Natural Foods Merchandiser

Nutrition Q&A With Dan Lukaczer, N.D.

Beneficial Yeast
Q: A customer was told to take a friendly bacterium called Saccharomyces boulardii after finishing a course of antibiotics. Have you heard of this?

A: Yes, and it's a good idea. S. boulardii is a nonpathogenic yeast, not a bacteria, and it's widely prescribed in Western Europe to prevent diarrhea and other gastrointestinal diseases associated with antibiotic use. S. boulardii transits the gut in a viable form, but does not appear to permanently colonize the intestinal tract.1 It has been used successfully to treat antibiotic-associated diarrhea and pseudomembranous colitis involving clostridium difficile.2,3 Additionally, researchers have shown it is a beneficial maintenance treatment for those with Crohn's disease.4 This friendly yeast appears to exert antagonistic activity against various bacterial pathogens.5 Perhaps complementary to this anti-microbial activity are its immunological actions. In recent research, S. boulardii appeared to induce cellular and humoral changes involved in nonspecific host defenses.6 These results show that this yeast modulates host immune responses, which may be of interest for improving resistance to enteropathogenic bacterial infections.

Allergic To Echinacea
Q: What should I tell my customers with allergies who want to take echinacea to prevent colds?

A: Overall, echinacea (Echinacea spp) appears to be very safe; however, you raise an important point regarding allergies. Anything can cause an allergic reaction, so it is not surprising that there are reports implicating echinacea as a potential allergen. Echinacea is popular as a preventive or treatment for colds and influenza. Although most reference books point to echinacea's years of safe use, and the German Commission E even suggests it is safe for use during pregnancy, there may be cause for concern for those with allergic tendencies.

Recently, Australian researchers evaluated five patients who developed serious allergic reactions after taking echinacea. Allergy symptoms ranged from dizziness and itchy eyes to chest constriction and severe difficulty breathing. Four of the five subjects apparently reacted to their first-ever echinacea dose.7 These researchers also reviewed 51 adverse reaction reports involving the herb and submitted to the Australian Adverse Drug Reaction Committee between 1979 and 2000. Half of the cases appeared to involve some kind of allergic response. The authors conclude: "Given its widespread (and largely unsupervised) community use, even rare adverse events become inevitable. Atopic patients should be cautioned appropriately." I agree. Although events are rare, as these authors suggest, they are real. Allergy-sensitive individuals needn't avoid echinacea, but they should be made aware of possible reactions.

Get The Lead Out
Q: I'm confused about the allowable levels of lead in calcium supplements. I thought that any amount of lead could cause harm. Why do some companies permit lead in their products?

A: With the sophisticated detection techniques we use, it is very difficult to find no lead at all. Lead is clearly all around us in the environment—we've seen to that. It is quite clear that lead is toxic, even in minute amounts, but there is still uncertainty and controversy as to the acceptable maximum total oral daily level. Some researchers suggest a 6 mcg daily limit from all oral sources, not just from supplements, is the highest we can accept without causing harm. Some lead experts have even suggested a rigorous safety margin that would lower the permissible intake from supplements to approximately 1 mcg per day.8 Some argue whether there is an acceptable level of lead intake since no risk-free blood level has actually been established.

There are manufacturers who have third-party verification that their supplements contain less then 1 mcg per 1,000 mg of calcium. Because that is clearly attainable, it would seem a reasonable goal to limit the lead contained in calcium supplements to that. In California, which often has more stringent safety standards then the rest of the country, lead limits for calcium supplements are 1.5 micrograms per gram of calcium.9 The United States Pharmacopoeia set the allowable level of lead in calcium carbonate preparations at 3 micrograms per gram. Any supplement manufacturer should provide information on lead content if asked.

Dan Lukaczer, N.D., is director of clinical research at the Functional Medicine Research Center, a division of Metagenics Inc., in Gig Harbor, Wash.


1. Blehaut H, et al. Disposition kinetics of Saccharomyces boulardii in man and rat. Biopharm Drug Dispos 1989;10(4):353-64.

2. Surawicz CM, et al. The search for a better treatment for recurrent Clostridium difficile disease: use of high-dose vancomycin combined with Saccharomyces boulardii. Clin Infect Dis 2000;31(4):1012-7.

3. Bergogne-Berezin E. Treatment and prevention of antibiotic associated diarrhea. Int J Antimicrob Agents 2000;16(4):521-6.

4. Guslandi M, et al. Saccharomyces boulardii in maintenance treatment of Crohn's disease. Dig Dis Sci 2000;45(7):1462-4.

5. Elmer GW, McFarland LV. Suppression by Saccharomyces boulardii of toxigenic Clostridium difficile overgrowth after vancomycin treatment in hamsters. Antimicrob Agents Chemother 1987;31(1):129-31.

6. Caetano JA, et al. Immunopharmacological effects of Saccharomyces boulardii in healthy human volunteers. Int J Immunopharmacol 1986;8(3):245-59.

7. Mullins RJ, Heddle R. Adverse reactions associated with echinacea: the Australian experience. Ann Allergy Asthma Immunol 2002;88(1):42-51.

8. Ross EA, Szabo NJ, Tebbett IR. Lead content of calcium supplements. JAMA 2000;284(11):1425-9.

9. Scelfo GM, Flegal AR. Lead in calcium supplements. Environ Health Perspect 2000;108(4):309-19.

Natural Foods Merchandiser volume XXIII/number 11/p. 38, 40

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