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Probiotic

Probiotics are live microorganisms, primarily bacteria and yeasts, that, when administered in adequate amounts, confer a health benefit on the host.^[1] This definition, established by the World Health Organization and Food and Agriculture Organization in 2001, emphasizes their role in modulating the gut microbiota to support physiological functions.^[2] The concept of probiotics traces its origins to the early 20th century, when Russian Nobel laureate Élie Metchnikoff proposed that consuming fermented milk containing Lactobacillus could promote longevity by altering gut bacteria, based on observations of long-lived populations in regions with high yogurt consumption.^[3] The term "probiotic," meaning "for life," was coined in 1965 by microbiologists Vernon Lilly and Rosalie Stillwell to describe substances produced by microorganisms that stimulate microbial growth.^[4] Over the decades, research has evolved from empirical observations to clinical trials demonstrating strain-specific effects, with probiotics now recognized as a key component of microbiome science.^[5] Common probiotic strains belong to genera such as Lactobacillus (e.g., L. acidophilus, L. rhamnosus GG), Bifidobacterium (e.g., B. bifidum, B. longum), and the yeast Saccharomyces boulardii.^[6] These are naturally found in fermented foods like yogurt, kefir, sauerkraut, kimchi, and miso, as well as in dietary supplements available in capsules, powders, or liquids.^[1] Strain selection is critical, as benefits are often specific to individual isolates rather than the broader species.^[7] Probiotics exert health benefits primarily through gut microbiota modulation, including inhibition of pathogens, enhancement of the intestinal barrier, and immune system regulation.^[8] Evidence supports their use in preventing and treating antibiotic-associated diarrhea, acute infectious diarrhea, and irritable bowel syndrome symptoms, with some strains also showing potential in reducing cholesterol levels and supporting immune responses.^[6] However, benefits vary by strain, dosage, and individual health status, and not all probiotics are effective for every condition.^[9] In the United States, probiotics are regulated as dietary supplements under the Dietary Supplement Health and Education Act of 1994, meaning they do not require pre-market approval by the Food and Drug Administration unless making disease treatment claims, which would classify them as drugs.^[10] Generally recognized as safe for healthy individuals, probiotics carry low risk of adverse effects, though rare infections have been reported in immunocompromised patients or premature infants.^[1] Consumers should select products with verified live cultures and consult healthcare providers for targeted use.^[6]

Definition and Terminology

Definition

Probiotics are defined as live microorganisms which, when administered in adequate amounts, confer a health benefit on the host.^[11] This definition was established by a joint expert consultation of the Food and Agriculture Organization of the United Nations (FAO) and the World Health Organization (WHO) in 2001, specifically in the context of evaluating health properties of probiotics in fermented milks.^[11] This definition was reaffirmed with a slight grammatical revision by the International Scientific Association for Probiotics and Prebiotics (ISAPP) in 2014.^[12] Key criteria for qualifying microorganisms as probiotics include their viability at the time of consumption, the ability to reach sufficient numbers in the gastrointestinal tract—typically on the order of 10^9 to 10^10 colony-forming units (CFU) per serving—and demonstration of strain-specific health benefits through scientific evidence.^[11]^[13] Viability ensures that the microorganisms remain active throughout the product's shelf life and upon ingestion, while the CFU threshold supports effective colonization or modulation of the host's microbiota.^[13] Benefits are inherently strain-specific, meaning that effects observed with one strain of a species cannot be extrapolated to others without targeted validation.^[11] Probiotics are distinct from prebiotics, which are non-viable substrates—such as selectively fermented fibers—that are utilized by host microorganisms to confer health benefits, and from synbiotics, which are combinations of probiotics and prebiotics designed for synergistic effects, though synbiotics represent an emerging category outside the core probiotic definition.^[14]^[15] Common probiotic strains include various species of Lactobacillus and Bifidobacterium.^[1]

Etymology

The term "probiotic" derives from the Greek prefix pro- meaning "for" or "in favor of," combined with bios, meaning "life," to signify something "for life." This etymological root emphasizes concepts of vitality and support for living organisms, contrasting with "antibiotic," which means "against life." The word was first coined in 1953 by German scientist Werner Kollath, who introduced "Probiotika" (in German) to describe non-antibiotic organic and inorganic supplements intended to restore and revitalize health in weakened individuals, positioning it as the opposite of antibiotics.^[16] In 1965, researchers Daniel M. Lilly and Rosalie H. Stillwell repurposed the term in a microbiological context, defining probiotics as "growth-promoting factors produced by microorganisms" that stimulate the growth of other microbes.^[17] By 1974, Robert B. Parker expanded the concept further, redefining probiotics as "organisms and substances which contribute to intestinal microbial balance," thereby linking it more explicitly to host health and microbial ecology in animals.^[18] This evolution culminated in 1989 when Roy Fuller refined the term to emphasize live entities, describing probiotics as "a live microbial feed supplement which beneficially affects the host animal by improving its intestinal microbial balance," marking a decisive shift from inanimate substances to viable microorganisms.^[19]

History

Early Concepts

The use of fermented milk products for digestive health dates back to ancient civilizations, where fermentation served both preservation and therapeutic purposes. In ancient Egypt, tomb murals from around 2000 BCE depict the production of fermented dairy, such as yogurt-like zabady, which was consumed to aid digestion by reducing lactose content and inhibiting spoilage microbes.^[20] Similarly, the Greeks and Romans employed fermented milk to treat intestinal disorders; Roman naturalist Pliny the Elder (23–79 CE) specifically recommended it for gastrointestinal ailments, attributing benefits to its souring process.^[21] In the 19th century, Louis Pasteur's germ theory of disease, developed through his studies on fermentation in the 1850s–1880s, revolutionized microbiology by demonstrating that microbes drive both harmful infections and beneficial processes like lactic acid production in milk, laying the conceptual groundwork for recognizing some bacteria as allies rather than universal pathogens.^[22] This shifted perspectives from viewing all microbes as deleterious to appreciating their diverse roles in health. Early 20th-century scientific inquiry built on these foundations, with Élie Metchnikoff's 1908 hypothesis proposing that lactic acid bacteria, particularly Lactobacillus species in yogurt, could extend human lifespan by suppressing harmful gut putrefaction and promoting intestinal harmony; he advocated daily consumption of soured milk based on observations of long-lived Bulgarian peasants.^[23] Concurrently, in 1900, pediatrician Henry Tissier isolated Y-shaped bacteria (later classified as Bifidobacterium) from the feces of healthy breastfed infants at the Pasteur Institute, noting their absence in children with diarrhea and suggesting their administration could restore gut balance by outcompeting pathogens.^[24] Initial experiments in the early 1900s applied these ideas clinically, with Tissier pioneering the use of "bifidus milk"—fermented milk enriched with Bifidobacterium—to treat gastrointestinal disturbances in infants and children, reporting reduced diarrhea incidence through microbial replacement in the gut.^[25] Metchnikoff's collaborators similarly trialed fermented milk for adult digestive and renal issues, observing improved intestinal function.^[23]

Modern Advancements

The term "probiotic" was first introduced in 1953 by German scientist Werner Kollath, who used it to describe certain organic and inorganic dietary factors capable of promoting health and restoring balance in the intestinal flora. This marked an early conceptual shift toward viewing beneficial microbes as therapeutic agents, building on prior observations of fermented foods but formalizing the idea in scientific literature.^[26] During the 1980s and 1990s, probiotics gained traction through international expert consultations and commercial expansion. The Food and Agriculture Organization (FAO) and World Health Organization (WHO) convened panels that culminated in the 2001 definition of probiotics as "live microorganisms which when administered in adequate amounts confer a health benefit on the host," establishing a global standard for identification and evaluation. Concurrently, products like Yakult, originally developed in 1935 with the Lactobacillus casei Shirota strain, saw significant international growth, entering markets such as the United States in 1990 and expanding production facilities worldwide, which popularized probiotic beverages among consumers.^[27] In the 2000s, advancements in genomics revolutionized probiotic research, with the first complete genome sequences of key strains published, such as Lactobacillus plantarum WCFS1 in 2001 and Lactobacillus acidophilus NCFM in 2005, enabling detailed analysis of their genetic mechanisms and safety profiles.^[28]^[29] Regulatory frameworks also evolved, notably with the European Union's Regulation (EC) No 1924/2006, which imposed stringent requirements for substantiating health claims on probiotic products, limiting approvals to those backed by robust clinical evidence and influencing global standards. From the 2010s to 2025, the field progressed toward next-generation probiotics (NGPs), defined as well-characterized, non-traditional microbial strains with targeted therapeutic potential, exemplified by Akkermansia muciniphila, which has shown promise in modulating gut barrier function and metabolic health in preclinical and early clinical studies. Synbiotic formulations, combining probiotics with prebiotics to enhance microbial survival and efficacy, became increasingly prevalent in product development. The global probiotics market expanded rapidly, reaching an estimated $86 billion by 2025, driven by consumer demand for gut health solutions and innovations in delivery formats.^[30] In 2024 and 2025, personalized probiotics emerged as a key innovation, leveraging advances in microbiome sequencing and analysis to tailor strains to individual gut profiles, with early applications in managing inflammatory conditions through precision modulation of microbial communities.^[31] This approach integrates multi-omics data to predict responses, marking a shift from one-size-fits-all supplements to bespoke therapies.

Types of Probiotics

Bacterial Strains

Bacterial strains constitute the majority of probiotics, with Lactobacillus and Bifidobacterium genera being the most prevalent due to their historical use and demonstrated safety in humans.^[32] These strains are typically Gram-positive, lactic acid-producing bacteria selected for their ability to survive gastrointestinal transit and confer health benefits when administered in adequate amounts.^[1] The Lactobacillus genus includes several well-characterized species used in probiotics, valued for their acid tolerance and antimicrobial properties. Lactobacillus acidophilus, for instance, thrives in low-pH environments like the stomach, enabling survival rates of up to 50% after simulated gastric exposure, and produces bacteriocins such as acidophilin that inhibit pathogenic bacteria like Escherichia coli.^[33]^[34] Similarly, Lactobacillus casei exhibits robust acid resistance and contributes to gut microbiota modulation through bacteriocin production.^[35] A prominent example is Lactobacillus rhamnosus GG (ATCC 53103), isolated from the intestinal tract of a healthy human in 1983 by Sherwood Gorbach and Barry Goldin, which has been extensively studied for its adhesion to intestinal cells and production of bacteriocins that support mucosal barrier function.^[36] Bifidobacterium species are anaerobic, Gram-positive rods that predominate in the gut microbiota of breastfed infants, where they can comprise up to 90% of the fecal bacteria.^[37] Bifidobacterium bifidum ferments human milk oligosaccharides and prebiotics like galactooligosaccharides, producing short-chain fatty acids that lower intestinal pH and inhibit pathogens.^[38] Bifidobacterium longum shares these fermentative capabilities, efficiently utilizing prebiotics such as inulin and fructooligosaccharides to promote bifidogenic growth in the colon, and is particularly abundant in infant microbiomes due to its adaptation to early-life carbohydrates.^[39]^[40] Other bacterial genera include Streptococcus thermophilus, a thermophilic lactic acid bacterium commonly paired with Lactobacillus bulgaricus in yogurt fermentation, where it enhances lactose breakdown and exhibits probiotic traits like bile tolerance.^[41] Bacillus subtilis, a spore-forming Gram-positive bacterium, provides exceptional stability in probiotic formulations, as its endospores resist heat, acidity, and desiccation, maintaining viability through manufacturing and storage for up to two years at room temperature.^[42]^[43] Spore-forming Bacillus strains such as B. coagulans and B. clausii are frequently discussed in probiotic contexts due to their unique sporulation, which confers superior resilience to processing, heat, and gastric acid compared to non-spore-forming lactobacilli.^[44] B. coagulans forms lactic acid-producing spores that germinate in the intestine, while B. clausii exhibits immunomodulatory effects and oxygen consumption in the gut, aiding in flora balance.^[45] These gram-positive rods survive manufacturing stresses better, enabling longer shelf life in formulations.^[46] Probiotic efficacy is inherently strain-specific, meaning benefits are linked to precise genetic and phenotypic profiles rather than the species alone; for example, Lactobacillus reuteri DSM 17938 has been shown to reduce crying time in breastfed infants with colic by an average of 50 minutes per day after three weeks of supplementation.^[47]^[48] Research has demonstrated applications for strains like Lactobacillus gasseri, particularly the BNR17 variant, which has shown reductions in body weight and visceral fat in overweight adults through mechanisms involving gut microbiota modulation and fat absorption inhibition.^[49]

