Chris Kresser: Next question from Gavin, “How careful do we need to be with S. boulardii and those who are immunocompromised? Technically, diabetes makes people compromised, so is there something we need to watch out for? Any evidence of systemic infection with probiotics?”
Great question. The answer is I’ve only been able to find evidence of adverse events in people who are severely immunocompromised. Usually, when you see immunocompromised in the scientific literature, it’s referring to [people with] AIDS or people who have been on steroids for many years or biologics or something like that. It’s not typically referring to somebody with diabetes who may have slightly reduced immune function. With S. boulardii, I think people who have gut infections, diarrhea, etc., I would not hesitate and have not hesitated to use it in those cases, but if someone has AIDS or some other much more severe compromise of the immune system, then I would not use it in that situation.