Herbal Medicine: Expanded Commission E

Latin Name: Saccharomyces cerevisiae Hansen CBS 5926, S. boulardii
Pharmacopeial Name: accharomyces cerevisiae Hansen CBS 5926
Other Names: n/a

• Overview
• Description
• Chemistry and Pharmacology
• Uses
• Contraindications
• Side Effects
• Use During Pregnancy and Lactation
• Interactions with Other Drugs
• Dosage and Administration
• References
• Additional Resources

Overview

Brewer's yeast is a fungus, classified under the genus Saccharomyces, meaning sugar (saccharo) fungus (myces). Medicinal brewer's yeast is the focus of ongoing scientific and medical study. The Hansen CBS strain binds to fibriated pathogenic bacteria. Medicinal applications relate to the treatment of acute diarrhea, the prevention of Candida proliferation, the treatment of acne, and the alleviation of premenstrual symptoms (PMS). Uses for disorders associated with specific diseases, such as recurrence of Clostridium difficile disease (CDD) and Candida proliferation in pediatric cystic fibrosis patients, are currently being investigated (Muller et al., 1995; McFarland et al., 1994).

Diarrhea prevention has been demonstrated through clinical studies. Tested in a multicenter, double-blind, controlled study of critically ill patients fed through tubes, Hansen CBS prevented diarrhea, even in patients for whom additional factors placed them at even higher risk than that presented by the feeding tubes alone (Bleichner et al., 1997). Beta-lactam antibiotics are also associated with causing diarrhea. In a double-blind, placebo-controlled study, high-risk patients were given either Hansen CBS or placebo within 72 hours of starting a beta-lactam antibiotic. The patients continued to take the yeast supplement for three days following the course of therapy. The resulting protection of Hansen CBS against antibiotic-induced diarrhea was 51%, with no accompanying adverse side effects (McFarland et al., 1995). Because antibiotic-induced diarrhea is common in the elderly, a placebo-controlled study was designed to determine whether or not older patients could benefit from the antidiarrheal effects of Hansen CBS as well; however, in this study the yeast supplement was not effective (Lewis et al., 1998).

A double-blind, placebo-controlled study was designed to demonstrate effects of yeast supplementation on varying types of acne in 139 subjects. According to their doctors, 74.3% of the patients were reported to have seen improvement. Over 80% of the patients felt their acne had completely healed (Weber et al., 1989).

A randomized, placebo-controlled, double-blind study of 40 patients with mild to moderate premenstral syndrome was conducted to test the effects of yeast supplementation versus placebo against PMS. At the end of the six-month study, brewer's yeast was determined more effective in reducing premenstrual symptoms than placebo (Facchinetti et al., 1997).

Yeast supplementation may also be effective in reducing preterm infant mortality in areas where nutritional deficiencies are endemic. In a recent trial, 28 preterm infants in Hungary were given a selenium-enriched yeast product. The product was found to be safe and to increase selenium levels effectively in preterm infants (Bogye et al., 1998).

Both brewer's yeast and Hansen CBS 5926 brewer's yeast are approved in Germany for the treatment of chronic acne and furunculosis (the occurrence of several boils at the same time) and loss of appetite. Hansen CBS 5926 is given in cases of acute and traveler's diarrhea and diarrhea associated with the use of a feeding tube.

Description

Brewer's yeast from Saccharomyces cerevisiae Hansen CBS 5926 (syn. S. boulardii) [Fam. Saccharomycetaceae] and genetically identical strains in lyophilized (freeze-dried) form. One gram of the lyophilisate contains 885 mg S. cerevisiae Hansen CBS 5926 corresponding to 1 times 1010 viable organisms.

Chemistry and Pharmacology

The effectiveness of brewer's yeast depends on the viability of the organism. Brewer's yeast can bind fimbriated, pathogenic bacteria. In vitro, growth inhibition was demonstrated by co-culturing brewer's yeast with the following organisms: Proteus mirabilis and P. vulgaris,Salmonella typhi and S. typhimurium,Pseudomonas aeruginosa, Staphylococcus aureus,Escherichia coli, certain Shigella, and C. albicans. Concentration dependencies for growth inhibitions were not given. Brewer's yeast can also inhibit the growth of Clostridium difficile, as well as the diarrhea-causing effect of enterotoxic strains of E. coli. On the isolated intestinal loop model, sodium and water influx into the intestinal lumen was induced by incubation with the toxin from the cholera vibrio; this reaction was reduced by 40% in the presence of brewer's yeast. Intestinal preparations were also employed to show the reversal of the increased chloride transport induced by prostaglandins E2 and I2 in the presence of brewer's yeast compared to untreated controls. An increase in the activity of the disaccharidases saccharidase, lactase, and maltase, located in the intestinal membrane, was observed in animal and human experiments. In animal experiments, the secretory immunoglobulin (sIgA) was increased in the gastrointestinal tract after oral intake of brewer's yeast. With a single oral dosage of 3 g/kg body weight of brewer's yeast, no toxic reactions were observed in mice and rats. No substance-dependent changes were observed with a dosage of 330 mg/kg body weight over six weeks (six days per week) given to dogs, and about 100 mg/kg body weight given daily over six months to rats and rabbits. The Ames test with Salmonella typhimurium TA 90, TA 100, TA 1335, TA 1337, and TA 1338 revealed no mutagenic effects, with or without activation of SY-mix. Experiments for embryocytic and carcinogenic effects are not available.

