Why Do I Feel Worse After Taking Probiotics? The Die-Off Reaction Explained (And What to Do About It)

ByDailinn

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You did everything right. You bought a high-quality probiotic supplement, excited to finally heal your gut and feel better. You took your first dose with optimism… and within hours or days, you felt absolutely terrible. 😰

Bloating. Gas. Brain fog. Fatigue. Headaches. Maybe even flu-like symptoms. You’re feeling worse than before you started the probiotics, and you’re wondering: “Am I allergic to probiotics? Is something wrong with me? Should I throw these expensive supplements away?” 💊🗑️

Here’s the truth: feeling worse after taking probiotics doesn’t necessarily mean they’re wrong for you. In many cases, it means they’re actually working—triggering something called a “die-off reaction” or Herxheimer reaction. Understanding this phenomenon can be the difference between giving up on gut healing and successfully restoring your microbiome.

Let’s dive deep into why probiotics can make you feel worse before you feel better, and more importantly, what you can do about it. 🌱

What Is a Die-Off Reaction (Herxheimer Reaction)? 🔬

The die-off reaction, medically known as the Jarisch-Herxheimer reaction, was first identified over a century ago when doctors noticed that patients being treated for syphilis and other infections often felt dramatically worse immediately after starting treatment (Butler, 2017).

But what does a bacterial infection from the 1800s have to do with your probiotic supplement? Everything. ✨

The Science Behind Die-Off

When you introduce beneficial bacteria (probiotics) into your gut, they don’t just peacefully coexist with whatever’s already there. They actively compete with harmful bacteria, yeast, and other pathogens for space and resources. As probiotics begin to colonize your gut, they:

  1. Crowd out pathogenic organisms by competing for attachment sites on your intestinal wall
  2. Produce antimicrobial compounds that actively kill harmful bacteria and yeast
  3. Alter the gut environment (pH, oxygen levels) to favor beneficial species over pathogens
  4. Stimulate your immune system to more effectively eliminate unwanted microbes

As these harmful organisms die, they release toxins into your system—a lot of toxins. 💥

The Toxic Release

When bacteria and yeast die, their cell walls break apart and release their internal contents, including:

  • Lipopolysaccharides (LPS): Inflammatory compounds from bacterial cell walls that trigger immune responses
  • Endotoxins: Toxic substances found inside bacterial cells
  • Proteins and antigens: That your immune system must process
  • Mycotoxins: From dying yeast like Candida

Your body suddenly has to process and eliminate all these toxins at once, and your detoxification organs (liver, kidneys, lymphatic system) can become temporarily overwhelmed. This toxic overload is what causes the uncomfortable symptoms we call a die-off reaction (Vasquez et al., 2005). 😓

Think of it like this: if your gut was a messy house and you suddenly started cleaning, you’d stir up a lot of dust before things got better. That “dust” is the die-off reaction. 🏠✨

Common Die-Off Symptoms: What to Expect 📋

Die-off reactions can affect multiple body systems because the toxins released enter your bloodstream and circulate throughout your body. Here are the most common symptoms:

Digestive Symptoms 💨

  • Bloating and gas (often worse than before starting probiotics)
  • Abdominal cramping or discomfort
  • Diarrhea or loose stools
  • Constipation (less common but possible)
  • Nausea
  • Changes in bowel movement frequency or consistency

These digestive symptoms make sense—the battlefield is your gut! As we discussed in our comprehensive guide to digestive issues, many digestive symptoms are actually warning signs that something deeper is happening in your gut ecosystem.

