The benefits of L. rhamnosus GG for gut health and immunity
Today’s probiotic story began in 1983, when Drs. Sherwood Gorbach and Barry Goldin, colleagues at Tufts University, were poring over stool specimens from healthy adults – a task few of us would envy. They managed to isolate “a strain of bacteria of a Lactobacillus species in which the bacteria have avid adherence to intestinal cells, are able to survive at low pH, and produce large amounts of lactic acid.”
The strain was named “Lactobacillus rhamnosus Gorbach-Goldin”, wherein Lactobacillus refers to the bacterial genus, rhamnosus refers to the species, and Gorbach-Goldin refers to the discovers. Now known as Lactobacillus rhamnosus GG, it has become the most extensively-studied probiotic strain of all time.,, This strain is still benefiting human health, 35 years later, and our understanding of its features and benefits continues to grow.
L. rhamnosus GG has been shown to colonize the gut when it is consumed regularly, and to modulate the functions of epithelial, immune, and nerve cells that reside within the gastrointestinal tract.,, While it is in residence, L. rhamnosus GG churns out lactic acid, bioactive peptides, proteins, and amino acids. These soluble mediators have been shown to support intestinal function, reduce infections and inflammation, and assist with immunity throughout the body.,,,
Infection-fighting properties of L. rhamnosus GG
Extensive research has shown that L. rhamnosus GG can inhibit the growth of bacterial pathogens.
Extensive research has shown that L. rhamnosus GG can inhibit the growth of bacterial pathogens, thereby reducing the risk of harmful infections in the gastrointestinal tract., It has been shown to inhibit Salmonella, Listeria, Escherichia coli, and other bacteria that cause serious foodborne illnesses.,,,
L. rhamnosus GG also inhibits many opportunistic pathogens, such as Staphylococcus aureus, Pseudomonas aeruginosa, Clostridium difficile, and Candida spp., all of which can cause systemic infections.,,,,, Opportunistic pathogens are a particular problem for individuals who are immunocompromised.
Rotavirus is a very contagious virus that causes diarrhea in infants and children.,, The consumption of L. rhamnosus GG has been shown to reduce the duration and severity of rotavirus infection, especially at doses greater than 10 billion colony-forming units (CFU) per day., A meta-analysis of 19 clinical trials concluded that high-dose L. rhamnosus GG therapy reduces the duration of diarrhea and the stool number per day, especially if supplementation is started at the early stage of infection.
The antimicrobial properties of L. rhamnosus GG may also help the body fight off respiratory infections. In a placebo-controlled trial, 742 children who were hospitalized, and therefore susceptible to opportunistic infections, were randomly allocated to receive L. rhamnosus GG (1 billion CFU in 100 mL of a fermented milk product daily). As compared to the placebo, L. rhamnosus GG supplementation reduced the risk for hospital-acquired gastrointestinal and respiratory tract infections by 60%.
Another study, done in healthy preschool children, showed that daily supplementation with L. rhamnosus GG for seven months over the winter season reduced the risk of bacterial infections for up to three years after the trial, as indicated by reduced antibiotic use during that period.
Over the long term, L. rhamnosus GG may even combat bacteria that produce cavities in teeth. In one study, 594 children received either regular milk or milk containing L. rhamnosus GG for five days per week. After seven months, children in the probiotic group had fewer cavities and a lower number of potentially harmful bacteria in the mouth than children in the milk-only group.
L. rhamnosus GG helps alleviate leaky gut
Clinical studies have shown that L. rhamnosus GG supplementation may ameliorate symptoms of irritable bowel.
Leaky gut can occur as a result of environmental exposures, infections, medications, and many other factors.,, This condition allows troublesome bacteria, toxins, incompletely digested food, and metabolic waste products to pass from the digestive tract into the body, triggering systemic inflammation.
L. rhamnosus GG has been shown to improve the survival of gut epithelial cells exposed to damaging agents, thereby reducing leaky gut., It exerts this function by secreting bioactive proteins with cell-protective effects.,,,,, In animal models, L. rhamnosus GG has been shown to alleviate leaky gut resulting from gastrointestinal infections,,,, alcohol use,,, gluten toxicity, and radiation treatments.
