Probiotics / Fermented Foods

There are more than 400 different species of bacteria in the human digestive tract. The most important of these are Lactobacillus acidophilus and Bifidobacterium bifidum. They are called probiotics, the opposite of antibiotics, because they aid in creating a healthy balance of microflora in the gut.

The primary use of probiotics is to restore the normal flora in the intestines that often occurs because of poor diet or the use of antibiotics. They do this first by competing with other organisms for nutrients. They secrete lactic acid and acetic acid that decrease the pH of the vagina and intestines, making the environment less favorable for the pathogenic bacteria to thrive. Antibiotics can alter the bacteria in the gastrointestinal tract, decreasing the numbers of healthy bacteria and causing diarrhea. Probiotics, taken during or after antibiotic therapy, can reduce or prevent this effect.

Probiotics produce certain antimicrobial compounds that kill some of the undesirable pathogens in the intestines, including yeasts, viruses and bacteria. The associated decrease in the production of potentially cancer-causing toxins by the unfavorable microorganisms may help decrease the incidence of colon cancer. Probiotics also make certain vitamins needed by the body including folic acid, vitamin B6, niacin and vitamin K.

When large doses of probiotics are first taken, mild gastrointestinal symptoms may occur and flu-like symptoms may also occur within 3 days. Low counts of Lactobacillus and Bifidobacterium, with an increase in less desirable bacteria in the intestines can cause gas, diarrhea, constipation, mucosal irritation and contribute to the development of allergies. As the number of undesirable bacteria increases, the absorption of certain nutrients, including the B vitamins, decreases, leading to the possibility of deficiencies. Symptoms of toxicity from taking probiotics are rare.

If supplementation is needed, start by taking at least 1-10 billion viable L. acidophilus or B. bifidum cells daily divided into 3 or 4 doses. Take them on an empty stomach or at least 30-60 minutes before eating. Take 15-20 billion viable organisms daily to prevent diarrhea from antibiotic therapy. Generally you should use products that contain a mixture of live organisms and have an expiration date on the label. Extreme heat or freezing can kill the live cells. Food sources of probiotics include yogurt and milk with live cultures.

Problems with Lactobacillus administration include the failure of organisms to adhere to the intestinal mucosa or to survive damage from gastric acid and bile. The acidophilus sweepstakes has led to the search for newer and better strains for medical uses.

Supplements of fructooligosaacharrides (FOS) promote the growth of Bifidobacteria. Bifidobacteria use the fiber from foods such as fruits, vegetables, legumes and grains to make short-chain fatty acids, including butyrate. Butyrate is an important source of energy for the cells lining the colon and promote a healthy colon. The recommended dose of FOS is 2-3gm per day. Foods containing fructooligosaacharrides include onions, asparagus, garlic and Jerusalem artichokes.

Many years ago, food preservation was accomplished through lacto-fermentation, a process that adds a host of beneficial microorganisms to food, making them easier to digest and increasing the healthy flora in our intestinal tracts. Because fermentation is an inconsistent process, commercial food processors developed techniques like pasteurization (which kills all microorganisms) to help standardize more consistent yields.

Sadly, modern culture has sacrificed many of the advantages of traditionally fermented healthy foods for faster and cheaper methods of mass production. Increases in viruses, intestinal parasites and chronic health problems are warning signs that it’s time to return to the use of traditionally fermented foods.

The living cultured foods commercially available include some brands of kefir, yogurt, miso, sauerkraut and a pickled Chinese cabbage called kimchee.


Probiotics / Fermented Foods can help with the following


Current Smoker

Supplementation with a rose-hip drink containing Lactobacillus plantarum 299v (500,000,000 colony-forming units/mL; 400 mL/d) reduced blood pressure and improved markers of cardiovascular disease risk in a study of 36 heavy smoking adults. [Am J Clin Nutr 2002;76(6): pp.1249-55]


Allergies Indoor

Supplementation with one pound (1/2kg) of yogurt, but not partially skimmed milk at the same dose, improved symptom scores and immune markers of allergic reactivity in a study of 13 people with allergic rhinopathy. [Eur J Clin Nutr 2002;56(12): pp.1155-61]


Allergic Rhinitis / Hay Fever

Supplementation with one pound (1/2kg) of yogurt, but not partially skimmed milk at the same dose, improved symptom scores and immune markers of allergic reactivity in a study of 13 people with allergic rhinopathy. [Eur J Clin Nutr 2002;56(12): pp.1155-61]


Allergy to Cow's Milk

Oral administration of probiotic bacteria has been shown to stabilize intestinal integrity, promote local IgA production and reduce intestinal inflammation in atopic individuals with cow’s-milk allergy.


