Saccharomyces boulardii (S. boulardii) is a probiotic yeast that is a variety of Saccharomyces cerevisiae (also known as baker’s or brewer’s yeast). It has been isolated from lychee and mangosteen fruit.
The probiotic activity of S. boulardii ranges from improving gut barrier function, eradicating pathogens, producing antimicrobial peptides, stimulating the immune system, and inhibiting inflammation. Specifically, S. boulardii is used for the prevention and treatment of gastrointestinal tract disorders, including diarrhea symptoms.
This article discusses the uses, side effects, and precautions of S. boulardii. It also covers what to look for in an S. boulardii supplement.
Dietary supplements are not regulated like drugs in the United States, meaning the Food and Drug Administration (FDA) does not approve them for safety and effectiveness before products are marketed. Therefore, when possible, choose a supplement that a trusted third party, such as USP, ConsumerLabs, or NSF, has tested.
However, even if supplements are third-party tested, that doesn’t mean they are necessarily safe for all or effective in general. Therefore, it is important to talk to your healthcare provider about any supplements you plan to take and check in about any potential interactions with other supplements or medications.
Supplement Facts
- Active ingredient(s): Saccharomyces Boulardii
- Alternate name(s): Yeast probiotic
- Legal status: Over-the-counter (OTC) dietary supplement (United States)
- Suggested dose: The optimal dose for S. boulardii has not been established; doses used in clinical trials tend to be 250 to 500 milligrams (mg) per day in children and not more than 1,000 milligrams (mg) per day in adults.
- Safety considerations: Pregnancy, breastfeeding, children, older adults, those with digestive tract disease and weakened immune systems, and yeast allergies. Common side effects: bloating, flatulence. Rare but serious side effect: fungal blood infection (in people with multiple serious medical conditions or central venous catheters).
Uses of Saccharomyces Boulardii
Supplement use should be individualized and vetted by a healthcare professional, such as a registered dietitian, pharmacist, or healthcare provider. No supplement is intended to treat, cure, or prevent disease.
Saccharomyces boulardii is commonly used for gastrointestinal disorders such as the following:
- Traveler’s diarrhea (TD)
- Antibiotic-associated diarrhea (AAD)
- Irritable bowel syndrome (IBS)
- Crohn’s disease
- Ulcerative colitis
Other uses of S. boulardii include the following:
- High cholesterol
- Helicobacter pylori (H. pylori) infection
- Clostridioides difficile (C. difficile) infection
- Candida albicans (C. albicans) infection
Traveler’s Diarrhea
A randomized study of traveling individuals used either 250 or 500 milligrams (mg) per day of S. boulardii or a placebo for three weeks. The product was given five days before the trip and continued throughout. In the placebo group, 43% developed TD. However, in the low-dose S. boulardii, 34% developed TD. And in the higher-dose S. boulardii group, 32% developed TD. So treatment with S.boulardii lowered development of TD by around 10% in these groups. A limitation of the study was that it was conducted on people from Austria and thus may not be generalizable to other populations.
In a similar study of 3,000 travelers, S. boulardii was shown to reduce the incidence of TD dose-dependently (the outcome depended on the dose). Specifically, 39% in the placebo group, 34% in the group given a lower dose of S. boulardii, and 29% in the group given a higher dose of S. boulardii developed TD. However, the study was limited because only 34% of the participants completed the study.
Antibiotic-Associated Diarrhea
A systematic review (a collection of studies) showed that S. boulardii reduced the risk of AAD in people treated with antibiotics from 18.7% to 8.5% compared with placebo or no treatment. The risk of AAD decreased in both adults and children. However, one limitation was that the quality of the included trials varied. More studies may be needed.
Irritable Bowel Syndrome (IBS)
A study of people with irritable bowel syndrome (IBS) used S. boulardii (9 billion colony-forming units, or CFU, per day) or a placebo for four weeks. The daily number of stools in the S. boulardii group decreased, and 87.5% of this group reported improvement in IBS symptoms compared with 72% of the placebo group. However, the sample size of the study was small.
Crohn’s Disease
A randomized, double-blinded trial conducted on 34 people aged from 19 to 54 years with Crohn’s disease in remission showed that after three months, the S. boulardii group improved the gut barrier function compared to the placebo group. However, the study was limited due to its small sample size.
