• One of the most studied friendly bacteria particularly for kids
• Extensive research supports its positive impact on the immune system, particularly in preventing upper respiratory infections
• Proven to help with various gut problems
• You can find this helpful strain in Advenza Probiotics for kids

Lactobacillus rhamnosus GG, sometimes called LRGG by different probiotic brands, is a well-known and extensively studied probiotic strain. It belongs to the Lactobacillus rhamnosus species. It’s important to note that the LRGG and the regular Lactobacillus rhamnosus strains are genetically identical.

This probiotic has been the focus of more than 250 clinical trials, with around 40 specifically involving children. According to clinicaltrials.gov, it holds the record as the most researched probiotic strain globally (Dronkers, Ouwehand, and Rijkers, 2020).

In April 2020, there was an official reclassification, and L. rhamnosus is now officially known as Lacticaseibacillus rhamnosus. So, you might also see it referred to as Lacticaseibacillus rhamnosus GG (Zheng J et al., 2020).

Research:

• Ensuring safety and well-being
• Infections in the upper respiratory system
• Allergy to cow’s milk protein
• Persistent crying (colic)
• Different types of diarrhea – infectious and caused by antibiotics
• Irritable Bowel Syndrome (IBS)
• Skin condition characterized by itching and redness (eczema)
• Attention deficit hyperactivity disorder (ADHD)
• Cystic fibrosis
• Health considerations for adults
• Studied in various groups: premature babies, newborns, children, adults, and the elderly

 

Lactobacillus rhamnosus GG – Safety and Survival 

L. rhamnosus GG, a strain of probiotics, has been proven to reach the gut effectively in various studies, even with a lower dosage of 100 million CFU (colony-forming units) (Petschow et al., 2005; Szachta, Ignyś, and Cichy, 2011; DebMandal, Mandal, and Pal, 2012). Extensive trials over 30 years, involving a diverse range of individuals from premature babies to the elderly, have shown that L. rhamnosus GG is not only safe but also well-tolerated, with minimal to no significant side effects (Capurso, 2019).

In a retrospective study conducted in two Neonatal Intensive Care Units (NICUs) in Italy between 2003 and 2008, very low birth weight infants were given L. rhamnosus GG from the fourth day of life for four to six weeks. The study involved 743 infants with no adverse effects reported, and the probiotic was not linked to any sepsis cases, leading the researchers to conclude that it is safe and well-tolerated (Manzoni et al., 2011). Another study with very low birth weight infants found that L. rhamnosus GG, along with lactoferrin, was safe, well-tolerated, and significantly reduced the incidence of necrotising enterocolitis (NEC) (Manzoni et al., 2014).

However, it’s essential to note that one trial discovered bacteraemia associated with L. rhamnosus GG in an infant with short gut syndrome. This suggests that further care and research are necessary when considering probiotic supplementation for infants with this condition (De Groote et al., 2005).

 

Lactobacillus rhamnosus GG and upper respiratory tract infections 

Common colds and respiratory infections are widespread issues for both adults and kids. Kids, especially those in school, may face around five to six episodes of these infections annually, and for some, this number can even go up to 12 per year (Toivonen et al., 2016). Children attending day care have about 2-3 times higher chances of getting respiratory infections (Lu et al., 2004). Probiotics have been studied a lot to see if they can help reduce these infections. A recent Cochrane review found that certain probiotic strains are effective in lowering the number of respiratory infections, the average duration of each episode, antibiotic use, and school absences due to colds (Hao, Dong and Wu, 2015). L. rhamnosus GG, a specific probiotic strain, was part of this review and has also been positively evaluated in other studies when used alone.

In a study from 2013, researchers looked at how L. rhamnosus GG could help prevent respiratory infections in children. The study included 1,805 children from four different trials, and it found that L. rhamnosus GG significantly reduced the occurrence of respiratory infections, ear infections, and the use of antibiotics in children. When they looked specifically at children older than one year, they found that L. rhamnosus GG could significantly decrease overall respiratory tract infections (S. Liu et al., 2013).