Uses

The Commission E approved the use of brewer's yeast Hansen CBS 5926 for symptomatic treatment of acute diarrhea, for prophylactic and symptomatic treatment of diarrhea during travel, diarrhea occurring while tube feeding, as an adjuvant for chronic forms of acne, as a dietary supplement, and as a source of B vitamins and protein (Stecher, 1968). Medically it has been used as an application to ulcers and as an internal remedy for putrid fevers. Yeast has shown therapeutic action in the cases of furunculosis, acne, and similar skin diseases (Nadkarni, 1976).

Note: In case of diarrhea, replacement of fluids and electrolytes is an important therapeutic measure, especially for children. Diarrhea of infants and small children requires consultation with a physician. Diarrheas lasting longer than two days, containing blood, or accompanied by fever, require medical attention. If during therapy with brewer's yeast microbiological tests are performed on stool samples, the intake of yeast must be reported to the laboratory, since false positive results may be reported.

Contraindications

Not to be used in case of yeast allergies.

Warning: Infants and small children are excluded from self-medication in any case.

Side Effects

Oral intake may cause flatulence. In individual cases, intolerance (incompatibilities) may occur in the form of itching, urticaria, local or general exanthemas, and Quincke's edema.

Use During Pregnancy and Lactation

No restrictions known.

Interactions with Other Drugs

The simultaneous intake of brewer's yeast and antimycotics can influence the activity of brewer's yeast.

Warning: Simultaneous intake of MAO-inhibitors may cause increased blood pressure.

Dosage and Administration

Unless otherwise prescribed: Lyophylisate in capsules for internal use as well as addition to tubal feed mixtures.

Daily dosage (children older than 2 years/adults):

For prevention of travel diarrhea, beginning 5 days prior to journey: 250-500 mg daily.

For therapy of diarrhea: 250-500 mg daily

For diarrhea due to tube feeding: Add 500 mg brewer's yeast per liter of nutrient solution. The treatment should be continued for several days after diarrhea has ceased.

For acne: 750 mg daily.

References

Bleichner, G., H. Blehaut, H. Mentec, D. Moyse. 1997. Saccharomyces boulardii prevents diarrhea in critically ill tube-fed patients. A multicenter, randomized, double-blind placebo-controlled trial. Intensive Care Med 23(5):517523.

Bogye, G., G. Alfthan, T. Machay. 1998. Randomized clinical trial of enteral yeast-selenium supplementation in preterm infants. Biofactors 8(12):139142.

Facchinetti, F. et al. 1997. Effects of a yeast-based dietary supplementation on premenstrual syndrome. A double-blind placebo-controlled study. Gynecol Obstet Invest 43(2):120124.

Lewis, S.J., L.F. Potts, R.E. Barry. 1998. The lack of therapeutic effect of Saccharomyces boulardii in the prevention of antibiotic-related diarrhoea in elderly patients. J Infect 36(2):171174.

McFarland, L.V. et al. 1995. Prevention of beta-lactam-associated diarrhea by Saccharomyces boulardii compared with placebo. Am J Gastroenterol 90(3):439448.

McFarland, L.V. et al. 1994. A randomized placebo-controlled trial of Saccharomyces boulardii in combination with standard antibiotics for Clostridium difficile disease. JAMA 271(24):19131918.

Muller, J., N. Remus, K.H. Harms. 1995. Mycoserological study of the treatment of paediatric cystic fibrosis patients with Saccharomyces boulardii (Saccharomyces cerevisiae Hansen CBS 5926). Mycoses 38(34):119123.

Nadkarni, K.M. 1976. Indian Materia Medica. Bombay: Popular Prakashan.

Stecher, P.G. (ed.). 1968. The Merck Index: An Encyclopedia of Chemicals and Drugs, 8^th ed. Rahway, N.J.: Merck & Co., Inc.

