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Potential Benefits of the Lactobacillus reuteri Probiotic

Written by Ana Aleksic, MSc (Pharmacy) | Last updated:
Jonathan Ritter
Puya Yazdi
Medically reviewed by
Jonathan Ritter, PharmD, PhD (Pharmacology), Puya Yazdi, MD | Written by Ana Aleksic, MSc (Pharmacy) | Last updated:

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Lactobacillus reuteri

Lactobacillus reuteri is a well-studied strain of probiotic bacteria. People are using it as a beauty supplement and to increase vitamin D. Although Lactobacillus reuteri boasts many purported health benefits, the majority still lack proper evidence. Read on for a breakdown of the science.

What is Lactobacillus reuteri?

Overview

Lactobacillus reuteri is a strain of lactic acid bacteria that live in the intestines, and occasionally the stomachs, of humans (although not all individuals), other mammals, and birds.

Its name comes from German microbiologist, Gerhard Reuter, who discovered it in samples of human intestine and feces in the 1960s.

Different strains of Lactobacillus reuteri have been shown to have different physiological effects. For example, Lactobacillus reuteri DSMZ 17648, trademarked “Pylopass” is used for H. pylori [1], while Lactobacillus reuteri NCIMB 30242, trademarked “Cardioviva” is used to address high cholesterol [2].

In the 1960s, 30-40 percent of the population had Lactobacillus reuteri as a part of their microbiome. Today, estimates suggest it is found in only 10-20 percent [3, 4].

Have in mind that Lactobacillus reuteri supplements have not been approved by the FDA for medical use and generally lack solid clinical research. Regulations set manufacturing standards for supplements but don’t guarantee that they’re safe or effective. Speak with your doctor before supplementing.

Lactobacillus reuteri is a probiotic strain of lactic acid bacteria that normally resides in the gut.

Snapshot

Proponents

  • People say it promotes beautiful skin and thick, lustrous hair
  • May help fight infections
  • May reduce inflammation and increase beneficial TREGs
  • May improve gut health (possibly decreasing IBS and IBD symptoms)
  • May lower cholesterol

Skeptics

  • May not be good for those with histamine intolerance
  • May cause weight gain in some people
  • Large-scale clinical research lacking
  • The safety of long-term supplementation is unknown

Research Limitations

Most of the research on Lactobacillus reuteri was conducted in animals or cells. Clinical studies are sparse, and most of them are low quality, small, or potentially biased. Additionally, the exact strains that were used differ from one study to another.

Purported Benefits of Lactobacillus reuteri

Remember to speak with a doctor before taking Lactobacillus reuteri supplements. Probiotics should never be used as a replacement for approved medical therapies.

Possibly Effective for:

1) Abdominal Pain

According to clinical studies, taking Lactobacillus reuteri (DSM 17938 100 million colony-forming units daily) for 4 weeks may reduce abdominal pain in children aged 6-15 years [5].

2) Diarrhea from Antibiotics

Solid evidence suggests that L. reuteri (particularly Lactobacillus reuteri ATCC 55730–BioGaia probiotic tablets and drops) seems to reduce antibiotic-associated diarrhea and functional constipation in adults and children.

This probiotic strain also likely helps prevent diarrhea in infants and children, according to one small study [6].

3) Colic

According to clinical research, taking L. reuteri (Probiotic drops, BioGaia AB) for one week can improve infantile colic and symptoms such as crying time in breast-fed infants [7].

4) Constipation

Some studies suggest that Lactobacillus reuteri helps with constipation, increasing the number of bowel movements people have. People went from having 3.89 bowel movements per week to 5.28 in one study [8].

Infants also had increased bowel frequency even at a dosage of 100 million cfu (colony forming units) [9].

All in all, research suggests that this probiotic strain likely supports gut health when part of a healthy microbiome. Supplementing may be beneficial in infants, children, and people with specific gut/digestive issues.

Clinical studies suggest that L. reuteri may improve abdominal pain, antibiotic-associated diarrhea, infantile colic, and constipation.

5) Eczema

Some evidence suggests that Lactobacillus reuteri supplementation, in combination with Lactobacillus rhamnosus, may help prevent eczema or reduce symptoms of eczema in children.

One study found this effect when both probiotics were given to women for the last 4 weeks of pregnancy and to babies for the first 12 months of life. Children recieving this regimen has less eczema at 2 years of age [10].

In another study, a supplement containing Lactobacillus reuteri and Lactobacillus rhamnosus reduced the severity of eczema when given to 1- to 13-year-old children for 6 weeks [10].

6) As a Add-on to H. Pylori Therapy

Some studies have shown that L. reuteri has the potential to help eradicate H. pylori from the intestine when added to standard H. Pylori therapy [11].

