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Having *very Minor* Withdrawal Symptoms


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#1 MrsGriffin

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Posted 31 July 2017 - 03:59 PM

I really just wanted to share what's been working for me.  I have been working with a ND who has successfully weaned many people off of duloxetine.  I've been taking 60 mg of Cymbalta for 10 years and I know how bad I've felt after occasionally missing ONE dose so, honestly, I was skeptical, but I am currently in week 5 of 7 of my doctor's weaning plan and it's going very well.

 

Before starting the withdrawal process, we spent about a year getting my gut healthy, since the majority of a person's serotonin is produced in their gastrointestinal tract.  For me, this involved removing foods that were causing inflammation in my body, and taking probiotics, L-Glutamine, fish oil and Vitamin D.

 

One of the reasons I wanted to get off of Cymbalta was that it was no longer effective for my depression.   To address that issue, my ND started me on a combination of supplements in a capsule created especially for their office.  It contains L-Theanine, DL-Phenylalanine, L-Tyrosine, 5HTP, and Tryptophan.  In addition, this blend includes Vitamin C, Vitamin B6, Folate, Calcium and Zinc.   They have found this combination to work really well for people and it certainly seems to be working for me!   My mood is 100% improved and I am finally feeling good for the first time in a LONG time.

 

Per my ND's advice, I am also taking fish oil, magnesium, and other supplements to help with anxiety and high cholesterol.  

 

So, with these supplements under my belt, I began the 7 week plan to taper my Cymbalta.  For me this meant skipping one dose the first week, 2 doses the second week, 3 doses the third week (spread evenly apart), etc.  She told me to go as slow as I needed but this schedule is quite tolerable and I am having minimal withdrawal symptoms.

 

Today I am starting week 5 of 7.  I am experiencing a little bit of dizziness, mostly when I move my head quickly or cut my eyes sharply to the side.  I know what a "brain zap" feels like but I have not had major problems with them at all during this process.  Instead I hear occasional sounds that resemble an individual beat -or three- of a snare drum.  They are not painful nor disabling.  I can get around and drive and sleep.   I do not think this this would be the case if I were not taking the supplements mentioned previously.

 

I hope this has been helpful.  Apparently getting off of Cymbalta doesn't have to be awful!

 

I'll check back in a bit and will update my experience.

 

Be well. 


#2 fishinghat

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Posted 31 July 2017 - 04:41 PM

Welcome Mrs Griffin
 
I really enjoyed your post and most of those supplements you can find referenced on our website. I must admit that I am very surprised you aren't hospitalized as many of those supplements are incompatible with Cymbalta such as L-Theanine, L-Tyrosine, 5HTP, and Tryptophan. Matter of fact those 4 (L-Theanine, L-Tyrosine, 5HTP, and Tryptophan) are incompatible with each other.Many people have been sent to the hospital with severe cases of serotonin syndrome while taking any just one of these supplements while on Cymbalta and other ssri/snri.. Extremely dangerous. You will find references to this on some of the personal posts here.
 
I am glad it worked for you and happy you are nearly off the Cymbalta. By the way most of the Cymbalta withdrawal symptoms start after you drop below 10 mg on your Cymbalta dose. Good luck and keep us posted as to how you progress. We will be most interested.

 

Again, welcome.


#3 gail

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    Needed understanding and support, and a place where I was not alone. To read others stories and realizing that I was not the only one going through all that crap.
    In hope that one day, I can return the favors in some kind of way.

Posted 31 July 2017 - 05:06 PM

Hello Mrs Griffin,

Interesting to read. Two more weeks to go and it's over.

We have never heard about this method and would appreciate any updates on this.

I figure that your supplements are real low as you have not had any adverse effect, plus you feel fine.

Looking forward to reading you in the times to come. Bonne route!

#4 bronxbomber

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Posted 08 August 2017 - 10:21 PM

Mrs. G,

That's great to hear; thanks for sharing.

I hope and pray that your remaining 2 weeks, and the time PC (post-Cymbalta) is equally uneventful.

Has your doctor used this method on others? If so, perhaps she should publish it. You are fortunate to have found her.

Please continue to post, and best of luck.

#5 MrsGriffin

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Posted 16 August 2017 - 12:35 PM

Update: I have been off of Cymbalta for 1 week now and my withdrawal symptoms are almost unnoticable.  Every day continues to be better than the one before and, at it's worst, it wasn't very bad.  I had not heard about his method of weaning off Cymbalta and just wanted to let others know that it worked for me.   


#6 fishinghat

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Posted 16 August 2017 - 01:20 PM

That is fantastic!! I am so glad you came back and shared that with us. If you are a week off the C then you should be out of the woods. I am so glad you didn't have any problems with that 'cocktail'. Now if only the dr would share the amounts of each item in his cocktail.  lol  Oh, well, wishful thinking.

 

God bless and come back anytime.


#7 gail

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Posted 17 August 2017 - 06:42 AM

Good morning Mrs Griffin,

Indeed, such good news here! We thank you for coming back with an update.

Do you mind if members pm you for the details of such a quick recovery?
Since we never recommend skipping days, this could be a new dimension for us.

Again, thank you!

#8 MrsGriffin

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Posted 17 August 2017 - 08:08 AM

Hi Gail, no I don't mind Private Messages.  My 7-week tapering schedule looked like this:

 

Week 1: I skipped my 60 mg Cymbalta dose on Sunday only

Week 2: skipped my dose on Sunday and Thursday

Week 3:  skipped Sun, Wed, Fri

Week 4: skipped Sun, Tue, Thur, Sat

Week 5: skipped Sun, Tue, Wed, Thur, Sat

Week 6: skipped Sun, Mon, Wed, Thur, Fri, Sat

Week 7: I stopped taking Cymbalta

 

This tapering schedule is not magical.  My doctor offered me this option as well as the Reducing-The-Daily-Dose route and I picked this.  I think the success can be credited to having a good doctor, following her recommendations, and being physically prepared beforehand.