Systemic Symptoms 🤒

  • Fatigue and low energy (sometimes extreme)
  • Brain fog and difficulty concentrating
  • Headaches or migraines
  • Flu-like symptoms (body aches, chills)
  • Low-grade fever
  • Joint and muscle pain
  • Increased anxiety or mood changes

Skin Symptoms 🌡️

  • Breakouts or acne flares
  • Rashes or hives
  • Itching
  • Eczema flare-ups

Other Symptoms

  • Sleep disturbances
  • Increased heart rate
  • Night sweats
  • Swollen lymph nodes

The intensity and combination of symptoms vary greatly between individuals and depend on several factors, including how dysbiotic (imbalanced) your gut was to begin with, which probiotic strains you’re taking, and your body’s detoxification capacity. 🎯

Die-Off vs. True Probiotic Intolerance: How to Tell the Difference 🤔

This is crucial: not every negative reaction to probiotics is a die-off reaction. Sometimes, you genuinely don’t tolerate certain probiotic strains, or there’s another issue at play.

Signs It’s Likely a Die-Off Reaction ✅

  • Symptoms started within 1-7 days of beginning probiotics
  • Symptoms are temporary and begin improving after a few days to two weeks
  • Symptoms fluctuate in intensity rather than being constant
  • You had significant gut dysbiosis, SIBO, or yeast overgrowth before starting probiotics
  • Symptoms include multiple body systems (gut + brain fog + fatigue, for example)
  • You feel better after slowing down or pausing the probiotic, then worse again when restarting

Signs It Might Be True Intolerance ⚠️

  • Severe symptoms that don’t improve after 2-3 weeks
  • Immediate allergic reactions (hives, swelling, difficulty breathing) – seek emergency care!
  • Symptoms that consistently worsen the longer you take probiotics
  • Histamine intolerance symptoms if taking high-histamine producing strains (flushing, headaches, rapid heart rate, anxiety)
  • Pre-existing histamine intolerance or MCAS (mast cell activation syndrome)
  • Small intestinal bacterial overgrowth (SIBO) that worsens with certain probiotic strains

If you have SIBO, some probiotics can actually make things worse by adding more bacteria to an already overgrown small intestine. This is different from a die-off reaction and requires a different treatment approach (Zhong et al., 2017). 🔍

The Histamine Connection 🧬

Some probiotic strains produce histamine, while others help break it down. If you have histamine intolerance, taking histamine-producing probiotics (like certain Lactobacillus strains) can cause symptoms that mimic die-off but are actually histamine overload:

High-Histamine Producing Strains to Avoid if Histamine Intolerant:

  • Lactobacillus casei
  • Lactobacillus reuteri
  • Lactobacillus bulgaricus

Low-Histamine/Histamine-Degrading Strains:

  • Bifidobacterium species (most)
  • Lactobacillus plantarum
  • Lactobacillus rhamnosus

If you suspect histamine intolerance, choose your probiotic strains carefully! 💡

Why Some People Experience Die-Off More Intensely 🎯

Not everyone experiences die-off reactions, and among those who do, severity varies dramatically. Several factors influence your likelihood and intensity of die-off:

1. Degree of Gut Dysbiosis

The more imbalanced your microbiome, the more dramatic the die-off. If you have:

  • Candida overgrowth
  • SIBO (small intestinal bacterial overgrowth)
  • History of multiple antibiotic courses
  • Chronic gut issues like IBS or IBD
  • Poor diet high in sugar and processed foods

…you’re more likely to experience significant die-off reactions because there are simply more harmful organisms to eliminate. 🦠

2. Detoxification Capacity

Your body’s ability to process and eliminate toxins depends on:

  • Liver function: Your primary detoxification organ
  • Kidney function: Eliminates water-soluble toxins
  • Lymphatic system health: Clears cellular waste
  • Genetic variations: Some people have genetic polymorphisms (like MTHFR) that affect detoxification pathways

As we explored in our article about why your body won’t bounce back, your body’s healing capacity—including detoxification—is intimately connected to gut health. A compromised gut often means compromised detox pathways. 💪

3. Probiotic Strain and Dosage

  • High CFU counts (50+ billion) are more likely to cause die-off than lower doses
  • Multi-strain formulas can trigger broader microbial shifts
  • Particularly aggressive strains that strongly compete with pathogens
  • Soil-based organisms sometimes cause more initial die-off

4. Speed of Introduction

Taking a full dose of probiotics on day one is more likely to cause die-off than slowly building up over weeks. 🐌

5. Overall Health Status

People with:

  • Compromised immune systems
  • High toxic burden (heavy metals, environmental toxins)
  • Chronic inflammation
  • Multiple health conditions

…are more likely to experience pronounced die-off reactions.