Leaky gut is an important factor in the pathology of irritable bowel syndrome (IBS)., Scientists have shown that the medium (solution from its culture) collected from L. rhamnosus GG cultures can prevent the increase in leaky gut associated with this condition and can alleviate visceral pain hypersensitivity in animal models.,
Consistent with these findings, clinical studies have shown that L. rhamnosus GG supplementation may ameliorate symptoms of IBS in children and adults.,, In children aged 4 to18 who were diagnosed with IBS, a reduction in pain scores was seen after four week’s supplementation with L. rhamnosus GG at a dose of approximately 20 billion CFU/day. A significant reduction in symptoms also was observed in adults with IBS (especially the diarrhea-predominant type) who were supplemented with L. rhamnosus GG (12 billion CFU daily for six weeks).
L. rhamnosus GG can reduce the risk of allergies
L. rhamnosus GG supplementation was shown to relieve gastrointestinal symptoms in children with cow’s milk allergy.
Food allergy affects nearly 8% of children and 5% of adults., The risk of allergies is influenced by many factors, including heredity (allergy in one or both parents), duration of pregnancy, mode of birth (vaginal or cesarean), and breastfeeding or formula feeding.,,,
Studies have shown that the risk of developing childhood allergies is influenced by the gut microbiota in infancy.,, Recent studies have shown that a relative absence of lactobacilli species (L. casei, L. paracasei, and L. rhamnosus) in infant fecal samples collected between one week and two months of age was associated with the development of allergy, and that colonization with these species seems to decrease the risk for allergy at five years of age, regardless of allergic heredity. Supplementation with L. rhamnosus GG may help restore more normal levels of lactobacilli and other friendly bacteria.,,
For infants and children with cow’s milk allergy (CMA), the use of a hypoallergenic formula (extensively hydrolyzed casein formula; EHCF), supplemented with L. rhamnosus GG, has been shown to accelerate the acquisition of immune tolerance in infants compared to EHCF alone.,,, After 12 months of continuous supplementation, the proportion of children acquiring immune tolerance to cow’s milk was significantly higher in the group receiving the probiotic formula (79%), compared to EHCF alone (44%); soy formula (24%); and the amino acid-based formula (18%).
In long-term studies, supplementation with EHCF containing L. rhamnosus GG was confirmed to reduce the incidence of CMA and eczema (an allergic skin condition). L. rhamnosus GG supplementation was also shown to relieve gastrointestinal symptoms in children with CMA. Studies in animal models further suggest that L. rhamnosus GG may protect against allergic airway inflammation.,
L. rhamnosus and vaccine responses
L. rhamnosus GG promotes Th1-type immune responses, which are associated with protection against infections and with improved vaccine efficacy.,,, In a placebo-controlled study of influenza vaccination, 84% of those who consumed L. rhamnosus GG developed a protective titer for the H3N2 strain versus only 55% of those in the placebo group. The L. rhamnosus GG was consumed at a dose of 20 billion CFU daily for 28 days, beginning on the day of vaccination.
In another placebo-controlled trial, supplementation with L. rhamnosus GG (10 billion CFU/day) for five weeks (one week prior to vaccination, and four weeks afterwards) greatly increased the response to poliovirus vaccine. The maximum increase after immunization in the probiotic group was about 2-fold or 4-fold higher, respectively, for poliovirus-neutralizing antibody titers and immunoglobulin G (IgG) levels in volunteers consuming probiotics instead of placebo.
Can L. rhamnosus GG influence brain aging?
As time goes on, we continue to learn more and more about the systemwide effects of L. rhamnosus GG, which clearly extend beyond the gut. For example, the gut microbiota may be an important contributor to cognitive aging, and probiotics can influence this process. In a double-blind, placebo-controlled, randomized clinical trial of 145 adults aged 52 to 75, supplementation with L. rhamnosus GG (20 billion CFU/day for 90 days) was shown to improve cognitive performance in individuals with cognitive impairment. The authors of this intriguing study conclude that supplementation with this probiotic may be a novel method for protecting cognitive health with increasing age.