 

As mentioned in my original post, I spent almost a year getting my GI tract healthy before attempting to go off of Cymbalta.  The majority of serotonin is produced in your gut and it needs to be working well!  In addition, 6 weeks before I started my taper, my naturopath increased my dose of L-Theanine, DL-Phenylalanine, L-Tyrosine, 5HTP, and Tryptophan.  I believe this combination of helping my own body produce serotonin along with taking these supplements drastically reduced my withdrawal symptoms.   No, I don't know the exact amounts of each supplement which is one of the reasons why I recommend being under a doctor's care for this.  I found a Naturopath who has a degree in Biology and years of practicing Integrative Medicine at a well-known hospital.  She knows her stuff and has had experience successfully helping people get off of duloxetine as well as addressing the underlying physiological issues.  

 

Good morning Mrs Griffin,

Indeed, such good news here! We thank you for coming back with an update.

Do you mind if members pm you for the details of such a quick recovery?
Since we never recommend skipping days, this could be a new dimension for us.

Again, thank you!


#9 gail

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    Needed understanding and support, and a place where I was not alone. To read others stories and realizing that I was not the only one going through all that crap.
    In hope that one day, I can return the favors in some kind of way.

Posted 17 August 2017 - 10:03 AM

Thank you so much,

One question, you say that you took care of your gut before all this.

Curious here, how did you manage to do this? Probiotics? Eliminating something from your diet?
It's not just curiosity, I really want to know. I'm sure others do! Was it drastic?

Again, thank you! You are a blessed woman to have fallen in such good hands with so much knowledge. Right Fishingbrain? thanks!

#10 fishinghat

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Posted 17 August 2017 - 10:08 AM

Right Gail. I assumed, probably in error lol, that she was referring to the pretreatment with the cocktail in order to elevate the serotonin levels in her gut prior to withdrawal. If I am wrong please correct me. This is how we can all learn.


#11 gail

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Posted 17 August 2017 - 04:15 PM

I am eager to know the answer concerning the gut. The cocktail began just before tapering.

Spending one year cleaning the gut! How do we do this? Besides probiotics?

Fishinghat, we will wait for the answer, but I may think that someone read wrong. It's you or me!

Off to bed with Sid shortly. Goodnight!

#12 MrsGriffin

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Posted 17 August 2017 - 08:43 PM

Gail and Fishinghat, to clarify, it was a combo of getting my gut healthy, which took about a year, and the recent "cocktail" of supplements that increased the serotonin in my body.  I believe both of these were instrumental in helping me successfully get off of Cymbalta.  

 

In order to help heal my GI tract over the last year, I took a quality probiotic and L-Glutamine .  I also eliminated certain foods from my diet then reintroduced them slowly back in, looking for signs and symptoms of food intolerances, which took about 6 months.  All of this was while under care and direction of my naturopath.  

 

In addition to my serotonin being low, lab work revealed that my Vitamin D levels were low so I have been taking a Vit D3 supplement as well as fish oil during the last year.

 

I would recommend that people learn more about the link between our brains and our GI tracts.  It's a fascinating subject.  A couple of books that will give you more information are The Mind-Gut Connection by Dr. Emeran Mayer and Eat Dirt by Dr. Josh Axe.   

 

I hope that helped!  :)


#13 gail

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Posted 18 August 2017 - 06:30 AM

Mrs Griffin,

Thank you so much for clarifying. It helps a lot. I hope to see you again! Xx

#14 fishinghat

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Posted 18 August 2017 - 08:31 AM

Very logical MG

 

I spent a lot of time studying what was originally called the gut-skin-brain connection developed by a dermatologist nearly 70 years ago. Of course much more has been learned over the years since. I don't know why they have dropped the 'skin' part of the connection as most dermatologists still refer to it that way. I had some issues many years back that were bothering me and simply getting on a good probiotic took care of it within 2 months. This connection has been linked to not only the obvious areas mentioned but also gout, asthma, and much more. I posted some information on this a couple years ago but with you bringing this up I think it may be time to repost. Thanks for mentioning this.  You are right, a truly fascinating subject.


#15 fishinghat

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Posted 18 August 2017 - 08:38 AM

Wiki

Introduction

"Commonly claimed benefits of probiotics include the decrease of potentially pathogenic gastrointestinal microorganisms, the reduction of gastrointestinal discomfort, the strengthening of the immune system, the improvement of the skin's function, the improvement of bowel regularity, the strengthening of the resistance to cedar pollen allergens, the decrease in body pathogens, the reduction of flatulence and bloating, the protection of DNA, the protection of proteins and lipids from oxidative stress damage, and the maintaining of individual intestinal microbiota in subjects receiving antibiotic treatment."

"Research

Probiotics are under considerable research, as the concept holds promise for human health and well-being, and corresponding commercial opportunities. Protection of consumers requires health claims to be confirmed with sufficient scientific evidence. Overall scientific demonstration of probiotic effects requires defining a healthy microbiota and interactions between microbiota and host, and the difficulty to characterize probiotic effectiveness in health and disease. Recent developments of high-throughput sequencing technology and the consequent progresses of metagenomics represent a new approach for the future of probiotics research.

Studies are examining whether probiotics affect mechanisms of intestinal inflammation, diarrhea,or urogenital infections. Through 2012, however, in all cases proposed as health claims to the European Food Safety Authority, the scientific evidence remains insufficient to prove a cause and effect relationship between consumption of probiotic products and any health benefit.
Research into the potential health effects of supplemental probiotics has included the molecular biology and genomics of Lactobaccillus in immune function, cancer, and antibiotic-associated diarrhea, travellers' diarrhea, pediatric diarrhea, inflammatory bowel disease, and irritable bowel syndrome. Testing of a probiotic applies to a specific strain under study. The scientific community cautions against extrapolating an effect from a tested strain to an untested strain.

Although research does suggests that the relationship between gut flora and humans is a mutualistic relationship, very little evidence supports claims that probiotic dietary supplements have any health benefits. Improved health through gut flora modulation appears to be directly related to long-term dietary changes.

In a 2009 blog post, one expert reasoned that preliminary clinical results exist for some applications, such as treating diarrhea, but wider health benefits claimed by probiotic proponents lack plausibility since the body's "ecosystem" is sufficiently complex that adding a few bacteria is unlikely to have the claimed effect. Accordingly, he reasoned, "the alleged health benefits of probiotics are often an example of spin". Since then, there has been an increase in the body of scientific evidence supporting the use of specific probiotics to improve health. Although the body's complex microbial community is incompletely understood at present, there is strong scientific consensus on the benefits of using of probiotics to address certain medical states or conditions.

