Probiotics for Travelers

August 10, 2012 Written by JP    [Font too small?]

The last thing you want to contend with while on a business trip or vacation is TD or traveler’s diarrhea. And, while many people assume TD only affects those visiting exotic or remote locales, I can assure you this isn’t always the case. In fact, I was quite surprised to find that my digestive system was in a bad way for about a week following a recent trip to New York. There, we stayed at a pretty high end hotel and ate mostly at top-notch restaurants. Nevertheless, some troublemaking bacteria, protozoa or virus temporarily camped out in my body and made me quite miserable in the process.

Whenever an unexpected situation such as this arises, it affords me the opportunity to reassess how I care for myself. Clearly, I should have done something different in order to shield myself while on the road. One thing that immediately came to mind was that I ought to have been more diligent about washing my hands and disinfecting with all-natural antiseptic wipes. My wife sets an excellent example in this arena and I would do well to follow her lead. CleanWell, a line of gentle products featuring natural ingredients including thyme extract, are a good choice in this regard.

The judicious use of probiotics prior to, during and after travel is another valuable resource. However, not just any probiotic will do. According to several clinical trials and scientific reviews, two strains of healthful bacteria merit particular consideration: Lactobacillus GG and Saccharomyces boulardii. According to a review in the March 1997 issue of the Journal of Travel Medicine, the use of Lactobacillus GG may lower the incidence of TD by up to 56%. Meanwhile, supplementing with S. boulardii is not only indicated for TD, but also antibiotic-related diarrhea. In some instances, S. boulardii is even effective where conventional medications (antibiotics and antidiarrheals) fail to resolve symptoms. What’s more, all the trials I’ve reviewed indicate an excellent safety profile for both of these probiotic strains. Please be advised that other popular forms of beneficial bacteria, such as Lactobacillus acidophilus, have not produced satisfactory results in controlled studies.

I traveled again this past weekend. However, I did a few things differently this time. Prior to my flight, I began supplementing with the aforementioned probiotics for three days. I continued popping probiotic pills while away from home. Upon my return, I continued with the probiotics and stuck with them for a total of 3 days post-travel. I also used more antiseptic wipes this go-around, especially on the inbound and outbound flights – wiping down my seating area, remote control, tray, etc. So far, I’m feeling perfectly fine. And, since I travel frequently, I’ll strive to keep up with this periodic regimen so that I’ll remain that way.

Note: Please check out the “Comments & Updates” section of this blog – at the bottom of the page. You can find the latest research about this topic there!

To learn more about the studies referenced in today’s column, please click on the following links:

Study 1 – Meta-Analysis of Probiotics for the Prevention of Traveler’s Diarrhea (link)

Study 2 – Pharmaceutical Probiotics for the Treatment of Anaerobic and Other(link)

Study 3 – American Journal of Clinical Nutrition: Clinical Applications of Probiotic (link)

Study 4 – What is Effective in Traveler’s Diarrhea? Current Recommendations (link)

Study 5 – Absence of Efficacy Of Nonviable Lactobacillus Acidophilus for the … (link)

Study 6 – Eficacy of Lactobacillus GG as a Diarrheal Preventive in Travelers (link)

Study 7 – Prevention of Travelers’ Diarrhea by Lactobacillus GG (link)

Study 8 – Systematic Review and Meta-Analysis of Saccharomyces Boulardii (link)

Study 9 – Treatment of Persistent Diarrhea w/ S. Boulardii in Returning Travelers (link)

Study 10 – Prevention of Traveler’s Diarrhea with Saccharomyces Boulardii (link)

Probiotics Protect Against Pathogens & Support Immune Function

Source: World J Gastroenterol. 2010 May 14;16(18):2202-22. (link)

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Posted in Alternative Therapies, General Health, Nutritional Supplements

8 Comments & Updates to “Probiotics for Travelers”

  1. Iggy Dalrymple Says:

    In 1980 my late wife and I toured Egypt and took a Nile cruise. Our tour guide warned us to avoid unboiled water and raw salad. My wife had a fragile stomach so she premedicated with antibiotics for a week before the trip. I always had a cast-iron stomach so I wasn’t too worried. I had traveled extensively in Mexico and never got sick. I always loved salad so I usually ate my serving plus several others because everyone else shunned it. One by one, all the members of the tour group got sick…very sick. Our leader, a dentist, almost died. After 4 or 5 days, only my wife and remained well. Then it finally hit me. My wife said that when she arrived at dinner, someone asked (fighting back a smile), “Where’s Iggy?” I recovered pretty quickly and my wife was the sole victor.

    Years later I got a prolonged case of diarrhea from taking black walnut hull extract. I was attempting a “cleansing”, when I didn’t need one. Apparently I “cleansed” the beneficial bacteria as well as the bad. I tried every probiotic in the healthfood store to no avail. It went on about 6 months before I read about Culturelle (Lactobacillus GG). Back then it was only available by mailorder. One course of Culturelle cured my condition.