In sum, L. rhamnosus GG is one of the most versatile probiotics known to humankind. It is often used in combination with other probiotic species, but it has many positive health effects on its own. It can help reduce the risk of opportunistic and foodborne infections (and the diarrhea that results); ameliorate leaky gut and IBS; promote the development of tolerance to allergens in children; and improve immunity and vaccine responses in adults. It’s worth considering as a probiotic that is suitable for all ages.Click here to see References
 Doron S, et al. Lactobacillus GG: bacteriology and clinical applications. Gastroenterol Clinics. 2005 Sep 1;34(3):483-98.
 Kankainen M, et al. Comparative genomic analysis of Lactobacillus rhamnosus GG reveals pili containing a human-mucus binding protein. Proc Natl Acad Sci. 2009 Oct 6;106(40):17193-8.
 Capurso L. Thirty years of Lactobacillus rhamnosus GG: a review. J Clin Gastroenterol. 2019 Mar 1;53:S1-41.
 Alander M, et al. Persistence of colonization of human colonic mucosa by a probiotic strain, Lactobacillus rhamnosus GG, after oral consumption. Appl Environ Microbiol. 1999 Jan 1;65(1):351-4.
 Ardita CS, et al. Epithelial adhesion mediated by pilin SpaC is required for Lactobacillus rhamnosus GG-induced cellular responses. Appl Environ Microbiol. 2014 Aug 15;80(16):5068-77.
 Bornholdt J, et al. Personalized B cell response to the Lactobacillus rhamnosus GG probiotic in healthy human subjects: a randomized trial. Gut Microbes. 2020 Nov 9;12(1):1-4.
 Chandrasekharan B, et al. Interactions between commensal bacteria and enteric neurons, via FPR1 induction of ROS, increase gastrointestinal motility in mice. Gastroenterol. 2019 Jul 1;157(1):179-92.
 Yan F, et al. Soluble proteins produced by probiotic bacteria regulate intestinal epithelial cell survival and growth. Gastroenterol. 2007 Feb 1;132(2):562-75.
 Yan F, et al. Colon-specific delivery of a probiotic-derived soluble protein ameliorates intestinal inflammation in mice through an EGFR-dependent mechanism. J Clin Invest. 2011 Jun 1;121(6):2242-53.
 Gao J, et al. A novel postbiotic from Lactobacillus rhamnosus GG with a beneficial effect on intestinal barrier function. Front Microbiol. 2019 Mar 14;10:477.
 Kepert I, et al. D-tryptophan from probiotic bacteria influences the gut microbiome and allergic airway disease. J Allergy Clin Immunol. 2017 May 1;139(5):1525-35.
 Hojsak I, et al. Lactobacillus GG in the prevention of nosocomial gastrointestinal and respiratory tract infections. Pediatrics. 2010 May 1;125(5):e1171-7.
 Korpela K, et al. Lactobacillus rhamnosus GG intake modifies preschool children’s intestinal microbiota, alleviates penicillin-associated changes, and reduces antibiotic use. PloS One. 2016 Apr 25;11(4):e0154012.
 De Keersmaecker SC, et al. Strong antimicrobial activity of Lactobacillus rhamnosus GG against Salmonella typhimurium is due to accumulation of lactic acid. FEMS Microbiol Lett. 2006 Jun 1;259(1):89-96.
 Jacobsen CN, et al. Screening of probiotic activities of forty-seven strains of Lactobacillus spp. by in vitro techniques and evaluation of the colonization ability of five selected strains in humans. Appl Environ Microbiol. 1999 Nov 1;65(11):4949-56.
 Naik AK, et al. Lactobacillus rhamnosus GG reverses mortality of neonatal mice against Salmonella challenge. Toxicology research. 2019 May 1;8(3):361-72.
 Johnson-Henry KC, et al. Lactobacillus rhamnosus strain GG prevents enterohemorrhagic Escherichia coli O157: H7-induced changes in epithelial barrier function. Infect Immun. 2008 Apr 1;76(4):1340-8.
 Versterlund S, et al. Staphylococcus aureus adheres to human intestinal mucus but can be displaced by certain lactic acid bacteria. Microbiology. 2006 Jun 1;152(6):1819-26.