Non-Bacterial Strains

Non-bacterial probiotics primarily encompass yeast and fungal strains, which offer distinct advantages over bacterial counterparts due to their resilience in harsh environmental conditions. Saccharomyces boulardii, a subspecies of Saccharomyces cerevisiae, is the most well-established yeast probiotic, first isolated in the 1920s from the peels of lychee and mangosteen fruits by French scientist Henri Boulard during studies on traditional remedies for diarrhea.^[50] This heat-stable strain survives temperatures up to 50°C and maintains viability through gastric acid and bile, making it suitable for oral administration in treating gastrointestinal disturbances.^[51] Other yeasts, such as Kluyveromyces marxianus, have gained recognition for their probiotic potential, particularly in fermented dairy products like certain cheeses where they contribute to flavor development and exhibit antimicrobial properties.^[52] Isolated from sources including artisanal sourdoughs and traditional fermented foods, K. marxianus demonstrates thermotolerance, rapid growth, and the ability to utilize diverse sugars, enhancing its survival in the human gut and potential benefits for lactose-intolerant individuals.^[53] These non-Saccharomyces yeasts often produce extracellular enzymes that support gut microbiota modulation, distinguishing them from more fragile bacterial strains like lactobacilli.^[54] Emerging research as of 2025 highlights engineered fungal probiotics for enhanced targeted delivery, such as genetically modified Saccharomyces boulardii designed to bind intestinal extracellular matrix proteins, improving localization in the gut for precise therapeutic release.^[55] These innovations underscore the growing role of resilient non-bacterial strains in overcoming limitations of traditional probiotics.^[56]

Formulations and Production

Probiotic production typically involves the fermentation of microorganisms in nutrient-rich media under controlled conditions, followed by harvesting via centrifugation or filtration, and subsequent formulation to ensure viability.

Delivery Systems

Probiotics are formulated in various delivery systems to ensure their viability and effective administration, with common formats including capsules, powders, and liquids. Capsules and powders, often produced via freeze-drying, encapsulate dried bacterial cells in moisture-resistant packaging to maintain stability under ambient conditions, targeting doses of 10^9 colony-forming units (CFU) per serving as recommended by regulatory guidelines in regions like Canada and Italy.^[57]^[1] Liquids, such as those in beverages or suspensions, provide an alternative for easier consumption but typically require refrigeration to preserve bacterial integrity, as higher water activity can accelerate viability loss.^[57] Microencapsulation represents a key strategy to protect probiotics from gastrointestinal stressors, particularly stomach acid. Materials like alginate form insoluble hydrogels in acidic environments (pH < 4), shielding encased bacteria during gastric passage, while chitosan coatings add an additional layer of protection by stabilizing the microcapsules against low pH and enzymatic degradation, resulting in up to 1-2 log higher survival rates in simulated digestion compared to free cells.^[58]^[59] Innovations from 2024-2025 have advanced targeted delivery, including nanoencapsulation techniques that achieve over 95% efficiency and enhance gastric survival by 1.4 log CFU/mL for strains like Lactiplantibacillus plantarum. Double emulsions using biopolymers enable pH-responsive release in the intestines, improving viability under gastrointestinal conditions compared to free cells. Aerosol delivery via nebulizers or dry powder inhalers is also emerging for respiratory applications, allowing direct lung deposition of probiotics like Lacticaseibacillus rhamnosus GG to modulate airway microbiota, with particle sizes of 4–5.5 μm achieving fine-particle fractions up to 20.5%, suitable for lung delivery.^[60]^[61]^[62] Synbiotics integrate probiotics with prebiotics like inulin to boost survival, as inulin serves as a fermentable substrate that lowers colonic pH through short-chain fatty acid production, promoting bacterial implantation and growth while overcoming transit-related viability challenges.^[63] Overall, these systems prioritize maintaining probiotic viability above 10^6 CFU/g at the end of shelf life, a threshold established by international standards to guarantee therapeutic benefits upon consumption.^[64]

Stability and Encapsulation

Probiotics exhibit high sensitivity to environmental stressors, including heat, oxygen, and pH fluctuations, which compromise their viability during manufacturing, storage, and passage through the gastrointestinal tract. Non-encapsulated strains can lose 3–4 log CFU/g under these conditions, with heat from processes like spray drying causing rapid cell membrane damage and oxygen exposure leading to oxidative stress that reduces metabolic activity. Acidic pH in the stomach further exacerbates losses, often resulting in 1–2 log CFU reductions during simulated gastric transit due to proton influx and enzyme degradation.^[65]^[66] Optimal storage conditions emphasize refrigeration at 4°C to preserve cell integrity, as this temperature minimizes metabolic slowdown and extends shelf life, with strains like Lactobacillus plantarum maintaining 9.15 log CFU/g viability for up to 90 days. Room temperature storage (around 20–25°C), however, accelerates viability decline, potentially halving counts within weeks due to increased enzymatic activity and desiccation. Spore-forming probiotics, such as Bacillus subtilis, offer greater resilience, retaining stability at ambient temperatures through their dormant endospores, which resist dehydration and thermal stress.^[67]^[67] Encapsulation techniques address these challenges by creating protective barriers around probiotic cells. Spray drying, which involves atomizing a probiotic suspension into hot air streams (inlet temperatures of 110–160°C), achieves high survival rates when combined with cryoprotectants like trehalose or maltodextrin, forming microcapsules that shield against heat and oxygen. Complex coacervation, utilizing electrostatic interactions between polymers such as whey protein and gum arabic, encapsulates cells with improved viability, enhancing acid tolerance during gastric exposure. Recent innovations in nanocellulose-based encapsulation have demonstrated improved survival rates in simulated gastrointestinal conditions by forming nanofibril networks that control release and prevent aggregation.^[68]^[68]^[68] As of 2025, advancements include hydrogel matrices incorporating probiotics for targeted applications like wound healing, where Lactobacillus paracasei-embedded gels maintain microbial stability while promoting angiogenesis and reducing inflammation in rat models. Viability in these formulations is routinely assessed via plate count methods, which involve serial dilution and incubation on selective agar to enumerate colony-forming units (CFU), adhering to standards like ISO 29981 for accurate quantification of culturable cells. In multi-strain formulations, interspecies interactions—such as quorum sensing synergies or antagonistic bacteriocin production—can influence overall stability, potentially reducing efficacy by 1–2 log CFU if strains like L. plantarum inhibit companions; proper screening and balanced ratios during formulation mitigate these effects.^[69]^[70]^[71]

Sources

Fermented Foods

Fermented foods have played a significant historical role in promoting gut health, with empirical observations of benefits such as improved digestion and reduced gastrointestinal ailments dating back to ancient civilizations, including the use of yogurt-like products in early 20th-century studies linking them to better intestinal flora balance.^[72] Traditional fermentation processes relied on naturally occurring microorganisms to preserve food and inadvertently support microbial diversity in the human gut, as evidenced by longstanding cultural practices across Asia, Europe, and Africa.^[73] Among dairy-based fermented foods, yogurt stands out as a primary probiotic source, produced through the fermentation of milk by Lactobacillus delbrueckii subsp. bulgaricus and Streptococcus thermophilus, which must contain at least 10^6 colony-forming units (CFU) per gram of live cultures to qualify as containing active probiotics.^[74] This symbiotic bacterial interaction during production enhances lactose breakdown and generates bioactive compounds that aid gut colonization.^[75] Similarly, kefir is crafted from milk fermented with a complex consortium of lactic acid bacteria, yeasts, and acetic acid bacteria—often comprising up to 61 strains—forming a symbiotic matrix that yields a tangy, effervescent beverage rich in viable probiotics.^[76]^[77] Non-dairy fermented foods provide accessible probiotic options, particularly for those avoiding animal products. Sauerkraut, made by lacto-fermenting cabbage, features early dominance by Leuconostoc mesenteroides strains that initiate acidification and pave the way for subsequent Lactobacillus species, contributing to its tangy profile and microbial benefits.^[78] Kimchi, a Korean staple of fermented vegetables like cabbage and radish, is enriched with Lactobacillus strains such as L. plantarum, which thrive during the anaerobic process and exhibit robust survival in gastrointestinal conditions.^[79] Miso, a Japanese paste from fermented soybeans, involves initial saccharification by Aspergillus oryzae mold followed by bacterial fermentation with lactic acid producers like Lactobacillus and Tetragenococcus, yielding a umami-rich product with probiotic potential when unpasteurized.^[80] For a food to qualify as probiotic, it must contain live, viable cultures at sufficient levels—generally at least 10^6 to 10^7 CFU per gram at consumption—to exert health effects, as viability is essential for microbial activity in the gut.^[81] Pasteurization, while extending shelf life, eliminates these live bacteria by heating, rendering the product non-probiotic despite retained flavor or nutrients.^[82] Recent trends from 2024 to 2025 highlight the rise of plant-based fermented alternatives, such as oat and soy yogurts fortified with added probiotic strains like Lactobacillus and Bifidobacterium, catering to vegan consumers and projected to drive market growth through enhanced nutritional profiles and sustainability.^[83] These innovations maintain traditional fermentation principles while adapting to dietary preferences, often achieving comparable CFU levels to dairy counterparts.^[84]

