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Prevention and maintenance are DIFFERENT doses and are often conflated. Preventing the first onset of acute pouchitis used 900 billion CFU/day (1 sachet). Maintaining remission in established chronic or refractory pouchitis — where the effect size is largest — used 6 g/day, which at 5 x 10^11 viable bacteria per gram is about 3 trillion CFU/day, in both maintenance trials. As a ulcerative colitis add-on, 3.6 trillion CFU daily; the active-UC induction trial went highest at 3.6 trillion CFU TWICE daily (7.2 trillion/day), and the paediatric trial lowest at 450 billion/day weight-based

Any time

Refrigerated sachet of the De Simone Formulation

30grams

Any time · with food (preferred)

Whey Protein Isolate

• Severe immunocompromise or immunosuppression (class-level precaution for live probiotics)
• Critical illness or indwelling central venous catheter

• Systemic antibiotics

• Milk allergy (use plant-based alternatives)
• Severe lactose intolerance (use isolate or lactose-free)

• Levodopa
• Levothyroxine
• Alendronate (bisphosphonates)