Ingredient review —Saccharomyces boulardii
What is it?
Description
Saccharomyces boulardii (S. boulardii) is a non-pathogenic yeast microbe with properties that protect it against antibiotics, the body’s internal temperatures, and the acidic environments of the gastrointestinal tract. These properties are not typically observed with bacterial probiotics. (2)(9) S. boulardii was first discovered in lychee and mangosteen fruit and is now cultivated for use in supplements as lyophilized powders, capsules, or liquid beverages. (5)
Not to be confused with: Saccharomyces cerevisiae (7)
Main uses
Diarrhea
Gastrointestinal disorders
Parasitic infections
Formulations
Dosing & administration
Acute diarrhea
General outcomes from A-level evidence
No data currently available.
Dosing & administration
500-750 mg w/ concurrent therapy, 8-10 days
Outcomes
diarrhea severity score, Entamoeba histolytica dysentery (7)
Class of evidence
a
Antibiotic-associated diarrhea
General outcomes from A-level evidence
No data currently available.
Dosing & administration
500-1000 mg w/ concurrent therapy, + 2 weeks
Outcomes
prevention of AAD (7)
Class of evidence
a
Dosing & administration
Children: 250-500 mg w/ concurrent therapy Adults: up to 1000 mg w/ concurrent therapy
Outcomes
risk of AAD from 20.9% to 8.8%
risk of AAD from 17.4% to 8.2% (8)
Class of evidence
a
Clostridium difficile
General outcomes from A-level evidence
No data currently available.
Dosing & administration
1000 mg w/ concurrent therapy, 4 weeks
Outcomes
C. difficile recurrence post-eradication (7)
Class of evidence
a
Giardiasis
General outcomes from A-level evidence
No data currently available.
Dosing & administration
500 mg w/ concurrent therapy, 4 weeks
Outcomes
giardia cyst count (1)
Class of evidence
b
Helicobacter pylori
General outcomes from A-level evidence
No data currently available.
Dosing & administration
1000 mg w/ concurrent therapy, 2 weeks
Outcomes
epigastric distress, global dyspepsia symptom scores, AAD (7)
Class of evidence
a
HIV-related diarrhea
General outcomes from A-level evidence
No data currently available.
Inflammatory bowel disease
General outcomes from A-level evidence
No data currently available.
Dosing & administration
750-1000 mg w/ concurrent therapy, 7 weeks-6 months
Outcomes
ulcerative colitis, Crohn’s bowel movements, relapse in Crohn’s treatment (7)
Class of evidence
a
Dosing & administration
100 mg w/ concurrent therapy, 3 months
Outcomes
intestinal permeability in Crohn’s (3)
Class of evidence
c
Irritable bowel syndrome
General outcomes from A-level evidence
No data currently available.
Dosing & administration
500 mg, 4 weeks
Outcomes
bowel movements, global IBS symptoms (7)
Class of evidence
a
Nutrient-associated diarrhea
General outcomes from A-level evidence
No data currently available.
Dosing & administration
2000 mg, 8-28 days
Outcomes
occurrence of diarrhea and number of days (7)
Class of evidence
a
Adverse effects
S. boulardii is generally regarded as safe, however, an increased risk of non-infectious adverse effects (e.g., biliary tract stenoses, fistulas, lienalis-steal syndrome, abdominal hemorrhage, and acute renal failure) has been found in specific groups (e.g., immunocompromised patients, transplant patients or patients with pancreatitis). Rare cases of fungemia associated with S. boulardii have also been reported. (6)(7)(10)
Pharmacokinetics
Absorption
Distribution
- Survives in the intestinal tract to reach the colon, its most common target. (6)
Metabolism
- S. boulardii is not metabolized but rather dies within the competitive environment of the gastrointestinal tract and is excreted. Levels found excreted in the stool can be 100-1000 times smaller than the ingested dose. (6)
References
- Besirbellioglu, B. A., Ulcay, A., Can, M., Erdem, H., Tanyuksei, M., Avci, I. Y., … Pahsa, A. (2006). Saccharomyces boulardii and infection due to Giardia lamblia. Scandinavian Journal of Infectious Diseases, 38(6-7), 479-481. ()
- Czerucka, D., Piche, T., & Rampal, P. (2007). Review article: Yeast as probiotics -Saccharomyces boulardii. Alimentary Pharmacology & Therapeutics, 26(6), 767-778. ()
- Garcia Vilela, E., De Lourdes De Abreu Ferrari, M., Oswaldo Da Gama Torres, H., Guerra Pinto, A., Carolina Carneiro Aguirre, A., Paiva Martins, F., … Sales Da Cunha, A. (2008). Influence of Saccharomyces boulardii on the intestinal permeability of patients with Crohn’s disease in remission. Scandinavian Journal of Gastroenterology, 43(7), 842-848. ()
- Graff, S., Chaumeil, J. C., Boy, P., Lai-Kuen, R., & Charrueau, C. (2008). Influence of pH conditions on the viability of Saccharomyces boulardii yeast. The Journal of General and Applied Microbiology, 54(4), 221-227. ()
- Hu, Y., Qin, H., Zhan, Z., Dun, Y., Zhou, Y., Peng, N., ... & Zhao, S. (2016). Optimization of Saccharomyces boulardii production in solid-state fermentation with response surface methodology. Biotechnology & Biotechnological Equipment, 30(1), 173-179. ()
- Kelesidis, T., & Pothoulakis, C. (2012). Efficacy and safety of the probiotic Saccharomyces boulardii for the prevention and therapy of gastrointestinal disorders. Therapeutic Advances in Gastroenterology, 5(2), 111-125. ()
- Mcfarland, L. V. (2010). Systematic review and meta-analysis of Saccharomyces boulardii in adult patients. World Journal of Gastroenterology, 16(18), 2202-2222. ()
- Szajewska, H., & Kołodziej, M. (2015). Systematic review with meta-analysis: Saccharomyces boulardii in the prevention of antibiotic-associated diarrhoea. Alimentary Pharmacology & Therapeutics,42(7), 793-801. ()
- Terciolo, C., Dapoigny, M., & Andre, F. (2019). Beneficial effects of Saccharomyces boulardii CNCM I-745 on clinical disorders associated with intestinal barrier disruption. Clinical and Experimental Gastroenterology, 12, 67-82. ()
- Whelan, K., & Myers, C. E. (2010). Safety of probiotics in patients receiving nutritional support: A systematic review of case reports, randomized controlled trials, and nonrandomized trials. The American Journal of Clinical Nutrition, 91(3), 687-703. ()