Dietary Supplements

Dietary supplements containing probiotics are commercially available in various forms, including tablets, capsules, powders, and gummies, which allow for convenient consumption and targeted delivery of live microorganisms. These products often feature multi-strain formulations, typically incorporating 5 to 10 different bacterial species such as Lactobacillus and Bifidobacterium, to provide a broader spectrum of potential benefits compared to single-strain options.^[85]^[86]^[87] The composition of probiotic supplements is standardized by labeling colony-forming units (CFU), with most products specifying 1 to 50 billion CFU per serving to indicate the viable bacterial count at the time of manufacture. Many formulations also include added prebiotics, such as inulin or fructooligosaccharides, to support bacterial growth, along with vitamins like B12 or D for enhanced nutritional value.^[1]^[88] The global market for probiotic dietary supplements reached approximately USD 13.3 billion in 2025, driven by increasing consumer awareness of gut health and demand for immune support products. Key players in this sector include Nestlé, Danone, and Procter & Gamble, which invest heavily in research and strain-specific innovations to capture market share.^[89]^[90]^[91] Probiotic supplements offer advantages over fermented food sources, such as delivering higher, more consistent doses of specific strains and enabling customization for particular health needs. However, a notable disadvantage is their variable quality, as supplements are not as rigorously regulated as pharmaceuticals, potentially leading to inconsistencies in viability and potency.^[92]^[93] Recent advancements include personalized probiotic supplements, developed from 2024 onward, which use at-home gut microbiome testing to tailor formulations to an individual's microbial profile for optimized efficacy.^[94]^[95]

Consumption and Dosage

Recommended Dosages

Recommended dosages for probiotics lack a universal recommended daily allowance (RDA), as effective intake varies by bacterial strain, targeted health condition, and individual factors rather than a one-size-fits-all standard.^[1] Instead, guidelines emphasize strain-specific dosing derived from clinical trials demonstrating benefits.^[96] For adults, the general range is 10⁸ to 10¹⁰ colony-forming units (CFU) per day, with many over-the-counter supplements providing 1 to 10 billion CFU per dose.^[1] ^[96] Strain-specific examples include Lactobacillus rhamnosus GG at 10⁹ CFU per day, which has shown efficacy in supporting gut health based on viability and colonization studies.^[1] These dosages are calculated to ensure sufficient live microbes survive gastric transit and reach the intestines for potential colonization, as determined by in vitro and human viability assessments.^[96] Duration of probiotic intake depends on the purpose, with 1 to 4 weeks commonly recommended for addressing acute issues like transient digestive discomfort, while chronic conditions may require ongoing use for months under medical supervision.^[1] The 2023 World Gastroenterology Organisation (WGO) guidelines highlight that effective durations align with those proven in randomized controlled trials, avoiding arbitrary extensions.^[96] Exceeding recommended doses offers minimal additional benefits and is generally unnecessary, though risks remain low in healthy individuals.^[96] Dosage should be adjusted based on age, health status, and vulnerability; for example, infants and immunocompromised individuals require lower starting doses to minimize any potential imbalance in gut microbiota.^[1] The 2023 European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) position paper specifies doses of 5 × 10⁹ CFU per day or higher for select pediatric strains, underscoring the need for tailored approaches across life stages.^[1] Overall, these evidence-based parameters from WGO and ESPGHAN prioritize safety and efficacy without overgeneralization.^[96] ^[1]

Administration Methods

Probiotics are primarily administered orally, through capsules, powders, or fortified foods, allowing the microorganisms to transit through the gastrointestinal tract where they can interact with the host microbiome.^[1] Emerging delivery methods include nasal sprays and aerosols, particularly for targeting respiratory health; for instance, Bacillus spore probiotics delivered via nasal spray have shown potential in preventing pneumonia in children by localizing beneficial bacteria in the upper airways.^[97] To optimize survival during gastric transit, probiotics are often recommended to be taken with meals, as food can buffer stomach acid and raise gastric pH, reducing exposure to the low pH environment that may inactivate sensitive strains.^[98] Conversely, hot beverages or foods should be avoided immediately after consumption, as temperatures above 40–50°C can kill live microbial cells, compromising viability.^[99] Interactions with other substances can influence probiotic efficacy; antibiotics may reduce viability by targeting both pathogenic and beneficial bacteria, so administration should be spaced at least 2 hours apart to minimize interference.^[100] Dietary fiber, acting as a prebiotic, can enhance probiotic effects by providing substrates for microbial growth and improving colonization in the gut.^[101] For compliance, non-spore-forming probiotics require refrigeration at 2–8°C to maintain viability over time, as elevated temperatures accelerate cell death in vegetative strains, whereas spore-formers are more stable at room temperature.^[102] Daily intake is generally advised for sustained benefits, though intermittent dosing may suffice for specific applications, depending on the strain and health goal.^[92] In infants, probiotics are commonly delivered via oral drops mixed with breast milk or formula, facilitating safe administration from birth; breastfeeding mothers may also consume probiotics, potentially transferring benefits through milk oligosaccharides that support microbial growth.^[103]

Mechanisms of Action

Core Mechanisms

Probiotics exert their beneficial effects through several core mechanisms at the cellular and physiological levels, primarily within the gastrointestinal tract. These mechanisms include enhancing the intestinal barrier, antimicrobial actions against pathogens, modulation of the immune response, competition for adhesion sites, and emerging evidence of epigenetic modifications. These processes are strain-specific, with variations in efficacy depending on the probiotic species and individual host factors.^[9] One key mechanism is the enhancement of the intestinal barrier function. Probiotic bacteria, such as certain strains of Lactobacillus and Bifidobacterium, ferment dietary fibers to produce short-chain fatty acids (SCFAs), including butyrate, which serve as primary energy sources for colonocytes. Butyrate promotes the expression of tight junction proteins like zonula occludens-1 (ZO-1) and occludin, thereby strengthening the gut mucosa and reducing permeability to harmful substances. This barrier reinforcement helps prevent the translocation of pathogens and toxins into the bloodstream.^[104]^[105] Probiotics also demonstrate antimicrobial actions by producing inhibitory compounds. They secrete bacteriocins, which are ribosomally synthesized antimicrobial peptides that target and disrupt the cell membranes of pathogenic bacteria such as Escherichia coli and Salmonella. Additionally, probiotics generate organic acids like lactic acid, which lower the intestinal pH, creating an acidic environment unfavorable for pathogen growth and survival. These actions collectively inhibit pathogen colonization and proliferation in the gut.^[106]^[9] Immune modulation represents another fundamental mechanism, where probiotics interact directly with immune cells in the gut-associated lymphoid tissue. They stimulate the production of anti-inflammatory cytokines, such as interleukin-10 (IL-10), which dampens excessive immune responses and promotes tolerance. Probiotics also influence T-cell regulation, enhancing the differentiation and activity of regulatory T-cells (Tregs) that maintain immune homeostasis and suppress pro-inflammatory pathways. This modulation helps balance Th1/Th2 responses without overstimulating the immune system.^[107]^[108] Through adhesion, probiotics compete with pathogens for binding sites on epithelial cells. Probiotic strains adhere to mucus layers and host cell receptors via surface proteins, such as pili and adhesins, thereby occupying sites that would otherwise be available to harmful bacteria. This competitive exclusion limits pathogen attachment and invasion of the intestinal epithelium.^[106]^[109] Recent research as of 2025 highlights probiotics' role in inducing epigenetic changes, particularly through histone modifications. SCFAs like butyrate, produced by probiotics, act as histone deacetylase (HDAC) inhibitors, leading to increased histone acetylation and altered gene expression in intestinal cells. These modifications enhance anti-inflammatory pathways and barrier gene transcription, offering a novel layer of probiotic influence on host physiology.^[110]^[111]

Microbiome Interactions

Probiotics exert a profound influence on the gut microbiota by modulating its composition, particularly through the enhancement of beneficial bacterial taxa and the alleviation of dysbiosis. Strains such as Lactobacillus and Bifidobacterium species have been shown to increase the relative abundance of beneficial microbes, including Bifidobacterium, in certain models of high-fat diet-induced dysbiosis, thereby restoring microbial balance and reducing the proliferation of pathogenic bacteria like Klebsiella pneumoniae. This modulation helps counteract dysbiosis, a state of microbial imbalance associated with various health conditions, by competitively excluding harmful taxa and promoting a more stable ecosystem. For instance, administration of multi-strain probiotics in obese individuals has been observed to reverse dysbiotic patterns, leading to decreased inflammation and improved gut barrier integrity.^[112]^[113]^[114] Regarding microbial diversity, probiotics typically achieve transient colonization of the gut, lasting from days to weeks, rather than permanent engraftment, which allows them to temporarily bolster the resident community without displacing it. This short-term presence promotes the growth of short-chain fatty acid (SCFA)-producing bacteria, such as certain Bifidobacterium and Faecalibacterium species, enhancing the production of metabolites like acetate, propionate, and butyrate that support epithelial health and immune regulation. Studies indicate that lactic acid bacteria in probiotics stimulate the intrinsic expansion of these SCFA producers, contributing to overall microbiota resilience without long-term dominance.^[115]^[116]^[117] Probiotics also interact with the gut-brain axis, influencing neurological functions through microbial signaling pathways. Via the vagus nerve, probiotic-derived metabolites can modulate serotonin production, as strains like Lactobacillus and Bifidobacterium enhance tryptophan metabolism, leading to increased serotonin synthesis in the gut, which constitutes about 90% of the body's total serotonin. This bidirectional communication helps regulate mood and stress responses by altering neurotransmitter availability.^[118]^[119] Recent metagenomic studies from 2024 and 2025 underscore the strain-specific nature of probiotic-induced shifts in the microbiome, revealing targeted alterations in community structure that vary by individual baseline microbiota. For example, precision interventions combining metagenomic profiling with strain-specific probiotics have demonstrated significant enhancements in microbial diversity and function in non-alcoholic fatty liver disease patients, highlighting personalized efficacy. In post-antibiotic recovery, probiotics aid in restoring microbiota composition by preserving diversity and accelerating the rebound of beneficial taxa, though effects differ by strain—some accelerate recovery while others may delay it, emphasizing the need for tailored selection to minimize disruptions.^[120]^[121]^[122] A key aspect of probiotic function involves cross-feeding interactions with resident microbes, which underpin synbiotic effects when combined with prebiotics. Probiotic strains release metabolites that nourish commensal bacteria, fostering mutualistic networks; for instance, Bifidobacterium-derived acetate can be utilized by butyrate producers like Faecalibacterium prausnitzii, amplifying SCFA output and enhancing overall community stability. This cross-feeding promotes synbiotic synergy, where prebiotics selectively stimulate probiotic growth, leading to amplified benefits for host health through improved microbial homeostasis.^[123]^[124]