One important study from this research was done in Croatia and involved 281 children aged one to seven years in day care centers. They were split into two groups – one group drank a fermented milk with L. rhamnosus GG, and the other group had the milk alone without the probiotic. They did this daily for three months during the winter. Only 43% of kids in the probiotic group got a respiratory infection compared to 68% in the group without the probiotic (p<0.001) (Graph 1). There was also a decrease in gastrointestinal infections in the probiotic group, although it was not quite statistically significant (p<0.08).

Graph 1– Percentage of Kids with respiratory infection and gastrointestinal infections in winters

Graph 2– Attendance of kids from daycare with and without probiotics

Kids in the group that had probiotics also got sick for a shorter time and missed fewer days at daycare compared to the group without probiotics (Graph 2) (Hojsak, Snovak, et al., 2010). Other studies in Finland also found that probiotics reduced the number of respiratory infections in kids at daycare centers (Hatakka, 2001; Kumpu et al., 2012).

In hospitals, kids often catch infections that can lead to more medications and longer stays. A study was done to see if L. rhamnosus GG could lower the number of these infections in a children’s hospital. They studied 742 kids (average age=10) and gave them either fermented milk with one billion CFU of L. rhamnosus GG or the same milk without probiotics (control). Kids had their daily milk from the day they were admitted until they left. Respiratory and gastrointestinal infections were much lower in the group with probiotics. Only 2% of kids with probiotics got respiratory infections compared to 5.5% in the control group. Also, kids with probiotics had a lower chance of getting a respiratory infection that lasted more than three days (Hojsak, Abdović, et al., 2010). Another study found that L. rhamnosus GG (6 billion CFU) with B vitamins, Vitamin C, and zinc significantly reduced the number of hospital infections compared to those without probiotics (9% vs. 33%). Kids with probiotics also had shorter stays in the hospital (Bruzzese et al., 2016).

A recent study looked at L. rhamnosus GG in malnourished kids to see if it could reduce infections and improve their health. They studied 71 kids aged six months to five years, giving them either probiotics or nothing (control). All kids had a good diet, and the probiotic group got one billion CFU of L. rhamnosus GG every day. They checked different things every month for three months. In the probiotic group, there were significantly fewer respiratory infections, stomach bugs, and overall infections every month and at the end of the study compared to the control group and how things were at the start. By month three, kids with probiotics had 0.24 respiratory infections compared to 1.47 at the beginning. Also, in the probiotic group, there were significantly fewer urinary tract infections than in the control group by the end of the study.

Graph 3– Total number of infections during the intervention period

In simpler terms, the research showed that people who took probiotics had fewer hospitalizations and infections compared to those who didn’t. The study demonstrated that a specific probiotic, L. rhamnosus GG, had positive effects on various infections like upper respiratory tract infections, acute gastroenteritis, and urinary tract infections. Another study on premature babies found that giving them L. rhamnosus GG reduced the chances of them getting respiratory tract infections, especially those caused by rhinoviruses.

Lactobacillus rhamnosus GG and Cow’s Milk Protein Allergy 

Cow’s milk protein allergy (CMPA) is a common food allergy in kids, affecting about 2-7.5% of infants under one year old. Usually, babies on formula get a special formula, and moms breastfeeding CMPA infants cut dairy from their diet. Sometimes, dairy is reintroduced around age one, but it can take until age five to outgrow the allergy. CMPA varies in severity, and L. rhamnosus GG has been studied in CMPA infants and found to be safe and well-tolerated.

In a study with kids aged 0-12 diagnosed with CMPA, they were split into two groups: one got a milk-free diet plus L. rhamnosus GG, and the other just a milk-free diet. After four weeks, both groups showed improvement, but the probiotic group had more significant improvements in various symptoms. This suggests that L. rhamnosus GG can enhance CMPA symptom relief beyond just changing the diet.

