probiotics not all yogurt gives you the shits…. probiotics versus acute infectious diarrhoea...
TRANSCRIPT
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ProbioticsNot all yogurt gives you the shits…
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PROBIOTICS VERSUS
ACUTE INFECTIOUS DIARRHOEA
COCHRANE REVIEW
2010
OVER 8000 PEOPLE
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“proven in childhood gastroenteritis”
How about us big people?
And how about other immune-mediated illnesses???
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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”
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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
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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
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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)
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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
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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)
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Could your #2 be super too??
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Studies in adults:
inflammatory bowel disease
Probiotics: what a good idea!
Many trials
Many confounders
UC: yes Crohn’s: noJonkers et al. Drugs 2012
Meijer et al. Journal of Clinical Gastroenterology 2011
Austin Dieticians?
Austin Gastroenterology Registrars?
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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
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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…”