Crohn's Disease

Use of a good probiotic product can help keep the bacterial flora in balance and reduce inflammation. Caution is advised with active inflammation, as bacteria may penetrate the gut wall and enter the blood stream.


Ulcerative Colitis

Dr. McCann, originally with Kaiser Permanente in Ohio, has pioneered a dramatic, experimental treatment for inflammatory bowel disease which has induced a rapid remission in 16 out of 20 patients with ulcerative colitis. A two-day course of multiple broad-spectrum antibiotics to “decontaminate” the gut is followed by administration of defined strains of E. coli, and Lactobacillus acidophilus to produce a “reflorastation” of the colon. Others have not achieved this same degree of success.

In another clinical trial, 77% of those treated with a probiotic bacteria mixture experienced relief of their mild to moderate ulcerative colitis. Of the 34 patients treated, 26 demonstrated improvement in their condition, with most of those experiencing a complete remission. Only three patients found their condition worsened after the treatment. [American Journal of Gastroenterology July 2005; 100(7):1539-46]

The mixture of eight lactic acid bacterial species is believed to work by:



IBS (Irritable Bowel Syndrome)

Whenever antibiotics are used to treat bacterial overgrowth, probiotics should be used during and/or afterwards to help restore a healthy balance of gut flora.

Additionally, in IBS there is a deficiency of bacteria that break down starch. Encouraging the growth or addition of these bacteria is advisable. The following study demonstrates this need and improvement with a specific probiotic formula.

Irritable bowel syndrome (IBS) represents one of three major forms of chronic inflammatory bowel disease. The aim of the present study was to investigate the composition and metabolic activities of faecal flora in IBS patients that may take part in initiation and/or maintaining of the disease state. All experiments were designed for three groups of stool donors: healthy individuals, patients with irritable bowel syndrome (IBS) diagnosis before and after treatment by prebiotic preparation Hylak Tropfen Forte.

The faecal short chain fatty acid (SCFA) profile of IBS patients was characterized by lower concentration of total SCFA, acetate and propionate (88.15, 60.16 and 18.06 mmol/l, resp.) and by higher concentration of butyrate (9.93 mmol/l). After Hylak Tropfen Forte treatment, the concentration of total short chain fatty acids (SCFA), acetate and propionate increased (100.66, 75.60 and 18.21 mmol/l, resp.). On the other hand the butyrate concentration was lowered (from 9.93 to 6.84 mmol/l). SCFA concentrations in the control group samples for total SCFA, acetate and propionate were as follows: 108.95, 73.26, 26.08 mmol/l.

Patients with irritable bowel syndrome diagnosis showed significant changes in faecal bacterial population. There were increased numbers of facultative anaerobes and sulphate reducing bacteria. Significantly lower were the counts of cellulolytic bacteria. Total counts of pectinolytic, proteolytic, lactate utilizing and lipolytic bacteria were not significantly different. After treatment with Hylak Tropfen Forte the counts of facultative anaerobes and sulphate reducing bacteria decreased and proportion of cellulolytic bacteria increased significantly and were closer to numbers in faecal samples from healthy persons. This activity could be therefore a possible indicator of irritable bowel syndrome.

Fecal bacteria from all three groups of donors were tested for their ability to degrade cellulose, pectin and starch in vitro. Starch degradation was significantly depressed in IBS patients and lower concentrations of acetate, propionate and butyrate were found. Pectin degradation in vitro followed a similar pattern. No degradation of cellulose was found. After treatment with Hylak Tropfen Forte bacterial degradation of these polysaccharides increased but not to the levels of the control group. [Kopecný J., J. Šimunek: Cellulolytic Bacteria in Human Gut and Irritable Bowel Syndrome. Acta Vet. Brno 2002, 71: 421-427]

Separately, a systematic review of the efficacy of probiotics in IBS that included 19 randomized controlled trials in 1,628 IBS patients found that “probiotics are effective in IBS, but we do not have enough information to be sure whether there is one probiotic that is particularly effective or whether combinations of probiotics are required,” according to Dr. Paul Moayyedi, the study’s lead researcher. [Moayyedi and co-investigators at Mayo Clinic in Jacksonville, FL and Rochester, MN; McMaster University in Ontario, Canada; University College in Cork, Ireland and Montefiore Medical Center in New York City, conducted this meta-analysis presented at the ACG Annual Scientific Meeting 2008 in Orlando.]

