Chronic Diarrhea: Saccharomyces boulardi

From Liz Meyer:

DNC NEWS: Honey not sugar: Saccharomyces boulardi

Subject: A novel yeast supplement is not only useful for treating chronic diarrhea but may be useful at stimulating enzyme production.

In the course of my work I hear occasional curious symptoms that I have no treatment for. I file these stories away somewhere in the back corner of my memory.

I remember a patient who in passing told me she gets terribly bloated if she eats any sugar but is perfectly fine eating honey.

So use honey, I told her, without any better solution to offer. What was going on? Curiously, she probably secreted inadequate amounts of disaccharidases. These enzymes cleave apart the two sugar molecules in white sugar to form glucose and fructose.

Bees add these enzymes to flower nectar (which is really just perfumed sugar syrup) and predigest the sucrose into glucose and fructose. This patient couldnt break apart the double sugar molecules in white sugar so she couldnt absorb these sugars into her bloodstream.

Instead any sugar she ate went through her small intestine untouched into her large intestine where it was fermented by the bacteria and yeast that live there. Fermentation releases a huge amount of gas. She wasnt happy about it.

I tell you this long winded story because this morning I noticed a possible solution to her problem. There is a nutritional supplement imported from France called Saccharomyces boulardi that might do the trick.

This supplement is a specific kind of yeast, most often used to treat diarrhea. In several studies of hospitalized patients who received antibiotics, taking Saccharomyces reduced their incidence of diarrhea by more than half.1, 2

This unusual supplement first gained a reputation in our practice about 8 years ago for its ability to calm down the unexplained diarrhea sometimes seen in AIDS patients. In fact it seems to be useful for most types of diarrhea.3

Why is this yeast so effective at treating diarrhea? It isnt simple. Apparently it causes a number of changes in the intestinal mucosa. It stimulates immune activity so the body can fight more aggressively against invading pathogenic bacteria.

It also stimulates enzyme production, especially the enzymes that break up sugars and starches. Disaccharidase enzyme, the one that breaks down sucrose, production increases significantly.4 This is the enzyme that my honey not sugar patient needed. So next time I hear a similar story, well have something to try.

1. In a prospective, double-blind, controlled study investigating antibiotic-associated diarrhea in hospitalized patients, over a 23-month period in 180 subjects who completed the study, it was found that 22% of the placebo subjects experienced diarrhea compared with 9.5% of those who received antibiotics plus lyophilized Saccharomyces boulardi concurrently at a dose of 1 g daily (two 250 mg capsules, b.i.d.).

Of the Clostridium difficile-positive patients, 31% receiving placebo developed diarrhea compared with 9.4% who were taking S. boulardi.

There were no adverse effects with the yeast administration. "Prevention of Antibiotic-Associated Diarrhea by Saccharomyces boulardi: A Prospective Study," Surawicz CM, Elmer GW, Speelman P, et al, Gastroenterology, April 1989;96(4):981-988.

2. In a double-blind, placebo-controlled trial of 193 adults who were between 18 and 86 years of age and receiving at least 1 prescription for beta-lactam antibiotics, inpatients received the antibiotic and either oral Saccharomyces boulardi or placebo at 1 g/day (equal to 3 x 1010 colony-forming units) as two 250-mg capsules, twice daily.

Results showed that 7.2% of the patients receiving S. boulardi developed antibiotic-associated diarrhea compared with 14.6% of those receiving placebo. The efficacy of S. boulardi for the prevention of antibiotic-associated diarrhea was 51%. "Prevention of -Lactam-Associated Diarrhea by Saccharomyces boulardi Compared With Placebo," McFarland LV, Surawicz CM, et al, Am J Gastroenterol, 1995;90(3);439-448.

3 Saccharomyces boulardi at doses between 1 and 2 g daily has shown benefit in the treatment of antibiotic-induced Clostridium difficile diarrhea, antibiotic-associated diarrhea, traveler's diarrhea, acute pediatric diarrhea, diarrhea in the elderly, critically ill patients with diarrhea (such as those with burns) and AIDS-associated diarrhea.

Mechanisms of action include attachment inhibition, interference with bacterial toxins and immune system stimulation, inhibition of translocation, and polyamine production.

The role of yeast polyamines, such as sucrase and maltase, appears to be a potential mediator of the intestinal trophic response, which increases enzyme activities, mucosal DNA content, levels of immunoglobulin receptors and secretion of IgA. "Saccharomyces boulardi: The Tale of an Innovative Yeast," McFarland LV, Company Review Article of Florastor, March 28, 2000.

4. Seven healthy adult volunteers (mean age of 20 years, 6 males and 1 female) were treated with high doses of lyophilized Saccharomyces boulardi at 250 mg, 4 times daily, for 2 weeks.

Results showed after a peroral jejunal suction biopsy performed on days 0 and 15 of the study that, after treatment, the specific activity of sucrase, lactase and maltase increased by 82%, 77% and 75%, respectively, over the basal activity of the enzymes measured on day 0, whereas mucosal protein content remained unchanged. Short-term treatment with S. boulardi increased the activity of disaccharidases without morphological changes of the intestinal mucosa.

"Response of Human and Rat Small Intestinal Mucosa to Oral Administration of Saccharomyces boulardi," Buts J-P, Bernasconi P, van Carynest --P, et al, Pediatr P, 1986;20(2):192-196

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