Claims that some lactobacilli may contribute to weight gain in some humans remain controversial.

Allergies

Probiotics are ineffective in preventing allergies in children, with the possible exception of eczema.

Diarrhea

Some probiotics are suggested as a possible treatment for various forms of gastroenteritis, and a Cochrane Collaboration meta-analysis on the use of probiotics to treat acute infectious diarrhea based on a comprehensive review of medical literature through 2010 (35 relevant studies, >4500 participants) reported that use of any of the various tested probiotic formulations appeared to reduce the duration of diarrhea by a mean of 25 hours, also noting, however, that "the differences between the studies may be related to other unmeasured and unexplored environmental and host factors" and that further research was needed to confirm reported benefits.

Antibiotic-associated diarrhea

Some of the best evidence in support of probiotic health benefits is in the treatment of antibiotic-associated diarrhea (AAD). Antibiotics are a common treatment for children, and 20% of antibiotic-treated children develop diarrhea. AAD results from an imbalance in the colonic microbiota caused by antibiotic therapy. Microbiota alteration changes in carbohydrate metabolism, with decreased short-chain fatty acid absorption and osmotic diarrhea as a result. The preventive role of some probiotics has been correctly assessed in randomized, controlled clinical trials. A review assessing the work of 16 different studies representing the evaluation of more than 3,400 patients concluded that the evidence gathered suggested a protective effect of some probiotics in this condition. In adults, some probiotics showed a beneficial role in reducing the occurrence of AAD. Another consequence of antibiotic therapy leading to diarrhea is the overgrowth of potentially pathogenic organisms such as Clostridium difficile.

Probiotic treatment might reduce the incidence and severity of AAD as indicated in several meta-analyses, For example, treatment with probiotic formulations including L. rhamnosus may reduce the risk of AAD, improve stool consistency during antibiotic therapy, and enhance the immune response after vaccination. However, further documentation of these findings through trials is required to confirm specific effects and obtain regulatory approval, which currently does not exist.

The potential efficacy of probiotic AAD prevention is dependent on the probiotic strain(s) used and on the dosage. A Cochrane Collaboration systematic review, in which 16 randomized clinical trials were analyzed, concluded that treatments with less than 5000 million CFUs/day did not show a significant decrease of AAD. However, patients treated with ≥5000 million CFUs/day (including L. rhamnosus and Saccharomyces boulardii) had 60% lower relative risk (95%CI: 44–71%) of experiencing AAD than untreated patients.

Lactose intolerance

Ingestion of certain active strains may help lactose-intolerant individuals tolerate more lactose than they would otherwise have tolerated.

Cholesterol

Preliminary human and animal studies have demonstrated the efficacy of some strains of lactic acid bacteria (LAB) for reducing serum cholesterol levels, presumably by breaking down bile in the gut, thus inhibiting its reabsorption (where it enters the blood as cholesterol).

A meta-analysis that included five double-blind trials examining the short-term (2–8 weeks) effects of a yogurt with probiotic strains on serum cholesterol levels found a minor change of 8.5 mg/dL (0.22 mmol/L) (4% decrease) in total cholesterol concentration, and a decrease of 7.7 mg/dL (0.2 mmol/L) (5% decrease) in serum LDL concentration.

A slightly longer study evaluating the effect of a yogurt with probiotic strains on 29 subjects over six months found no statistically significant differences in total serum cholesterol or LDL values. However, the study did note a significant increase in serum HDL from, 50 to 62 mg/dL (1.28 to 1.6 mmol/L) following treatment. This corresponds to a possible improvement of LDL/HDL ratio.
Studies specifically on hyperlipidemic subjects are still needed.

Blood pressure

The consumption of probiotics may effect a modest benefit in helping to control high blood pressure.
Immune function and infections

Some strains of LAB may affect pathogens by means of competative inhibition (i.e., by competing for growth) and some evidence suggests they may improve immune function by increasing the number of IgA-producing plasma cells and increasing or improving phagocytosis, as well as increasing the proportion of T lymphocytes and natural killer cells. Clinical trials have demonstrated that probiotics may decrease the incidence of respiratory-tract infections and dental caries in children. LAB products might aid in the treatment of acute diarrhea, and possibly affect rotavirus infections in children and travelers' diarrhea in adults, but no products are approved for such indications.

Helicobacter pylori

Some strains of LAB may affect Helicobacter pylori infections (which may cause peptic ulcers) in adults when used in combination with standard medical treatments, but no standard in medical practice or regulatory approval exists for such treatment.

Inflammation

Some strains of LAB may modulate inflammatory and hypersensitivity responses, an observation thought to be at least in part due to the regulation of cytokine function. Clinical studies suggest they can prevent reoccurrences of inflammatory bowel disease in adults, as well as improve milk allergies. How probiotics may influence the immune system remains unclear, but a potential mechanism under research concerns the response of T lymphocyts to proinflammatory stimuli.

Irritable bowel syndrome and colitis

Probiotics may help people with irritable bowel syndrome, although uncertainty remains around which type of probiotic works best, and around the size of the effect.
No good evidence indicates taking probiotics helps maintain remission from ulcerative colitis.

Necrotizing enterocolitis

Several clinical studies provide evidence for the potential of probiotics to lower the risk of necrotizing enterocolitis (NEC) and mortality in premature infants. One meta-analysis indicated that probiotics reduce all-cause mortality and risk of having NEC by more than 50% compared with controls.

Vitamin production

Probiotic treatment has been studied as a means of addressing maladies associated with vitamin deficiency, e.g., of Vit K, folic acid, and Vit B 12.

Eczema

Probiotics are commonly given to breast-feeding mothers and their young children to prevent eczema, but some doubt exists over the strength of evidence supporting this practice.

Bacterial Vaginosis

Probiotic treatment of bacterial vaginosis is the application or ingestion of bacterial species found in the healthy vagina to cure the infection of bacteria causing bacterial vaginosis. This treatment is based on the observation that 70% of healthy females have a group of bacteria in the genus Lactobacillus that dominate the population of organisms in the vagina. Currently, the success of such treatment has been mixed since the use of probiotics to restore healthy populations of Lactobacillus has not been standardized. Often, standard antibiotic treatment is used at the same time that probiotics are being tested. In addition, some groups of women respond to treatment based upon ethnicity, age, number of sexual partners, pregnancy, and the pathogens causing bacterial vaginosis. In 2013, researchers found that administration of hydrogen peroxide producing strains, such as L. acidophilus and L. rhamnosus, were able to normalize vaginal pH and rebalance vaginal flora, preventing and alleviating bacterial vaginosis.