How Long Does Die-Off Last? ⏰

The million-dollar question! Die-off reactions typically follow this timeline:

Typical Die-Off Timeline:

Days 1-3: Symptoms begin, often peaking in intensity

Days 4-7: Symptoms may remain intense or begin to fluctuate

Days 8-14: Gradual improvement for most people

Weeks 3-4: Symptoms mostly resolved, beginning to feel benefits of probiotics ✨

Important notes:

  • Some people experience waves of die-off as different populations of organisms are eliminated
  • Die-off from Candida overgrowth can last longer (3-4 weeks or more)
  • SIBO-related reactions may persist if the underlying bacterial overgrowth isn’t properly addressed
  • Very severe dysbiosis may involve multiple rounds of die-off over months

If symptoms persist beyond 3-4 weeks without improvement, this is likely not a simple die-off reaction, and you should consult a healthcare practitioner. 👨‍⚕️

How to Manage Die-Off Symptoms: 8 Effective Strategies 🛠️

The good news? You don’t have to suffer through die-off. Here are proven strategies to minimize discomfort while still reaping the benefits of probiotics:

1. Start Low and Go Slow 🐢

This is the single most important strategy for preventing severe die-off.

Instead of starting with a full dose:

  • Begin with just 1/4 or 1/2 of the recommended dose
  • Take it for 3-5 days at this lower dose
  • If tolerated well, increase by 1/4 dose every 4-7 days
  • Build up gradually to the full recommended dose over several weeks

Example: If your probiotic recommends 2 capsules daily (50 billion CFU), start with half a capsule once daily for a week, then increase to 1 full capsule, etc.

Pro tip: Open the capsule and mix with food if you need to take partial doses. 💡

2. Support Your Detoxification Pathways 🌿

Help your body process and eliminate die-off toxins more efficiently:

Hydration 💧

  • Drink at least 8-10 glasses of filtered water daily
  • Add lemon for liver support
  • Herbal teas (dandelion, milk thistle) support detox

Activated Charcoal

  • Take 1-2 hours away from probiotics and medications (it binds everything!)
  • Dose: 500-1000mg during peak die-off symptoms
  • Helps bind and eliminate toxins in the gut
  • Don’t use long-term or it will bind nutrients too

Bentonite Clay

  • Similar to charcoal but gentler
  • Can be taken as a supplement or used in detox baths
  • Also take away from probiotics and meds

Liver Support Supplements

  • Milk thistle (silymarin)
  • N-acetylcysteine (NAC)
  • Glutathione or its precursors
  • B-complex vitamins

Ensure Regular Bowel Movements 🚽

  • Toxins are eliminated through stool
  • If constipated during die-off, toxins recirculate
  • Use magnesium citrate, vitamin C, or fiber to keep things moving
  • Aim for at least one bowel movement daily

3. Take Probiotics With or After Meals 🍽️

Taking probiotics with food:

  • Buffers their impact on your gut
  • Reduces intensity of die-off
  • May improve probiotic survival through stomach acid
  • Makes symptoms more tolerable

4. Consider Alternating Days 📅

If die-off is intense even with low doses:

  • Take your probiotic every other day instead of daily
  • Or take it 3-4 times per week
  • This gives your body time to process toxins between doses
  • Gradually increase frequency as tolerated

5. Support Your Immune System 💪

Your immune system is working overtime during die-off. Support it with:

Quality Sleep 😴

  • Aim for 7-9 hours
  • Die-off can disrupt sleep, but prioritize rest
  • Consider melatonin or magnesium if needed

Stress Management 🧘‍♀️

  • Stress impairs detoxification
  • Practice meditation, deep breathing, gentle yoga
  • Die-off symptoms can be stressful—be patient with yourself