Clinical Applications and Research

Gastrointestinal Disorders

Probiotics have demonstrated efficacy in managing various gastrointestinal disorders, particularly through strain-specific interventions supported by clinical trials and meta-analyses. In the context of antibiotic-associated diarrhea (AAD), strains such as Saccharomyces boulardii and Lactobacillus rhamnosus GG (LGG) have been shown to significantly reduce incidence and duration. Reviews and meta-analyses, including those cited in a 2024 article, indicate that these probiotics lower AAD risk by approximately 48-60% in both adults and children, with S. boulardii exhibiting strain-specific benefits in preventing antibiotic-induced disruptions to the gut microbiota.^[125]^[126]^[127] For infectious diarrhea, particularly rotavirus-related cases in children, Lactobacillus reuteri DSM 17938 at doses around 10^8-10^9 colony-forming units (CFU) per day has preventive and therapeutic effects. A 2023 meta-analysis indicated that supplementation with this strain shortens diarrhea duration by 0.5-1 day and reduces stool frequency, aiding in the management of acute gastroenteritis including rotavirus infections.^[128]^[129] In irritable bowel syndrome (IBS), multi-strain probiotics targeting symptoms like bloating and abdominal pain show promising results, especially in trials using Rome IV diagnostic criteria. A 2024 meta-analysis of randomized controlled trials reported symptom improvement in up to 70% of patients, with multi-strain formulations (e.g., combinations of Lactobacillus and Bifidobacterium species) reducing global IBS severity scores by 20-30% compared to placebo, though evidence certainty remains moderate.^[130]^[131] For inflammatory bowel disease (IBD), including Crohn's disease and ulcerative colitis (UC), the multi-strain probiotic VSL#3 supports remission maintenance. Clinical studies demonstrate that VSL#3 at high doses (e.g., 3.6 × 10^12 CFU/day) helps sustain endoscopic remission in mild-to-moderate UC, with reductions in markers of inflammation such as fecal calprotectin.^[132]^[133] Other applications include adjunctive use in Helicobacter pylori eradication and prevention of necrotizing enterocolitis (NEC) in preterm infants. L. reuteri supplementation alongside standard triple therapy improves eradication rates by 10-15% and reduces side effects like diarrhea, as per a 2024 meta-analysis of 12 trials. For NEC, a 2025 large-scale study of over 32,000 preterm infants found no significant reduction in incidence with multi-strain probiotics such as Bifidobacterium and Lactobacillus combinations (aOR 0.92, 98.3% CI: 0.78–1.09), though it was associated with reduced mortality without increasing sepsis risk; earlier meta-analyses had suggested benefits, highlighting ongoing debate.^[134]^[135]^[103]

Immune Function and Infections

Probiotics have been shown to enhance general immune function by promoting the production of immunoglobulin A (IgA), a key antibody in mucosal immunity that helps protect against pathogens at entry points such as the respiratory and urogenital tracts.^[136] Specific strains, including those from the Lactobacillus genus, stimulate B cells in the gut-associated lymphoid tissue to increase secretory IgA levels, thereby strengthening barrier defenses without overactivating systemic inflammation.^[137] This immunomodulatory effect contributes to reduced susceptibility to extra-intestinal infections. In the context of upper respiratory tract infections (URTIs), supplementation with Lactobacillus casei strains, such as Shirota, has demonstrated efficacy in lowering incidence and duration among healthy adults and children. A meta-analysis of randomized controlled trials reported a relative risk (RR) of 0.83 for URTI occurrence with probiotic fermented dairy products containing L. casei, corresponding to approximately a 17% reduction, with greater benefits observed in subgroups like the elderly.^[138] Broader probiotic use, including L. casei, has been associated with symptom reductions of up to 27% in self-reported URTI severity, particularly in individuals over 45 years or with higher body mass index.^[139] For allergies, early-life exposure to Lactobacillus rhamnosus during the perinatal period significantly lowers the risk of eczema in infants. A 2022 systematic review and meta-analysis of randomized trials, updated with 2024 data, found an RR of 0.60 (95% CI: 0.47–0.75) for atopic eczema incidence up to age 2 years, with sustained effects to 6–7 years (RR: 0.62, 95% CI: 0.50–0.75), attributed to modulation of Th1/Th2 immune balance and reduced allergen sensitization.^[140] Probiotics also reduce the recurrence of acute otitis media (AOM) in children, with Bifidobacterium lactis Bb-12 playing a notable role. In a randomized, double-blind, placebo-controlled trial of formula-fed infants, daily supplementation with B. lactis Bb-12 combined with L. rhamnosus GG decreased AOM incidence from 50% in the placebo group to 22% in the probiotic group (RR: 0.44, 95% CI: 0.21–0.90), alongside lower antibiotic needs.^[141] This protective effect is linked to enhanced nasopharyngeal microbiota stability and reduced pathogen adhesion. In urinary tract infections (UTIs), Lactobacillus rhamnosus GR-1 supports vaginal recolonization to prevent cystitis, particularly in women prone to recurrence. Oral or vaginal administration of L. rhamnosus GR-1, often with L. reuteri RC-14, restores lactobacilli dominance in the vaginal microbiome, inhibiting uropathogen adhesion and reducing UTI episodes by competing for epithelial sites and producing antimicrobial compounds like lactic acid.^[142] Clinical evidence indicates this approach lowers recurrence rates by up to 50% compared to placebo in randomized trials.^[143] As of 2025, emerging research highlights probiotics' role in modulating respiratory sequelae post-COVID-19 infection. Probiotic strains such as Lactobacillus and Bifidobacterium species help restore gut microbiota dysbiosis associated with long COVID, alleviating persistent respiratory symptoms like dyspnea through anti-inflammatory cytokine regulation and immune normalization.^[144] Additionally, probiotics serve as vaccine adjuvants by enhancing mucosal and systemic antibody responses; for instance, Lactobacillus supplementation improves influenza and COVID-19 vaccine efficacy by boosting IgA production and T-cell activation, with meta-analyses showing up to 20% higher seroconversion rates in supplemented groups.^[145]

Metabolic and Cardiovascular Health

Probiotics have shown potential in modulating metabolic and cardiovascular health through interactions with the gut microbiota, influencing lipid metabolism, glycemic control, blood pressure regulation, and body weight management. Specific strains, such as Lactobacillus acidophilus, Lactobacillus helveticus, Akkermansia muciniphila, and Lactobacillus gasseri, have been investigated in clinical trials and meta-analyses for their targeted effects on components of metabolic syndrome. These benefits are often linked to alterations in gut-derived metabolites and hormones, contributing to reduced cardiovascular disease (CVD) risk factors like dyslipidemia, hypertension, insulin resistance, and obesity. Recent research, including 2025 updates, highlights emerging roles in lowering trimethylamine N-oxide (TMAO) levels and improving non-alcoholic fatty liver disease (NAFLD) outcomes via synbiotics. In lipid metabolism, Lactobacillus acidophilus supplementation has been associated with reductions in low-density lipoprotein (LDL) cholesterol levels by approximately 5-10% in hypercholesterolemic individuals, primarily through the production of bile salt hydrolase enzymes that promote bile acid deconjugation and increased fecal excretion of cholesterol.^[146]^[147] This mechanism enhances hepatic cholesterol conversion to bile acids, thereby lowering circulating LDL without significantly affecting high-density lipoprotein (HDL) cholesterol in most studies. Meta-analyses of randomized controlled trials confirm these effects are more pronounced in patients with baseline elevations in total cholesterol.^[146] Probiotics also contribute to blood pressure management, with Lactobacillus helveticus-containing formulations demonstrating modest reductions in systolic blood pressure by 3-5 mmHg among hypertensive adults.^[148] A 2024 meta-analysis of 26 trials involving over 1,600 participants reported that probiotic interventions, including L. helveticus strains, significantly lowered office systolic blood pressure, with greater effects observed in those with elevated baseline values (>130 mmHg).^[149] These changes are attributed to enhanced production of bioactive peptides from fermented dairy and improvements in endothelial function, though diastolic pressure reductions are typically smaller (1-2 mmHg).^[150] For glycemic control in type 2 diabetes, supplementation with Akkermansia muciniphila has improved insulin sensitivity, as evidenced by a 12-week randomized trial in overweight patients showing enhanced glucose homeostasis, though HbA1c levels were not significantly changed. This next-generation probiotic strengthens the gut mucosal barrier and modulates inflammatory pathways, leading to better insulin signaling in metabolic tissues; pasteurized forms were equally effective and well-tolerated.^[151] Earlier studies corroborate these findings, with daily doses of 10^10 bacteria improving insulin resistance indices without adverse gastrointestinal effects.^[151] Regarding obesity and weight management, Lactobacillus gasseri strains, such as BNR17 and SBT2055, have reduced body mass index (BMI) by 1-2 points in overweight and obese individuals over 12 weeks, alongside decreases in visceral fat and waist circumference.^[152]^[153] These effects involve modulation of gut hormones, including increased glucagon-like peptide-1 (GLP-1) secretion, which promotes satiety and inhibits appetite, as well as reductions in serum leptin and insulin levels.^[154] Clinical trials indicate these changes are sustained with consistent dosing and are more effective when combined with dietary interventions.^[152] As of 2025, emerging evidence supports probiotics' role in CVD risk reduction by lowering TMAO, a gut-derived metabolite linked to atherosclerosis and thrombosis; interventions with strains like Bifidobacterium and Lactobacillus plantarum decreased serum TMAO by up to 20% in high-risk patients, potentially mitigating plaque formation.^[155]^[156] Similarly, synbiotic combinations (probiotics plus prebiotics) have shown benefits in NAFLD management, with a 2025 meta-analysis reporting improvements in liver enzymes, insulin resistance, and hepatic fat content across multiple randomized trials, though effects on blood pressure and lipids were inconsistent.^[157] These microbiome shifts in metabolism parallel broader interactions detailed elsewhere.^[158]

Mental Health and Neurological Conditions

Probiotics have shown potential in modulating mental health and neurological conditions primarily through the gut-brain axis, a bidirectional communication pathway linking the gastrointestinal microbiome to central nervous system function. This axis influences neurotransmitter production, immune responses, and neural signaling, with dysbiosis implicated in disorders such as depression, anxiety, autism spectrum disorder (ASD), attention-deficit/hyperactivity disorder (ADHD), post-traumatic stress disorder (PTSD), and post-stroke recovery.^[159] Emerging research highlights specific probiotic strains that may alleviate symptoms by restoring microbial balance and mitigating neuroinflammation. In clinical trials for depression and anxiety, the combination of Lactobacillus helveticus R0052 and Bifidobacterium longum R0175 has demonstrated efficacy in reducing symptoms. A randomized controlled trial reported a 25% reduction in total scores on the Hospital Anxiety and Depression Scale (HADS) after 30 days of supplementation in healthy volunteers experiencing psychological stress.^[160] A 2024 meta-analysis of multiple studies confirmed substantial reductions in depression symptoms (effect size ≈0.6) and moderate improvements in anxiety, particularly with multi-strain formulations including these species, though effects were more pronounced in individuals with baseline mild-to-moderate symptoms.^[161] These probiotics exert effects via the gut-brain axis by enhancing production of key neurotransmitters and curbing inflammation. Supplementation increases central levels of gamma-aminobutyric acid (GABA) and serotonin, which regulate mood and stress responses, while decreasing peripheral inflammatory markers such as C-reactive protein (CRP).^[162] For instance, L. helveticus and B. longum strains have been shown to elevate serotonin synthesis in the gut, with downstream signaling to the brain reducing anxiety-like behaviors in preclinical models.^[163] Concurrently, they lower CRP by modulating gut permeability and systemic immune activation, thereby attenuating neuroinflammatory pathways linked to mood disorders.^[164] For neurodevelopmental conditions like ASD and ADHD, Bacteroides fragilis has emerged as a promising strain. In animal models of ASD, oral administration of B. fragilis improved social behaviors, reduced repetitive actions, and restored gut barrier integrity, effects attributed to decreased gut-derived toxins reaching the brain.^[165] Human pilot studies support these findings; a 2024 randomized, double-blind trial in children with ASD found that B. fragilis BF839 supplementation for 12 weeks significantly improved core behavioral symptoms on the Autism Behavior Checklist, with no adverse effects reported.^[166] Preliminary evidence in ADHD suggests similar microbiome-targeted interventions may address associated gut dysbiosis, though strain-specific data remain limited.^[167] Recent advancements as of 2025 explore probiotics in neurological recovery contexts. For post-stroke rehabilitation, multi-strain probiotics including Lactobacillus and Bifidobacterium species have reduced infection incidence and enhanced functional outcomes in clinical trials, with a ongoing study evaluating impacts on quality of life and anxiety in stroke survivors.^[168]^[169] In PTSD, personalized probiotic formulations tailored to individual microbiome profiles show promise; a 2024 trial in combat trauma patients demonstrated symptom relief through targeted restoration of beneficial taxa, reducing anxiety and depression via gut-brain modulation.^[170] Animal models further indicate that probiotics increase beneficial microbiota abundance, alleviating PTSD-like fear responses.^[171] Overall, evidence for probiotics in mental health and neurological conditions is promising yet mixed, with consistent benefits in smaller trials but variability across populations and strains. Larger randomized controlled trials are essential to establish optimal dosing, long-term efficacy, and mechanisms beyond the gut-brain axis.^[172]^[173]