Side effects

In some situations, such as where the person consuming probiotics is critically ill, probiotics could be harmful. In a therapeutic clinical trial conducted by the Dutch Pancreatitis Study Group, the consumption of a mixture of six probiotic bacteria increased the death rate of patients with predicted severe acute pancreatitis.

In a clinical trial aimed at showing the effectiveness of probiotics in reducing childhood allergies, researchers gave 178 children either a probiotic or a placebo for the first six months of their lives. Those given the probiotic were more likely to develop a sensitivity to allergens.

Some hospitals have reported treating Lactobacillus septicemia, which is a potentially fatal disease caused by the consumption of probiotics by people with lowered immune systems or who are already very ill.

Probiotics taken orally can be destroyed by the acidic conditions of the stomach. A number of microencapsulation techniques are being developed to address this problem.

One 2009 paper cited a 2007 study in chickens as a support for causally linked probiotic products such as yogurts with obesity trends. However, this is contested as the link to obesity, and other health-related issues with yogurt may link to its dairy and calorie attributes.

Some experts are skeptical on the efficacy of many strains and believe not all subjects will benefit from the use of probiotics.


#16 fishinghat

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Posted 18 August 2017 - 08:49 AM

Research

Gastric Issues

Inflammatory Bowel Disease
https://www.ncbi.nlm...pubmed/25940150
https://www.ncbi.nlm.../?term=17242485
https://www.ncbi.nlm.../?term=14557292
Probiotics can prevent reoccurrences of Inflammatory Bowel Disease in adults,
https://www.ncbi.nlm...pubmed/24280877
Administration of probiotics results in additional benefit in inducing remission of patients with inflammatory bowel diseases like ulcerative colitis, Crohn's disease, and pouchitis.
https://www.ncbi.nlm...pubmed/25206258
There is very strong evidence supporting the use of multispecies probiotic VSL#3 for the prevention or recurrence of postoperative pouchitis in patients. For treatment of active ulcerative colitis, as well as for maintenance therapy, the clinical evidence of efficacy is strongest for VSL#3 and Escherichia coli Nissle 1917. Moreover, some prebiotics, such as germinated barley foodstuff, Psyllium or oligofructose-enriched inulin, might provide some benefit in patients with active ulcerative colitis or ulcerative colitis in remission. The results of clinical trials in the treatment of active Crohn's disease or the maintenance of its remission with probiotics and prebiotics are disappointing and do not support their use in this disease. The only exception is weak evidence of advantageous use of Saccharomyces boulardii concomitantly with medical therapy in maintenance treatment.
https://www.ncbi.nlm...pubmed/23286925
Clearly, some probiotics have considerable potential in the management of IBS and IBD; however, the benefits are strain specific

Diarrhea
https://www.ncbi.nlm.../?term=17053425

Constipation
https://www.ncbi.nlm...pubmed/25099542
Probiotics may improve whole gut transit time, stool frequency, and stool consistency, with subgroup analysis indicating beneficial effects of B. lactis in particular.

Irritable Bowel Syndrome
Ljungh A, Wadstrom T, ed. (2009). Lactobacillus Molecular Biology: From Genomics to Probiotics. Caister Academic Press. ISBN 978-1904455417.
https://www.ncbi.nlm...pubmed/19091823
Probiotics may help people with irritable bowel syndrome.
https://www.ncbi.nlm...pubmed/25070051
Probiotics are effective treatments for IBS.
https://www.ncbi.nlm...pubmed/23829297
The proportion of patients whose IBS symptoms were substantially relieved at week 4 was significantly higher in the probiotics group than in the placebo group: 68.0% (17/25) versus 37.5% (9/24) (P < 0.05). Secondary end-points such as improvement in abdominal pain/discomfort and bloating occurred in the probiotics group but not in the placebo group.

Gasteroenteritis
https://www.ncbi.nlm.../?term=14627948
https://www.ncbi.nlm...pubmed/25333367
https://www.ncbi.nlm...pubmed/23632352
Seven-day BIO-THREE administration demonstrated high efficacy and safety in infants and children with severe gastroenteritis. The incidence of severe gastroenteritis was significantly reduced in the rotavirus origin and BIO-THREE intervention groups.
https://www.ncbi.nlm...pubmed/14557292
Latic acid bacteria products might aid in the treatment of acute diarrhea, and possibly affect rotavirus infections in children and travelers' diarrhea in adults,
https://www.ncbi.nlm...pubmed/12369194
https://www.ncbi.nlm...pubmed/25934376
Campylobacter jejuni is one of the most common bacterial causes of human gastroenterocolitis worldwide, leading to diarrhea and other serious post-infectious complications. This review has collated the studies conducted using probiotics to inhibit C. jejuni colonization and growth to date to provide a collective knowledge about the role of probiotics as an alternative intervention strategy for campylobacteriosis.

Acute Infectious Diarrhea - See "Infections"

Antibiotic-Associated diarrhea (AAD)
https://www.scienceb....org/probioticsCrisp, Mark
A review assessing the work of 16 different studies representing the evaluation of more than 3,400 patients concluded that the evidence gathered suggested a protective effect of some probiotics in this condition.
https://www.ncbi.nlm...pubmed/26155632
https://www.ncbi.nlm...pubmed/22071814
https://www.ncbi.nlm...?term=Szajewska
In adults, some probiotics showed a beneficial role in reducing the occurrence of AAD.
https://www.ncbi.nlm.../?term=16635227
Probiotic treatment might reduce the incidence and severity of AAD as indicated in several reviews.
https://www.ncbi.nlm...pubmed/18542041
https://www.ncbi.nlm.../?term=12052801
https://www.ncbi.nlm...pubmed/12182746
The results suggest a strong benefit of probiotic administration on antibiotic-associated diarrhoea
https://www.ncbi.nlm...pubmed/16635227
https://www.ncbi.nlm...pubmed/23728658
Three types of probiotics (Saccharomyces boulardii, Lactobacillus rhamnosus GG, and probiotic mixtures) significantly reduced the development of antibiotic-associated diarrhea. Only S. boulardii was effective for Clostridium difficile disease (CDD).
https://www.ncbi.nlm...pubmed/16939749
Probiotics reduce the risk of AAD in children. For every 7 patients that would develop diarrhea while being treated with antibiotics, one fewer will develop AAD if also receiving probiotics.
https://www.ncbi.nlm...pubmed/16728323
The potential efficacy of probiotic AAD prevention is dependent on the probiotic strain(s) used and on the dosage.