Other studies have also found that L. rhamnosus GG improves digestive symptoms associated with CMPA and even lowers levels of a marker called faecal calprotectin. Additionally, a study involving 256 CMPA infants found that L. rhamnosus GG, when added to different diets, improved the rate of oral tolerance. This means that the probiotic helps kids become more tolerant to cow’s milk over time.

Graph 4- Percentage of children who were able to tolerate dairy after 12

In simpler terms, a study showed that the group of kids who had EHCF (a special formula) along with L. rhamnosus GG had the highest rate of tolerance to cow’s milk by one year, with almost 79% of children becoming tolerant. EHCF alone also had a higher tolerance rate (43.6%) compared to other formulas like HRF, soy, and amino acid-based formulas. This means that adding L. rhamnosus GG to the formula significantly improved the kids’ ability to tolerate cow’s milk.

Another study by the same researcher found that adding L. rhamnosus GG to EHCF not only increased oral tolerance but also reduced the occurrence of other allergic reactions in kids with a specific type of cow’s milk allergy.

A study from 2004 suggested that L. rhamnosus GG might work by boosting a specific immune response (IFN-gamma) in kids with cow’s milk allergy. This response helps improve symptoms and the ability to tolerate cow’s milk in these children.

Lactobacillus rhamnosus GG and colic 

In simpler terms, studying colic in infants can be tricky because it has various causes. However, some research has found changes in the gut bacteria of colicky babies, such as higher levels of gas-producing and inflammatory microbes and lower diversity, along with fewer beneficial Bifidobacteria. Probiotics, which are good bacteria, might help manage colic.

In a study, L. rhamnosus GG was tested on crying and irritability in 94 pre-term babies. The babies were divided into three groups: one got a prebiotic mixture, another received the probiotic L. rhamnosus GG, and the third group got a placebo. They took their assigned supplement daily for two months. In the probiotic group, fewer babies (19%) cried excessively compared to the placebo group (47%). This suggests that giving infants L. rhamnosus GG might help reduce excessive crying and irritability associated with colic.

Graph 5- Percentage of excessive criers after two months intervention

Surprisingly, even though the overall levels of Bifidobacteria were similar, the types of Bifidobacteria present were different between babies who cry a lot and those who are content. Babies who cry excessively had significantly lower levels of a specific type called B. infantis. In a study, a probiotic called L. rhamnosus GG was found to decrease the risk of excessive crying and had positive effects on the types of bacteria in the baby’s gut, especially reducing harmful bacteria like Clostridium histolyticum.

In another study with 30 colicky children, all on a diet without cow’s milk, researchers looked at L. rhamnosus GG’s potential to reduce crying. The children were split into two groups: one received the probiotic, and the other got a placebo. After four weeks, parents in the probiotic group reported a 68% reduction in daily crying, compared to 49% in the placebo group. The probiotic group also had fewer cry days per week. Interestingly, the probiotic group showed an increase in beneficial Bifidobacteria species, suggesting that L. rhamnosus GG might be helpful for babies with colic.

Lactobacillus rhamnosus GG and diarrhoea 

When kids have diarrhea, it can lead to dehydration and serious problems. Surprisingly, there aren’t many over-the-counter medicines for children to prevent or manage diarrhea. However, there’s good news—L. rhamnosus GG has been discovered to help ease diarrhea symptoms, whether it’s from a stomach bug or caused by taking antibiotics.

Gastroenteritis

Diarrhea is a significant health issue for children, causing a considerable number of deaths globally, according to the Centers for Disease Control and Prevention (CDC). It’s especially concerning for kids under 5 years old, where diarrhea ranks as the second leading cause of death.

Even in hospitals, a notable percentage of children (5-44%) end up with infections, often related to the gastrointestinal or respiratory systems. L. rhamnosus GG has demonstrated its ability to reduce the risk of these infections, particularly those affecting the gut.