 Kim SM, et al. LC-MS/MS based observation of Clostridium difficile inhibition by Lactobacillus rhamnosus GG. J Ind Eng Chem. 2020 May 25;85:161-9.
 Ephraim E, et al. Lactobacillus rhamnosus GG protects cells from Clostridium difficile toxins. Microbiol Res J Intl. 2013 Mar 19:165-75.
 Allonsius CN, et al. Interplay between Lactobacillus rhamnosus GG and Candida and the involvement of exopolysaccharides. Microb Biotechnol. 2017 Nov;10(6):1753-63.
 Khailova L, et al. Lactobacillus rhamnosus GG improves outcome in experimental Pseudomonas aeruginosa pneumonia: potential role of regulatory T cells. Shock (Augusta, GA). 2013 Dec;40(6):496.
 Ventola H, et al. Effects of the viability of Lactobacillus rhamnosus GG on rotavirus infection in neonatal rats. World J Gastroenterol. 2012 Nov 7;18(41):5925.
 Sindhu KN, 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 Apr 15;58(8):1107-15.
 Pant N, et al. Effective prophylaxis against rotavirus diarrhea using a combination of Lactobacillus rhamnosus GG and antibodies. BMC Microbiol. 2007 Dec;7(1):1-9.
 Szajewska H, et al. Systematic review with meta‐analysis: Lactobacillus rhamnosus GG for treating acute gastroenteritis in children-a 2019 update. Aliment Pharmacol Ther. 2019 Jun;49(11):1376-84.
 Li YT, et al. Efficacy of Lactobacillus rhamnosus GG in treatment of acute pediatric diarrhea: a systematic review with meta-analysis. World J Gastroenterol. 2019 Sep 7;25(33):4999.
 Allaker RP, Stephen AS. Use of probiotics and oral health. Curr Oral Health Rep. 2017 Dec;4(4):309-18.
 Näse L, et al. Effect of long-term consumption of a probiotic bacterium, Lactobacillus rhamnosus GG, in milk on dental caries and caries risk in children. Caries Res. 2001;35(6):412-20.
 Khailova L, et al. Lactobacillus rhamnosus GG treatment improves intestinal permeability and modulates inflammatory response and homeostasis of spleen and colon in experimental model of Pseudomonas aeruginosa pneumonia. Clin Nutr. 2017 Dec 1;36(6):1549-57.
 Lin R, et al. Lactobacillus rhamnosus GG supplementation modulates the gut microbiota to promote butyrate production, protecting against deoxynivalenol exposure in nude mice. Biochem Pharmacol. 2020 May 1;175:113868.
 Chen L, et al. Lactobacillus rhamnosus GG treatment improves intestinal permeability and modulates microbiota dysbiosis in an experimental model of sepsis. Int J Mol Med. 2019 Mar 1;43(3):1139-48.
 Yan F, Polk DB. Probiotic bacterium prevents cytokine-induced apoptosis in intestinal epithelial cells. J Biol Chem. 2002 Dec 27;277(52):50959-65.
 Mao X, et al. Dietary Lactobacillus rhamnosus GG supplementation improves the mucosal barrier function in the intestine of weaned piglets challenged by porcine rotavirus. PLoS One. 2016 Jan 4;11(1):e0146312.
 Li Y, et al. Inhibitory effects of the Lactobacillus rhamnosus GG effector protein HM0539 on inflammatory response through the TLR4/MyD88/NF-кB axis. Front Immunol. 2020;11:551449.
 Donato KA, et al. Lactobacillus rhamnosus GG attenuates interferon-γ and tumour necrosis factor-α-induced barrier dysfunction and pro-inflammatory signalling. Microbiology. 2010 Nov 1;156(11):3288-97.
 Ammoscato F, et al. Lactobacillus rhamnosus protects human colonic muscle from pathogen lipopolysaccharide‐induced damage. NeurogastroenterolMotil. 2013 Dec;25(12):984-e777.
 Han X, et al. Lactobacillus rhamnosus GG prevents epithelial barrier dysfunction induced by interferon-gamma and fecal supernatants from irritable bowel syndrome patients in human intestinal enteroids and colonoids. Gut Microbes. 2019 Jan 2;10(1):59-76.