Anti-Inflammatory Foods

  • Omega-3 fatty acids (fish oil)
  • Turmeric/curcumin
  • Ginger
  • Colorful vegetables and berries 🫐

Vitamin D

  • Supports both immune function and gut health
  • Many people with gut issues are deficient

6. Add Biofilm Disruptors (Carefully) 🛡️

Many harmful bacteria and yeast create protective “biofilms” that shield them from probiotics and your immune system. Disrupting these biofilms can enhance probiotic effectiveness but may intensify die-off:

Natural Biofilm Disruptors:

  • NAC (N-acetylcysteine)
  • Serrapeptase or nattokinase (enzymes)
  • Monolaurin
  • Lactoferrin

**Top 3 NAC supplements:**
1. Designs For Health-NAC  (my personal choice)
2. NOW-NAC (popular option)
3. Nutricost- NAC (budget-friendly)

Top recommended supplements for biofilm disruptors:

Designs For Health- Natto-Serrazime

Designs For Health- Monolaurin Avail

Double Wood-Lactoferrin

Timing strategy:

  • Start probiotics first OR try a postbiotic to minimize die-off symptoms. Link to top recommended postbiotic can be found below….
  • Add biofilm disruptors 2-4 weeks later if progress stalls
  • Expect increased die-off symptoms temporarily

Top recommended postbiotic supplement:

Synbiotic-Postbiotic

7. Consider Digestive Support 🥗

Taking digestive enzymes can help:

  • Reduce the burden on your gut
  • Decrease food sensitivities during die-off
  • Support overall gut healing
  • Minimize bloating and gas

My all-time favorite digestive enzyme can be found here!

Designs For Health-Digestzymes

As we discussed in our article about postbiotics, sometimes probiotics alone aren’t enough—supporting your gut with additional strategies can make all the difference in your healing journey. ✨

8. Temporarily Pause If Needed 🛑

There’s no shame in taking a break if die-off becomes overwhelming:

  • Pause probiotics for 3-5 days
  • Focus on detox support and hydration
  • Allow your body to catch up on toxin elimination
  • Restart at an even lower dose when ready

This isn’t “failure”—it’s strategic pacing! 💚

The Best Probiotic Strains for Minimizing Die-Off 🦠

Not all probiotics are created equal when it comes to die-off reactions. Some strains are gentler and less likely to cause intense reactions:

Gentler Probiotic Options:

Saccharomyces boulardii ⭐ Can be found here: Designs For Health- FloraMyces (saccharomyces boulardii probiotic)

  • A beneficial yeast, not bacteria
  • Excellent for crowding out Candida
  • Generally very well tolerated
  • Great first probiotic for sensitive individuals
  • Doesn’t colonize, so die-off is minimal

Soil-Based Organisms (SBOs)

  • Bacillus species (subtilis, coagulans, clausii). Can be found here: Vitamatic-Bacillus Coagulans
  • More resilient, survive stomach acid better
  • Can cause initial die-off but often milder
  • Good for SIBO (don’t overgrow in small intestine)

Bifidobacterium-Dominant Formulas

Spore-Based Probiotics

  • More aggressive at killing pathogens
  • Expect more die-off initially
  • Very effective for stubborn gut issues
  • Start extra low and slow

Potentially More Intense (But Effective):

High-Dose Multi-Strain Formulas

  • 50-100+ billion CFUs
  • 10-15+ different strains
  • More likely to cause die-off
  • Start with much smaller doses

Lactobacillus-Heavy Formulas

  • Can increase histamine
  • May worsen SIBO
  • Very beneficial for the right person
  • Just know they can trigger stronger reactions

When to See a Healthcare Provider 👨‍⚕️

While die-off reactions are generally temporary and manageable, certain situations require professional guidance:

Seek Medical Attention If:

Immediate/Emergency Situations: ⚠️

  • Difficulty breathing or swallowing
  • Severe allergic reactions (anaphylaxis)
  • High fever (>101°F)
  • Severe abdominal pain
  • Blood in stool
  • Signs of dehydration