Surawicz CM (July 2008). "Role of probiotics in antibiotic-associated diarrhea, Clostridium difficile-associated diarrhea, and recurrent Clostridium difficile-associated diarrhea". J Clin Gastroenterol 42 (Suppl 2): S64–70.
A Cochrane Collaboration systematic review, in which 16 randomized clinical trials (n=3432 participants) were analyzed, concluded that treatments with less than 5000 million CFUs/day did not show a significant decrease of AAD. However, patients treated with ≥5000 million CFUs/day (including L. rhamnosus and Saccharomyces boulardii) had 60% lower relative risk of experiencing AAD than untreated patients.
Johnston BC, Goldenberg JZ, Vandvik PO, Sun X, Guyatt GH; Goldenberg; Vandvik; Sun; Guyatt (2011). "Probiotics for the prevention of pediatric antibiotic-associated diarrhea". Cochrane Database Syst Rev (11): CD004827.

Peptic Ulcers
https://www.ncbi.nlm...pubmed/14522098
Some strains of LAB may affect helicobacter pylori infections (which may cause peptic ulcers) in adults when used in combination with standard medical treatments.
https://www.ncbi.nlm...pubmed/26051728
Probiotics combined with triple therapy for treating PU infected by H. Pylory can greatly improve the eradication rate of H. Pylory and increase recovery rate of patients, with less adverse reaction. Therefore, the method is worth for promotion.

Colitis
https://www.ncbi.nlm...pubmed/22161412
No good evidence was found to indicate taking probiotics helps maintain remission from ulcerative colitis.
https://www.ncbi.nlm...pubmed/26019464
Probiotics may be effective for maintaining clinical remission in patients with quiescent UC, especially those who belong to cluster I on fecal bacterial analysis

Necrotizing Enterocolitis
Several clinical studies provide evidence for the potential of probiotics to lower the risk of necrotizing enterocolitis (NEC) and mortality in premature infants. One review indicated that probiotics reduce all-cause mortality and risk of having NEC by more than 50% compared with controls.
AlFaleh K. & Anabrees J., 2014, "Probiotics for prevention of necrotizing enterocolitis in preterm infants." Cochrane Database of Systematic Reviews Issue 4, Art. No.: CD005496, DOI 10.1002/14651858.CD005496.pub4, accessed 11 June 2015.
https://www.ncbi.nlm...les/PMC2856678/

https://www.ncbi.nlm...pubmed/25236308
Enteral supplementation of probiotics prevents severe NEC and all-cause mortality in preterm infants. Our updated review of available evidence strongly supports a change in practice.

Colonoscopy
https://www.ncbi.nlm...pubmed/26183594
Our study has shown a significant reduction in the duration of pain days post colonoscopy in patients taking probiotic compared with placebo. No significant effect was seen in terms of return to normal bowel function or bloating post colonoscopy.

Diabetes Mellitus
https://www.ncbi.nlm...pubmed/25963407
This systematic review generally demonstrated beneficial effects of the probiotic administration, especially Lactobacillus sub-strains, on the management of diabetes-related blood parameters, although, more evidence, especially from human trials, is needed to confirm these effects and also to conduct a meta-analysis

Liver Function

Hepatic Encephalopathy
https://www.ncbi.nlm...pubmed/25956487
https://www.ncbi.nlm...pubmed/24246768
In a prospective, randomized controlled trial, probiotics were found to be effective in preventing HE in patients with cirrhosis.

https://www.ncbi.nlm...pubmed/25038208
Intention-to-treat analysis showed the number of patients who improved after giving treatment were 67.7% (21/31), 70.9% (22/31), 50% (16/32), and 30% (9/30) for LOLA, rifaximin, probiotics, and placebo, respectively.

Pancreas
https://www.ncbi.nlm...les/PMC4056604/
Probiotics showed neither beneficial nor adverse effects on the clinical outcomes of patients with predicted SAP

Immune Function and Infections

Immune Response
https://www.ncbi.nlm...pubmed/26143437
This study suggests that these two Lactobacillus strains have beneficial effects on regulation of immune responses, which has promising implications for the development of ecological agents and functional foods.

Urogenital Infections
https://www.ncbi.nlm.../?term=18685506
A 2 strain combination of Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14 have proved to be the most effective at restoring and maintaining a normal vaginal microbiota

Acute Infectious Diarrhea
Allen SJ, Martinez EG, Gregorio GV, Dans LF; Martinez; Gregorio; Dans (2010). Allen, Stephen J, ed. "Probiotics for treating acute infectious diarrhea". Cochrane Database Syst Rev 11 (11): CD003048. doi:10.1002/14651858.CD003048.pub3. PMID 21069673. 
LAB products might aid in the treatment of acute diarrhea, and possibly affect rotavirus infections in children and travelers' diarrhea in adults,
Reid G, Jass J, Sebulsky MT, McCormick JK; Jass; Sebulsky; McCormick (October 2003). Clin. Microbiol. Rev. 16 (4): 658–72. doi:10.1128/CMR.16.4.658-672.2003. PMC 207122. PMID 14557292. 
Ouwehand AC, Salminen S, Isolauri E; Salminen; Isolauri (August 2002). (PDF). Antonie Van Leeuwenhoek 82 (1–4): 279–89. doi:10.1023/A:1020620607611. PMID 12369194. Retrieved 2012-05-14.
"http://www.nhs.uk/ne...ach-upset.aspx"NHS Choices. 2010. Retrieved 28 October 2013
Some strains of LAB may affect pathogens by means of competitive inhibition (i.e., by competing for growth) and some evidence suggests they may improve immune function.
Reid G, Jass J, Sebulsky MT, McCormick JK; Jass; Sebulsky; McCormick (October 2003). Clin. Microbiol. Rev. 16 (4): 658–72. doi:10.1128/CMR.16.4.658-672.2003. PMC 207122. PMID 14557292. 
Ouwehand AC, Salminen S, Isolauri E; Salminen; Isolauri (August 2002). (PDF). Antonie Van Leeuwenhoek 82 (1–4): 279–89. doi:10.1023/A:1020620607611. PMID 12369194. Retrieved 2012-05-14.
Clinical trials have demonstrated that probiotics may decrease the incidence of respiratory-tract infections.
Hatakka K, Savilahti E, Pönkä A, Meurman JH, Poussa T, Näse L, Saxelin M, Korpela R; Savilahti; Pönkä; Meurman; Poussa; Näse; Saxelin; Korpela (June 2001). BMJ 322 (7298): 1327. doi:10.1136/bmj.322.7298.1327. PMC 32161. PMID 11387176

