Is it safe to take Saccharomyces (S.) boulardii if I have low secretory Immunoglobulin A (sIgA) in stool?

Saccharomyces boulardii in Patients with Low Secretory IgA in Stool

I do not recommend taking Saccharomyces boulardii if you have low secretory IgA (sIgA) in stool due to potential safety concerns in immunocompromised states. 1

Safety Concerns with S. boulardii in Immunocompromised States

• S. boulardii has been reported to be associated with fungemia in critically ill patients and immunocompromised individuals 1
• Low sIgA in stool may indicate compromised mucosal immunity, which could potentially increase risk of adverse effects from probiotics 1
• The American Gastroenterological Association (AGA) recommends careful evaluation of probiotics in vulnerable groups before use, including patients with immune dysregulation 1
• Safety concerns become more significant with high-concentration probiotic products 1

Evidence for S. boulardii in Various Conditions

• S. boulardii has shown benefits primarily in:

  • Prevention of Clostridioides difficile infection (RR, 0.41; 95% CI, 0.22–0.79) 1
  • Antibiotic-associated diarrhea prevention 2
  • Acute infectious gastroenteritis in certain populations 3

• For irritable bowel syndrome (IBS) and bloating:

  • Three studies testing S. boulardii among 232 adults with IBS found no difference between S. boulardii and placebo for abdominal pain scores 1, 4
  • The AGA makes no recommendations for probiotics in IBS due to significant heterogeneity in study designs and outcomes 4
  • The AGA specifically states that "treatment with probiotics and medical foods is not recommended for bloating or distention" 4

Relationship Between S. boulardii and Secretory IgA

• Research in animal models suggests that S. boulardii supplementation may increase secretory IgA production in the intestine 5
• However, this finding from neonatal dairy calves cannot be directly extrapolated to humans with low sIgA 5
• There is insufficient evidence specifically addressing the use of S. boulardii in humans with low sIgA levels 5

Risk-Benefit Assessment

• The AGA recommends consideration of the risk-benefit ratio before prescribing probiotics 1
• For patients with immune dysregulation (which low sIgA may indicate), the risks may outweigh potential benefits 1
• Patients who place high value on avoiding potential harms, especially those with immune concerns, may reasonably select no probiotics 1

Alternative Approaches

• Consider addressing underlying causes of low sIgA rather than using probiotics:
  • Evaluate for potential underlying causes such as food intolerances, small intestinal bacterial overgrowth (SIBO), or other gastrointestinal disorders 4
  • Regular exercise is strongly recommended for patients with gastrointestinal symptoms 4
  • First-line dietary advice should be offered 4
  • Soluble fiber supplementation may be beneficial for some gastrointestinal symptoms 4

Clinical Pitfalls to Avoid

• Avoid recommending probiotics based solely on manufacturer claims without supporting evidence 4
• Do not rely on probiotics as primary treatment when other evidence-based approaches are available 4
• Be cautious about potential adverse effects of probiotics, especially in those with compromised immunity 1