The Bay Area Reporter - May 19, 1995
Matthew Sharp ACT UP/Golden Gate Writer's Pool

Saccharomyces Boulardii (S. boulardii) is a type of friendly flora, but perhaps is the friendliest of them all. Not a bacteria, it is a live, nonpathogenic yeast that is not completely understood. Researchers are not sure of S. boulardii's method of action. One theory on how it works is that S. boulardii is thought to produce lactose and therefore can acidify its environment. Most yeasts (such as Candida albicans) decrease the acidity of the mucosal environment, making it easy for pathogens to take hold.

S. boulardii is not related to Candida, in fact in an animal study published in The Journal of Infectious Disease (1993;168:1314-8) it has been shown that S. boulardii prevents the fungus from reproducing in the gut. Another theory is that S. boulardii may compete in the intestine with amoebas and Candida and eventually crowds them out.

S. boulardii has been available over the counter in Europe for years, and many animal and human studies show effectiveness but highlight the need for further, more complete trials. Research in controlling diarrhea from a variety of causes demonstrates that S. boulardii is promising in a number of situations, including: Crohn's disease, fungemia, C. difficile (a difficult to treat diarrhea-causing bacteria), amoebas, colitis, and use of antibiotics.

Diarrhea is seen in 50 percent of HIV-positive people at some point during their disease. Most often the diarrhea is caused by bacterias, parasites, viruses, or fungi. Other diarrhea can be caused by certain medications (such as antibiotics) and by neoplasms such as Kaposi's Sarcoma and lymphoma. Sometimes the cause of the diarrhea cannot be identified, and often it cannot be treated. Most medications can help ease the diarrhea but do not kill the culprit. The best treatment is to first identify the cause and eliminate it, but when the cause cannot be diagnosed, the diarrhea will obviously be difficult to treat.

The current standards for relief in diarrhea are lomotil, motofen, paregoric and imodium. All of these anti-diarrhea medications except imodium are controlled substances because they are related to opium and they can be habit forming. Other over the counter products such as Kaopectate and Pepto-Bismol are usually ineffective in treating AIDS-related diarrhea.

Alternative sources for treating diarrhea are psyllium husk, charcoal, and lactobacillus or acidophilus. Unfortunately, AIDS diarrhea caused by serious infections may not be easily treated by these alternative therapies. Psyllium husk and acidophilus may best be taken advantage of in early stage disease maintenance. Charcoal can be used to halt diarrhea, but should not be used with other medications since it absorbs everything in the GI tract. Furthermore, increasing fiber by eating whole grains and legumes are old remedies but may not hold water, so to speak, with serious AIDS-related diarrhea.

Lactobacillus is a genus of friendly bacteria (meaning that it is not pathogenic) that includes the species acidophilus and bifidus. Antibiotics can kill the "friendly flora" in our intestines, and replacing them with these products can be helpful. Lactobacillus plus S. boulardii may be an important prophylaxis in controlling the GI environment. However, treatment of serious watery diarrhea may require a more powerful drug in the long run, and as noted above, some causes of diarrhea are quite untreatable.

The reason there are not many anti-diarrhea treatments is because it is not a popular field of study. In AIDS, studies are also few but gaining ground as researchers see that people with AIDS-related diarrhea are a perfect population to research. Because the causes of AIDS-related diarrhea are varied, however, results can be difficult to measure. Two French studies on S. boulardii in AIDS were presented at the 1990 International Conference on AIDS in San Francisco. Both studies were of people with AIDS with common chronic diarrhea caused by a wide variety of pathogens.

The studies showed that stools decreased significantly and weight was gained after high doses (up to three grams a day) were administered. It should be noted that S. boulardii is effective rather immediately, from one day to one week's time.

One Phase II pilot study of S. boulardii in HIV-related chronic diarrhea at the University of Washington in Seattle has been closed. The French company sponsoring the trial, Biocodex, decided to put their energies in a larger, non-AIDS-related phase III trial that would gain them approval from the FDA sooner. According to Kris Moyer, R.N., research coordinator of the trial, "as a nurse on the trial I was very encouraged by the response I was seeing." Although half of the participants were on placebo, based on Moyer's observations, about a third of the 23 participants were "responders." Clearly this shows that more studies of S. boulardii need to be done. Moyer seemed to think that the field was opening up as researchers understand more about the etiology of AIDS-related diarrhea and face the fact that the problem is "not going away."

One of the amazing things about S. boulardii is that studies have shown a remarkably low toxicity profile. There may be, however, more of a risk with S. boulardii in immunocompromised people. In people with AIDS, safety data is not entirely available. Systemic fungal infections were seen in non-AIDS trials in Europe in a few patients with severe colonic problems. Therefore, even though we are dealing with different populations, a damaged colon is a damaged colon and further toxicity studies need to be conducted in PWAs.

People with AIDS have been using S. boulardii for years. Available in the buyers clubs, it is another promising treatment not accessible through conventional means. At the PWA Health Group, the buyer's club in New York City, the German-imported S. boulardii is probably one of the club's top five sellers. California based Jarrow Formulas, Inc. was experiencing such a demand for the yeast that they temporarily ran out of stock.

One anecdotal report from Keith Trummer shows the dramatic and speedy results of S. boulardii. Keith is a person with AIDS who was diagnosed in late 1990. He developed cryptosporidium that caused severe diarrhea, and was treated with humatin for over a year. Keith discovered S. boulardii through a friend and began taking high doses. His diarrhea stopped - literally overnight. Three months later, maintenance with a combination of lower dose S. boulardii, acidophilus, and bifidus cultures have rendered him free from diarrhea. He states, "S. boulardii is a relatively inexpensive way to go to treat yourself for diarrhea in whatever [illness] you have. It's easy to take, there are no side effects ... it definitely works".

The confusion over systemic fungal infections in people with AIDS must be sorted out before we can definitely determine if S. boulardii is 100 percent safe. Until then, waiting for further studies may seem futile when an effective product as inexpensive as Saccharomyces boulardii is available now.

Saccharomyces Boulardii can be obtained at: The Healing Alternatives Foundation in San Francisco (phone: 415/626-4053; fax: 415/626-0451) Business hours - 12-6 p.m. Tuesday - Friday; 12-5 p.m. Saturday.

Call the Toll-Free Order Line: 1-800-219-2233 (MasterCard/Visa only) or the PWA Health Group in New York (phone: 212/252-0520; fax: 212/255-2080) for purchases and further information.
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