Dermatological and Other Conditions

Probiotics have shown potential in managing various dermatological conditions, particularly atopic dermatitis and eczema. Oral administration of Lactobacillus rhamnosus strains, often in combination with other lactobacilli, has been associated with significant reductions in disease severity. In a randomized controlled trial involving children and adolescents with atopic dermatitis, a probiotic mixture including L. rhamnosus HN001 led to a mean SCORAD reduction of approximately 28 percentage points compared to placebo, with effects persisting up to three months post-treatment.^[174] Topical applications of L. rhamnosus have also demonstrated efficacy, serving as adjuncts to standard therapies by modulating local immune responses and reducing inflammation, though larger studies are needed to confirm optimal formulations.^[175] Emerging research supports the use of probiotics for ocular conditions such as dry eye syndrome. Recent 2024 clinical trials indicate that eye drop formulations containing Lactobacillus plantarum improve symptoms by enhancing tear production and reducing ocular surface damage. Two randomized controlled trials specifically highlighted the superiority of probiotic eye drops over oral administration alone in alleviating dryness and discomfort, with measurable improvements in tear break-up time and Schirmer's test scores.^[176] In reproductive health, probiotics play a role in mitigating risks during pregnancy and treating vaginal dysbiosis. Supplementation with multi-strain probiotics, including Lactobacillus species, has been linked to a 27% reduction in gestational diabetes risk among pregnant women, particularly those under 30 years with lower BMI, by improving glycemic control and metabolic parameters.^[177] Vaginal probiotics during pregnancy show promise in preventing bacterial vaginosis (BV), with studies demonstrating a trend toward restored normal microbiota and reduced preterm delivery risk in women with intermediate vaginal flora.^[178] For established BV, Lactobacillus crispatus strains effectively restore vaginal flora post-treatment, increasing the proportion of healthy Nugent scores and supporting long-term microbial balance, even when administered orally alongside antibiotics.^[179] Beyond these areas, probiotics address miscellaneous conditions like recurrent abdominal pain in children and wound healing. In pediatric populations, probiotic interventions increase the odds of pain improvement by 63% in the short term compared to placebo, with strains such as Lactobacillus reuteri showing sustained benefits in functional abdominal disorders.^[180] For wound healing, 2025 innovations include chitosan-based hydrogels incorporating metabolites from Lactiplantibacillus plantarum, which accelerate burn and diabetic wound closure by up to 90% through antibacterial activity and enhanced tissue regeneration. Injectable living hydrogels with embedded L. plantarum further combat infections by reducing bacterial loads by 3-7 logs while promoting fibroblast compatibility.^[181]^[182]

Oncology Applications

Probiotics have garnered attention in oncology for their potential roles in cancer prevention, adjunctive therapy during treatment, and management of therapy-related side effects. Research indicates that certain probiotic strains can influence carcinogenesis and tumor progression by modulating the gut microbiota and producing bioactive metabolites that inhibit malignant cell growth. In preventive contexts, Lactobacillus acidophilus has been shown to reduce the risk of colorectal cancer through the generation of anti-carcinogenic short-chain fatty acids and other metabolites that suppress tumor initiation in preclinical models.^[183] During chemotherapy, probiotics offer supportive benefits, particularly in mitigating gastrointestinal toxicities. For instance, administration of probiotic consortia has been associated with a reduction in irinotecan-induced diarrhea by decreasing intestinal β-glucuronidase activity, which otherwise reactivates the drug's toxic metabolites; phase II trials reported up to a 20% decrease in moderate-to-severe diarrhea incidence compared to placebo.^[184] Similarly, probiotics can enhance the efficacy of immunotherapy agents like PD-1 inhibitors. Strains such as Bifidobacterium species promote dendritic cell maturation and T-cell activation in the tumor microenvironment, leading to improved response rates in preclinical and early-phase human studies of colorectal and other solid tumors.^[185]^[186] Emerging innovations as of 2025 highlight targeted delivery approaches. Aerosolized probiotics have demonstrated promise in preclinical lung cancer models by altering pulmonary microbiota to boost anti-tumor immunosurveillance and reduce metastatic burden in the lungs, with studies showing enhanced infiltration of cytotoxic T cells following intranasal administration.^[187] In breast cancer models, Bifidobacterium breve engineered strains have inhibited HER2-positive tumor growth both in vitro and in vivo by colonizing tumor sites and eliciting localized immune responses, marking a shift toward strain-specific, tumor-homing probiotics.^[188] At the mechanistic level, probiotics exert anti-oncogenic effects by inducing apoptosis in cancer cells through activation of intrinsic pathways involving caspase-3 and Bcl-2 modulation, as observed in gastric and colorectal cancer cell lines. They also remodel the tumor microenvironment by reducing immunosuppressive regulatory T cells and myeloid-derived suppressor cells while promoting pro-inflammatory cytokine profiles that favor anti-tumor immunity.^[189]^[190] Preclinical evidence is robust, with consistent demonstrations of tumor growth inhibition across models, but human data remain preliminary. Ongoing phase II and III trials, including those evaluating multi-strain probiotics alongside chemotherapy or immunotherapy, report symptom reductions such as 15-25% lower rates of treatment-related diarrhea and fatigue, alongside trends toward prolonged progression-free survival; however, larger randomized studies are needed to confirm efficacy and optimal strains.^[191]^[192]

Safety Profile

Adverse Effects

Probiotics are generally well-tolerated in healthy individuals, with the most common adverse effects being mild gastrointestinal symptoms such as bloating and gas. These effects typically occur in approximately 5-10% of users and resolve within a few days as the body adjusts to the microbial introduction.^[1] Rare but more serious adverse effects include systemic infections, such as bacteremia or fungemia, primarily observed in immunocompromised patients. The incidence of such infections is extremely low, estimated at less than 1 case per 1 million doses in the general population, though risks may increase in vulnerable groups due to translocation of probiotic strains from the gut.^[193] Allergic reactions to probiotics are uncommon, but they can occur with yeast-based strains like Saccharomyces boulardii, manifesting as skin rashes or anaphylaxis in sensitized individuals. Such events are documented in isolated case reports and affect a very small fraction of users.^[194] As of 2025, extensive reviews confirm no significant long-term risks associated with probiotic use in healthy adults, with studies showing sustained safety over periods exceeding one year. The potential for antibiotic resistance gene transfer from probiotics to pathogenic bacteria remains minimal in clinical settings, supported by regulatory assessments and surveillance data.^[1]^[195] Adverse events related to probiotics can be reported through the FDA's MedWatch program, which facilitates post-market surveillance of dietary supplements.^[196]

Special Populations

In infants, particularly preterm neonates, administration of multi-strain probiotics has been associated with a reduced incidence of necrotizing enterocolitis (NEC) and all-cause mortality in very low birth weight infants, though ongoing monitoring for potential sepsis is recommended due to rare reports of probiotic-related bacteremia in vulnerable neonates.^[197]^[198] As of 2023, the U.S. Food and Drug Administration (FDA) has warned against the use of certain unregulated probiotic products in hospitalized preterm infants due to contamination risks leading to severe infections, including sepsis and deaths.^[199] In 2025, the American Academy of Pediatrics (AAP) reviewed evidence indicating that probiotics can reduce NEC and mortality in preterm infants when using high-quality, regulated preparations, with benefits generally outweighing risks in controlled settings.^[200] For the elderly, probiotics may require adjusted lower dosing regimens when addressing conditions like irritable bowel syndrome (IBS), as age-related changes in gut motility and microbiota diversity can influence efficacy and absorption.^[201] In frail older adults, the benefits of probiotics in modulating gut microbiota and reducing inflammation generally outweigh potential risks, with studies showing improvements in immune function and cognitive health without significant adverse events.^[202]^[203] During pregnancy, certain probiotic strains, such as various Lactobacillus species, are considered safe for maternal use based on available studies and have been linked to a reduced risk of spontaneous preterm delivery when consumed habitually through dairy products.^[204] These strains support vaginal and gut microbiota balance, potentially mitigating preterm birth risks associated with bacterial vaginosis, though supplementation should align with individual health assessments.^[205] In immunocompromised individuals, Saccharomyces boulardii should be avoided due to documented risks of fungemia and severe infections, particularly in those with central venous catheters or critical illness.^[206]^[207] Spore-forming probiotics, such as Bacillus licheniformis, warrant cautious use in this population, as they have been implicated in bloodstream infections among those with compromised intestinal barriers.^[208] As of 2025, emerging research highlights tailored probiotic interventions targeting HIV-associated gut dysbiosis to reduce persistent inflammation and support immune recovery, with microbiome-modulating therapies showing promise in clinical trials.^[209] Pediatric guidelines for probiotic use have been updated to emphasize strain-specific recommendations for gastrointestinal disorders, incorporating higher doses like 5 × 10^9 CFU/day of Lactobacillus rhamnosus GG for conditions such as antibiotic-associated diarrhea, while prioritizing safety in preterm and vulnerable infants.^[1]^[210]