Schedule an Appointment If:

  • Symptoms last longer than 3-4 weeks without improvement
  • Symptoms are so severe they interfere with daily life
  • You have a compromised immune system (HIV, cancer treatment, organ transplant)
  • You’re pregnant or breastfeeding and experiencing concerning symptoms
  • You have underlying health conditions that complicate treatment
  • You suspect SIBO, Candida overgrowth, or other specific conditions that need testing

Consider Functional Medicine Testing:

  • Comprehensive stool analysis to identify dysbiosis patterns
  • SIBO breath testing if bloating is severe
  • Organic acids test to assess yeast overgrowth
  • Food sensitivity panels if symptoms persist

A qualified functional medicine practitioner can help you navigate complex gut issues and develop a personalized protocol. 🎯

The Die-Off Timeline: What Recovery Looks Like 🌈

Understanding what to expect can help you stay motivated through the uncomfortable phase:

Week 1: The Storm ⛈️

  • Die-off symptoms peak
  • You might question your decision
  • Focus on detox support and hydration
  • Remind yourself: this is temporary!

Week 2: Fluctuation 🌊

  • Symptoms come and go
  • Some days feel better than others
  • Your body is adjusting
  • Continue support strategies

Week 3-4: The Shift ☀️

  • Die-off symptoms begin fading
  • Energy starts improving
  • Digestion becomes more regular
  • You begin feeling the benefits of probiotics

Week 5-8: Transformation ✨

  • Significant improvements in gut symptoms
  • Better energy and mental clarity
  • Reduced bloating and digestive discomfort
  • Stronger immune function
  • Better mood and sleep

Week 9-12: The New Normal 🌱

  • Gut microbiome rebalanced
  • Sustained improvements in health
  • Reduced inflammation
  • Better nutrient absorption
  • Overall vitality restored

Remember, healing isn’t linear. There may be setbacks, but the overall trend should be positive improvement. 📈

Beyond Probiotics: Comprehensive Gut Healing 🌿

While probiotics are powerful tools, they work best as part of a comprehensive gut-healing protocol:

The 5 Rs of Gut Healing:

1. Remove 🚫

  • Food sensitivities and allergens
  • Inflammatory foods (excess sugar, processed foods)
  • Chronic stress
  • Toxin exposures

2. Replace 🔄

  • Digestive enzymes
  • Stomach acid support (if needed)
  • Bile salts (if gallbladder issues)

3. Reinoculate 🦠

  • Probiotics (the focus of this article!)
  • Prebiotic fibers to feed good bacteria
  • Fermented foods

4. Repair 🛠️

  • L-glutamine for gut lining
  • Zinc carnosine
  • Collagen or bone broth
  • Omega-3 fatty acids
  • Postbiotics for additional support

Speaking of postbiotics, if you’re struggling with probiotics or die-off is too intense, you might benefit from learning about postbiotics—the beneficial metabolites produced by probiotics that can support gut healing without the die-off reactions. 💡

5. Rebalance ⚖️

  • Manage stress
  • Improve sleep
  • Regular exercise
  • Mindful eating practices

Foods That Support Your Gut During Probiotic Supplementation 🥗

What you eat can either help or hinder your probiotic success:

Eat More Of: ✅

Prebiotic Fiber (feeds good bacteria)

  • Asparagus, artichokes, garlic, onions
  • Bananas (especially slightly green)
  • Apples, berries
  • Oats, flaxseeds
  • Chicory root, dandelion greens

Anti-Inflammatory Foods

  • Wild-caught fatty fish (salmon, sardines) 🐟
  • Leafy greens and colorful vegetables
  • Turmeric and ginger
  • Extra virgin olive oil
  • Green tea

Fermented Foods (natural probiotics)

  • Sauerkraut, kimchi
  • Kefir, yogurt (if tolerated)
  • Kombucha
  • Miso, tempeh