Ulcerative Colitis
A study assessed the efficacy of adding S. boulardii in adults with mild-to-moderate clinical flare-ups of ulcerative colitis. The dosage was 250 milligrams (mg) by mouth three times a day for four weeks. S. boulardii was used in addition to maintenance treatment with Lialda (mesalamine). Over half of the participants attained clinical remission. Further studies with higher sample sizes are needed to confirm the result.
What Are the Side Effects of Saccharomyces Boulardii?
Your provider may recommend you take S. boulardii for certain gastrointestinal conditions. However, consuming a supplement like S. boulardii may have potential side effects. These side effects may be common or severe.
Common Side Effects
No side effects were noted by travelers in studies assessing the effect of S. boulardii supplementation on TD. Likewise, no side effects were reported in studies using S. boulardii for AAD and IBS.
However, common side effects of S. boulardii include the following:
- Bloating
- Flatulence
- Constipation
- Rash
- Nausea
Severe Side Effects
Although infrequent, cases of fungemia (a condition marked by fungi in the blood) have been reported, particularly in those with severe comorbidities and those with central venous catheters.
Seek medical attention if you experience an allergic reaction to S. boulardii.
Precautions
Caution should be taken if the following apply to you:
- Pregnancy and breastfeeding: Due to insufficient safety information on usingS. boulardii when pregnant or breastfeeding, S. boulardii should be avoided.
- Children: A healthcare provider should evaluate diarrhea in children before using S. boulardii.Saccharomyces boulardii supplementation has reduced the duration and severity of diarrhea in children with acute diarrhea.
- Older adults: Due to the increased risk of fungal infection, older adults should avoid using S. boulardii.
- Digestive tract disease: S. boulardii has caused fungal infections in people with digestive tract diseases; please consult your healthcare provider before starting S. boulardii.
- Weakened immune system: S. boulardii has caused fungal infections due to catheter contamination in people with a weakened immune system. Please consult your healthcare provider before starting S. boulardii.
- Yeast allergy: Avoid S. boulardii if you have a yeast allergy.
Dosage: How Much Saccharomyces Boulardii Should I Take?
Always speak with a healthcare provider before taking a supplement to ensure that the supplement and dosage are appropriate for your needs.
Listed below are the doses of S. boulardii used in clinical trials for various conditions:
- Traveler’s Diarrhea: Doses of 250, 500, or 1,000 milligrams (mg) capsules taken by mouth per day for three weeks in adults.
- Antibiotic-Associated Diarrhea: Not less than 250 milligrams (5 billion CFU) but not more than 500 milligrams (10 billion CFU) in children and not more than 1,000 mg (20 billion CFU) in adults.
- Irritable Bowel Syndrome: An S. boulardii dose of 9 billion CFU taken by mouth per day was used for four weeks in adults with IBS.
- Crohn’s disease: For adults with Crohn’s disease, an S. boulardii dose of 500 milligrams (mg), two capsules taken by mouth per day for up to six months, was used in addition to maintenance therapy with mesalamine.
- Ulcerative colitis: For adults with ulcerative colitis, 250 milligrams (mg) of S. boulardii was taken by mouth three times a day for four weeks during maintenance treatment with mesalamine.
What Happens If I Take Too Much Saccharomyces Boulardii?
In general, the daily dose of S. boulardii is typically greater than 1 billion per day (but no more than 20 billion CFU per day in adults for AAD), and the duration of treatment ranges from seven days to six months.
Unlike other probiotics derived from bacterial strains, S. boulardii has not developed any antibiotic or antifungal resistance.
Moreover, human studies indicated that S. boulardii does not persist in the intestines three to five days after oral (by mouth), and ingestion is discontinued.
Interactions
Saccharomyces boulardii is a yeast and fungus. Therefore, taking antifungal medications with S. boulardii can reduce its effects. If an antifungal medication needs to be taken concurrently with S. boulardii, it is suggested that the two be separated by at least four hours apart.
It is essential to carefully read a supplement's ingredient list and nutrition facts panel to know which ingredients and how much of each ingredient is included. Please review this supplement label with your healthcare provider to discuss potential interactions with foods, other supplements, and medications.
