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Lactobacillus rhamnosus

Also known as: Lactobacillus rhamnosus GG, LGG, Lactobacillus GG, L. rhamnosus GG

Overview

Lactobacillus rhamnosus GG (LGG) is a well-studied probiotic strain originally isolated from the human gastrointestinal tract. As a Gram-positive, lactic acid bacterium, it's widely available in probiotic supplements and some fermented dairy products. LGG is primarily used for the prevention and treatment of antibiotic-associated diarrhea (AAD), acute gastroenteritis, and infantile colic. It is also used to promote oral tolerance in children with cow’s milk allergy (CMA). LGG is known for its robust survival in the GI tract and a strong safety profile. Research on LGG is extensive, with numerous randomized controlled trials, systematic reviews, and meta-analyses supporting its efficacy in specific conditions. The quality of available evidence ranges from moderate to high, although some studies exhibit heterogeneity and methodological limitations.

Benefits

Lactobacillus rhamnosus GG (LGG) has several evidence-based benefits. It reduces the risk of antibiotic-associated diarrhea (AAD) in children and adults, although the quality of evidence is low (RR 0.48, 95% CI 0.20–1.15). LGG also reduces the duration of diarrhea in acute gastroenteritis by approximately 0.85 days (MD -0.85 day, 95% CI -1.15 to -0.56). Furthermore, LGG enhances oral tolerance in children with cow’s milk allergy (CMA) (RR 2.22, 95% CI 1.86–2.66), with moderate quality evidence supporting this benefit. Some studies suggest that LGG may reduce the duration of hospitalization in acute gastroenteritis cases. The effects of LGG appear to be more pronounced in European populations and in children.

How it works

Lactobacillus rhamnosus GG (LGG) exerts its probiotic effects through several mechanisms. Primarily, it modulates the gut microbiota composition, promoting a more balanced and beneficial microbial environment. LGG also enhances gut barrier function, strengthening the intestinal lining and reducing permeability. Additionally, it modulates immune responses by interacting with Toll-like receptors and influencing cytokine production. These actions collectively contribute to LGG's ability to alleviate gastrointestinal distress and promote immune tolerance. LGG is not absorbed systemically; instead, it exerts its effects locally within the GI tract.

Side effects

Lactobacillus rhamnosus GG (LGG) is generally recognized as safe (GRAS) for most populations. Common side effects are rare, with mild gastrointestinal symptoms such as bloating and gas reported in some individuals. Uncommon side effects are very rare, and no significant adverse events have been reported in large clinical trials. Extremely rare side effects, such as isolated reports of bacteremia, have occurred in severely immunocompromised individuals. LGG does not have significant drug interactions but may reduce antibiotic-associated gastrointestinal side effects. Caution is advised when administering LGG to severely immunocompromised individuals. It is considered safe for children and adults, but there is limited data on its use during pregnancy and lactation.

Dosage

The minimum effective dose of Lactobacillus rhamnosus GG (LGG) is ≥10^10 CFU/day for acute gastroenteritis and antibiotic-associated diarrhea (AAD). Optimal dosage ranges from 10^9 to 10^10 CFU/day, depending on the specific indication and the population being treated. Doses up to 10^11 CFU/day have been used safely in clinical trials. It is best taken with food, and during antibiotic therapy for AAD. LGG is available in capsules, powders, and some dairy products. Ensure product viability and proper storage. LGG is not absorbed systemically, exerting local effects in the GI tract. Prebiotics may enhance its effects.

FAQs

Is Lactobacillus rhamnosus GG safe?

LGG is safe for most people, including children. However, it should be avoided in severely immunocompromised individuals due to a very rare risk of bacteremia.

When and how should I take Lactobacillus rhamnosus GG?

Take LGG with food, ideally during antibiotic therapy if using it to prevent or treat antibiotic-associated diarrhea. Follow the dosage instructions on the product label.

What results can I expect from taking Lactobacillus rhamnosus GG?

You can expect a reduction in the duration and risk of diarrhea. In children with cow's milk allergy, it can improve oral tolerance over time with consistent use.

Is Lactobacillus rhamnosus GG a cure-all for gut problems?

No, LGG is not a cure-all. Its effects are modest and can vary depending on the individual and the specific condition being treated. It's most effective for specific issues like AAD and acute diarrhea.

Research Sources

  • https://pubmed.ncbi.nlm.nih.gov/26365389/ – This study investigates the efficacy of probiotics, including Lactobacillus rhamnosus GG, in preventing antibiotic-associated diarrhea (AAD). It suggests that probiotics may be beneficial in reducing the risk of AAD, highlighting the importance of strain-specific effects and dosage considerations. The research contributes to the growing body of evidence supporting the use of probiotics in managing antibiotic-related gastrointestinal disturbances.
  • https://pubmed.ncbi.nlm.nih.gov/31025399/ – This systematic review and meta-analysis assesses the effectiveness of Lactobacillus rhamnosus GG in treating acute gastroenteritis in children. The findings indicate that LGG can reduce the duration of diarrhea, supporting its use as an adjunct therapy in managing acute gastroenteritis. The study emphasizes the need for further research to address heterogeneity and regional differences in treatment effects.
  • https://onlinelibrary.wiley.com/doi/10.1111/apt.13404 – This meta-analysis evaluates the efficacy of probiotics, including Lactobacillus rhamnosus GG, in preventing antibiotic-associated diarrhea (AAD). The results suggest that LGG is effective in preventing AAD, although the quality of evidence varies across subgroups. The study underscores the importance of considering patient-specific factors and probiotic strain characteristics in AAD prevention strategies.
  • https://www.frontiersin.org/journals/pediatrics/articles/10.3389/fped.2021.727127/full – This meta-analysis examines the impact of Lactobacillus rhamnosus GG on enhancing oral tolerance in children with cow's milk allergy (CMA). The study demonstrates that LGG significantly improves oral tolerance in CMA patients, supporting its use as a therapeutic intervention. The research highlights the potential of LGG to modulate immune responses and promote tolerance in allergic conditions.
  • https://tp.amegroups.org/article/view/128126/html – This review provides a comprehensive overview of Lactobacillus rhamnosus GG, covering its mechanisms of action, clinical applications, and safety profile. It highlights the benefits of LGG in managing various gastrointestinal conditions, including antibiotic-associated diarrhea and acute gastroenteritis. The review emphasizes the importance of evidence-based probiotic use and the need for further research to optimize treatment strategies.