Lactoferrin 100% by Symbiotics

POSSIBLY EFFECTIVE

• Pregnancy-related iron deficiency. Oral lactoferrin seems to improve hemoglobin levels similarly to oral or parenteral iron therapy in patients with pregnancy-related iron deficiency. Details: A meta-analysis of 4 clinical studies in patients with pregnancy-related iron deficiency anemia shows that taking bovine lactoferrin 200-250 mg daily for 4-8 weeks during the second or third trimester is equally effective to ferrous sulfate 150-520 mg for improving hemoglobin levels (97788). Another meta-analysis of 6 mostly small, low-quality clinical studies in pregnant patients with iron deficiency anemia, iron deficiency, or hereditary thrombophilia shows that taking lactoferrin improves hemoglobin and serum iron, but not serum ferritin, when compared with ferrous sulfate (110773). However, the validity of these findings is limited by the heterogeneity of the included studies and lack of information about lactoferrin and iron doses.
• Sepsis. Oral lactoferrin seems to reduce the risk of late-onset sepsis in some premature infants. However, the optimal dosing regimen and patient population is unclear. Details: A meta-analysis of 12 clinical studies in premature infants shows that lactoferrin 150-200 mg/kg daily reduces the risk of late-onset sepsis by 20%, largely due to reductions in fungal infections specifically (104868). In contrast, other meta-analyses have reported conflicting findings (97783,104856) and some suggest that any benefits may be relegated to certain sub-groups of premature infants, including infants fed with bovine formula (104856,104868) or those with very low birth weight or extremely low birth weight (104856,104868,104869). These groups seemed to obtain greater benefits than other premature infants or those fed exclusively or almost exclusively with breast milk. Early data from one meta-analysis also suggests that lactoferrin may be more effective at preventing late-onset sepsis when combined with probiotics (104868). Fixed doses of 100-250 mg daily and weight-based doses up to 300 mg/kg daily have been studied (97783,104856,104868,104869,104870). However, many individual clinical studies, including 3 large studies, have failed to demonstrate clear benefits of lactoferrin. These clinical trials, one in very premature infants and the others in very low birthweight infants, show that lactoferrin 150 mg/kg daily, 200 mg/kg daily, or 100 mg daily does not reduce late-onset sepsis when compared with control (104857,104858,110771). Two of these trials had very few infants exclusively fed bovine formula, which may have limited potential benefits. Subgroup analyses from these trials also suggest that extremely low birth weight and/or extremely premature infants may have benefited from lactoferrin (104857,104858).

LIKELY INEFFECTIVE

• Fetal and premature infant mortality. Oral lactoferrin does not reduce the risk of all-cause mortality in premature infants. Details: Many meta-analyses and large clinical trials show that taking lactoferrin does not reduce the risk of mortality from any cause in premature infants (104856,104857,104858,104868,110771).
• Necrotizing enterocolitis (NEC). Most research shows that oral lactoferrin does not reduce the incidence of NEC in premature infants. Details: Many meta-analyses and large clinical studies show that lactoferrin does not reduce the incidence of NEC in premature infants (104856,104857,104858,104868,110771). Exploratory data from one meta-analysis suggest that lactoferrin combined with probiotics may reduce the incidence of NEC when compared with control (104868). However, since probiotics alone have demonstrated benefit for the prevention of NEC in clinical trials, it is unclear if lactoferrin confers any additional benefit.