It has been suggested that L. reuteri works by competing with H. pylori and inhibiting its binding to glycolipid receptors. The competition reduces the bacterial load of H. pylori and decreases the related symptoms [11].

2-week treatment with L. reuteri DSM17648 significantly reduced H. pylori overgrowth in otherwise healthy adults in one small study [12].

Additional human studies are needed.

According to several clinical studies, L. reuteri may help prevent or reduce symptoms of eczema in children. It’s also possibly beneficial when added to standard H. Pylori therapy.

7) High Cholesterol

Limited clinical evidence supports the benefits of L. reuteri as a complementary strategy for lowering blood cholesterol levels.

In one human study, Lactobacillus reuteri reduced LDL cholesterol by 11.64%, reduced total cholesterol by 9.14%, non-HDL-cholesterol by 11.30% and apoB-100 by 8.41% [13].

Hs-C-reactive protein and fibrinogen were reduced by 1.05 mg/l and 14.25%, respectively [13].

Another study used microencapsulated Lactobacillus reuteri NCIMB 30242 yogurt taken twice a day over 6 weeks by adults with high cholesterol. Results included a reduction of LDL by 8.92% and total cholesterol 4.81% over the course of the study [2].

The Lactobacillus reuteri in that form and delivery method was found to work better than probiotics traditionally used and comparable to other cholesterol-lowering methods [2].

Scientists consider that Lactobacillus reuteri lowers cholesterol, in part, by reducing the absorption of bile (by increasing the deconjugation of bile in the intestines) [13].

However, large-scale, multicenter clinical trials using standardized Lactobacillus reuteri formulations are needed to confirm this benefit.

Some clinical trials show that L. reuteri may help lower high cholesterol levels when added to standard therapy.

Insufficient Evidence for:

The following purported benefits are only supported by limited, low-quality clinical studies. There is insufficient evidence to support the use of L. reuteri for any of the below-listed uses. 

8) Low Vitamin D Levels

Taking Lactobacillus reuteri increased blood levels of vitamin D3 by 25.5% in a Canadian study of 123 people [14].

According to the authors of the study, this is the first time blood levels of vitamin D3 have been increased by oral probiotic supplementation [14].

Though their findings are promising, this purported benefit remains unproven until additional, large-scale clinical trials are carried out.

9) IBS and Ulcerative Colitis

Yogurt containing Lactobacillus reuteri RC-14 and Lactobacillus rhamnosus GR-1 increased T regulatory cells in patients with Inflammatory Bowel Disease and decreased inflammation (TNF-alpha and IL-12) [15].

A rectal enema of Lactobacillus reuteri reduced gut lining inflammation in children with active Ulcerative Colitis [16].

Scientists have come up with several hypotheses around why this probiotic might improve gut health.

According to them, our gut bacteria need to consume tryptophan in order to make serotonin, which is crucial for proper gut function [17].

Some theories suggest that when our gut bacteria consume sugar instead of tryptophan, we are more susceptible to Candida and other infections (by not producing AhR ligands). Insufficient evidence backs up this viewpoint, though [17].

Nonetheless, some researchers believe that Lactobacillus reuteri switches our gut bacteria’s primary food source from sugar to tryptophan, which helps produce serotonin, and protects our gut from infections. According to them, this may lessen susceptibility to gut problems and IBS [17].

It inhibited the onset of colitis in mice [18] and may reduce stress-induced colitis flare-ups [19].

Despite some promising findings, there is insufficient evidence to rate the effectiveness of L. reuteri for improving IBD, ulcerative colitis, or vitamin D levels.

10) Candida in Preterm Infants

Oral Lactobacillus reuteri supplementation was effective as nystatin at preventing  invasive candidiasis in a study on very low weight preterm infants. It was also more effective at reducing the incidence of sepsis caused by gastrointestinal candida in another study on preterm infants [20, 21].

11) Oral Health

Scientists are exploring whether Lactobacillus reuteri fights major cavity-producing bacteria [22].

The existing data are conflicting.

Chewing gum containing Lactobacillus reuteri decreased plaque and bleeding from the gums in two weeks in one small study [23].

Oral Lactobacillus reuteri containing tablets significantly reduced inflammation markers (TNF-α, IL-1β, and IL-17) in patients with chronic periodontitis (gum inflammation) [24].

Lactobacillus reuteri lozenges were shown to fight oral candida in a study of older patients [25].

However, this probiotic likely doesn’t improve oral health in babies. In one study, women took l. reuteri in the last 4 weeks prior to delivery and then gave l. reuteri to their babies until 12 months of age. Supplementation did not appear to reduce dental plaque in these children by the age of 9 years [26].