Regulation and Quality Control

Regulatory Frameworks

In the United States, the Food and Drug Administration (FDA) regulates probiotics primarily as food ingredients or dietary supplements under the Federal Food, Drug, and Cosmetic Act, with many strains classified as Generally Recognized as Safe (GRAS) based on scientific evidence or historical use in food prior to 1958.^[211] GRAS status allows probiotics to be added to foods without pre-market approval, provided they meet safety criteria through expert consensus or common use, but if a product makes therapeutic claims—such as treating or preventing a disease—it is reclassified as a drug requiring rigorous pre-market demonstration of safety and efficacy via an Investigational New Drug application.^[212] Unlike food additives, dietary supplements containing probiotics face no mandatory pre-market review, though manufacturers must ensure safety and substantiate structure/function claims like "supports digestive health" without implying disease treatment. In the European Union, the European Food Safety Authority (EFSA) oversees probiotic regulation under Regulation (EC) No 1924/2006 for health claims and Regulation (EU) 2015/2283 for novel foods, requiring pre-market authorization for strains not historically consumed in significant amounts within the EU before May 1997.^[213] Health claims must be scientifically substantiated, with EFSA evaluating evidence for general function, disease risk reduction, or child health benefits; to date, few probiotic-specific claims have been approved, though a qualified claim exists for live yogurt cultures (e.g., certain Lactobacillus and Streptococcus strains) stating they improve lactose digestion in individuals with difficulty digesting lactose.^[214] Unauthorized use of terms like "probiotic" on labels is prohibited if implying unsubstantiated health benefits, emphasizing strain-specific evidence over genus-level generalizations.^[215] Globally, the World Health Organization (WHO) and Food and Agriculture Organization (FAO) provide foundational guidelines established in 2002 for evaluating probiotics in food, defining them as "live microorganisms which when administered in adequate amounts confer a health benefit on the host" and outlining criteria for strain identification, safety assessment, and efficacy testing through in vitro, animal, and human trials.^[11] These guidelines, referenced in ongoing Codex Alimentarius work, emphasize minimum viable counts at end-of-shelf-life and proper labeling of genus, species, and strain; efforts to update them for harmonization were shelved by the Codex Committee on Nutrition and Foods for Special Dietary Uses at its 44th session in October 2024, with the decision reported in November 2024, pending a systematic review that has extended into 2025 and beyond as of November 2025.^[216] In Asia, regulations are often stricter, as exemplified by Japan's Foods for Specified Health Uses (FOSHU) system, introduced in 1991, which requires rigorous pre-market approval from the Consumer Affairs Agency for probiotic-containing products, including scientific evidence of efficacy, safety, and targeted health benefits like improved gut function, with more than 1,000 approvals granted as of 2019 but limited to specific strains.^[217] Distinctions between probiotics as dietary supplements versus drugs hinge on intended use and claims: structure/function or general wellness statements keep products under lighter food/supplement oversight, while therapeutic claims—such as mitigating infections or metabolic disorders—trigger pharmaceutical regulations demanding clinical proof of safety and efficacy worldwide.^[212] As of 2025, harmonization efforts for next-generation probiotics (NGPs), which include non-traditional strains like Akkermansia muciniphila engineered for targeted therapies, remain fragmented, with evolving frameworks in the US, EU, and Asia prioritizing drug-like scrutiny to address safety and efficacy gaps in these advanced biotherapeutics.^[218]

Testing and Guidelines

Testing probiotics for efficacy, safety, and quality involves a multi-tiered approach that begins with precise strain identification to ensure reproducibility and specificity in research and manufacturing. Strain identification typically relies on 16S rRNA gene sequencing, which targets conserved regions of the bacterial 16S ribosomal RNA gene to classify probiotics at the species level with high accuracy, often using universal primers like 27F and 1492R for amplification and comparison against databases such as NCBI BLAST.^[219] For more granular strain-level differentiation, whole-genome sequencing (WGS) is employed, providing comprehensive genetic profiles that reveal polymorphisms, virulence factors, and functional genes, surpassing the limitations of 16S rRNA in resolving closely related strains.^[220] WGS has become increasingly accessible due to advances in next-generation sequencing technologies, enabling detailed comparative genomics to confirm probiotic identity and exclude contaminants.^[221] In vitro assessments evaluate a probiotic strain's potential to survive gastrointestinal conditions and interact with host cells, serving as initial screens before more resource-intensive in vivo studies. Acid tolerance tests simulate gastric passage by exposing strains to low pH (typically 2.0–3.0) with or without pepsin for 1–3 hours, measuring viable cell counts via colony-forming units (CFU) to assess survival rates, which should exceed 10^6 CFU/mL for promising candidates.^[222] Bile tolerance assays mimic small intestinal conditions using 0.3–0.5% bile salts for 4–24 hours, evaluating deconjugation and resistance mechanisms like bile salt hydrolase activity.^[223] Adhesion assays, often using human intestinal cell lines such as Caco-2 or HT-29, quantify bacterial attachment through microscopy or plate counts, with adherent strains demonstrating exclusion of pathogens like Escherichia coli by competitive binding to mucus or epithelial receptors.^[224] These tests prioritize strains with robust survival (e.g., >50% viability post-exposure) and adhesion (>10^5 bacteria per cell monolayer), though results must be validated in vivo due to model simplifications.^[225] In vivo evaluation through randomized controlled trials (RCTs) in humans provides direct evidence of probiotic viability and health impacts, with key endpoints including fecal recovery of administered strains to confirm engraftment. In RCTs, probiotics are dosed at 10^8–10^10 CFU/day, and fecal samples are analyzed via culture or qPCR for strain-specific CFU recovery, often detecting 10^4–10^7 CFU/g in responders after 1–4 weeks, indicating transient colonization without permanent alteration of the microbiota.^[226] Animal models, such as gnotobiotic mice or piglets, elucidate mechanisms like immunomodulation or pathogen inhibition, with endpoints measuring cytokine levels or pathogen load reduction following oral administration.^[227] These studies emphasize strain-specific outcomes, as efficacy varies; for instance, Lactobacillus rhamnosus GG has shown consistent fecal recovery and diarrhea reduction in pediatric RCTs.^[228] The International Scientific Association for Probiotics and Prebiotics (ISAPP) provides authoritative guidelines emphasizing strain-specific evidence for probiotic claims, as outlined in their 2014 consensus statement, which requires human clinical trials demonstrating health benefits for the exact strain and dose used.^[12] Updated perspectives in 2021 reinforce that benefits cannot be extrapolated from genus or species levels, mandating rigorous, well-controlled RCTs with appropriate controls and statistical power.^[229] For ongoing monitoring, ISAPP advocates post-market surveillance through pharmacovigilance systems to track rare adverse events and long-term safety, particularly for vulnerable populations, integrating real-world data from registries and consumer reporting.^[230] Quality control protocols ensure probiotic products maintain viability, purity, and safety throughout the supply chain, adhering to Good Manufacturing Practices (GMP) as defined by regulatory bodies like the FDA, which mandate controlled environments, validated processes, and batch testing for contaminants.^[231] Third-party verification, such as the United States Pharmacopeia (USP) program, independently audits manufacturers for label accuracy, potency (e.g., ≥10^9 CFU at expiration), and absence of pathogens, using standardized microbial assays and stability challenges.^[232] Antibiotic resistance screening is critical, involving minimum inhibitory concentration (MIC) tests against clinically relevant antibiotics per EFSA or FDA breakpoints, to detect transferable resistance genes via PCR or WGS, ensuring strains do not contribute to resistance dissemination.^[233] Products passing these verifications display USP seals, enhancing consumer trust and regulatory compliance.^[233]

Labeling and Standards

Probiotic product labels must include essential information to inform consumers about the composition and viability of the microbes. This typically encompasses the genus, species, and strain designation, such as Lactobacillus rhamnosus GG, to specify the exact microbial identity, as recommended by industry best practices for transparency and efficacy assessment.^[234] Labels are also required to declare the quantity of live microbes in colony-forming units (CFU), often expressed as a range or specific count like 1 × 10^9 CFU per serving at the end of shelf life, enabling consumers to evaluate potency.^[1] Storage instructions, such as refrigeration to maintain microbial viability, must be provided to ensure the product delivers the intended benefits throughout its shelf life.^[235] Regulatory frameworks distinguish between permissible claims on probiotic labels, with structure-function claims—such as "supports gut health" or "promotes digestive balance"—allowed on dietary supplements without pre-market approval, provided they are truthful and not misleading.^[236] In contrast, disease-related claims, like treating or preventing specific illnesses, are prohibited unless substantiated by authorized health claims backed by significant scientific evidence, as these fall under stricter drug-like oversight.^[236] For yogurt and similar cultured dairy products in the United States, the International Dairy Foods Association (IDFA) offers a voluntary "Live and Active Cultures" (LAC) seal, certifying that the product contains at least 100 million viable cultures per gram at manufacturing, verified through independent testing to assure probiotic activity.^[237] In the European Union, yogurt labeling requires proof of microbial viability to support any claims related to live cultures, with the term "probiotic" restricted unless approved under health claim regulations, emphasizing strain-specific substantiation.^[238] As of 2025, mandatory allergen disclosure on probiotic labels aligns with broader food safety updates, requiring clear listing of major allergens like milk derivatives in dairy-based formulations to protect sensitive consumers, in line with FDA guidance on food allergen labeling.^[239] Emerging practices include the use of QR codes on labels to provide detailed strain-specific data, such as genomic profiles or clinical study links, enhancing consumer access to information beyond space-limited packaging, though this remains voluntary in most jurisdictions.^[240] Recent audits have revealed that a significant percentage of probiotic supplements do not meet their labeled CFU counts by the expiration date, often due to inadequate viability preservation or inaccurate initial declarations, underscoring the need for rigorous quality controls.^[241]

