Lactobacillus rhamnosus GG (LGG®): the ideal probiotic for infants

Lactobacillus GG and Bifidobacterium (BB12) have each been proven to aid in the healthy development of infants

LGG® is the most clinically studied probiotic strain in the world, including in infants, and is even the standard of care in many neonatal intensive care units.1 LGG has been shown to colonize the intestinal tract, even at low doses,2-7 and has also been proven to be safe at doses as high as 100-200 billion CFU/d.8-14 

LGG® has been extensively studied in infants for a variety of outcomes including immune and gastrointestinal benefits. The probiotic strain helps train the immune system in early infancy to help reduce the incidence of atopic conditions. Additionally, by helping to balance the gastrointestinal microbiota, LGG® promotes digestive health.  

Though still emerging, early study indicates promising connections between LGG® and other benefits outside the immune and digestive systems. Findings suggest promising development of new strategies for reducing the incidence of ADHD and /or Asperger’s Syndrome. Similar to the research that indicates a connection between the gut microbiome, digestive health, and gastrointestinal disease, there is also data to indicate a strong gut-brain connection.15 Research finds pregnant mothers supplemented with LGG® prior to their due date and their newborn infants continuing the same intervention for six months, were found to be significantly less likely to be diagnosed by ADHD or Asperger’s Syndrome at age 13.

Digestive Studies

Lactobacillus GG helps reduce the incidence and duration of diarrhea in infants

If probiotics for preventing nosocomial diarrhea in children are considered, the working group recommends using L. rhamnosus GG (at least 1 billion CFU per day, for the duration of hospital stay).”
--European Society for Paediatric Gastroenterology Hapatology and Nutrition (ESPGHAN)
Hojsak, I., et al. J Ped. Gastroenterol Nutr 2017

According to the CDC, 1 in 9 child deaths worldwide are due to diarrheal disease. Acute gastroenteritis (AGE) causes inflammation of the gastrointestinal tract, affecting the stomach lining and the small intestine resulting in loose or liquid stools and/or increased frequency of evacuation, with or without fever and vomiting. AGE is caused by a range of factors including viruses, bacteria and parasites. 

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While supplementing with Lactobacillus GG during early infancy helps modulate the immune system and contributes to healthy development, supplementation at any point during infancy helps alleviate dysbiosis and has been clinically proven to reduce the incidence and duration of acute diarrheal infections,17-31 including rotavirus8,11,29-30 and nosocomial diarrhea,31 as well as antibiotic-associated side effects.24 These findings are supported by many clinical trials in older populations demonstrating similar results.32-36  Additonally, Lactobacillus GG has been shown to increase the lgA-specific antibody-secreting cell response to rotavirus in infants, leading to a rotavirus lgA serocoversion.8,26 This indicates that in addition to strengthening the epithelial barrier which contributes to pathogen exclusion and  helps keeps infants healthy, Lactobacillus GG also boosts the adaptive immune response to rotavirus.  

Immune Studies

Lactobacillus GG Helps Reduce the Risk of Eczema in High Risk Infants

Over the past several decades, the prevalence of ‘modern day maladies,’ such as atopic diseases like eczema, have drastically increased according to the Centers for Disease Control and Prevention (CDC). While some children quickly outgrow atopic disease, for many these illnesses persist into adulthood and can result in life-long struggles. Data collected over the last two decades indicate that a lack of optimal microbial colonization during the crucial window promotes the risk of atopic disease, highlighting the importance of a healthy human microbiota very early during infancy.37 

Clinical studies support the efficacy of administration of Lactobacillus GG early during infancy to help promote healthy immune responses later in childhood and life, as demonstrated by reduced incidence of atopic eczema in high risk infants, as well as reduced severity of eczema in infants already affected.38-41

Lactobacillus GG Helps Reduce the Risk of Eczema in High Risk Infants

Lactobacillus GG is shown to reduce the incidence and severity of eczema when supplementation begins during the critical window of microbial development.39-41

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Lactobacillus GG Helps Reduce the Severity of Eczema in Infants

