ProbioticsNot all yogurt gives you the shits…

PROBIOTICS VERSUS

ACUTE INFECTIOUS DIARRHOEACOCHRANE REVIEW

2010OVER 8000 PEOPLE

“proven in childhood gastroenteritis”

How about us big people?And how about other immune-mediated illnesses???

Probiotics: the friendly guys

Live microorganisms which when given in adequate amounts confer a health

benefit on the host

Lactobacilli and BifidobacteriaeGram positive anaerobes

Ilya Mechnikov: “Father of probiotics”

How do probiotics work?

Review by World Gastroenterology Organization 2011

Alter local pH to be less optimal for pathogens

compete for nutrients and adhesion sites

produce bacteriocins

Modify toxins produced by pathogens

stimulate epithelial mucin production

Enhance intestinal barrier function

Activate local macrophages: IgA

Modulate cytokine profiles

Down regulation of inflammatory responses to food antigens

Where will you get your

probiotics?• Limited species• Strain-specific• limited doses

• Manufactured cultures of bacteria too “tame”

• If only a mild effect:Cost vs benefit

Studies in adults: acute

infectious diarrhoea

Grossi (J Clin Gastro 2010)174 Italians:• Primary care setting (14

GP’s)• Adults• “acute diarrhoea”• Comparison of 2 groups -

Lactobacillus paracasei or Lactobacillus GG

• less toilet time: 20.4 hours (but p=0.09)

Studies in adults: acute

infectious diarrhoea

Margreiter (J Clin Gastro 2006)169 Austrians:• outpatients (9 centres)• Adults• “acute diarrhoea”• Comparison of 2 groups both

taking probiotics (combination of bacteria vs single strain)

• No significant difference

Studies in adults:

nosocomial diarrhoea

• Many studies• no adverse outcomes • Best results when probiotics

taken prior to onset of diarrhoea

Stay tuned: the PLACIDE study (BMC Inf Diseases 2012)

Could your #2 be super too??

Studies in adults:

inflammatory bowel disease

Probiotics: what a good idea!Many trialsMany confoundersUC: yes Crohn’s: noJonkers et al. Drugs 2012Meijer et al. Journal of Clinical Gastroenterology 2011

Austin Dieticians?Austin Gastroenterology Registrars?

Studies in adults:

reduction in infection

Studies in athletes• Reduction in man-fluWest et al. Journal of Nutrition 2011

• Better maintenance of saliva IgA levelsGleeson et al. Intern Journal of Sport Nutrition and Exercise Metabolism 2011

Study in healthy volunteers• Decreased URTI frequency + severityPregliasco et al. Journal 2008

Study in ICU patients• Variable results – yes, no, maybe

4.10?

I wish you’d put the lid on your petri dish Allan – we came here with 4 kids and now we’ve got 20 million…”