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Probiotics in man and animals. R. FULLER AFRC, ... The effects of Lactobacillus sporogenes in the growing performance and the change in microbial flora of the ...
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The Evolution of Fermented Milks, from Artisanal to Industrial Products
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History and development of probiotics
Probiotics and their considerable powers were revealed when the Roman naturalist Pliny the Elder used fermented milk to treat intestinal problems.
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From germ theory to germ therapy - Chen - 2019 - Wiley Online Library
Mar 7, 2019 · In the 19th century, improvements in microscope broadened scientist's horizon and germ theory of disease was proposed by Louis Pasteur and ...
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Probiotics, their action modality and the use of multi-omics in ... - NIH
The evolution of probiotics began around 1856–1864 when French microbiologist Louis Pasteur proved that food spoilage was caused by microorganisms (13–15).
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[PDF] Probiotics: History and Evolution - Longdom Publishing
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[PDF] The ISAPP quick guide to probiotics for health professionals: History ...
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Complete genome sequence of Lactobacillus plantarum WCFS1
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Complete genome sequence of the probiotic lactic acid bacterium ...
Mar 7, 2005 · Lactobacillus acidophilus NCFM is a probiotic bacterium that has been produced commercially since 1972. The complete genome is 1993564 nt ...Abstract · Sign Up For Pnas Alerts · Results And Discussion<|control11|><|separator|>
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Personalized probiotic strategy considering bowel habits - Frontiers
Feb 15, 2024 · This study aimed to explore the efficacy of personalized probiotic interventions in managing distinct stool patterns (constipation and diarrhea)
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Microorganisms with Claimed Probiotic Properties Overview
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Evaluation of the Effect of Lactobacillus acidophilus ATCC 4356 ...
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Characterization and Purification of a Bacteriocin Produced by a ...
Lactobacillus acidophilus 30SC was tested for its potential as a probiotic culture. The strain exhibited good acid tolerance in an artificial gastric solution ...
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Comparison of probiotic lactobacilli and bifidobacteria effects ... - NIH
This review presents selected data on different probiotic strains of lactobacilli and bifidobacteria and summarizes the knowledge of their immunomodulatory ...
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Antibiotic administration in full-term infants during the first hours of life led to a relative decrease in Bifidobacterium and an increase in fecal ...
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Combining Bifidobacterium longum subsp. infantis and human milk ...
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Impact of Bifidobacterium longum Subspecies infantis on Pediatric ...
Oct 16, 2024 · Among these microbes, Bifidobacterium plays a crucial role in early gut colonization during neonatal stages, where Bifidobacterium longum ...
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Bosom Buddies - Annual Reviews
Bifidobacterium longum is one of the most abundant species in the human intestinal microbiota and is one of the species most widely used as probiotics.
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Streptococcus thermophilus: From yogurt starter to a new promising ...
Streptococcus thermophilus is a Gram positive bacterium widely used in dairy fermentations for the production of yogurt and cheese.
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The Potential of Bacillus Species as Probiotics in the Food Industry
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Novel methods for storage stability and release of Bacillus spores
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Strain-Specificity and Disease-Specificity of Probiotic Efficacy
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Lactobacillus reuteri to Treat Infant Colic: A Meta-analysis | Pediatrics
Jan 1, 2018 · The pooled data suggest that L reuteri DSM17938 effectively reduces crying and/or fussing in breastfed infants with colic. Although the results ...Eligibility Criteria and Search... · Results · Discussion · Conclusions
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Lactobacillus gasseri BNR17 Supplementation Reduces the ...
L. gasseri BNR17 is a probiotic strain isolated from human breast milk. Previous studies have demonstrated that L. gasseri BNR17 suppressed body weight and fat ...
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Saccharomyces cerevisiae var. boulardii – Probiotic Yeast
Oct 3, 2012 · As mentioned before, the history of probiotic strain started in 1920. Henri Boulard after his return to France patented isolated strain and ...
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Saccharomyces boulardii CNCM I-745: A Non-bacterial ... - NIH
May 29, 2020 · Saccharomyces boulardii CNCM I-745 was discovered by Henri Boulard (French microbiologist) in 1920 [11]. The probiotic strain of S. boulardii ...
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Snapshot of the Probiotic Potential of Kluveromyces marxianus ...
Nov 30, 2023 · Kluyveromyces marxianus is a rapidly growing thermotolerant yeast that secretes a variety of lytic enzymes, utilizes different sugars, and ...
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The Biotherapeutic Potential of a Novel Probiotic Kluyveromyces ...
We isolated from an artisanal sourdough a new yeast strain which was identified as Kluyveromyces marxianus and assessed its probiotic and safety properties.
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Potential of Non-Saccharomyces Yeasts as Probiotics and ...
Aug 26, 2024 · Within the NSYs group, Kluyveromyces and Pichia are the most reported yeast genera with probiotic properties and beneficial effects on human and ...
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Probiotic characteristics of Bacillus coagulans and associated ...
As facultative anaerobic bacteria, B. coagulans strains can consume free oxygen in the intestine and stomach and reduce redox reactions.
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Bacillus clausii: A Review into Story of Its Probiotic Success and ...
Oct 14, 2024 · Bacillus clausii is a spore-producing potential probiotic. Its application in the food industry has been highly recommended.
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The antimicrobial and immunomodulatory properties of B. clausii support its use for the treatment and prevention of intestinal bacterial flora disorders, with ...
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Targeted delivery of the probiotic Saccharomyces boulardii to the ...
May 6, 2024 · We engineered a targeted probiotic yeast platform wherein Saccharomyces boulardii is designed to bind to abundant extracellular matrix proteins found within ...
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Probiotics as Antifungals in Mucosal Candidiasis - Oxford Academic
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A yeast-based oral therapeutic delivers immune checkpoint ...
Nov 20, 2024 · This proof of concept demonstrates the capacity of probiotics engineered with modular therapeutic delivery systems to treat gastrointestinal.
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The Production and Delivery of Probiotics - NIH
Mar 17, 2019 · Capsules, tablets, and powder in stick packaging or sachets are the most commonly found formats on store shelves and are usually stored at ...
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Microencapsulating Alginate-Based Polymers for Probiotics Delivery ...
Hydrogel formed by Alg is indissoluble in acidic conditions, which may protect probiotics from gastric acid and bile [3,33]. To prepare microcapsules, alginate ...
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Microencapsulation Improved Probiotics Survival During Gastric ...
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Exploring the future of probiotics with innovations in delivery ...
This review aims to explore recent advances in conventional and non-conventional probiotic microorganisms, focusing on their functional mechanisms, innovative ...
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Double Emulsion Microencapsulation System for Lactobacillus ...
Microencapsulation using a double emulsion system can improve the viability of probiotic cells during storage and digestion. In this study, a double ...Missing: aerosol | Show results with:aerosol<|separator|>
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Respiratory Delivery of Lacticaseibacillus rhamnosus GG by ... - NIH
Oct 14, 2024 · The current data suggest that the respiratory route will deliver probiotics efficiently. However, it is an underexplored area, with only nasal ...
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Probiotics, prebiotics and synbiotics- a review - PMC - NIH
Prebiotics like FOS, GOS, XOS, Inulin; fructans are the most commonly used fibers which when used together with probiotics are termed synbiotics and are able to ...
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Probiotics in Food Systems: Significance and Emerging Strategies ...
... minimum therapeutic” level of viable probiotic microorganisms should be at least 106 CFU/g of viable cells throughout the product shelf-life [11]. One of ...
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Targeted Delivery of Probiotics: Perspectives on Research and ...
Apr 27, 2021 · This review focuses on the need to encapsulate probiotics, trends in various encapsulation techniques, current research and challenges in targeted delivery.
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Viability and In Vitro Gastrointestinal Transit Tolerance of ... - NIH
Jun 2, 2023 · Probiotic storage stability and gastrointestinal transit tolerance were species-dependent and affected by carrier type and combinations.
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Characteristics of Probiotic Preparations and Their Applications - PMC
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Application of Encapsulation Strategies for Probiotics - NIH
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Highly active probiotic hydrogels matrixed on bacterial EPS ...
Jan 19, 2024 · Our results showed that live probiotic hydrogels reduce the incidence of inflammation during wound healing while promoting angiogenesis and increasing collagen ...
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Assessing Viability and Stress Tolerance of Probiotics—A Review
Jan 27, 2022 · This review presents and discusses the complexity of assuring that a probiotic is suitable for beneficial consumption.<|separator|>
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Multi-Strain Probiotics: Synergy among Isolates Enhances Biological ...
Apr 13, 2021 · The strains of microorganisms used as probiotics include members of the genus Bacillus, Enterococcus, Lactobacillus, Pedicoccus, Streptococcus, ...
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Fermented Foods, Health and the Gut Microbiome - PMC
Apr 6, 2022 · Thus, fermented foods have been linked positively with human health beginning in the early 1900s; the mechanisms subsequently postulated by ...2. Fermented Food · 2.2. Primary Food... · Table 1
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Fermented Foods: Definitions and Characteristics, Impact on the Gut ...
Aug 5, 2019 · In summary, there is very limited clinical evidence for the effectiveness of most fermented foods in gastrointestinal health and disease. Given ...2. Kefir · Kefir In Gastrointestinal... · Sourdough Bread In...
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Yogurt - The Nutrition Source - Harvard University
Yogurt typically contains at least 1,000,000, or 106 CFUs, which is the minimum needed to display a “Live and Active Cultures” seal on the packaging.
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Survival of Lactobacillus delbrueckii subsp. bulgaricus and ... - NIH
Living L. delbrueckii subsp. bulgaricus and S. thermophilus were detected in the magnitude of 106 to 107 per gram of intestinal contents (wet ...
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Milk kefir: composition, microbial cultures, biological activities, and ...
12 Oct 2015 · Kefir may not only be a natural probiotic beverage, but also acts as an effective matrix for the delivery of probiotic microorganisms (Vinderola ...
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9 Evidence-Based Health Benefits of Kefir - Healthline
Kefir grains contain up to 61 strains of bacteria and yeasts, making them a very rich and diverse probiotic source, though this diversity may vary. Other ...<|separator|>
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DNA Fingerprinting of Lactic Acid Bacteria in Sauerkraut ... - NIH
Historically, four species of lactic acid bacteria (LAB) have been identified as organisms that are present in sauerkraut fermentations: Leuconostoc ...
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Full article: Does kimchi deserve the status of a probiotic food?
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Fermentation and the microbial community of Japanese koji and ...
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Probiotic viability – does it matter? - PMC - NIH
Probiotics are viable by definition, and viability of probiotics is often considered to be a prerequisite for the health benefits.
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Probiotics and Disease: A Comprehensive Summary—Part 2 ...
One caveat is that pasteurization destroys bacteria; thus, for foods to retain their active cultures, foods must be pasteurized before fermentation.1. In ...
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Plant-based probiotic foods: current state and future trends - PMC
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Oct 25, 2025 · This review explores the current state of PBY research, focusing on product quality, nutritional composition, and processing methods.
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Probiotic Supplements: Delivery Formats
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Probiotics 101: A Simple Beginner's Guide - Healthline
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Multi-strain probiotics: Functions, effectiveness and formulations for ...
Multi-strain probiotics provide more benefits to aquatic organisms as it provides synergistic effect in contrast to the use of a single-strain probiotic (SSP).
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Probiotics: How Many Billion CFU Do I Need? - Nordic Naturals
Aug 22, 2024 · For individuals in relatively good health, a daily dose of 10-20 billion CFU is likely sufficient for everyday immune and digestive support.
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Probiotic Supplements Market Size & Trends 2025-2035
Aug 18, 2025 · The global probiotic supplements market is expected to grow from USD 13.30 billion in 2025 to USD 34.08 billion by 2035, registering a CAGR of 9.7%.
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Probiotic Supplements Market Report 2024-2029, Featuring Key ...
Dec 23, 2024 · The key players in the global probiotic supplements are Nestle, Procter & Gamble, BioGaia, Dr. Willmar Schwabe, Amway, Reckitt Benckiser Group, ...
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Probiotic Based Dietary Supplement Market Size, Forecasts 2034
The Nestle S.A., Danone S.A., Yakult Honsha Co., Ltd., Chr. Hansen Holding A/S and BioGaia AB are significant 5 players in the probiotics based dietary ...<|separator|>