Numerous studies have explored the use of L. rhamnosus GG to treat diarrhea, and a recent analysis of 19 studies with over 4000 participants found that it significantly reduces the duration of diarrhea, shortens hospital stays, and speeds up the improvement of stool consistency. This probiotic has also shown positive effects in children with rotavirus infections, a common cause of diarrhea. The researchers believe that L. rhamnosus GG helps the lining of the intestines by influencing certain immune cells and reducing inflammation, as well as fighting against viruses.

In a larger study involving children aged 6 months to 5 years with watery diarrhea, a five-day probiotic treatment with L. rhamnosus GG (10 billion CFU per day) significantly shortened the duration of diarrhea and hastened the improvement in stool consistency when compared to standard treatment alone.

A more recent meta-analysis in 2021, which looked at 84 studies involving over 13,000 children, confirmed the effectiveness of certain probiotics, including L. rhamnosus GG, in treating acute diarrhea in children. This suggests that L. rhamnosus GG could be a valuable option for managing and treating diarrhea, especially when given in higher doses and administered early.

Antibiotic associated diarrhoea (AAD)

Antibiotics are commonly prescribed for children, especially for respiratory tract infections, which account for about three-quarters of antibiotic prescriptions in children worldwide. However, using antibiotics in a child’s early years can have both immediate and long-term effects on their health, often leading to common side effects like diarrhea.

Research has looked into the effectiveness of L. rhamnosus GG in preventing antibiotic-associated diarrhea (AAD) in both adults and children. The analysis of 12 studies involving 1,499 participants found that L. rhamnosus GG significantly reduced the risk of AAD, particularly in children. Interestingly, the type of antibiotic didn’t seem to affect the effectiveness of L. rhamnosus GG.

In a notable study involving 188 children aged 6 months to 10 years prescribed a 10-day antibiotic course, those who took L. rhamnosus GG alongside their prescription had a significantly lower incidence of AAD (8% compared to 26% in the placebo group). The probiotic group also experienced a shorter duration of diarrhea, and their stool consistency improved faster.

A more recent study with 90 boys undergoing hypospadias repair surgery assessed the preventative effects of L. rhamnosus GG on AAD. The group taking the probiotic alongside antibiotics had a significantly lower incidence of AAD (10% compared to 50% and 40% in the other groups). Additionally, they experienced a shorter duration of AAD, fewer dressing changes, and lower rates of postoperative complications.

Lactobacillus rhamnosus GG and IBS 

In the UK and around the world, it’s widely known that stomach problems and irritable bowel syndrome (IBS) can seriously affect children’s lives and how well they do in school. A recent study in the US revealed that about 24.7% of kids aged 0-3 years and 25% of those aged 4-18 years met the criteria for a stomach issue based on the Rome IV criteria.

Another study looked at L. rhamnosus GG in 141 children dealing with IBS or ongoing stomach pain. The kids were split into two groups: one received L. rhamnosus GG, and the other got a placebo for eight weeks. After another eight weeks of monitoring, the researchers found that the group taking L. rhamnosus GG had less severe and less frequent stomach pain. Also, a higher percentage of kids in the probiotic group (87%) felt their treatment was successful compared to the placebo group (50%).

At the beginning of the study, 59% of the children had abnormal results in a test measuring intestinal permeability. However, in the group that took the probiotic, the number of children with abnormal results decreased after the intervention. This suggests that the probiotic had a positive effect on intestinal health.

The probiotic, L. rhamnosus GG, has been shown in lab studies to stimulate the growth of cells in the intestine and increase the production of protective substances called mucins. These actions help to keep the gut lining strong and protect it from the harmful effects of germs, antibiotics, and unhealthy foods.

In one study involving 104 children with conditions like IBS, functional dyspepsia, or functional abdominal pain, those who took L. rhamnosus GG for four weeks were more likely to have successful treatment compared to those who took a placebo. This was especially true for children with IBS, where the probiotic significantly improved symptoms.

Another study with 52 children experiencing abdominal pain found that those who took L. rhamnosus GG for four weeks had a significant reduction in pain starting from the first week of the intervention. The improvement continued throughout the study, suggesting that the probiotic was effective in relieving abdominal pain in these children.

