Did you know that a healthy gut has been linked to a healthier life and you can choose natural foods or supplements to help you?

If you are experiencing gastrointestinal problems, you are not alone. The National Institute of Diabetes and Digestive and Kidney Diseases estimates between 60 million and 70 million people in the U.S. suffer from a digestive disease.^[i]

Not only will your gut thank you for bringing back a healthier gut, but you may be helping your overall health by preventing other metabolic and inflammation-based diseases such as heart disease, diabetes, skin disorders like eczema and psoriasis, arthritis, cancers and even neurological problems.

The top natural gastrointestinal agents include yogurt, kefir/fermented foods, green tea, ginger, vitamin D, berberine, probiotics and prebiotics.

1. Yogurt

Yogurt is a nutrient-dense food that may help people with lactose intolerance, constipation and diarrheal diseases, high blood pressure, cardiovascular diseases, diabetes and certain cancers.^[ii]

Emerging evidence suggests that eating yogurt might also improve the health of obese individuals by reducing chronic, low-grade inflammation caused by adipose tissue and an unhealthy gut. In the gut, obesity-associated dysregulation of microbiota and impaired gut barrier function may increase endotoxin exposure. Yogurt can enhance immune responses, intestinal barrier function, lipid profiles and regulate appetite.^[iii]

In two cohorts of 2,103 people in the United Kingdom, analysis of food consumption, clinical variables, metabolomics and genomic data showed that eating yogurt created a healthier diet pattern and improved metabolic health by reducing visceral fat.

Yogurt consumption also increased two yogurt-related bacteria in the gut -- Streptococcus thermophilus and Bifidobacterium (B.) lactis -- which helped activate 3 hydroxyoctanoic acid -- a known regulator of gut inflammation.^[iv]

2. Kefir and Fermented Foods

Kefir is a fermented drink made from yeast and lactic acid bacteria. It has been associated with various health benefits, including relieving inflammatory bowel disease (IBD). In an induced-IBD mouse model. kefir-derived Lactobacillus extracellular vesicles resulted in significantly alleviated weight loss and rectal bleeding and improved stool consistency related to IBD.^[v]

In a review of research, kefir promoted an increase in the number of bifidobacteria in the colon and an increase in glycemic control while balancing blood cholesterol and intestinal microbiota. These actions reduced constipation and diarrhea, improved intestinal permeability and stimulated and balanced the immune system.^[vi]

Other fermented products are also gastrointestinal agents. For example, fermented ginseng can treat antibiotic-associated diarrhea symptoms and colon inflammation and restore the gut microbiota to its original state.^[vii] Fermented sea buckthorn liquid protected against alcoholic liver disease and modulated the composition of gut microbiota.^[viii]

In mice studies, fermented rice bran significantly reduced the levels of blood glucose and lipids and elevated antioxidant activity in Type 2 diabetic mice, while also changing the composition of gut microbiota in short-chain-fatty-acids (SCFAs)-producing bacteria.^[ix]

3. Green Tea

Green tea can prevent or ameliorate high blood pressure,^[x] elevated triglycerides and cholesterol^[xi] and obesity^[xii] by regulating and altering the intestinal flora.

In a high-fat diet induced-obesity canine study, green tea exhibited beneficial effects on obesity and intestinal inflammation by decreasing expressions of inflammatory cytokines, including tumor necrosis factor alpha (TNF-α), interleukin (IL)-6, and IL-1β, and inhibiting induction of the toll-like receptor (TLR) 4 signaling pathway.^[xiii]

TLR4 initiates the innate immune response and is activated by bacterial endotoxins which cause chronic and acute inflammatory disorders.^[xiv] Green tea flowers have also been found to inhibit the growth and metastasis of breast cancer into the lungs by modulating gut microbiota.^[xv]

4. Ginger

Ginger has a broad spectrum of clinical applications due to its anti-inflammatory and antioxidative functions.^[xvi] Inflammation and oxidative stress are key factors in gastrointestinal problems from IBD and constipation to diarrhea.^[xvii]

The anti-inflammatory activity of ginger makes it a strong inhibitor of the nuclear factor kappa B (NF-κB), signal transducer of activators of transcription (STATs), Nod-like receptor family proteins (NLRPs), TLRs, mitogen-activated protein kinase (MAPKs), mTOR pathways and various pro-inflammatory cytokines.^[xviii]

5. Vitamin D

Vitamin D deficiency has been linked with a variety of gastrointestinal disorders, including IBD, diverticulitis, colorectal cancer and irritable bowel syndrome (IBS).^[xix] Several studies have demonstrated that individuals with IBS and IBD are more likely to have a vitamin D deficiency than healthy controls.^[xx]