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Probiotics: What They Are, Benefits & Side Effects - Cleveland Clinic
Probiotics are live bacteria and yeasts that have beneficial effects on your body. You can take them as dietary supplements or use them as topical products.
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Probiotics: Food vs. Supplements and What You Need to Know
Jul 17, 2024 · As with all supplements, probiotic pills and powders aren't regulated by the FDA, whereas food products that naturally contain probiotics have ...
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Personalized and Precision Probiotics Market Latest Report 2025 ...
May 26, 2025 · Personalized and Precision Probiotics Market Size is predicted to witness a 5.7% CAGR during the forecast period for 2025-2034.
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Probiotics and prebiotics - World Gastroenterology Organisation
... dose of other probiotic products is 300–450 billion cfu three times daily. ... The probiotic mix is recommended for adults and children with pouchitis of ...
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Nasal-spraying Bacillus spore probiotics for pneumonia in children ...
Aug 7, 2025 · Patient enrollment was conducted from July 2023 to March 2024. The study evaluated the efficacy of LiveSpo Navax, a nasal-spraying probiotic, ...
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Probiotic Gastrointestinal Transit and Colonization After Oral ... - NIH
Mar 10, 2021 · Orally administered probiotics encounter various challenges on their journey through the mouth, stomach, intestine and colon.
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Coffee and Probiotics | Probiotics Learning Lab
As we've learned in the previous paragraph, heat kills most types of probiotic bacteria. Therefore, I wouldn't advise mixing your probiotics into a hot drink. ...Is coffee a probiotic? · Should I take probiotics before... · Taking probiotics with hot...Missing: microbes | Show results with:microbes
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Promoting a Healthy Microbiome with Food and Probiotics - VA.gov
A diet rich in fiber, vegetables, and fruit helps establish a varied and rich microbiome that promotes the health of the host.
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The promotion mechanism of prebiotics for probiotics: A review - PMC
Prebiotics and probiotics play a positive role in promoting human nutrition and health. Prebiotics are compounds that cannot be digested by the host, ...Types Of Prebiotics · Emerging Prebiotics · Types Of Probiotics
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Storage Temperature Effects on Bacillus Spores and Lactobacillus ...
Although 25°C storage tended to result in higher log reductions compared to 4°C and −18°C, these differences were not statistically significant. Furthermore, no ...
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Effectiveness and Risks of Probiotics in Preterm Infants | Pediatrics
Feb 12, 2025 · The typical dose of FloraBABY is 0.5 g (1 sachet daily), and the typical dose of BioGaia is 5 drops daily. Probiotics are mostly continued until ...
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The Effect of Probiotics on the Production of Short-Chain Fatty Acids ...
The results of many studies confirm the beneficial effect of probiotic microorganisms on the balance of the intestinal microbiome and produced metabolites, ...
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Gut microbiota-derived short chain fatty acids are potential ...
Dec 29, 2021 · Specifically, these SCFA protect the gut from inflammation, maintain gut barrier integrity, facilitate epithelial cells in nutrient absorption, ...
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Molecular insights into probiotic mechanisms of action employed ...
Oct 28, 2020 · Most probiotics can inhibit enteric pathogens via the production of antimicrobial substances such as bacteriocins. C. Probiotics can compete ...
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Probiotics Mechanism of Action on Immune Cells and Beneficial ...
Probiotic bacteria can interact and stimulate intestinal immune cells and commensal microflora to modulate specific immune functions and immune homeostasis.
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Importance of IL-10 Modulation by Probiotic Microorganisms in ...
Feb 8, 2011 · This paper will demonstrate the critical role that IL-10 plays in gastrointestinal inflammatory diseases and how probiotics could be used in their treatment.
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Adhesion mechanisms mediated by probiotics and prebiotics ... - NIH
The aim of this mini review is to provide a comprehensive overview on the potential effect of the adhesive properties of probiotics and prebiotics on the host.
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Implications of gut microbiota-mediated epigenetic modifications in ...
Jun 4, 2025 · Gut microbiota can significantly influence host health by modulating epigenetic mechanisms such as DNA methylation and histone modification.
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The Gut Microbial Regulation of Epigenetic Modification from a ...
This review primarily focuses on the understanding of the relationship between the gut microbiota and its metabolites with epigenetic mechanisms.
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Alteration of gut bacteria and metabolomes after glucaro-1,4-lactone ...
Jul 30, 2014 · Colonic flora test results reveal that the quantity of Bifidobacterium and Lactobacillus in the intestines respectively increase by ... Probiotics ...<|control11|><|separator|>
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Effects of Probiotics on Gut Microbiota: An Overview - MDPI
Another study reported that long-travel-associated gut dysbiosis can be prevented by the administration of probiotics, as evidenced by an increase in ...
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Effects of Probiotics on Gut Microbiota: An Overview - PMC
Probiotics play a significant role in regulating the gut microbiota, boosting overall immunity, increasing the abundance of beneficial bacteria.
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Colonization Ability and Impact on Human Gut Microbiota of ... - NIH
The results of colonization analyses highlighted the ability of all probiotic strains to transiently colonize the human gut, with the only exception of the ...
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Human-origin probiotic cocktail increases short-chain fatty acid ...
Aug 23, 2018 · Lactic acid bacteria, which are extensively used as probiotics, can also promote the intrinsic growth of SCFA-producing gut bacteria.
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Is probiotic colonization essential?
Aug 20, 2019 · My answer to the first question is no – probiotics generally do not colonize the digestive tract or other sites on the human body.
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Interaction of the Vagus Nerve and Serotonin in the Gut–Brain Axis
Jan 29, 2025 · Microorganisms such as Lactobacillus and Bifidobacterium modulate tryptophan metabolism to promote serotonin production and increase tryptophan ...
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the vagus nerve and the microbiota-gut-brain axis in depression. A ...
This narrative review summarizes key aspects of vagus nerve function as a main player in the microbiota-gut-brain axis in depression.
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Precision Modulation of Gut Microbiome via Metagenomic-drive...
This study confirms that integrating metagenomic-driven dietary planning with strain-specific probiotic supplementation significantly induces hepatic fat ...
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A double-blind, randomized, placebo-controlled study assessing the ...
Mar 21, 2024 · This study suggests that the probiotic may minimize the disruption of antibiotic treatment on the gut microbiome by preserving microbial ...Introduction · Materials and methods · Results · Discussion
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Differential modulation of post-antibiotic colonization resistance to ...
Jul 21, 2025 · Probiotics are often thought to counteract the negative consequences of antibiotic administration and prevent AAD by reconstituting and ...
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Cross-feeding-based rational design of a probiotic combination of ...
Apr 6, 2025 · Cross-feeding plays indispensable roles in maintaining gut microbiota homeostasis and host health. Microbial communities engage in cross-feeding ...Missing: resident | Show results with:resident
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The resident gut microbiome modulates the effect of synbiotics on ...
Aug 25, 2025 · The study aims to tackle the seed and soil microbiome and mechanisms that contribute to the effect of synbiotics in enhancing immunogenicity ...
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Can the Evidence-Based Use of Probiotics (Notably Saccharomyces ...
Jan 30, 2024 · Systematic reviews and meta-analyses of clinical trials have confirmed the strain-specific efficacy of some probiotics (notably the yeast ...
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A COMPREHENSIVE SYSTEMATIC REVIEW AND META-ANALYSIS
Dec 18, 2024 · Probiotics, particularly LGG and S. boulardii, are effective in managing AAD in pediatric patients. Their use is associated with reduced diarrhea duration and ...
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Probiotics for pediatric diarrhea and constipation: an umbrella meta ...
Oct 2, 2025 · The results of our analysis showed that probiotic supplementation significantly reduced the incidence of diarrhea by about 48% (ES = 0.52; 95% ...
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the therapeutic and preventive effect of Lactobacillus reuteri DSM ...
May 5, 2023 · A systematic review and meta-analysis: the therapeutic and preventive effect of Lactobacillus reuteri DSM 17,938 addition in children with ...
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the therapeutic and preventive effect of Lactobacillus reuteri DSM ...
May 5, 2023 · A few studies have shown that Lactobacillus reuteri can reduce the time of diarrhea, the number of days with watery stools, and days of hospital stay.
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Effectiveness of Probiotic Use in Alleviating Symptoms of Irritable ...
Apr 15, 2024 · According to the findings in the current analysis, there does not appear to be a difference in symptom improvement following probiotic ...
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Aug 2, 2023 · As in our previous meta-analyses, we found some evidence to support the use of some probiotics for global IBS symptoms, abdominal pain, and ...
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Probiotics in IBD: Evidence and Perspectives on Patient Health and ...
Sep 17, 2025 · The multi-strain probiotic was superior to the placebo in reducing fecal calprotectin levels, but with no significant differences in IBD ...
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Lactobacillus reuteri compared with placebo as an adjuvant in ...
Jun 5, 2024 · The present meta-analysis demonstrated that supplementation with L. reuteri was beneficial for improving the eradication rate of H. pylori.
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The effectiveness of treatment with probiotics in preventing ...
Apr 11, 2025 · This umbrella meta-analysis assesses the effects of probiotics, including single-strain and multi-strain formulations, on NEC and related mortality.
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Unveiling the therapeutic symphony of probiotics, prebiotics, and ...
Additionally, probiotics boost mucosal immune responses, encouraging B cells to produce more immunoglobulin A (IgA) antibodies.
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The molecular mechanism for activating IgA production by ... - Nature
Mar 22, 2018 · Recent studies revealed that probiotic strains of LAB activate the innate immune system and then activate the acquired immune system, resulting ...
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Effect of probiotic fermented dairy products on incidence of ...
Jun 28, 2021 · Daily intake of fermented milk with Lactobacillus casei strain Shirota reduces the incidence and duration of upper respiratory tract infections ...
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Probiotics reduce self-reported symptoms of upper respiratory tract ...
Daily intake of fermented milk with Lactobacillus casei strain Shirota reduces the incidence and duration of upper respiratory tract infections in healthy ...
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(PDF) Lactobacillus rhamnosus Used in the Perinatal Period for the ...
Aug 9, 2025 · Lactobacillus rhamnosus Used in the Perinatal Period for the Prevention of Atopic Dermatitis in Infants: A Systematic Review and Meta-Analysis ...
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Specific probiotics in reducing the risk of acute infections in infancy
Nov 6, 2008 · These data suggest that probiotics may offer a safe means of reducing the risk of early acute otitis media and antibiotic use and the risk of ...<|separator|>
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Lactobacilli vs Antibiotics to Prevent Urinary Tract Infections
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The role of probiotics in women with recurrent urinary tract infections
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Changes in the Gut Microbiota of Patients After SARS-CoV-2 Infection
Treatments options for intestinal dysbiosis in Long-COVID patients include probiotics, prebiotics, and fecal microbiota transplantation. These treatments ...
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Boosting vaccine effectiveness: The groundbreaking role of probiotics
Probiotics can enhance mucosal/systemic immunity, and improve vaccination outcomes. Symbiotics can increase the efficacy of cancer vaccines.
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Meta-Analysis: Effects of Probiotic Supplementation on Lipid Profiles ...
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Microbial impact on cholesterol and bile acid metabolism
In this review, we discuss the impact of gut microbiota on cholesterol metabolism, its association with disease settings, and the potential of modulating gut ...
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Lactobacillus helveticus Fermented Milk Lowers Blood Pressure in ...
In the meta-analysis of 33 controlled clinical studies the potassium supplementation (about 2.9 g/d) reduced systolic BP −3.11 mm Hg and diastolic BP −1.97 mm ...
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The meta-analysis included 26 trials with a total of 1624 participants, demonstrating that probiotic consumption significantly reduced office systolic BP by ...3. Microbiota And The... · 4.2. Microbiota And... · 5. Impact On Kidney And...
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Effect of Lactobacillus gasseri BNR17 on Overweight and Obese ...
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Modulation of the Gut Microbiota by Nutrients with Prebiotic and ...
gasseri SBT2055 allows for the reduction of fat-mass gain, body weight, BMI, waist, hip, and waist-to-hip ratio in the probiotic group compared with placebo ...
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Anti-Obesity Effect of Lactobacillus gasseri BNR17 in High-Sucrose ...
Jan 30, 2013 · L. gasseri BNR17 also reduced the levels of leptin and insulin in serum. These results suggest that the anti-obesity actions of L. gasseri BNR17 ...<|separator|>
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The gut-heart axis: unveiling the roles of gut microbiota in ... - Frontiers
Elevated TMAO levels are linked to a greater risk of adverse cardiovascular disease ... probiotics can lower cardiovascular risk, particularly in light of ...
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