Higher-quality clinical trials are needed to explore this purported benefit.

12) Weight Control

The microbiota composition varies between lean and obese individuals [11].

It seems like some strains of L. reuteri may cause weight gain, while other strains can cause weight loss [11].

A surprisingly high level of Lactobacillus species has been found in the microbiota of obese people, especially L. reuteri. In fact, when individuals had strains of L. reuteri that are resistant to antibiotics (vancomycin), they gained weight after antibiotic (vancomycin) treatment [11, 27].

However, in a randomized, double-blind and placebo-controlled clinical trial, taking L. reuteri JBD301 for 12 weeks significantly reduced body weight in overweight adults [11].

These results seem conflicting because some L. reuteri strains can cause weight gain, while others cause weight loss [11].

In a study that tested different strains of L. reuteri, only PTA 4659 efficiently reduced the bodyweight of mice fed with high-fat diet (HFD), whereas L6798-treated mice even gained some weight [11, 28].

L. reuteri GMNL-263 reduces both insulin resistance and fatty liver in rats [29].

Until more studies come out, the effects of L. reuteri on weight control, oral health, and candida infections in newborns remain largely unknown.

Lacking Evidence:

No clinical evidence supports the use of L. reuteri for any of the conditions listed in this section.

Below is a summary of the existing animal and cell-based research, which should guide further investigational efforts. However, the studies listed below should not be interpreted as supportive of any health benefit.

13) Skin & Hair Health

Animal research on a Lactobacillus reuteri strain called ATCC PTA 6475 has shown potential for improving skin quality (thickness and “glow”) and creating thick, lustrous hair [30].

The probiotic improved skin and hair quality in both sexes, but in female animals caused a dramatic improvement in the level of shine of their hair. The Lactobacillus reuteri caused females to have a more acidic pH, which was found to correlate with hair luster [30].

However, remember that these alleged beauty benefits are based solely on animal studies. It’s unknown whether this probiotic strain can improve hair and skin health in humans, as clinical studies are lacking.

High IL-17 inflammation can inhibit hair growth, and Lactobacillus reuteri has been researched for suppressing IL-17 [30].

14) Anti-Inflammatory Effects

Decreased levels of L. reuteri in humans in the past decades is correlated with an increase in the incidences of inflammatory diseases over the same period of time. This, however, does not imply that lower l. reuteri levels directly caused inflammatory diseases, as researchers only looked at associations [11].

No clinical studies about the effects of L. reuteri on inflammation exist.

Lactobacillus reuteri increased Treg cells in animals and cells, causing an increase in the cytokine IL-10. As a result, Th17 (and its production of IL-17) is suppressed [31, 32].

Lactobacillus reuteri inhibits NF-kB, one of the most important factors in reducing whole-body inflammation [33].

Lactobacillus reuteri was also shown to improve levels of the “feel good” hormone oxytocin in animals, which has anti-inflammatory effects [30].

Note: Lactobacillus reuteri may not be good for histamine intolerance. Lactobacillus reuteri is able to convert dietary l-histidine into histamine, increasing IL-10, and suppressing TNF-α (by activating the histamine H2 receptor) [34, 35].

Lupus

In animal models of lupus nephritis, L. reuteri increased Lactobacilli in the gut, improved kidney function, reduced serum autoantibodies, and prolonged survival. Clinical studies are lacking [11].

15) Stress & Pain

No human evidence supports the use of L. reuteri for stress and pain management.

In animal models of gut pain, reuteri has been shown to lower the activation of the nervous system and lessen the pain [36, 37].

Scientists think that Lactobacillus reuteri ingestion impacts the nerves in such a way that it may slow gut motility (improving cases of diarrhea) and decrease pain perception. This theory is still unproven, though [38].

16) Vitamin B12 and B9 (Folate) Status

Like many other Lactobacillus spp., scientists believe that several L. reuteri strains are able to produce different types of vitamins, including vitamin B12 (cobalamin) and B9 (folate) [11].

At least 4 L. reuteri strains with various origins have been found to produce B12. Among these strains, L. reuteri CRL1098 (isolated from sourdough) and L. reuteri JCM1112 are the most studied [11].

In one study, the administration of L. reuteri CRL1098 together with a diet lacking vitamin B12 was shown to ameliorate pathologies in B12-deficient pregnant female mice and their offspring. It’s unknown if L. reuteri will have similar effects in humans [11].

Folate can also be synthesized by some specific L. reuteri strains, including L. reuteri 6475 and L. reuteri JCM1112. Whether this happens in humans or not remains to be researched [39, 40].

Despite the ongoing research efforts, clinical data are lacking to support the use of L. reuteri for improving vitamin B12 and folate levels.