Common Cold
https://www.ncbi.nlm...pubmed/24793963
Probiotics decreased the presence of picornaviruses after 3 months, which may imply that probiotics play a role against viruses causing common cold.

Helicobacter pylori
https://www.ncbi.nlm...pubmed/25935190
https://www.ncbi.nlm...pubmed/25997615
https://www.ncbi.nlm...pubmed/14522098
Some strains of lactic acid bacteria may affect Helicobacter pylori infections (which may cause peptic ulcers) in adults when used in combination with standard medical treatments.
https://www.ncbi.nlm...pubmed/25929897
https://www.ncbi.nlm...pubmed/23757373
Long-term intakes of products containing probiotic strains may have a favorable effect on H. pylori infection in humans, particularly by reducing the risk of developing disorders associated with high degrees of gastric inflammation.

https://www.ncbi.nlm...pubmed/24323343
Probiotics supplementation in triple therapy for H. pylori infection may have beneficial effects on eradication and therapy-related side effects, particularly diarrhea, in children.
https://www.ncbi.nlm...pubmed/25997615
Because increased density of H. pylori on the gastric mucosa is linked to more severe gastritis and increased incidence of peptic ulcers, we can infer that a reduction of the density might help to decrease the risk of developing pathologies, probably the progression toward atrophic gastritis and gastric adenocarcinoma. These effects together with improving the H. pylori eradication rates and amelioration of treatment related side effects might open the door for probiotics to be added to H. pylori eradication regimens.

Clostridium difficile Infection
https://www.ncbi.nlm...pubmed/25922397
There is moderate evidence on the effectiveness of probiotics to prevent primary CDI, but there are few data to support use in secondary prevention of recurrent CDI. This review discusses the literature available on the use of probiotics to prevent primary and secondary CDI.

Bacterial Vaginosis
Probiotic treatment of bacterial vaginosis is the application or ingestion of bacterial species found in the healthy vagina to cure the infection of bacteria causing bacterial vaginosis. This treatment is based on the observation that 70% of healthy females have a group of bacteria in the genus Lactobacillus that dominate the population of organisms in the vagina.
Petrova, Mariya I.; Lievens, Elke; Malik, Shweta; Imholz, Nicole; Lebeer, Sarah (2015). "Lactobacillus species as biomarkers and agents that can promote various aspects of vaginal health". Frontiers in Physiology 6.
https://www.ncbi.nlm...pubmed/24318276
Compared with the control arm, the limited evidence suggests that probiotics show a beneficial effect in patients who are suffering from BV.
https://www.ncbi.nlm...pubmed/24170161
In 2013, researchers found that administration of hydrogen peroxide producing strains, such as L. acidophilus and L. rhamnosus, were able to normalize vaginal pH and rebalance vaginal flora, preventing and alleviating bacterial vaginosis.
https://www.ncbi.nlm...pubmed/26142892
Probiotic supplementation with vaginal Lactobacillus rhamnosus BMX54 seems to be useful in hindering bacteria growth especially after antibiotic therapy; therefore this intervention may be considered a new prophylactic treatment for preventing recurrence of BV, in particular in high-risk patients.

Steatohepatitis
https://www.ncbi.nlm...pubmed/23396737
Probiotics treatment may reduce liver fat and AST level in NASH patients

Respiratory Infections
https://www.ncbi.nlm...pubmed/25920295
Administration of probiotics containing Lactobacillus casei (Shirota strain) has a tendency to reduce the incidence of ventilator-associated pneumonia and colonization with resistant bacteria in oropharyngeal cavity without significant effects on mortality and length of hospital stay.
https://www.ncbi.nlm...pubmed/25344083
Evidence suggests that use of probiotics is associated with a reduction in the incidence of VAP. However, the quality of the evidence is low and the exclusion of the one study that did not provide a robust definition of VAP increased the uncertainty in this finding. The available evidence is not clear regarding a decrease in ICU or hospital mortality with probiotic use.
https://www.ncbi.nlm...pubmed/25927096
Probiotics were better than placebo in reducing the number of participants experiencing episodes of acute URTI, the mean duration of an episode of acute URTI, antibiotic use and cold-related school absence. This indicates that probiotics may be more beneficial than placebo for preventing acute URTIs.
https://www.ncbi.nlm...pubmed/25430686
At least one beneficial effect of prophylactic probiotic was observed in the majority of RCTs. Even a minimal reduction of 5 - 10% in the incidence of URTIs would have an important clinical and economic mpact on societies. Furthermore, the long-term administration of probiotics appeared to have a good safety profile in childhood and none of the studies reported any serious adverse events related to the probiotic strain.
https://www.ncbi.nlm...pubmed/24638909
Based on experimental studies, probiotics may exert antiviral effects directly in probiotic-virus interaction or via stimulation of the immune system. Probiotics seem to be beneficial in respiratory illnesses.
https://www.ncbi.nlm...pubmed/26054771
The present review identified 11 peer-reviewed, randomized clinical trials, which analyzed a total of 2417 children up to 10 incomplete years of age. In the analysis of the studies, reduction in new episodes of disease was a favorable outcome for the use of probiotics in the treatment of respiratory infections in children.