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Acne. Oral lactoferrin has only been studied in combination with other ingredients; its effect when used alone is unclear. Details: A large clinical study in adult females with acne shows that taking an oral supplement containing lactoferrin, zinc, niacinamide, and prebiotics once daily for 12 weeks, in addition to applying a topical combination retinoid-based cream, modestly improves the number of acne lesions (i.e., non-inflammatory, inflammatory, and total) when compared with the topical combination retinoid-based cream alone (112915). It is unclear if these effects are due to lactoferrin, other ingredients, or the combination.
• Anemia of chronic disease. Oral lactoferrin might improve hemoglobin levels in some patients with anemia of chronic disease. However, the optimal patient population is unclear. Details: One nonrandomized clinical study evaluated bovine lactoferrin in patients with anemia of chronic disease. In pregnant patients with anemia related to beta-thalassemia or hereditary thrombophilia, taking a specific bovine lactoferrin 100 mg capsule (Lattoglobina, Aqma Italia) twice daily with meals, starting at 6-8 weeks' gestation and continuing until delivery, improves hemoglobin levels by 50% and 15%, respectively, when compared with baseline. In non-pregnant patients, taking this same product twice daily for 30 days improves hemoglobin levels by 18% in patients with hereditary thrombophilia, but not in those with beta-thalassemia. The study may have been inadequately powered to detect a difference from baseline (104865).
• Antibiotic-associated diarrhea. It is unclear if oral lactoferrin is beneficial for preventing antibiotic-associated diarrhea in children or adults. Details: A very small clinical study in long-term care patients shows that adding lactoferrin at an unspecified dose to 600 mL of gastronomy tube solution daily for 56 days reduces the risk for antibiotic-associated diarrhea when compared with placebo (97782). Conversely, a clinical study in children aged 1-18 years receiving antibiotic therapy for an acute respiratory or urinary tract infection shows that those taking bovine lactoferrin 100 mg twice daily are more than twice as likely to develop antibiotic-associated diarrhea during or for the two weeks following antibiotic therapy when compared with those taking placebo (106729). However, the validity of these findings is limited by differences in baseline characteristics between groups.
• Atopic dermatitis (eczema). Oral lactoferrin has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: A very small clinical study in adults with atopic dermatitis shows that taking a combination of lactoferrin 250 mg and a whey derived immunoglobulin-rich fraction 250 mg daily for 56 days improves symptoms in 13 of 22 patients, compared with 4 of 13 patients taking placebo (97789).
• Bacterial vaginosis. Oral lactoferrin has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: Preliminary clinical research in adults with recurrent bacterial vaginosis shows that adding a specific combination capsule (Respecta, Giellepi Spa Health Science) containing bovine lactoferrin 50 mg and 5 billion colony-forming units of Lactobacillus acidophilus GLA-14 and Lactobacillus rhamnosus HN001 on a varying schedule over 6 months, in conjunction with metronidazole 500 mg twice daily for the first 7 days, reduces the proportion of patients with vaginal discharge by 63%, itching by 57%, and a recurrent episode by 50% when compared with placebo. Patients took 2 capsules daily for 5 days, then 1 capsule daily for 10 days, followed by 1 capsule daily for 10 days of each month, beginning on the first day of the menstrual cycle. It is unclear if these effects are due to lactoferrin, other ingredients, or the combination (104872).
• Chemotherapy-induced anemia. It is unclear if oral lactoferrin is beneficial for chemotherapy-induced anemia. Details: An open-label clinical study in adults with advanced cancer and chemotherapy-induced anemia who are receiving treatment with recombinant human erythropoietin shows that taking oral lactoferrin (Lattoglobina, Grunenthal-Formenti) 200 mg daily for 12 weeks is as effective as intravenous ferric gluconate 125 mg weekly for improving hemoglobin and iron levels (97781).
• Cognitive function. Oral lactoferrin has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: A small clinical trial in healthy adults shows that taking a product containing a combination of lactoferrin 10 mg, probiotics, prebiotics, minerals, and glutathione (Puraflor, GSK Consumer Healthcare, Milano, Italy) daily for 4 weeks does not affect cognitive performance during acute stress when compared with placebo (110923). It is unclear if this effect is due to lactoferrin, other ingredients, or the combination.
• Common cold. It is unclear if oral lactoferrin is beneficial for preventing the common cold. Details: A clinical study in healthy adults shows that taking bovine lactoferrin 200 mg or 600 mg daily for 12 weeks does not reduce the frequency or duration of self-reported symptoms of the common cold when compared with placebo (104859). Another clinical study in adults with frequent colds shows that taking a combination of bovine lactoferrin 400 mg and whey protein immunoglobulin-rich fraction 200 mg daily for 90 days reduces the number of colds by 57% when compared with placebo. There was no effect on cold severity (97786). It is not clear if this effect is due to lactoferrin, whey protein fraction, or the combination.
