairy products and is a key ingredient in many probiotic formulations. Its primary applications include the prevention and treatment of several gastrointestinal conditions, such as antibiotic-associated diarrhea (AAD), infantile colic, and food allergies, particularly cow's milk allergy (CMA) in children. The efficacy of LGG is supported by a substantial body of research, including numerous randomized controlled trials (RCTs) and comprehensive systematic reviews and meta-analyses. The quality of evidence for its various indications ranges from moderate to high, underscoring its established role in clinical and supplemental use.
Benefits
Lacticaseibacillus rhamnosus GG (LGG) offers several evidence-based benefits, primarily focused on gastrointestinal health and immune modulation: * **Prevention of Antibiotic-Associated Diarrhea (AAD):** Multiple high-quality meta-analyses consistently demonstrate that LGG significantly reduces the incidence of AAD in both children and adults. One meta-analysis reported a relative risk reduction to 0.48, with even stronger effects observed in specific subgroups, such as patients undergoing Helicobacter pylori eradication therapy (RR 0.26). This benefit is supported by moderate to high-quality evidence. * **Reduction in Duration of Diarrhea and Hospitalization:** LGG supplementation has been shown to decrease the duration of diarrheal episodes and shorten the length of hospital stays, particularly in European populations. This effect is supported by moderate-quality evidence from systematic reviews. * **Treatment of Infantile Colic:** Systematic reviews and meta-analyses indicate that LGG is effective in alleviating symptoms of infantile colic, leading to improved infant comfort and enhanced parental quality of life. The evidence for this benefit is generally strong. * **Promotion of Oral Tolerance in Cow's Milk Allergy (CMA):** There is moderate-quality evidence supporting LGG's role in facilitating immune tolerance in children with CMA. A meta-analysis of five trials involving 565 children demonstrated a significant increase in tolerance acquisition in the LGG group compared to controls (RR 2.22; 95% CI 1.86–2.66), with no heterogeneity across studies, indicating consistent positive effects.
How it works
Lacticaseibacillus rhamnosus GG (LGG) exerts its beneficial effects through several key mechanisms within the gastrointestinal tract. It modulates the gut microbiota by promoting the growth of beneficial bacteria and inhibiting the proliferation of pathogenic microorganisms. LGG also plays a crucial role in immune modulation, stimulating mucosal immune responses and fostering the activity of regulatory T-cells, which are essential for developing oral tolerance. Furthermore, it enhances the intestinal barrier function by strengthening epithelial tight junctions, thereby reducing gut permeability and inflammation. LGG also produces antimicrobial substances that directly inhibit the growth of harmful pathogens. Its efficacy is dependent on its ability to survive the acidic environment of the stomach and successfully colonize the gut.
Side effects
Lacticaseibacillus rhamnosus GG (LGG) is generally recognized as safe (GRAS) and possesses a robust safety record across various age groups, including infants, children, and adults. The most commonly reported side effects are mild gastrointestinal symptoms, such as bloating or gas, which occur in less than 5% of users and are typically transient. Uncommon or rare adverse effects include very rare instances of bacteremia or sepsis, primarily observed in severely immunocompromised or critically ill individuals. These severe events are exceedingly rare and highlight the importance of caution in vulnerable populations. No significant drug interactions have been consistently reported with LGG supplementation. However, it is contraindicated or should be used with extreme caution in severely immunocompromised patients, those with central venous catheters, or critically ill individuals due to the theoretical risk of systemic infection. Overall, LGG is considered safe for most healthy individuals when used appropriately, but medical supervision is advised for special populations.
Dosage
The minimum effective dose for Lacticaseibacillus rhamnosus GG (LGG) is typically at least 10^9 Colony Forming Units (CFU) per day, particularly for indications such as antibiotic-associated diarrhea prevention and allergy tolerance. The optimal dosage range commonly used in clinical trials is between 10^9 and 10^10 CFU per day. While there is no established upper limit for safety, doses up to 10^11 CFU per day have been administered safely in research settings. For antibiotic-associated diarrhea prevention, LGG is often started concurrently with the antibiotic regimen and continued for several days after the antibiotic course is completed. The duration of supplementation varies depending on the specific indication. LGG is available in various forms, including capsules, powders, and incorporated into fermented dairy products. Its efficacy is influenced by its survival through stomach acid, and enteric-coated formulations may enhance delivery to the intestines.
FAQs
Is LGG safe for children?
Yes, Lacticaseibacillus rhamnosus GG has been extensively studied and is considered safe for pediatric use, including infants, with a strong safety record.
When should LGG be taken with antibiotics?
For optimal prevention of antibiotic-associated diarrhea, LGG should ideally be started at the same time as the antibiotic course and continued for several days after the antibiotics are finished.
How soon can benefits be expected?
Benefits for diarrhea prevention can be observed within days. However, for conditions like allergy tolerance, sustained effects may require continuous supplementation over months to years.
Does LGG permanently colonize the gut?
No, colonization by LGG is transient. For sustained benefits, continuous supplementation is often necessary as the bacteria do not permanently establish themselves in the gut.
Research Sources
- https://pubmed.ncbi.nlm.nih.gov/26365389/ – This systematic review and meta-analysis by Szajewska et al. (2016) found that Lacticaseibacillus rhamnosus GG significantly reduces the risk of antibiotic-associated diarrhea (AAD) across various populations. The study, involving over 1000 participants, reported a relative risk reduction of approximately 0.48, with a stronger effect observed in patients undergoing H. pylori eradication therapy. The evidence quality was moderate, with some heterogeneity noted among the included trials.
- https://onlinelibrary.wiley.com/doi/10.1111/apt.13404 – This source, likely related to the Szajewska et al. (2016) meta-analysis, provides further details on the efficacy of LGG in preventing antibiotic-associated diarrhea. It reinforces the finding of a significant reduction in AAD risk, particularly highlighting the benefit in specific clinical contexts like H. pylori eradication. The study contributes to the moderate-quality evidence base supporting LGG's role in this indication.
- https://pubmed.ncbi.nlm.nih.gov/31025399/ – A systematic review and meta-analysis by Szajewska et al. (2019), involving over 2000 participants, demonstrated that LGG supplementation effectively reduces the duration of diarrheal episodes and the length of hospital stays. This effect was particularly pronounced in European populations. The study provided moderate-quality evidence, with consistent findings across the included randomized controlled trials.
- https://tp.amegroups.org/article/view/128126/html – This systematic review and meta-analysis by Zhang et al. (2024) focused on the efficacy of LGG in treating infantile colic. The study concluded that LGG effectively reduces the symptoms of infantile colic, leading to improved infant comfort. It included multiple randomized controlled trials with adequate sample sizes, although some heterogeneity was noted across the studies.
- https://www.frontiersin.org/journals/pediatrics/articles/10.3389/fped.2021.727127/full – This meta-analysis by Tang et al. (2021) investigated the role of LGG in cow's milk allergy (CMA) in children. The study, which included 565 children across five trials, found that LGG supplementation significantly increased the acquisition of oral tolerance in children with CMA (RR 2.22; 95% CI 1.86–2.66). The evidence was considered high-quality with no heterogeneity, and follow-up periods ranged from 12 to 36 months.