How to Store Saccharomyces Boulardii
Some S. boulardii products are stored at room temperature, while others are stored in the refrigerator. Follow the directions on the product label. Discard per packaging instructions.
Similar Supplements
In addition to S. boulardii, here are some examples of other probiotic supplements:
- Bacillus coagulans
- Bifidobacterium bifidum
- Bifidobacterium breve
- Bifidobacterium longum
- Lactobacillus acidophilus
- Lactobacillus casei
- Lactobacillus plantarum
- Lactobacillus rhamnosus
Similar to S. boulardii, the aforementioned probiotics are used for AAD, IBS, TD, and ulcerative colitis. Specifically, Bacillus coagulans, bifidobacterium (B. bifidum, B. breve, and B. longum), and lactobacillus (L. acidophilus, L. casei, L. plantarum, and L. rhamnosus) are used for AAD.
For IBS, B. bifidum, B. breve, and B. longum and L. acidophilus, L. plantarum, and L. rhamnosus have been shown to be effective.
Bifidobacterium breve, L. acidophilus, and L. rhamnosus have also been shown to be effective for TD and ulcerative colitis.
Frequently Asked Questions
When do I take an S. boulardii supplement to help prevent antibiotic-associated diarrhea (AAD)?
To prevent AAD, S. boulardii should be started early in the course of antibiotic treatment before the change in the gut flora occurs. In clinical trials, S. boulardii is continued for the duration of antibiotic treatment. However, it is unclear whether prolonged use of S. boulardii would be necessary.
Why are some S. boulardii supplements stored at room temperature while others are stored in the refrigerator?
Saccharomyces boulardii can be in eitherthe lyophilized (freeze-dried) or heat-dried forms.
Whereas freeze-dried products are stable at room temperature and thus are stored at room temperature, heat-dried products are unstable at room temperature and thus must be refrigerated.How is S. boulardii different from other probiotic strains?
Due to its natural fungal properties, S. boulardii cannot promote the spread of antimicrobial resistance. On the other hand, bacterial probiotics can contribute to antimicrobial resistance.
Other differences between yeast probiotics and bacterial probiotics exist. For example, bacterial probiotics should be taken separately from antibiotics by at least two hours.
However, yeast probiotics do not need to be taken separately from antibiotics because they are intrinsically resistant to antibiotics.
Sources of Saccharomyces Boulardii & What to Look For
Saccharomyces boulardii is available as a supplement or in liquid beverages along with other probiotics.
The quality and efficacy of probiotic supplements vary from product to product even if the label states that it contains S. boulardii due to the lower than stated dose or inaccurate strain composition.
Furthermore, a systematic review suggested finding a probiotic product in which the manufacturing company has sponsored original clinical trials. Such a product indicates a degree of commitment that may be absent in other companies that do not sponsor original research.
Food Sources of Saccharomyces Boulardii
Saccharomyces boulardii, in combination with other probiotics, can be found in fermented kombucha tea.
Not only can S. boulardii be derived from lychee, mangosteen fruit, and kombucha, but it is also derived from dairy products such as kefir.
Saccharomyces Boulardii Supplements
Saccharomyces boulardii is available in capsules of either lyophilized (freeze-dried) or heat-dried preparations.
The potency or shelf-life of the probiotic product depends on how it is manufactured. For example, heat-dried products, which lose their potency rapidly, should be refrigerated after opening. Conversely, freeze-dried products of S. boulardii are stable at room temperature, provided they are protected from moisture.
Summary
Saccharomyces boulardii is a yeast probiotic clinically studied for gastrointestinal disorders, including traveler’s diarrhea, antibiotic-associated diarrhea, irritable bowel syndrome, Crohn’s disease, and ulcerative colitis.
In general, S. boulardii is well-tolerated, but common side effects include bloating, flatulence, and constipation. People with a weakened immune system or who have central venous catheters should not use S. boulardii due to the risk of fungal infection in the blood.
It would help if you talked with your healthcare provider before taking S. boulardii to ensure it is safe. Tell them about any other conditions and symptoms you have or medications you take.