 Cao YN, et al. Effect of Lactobacillus rhamnosus GG supernatant on serotonin transporter expression in rats with post-infectious irritable bowel syndrome. World J Gastroenterol. 2018 Jan 21;24(3):338.
 Wang Y, et al. Lactobacillus rhamnosus GG culture supernatant ameliorates acute alcohol-induced intestinal permeability and liver injury. Am J Physiol Gastrointest Liver Physiol. 2012 Jul 1;303(1):G32-41.
 Wang Y, et al. Lactobacillus rhamnosus GG reduces hepatic TNFα production and inflammation in chronic alcohol-induced liver injury. J Nutr Biochem. 2013 Sep 1;24(9):1609-15.
 Chen RC, et al. Lactobacillus rhamnosus GG supernatant promotes intestinal barrier function, balances Treg and TH17 cells and ameliorates hepatic injury in a mouse model of chronic-binge alcohol feeding. Toxicol Lett. 2016 Jan 22;241:103-10.
 Orlando A, et al. Lactobacillus rhamnosus GG protects the epithelial barrier of Wistar rats from the pepsin-trypsin-digested gliadin (PTG)-induced enteropathy. Nutrients. 2018 Nov;10(11):1698.
 Riehl TE, et al. Lactobacillus rhamnosus GG protects the intestinal epithelium from radiation injury through release of lipoteichoic acid, macrophage activation and the migration of mesenchymal stem cells. Gut. 2019 Jun 1;68(6):1003-13.
 Shulman RJ, et al. Associations among gut permeability, inflammatory markers, and symptoms in patients with irritable bowel syndrome. J Gastroenterol. 2014 Nov 1;49(11):1467-76.
 Zhou Q, et al. Intestinal membrane permeability and hypersensitivity in the irritable bowel syndrome. Pain. 2009 Nov 1;146(1-2):41-6.
 Neufeld KA, et al. Soluble mediators derived from Lactobacillus rhamnosus GG decrease visceral pain hypersensitivity induced by early life stress. FASEB J. 2016 Apr;30:1176-5.
 Ding FC, et al. Probiotics for paediatric functional abdominal pain disorders: a rapid review. Pediat. Child Health. 2019 Sep 5;24(6):383-94.
 Francavilla R, et al. A randomized controlled trial of Lactobacillus GG in children with functional abdominal pain. Pediatrics. 2010 Dec 1;126(6):e1445-52.
 Pedersen N, et al. Ehealth: low FODMAP diet vs Lactobacillus rhamnosus GG in irritable bowel syndrome. World J Gastroenterol. 2014 Nov 21;20(43):16215.
 Kianifar H, et al. Probiotic for irritable bowel syndrome in pediatric patients: a randomized controlled clinical trial. Electronic physician. 2015 Sep;7(5):1255.
 Yazdanbakhsh M, et al. Allergy, parasites, and the hygiene hypothesis. Science. 2002 Apr 19;296(5567):490-4.
 Sicherer SH. Epidemiology of food allergy. J. Allergy Clin. Immunol. 2011 Mar 1;127(3):594-602.
 Munyaka PM, et al. External influence of early childhood establishment of gut microbiota and subsequent health implications. Front Pediatr. 2014 Oct 9;2:109.
 Wu P, et al. Relative importance and additive effects of maternal and infant risk factors on childhood asthma. PloS One. 2016 Mar 22;11(3):e0151705.
 Dominguez-Bello MG, et al. Delivery mode shapes the acquisition and structure of the initial microbiota across multiple body habitats in newborns. Proc Natl Acad Sci. 2010 Jun 29;107(26):11971-5.
 Hendaus MA, et al. Allergic diseases among children: nutritional prevention and intervention. Ther Clin Risk Manag. 2016;12:361.
 Fujimura KE, et al. Neonatal gut microbiota associates with childhood multisensitized atopy and T cell differentiation. Nature Med. 2016 Oct;22(10):1187-91.
 Sarkar A, et al. The association between early-life gut microbiota and long-term health and diseases. J Clin Med. 2021 Jan;10(3):459.
 Björkander S, et al. Childhood allergy is preceded by an absence of gut lactobacilli species and higher levels of atopy‐related plasma chemokines. Clin Exp Immunol. 2020 Dec;202(3):288-99.