Gut-Healing Foods

  • Bone broth (collagen for gut lining)
  • Aloe vera juice
  • Slippery elm
  • Marshmallow root tea

Avoid or Minimize: ⚠️

During Die-Off:

  • Excess sugar (feeds pathogens you’re trying to eliminate)
  • Alcohol (impairs detoxification and liver function)
  • Processed foods (inflammatory and lack nutrients)
  • Known food sensitivities (add extra burden to healing gut)
  • Excessive caffeine (can worsen anxiety and sleep issues during die-off)

As we’ve emphasized throughout our comprehensive digestive health resources, your body is incredibly intelligent and capable of healing—but it needs the right support and sometimes, patience through the uncomfortable phases. 💚

The Bottom Line: Die-Off Is Often a Sign of Progress 🎯

If you’re experiencing uncomfortable symptoms after starting probiotics, take heart: in many cases, this is actually evidence that the probiotics are working. Your gut ecosystem is shifting, harmful organisms are being eliminated, and your body is recalibrating toward health.

Key Takeaways: ✨

✅ Die-off reactions are caused by toxins released when harmful gut organisms die ✅ Symptoms typically last 1-4 weeks and then improve ✅ Start with low doses and increase gradually to minimize die-off ✅ Support detoxification with hydration, activated charcoal, and liver support ✅ Not all negative reactions are die-off—learn to distinguish true intolerance ✅ Be patient with yourself—gut healing takes time ✅ Consider working with a functional medicine practitioner for severe symptoms

Remember: healing isn’t comfortable, but it IS worth it. The temporary discomfort of die-off is your ticket to long-term gut health, better immunity, clearer thinking, sustained energy, and overall vitality. 🌈

Your gut is the foundation of your health. By understanding and working with your body’s healing processes—even the uncomfortable ones—you’re investing in your long-term wellbeing. Keep going. You’ve got this! 💪💚

Frequently Asked Questions (FAQ) ❓

Q: Should I stop taking probiotics if I experience die-off? A: Not necessarily. If symptoms are tolerable, continue at a reduced dose while supporting detox. If symptoms are severe or interfering with daily life, pause and consult a healthcare provider.

Q: Can I take probiotics with antibiotics? A: Yes! Take them at least 2 hours apart from antibiotics. This can help minimize gut damage and reduce die-off reactions later. Continue probiotics for several weeks after finishing antibiotics.

Q: Are expensive probiotics better at preventing die-off? A: Not necessarily. Price doesn’t determine die-off potential—strain selection and CFU count matter more. Sometimes more expensive, high-potency probiotics cause more die-off.

Q: Can children experience die-off from probiotics? A: Yes, but it’s generally milder. Start with very low doses (open capsules and use partial amounts) and children-specific formulas when possible.

Q: How do I know if my probiotic is actually working? A: After the die-off phase (2-4 weeks), you should notice improvements in digestion, energy, mood, immune function, and overall wellbeing. If there’s no improvement after 2 months, you may need a different probiotic or additional gut healing support.

Q: Can I take multiple probiotic supplements at once? A: It’s better to start with one, assess tolerance, then potentially add others. Multiple probiotics at once can intensify die-off reactions.

Medical Disclaimer: This article is for informational and educational purposes only and is not intended as medical advice. The information provided should not be used for diagnosing or treating a health condition or disease. If you experience severe or persistent symptoms after taking probiotics, consult with your healthcare provider. Individual responses to probiotics vary, and what works for one person may not be appropriate for another. Always discuss supplement use with a qualified healthcare professional, especially if you have underlying health conditions or take medications.

