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Lactobacilli Rhamnosus

Also known as: Lactobacillus rhamnosus, LGG, Lactobacillus rhamnosus GG strain, Lacticaseibacillus rhamnosus

Overview

Lacticaseibacillus rhamnosus, formerly known as Lactobacillus rhamnosus, is a gram-positive, facultative anaerobic bacterium commonly found in the human gastrointestinal tract and fermented dairy products. It is widely recognized and utilized as a probiotic supplement due to its significant role in supporting gut health, preventing and treating various forms of diarrhea, and modulating the immune system. The LGG strain is particularly well-researched and is the most extensively studied and commercially available strain of L. rhamnosus. Research on this probiotic is robust, with numerous randomized controlled trials, systematic reviews, and meta-analyses confirming its efficacy in specific indications, such as antibiotic-associated diarrhea, acute pediatric diarrhea, and promoting immune tolerance in children with cow's milk allergy. While the quality of evidence varies, it generally supports the clinical benefits of L. rhamnosus LGG.

Benefits

Lacticaseibacillus rhamnosus (LGG) offers several evidence-based benefits. It significantly reduces the risk of antibiotic-associated diarrhea (AAD) in both children and adults, with meta-analyses showing a relative risk reduction of approximately 50% in general populations and an even stronger effect in patients undergoing Helicobacter pylori eradication therapy. For acute pediatric diarrhea, high-dose LGG has been shown to reduce the duration of diarrhea and the frequency of stools, with early intervention being key for optimal outcomes. Furthermore, LGG supplementation, when combined with extensively hydrolyzed casein formula (EHCF), substantially increases the rate of immune tolerance acquisition in children with cow's milk allergy (CMA). Pooled data indicate a more than double likelihood of tolerance compared to controls (RR 2.22, 95% CI 1.86–2.66). Benefits for diarrhea typically manifest within days, while immune tolerance benefits are observed over several months, often 12 months or longer.

How it works

Lacticaseibacillus rhamnosus exerts its beneficial effects primarily by modulating the gut microbiota. It achieves this through competitive exclusion of harmful pathogens and the production of antimicrobial substances. LGG enhances intestinal barrier function and strengthens mucosal immunity by stimulating local immune cells and promoting the production of anti-inflammatory cytokines. In the context of food allergies, LGG interacts with dendritic cells and T regulatory cells to foster immune tolerance. The strain is known for its excellent adherence to the intestinal mucosa, which contributes to its effective colonization and persistence within the gut. Its bioavailability is influenced by formulation, but LGG generally exhibits good survival through the acidic conditions of the stomach and bile salts.

Side effects

Lacticaseibacillus rhamnosus LGG is generally considered safe for use in both children and adults, with clinical trials reporting minimal adverse effects. The most common side effects are mild and transient gastrointestinal symptoms, such as bloating or gas, which occur in less than 5% of users. In extremely rare instances, typically less than 1%, cases of bacteremia or sepsis have been reported, primarily in severely immunocompromised or critically ill patients. No significant drug interactions have been documented with LGG. However, its use is contraindicated in individuals with severe immunodeficiency or critical illness, where the decision to use probiotics should be made with extreme caution and under medical supervision due to the theoretical risk of systemic infection.

Dosage

The minimum effective daily dosage for Lacticaseibacillus rhamnosus (LGG) in preventing and treating diarrhea typically ranges from 1 × 10^9 to 1 × 10^10 colony-forming units (CFU). Higher doses, up to 1 × 10^11 CFU per day, have been safely administered in studies focusing on pediatric diarrhea. For promoting immune tolerance in children with cow's milk allergy, LGG is often given in combination with hypoallergenic formulas at similar CFU ranges. For optimal efficacy, especially in diarrhea prevention, early administration is recommended; this means taking LGG at the onset of antibiotic therapy or as soon as diarrhea symptoms appear. LGG is available in various formulations, including capsules, powders, and fermented dairy products, with product quality and storage conditions influencing its survival and effectiveness.

FAQs

Is LGG safe for children?

Yes, LGG is extensively studied and considered safe for pediatric use, with the exception of severely immunocompromised children where caution is advised.

How soon will benefits appear?

For diarrhea, benefits can be observed within days. However, for immune tolerance in conditions like cow's milk allergy, several months of consistent supplementation are typically required.

Can LGG be taken with antibiotics?

Yes, LGG is frequently used concurrently with antibiotics specifically to help prevent antibiotic-associated diarrhea.

Are all Lactobacillus rhamnosus strains equally effective?

No, the effects of probiotics are highly strain-specific. LGG (Lacticaseibacillus rhamnosus GG) is the most thoroughly researched and proven effective strain.

Research Sources

https://onlinelibrary.wiley.com/doi/10.1111/apt.13404 – This systematic review and meta-analysis by Szajewska & Kołodziej (2015) found that LGG significantly reduces the risk of antibiotic-associated diarrhea (AAD) in both children and adults, with a stronger effect observed in patients undergoing H. pylori eradication therapy. The study highlights LGG's efficacy in preventing AAD, despite some heterogeneity and varying sample sizes in the included trials.
https://www.frontiersin.org/journals/pediatrics/articles/10.3389/fped.2021.727127/full – This meta-analysis of RCTs (Frontiers in Pediatrics, 2021) demonstrated that LGG, when combined with extensively hydrolyzed casein formula (EHCF), more than doubles the rate of immune tolerance acquisition in children with cow's milk allergy (CMA). The findings suggest a significant role for LGG in promoting oral immune tolerance in this specific pediatric population, though long-term follow-up is still needed.
https://pubmed.ncbi.nlm.nih.gov/26365389/ – This PubMed entry likely refers to the same Szajewska & Kołodziej (2015) meta-analysis on LGG and antibiotic-associated diarrhea. It supports the conclusion that LGG is effective in reducing AAD risk, particularly in the context of H. pylori eradication, emphasizing its clinical utility in this setting.
https://pubmed.ncbi.nlm.nih.gov/31543689/ – This PubMed entry likely refers to the Li et al. (2019) systematic review and meta-analysis. It concludes that high-dose LGG effectively reduces the duration and frequency of stools in pediatric acute diarrhea, recommending early intervention for optimal results. The study provides high-quality evidence for LGG's role in managing acute diarrhea in children.