Lactobacillus rhamnosus GG and Eczema 

The link between our gut bacteria (microbiome) and eczema (atopic dermatitis) is quite intricate. Scientists are just starting to dive into the connection between our gut and our skin, and early studies are showing that the types and amounts of bacteria in our gut play a big role. Children with eczema tend to have lower levels of Bifidobacteria and higher levels of Clostridia.

However, when it comes to the specific probiotic L. rhamnosus GG and its role in eczema, the research results are a bit inconsistent. This could be because eczema development is influenced by many factors like family history, diet, environment, and when and how much of the probiotic is taken.

One particularly promising study focused on giving L. rhamnosus GG to pregnant mothers with a family history of eczema. The study divided 132 pregnant women into two groups: one group received the probiotic, and the other got a placebo. Mothers took the probiotic until childbirth, and for six months after delivery, breastfeeding moms continued, while formula-fed infants got the probiotic mixed with water. The study found that only 23% of children who received L. rhamnosus GG developed eczema compared to 46% in the placebo group.

In a follow-up study seven years later, it was found that the protective benefits of L. rhamnosus GG were still present. The risk of developing eczema in the first seven years of life was significantly lower in the group that received the probiotic compared to the placebo group.

Lactobacillus rhamnosus GG and ADHD 

Attention deficit hyperactivity disorder (ADHD) is a condition characterized by persistent symptoms of inattention, hyperactivity, and impulsivity, affecting around 5.29% of people globally. Surprisingly, there’s not much research on the connection between the gut and ADHD, but there’s early hope with L. rhamnosus GG.

In one study, researchers followed up on babies who received L. rhamnosus GG for the first six months of life. By the age of 13, none of the kids who had the probiotic developed ADHD or Aspergers, compared to 17% of those who didn’t get it. Interestingly, the kids who developed ADHD or Aspergers had lower levels of Bifidobacteria at six months old. This suggests that the first thousand days of life, a crucial developmental stage, might be a key time to positively influence later mental health.

Another study involved children diagnosed with ADHD who took L. rhamnosus GG for three months. Those who took the probiotic showed improved quality of life scores, while there was no significant change in the placebo group. The researchers think that L. rhamnosus GG might help the gut stay healthy by affecting tight junctions, mucin, and IgA production. In a mouse study, the probiotic was found to influence emotional behavior and the central nervous system, possibly explaining the positive results in the ADHD study.

While these studies show exciting potential for L. rhamnosus GG, it’s crucial to note that more research is needed to fully understand the impact of this probiotic on ADHD.

Lactobacillus rhamnosus GG and cystic fibrosis 

People with cystic fibrosis (CF) often experience high levels of inflammation, excess mucus, and an imbalance in their gut bacteria. Probiotics, especially those that can help reduce respiratory infections through the gut-lung connection, might be beneficial. L. rhamnosus GG, a specific probiotic, has been tested in a few small studies with children having CF.

In one study, researchers looked at gut inflammation in 30 children with CF. Ten of them took 5 billion L. rhamnosus GG daily for four weeks. After this period, the levels of a marker for inflammation significantly decreased in this group, suggesting that L. rhamnosus GG has the potential to reduce gut inflammation in CF patients. Another trial using the same probiotic found similar positive effects on inflammation and identified changes in the gut bacteria of CF individuals.

A pilot study involved 38 children with CF who were split into two groups. One group took L. rhamnosus GG for six months, and the other started with an oral rehydration solution (ORS) for six months. Then, they switched. The group taking the probiotic had fewer lung issues, fewer hospital visits, and better lung function scores compared to those using ORS.

However, a more extensive study in 2018 didn’t find the same positive effects. In this trial with 95 children with CF, those taking L. rhamnosus GG for 12 months didn’t show a difference in lung issues or hospital visits compared to those taking a placebo. Researchers suggested that the different outcomes might be due to the trial’s conditions or the children’s ages.

In summary, the mixed results emphasize the need for more research to understand how L. rhamnosus GG affects children with CF.