Oral Treatments

General
https://www.ncbi.nlm...pubmed/26123783
Results show that probiotic bacteria are effective against tooth caries, periodontal disease, oral mucosal lesions and oral malodour.
https://www.ncbi.nlm...pubmed/26053410
Lactobacillus crispatus YIT 12319, Lactobacillus fermentum YIT 12320, Lactobacillus gasseri YIT 12321, and Streptococcus mitis YIT 12322 were selected because they showed no cariogenic potential in an artificial mouth system and a lower risk of experimental infective endocarditis in a rat model. These candidates are expected as new probiotics with potential oral health benefits and no adverse effects on general health.

Dental Caries
https://www.ncbi.nlm...pubmed/24919536
L. acidophilus and L casei integrated into the biofilm model. These results suggest that L. rhamnosus may inhibit oral biofilm formation by decreasing glucan production of S. mutans and antibacterial activity and did not integrate into oral biofilm, which can be a candidate for caries prevention strategy.

Dental Caries in Children
https://www.ncbi.nlm...pubmed/25918670
https://www.ncbi.nlm...pubmed/11799281
The results showed less dental caries in the LGG group and lower mutans streptococcus counts at the end of the study. LGG was found to reduce the risk of caries significantly (OR = 0.56, p = 0.01; controlled for age and gender, OR = 0.51, p = 0.004). The effect was particularly clear in the 3- to 4-year-olds.
https://www.ncbi.nlm...pubmed/25793955
We found a significant reduction of RLU values in preschool children who ingested the tested probiotics in relation to the baseline values and 15 days after ceasing consumption.

Ligature-induced Periodontitis
https://www.ncbi.nlm...pubmed/25918871
Local use of the probiotic did not result in any adverse effects on periodontal tissues. When used as monotherapy or as an adjuvant, the probiotic was effective at controlling periodontitis in rats.

Oral Candida
https://www.ncbi.nlm...pubmed/23952962
The detection rate of Candida spp. decreased (P = 0.000) in both groups and was significantly lower in the probiotic group than the control group (P = 0.038). Other analysed micro-organisms, including the decreased detection rate for Lactobacillus spp. (P = 0.049) and the increased detection rate for Staphylococcus epidermidis (P = 0.019), did not display consistent change trends in the probiotics group. Compared with conventional antifungal therapies for oral candidiasis, the inclusion of locally administered probiotics helped improve certain clinical conditions and reduced the prevalence of Candida spp..

Allergic Rhinitis
https://www.ncbi.nlm...pubmed/25899251
Probiotics may be beneficial in improving symptoms and quality of life in patients with allergic rhinitis

Bone Density
https://www.ncbi.nlm...pubmed/24587733
Probiotics showed potential effects on bone metabolism through different mechanisms with outstanding results in the animal model. The results also showed that postmenopausal women who suffered from low bone mass density are potential targets to consume probiotics for increasing mineral bioavailability including calcium and consequently increasing bone mass density.

Allergies
https://www.ncbi.nlm...pubmed/26044853
Probiotics are ineffective in preventing allergies in children, with the possible exception of eczema.
In a clinical trial aimed at showing the effectiveness of probiotics in reducing childhood allergies, researchers gave 178 children either a probiotic or a placebo for the first six months of their lives. Those given the probiotic were more likely to develop a sensitivity to allergens.
Bee, Peta (November 10, 2008). " http://www.thetimes....icle1788597.eceThe Times (London).

Asthma
http://www.ncbi.nlm....pubmed/16248828
http://www.ncbi.nlm....les/PMC3662166/

Gout
https://www.ncbi.nlm...probiotics gout

Lactose Intolerance
https://www.ncbi.nlm...pubmed/10721912
Ingestion of certain active strains may help lactose-intolerant individuals tolerate more lactose than they would otherwise have tolerated.
Probiotics may help milk allergies.
Kirjavainen PV, Salminen SJ, Isolauri E; Salminen; Isolauri (February 2003). "Probiotic bacteria in the management of atopic disease: underscoring the importance of viability". J. Pediatr. Gastroenterol. Nutr. 36 (2): 223–7. doi:10.1097/00005176-

Mental Health
https://www.ncbi.nlm...pubmed/25879690
The consumption of probiotic yogurt or a multispecies probiotic capsule had beneficial effects on mental health parameters in petrochemical workers.

Myasthenia Gravis
https://www.ncbi.nlm...les/PMC3527378/

Cholesterol
https://www.ncbi.nlm...pubmed/10721912
https://www.ncbi.nlm...pubmed/25893960
https://www.ncbi.nlm...les/PMC3352670/
Preliminary human and animal studies have demonstrated the efficacy of some strains of lactic acid bacteria for reducing serum cholesterol levels.
https://www.ncbi.nlm...pubmed/11114681
A review that included five double-blind trials examining the short-term (2–8 weeks) effects of a yogurt with probiotic strains on serum cholesterol levels found a minor change of 8.5 mg/dL (4% decrease) in total cholesterol concentration, and a decrease of 7.7 mg/dL (5% decrease) in serum LDL concentration.
https://www.ncbi.nlm...pubmed/12209372
A slightly longer study evaluating the effect of a yogurt with probiotic strains on 29 subjects over six months found no statistically significant differences in total serum cholesterol or LDL values. However, the study did note a significant increase in serum HDL from, 50 to 62 mg/dL following treatment. This corresponds to a possible improvement of LDL/HDL ratio.

Hypertriglyceridemia
https://www.ncbi.nlm...pubmed/26117402
The consumption of two probiotic strains for 12 weeks reduced TGs and increased the apo A-V and LDL particle size in hypertriglyceridemic subjects
https://www.ncbi.nlm...pubmed/26044516
The triglyceride-lowering effects of probiotic supplementation, partly through elevated apoA-V, in borderline to moderate hypertriglyceridemic subjects showed reductions in plasma metabolites, fatty acid primary amides and lysoPCs

Circulatory System

Blood pressure

Hypertension
https://www.ncbi.nlm...pubmed/25047574
The present meta-analysis suggests that consuming probiotics may improve BP by a modest degree, with a potentially greater effect when baseline BP is elevated, multiple species of probiotics are consumed, the duration of intervention is ≥8 weeks, or daily consumption dose is ≥10(11) colony-forming units.

Inflammation
Some strains of lactic acid bacteria may modulate inflammatory and hypersensitivity responses, an observation thought to be at least in part due to the regulation of cytokine function.