Weber, G., A. Adamczyk, S. Freytag. 1989. [Treatment of acne with a yeast preparation] [In German]. Fortschr Med 107(26):563566.

Additional Resources

Andre, F.E. and A. Safary. 1987. Summary of clinical findings on Engerix-B, a genetically engineered yeast derived hepatitis B vaccine. Postgrad Med J 63(2):169177.

Bizeau, C., P. Galzy, M. Bastide, J.M. Bastide. 1974. [Immunofluorescent study of morphologic mutants of Saccharomycescerevisiae Hansen] [In French]. C RAcad Sci Hebd Seances Acad Sci D 279(25):19551958.

Bckeler, W. and G. Thomas. 1989. In-vitro-Studien zur destabilisierenden Wirkung lyophilisierter Saccharomycescerevisiae Hansen CBS 5926-Zellen auf Engerobakterien. Lsst sich diese Eigenschaft biochemisch erklren? In: M ller, J., R. Ottenjann, J. Seifert (eds.). kosystem Darm. Heidelberg: Springer Verlag. 142153.

Chavanet, P. et al. 1994. Cross-sectional study of the susceptibility of Candida isolates to antifungal drugs and in vitro-in vivo correlation in HIV-infected patients. AIDS 8(7):945950.

Gedek, B. and G. Hagenhoff. 1989. Orale Verabreichung von lebensfhigen Zellen des Hefestammes Saccharomycescerevisiae Hansen CBS 5926 und deren Schicksal whrend der Magen-Darm-Passage. Therapiewoche (38):3340.

McCullough, M.J., K.V. Clemons, J.H. McCusker, D.A. Stevens. 1998. Species identification and virulence attributes of Saccharomyces boulardii (nom. inval.) J Clin Microbiol 36(9):26132617.

Oblack, D.L. et al. 1981. Clinical evaluation of the AutoMicrobic system Yeast Biochemical Card for rapid identification of medically important yeasts. J Clin Microbiol 13(2):351355.

Petzoldt, K. and E. Muller. 1986. [Animal experiment and cell biology study of Saccharomycescerevisiae Hansen CBS 5926 in the non-specific enhancement of resistance to infection] [In German]. Arzneimforsch 36(7):10851088.

Pfaller, M.A. et al. 1994. Selection of candidate quality control isolates and tentative quality control ranges for in vitro susceptibility testing of yeast isolates by National Committee for Clinical Laboratory Standards proposed standard methods. J Clin Microbiol 32(7):16501653.

Plein, K. and J. Hotz. 1993. Therapeutic effects of Saccharomyces boulardii on mild residual symptoms in a stable phase of Crohn's disease with special respect to chronic diarrheaa pilot study. Z Gastroenterol 31(2):129134.

Sinai, Y. et al. 1974. Enhancement of resistance to infectious disease by oral administration of brewer's yeast. Infection Immunol (9):781787.

Surawicz, C.M. et al. 1989. Die prophylaxe antibiotika-assoziierter diarrhoen mit Saccharomycesboulardii. eine prospektive studie [Prevention of antibiotic-associated diarrhea by Saccharomyces boulardii: a prospective study]. Gastroenterol 96(4):981988.

This material was adapted from The Complete German Commission E MonographsTherapeutic Guide to Herbal Medicines. M. Blumenthal, W.R. Busse, A. Goldberg, J. Gruenwald, T. Hall, C.W. Riggins, R.S. Rister (eds.) S. Klein and R.S. Rister (trans.). 1998. Austin: American Botanical Council; Boston: Integrative Medicine Communications.

1) The Overview section is new information.

2) Description, Chemistry and Pharmacology, Uses, Contraindications, Side Effects, Interactions with Other Drugs, and Dosage sections have been drawn from the original work. Additional information has been added in some or all of these sections, as noted with references.

3) The dosage for equivalent preparations (tea infusion, fluidextract, and tincture) have been provided based on the following example:

• Unless otherwise prescribed: 2 g per day of [powdered, crushed, cut or whole] [plant part]
• Infusion: 2 g in 150 ml of water
• Fluidextract 1:1 (g/ml): 2 ml
• Tincture 1:5 (g/ml): 10 ml

4) The References and Additional Resources sections are new sections. Additional Resources are not cited in the monograph but are included for research purposes.

This monograph, published by the Commission E in 1994, was modified based on new scientific research. It contains more extensive pharmacological and therapeutic information taken directly from the Commission E.

Excerpt from Herbal Medicine: Expanded Commission E Monographs
Copyright 2000 American Botanical Council
Published by Integrative Medicine Communications
Available from the American Botanical Council.

This monograph, published by the Commission E in 1994, was modified based on new scientific research. It contains more extensive pharmacological and therapeutic information taken directly from the Commission E.