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Rapid response to:


Effect of long term consumption of probiotic milk on infections in children attending day care centres: double blind, randomised trial

BMJ 2001; 322 doi: (Published 02 June 2001) Cite this as: BMJ 2001;322:1327

Rapid Response:

Effective dose of Lactobacillus GG

Dr's Cremonini and Gasbarrini raised the question on the effective
dose of the probiotics. It is an important and relevant question and we
agree that when probiotic bacteria are given in dry form (in capsules,
sachets etc), daily doses of billions may be needed. However, we have seen
that milk (and maybe other buffering food substances) protect the bacteria
very effectively in the intestine. In 1991 (1) we showed that about ten
billion Lactobacillus GG bacteria (in powder form) were needed daily to be
able to recover the strain in stools. Then we showed that when
administered in fermented milk, one billion was high enough for faecal
recovery (2). We did not study lower doses with fermented milk but later
we studied the faecal recovery of LGG when administered in fresh milk. We
found that 100 million cfu/day was high enough for faecal recovery (3).
Another excellent vehicle is e.g. a ripened cheese. And the LGG level in
faecal samples is higher when 10^8 cfu is administered in milk or cheese,
compared to 10^10 in powder form (1, 3, 4).

The compliance of the LGG administration was evaluated also in our
study published recently in BMJ (5). It can be read in the electronic form
of the article, unfortunately the printed version was shortened quite a
lot. "Compliance was also measured by the faecal recovery of Lactobacillus
(from 100 child before, in the middle and at the end the intervention).
Initially 12% of children in the Lactobacillus group and 4% in the control
group carried Lactobacillus GG type bacteria (P = 0.29). Recovery figures
from the same children were 97% v 9% (P <0.0001), respectively, in the
middle of the study and 91% v 15% (P <0.0001) at the end." There are
still many open questions about probiotics and an effective dose is one of
those. In our opinion there is not only one right answer to that, but it
depends on the form of application. Recovery from faecal or biopsy samples
(5) of the living probiotic strain is one tool to evaluate the effective
dose, but the human intervention studies like our day care centre study
are needed to confirm the health benefits.


1. SAXELIN, M., ELO, S., SALMINEN, S., and VAPAATALO, H. 1991. Dose
response colonization of faeces after oral administration of Lactobacillus
casei strain GG. Microb. Ecol. Health Dis. 4: 209-214.

2. SAXELIN, M., AHOKAS, M., and SALMINEN, S. 1993. Dose response on the
faecal colonization of Lactobacillus strain GG administered in two
different formulations. Microb. Ecol. Health Dis. 6: 119-122.

3. SAXELIN, M. 1996. Colonization of the human gastrointestinal tract by
probiotic bacteria. Nutrition Today 31 (6), Supplement 1: 5S-8S.

4. SAXELIN, M., PESSI, T., and SALMINEN, S. 1995. Fecal recovery following
oral administration of Lactobacillus strain GG (ATCC 53103) in gelatine
capsules to healthy volunteers. Int. J. Food Microb. 25: 199-203.

L., SAXELIN, M., and KORPELA, R. 2001. Effect of long term consumption of
probiotic milk on infections in children attending day care centres:
double blind, randomised trial. Br. Med. J. 322: 1327-1329.

T., MATTILA-SANDHOLM, T., and VON WRIGHT, A. 1999. Persistence of
colonization of human colonic mucosa by a probiotic strain, Lactobacillus
rhamnosus GG, after oral consumption. Appl. Environm. Microbiol. 65 (1):

Competing interests: No competing interests

27 June 2001
Maija Saxelin
Ph.D., Senior Microbiologist
Valio R&D