🌿 More Gut-Health Resources

Explore more evidence-based guides on gut health, inflammation, and functional medicine:

• The Hidden Truth About Common Digestive Issues: Why Your Bloating, Acid Reflux, and IBS Symptoms Are Actually Warning Signs Your Body Can’t Ignore

• Postbiotics: The Missing Link in Your Gut Health Healing Journey and Why Your Probiotics Aren’t Working

• 7 Signs Your Gut Needs Healing and Why Your Body Won’t Bounce Back: The Hidden Gut Health Connection

• SIBO vs. SIFO: Understanding Small Intestinal Overgrowth (And Why It Matters for Your Gut Healing)

• The Autoimmune–Gut Connection: How to Heal the Root Cause and Break the Cycle

• Healing Leaky Gut: Myths vs. Science (What Actually Works)

• The Shocking Truth About NSAIDs and Leaky Gut: How Your Pain Medication Could Be Destroying Your Intestinal Health

• The Hidden Dangers of Proton Pump Inhibitors: How Long-Term PPI Use Silently Destroys Your Gut Health

• The Antibiotic Aftermath: How Your Last Prescription Could Be Fueling Chronic Inflammation Years Later

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Cukrowska, B., Ceregra, A., Maciorkowska, E., Surowska, B., Zegadło-Mylik, M. A., Konopka, E., … & Fyderek, K. (2021). The effectiveness of probiotic Lactobacillus rhamnosus and Lactobacillus casei strains in children with atopic dermatitis and cow’s milk allergy: A multicenter, randomized, double-blind, placebo-controlled study. Nutrients, 13(4), 1169.

Dimidi, E., Christodoulides, S., Scott, S. M., & Whelan, K. (2017). Mechanisms of action of probiotics and the gastrointestinal microbiota on gut motility and constipation. Advances in Nutrition, 8(3), 484-494.

Hungin, A. P. S., Mitchell, C. R., Whorwell, P., Mulligan, C., Cole, O., Agréus, L., … & de Wit, N. (2018). Systematic review: Probiotics in the management of lower gastrointestinal symptoms—an updated evidence-based international consensus. Alimentary Pharmacology & Therapeutics, 47(8), 1054-1070.

Kristensen, N. B., Bryrup, T., Allin, K. H., Nielsen, T., Hansen, T. H., & Pedersen, O. (2016). Alterations in fecal microbiota composition by probiotic supplementation in healthy adults: A systematic review of randomized controlled trials. Genome Medicine, 8(1), 1-11.

Liu, Y., Tran, D. Q., & Rhoads, J. M. (2018). Probiotics in disease prevention and treatment. The Journal of Clinical Pharmacology, 58(S10), S164-S179.

Maziade, P. J., Pereira, P., & Goldstein, E. J. (2015). A decade of experience in primary prevention of Clostridium difficile infection at a community hospital using the probiotic combination Lactobacillus acidophilus CL1285, Lactobacillus casei LBC80R, and Lactobacillus rhamnosus CLR2 (Bio-K+). Clinical Infectious Diseases, 60(suppl_2), S144-S147.

Patel, R. M., & Denning, P. W. (2013). Therapeutic use of prebiotics, probiotics, and postbiotics to prevent necrotizing enterocolitis: What is the current evidence? Clinics in Perinatology, 40(1), 11-25.

Suez, J., Zmora, N., Zilberman-Schapira, G., Mor, U., Dori-Bachash, M., Bashiardes, S., … & Elinav, E. (2018). Post-antibiotic gut mucosal microbiome reconstitution is impaired by probiotics and improved by autologous FMT. Cell, 174(6), 1406-1423.

Vasquez, A., Manso, G., & Cannell, J. (2005). The clinical importance of vitamin D (cholecalciferol): A paradigm shift with implications for all healthcare providers. Alternative Therapies in Health and Medicine, 12(5), 28-36.

Zhong, C., Qu, C., Wang, B., Liang, S., & Zeng, B. (2017). Probiotics for preventing and treating small intestinal bacterial overgrowth: A meta-analysis and systematic review of current evidence. Journal of Clinical Gastroenterology, 51(4), 300-311.Zmora, N., Zilberman-Schapira, G., Suez, J., Mor, U., Dori-Bachash, M., Bashiardes, S., … & Elinav, E. (2018). Personalized gut mucosal colonization resistance to empiric probiotics is associated with unique host and microbiome features. Cell, 174(6), 1388-1405.

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