• Coronavirus disease 2019 (COVID-19). It is unclear if oral lactoferrin is beneficial for the treatment or prevention of COVID-19. Details: A small clinical study in adults hospitalized with mild-to-moderate COVID-19 receiving hydroxychloroquine, vitamin C, zinc, and acetylcysteine shows that taking lactoferrin 200 mg once or twice daily does not improve symptoms when compared with placebo (106731). Similarly, a large clinical study in adults hospitalized with moderate-to-severe COVID-19 receiving standard therapy shows that taking a specific product containing bovine lactoferrin (Mosaic, Pharmaguida) 400 mg twice daily for 30 days does not reduce intensive care unit admission or death, nor improve illness severity scores or discharge within 2 weeks when compared with placebo (112913). However, observational research with this product in outpatient adults with asymptomatic to moderately symptomatic COVID-19 suggests that taking 200-1000 mg daily is associated with a median of 15 days to a negative SARS-CoV-2 test, compared with 24 days in a historical control group (106732). The validity of these findings is limited by the retrospective nature of the study and differences in symptom severity between the groups at baseline. There is also interest in oral lactoferrin for prevention of COVID-19. A large clinical study conducted in healthcare workers in Peru who were screened and tested for COVID-19 shows that taking bovine lactoferrin 600 mg once daily for 65 days does not reduce the number of SARS-CoV-2 cases when compared with placebo (112914). However, the study was stopped prematurely due to vaccine availability; it may not have been powered to detect a difference between groups.
• Diarrhea. It is unclear if oral lactoferrin is beneficial for reducing the incidence of diarrhea in children or adults. Details: A large clinical study in weaned children 12-18 months of age shows that taking bovine lactoferrin 500 mg twice daily for 6 months does not reduce the incidence of diarrhea when compared with placebo (97787). However, a clinical study in infants with anemia who were exclusively breast-fed from 4-6 months before weaning and transitioning to infant formula from 6-9 months shows that fortification of each 100 grams of formula with 38 mg of bovine lactoferrin for 3 months improves vomiting and nausea when compared with formula without fortification. Similarly, fortification of each 100 grams of formula with 76 mg of bovine lactoferrin for 3 months improves diarrhea-related illness, diarrhea, vomiting, and nausea when compared with formula without fortification (106726). Lactoferrin has also been evaluated in adults. A large clinical study in healthy adults working at kindergartens or nursery schools in the winter shows that taking bovine lactoferrin 600 mg daily for 12 weeks is associated with a 1-day duration of diarrhea, compared with 2 days in those taking placebo (106728).
• Gastroenteritis-associated nausea and vomiting. It is unclear if oral lactoferrin prevents the development of gastroenteritis-associated nausea and vomiting in children or adults. Details: A large clinical study in children aged 3-6 years shows that consuming yogurt fortified with bovine lactoferrin 100 mg 3-5 days weekly for 15 weeks reduces the odds of school absence due to vomiting by 19% when compared with consuming the yogurt less than 3 days per week. However, consuming the yogurt did not reduce absences due to gastroenteritis, the presumed cause of vomiting (104862). A large clinical study in healthy adults working at kindergartens or nursery schools in the winter shows that taking bovine lactoferrin 200 or 600 mg daily for 12 weeks is associated with a 12% prevalence of acute gastrointestinal symptoms, compared with a prevalence of 22% in those taking placebo (106728).
• Gingivitis. Oral lactoferrin has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: A clinical study in adults with mild gingivitis shows that taking bovine lactoferrin 60 mg, bovine lactoperoxidase 7.8 mg, and glucose oxidase 7.8 mg daily for 12 weeks improves gingival health and plaque index scores when compared with placebo. A lower dose product containing bovine lactoferrin 20 mg, bovine lactoperoxidase 2.6 mg, and glucose oxidase 2.6 mg daily for 12 weeks improves plaque index scores, but not gingival health scores, when compared with placebo. It is unclear if these effects are due to lactoferrin, other ingredients, or the combination (104867).
• Helicobacter pylori. Research on the use of oral lactoferrin as an adjunct for H. pylori eradication is inconclusive and conflicting. Details: Monotherapy with human recombinant lactoferrin, even at high doses of 5 grams daily, does not suppress or eradicate H. pylori infection (13317). However, research on its use as an adjunct to standard therapy is conflicting. Some studies suggest that lactoferrin improves efficacy when added to a triple therapy regimen of rabeprazole, clarithromycin, and tinidazole (13316,13332). However, research using lactoferrin with a triple therapy regimen of esomeprazole, clarithromycin, and amoxicillin found no difference in eradication rates. It is possible that lactoferrin activity on the bacterial cell wall interferes with the cell wall activity of amoxicillin (13315). Other research shows that using lactoferrin in addition to a sequential therapy regimen of esomeprazole, amoxicillin, metronidazole, and clarithromycin or a triple therapy regimen of esomeprazole, amoxicillin, and clarithromycin is associated with eradication rates of 95% or 86%, respectively, compared with eradication rates of 83% and 70%, respectively, with the use of either regimen alone (106730). However, using lactoferrin in addition to a sequential therapy regimen (esomeprazole, amoxicillin, tinidazole, and clarithromycin) and probiotics does not increase eradication more than sequential therapy and probiotics alone (97790).
• Hepatitis C. It is unclear if oral lactoferrin is beneficial for hepatitis C. Details: Some clinical research shows that lactoferrin decreases serum levels of hepatitis C virus RNA and alanine aminotransferase (ALT) in adults with hepatitis C (13320,13321). Some experts recommend starting lactoferrin 1 to 3 months before starting interferon to identify lactoferrin responders (13321,13322,13323,13324). Lactoferrin doses of 1.8 or 3.6 grams daily appear to be necessary for efficacy (13323,13324); lower doses don't seem to have any effect (13313,13314).
• Infant development. Oral lactoferrin has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: A clinical study in healthy, full-term, exclusively formula-fed infants shows that taking a formula fortified with bovine lactoferrin 0.6 grams/L and bovine milk fat globule membrane 5 grams/L for 12 months improves cognitive development scores by about 8% after 12 months, but not after 18 months, when compared with control formula. This study may have been inadequately powered to detect a difference between groups at 18 months. It is unclear if any effect is due to lactoferrin, milk fat globule membrane, or the combination (104866).