Here is someone’s testimony about their experience with symptoms, fiber, and probiotics.

I have suffered with allium intolerance since I was about 16 or 17. Like most of you I worked it out for myself – I went to my GP and got told I had “IBS” and to “just deal with it”. She was very unsympathetic and gave me these fibre supplement drinks (GROSS) which made me 100 x worse. I saw another doctor when I got really bad (diahorrea and cramps every day for a month) & he referred me to a dietician who was wonderful and helped sooo much. She said taking all that fibre was probably the WORST thing I could have done!

This is what she said (in a nut shell):

Your gut is meant to contain lots of good bacteria to help with digestion.

Bacteria living on the gut wall feed off fibre.

Apparently the gas, bloating, diarrheoa etc is caused by bad bacteria in the gut. Taking pro-biotics at this stage is no good because if there is so much bad bacteria on your gut wall – there is no space for the good bacteria to live.

Increasing your fibre intake (like I did) will just make the bad bacteria thrive.

First you need to kill the bad bacteria and to do this I was put on a fibre-free diet for 2 weeks. Basically all the stuff you’re usually told is unhealthy – white bread no crusts potatos – no skins. The cramps and other symtoms almost instantly subsided – it was miraculous!!

After this I had lots and lots of probiotics – yoghurts and drinks etc to increase the good bacteria in my gut and slowly reintroduced fibre.

It really worked – I couldn’t believe it after trying so many other things!

Anyway, whenever my IBS symptoms get really bad (luckily not very often now) I just follow the advice she gave me. I also avoid onions, leeks, chives and shallots like the plague.

I have set up a group on facebook (just search for “onion allergy/intolerance”) or click on my website. I have started compiling some recipes and a list of onion-free supermarket finds on there. I hope people will find it useful and maybe help me add to it!

This and other stories found here make for some interesting reading.



A study of hospitalized children showed that a combination of Lactobacillus acidophilus and Bifidobacterium infantis was effective in treating acute diarrhea. One of the more common causes for hospitalization of infants and young children is dehydration related to acute diarrhea, especially from a rotavirus. Lactobacilli in the intestines play an important role in developing natural defenses against both intestinal bacterial and viral infections. In the study group, the frequency of diarrhea improved on the first and second day of hospitalization and the duration of diarrhea during hospitalization also decreased. The researchers concluded “Oral bacterial therapy is an effective adjuvant therapy in rotavirus positive and negative children with diarrhea and can safely be administered during an episode of acute diarrhea.” [Acta Paediatr Taiwan 2001 Sep-Oct; 42(5): pp.301-5]

Probiotics appear to be effective in treating acute diarrhea, according to researchers from Johns Hopkins Bloomberg School of Public Health. They conducted a meta-analysis of 34 masked, randomized, placebo-controlled trials. One was carried out in a developing country, while the others were carried out in health-care settings in developed countries. They found that probiotics reduced:


Heartburn / GERD

The use of acidophilus capsules has helped relieve heartburn in some patients.



In a controlled trial of one month, 56 weaning infants were supplemented with fructo-oligosaccharides in their cereal ( 0.75g FOS per serving of cereal; average FOS consumption 0.74g per day). This resulted in more regular, softer stools and less frequent symptoms of constipation. [Br J Nutr 2003;90(3): pp.581-8]

Emergency Care  

Upcoming Surgical Procedure

Probiotic use before surgery can be helpful in maintaining a healthy colonic flora if antibiotics are going to be used after your surgery. Do not use probiotics without your doctor’s approval if your immune system is seriously compromised.

The Immune System  

Immune System Imbalance (TH2 Dominance)

The specific bacteria that that help balance a TH2 dominant immune system are:


Dysbiosis, Bacterial

One of the ways to help reestablish a balanced bacterial population in the GI tract is the use of probiotics. There are many products on the market containing a variety of organisms and a general approach could be taken using a broad spectrum probiotic formula. However, a better method is to discover the type of imbalance by testing and then supplementing those specific bacteria that are needed. Bringing these normally-occurring bacteria into balance will help prevent the overgrowth of more pathogenic organisms.