Lactobacillus GG has been shown to improve the symptoms of eczema in infants, measured by the standardized symptom score scale.38

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Lactobacillus GG helps infants acquire tolerance to Cow’s Milk Allergy 

Cow’s milk allergy (CMA), the most common food allergy in early childhood and typically a non-lgE-mediated immunological reaction to the cow’s milk proteins(CMP) casein and whey,  results in a variety of symptoms, including skin rash, respiratory issues, vomiting, diarrhea, gas, and bloating.42

Studies indicate that the supplementation of Lactobacillus GG help infants achieve dairy tolerance earlier and more completely.43,44 As compared to the placebo, Lactobacillus GG effectively attenuating the increased intestinal permeability observed in infants with CMP allergy by creating complex responses in the intestinal mucosa, reflected by the up- and down-regulation of several genes involved in immune response, inflammation, cell-cell signaling, signal transcription, and signal transduction.43


Lactobacillus GG drives faster resolution of Cow’s milk allergy

Infants who receive Lactobacillus GG supplementation achieve milk tolerance faster and more completely than those given extensively hydrolyzed casein formula (ECHF).42

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The link between digestion, food allergies and colic—and how Lactobacillus GG can help

Infantile colic is defined by crying that lasts for three or more hours a day, for three or more days a week, for at least three weeks.45 While the root cause of colic is not well understood, one hypothesis suggests that the disorder may stem from gastrointestinal dysfunction and allergy issues, such a s food allergy.

Study findings support the use of Lactobacillus GG to help reduce the incidence of infantile colic, likely by reducing one of the presumed root causes of colic, namely gastrointestinal disorders and/or food allergies.42,43 

Lactobacillus GG Helps Reduce Crying Time 

Supplementation with Lactobacillus GG may alleviate fussing and crying associated with occasional digestive upset in preterm infants.6