Vitamin D deficiency also impacts autoimmune diseases such as rheumatoid arthritis, lupus^[xxi] amyotrophic lateral sclerosis (ALS) and Crohn's disease^[xxii] by its effects on the intestinal barrier function, microbiome composition and immune responses.^[xxiii]

Due to the strong connection between vitamin D and microbiota, vitamin D supplementation impacts gut microbiota regulation, the immune system and psychosocial factors that can improve your gut health and remedy a variety of gastrointestinal conditions.^[xxiv]

Recent vitamin D supplementation studies have shown improvement in quality of life and reduction in IBS symptoms from abdominal pain, distention and flatulence to constipation and visceral sensitivity.^[xxv]

6. Berberine

Berberine has been used in China for hundreds of years as a clinical anti-diarrhea and anti-inflammatory natural supplement due to its effects on gut microbiota.^[xxvi] In a systematic review of studies on berberine, 70% to 80% of patients with a gut functional disease characterized by diarrhea were successfully treated with berberine-based products after 90 days.^[xxvii]

Ulcerative colitis (UC) is a major inflammatory bowel disease that displays an abnormally elevated level of lysozyme in the feces and blood -- a marker of gastrointestinal inflammation. In a mouse study, results showed that berberine significantly inhibited the expression and secretion of lysozyme.^[xxviii]

Berberine treated UC effectively by suppressing the interferon gamma (IFN-γ) signaling pathway, which is crucial in immune-inflammatory responses of the colon mucosa in UC- induced mice and in vitro cell studies of UC patients.^[xxix]

7. Probiotics

In a meta-analysis of 17 studies including 1,700 patients with IBS, probiotics showed beneficial effects -- improved overall symptoms, alleviated abdominal pain/discomfort and relieved abdominal distention and defecation discomfort with fewer adverse reactions.^[xxx]

In a clinical study of 60 patients with moderate-to-severe UC, 30 were treated with an anti-inflammatory drug called mesalazine at a dose of 1,200 milligrams (mg) while the other 30 patients received mesalazine (same mg dose) and a probiotic blend of Lactobacillus salivarius, Lactobacillus acidophilus and a B. bifidus strain twice a day for a period of two years. All patients treated with both the probiotic and the anti-inflammatory had the most significant disease improvements. This combination was an effective alternative to corticosteroid treatment for moderate to severe UC.^[xxxi]

Gut microbiota is also an important contributor to the worldwide prevalence of metabolic syndrome (MS), which includes obesity, high blood pressure, imbalanced cholesterol and diabetes. The anti-MS effects exerted by probiotics B. animalis subspecies (ssp.) lactis (BlaG), and B. longum ssp. longum (BloJ) were compared.

BlaG treatment reduced visceral fat accumulation and improved glucose tolerance, while BloJ did not. BlaG exerted stronger effects on the overall bacterial structure of the gut microbiota than BloJ, including enrichment of the genus B. and increased levels of acetate, which accounted for superior BlaG-induced anti-MS effects.^[xxxii]

Probiotics Bifidobacteria, Lactobacilli and Saccharomyces strains are among the most widely used agents in gastrointestinal disorders, such as IBS, prevention of infectious diarrhea, IBD, non alcoholic fatty liver disease and colorectal cancer. The Lactobacilli strain, however, is the most clinically documented probiotic strain shown to prevent and relieve various types of diarrhea, improve many intestinal disorders as well as treat relapsing Clostridium difficile colitis.^[xxxiii]

8. Prebiotics

Lycopene-rich foods such as tomatoes, guavas and watermelon, along with dark chocolate, are among the best-documented prebiotic products with broad health benefits. A study of 30 patients with moderate obesity, who consumed lycopene and dark chocolate, showed positive impacts on their gut microbiota, blood, liver metabolism, skeletal muscle tissue oxygenation and skin.^[xxxiv]

Prebiotics with lycopene have also been shown to lower the risk for prostate cancer,^[xxxv] cardiovascular disease^[xxxvi] and cancer mortality^[xxxvii] and increase bone health.^{[xxxviii],[xxxix]} Imbalance of intestinal microbiota has been linked to colitis. Probiotics (Bifidobacterium and Lactobacillus) and prebiotics (inulin) together reduced the degree of inflammation in acute colitis mice by increasing the proportion of helpful bacteria and regulating the balance of intestinal microbiota.^[xl]

In a clinical study, 146 subjects with acute gastroenteritis receiving a prebiotic showed significant and sustained improvement of multiple symptoms such as stomach pain, discomfort, gas and bloating compared to the placebo group.^[xli]

Age-related cognitive impairment, such as learning and memory functions, is associated with selective neuronal loss, oxidative changes that lead to microglia activation and neuroinflammation. In aging, there is an alteration in microbiota and gut microbiota diversity is perturbed with an increase in pathogenic bacteria at the expense of beneficial ones. Prebiotics and probiotics can return your gut to a more balanced state and improve age-related cognitive impairment.^[xlii]

Agents for a Healthy Gut

Your gut supports your body's functions and a healthy gut can prevent or help treat metabolic, autoimmune and inflammatory diseases. For more research related to the top natural agents for a healthy gut or balanced microbiome, see GreenMedInfo.com's databases on gastrointestinal agents, yogurt, kefir or fermented foods and beverages, green tea, ginger, vitamin D, berberine, probiotics and prebiotics.