  2. JP Says:

    That’s our go-to probiotic as well, Iggy. I’ve recently added S. boulardii to my routine (in addition to Culturelle) since we’ve been traveling so much lately. The minimal cost, the probable health benefits and the peace of mind probiotics impart make them more than worth it. After all, who wants to see the wonders of the world from a bathroom window?

    Be well!


  3. JP Says:

    Update 05/19/15:

    World J Surg. 2015 Apr 17.

    A Four-Probiotics Regimen Reduces Postoperative Complications After Colorectal Surgery: A Randomized, Double-Blind, Placebo-Controlled Study.

    BACKGROUND: Heterogeneous results of published studies led to conduct a randomized clinical trial to assess the efficacy of a new formulation of four probiotics as prophylaxis for complications after colorectal surgery.

    METHODS: A double-blind, placebo-controlled randomized study was conducted enrolling patients undergoing colorectal surgery for cancer. Capsules of placebo or of a formulation containing Lactobacillus acidophilus, L. p lantarum, Bifidobacterium lactis and Saccharomyces boulardii were administered starting one day before operation and continuing for another 15 days postoperatively. Patients were followed up for 30 days with the development of postoperative complications as the primary outcome. Gene expression and serum levels of cytokines were measured on postoperative day 4 ( NCT02313519).

    RESULTS: The study was prematurely stopped after enrolment due to efficacy in the primary outcome. Administration of probiotics significantly decreased the rate of all postoperative major complication (28.6 vs. 48.8 % of the placebo arm, p 0.010, odds ratio 0.42). Major benefit was found in the reduction of the rate of postoperative pneumonia (2.4 vs. 11.3 %, p 0.029), of surgical site infections (7.1 vs. 20.0 %, p 0.020) and of anastomotic leakage (1.2 vs. 8.8 %, p 0.031). The time until hospital discharge was shortened as well. Gene expression of SOCS3 was positively related with gene expression of TNF and of circulating IL-6 in the probiotic group but not in the placebo group.

    CONCLUSIONS: The studied probiotic formulation significantly decreased the risk of postoperative complications, namely mechanical ventilation, infections and anastomotic leakage.

    Be well!


  4. JP Says:

    Update 05/19/15:

    Aliment Pharmacol Ther. 2015 Jun;41(12):1237-45.

    Systematic review with meta-analysis: Saccharomyces boulardii supplementation and eradication of Helicobacter pylori infection.

    BACKGROUND: Unsatisfactory Helicobacter pylori eradication rates and therapy-associated side effects remain a problem.

    AIM: To update our 2010 meta-analysis on the effects of Saccharomyces boulardii as supplementation to a standard eradication regimen on H. pylori eradication rates and therapy-associated side effects.

    METHODS: The Cochrane Library, MEDLINE and EMBASE databases were searched from July 2010 (end date of last search) to February 2015, with no language restrictions, for randomised controlled trials (RCTs); additional references were obtained from reviewed articles. Quality of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) guidelines.

    RESULTS: Eleven RCTs (2200 participants, among them 330 children) met the inclusion criteria. Of the 853 patients in the S. boulardii group, 679 (80%, 95% CI 77-82) experienced eradication compared with 608 of the 855 patients (71%, 95% CI 68-74) in the control group [relative risk (RR) 1.11, 95% confidence interval (CI) 1.06-1.17; moderate quality evidence]. S. boulardii compared with control reduced the risk of overall H. pylori therapy-related adverse effects (RR 0.44, 95% CI 0.31-0.64; moderate quality evidence), particularly of diarrhoea (RR 0.51, 95% CI 0.42-0.62; high quality evidence) and nausea [RR 0.6, 95% CI 0.44-0.83 (moderate quality of evidence)].

    CONCLUSIONS: In the populations studied, the effectiveness of standard triple therapy was unsatisfactory. The addition of S. boulardii significantly increased the eradication rate, but it was still below the desired level of success. Saccharomyces boulardii significantly decreased some therapy-related side effects.

    Be well!


  5. JP Says:

    Update 05/19/15:

    Altern Complement Med. 2015 May;21(5):288-93.

    Effect of the Probiotic Saccharomyces boulardii on Cholesterol and Lipoprotein Particles in Hypercholesterolemic Adults: A Single-Arm, Open-Label Pilot Study.

    OBJECTIVES: Elevated blood cholesterol levels are a major risk factor for coronary artery disease, the leading cause of death worldwide. Probiotics have been investigated as potential cholesterol-lowering therapies, but no previous studies have assessed the effect of the probiotic yeast Saccharomyces boulardii on cholesterol levels in human volunteers. The objective of this study was to examine the effect of S. boulardii on serum cholesterol and lipoprotein particles in hypercholesterolemic adults.

    DESIGN: This study was a single-arm, open-label pilot study.

    SUBJECTS: Twelve hypercholesterolemic participants were recruited into the study; one dropped out.

    INTERVENTION: Participants took 5.6×10(10) colony forming unit (CFU) encapsulated S. boulardii (Saccharomyces cerevisiae var. boulardii CNCM I-1079) twice daily for an 8-week period.