• Iron deficiency anemia. It is unclear if oral lactoferrin is beneficial for the treatment or prevention of iron deficiency anemia in infants and children. Details: An open-label clinical study in children aged 1-10 years with cerebral palsy and iron deficiency anemia shows that taking bovine lactoferrin (Pravotin, Hygint) 100 mg twice daily for 4 weeks improves hemoglobin by 1.4 grams/dL, compared with 0.8 grams/dL in those taking iron hydroxide polymaltose complex providing elemental iron 3 mg/kg twice daily. Lactoferrin also improves serum ferritin, but not the rest of the serum iron profile (106725). Conversely, a small open-label clinical study in children aged 1-18 years with iron deficiency anemia in Egypt shows that the improvement in hemoglobin, serum iron, ferritin, or transferrin saturation is less with lactoferrin 100 mg daily, or twice daily if over age 3, when compared with iron bisglycinate chelate 0.75 mg/kg daily or iron polymaltose complex 6 mg/kg daily for a month. However, improvement in hemoglobin and iron studies was similar when comparing 30% iron saturated lactoferrin (100 mg lactoferrin and 30 mg iron) daily, or twice daily if over age 3 years, with iron bisglycinate chelate or iron polymaltose complex (110189). Lactoferrin has also been evaluated for the prevention of iron deficiency anemia. A clinical study in healthy, full-term formula-fed infants aged 6 weeks to 6 months shows that feeding a low-iron infant formula supplemented with lactoferrin has no effect on iron status or incidence of iron deficiency when compared with the low-iron formula alone (106724).
• Preterm labor. It is unclear if vaginal lactoferrin is beneficial for preventing preterm labor. Details: Observational research in patients diagnosed with bacterial vaginosis in the first trimester of pregnancy and a previous history of preterm labor has found that using a lactoferrin vaginal tablet 300 mg daily for 21 days is associated with a 44% reduced incidence of preterm birth when compared with no intervention. The validity of this study is limited by the use of a retrospective chart review (105405).
• Psoriasis. It is unclear if topical lactoferrin is beneficial in psoriasis. Details: A small open-label clinical study in patients with mild to moderate stable plaque-type psoriasis shows that applying lactoferrin 10% or 20% ointment topically daily in addition to taking bovine lactoferrin 100 mg orally daily (Lattoglobina, Grünenthal-Formenti) for 4 weeks improves symptoms of psoriasis, such as redness and scaling, by up to 37% when compared with use of oral lactoferrin alone (97784).
• Respiratory tract infections. It is unclear if oral lactoferrin is beneficial for treating or preventing respiratory tract infections. Details: A clinical study in healthy children aged 12-32 months shows that taking bovine lactoferrin 48 mg daily for 13 weeks does not reduce symptoms of respiratory tract infections when compared with placebo (104861). However, a clinical study in infants with anemia who were exclusively breast-fed from 4-6 months before weaning and transitioning to infant formula from 6-9 months shows that fortification of each 100 grams of formula with 38 mg of bovine lactoferrin for 3 months improves rhinorrhea, wheezing, and skin rash when compared with formula without fortification. Similarly, fortification of each 100 grams of formula with 76 mg of bovine lactoferrin for 3 months improves respiratory-related illness and wheezing when compared with formula without fortification (106726). There is also interest in oral lactoferrin for prevention of respiratory tract infections. However, two meta-analyses that each included 6 clinical studies in infants, children, and adults who consumed a bovine lactoferrin supplement or bovine lactoferrin enhanced formula, with some studies included in both analyses, have conflicting results. One meta-analysis of 1194 patients shows that lactoferrin reduces the risk of developing a respiratory infection by 43% when compared with placebo or various controls (110774). Conversely, the second meta-analysis of 1157 patients shows that lactoferrin does not reduce the risk of developing a respiratory infection in adults but may reduce the risk by 22% in infants and children when compared with placebo or unenhanced formula (110775). The validity of the findings from these meta-analyses is limited by the heterogeneity of the included studies, which enrolled patients of a broad age range and utilized widely varying dosing regimens. Furthermore, some studies are of poor quality.
• Vaginal candidiasis. Oral lactoferrin has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: Preliminary clinical research in adults with recurrent vaginal candidiasis shows that taking a specific combination capsule (Respecta, Giellepi Spa Health Science) containing bovine lactoferrin 50 mg and 5 billion colony-forming units of Lactobacillus acidophilus GLA-14 and Lactobacillus rhamnosus HN001 on a varying schedule over 6 months, in conjunction with clotrimazole 100 mg daily for the first 7 days, reduces the proportion of patients with vaginal discharge by 63%, itching by 100%, and a recurrent infection by 71% when compared with placebo. Patients took 2 capsules daily for 5 days, then 1 capsule daily for 10 days, followed by 1 capsule daily for 10 days of each month, beginning during the premenstrual phase. It is unclear if these effects are due to lactoferrin, other ingredients, or the combination (104863).
• Ventilator-associated pneumonia (VAP). It is unclear if oral lactoferrin is beneficial for preventing VAP. Details: A clinical study in critically ill, mechanically ventilated adults shows that taking lactoferrin 500 mg four times daily for up to 28 days does not reduce the incidence of VAP or other infections, or increase antibiotic-free days, when compared with placebo (104873). More evidence is needed to rate lactoferrin for these uses.