Bifidobacteria are the predominant lactic acid bacteria of the colon with a concentration that is 1000 times higher than Lactobacilli. Administration of Bifidobacterium brevum to humans and animals reduces fecal concentrations of Clostridia and Enterobacter species, ammonia, and toxin-releasing bacterial enzymes including beta-glucuronidase and tryptophanase. Bacillus laterosporus, a novel organism classified as non-pathogenic to humans, produces unique metabolites with antibiotic, antitumor and immune modulating activity. This organism is available as a food supplement in the United States. It has been found to be an effective adjunctive treatment for control of symptoms associated with small bowel dysbiosis in a number of patients.

Fructose-containing oligosaccharides (FOS), found in vegetables like onion and asparagus, have been developed as a food supplement for raising stool levels of Bifidobacteria and lowering stool pH.


Lyme Disease

If taking antibiotics for Lyme disease, remember that they will kill both good and bad microorganisms. Replacing the friendly intestinal organisms killed with antibiotics by eating live culture yogurt or taking probiotic capsules regularly for at least six months is recommended. The aim of this treatment is to recolonize the intestine both during and after antibiotic use.


Yeast / Candida

The use of probiotics to help keep candidal overgrowth from occurring is a common part of many antifungal programs. However, in a privately funded study, Lactobacillus acidophilus, when used alone as a treatment for candida overgrowth, failed to produce any benefit. L. acidophilus, along with other bacteria, should be used as part of a more comprehensive treatment approach for known or suspected candidal overgrowth.

Other bacteria have proven to be more effective. A product called ThreeLac claims to:


Helicobacter Pylori Infection

Supplementation for one month with Lactobacillus and Bifidobacterium yogurt after one week of triple antibiotic therapy enhanced H. Pylori eradication. Only those patients supplemented with yogurt showed restoration of Bifidobacterium in their stools compared to the levels at the beginning of the trial. [Aliment Pharmacol Ther 2002;16(9): pp.1669-1676]

Using Lactobacillus johnsonii from a fermented milk product for 4 months reduced gastric inflammation and H. pylori density and improved mucus thickness in a well-controlled study of 50 patients with gastritis and H. pylori. [Aliment Pharmacol Ther 2003;18(8): pp.805-14]

A review of thirteen human studies concluded that probiotics may have a place as prophylaxis and supportive treatment of Helicobacter pylori infections. [Int J Antimicrob Agents 2003;22(4): pp.360-6]


Cystitis, Bacterial Bladder Infection

Dr. Andrew Bruce, Chief of Urology, and Dr. Gregor Reid, Director of Urology Research, at Toronto General Hospital have been studyed women with chronic bladder infections.”When we looked at the two groups of women, those who did

not have infections, had beautiful growths of lactobacilli,” Dr. Bruce commented in the Toronto Star (Apr13/92). “The lactobacilli seem to have a protective effect. A significant number of women who had repeated infections had a poor population of lactobacilli.”

As a result, Dr. Bruce and his research team developed an experimental vaginal suppository called Restoration Plus. It contains two key strains of lactobacilli called lactobacillus casei and lactobacillus fermentum. In the study, one group of 28

women with four proven bladder infections within the past 12 months, was treated with the acidophilus suppositories; the other group with inert suppositories. Another arm of the study treated 40 women with acute bladder infections with a three-day course of antibiotics followed by a three-month course of Restoration Plus, and compared it to results with 20 women treated with antibiotics followed by three months of placebo.The results of this study have shown Restoration Plus to be a very effective preventative treatment for bladder infections. The treatment is given once a week for six to 12 months.

This experimental product does not appear to be available to the public at this time. A similar product, Urex-Cap-5, developed by Urex Biotech Inc., seems poised for marketing but does not yet appear to be available either.

Organ Health  

Fatty Liver

Probiotics may interfere with the development of NASH at various levels:


Diverticular Disease

The use of probiotics can be helpful in maintaining a healthy bacterial population with uncomplicated diverticulitis. Probiotics, especially Bifidus bacteria, help reduce inflammation in inflammatory bowel disease and should provide benefit in diverticular disease by reducing pathogenic bacteria presence or overgrowth.



