The D-lactate free probiotics propaganda

In recent years probiotic manufacturers have increasingly delivered a host of ‘D-lactate free’, ‘low D-lactate’, ‘does not increase D-lactate status’ labelled formulations.

Even if you didn’t know what D-lactate was, you’d think it was generally to be avoided. Combine this with an article titled Brain fogginess, gas and bloating: a link between SIBO, probiotics and metabolic acidosis (1) that has been reproduced and referenced across media outlets, anyone would rightfully be concerned enough to opt for the ‘safer’ option.

Thankfully this study has been duly scrutinised (2). In summary, the probiotics addressed weren’t specified, the cited evidence didn’t support claims, conflicting research was ignored, hard conclusions were drawn from marginal data, overall carelessness in considering other contributing factors such as SIBO producing other metabolites, and multiple antibiotic treatments were employed along with no control for the probiotics (2).

And that’s just to name a few concerns about one paper that received much misdirected and undeserved attention. There have been earlier concerns raised regarding D-lactic acid production and other chronic illnesses (3), and again they were thwarted (4). So, rather than engaging in another game of clinical paper ping-pong, let’s blow the whistle on these probiotic manufacturers’ misinformed marketing and clarify the confusion.

The role and objective of all industry suppliers should be to produce products addressing patients’ unmet clinical needs. However, it seems they’ve lost sight of this mission and are instead clamouring for the fastest supply chain to keep up with the latest health fad, jumping on any bandwagon hoping to cash in first. Even if it means utilising information with no evidence that confuses and concerns even the most discerning healthcare practitioners and consumers.

To clarify on the topic, let’s address the real research worth touching upon:

  • Although rare, D-lactic acidosis is predominantly reported in patients with short bowel syndrome (5,7).
  • D-lactic acidosis in SBS patients can be treated with selective probiotic strains (10)
  • There is also some evidence that there is higher risk of D-lactic acidosis in other metabolic disorders (6).

  • There is safety evidence for increased D-lactate levels in healthy individuals and infants, whether from probiotics (8), infant formula (8,11), or even IV solution (7).

  • Toxicity occurs with serum D-lactate levels over 3mmol/L (a hundred-fold increase in serum D-lactate levels) in association with metabolic acidosis (blood pH<7.35) (6,7).
  • Multi species probiotics containing the D-lactate producing ones have a longstanding history of providing many health benefits (9,12).

The message to healthcare practitioners? Scrutinise the propaganda, prescribe and dispense with shrewdness, personalise to your patient. Choose probiotic preparations formulated with a clinical purpose, with real research.

Written By Lara Pham 



  1. Rao, S. S. C., Rehman, A., Yu, S. & Andino, N. M. Brain fogginess, gas and bloating: a link between SIBO, probiotics and metabolic acidosis. Clin. Transl. Gastroenterol. 9, 162 (2018).

  2. Quigley, E. M. M., Pot, B. & Sanders, M. E. ‘Brain Fogginess’ and D-Lactic Acidosis: Probiotics are not the cause. Clin. Transl. Gastroenterol. 9, 187 (2018).

  3. Sheedy, J. R., Wettenhall, R. E., Scanlon, D., Gooley, P. R., Lewis, D. P., McGregor, N., Stapleton, D. I., Butt, H. L., & DE Meirleir, K. I. Increased D-lactic acid intestinal bacteria in patients with chronic fatigue syndrome. In vivo. 23(4), 621-628 (2009).

  4. Vitetta, L., Coulson, S., Thomsen, M., Nguyen, T. & Hall, S. Probiotics, D-Lactic acidosis, oxidative stress and strain specificity. Gut Microbes. 8(4), 311-322 (2017).

  5. Uribarri, J., Oh, M. S. & Carroll H. J. D-lactic acidosis. A review of clinical presentation, biochemical features, and pathophysiologic mechanisms. Medicine (Baltimore), 77(2), 73-82 (1998).

  6. White, L. D-Lactic Acidosis: More prevalent than we think? Pract. Gastroenterol., 145, 26-45 (2015).

  7. Higgins, C. L-lactate and D-lactate- clinical significance of the difference. Acute Care Testing. (2011). Viewed at 13/12/19 at lactate-and-d-lactate-clinical-significance-of-the-difference

  8. Lukasik, J., Salminen, S. & Szajewska, H. Rapid review shows that probiotics and fermented infant formulas do not cause d-lactic acidosis in healthy children. Acta. Paediatr. 107(8), 1322-1326 (2018).

  9. Sanders, M. E., Merenstein, D. & Merrifield, C. A. Probiotics for human use. Nutr. Bull. 43, 212-225 (2018).

  10. Yilmaz, B., Schibli, S., Macpherson, A., J. & Sokollik, C. D-lactic Acidosis: Successful Suppression of D-lactate-Producing Lactobacillus by Probiotics. Pediatrics. 142, pii: e20180337 (2018).

  11. Papagaroufalis, K., Fotiou, A., Egli, D., Tran, L. A. & Steenhout, P. A randomized double blind controlled safety trial evaluating d-lactic acid production in healthy infants fed a lactobacillus reuteri-containing formula. Nutr. Metab. Insights, 7, 19-27 (2014).

  12. Gilliland, S. E. Health and nutritional benefits from lactic acid bacteria. Microbiology Reviews, 87, 175-188 (1990).

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