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LIKELY SAFE ...when used orally in amounts commonly found in foods. Lactoferrin has Generally Regarded as Safe (GRAS) status in the US (13312).

POSSIBLY SAFE ...when used orally in medicinal amounts. Bovine lactoferrin has been safely used at doses of up to 600 mg daily for up to 12 months (13313,13314,13315,13316,13320,13321,13322,13323,97786,104859,104860). Recombinant human lactoferrin has been used with apparent safety at a dose of 5 grams daily for up to 14 days (13317,13318,13319). There is insufficient reliable information available about the safety of lactoferrin when used topically.

CHILDREN: POSSIBLY SAFE
when used enterally in infants and children up to 6 years of age. Lactoferrin has been used safely as a part of enteral feeds in preterm infants at a dose of 250 mg daily or up to 300 mg/kg daily for up to 30 days (97783,97787,104857,104858,104870). Formula fortified with bovine lactoferrin 0.6 grams/L and bovine milk fat globule membrane 5 grams/L has also been used safely in infants for up to 12 months (104866). Bovine and recombinant human lactoferrin 1000 mg daily for up to 6 months has been used with apparent safety in weaned infants up to 18 months of age (97783,97787). Bovine lactoferrin 336-500 mg per week has been used with apparent safety in children 1-6 years of age for 13-15 weeks (104861,104862). There is insufficient reliable information available about the safety of lactoferrin in children over 6 years of age.