Lactobacillus rhamnosus GG in adults 

L. rhamnosus GG has been extensively studied in both children and adults, showing numerous health benefits. In adults, it has been researched for its positive effects on:

1. Digestive Health:

• Diarrhea, including antibiotic-associated diarrhea (AAD)
  • Gastroenteritis
  • Helicobacter pylori treatment

• Immunity
• Allergies
• Inflammatory Bowel Disease

Authors

Dr. Kate Stephens, who holds a Ph.D. in Food and Microbial Sciences with a specialization in Gut Microbiology from the University of Reading and a BSc in Medical Microbiology, has compiled information on various strains of probiotics. This information is current as of January 2022.

Because the properties and benefits of probiotics can vary depending on the specific strain, this database offers detailed information at the strain level. Here are some strains from different types of Lactobacillus bacteria:

• Lactobacillus acidophilus strains: Lactobacillus acidophilus LA-05, Lactobacillus acidophilus NCFM, Lactobacillus acidophilus Rosell-52.
• Lactobacillus casei strains: Lactobacillus casei Shirota, Lactobacillus casei DN-114001.
• Lactobacillus plantarum strains: Lactobacillus plantarum LP299v.
• Lactobacillus reuteri strains: Lactobacillus reuteri Protectis and Lactobacillus reuteri RC-14.
• Lactobacillus rhamnosus strains: Lactobacillus rhamnosus GR-1 , Lactobacillus rhamnosus HN001, and Lactobacillus rhamnosus Rosell-11.
• Lactobacillus paracasei strains: Lactobacillus paracasei CASEI 431.

For more in-depth information and the latest research on probiotics, you can explore the Probiotic Professionals pages.

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Bibliography

Certainly! Here’s a layman’s summary of the listed studies:

1. Lactobacillus GG for Childhood Diarrhea

• Aggarwal et al. (2014) conducted a trial on Lactobacillus GG for acute childhood diarrhea. The study explored its effectiveness in an open-label, randomized controlled setting.

2. Lactobacillus GG for Infants with Allergic Colitis

• Baldassarre et al. (2010) investigated how Lactobacillus GG could aid recovery in infants with blood in their stools and presumed allergic colitis compared to hydrolyzed formula alone.

3. Lactobacillus GG in Cow’s Milk Protein Allergy

• Basturk et al. (2020) conducted a randomized trial to assess the efficacy of Lactobacillus rhamnosus GG in infants with cow’s milk protein allergy.

4. Formula Selection in Cow’s Milk Allergy Management

• Berni Canani et al. (2013) studied how formula selection influences the rate of acquiring tolerance in children with cow’s milk allergy.

5. Lactobacillus GG in Children with Cystic Fibrosis

• Bruzzese et al. conducted various trials (2004, 2007, 2014, 2018) to explore the impact of Lactobacillus GG on intestinal inflammation, pulmonary exacerbations, and hospital admissions in children with cystic fibrosis. Results were varied.

6. Probiotics in Children with Nosocomial Infections

• Bruzzese et al. (2016) conducted a trial on Lactobacillus GG and micronutrient-containing mixtures, finding effectiveness in reducing nosocomial infections in children.

7. Probiotic Impact on Gut Microbiota in ADHD

• Kumperscak et al. (2020) explored the potential benefits of Lactobacillus rhamnosus GG in children with ADHD, reporting improved health-related quality of life.

8. Lactobacillus GG in Cystic Fibrosis: Conflicting Results

• The study by Bruzzese et al. (2018) reported conflicting results on the efficacy of Lactobacillus GG in reducing pulmonary exacerbations and hospital admissions in children with cystic fibrosis.

9. Overview of Lactobacillus GG Research

• Capurso (2019) provides an overview of thirty years of research on Lactobacillus rhamnosus GG.

10. Database Information by Dr. Kate Stephens

• Dr. Kate Stephens compiled information on various probiotic strains, specifying their properties and benefits. The data is updated as of January 2022.