17) Thyroid Health

Evidence is lacking to support the use of this probiotic strain for thyroid health.

In mice, Lactobacillus reuteri increased thyroid size and activity (increasing T4 levels), lessening the fatigue and weight gain associated with aging and causing a more youthful physical appearance [41].

According to some researchers, crucial to these anti-aging effects is Lactobacillus reuteri‘s ability to increase anti-inflammatory T regulatory cells [41].

18) Effects on Wound Healing

Overall, evidence is lacking to support this benefit.

Supplementing the rat microbiome with Lactobacillus reuteri in drinking water cuts wound-healing time in half compared to control animals [42].

According to one theory, Lactobacillus reuteri enhances healing by increasing oxytocin via the vagus nerve. The oxytocin then activates Tregs (CD4+Foxp3+CD25+), which improves the repair of wounds [42].

19) Infections

Scientists found that L. reuteri can produce antimicrobial molecules, such as alcohol, reuterin, lactic acid, acetic acid, and reutericyclin. Due to its antimicrobial activity, L. reuteri is able to inhibit the colonization of disease-causing microbes [11].

Vaginal Candida

Lactobacillus reuteri RC-14 alone and together with Lactobacillus rhamnosus GR-1 might inhibit the growth of candida in the vagina, according to cell-based experiments [43, 44].

Of the 8 probiotic strains tested in the lab, Lactobacillus reuteri ATCC 55730 showed the strongest inhibition of Candida albicans in the mouth [45].

Viral Infections

L. reuteri is being researched for its effects against pneumoviruses, circoviruses, rotaviruses, coxsackieviruses, and papillomaviruses [11].

It has been suggested that L. reuteri ameliorates viral infection by regulating the microbiota and secreting metabolites that have antiviral components. However, studies have yet to confirm this theory [11].

Other Bacterial Infections

Lactobacillus reuteri potently protects against Salmonella, cutting mortality rates in mice, chickens, and turkeys in half [46].

In chickens, Lactobacillus reuteri was as potent as the antibiotic gentamicin in preventing E. coli-related deaths [47]. The exopolysaccharides synthesized by L. reuteri is able to inhibit E. coli adhesion to pig cells [11].

An antibiotic produced by Lactobacillus reuteri, called reutericyclin, can kill C. difficile infections [48].

Derivatives of Lactobacillus reuteri may turn out to be helpful for MRSA on the skin, destroying biofilms and reducing the infection, according to some researchers [49].

Human studies are lacking.

20) Autism

There is no evidence to support the use of this probiotic strain in children or adults with autism.

The existing research suggests that future studies may be a good idea.

In an animal model of social deficits in offspring, Lactobacillus reuteri was found to be 9X lower. Supplementing with it significantly improved sociability and preference for social novelty in these offspring [50].

The main mechanism is by L. reuteri increasing oxytocin, including in the hypothalamus [50].

21) Sex Drive

Some companies market Lactobacillus reuteri‘s to men, claiming that it can strengthen sex drive.

However, it’s currently unknown if L. reuteri affects sex drive in men or women.

Animal studies suggest that Lactobacillus reuteri may increase testosterone (needs IL-10) [30].

22) Fertility

Eating probiotic yogurt or purified probiotic bacteria induced more acidic conditions in the skin, mouth, vagina, and rectum of female mice [30].

An acidic pH in the vagina correlates with the time of peak fertility, estimated to be around age 25. However, the specific benefits of L. reuteri should be researched in more detail [30].

Takeaway

Lactobacillus reuteri is a relatively well-studied strain of probiotic bacteria that normally resides in the gut. People are taking it as a beauty supplement, but research doesn’t support this use.

Others take it to improve their nutrititional status. Although L. reuteri has shown some promising effects at increasing vitamin D levels in preliminary studies, this use also remains unproven until more studies come out.

On the other hand, solid clinical studies suggest that L. reuteri may improve abdominal pain, antibiotic-associated diarrhea, infantile colic, and constipation.

Several clinical studies show that L. reuteri may also help prevent or reduce symptoms of eczema in children. Addotionally, it’s possibly beneficial when added to standard H. Pylori therapy and it might lower high cholesterol levels when used as a complementary strategy.

All other purported benefits haven’t been sufficiently researched.

About the Author

Ana Aleksic

Ana Aleksic

MSc (Pharmacy)
Ana received her MS in Pharmacy from the University of Belgrade.
Ana has many years of experience in clinical research and health advising. She loves communicating science and empowering people to achieve their optimal health. Ana spent years working with patients who suffer from various mental health issues and chronic health problems. She is a strong advocate of integrating scientific knowledge and holistic medicine.

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