    OUTCOME MEASURES: Fasting concentrations of cholesterol (total cholesterol, low-density lipoprotein-cholesterol [LDL-C], high-density lipoprotein-cholesterol [HDL-C], and triglycerides), lipoprotein particles (very-low-density lipoprotein-particle [VLDL-P], remnant lipoprotein particle [RLP-P], total LDL-P, LDL III-P, LDL IV-P, total HDL-P, and HDL 2b-P), and additional cardiovascular biomarkers (apo B-100, lipoprotein [a], high-sensitivity C-reactive protein, homocysteine, fibrinogen, and insulin) were measured at baseline, after 4 weeks, and after 8 weeks.

    RESULTS: Remnant lipoprotein particles decreased by 15.5% (p=0.03) over the 8-week period. The remaining outcome measures were not significantly altered.

    CONCLUSIONS: In this pilot study, 8 weeks of daily supplementation with S. boulardii lowered remnant lipoprotein, a predictive biomarker and potential therapeutic target in the treatment and prevention of coronary artery disease.

    Be well!


  6. JP Says:

    Updated 06/26/16:

    J Evid Based Complementary Altern Med. 2016 Jun 19.

    The Effect of Black Tea (Camellia sinensis (L) Kuntze) on Pediatrics With Acute Nonbacterial Diarrhea: A Randomized Controlled Trial.

    We aimed to evaluate the antidiarrheal effect of black tea in pediatric patients with acute nonbacterial diarrhea. This single-blind randomized clinical trial study was performed on 2 to 12-year-old patients, with acceptable criteria for acute nonbacterial diarrhea in Shiraz, Iran. In total, 120 patients took part in this study. Blocked randomization method was used to allocate them into 2 groups of intervention (black tea tablet + standard treatment) and control group (standard treatment; 60 patients in each). Frequency of defecation, volume, and consistency of stool were registered on arrival and 24 hours later. We used χ2 test, t test, and Mann-Whitney U test. After a 24-hour follow-up, the proportion of patients with formed stool was higher in the intervention group when compared with the control group (P < .001). There was a significant difference between the mean number of defecations per 24 hours in both groups, after treatment (P < .001). We found a possible antidiarrheal effect of black tea. Be well! JP

  7. JP Says:

    Updated 11/13/16:

    Probiotics Antimicrob Proteins. 2016 Aug 16.

    The Effect of a Yeast Probiotic on Acute Diarrhea in Children.

    A probiotic is a living micro-organism administered to promote the health of the host by treating or preventing infections owing to strains of pathogens. Saccharomyces boulardii is a nonpathogen yeast that has a direct inhibitory effect on the growth of many pathogens, an anti-secretory effect and a trophic effect on enterocytes. The aim of this study was to determine the effect of S. boulardii on diarrhea in children. The children from 6 months to 6 years of age with acute watery diarrhea admitted in pediatric clinic in Kashan in 2012 were included in this trial. Exclusion criteria were high fever (T > 38.5 °C), severe dehydration, bloody diarrhea, severe malnutrition, using of antibiotics, anti-diarrheal or antifungal drugs and children with more than one complain. Two hundred patients were assigned into two groups: A total of 100 patients were treated with S. boulardii in addition to ORS (case group) and 100 patients were given placebo in addition to ORS (control group). The duration of diarrhea and frequency of stools were recorded by asking the mothers of the children every day. The results showed that the defecation frequency after second day of treatment in the case group was significantly less than the control group (P = 0.001) and the mean numbers of days of diarrhea was significantly lower in the case group (P = 0.001). The result of this study confirms that S. boulardii reduces the frequency of stool and duration of illness in children.

    Be well!


  8. JP Says:

    Updated 08/16/17:

    Nutrients 2017, 9(8), 887

    The Efficacy of Bifidobacterium longum BORI and Lactobacillus acidophilus AD031 Probiotic Treatment in Infants with Rotavirus Infection

    A total of 57 infants hospitalized with rotavirus disease were included in this study. The children were randomly divided into the study’s two treatment groups: three days of the oral administration of (i) a probiotics formula containing both Bifidobacterium longum BORI and Lactobacillus acidophilus AD031 (N = 28); or (ii) a placebo (probiotic-free skim milk, N = 29) and the standard therapy for diarrhea. There were no differences in age, sex, or blood characteristics between the two groups. When the 57 cases completed the protocol, the duration of the patients’ diarrhea was significantly shorter in the probiotics group (4.38 ± 1.29, N = 28) than the placebo group (5.61 ± 1.23, N = 29), with a p-value of 0.001. Symptoms such as duration of fever (p = 0.119), frequency of diarrhea (p = 0.119), and frequency of vomiting (p = 0.331) tended to be ameliorated by the probiotic treatment; however, differences were not statistically significant between the two groups. There were no serious, adverse events and no differences in the frequency of adverse events in both groups.

    Be well!


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