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References
    • Luoto R, Isolauri E, Lehtonen L. Safety of lactobacillus GG probiotic in infants with very low birth weight:Twelve years of experience. Clin Infect Dis. 2010;50(9):1327-1328.
    • Uberos J, Aguilera-Rodriguez E, Jerez-Calero A, Molina-Oya M, Molina-Carballo A, Narbona-Lopez E. Probiotics to prevent necrotising enterocolitis and nosocomial infection in very low birth weight preterm infants. Br J Nutr. 2017;117(7):994-1000.
    • Nermes M, Kantele JM, Atosuo TJ, Salminen S, Isolauri E. Interaction of orally administered lactobacillus rhamnosus GG with skin and gut microbiota and humoral immunity in infants with atopic dermatitis. Clin Exp Allergy. 2011;41(3):370-377.
    • Petschow BW, Figueroa R, Harris CL, Beck LB, Ziegler E, Goldin B. Effects of feeding an infant formula containing lactobacillus GG on the colonization of the intestine: A dose-response study in healthy infants. J Clin Gastroenterol. 2005;39(9):786-790.
    • Millar MR, Bacon C, Smith SL, Walker V, Hall MA. Enteral feeding of premature infants with lactobacillus GG. Arch Dis Child. 1993;69(5 Spec No):483-487.
    • Partty A, Luoto R, Kalliomaki M, Salminen S, Isolauri E. Effects of early prebiotic and probiotic supplementation on development of gut microbiota and fussing and crying in preterm infants: A randomized, double-blind, placebo-controlled trial. J Pediatr. 2013;163(5):1272-7.e1-2.
    • Isolauri E, Arvola T, Sutas Y, Moilanen E, Salminen S. Probiotics in the management of atopic eczema. Clin Exp Allergy. 2000;30(11):1604-1610.
    • Isolauri E, Joensuu J, Suomalainen H, Luomala M, Vesikari T. Improved immunogenicity of oral D x RRV reassortant rotavirus vaccine by lactobacillus casei GG. Vaccine. 1995;13(3):310-312.
    • Oberhelman RA, Gilman RH, Sheen P, et al. A placebo-controlled trial of lactobacillus GG to prevent diarrhea in undernourished peruvian children. J Pediatr. 1999;134(1):15-20.
    • Pant AR, Graham SM, Allen SJ, et al. Lactobacillus GG and acute diarrhoea in young children in the tropics. J Trop Pediatr. 1996;42(3):162-165.
    • Kaila M, Isolauri E, Soppi E, Virtanen E, Laine S, Arvilommi H. Enhancement of the circulating antibody secreting cell response in human diarrhea by a human lactobacillus strain. Pediatr Res. 1992;32(2):141-144.
    • Brouwer ML, Wolt-Plompen SA, Dubois AE, et al. No effects of probiotics on atopic dermatitis in infancy: A randomized placebo-controlled trial. Clin Exp Allergy. 2006;36(7):899-906.
    • Kirjavainen PV, Salminen SJ, Isolauri E. Probiotic bacteria in the management of atopic disease: Underscoring the importance of viability. J Pediatr Gastroenterol Nutr. 2003;36(2):223-227.
    • Manzoni P, Meyer M, Stolfi I, et al. Bovine lactoferrin supplementation for prevention of necrotizing Enterocolitis.
    • Sudo N, Chida Y, Aiba Y, et al. Postnatal microbial colonization programs the hypothalamic-pituitary-adrenal system for stress response in mice. J Physiol. 2004;558(Pt 1):263-275.
    • Party A, Kalliomaki M, Wacklin P, Salminen S, Isolauri E. A possible link between early probiotic intervention and the risk of neuropsychiatric disorders later in childhood. A randomized trial. Pediatr Res. 2015:77(6):823-28.  
    • Nixon AF, Cunningham SJ, Cohen HW, Crain EF. The effect of lactobacillus GG on acute diarrheal illness in the pediatric emergency department. Pediatr Emerg Care. 2012;28(10):1048-1051.
    • Guandalini S, Pensabene L, Zikri MA, et al. Lactobacillus GG administered in oral rehydration solution to children with acute diarrhea: A multicenter european trial. J Pediatr Gastroenterol Nutr. 2000;30(1):54-60.
    • Oberhelman RA, Gilman RH, Sheen P, et al. A placebo-controlled trial of lactobacillus GG to prevent diarrhea in undernourished peruvian children. J Pediatr. 1999;134(1):15-20.
    • Canani RB, Cirillo P, Terrin G, et al. Probiotics for treatment of acute diarrhoea in children: Randomised clinical trial of five different preparations. BMJ. 2007;335(7615):340.
    • Rautanen T, Isolauri E, Salo E, Vesikari T. Management of acute diarrhoea with low osmolarity oral rehydration solutions and lactobacillus strain GG. Arch Dis Child. 1998;79(2):157-160.
    • Raza S, Graham SM, Allen SJ, Sultana S, Cuevas L, Hart CA. Lactobacillus GG promotes recovery from acute nonbloody diarrhea in pakistan. Pediatr Infect Dis J. 1995;14(2):107-111.