Probiotics should be taken after a course of antibiotics. The long term use of antibiotics for prostatitis has been found to destroy the normal urethral flora that would otherwise interfere with virulent organisms.



See the link between Pancreatitis and Dysbiosis, Bacterial.

February 18, 2008 — In patients with predicted severe acute pancreatitis, probiotic prophylaxis did not reduce the risk for infectious complications and was associated with an increased risk for mortality, according to the results of a multicenter, randomized, double-blind, placebo-controlled trial reported in the February 14 Online First issue of The Lancet.

The researchers conclude from these findings that prophylaxis with this combination of probiotic strains should not be administered in this category of patients as it did not reduce the risk of infectious complications and was associated with an increased risk of mortality.

This study does not negate the potential benefit of a specific probiotic discussed in the link mentioned at the top of this comment. The combination probiotic used in the Lancet study contained different Lactobaccilus strains and other species.


Erythema Nodosum

If Y. enterocolitica is involved in the initiation (and continuance) of EN, then using a probiotic may help oppose this dysbiosis.


Possible Pregnancy-Related Issues

Gastrointestinal alterations in bacterial flora are common in infants suffering from allergic disease or who will develop allergic disease later. Probiotic supplementation helps normalize and strengthen the lining of the GI tract in infants. Eczema symptoms have been reduced in infants when they were supplemented with probiotics. In addition, probiotic supplementation in mothers for 6 months before and after birth reduced the incidence of eczema in their children by 50%. [Brit J Nutr 2002 Sep; 88 Supp 1: pp. S19-27] Antibiotic use in early infancy has been associated with an increased risk of allergic disease in later childhood, which is in keeping with the understanding that a disturbed GI flora will contribute to an allergic tendency. A family history of atopic disorders like dermatitis further suggests that probiotic supplementation would be wise both pre- and postnatally.


Vaginitis/Vaginal Infection

Twice-daily vaginal douches, using 2 teaspoons full of acidophilus / bifidus powder in a quart of warm water, will help treat many recurrent vaginal yeast infections. Even just taking probiotics orally will increase the colonization of these organisms in the vagina and help prevent infections from occurring. The use of ‘live culture’ yogurt can also reduce or eliminate vaginal yeast infections as the organisms are able to find their way to the vagina, helping to establish a more candida resistant environment.

Several lactobacillus species given in suppository form have shown clinical efficacy as a treatment for vaginal infections. Acidophilus suppositories seem to stimulate the normal growth of lactobacilli in the vagina, reducing bacterial vaginosis and have reduced the frequency of urinary tract infections as well. If no specifically designed product is available to you, inserting a capsule of mixed acidophilus species (designed for oral use) once per day should accomplish the task of reestablishing a friendly floral environment and normalizing vaginal pH.

One study using intravaginal capsules of bacteria showed that the specific type of one bacteria over another related one may be better at recolonizing the vagina. The administration of Lactobacillus rhamnosus GR-1 and L. fermentum RC-14 promoted healthy vaginal ecology and helped prevent the development of yeast vaginitis. However, Lactobacillus GG, which has been well documented as a beneficial organism for the human digestive tract, was less able to colonize the genitourinary tract. [JAMA 2002;287: pp.1940-1941]

There is an OTC product made by Jarrow called Fem-dophilus which contains GR-1 and RC-14. It is designed to be taken orally. The oral use (taken by mouth) of these bacteria in two trials have demonstrated the ability to restore a healthy vaginal balance of bacteria. [FEMS Immunol Med Microbiol, 2003;35: pp.131-134]


Motherhood Issues

Gastrointestinal alterations in bacterial flora are common in infants suffering from allergic disease or who will develop allergic disease later. Probiotic supplementation helps normalize and strengthen the lining of the GI tract in infants. Eczema symptoms have been reduced in infants when they were supplemented with probiotics. In addition, probiotic supplementation in mothers for 6 months before and after birth reduced the incidence of eczema in their children by 50%. [Brit J Nutr 2002 Sep; 88 Supp 1: pp. S19-27] Antibiotic use in early infancy has been associated with an increased risk of allergic disease in later childhood, which is in keeping with the understanding that a disturbed GI flora will contribute to an allergic tendency. A family history of atopic disorders like dermatitis further suggests that probiotic supplementation would be wise both pre- and postnatally.


