1. Probiotics Not all yogurt gives you the shits…

2. PROBIOTICS VERSUS ACUTE INFECTIOUS DIARRHOEA COCHRANE REVIEW 2010 OVER 8000 PEOPLE

3. “proven in childhood gastroenteritis” How about us big people? And how about other immune-mediated illnesses???

4. Probiotics: the friendly guys Live microorganisms which when given in adequate amounts confer a health benefit on the host Lactobacilli and Bifidobacteriae Gram positive anaerobes Ilya Mechnikov: “Father of probiotics”

5. How do probiotics work? Review by 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

6. Where will you get your probiotics? Limited species Limited species Strain-specific Strain-specific limited doses limited doses Manufactured cultures of bacteria too “tame” Manufactured cultures of bacteria too “tame” If only a mild effect: If only a mild effect: Cost vs benefit

7. Studies in adults: acute infectious diarrhoea Grossi (J Clin Gastro 2010) 174 Italians: Primary care setting (14 GP’s) Primary care setting (14 GP’s) Adults Adults “acute diarrhoea” “acute diarrhoea” Comparison of 2 groups - Lactobacillus paracasei or Lactobacillus GG Comparison of 2 groups - Lactobacillus paracasei or Lactobacillus GG less toilet time: 20.4 hours less toilet time: 20.4 hours (but p=0.09)

8. Studies in adults: acute infectious diarrhoea (J Clin Gastro 2006) Margreiter (J Clin Gastro 2006) 169 Austrians: outpatients (9 centres) outpatients (9 centres) Adults Adults “acute diarrhoea” “acute diarrhoea” Comparison of 2 groups both taking probiotics (combination of bacteria vs single strain) Comparison of 2 groups both taking probiotics (combination of bacteria vs single strain) No significant difference No significant difference

9. Studies in adults: nosocomial diarrhoea Many studies Many studies no adverse outcomes no adverse outcomes Best results when probiotics taken prior to onset of diarrhoea Best results when probiotics taken prior to onset of diarrhoea Stay tuned: the PLACIDE study (BMC Inf Diseases 2012)

10. Could your #2 be super too??

11. Studies in adults: inflammatory bowel disease Probiotics: what a good idea! Many trials Many confounders UC: yes Crohn’s: no Jonkers et al. Drugs 2012 Meijer et al. Journal of Clinical Gastroenterology 2011 Austin Dieticians? Austin Gastroenterology Registrars?

12. Studies in adults: reduction in infection Studies in athletes Reduction in man-flu Reduction in man-flu West et al. Journal of Nutrition 2011 Better maintenance of saliva IgA levels Better maintenance of saliva IgA levels Gleeson et al. Intern Journal of Sport Nutrition and Exercise Metabolism 2011 Study in healthy volunteers Decreased URTI frequency + severity Decreased URTI frequency + severity Pregliasco et al. Journal 2008 Study in ICU patients Variable results – yes, no, maybe Variable results – yes, no, maybe

13. 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…”