 Johansson MA, et al. Early colonization with a group of Lactobacilli decreases the risk for allergy at five years of age despite allergic heredity. PloS One. 2011 Aug 1;6(8):e23031.
 Durack J, et al. Delayed gut microbiota development in high-risk for asthma infants is temporarily modifiable by Lactobacillus supplementation. Nat Commun. 2018 Feb 16;9(1):1-9.
 Canani RB, 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 Sep 1;163(3):771-7.
 Muraro A, et al. Extensively hydrolysed casein formula supplemented with Lactobacillus rhamnosus GG maintains hypoallergenic status: randomised double-blind, placebo-controlled crossover trial. BMJ Open. 2012 Jan 1;2(2).
 Canani RB, et al. Effect of Lactobacillus GG on tolerance acquisition in infants with cow’s milk allergy: a randomized trial. J Allergy Clin Immunol. 2012 Feb 1;129(2):580-2.
 Guest JF, et al. Cost-effectiveness of using an extensively hydrolyzed casein formula containing Lactobacillus rhamnosus GG in managing infants with cow’s milk allergy in the US. Curr Med Res Opin. 2018 Sep 2;34(9):1539-48.
 Canani RB, et al. Extensively hydrolyzed casein formula containing Lactobacillus rhamnosus GG reduces the occurrence of other allergic manifestations in children with cow’s milk allergy: 3-year randomized controlled trial. J Allergy Clin Immunol. 2017 Jun 1;139(6):1906-13.
 Nocerino R, et al. Dietary treatment with extensively hydrolyzed casein formula containing the probiotic Lactobacillus rhamnosus GG prevents the occurrence of functional gastrointestinal disorders in children with cow’s milk allergy. J Pediatr. 2019 Oct 1;213:137-42.
 Zhang J, et al. Lactobacillus rhamnosus GG induced protective effect on allergic airway inflammation is associated with gut microbiota. Cell Immunol. 2018 Oct 1;332:77-84.
 Feleszko W, et al. Probiotic-induced suppression of allergic sensitization and airway inflammation is associated with an increase of T regulatory‐dependent mechanisms in a murine model of asthma. Clin. Exp. Allergy. 2007 Apr;37(4):498-505.
 Fong FL, et al. Immunomodulatory effects of Lactobacillus rhamnosus GG on dendritic cells, macrophages and monocytes from healthy donors. J Funct Foods. 2015 Mar 1;13:71-9.
 Fong FL, et al. Mechanism of action of probiotic bacteria on intestinal and systemic immunities and antigen-presenting cells. Int Rev Immunol. 2016 May 3;35(3):179-88.
 Sharma R, et al. Improvement in Th1/Th2 immune homeostasis, antioxidative status and resistance to pathogenic E. coli on consumption of probiotic Lactobacillus rhamnosus fermented milk in aging mice. Age. 2014 Aug;36(4):1-7.
 van Baarlen P, et al. Human mucosal in vivo transcriptome responses to three lactobacilli indicate how probiotics may modulate human cellular pathways. Proc Natl Acad Sci. 2011 Mar 15;108(Supplement 1):4562-9.
 Davidson LE, et al. Lactobacillus GG as an immune adjuvant for live-attenuated influenza vaccine in healthy adults: a randomized double-blind placebo-controlled trial. Eur J Clin Nutr. 2011 Apr;65(4):501-7.
 De Vrese M, et al. Probiotic bacteria stimulate virus-specific neutralizing antibodies following a booster polio vaccination. Eur J Nutr. 2005 Oct 1;44(7):406-13.
 Manderino L, et al. Preliminary evidence for an association between the composition of the gut microbiome and cognitive function in neurologically-healthy older adults. J Int Neuropsychol Soc. 2017 Sep;23(8):700.
 Calvani R, et al. Of microbes and minds: a narrative review on the second brain aging. Front Med. 2018 Mar 2;5:53.
 Sanborn V, et al. Randomized clinical trial examining the impact of Lactobacillus rhamnosus GG probiotic supplementation on cognitive functioning in middle-aged and older adults. Neuropsychiatr Dis Treat. 2020;16:2765.