May do some good
Likely to help
Highly recommended



Microscopic germs. Some bacteria are "harmful" and can cause disease, while other "friendly" bacteria protect the body from harmful invading organisms.


A microflora (good bacteria) that acts as a digestive aid and lives in your intestines helping your body fight disease.


A measure of an environment's acidity or alkalinity. The more acidic the solution, the lower the pH. For example, a pH of 1 is very acidic; a pH of 7 is neutral; a pH of 14 is very alkaline.


Pertaining to the stomach, small and large intestines, colon, rectum, liver, pancreas, and gallbladder.


Excessive discharge of contents of bowel.


Tending to destroy microbes, hinder their multiplication or growth.


Any of a vast group of minute structures composed of a protein coat and a core of DNA and/or RNA that reproduces in the cells of the infected host. Capable of infecting all animals and plants, causing devastating disease in immunocompromised individuals. Viruses are not affected by antibiotics, and are completely dependent upon the cells of the infected host for the ability to reproduce.


The part of the large intestine that extends to the rectum. The colon takes the contents of the small intestine, moving them to the rectum by contracting.


Refers to the various types of malignant neoplasms that contain cells growing out of control and invading adjacent tissues, which may metastasize to distant tissues.

Folic Acid

A B-complex vitamin that functions along with vitamin B-12 and vitamin C in the utilization of proteins. It has an essential role in the formation of heme (the iron containing protein in hemoglobin necessary for the formation of red blood cells) and DNA. Folic acid is essential during pregnancy to prevent neural tubular defects in the developing fetus.

Vitamin B6

Influences many body functions including regulating blood glucose levels, manufacturing hemoglobin and aiding the utilization of protein, carbohydrates and fats. It also aids in the function of the nervous system.


(Vitamin B-3): A coenzyme B-complex vitamin that assists in the breakdown of carbohydrates, fats and proteins. Essential for the health of the skin, nerves, tongue and digestive system. It is found in every cell of the body and is necessary for energy production. Niacin is also needed for DNA formation.

Vitamin K

Helps the blood clot when the body is injured.


Difficult, incomplete, or infrequent evacuation of dry, hardened feces from the bowels.


Hypersensitivity caused by exposure to a particular antigen (allergen), resulting in an increased reactivity to that antigen on subsequent exposure, sometimes with harmful immunologic consequences.


A hollow, muscular, J-shaped pouch located in the upper part of the abdomen to the left of the midline. The upper end (fundus) is large and dome-shaped; the area just below the fundus is called the body of the stomach. The fundus and the body are often referred to as the cardiac portion of the stomach. The lower (pyloric) portion curves downward and to the right and includes the antrum and the pylorus. The function of the stomach is to begin digestion by physically breaking down food received from the esophagus. The tissues of the stomach wall are composed of three types of muscle fibers: circular, longitudinal and oblique. These fibers create structural elasticity and contractibility, both of which are needed for digestion. The stomach mucosa contains cells which secrete hydrochloric acid and this in turn activates the other gastric enzymes pepsin and rennin. To protect itself from being destroyed by its own enzymes, the stomach’s mucous lining must constantly regenerate itself.


Mucous tissue layer lining tubular structures (nasal passages, ear canal, etc.).


A bitter, yellow-green secretion of the liver. Bile is stored in the gallbladder and is released when fat enters the first part of the small intestine (duodenum) in order to aid digestion.

Fatty Acids

Chemical chains of carbon, hydrogen, and oxygen atoms that are part of a fat (lipid) and are the major component of triglycerides. Depending on the number and arrangement of these atoms, fatty acids are classified as either saturated, polyunsaturated, or monounsaturated. They are nutritional substances found in nature which include cholesterol, prostaglandins, and stearic, palmitic, linoleic, linolenic, eicosapentanoic (EPA), and decohexanoic acids. Important nutritional lipids include lecithin, choline, gamma-linoleic acid, and inositol.


Butyrate is an important short chain fatty acid that provides fuel for colon cells and may help protect against colon cancer. The most potent dietary source is butter (3%).


(gm): A metric unit of weight, there being approximately 28 grams in one ounce.


An organism living in or on another organism.


Usually Chronic illness: Illness extending over a long period of time.

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