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Head-to-head evidence comparison — which supplement is right for you?
L. casei Shirota vs VSL#3 / Visbiome: VSL#3 / Visbiome has the stronger overall evidence (6.5 vs 5/10); they're alternatives for improve digestion — the best pick depends on your goals. Take the 60-second quiz for a pick tailored to your goals.
VSL#3 / Visbiome wins 2 of 3 categories. Both are solid choices — the best pick depends on your specific goals.
Verdict
Too few graded studies
Top outcomes
Verdict
Too few graded studies
Top outcomes
One 65-100 mL bottle of the fermented milk drink daily, delivering roughly 6.5 x 10^9 to 1 x 10^11 CFU depending on the product. Doses across trials span this whole range with no dose-comparison study to separate them.
Any time of day
Fermented milk drink containing L. casei Shirota (Yakult), 65-100 mL daily
Prevention and maintenance are DIFFERENT doses and are often conflated. Preventing the first onset of acute pouchitis used 900 billion CFU/day (1 sachet). Maintaining remission in established chronic or refractory pouchitis — where the effect size is largest — used 6 g/day, which at 5 x 10^11 viable bacteria per gram is about 3 trillion CFU/day, in both maintenance trials. As a ulcerative colitis add-on, 3.6 trillion CFU daily; the active-UC induction trial went highest at 3.6 trillion CFU TWICE daily (7.2 trillion/day), and the paediatric trial lowest at 450 billion/day weight-based
Any time of day
Refrigerated sachet of the De Simone Formulation
4 weeks
2 weeks
2-12 weeks
8 weeks
9-12 months
12 months
8-12 weeks
n/a
Efficacy of daily intake of Lactobacillus casei Shirota on respiratory symptoms and influenza vaccination immune response: a randomized, double-blind, placebo-controlled trial in healthy elderly nursing home residents.
Am J Clin Nutr (2012) · Rct · n=737
PRIMARY ENDPOINTS ALL NULL: no effect on days with respiratory symptoms, probability of respiratory symptoms, or post-vaccination antibody titre
Probiotics and synbiotics in chronic constipation in adults: A systematic review and meta-analysis of randomized controlled trials.
Clin Nutr (2022) · Meta analysis
Probiotics overall increased stool frequency (SMD 0.71, 95% CI 0.37-1.04, p<0.00001) — but the effect was driven by Bifidobacterium lactis, 'not mixtures of probiotics, Bacillus coagulans Unique IS2 or Lactobacillus casei Shirota'
A study into the effect of Lactobacillus casei Shirota in preventing antibiotic associated diarrhoea including Clostridioides difficile infection in patients with spinal cord injuries: a multicentre randomised, double-blind, placebo-controlled trial.
EClinicalMedicine (2021) · Rct · n=359
PRIMARY ENDPOINT NULL: antibiotic-associated diarrhoea at 30 days 45% vs 42.1% (RR 1.071, 95% CI 0.8-1.4, p=0.639)
Treatment and prevention of pouchitis after ileal pouch-anal anastomosis for chronic ulcerative colitis.
Cochrane Database Syst Rev (2019) · Meta analysis
Chronic pouchitis maintenance: 85% (34/40) maintained remission at 9-12 months vs 3% (1/36) placebo — RR 20.24 (95% CI 4.28-95.81), low certainty
Oral bacteriotherapy as maintenance treatment in patients with chronic pouchitis: a double-blind, placebo-controlled trial.
Gastroenterology (2000) · Rct · n=40
Relapse in 3/20 (15%) on the probiotic vs 20/20 (100%) on placebo, P<0.001
Once daily high dose probiotic therapy (VSL#3) for maintaining remission in recurrent or refractory pouchitis.
Gut (2004) · Rct · n=36
Remission maintained at 1 year in 17/20 (85%) vs 1/16 (6%) placebo, p<0.0001
VSL#3 / Visbiome has a higher evidence score (6.5/10 vs 5/10) and wins in 2 of 3 categories.
Both L. casei Shirota and VSL#3 / Visbiome score equally (52) for improve digestion.
No documented interaction was found in the data searched. This does not establish that this exact combination is safe.
The right pick depends on your goals. Answer a few quick questions for a personalised recommendation — or dig into the full evidence on each.