Atherosclerosis
https://www.ncbi.nlm...pubmed/26175728
In humans, intestinal microflora could significantly influence the development of metabolic diseases including atherosclerosis. Commensal bacteria were shown to activate inflammatory pathways through altering lipid metabolism in adipocytes, macrophages, and vascular cells, inducing insulin resistance, and producing trimethylamine-N-oxide. However, gut microbiota could also play the atheroprotective role associated with anthocyanin metabolism and administration of probiotics and their components

Hyperglycemia
https://www.ncbi.nlm...pubmed/26161741
Probiotic consumption may improve glycemic control modestly. Modification of gut microbiota by probiotic supplementation may be a method for preventing and control hyperglycemia in clinical practice.

Liver Transplants
https://www.ncbi.nlm...pubmed/26044318
Based on the meta-analysis, giving patients a combination of probiotics and prebiotics before, or on the day of, liver transplantation reduces the rate of infection after surgery. These agents also reduced the amount of time spent in the hospital or intensive care unit and the duration of antibiotic use.

Vitamin Metabolism
Probiotic treatment has been studied as a means of addressing maladies associated with vitamin deficiency, e.g., of vitamin K, folic acid, and vitamin B12.
Cooke, G.; Behan, J.; Costello, M. (2006). "Newly identified vitamin K-producing bacteria isolated from the neonatal faecal flora". Microbial Ecology in Health and Disease 18 (3–4): 133. doi:10.1080/08910600601048894. 
Strozzi GP, Mogna L; Mogna (2008). "Quantification of Folic Acid in Human Feces After Administration of Bifidobacterium Probiotic Strains". Journal of Clinical Gastroenterology 42: S179–S184. doi:10.1097/MCG.0b013e31818087d8. PMID 18685499. 
Molina VC, Médici M, Taranto MP, Font de Valdez G; Médici; Taranto; Font De Valdez (2009). "Lactobacillus reuteriCRL 1098 prevents side effects produced by a nutritional vitamin B12 deficiency". Journal of Applied Microbiology 106 (2): 467–473. doi:10.1111/j.1365-2672.2008.04014.x.

Dermatological Conditions

Eczema
https://www.ncbi.nlm...pubmed/23799337
https://www.ncbi.nlm...pubmed/26044853
Probiotics are commonly given to breast-feeding mothers and their young children to prevent eczema, but some doubt exists over the strength of evidence supporting this practice.
https://www.ncbi.nlm...pubmed/26136864
Probiotic supplementation has a positive effect on the prevention and treatment of infantile eczema.

Acne Vulgaris
Strickler A, Kolmer JA, Schamberg JF: Complement fixation in acne vulgaris. J Cutaneous Dis 1916, 34:166-78. \l "
Seborrhea
"Zhang H, Yu L, Yi M, Li K: Quantitative studies on normal flora of seborrhoeic dermatitis. Chin J Dermatol 1999, 32:399-400. \l "
"Siver RH: Lactobacillus for the control of acne. J Med Soc New Jersey 1961, 59:52-53.

Atopic Dermatitist
https://www.ncbi.nlm...pubmed/24463205
Based on the available studies, supplementation with certain probiotics (Lactobacillus rhamnosus GG) appears to be an effective approach for the prevention and reduction in severity of atopic dermatitis. A mix of specific probiotic strains prevented atopic dermatitis among infants. Based on studies with prebiotics, there was a long-term reduction in the incidence of atopic dermatitis.

https://www.ncbi.nlm...pubmed/24954372
The overall result of this meta-analysis suggests that probiotics could be an option for the treatment of AD, especially for moderate to severe AD in children and adults. However, no evidence was found supporting the beneficial role of probiotics in infants.

Effects on Exercise

https://www.ncbi.nlm...pubmed/24150782
Four weeks of supplementation with a multi-strain probiotic increased running time to fatigue in the heat. Further studies are required to elucidate the exact mechanisms for this performance benefit.

Side effects

Dangerous to those who are very ill.
https://www.ncbi.nlm...pubmed/18279948
In some situations, such as where the person consuming probiotics is critically ill, probiotics could be harmful. In a therapeutic clinical trial the consumption of a mixture of six probiotic bacteria increased the death rate of patients with predicted severe acute pancreatitis.

Bee, Peta (November 10, 2008). " http://www.thetimes....icle1788597.eceThe Times (London). 
http://www.dailymail...ch--taking.html29 January 2008.
Some hospitals have reported treating Lactobacillus septicaemia, which is a potentially fatal disease caused by the consumption of probiotics by people with lowered immune systems or who are already very ill.

Weight Gain
https://www.ncbi.nlm...pubmed/21548178
One 2009 paper cited a 2007 study in chickens as a support for causally linked probiotic products such as yogurts with obesity trends.
https://www.ncbi.nlm.../?term=23332210
Certain strains of Lactobacillus appear to have a reproducible effect on weight as a weight-gain effect in lean humans and animals or a weight-loss effect in overweight/obese humans and animals.
https://www.ncbi.nlm.../?term=22634320
Review
https://www.ncbi.nlm...pubmed/26032481
Collectively, the RCTs examined in this meta-analysis indicated that probiotics have limited efficacy in terms of decreasing body weight and BMI and were not effective for weight loss.

Microencapsulation
https://www.ncbi.nlm...pubmed/21030820
Probiotics taken orally can be destroyed by the acidic conditions of the stomach. A number of microencapsulation techniques are being developed to address this problem.
https://www.ncbi.nlm...pubmed/26188314
Uncoated spheres gave partial acid protection, but enteric coated spheres effectively protected dried probiotic LBC from acid for 2h, and subsequently released all viable cells within 1h of transfer into simulated intestinal fluid.

Lactational Mastitis
https://www.ncbi.nlm...pubmed/24463206
The development of new strategies for mastitis management based on probiotics is particularly appealing. In fact, selected lactobacilli strains isolated from breast milk have already shown a high efficacy for treatment.

Shelf Life
https://www.ncbi.nlm...pubmed/24438190
Refrigerated storage provided a higher shelf-life stability with regards to CFU/g (as high as 84% on day 0 and 98% retention by the end of 30 d) compared to room temperature storage. Probiotic properties during shelf life are affected by the processing conditions and encapsulated food matrix

 





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