    • Pant AR, Graham SM, Allen SJ, et al. Lactobacillus GG and acute diarrhoea in young children in the tropics. J Trop Pediatr. 1996;42(3):162-165.
    • Arvola T, Laiho K, Torkkeli S, et al. Prophylactic lactobacillus GG reduces antibiotic-associated diarrhea in children with respiratory infections: A randomized study. Pediatrics. 1999;104(5):e64.
    • Shornikova AV, Isolauri E, Burkanova L, Lukovnikova S, Vesikari T. A trial in the karelian republic of oral rehydration and lactobacillus GG for treatment of acute diarrhoea. Acta Paediatr. 1997;86(5):460-465.  
    • Kaila M, Isolauri E, Soppi E, Virtanen E, Laine S, Arvilommi H. Enhancement of the circulating antibody secreting cell response in human diarrhea by a human lactobacillus strain. Pediatr Res. 1992;32(2):141-144.  
    • Isolauri E, Juntunen M, Rautanen T, Sillanaukee P, Koivula T. A human lactobacillus strain (lactobacillus casei sp strain GG) promotes recovery from acute diarrhea in children. Pediatrics. 1991;88(1):90-97.  
    • Majamaa H, Isolauri E, Saxelin M, Vesikari T. Lactic acid bacteria in the treatment of acute rotavirus gastroenteritis. J Pediatr Gastroenterol Nutr. 1995;20(3):333-338.  
    • Sindhu KN, Sowmyanarayanan TV, Paul A, et al. Immune response and intestinal permeability in children with acute gastroenteritis treated with lactobacillus rhamnosus GG: A randomized, double-blind, placebo-controlled trial. Clin Infect Dis. 2014;58(8):1107-1115.  
    • Isolauri E, Kaila M, Mykkanen H, Ling WH, Salminen S. Oral bacteriotherapy for viral gastroenteritis. Dig Dis Sci. 1994;39(12):2595-2600.  
    • Szajewska H, Kotowska M, Mrukowicz JZ, Armanska M, Mikolajczyk W. Efficacy of lactobacillus GG in prevention of nosocomial diarrhea in infants. J Pediatr. 2001;138(3):361-365.
    • Armuzzi A, Cremonini F, Bartolozzi F, et al. The effect of oral administration of lactobacillus GG on antibiotic associated gastrointestinal side-effects during helicobacter pylori eradication therapy. Aliment Pharmacol Ther. 2001;15(2):163-169.
    • Bennett R, Gorbach S, Goldin B, et al. Treatment of relapsing clostridium difficile diarrhea with lactobacillus GG. Nutrition Today Supplement. 1996;31(6):35S.
    • Armuzzi A, Cremonini F, Ojetti V, et al. Effect of lactobacillus GG supplementation on antibiotic-associated gastrointestinal side effects during helicobacter pylori eradication therapy: A pilot study. Digestion. 2001;63(1):1-7.
    • Cremonini F, Di Caro S, Covino M, et al. Effect of different probiotic preparations on anti-helicobacter pylori therapy-related side effects: A parallel group, triple blind, placebo-controlled study. Am J Gastroenterol. 2002;97(11):2744-2749.
    • Cremonini F, Di Caro S, Santarelli L, et al. Probiotics in antibiotic-associated diarrhoea. Dig Liver Dis. 2002;34(SUPPL. 2):S78-S80.
    • Umetsu DT. Flu strikes the hygiene hypothesis. Nat Med. 2004;10(3):232-234.
    • Isolauri E, Arvola T, Sutas Y, Moilanen E, Salminen S. Probiotics in the management of atopic eczema. Clin Exp Allergy. 2000;30(11):1604-1610.
    • Kalliomaki M, Salminen S, Arvilommi H, Kero P, Koskinen P, Isolauri E. Probiotics in primary prevention of atopic disease: A randomised placebo-controlled trial. Lancet. 2001;357(9262):1076-1079.
    • Kalliomaki M, Salminen S, Poussa T, Arvilommi H, Isolauri E. Probiotics and prevention of atopic disease: 4-year follow-up of a randomised placebo-controlled trial. Lancet. 2003;361(9372):1869-1871.
    • Kalliomaki M, Salminen S, Poussa T, Isolauri E. Probiotics during the first 7 years of life: A cumulative risk reduction of eczema in a randomized, placebo-controlled trial. J Allergy Clin Immunol. 2007;119(4):1019-1021.
    • Berni Canani R, Nocerino R, Terrin G, et al. Effect of lactobacillus GG on tolerance acquisition in infants with cow’s milk allergy: A randomized trial. J Allergy Clin Immunol. 2012;129(2):580-2, 582.e1-5.
    • Berni Canani R, Nocerino R, Terrin G, et al. Formula selection for management of children with cow’s milk allergy influences the rate of acquisition of tolerance: A prospective multicenter study. J Pediatr. 2013;163(3): 771-7.e1.
    • Lifschitz C, Szajewska H. Cow’s milk allergy: Evidence-based diagnosis and management for the practitioner. Eur J Pediatr. 2015;174(2):141-150.  
    • Dubois NE, Gregory KE. Characterizing the intestinal microbiome in infantile colic: Findings based on an integrative review of the literature. Biol Res Nurs. 2016;18(3):307-315.