PREGNANCY: LIKELY SAFE
when used orally in amounts commonly found in foods. Lactoferrin has Generally Regarded as Safe (GRAS) status in the US (13312).

PREGNANCY: POSSIBLY SAFE
when used orally in medicinal amounts. Lactoferrin has been used with apparent safety during the second or third trimester of pregnancy at doses of up to 250 mg daily for up to 8 weeks (97788). Also, bovine lactoferrin has been used with apparent safety throughout all trimesters of pregnancy at doses of up to 200 mg daily (104865). There is insufficient reliable information available about the safety of intravaginal lactoferrin during pregnancy and lactation; avoid using.

LACTATION: LIKELY SAFE
when used orally in amounts commonly found in foods. Lactoferrin has Generally Regarded as Safe (GRAS) status in the US (13312). There is insufficient reliable information available about the safety of lactoferrin when used medicinally during lactation; avoid using.

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General ...Orally, bovine and human recombinant lactoferrin are well tolerated when used in typical doses. However, hjgher doses of 7.2 grams daily increase the risk of side effects and decrease tolerability.
Topically, there is a limited amount of information on the adverse effects of lactoferrin.
Intravaginally, no adverse effects have been reported. However, a thorough evaluation of safety outcomes has not been conducted.
Most Common Adverse Effects:
Orally: Constipation, diarrhea, epigastric pain, and nausea.
Topically: Burning sensation.
Serious Adverse Effects (Rare):
Orally: Bowel obstruction, intestinal perforation.

Dermatologic ...Orally, at higher doses of 7. 2 grams daily, lactoferrin has been reported to cause skin rash (13323). Topically, burning sensation has been reported (97784).

Gastrointestinal ...Orally, lactoferrin has been reported to cause diarrhea in some patients. At higher doses of 7.2 grams daily, anorexia and constipation have been reported (13323). However, gastrointestinal effects of lactoferrin, including epigastric pain, constipation, nausea, and diarrhea, are less common than with other sources of iron such as ferrous sulfate (97788). In neonates, single cases of jaundice, bloody stool, bowel obstruction, and intestinal perforation have been reported in clinical trials (104857,104858).

Neurologic/CNS ...Orally, at higher doses of 7. 2 grams daily, lactoferrin has been reported to cause fatigue and chills (13323).

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