References

[i] National Institute of Health (NIH). National Institute of Diabetes and Digestive and Kidney Disease (NIDDK). Health Information. Health Statistics. Digestive Diseases. https://www.niddk.nih.gov/health-information/health-statistics/digestive-diseases

[ii] Healthline.com. Yogurt 101: Nutrition. Foods. Yogurt. https://www.healthline.com/nutrition/foods/yogurt

[iii] Ruisong Pei, Derek A Martin, Diana M DiMarco, Bradley W Bolling. Evidence for the effects of yogurt on gut health and obesity. Crit Rev Food Sci Nutr. 2017 May 24 ;57(8):1569-1583. PMID: 25875150

[iv] Caroline Ivanne Le Roy, Alexander Kurilshikov, Emily R Leeming, Alessia Visconti, Ruth C E Bowyer, Cristina Menni, Mario Fachi, Hana Koutnikova, Patrick Veiga, Alexandra Zhernakova, Mureil Derrien, Tim D Spector. Yoghurt consumption is associated with changes in the composition of the human gut microbiome and metabolome. BMC Microbiol. 2022 Feb 3 ;22(1):39. Epub 2022 Feb 3. PMID: 35114943

[v] M K Seo, E J Park, S Y Ko, E W Choi, S Kim. Therapeutic effects of kefir grain Lactobacillus-derived extracellular vesicles in mice with 2,4,6-trinitrobenzene sulfonic acid-induced inflammatory bowel disease. J Dairy Sci. 2018 Oct ;101(10):8662-8671. Epub 2018 Aug 9. PMID: 30100498

[vi] Mariana Buranelo Egea, Daiane Costa Dos Santos, Josemar Gonçalves de Oliveira Filho, Joana da Costa Ores, Katiuchia Pereira Takeuchi, Ailton Cesar Lemes. A review of nondairy kefir products: their characteristics and potential human health benefits. Crit Rev Food Sci Nutr. 2020 Nov 5:1-17. Epub 2020 Nov 5. PMID: 33153292

[vii] Qingsong Qu, Fang Yang, Chongyan Zhao, Xing Liu, Pengshuo Yang, Zhixun Li, Lu Han, Xinyuan Shi. Effects of fermented ginseng on the gut microbiota and immunity of rats with antibiotic-associated diarrhea. J Ethnopharmacol. 2021 Mar 1 ;267:113594. Epub 2020 Nov 18. PMID: 33217518

[viii] Beibei Ran, Chang-E Guo, Weidong Li, Weishi Li, Qing Wang, Jinxiu Qian, Hailong Li. Sea buckthorn (Hippophae rhamnoides L.) fermentation liquid protects against alcoholic liver disease linked to regulation of liver metabolome and the abundance of gut microbiota. J Sci Food Agric. 2021 May ;101(7):2846-2854. Epub 2020 Nov 20. PMID: 33145761

[ix] Xiaojuan Ai, Cuiling Wu, Tingting Yin, Olena Zhur, Congling Liu, Xiaotao Yan, CuiPing Yi, Dan Liu, Linhu Xiao, Wenkai Li, Binbin Xie, Hailun He. Antidiabetic Function ofMF423-Fermented Rice Bran and Its Effect on Gut Microbiota Structure in Type 2 Diabetic Mice. Front Microbiol. 2021 ;12:682290. Epub 2021 Jun 24. PMID: 34248898

[x] Xin Ye, Xiaojuan Tang, Fanglan Li, Jiangxiong Zhu, Meirong Wu, Xinlin Wei, Yuanfeng Wang. Green and Oolong Tea Extracts With Different Phytochemical Compositions Prevent Hypertension and Modulate the Intestinal Flora in a High-Salt Diet Fed Wistar Rats. Front Nutr. 2022 ;9:892801. Epub 2022 May 6. PMID: 35600813

[xi] Chih-Wei Chang, Yi-Ju Hsu, Yi-Ming Chen, Wen-Ching Huang, Chi-Chang Huang, Mei-Chich Hsu. Effects of combined extract of cocoa, coffee, green tea and garcinia on lipid profiles, glycaemic markers and inflammatory responses in hamsters. BMC Complement Altern Med. 2015 ;15:269. Epub 2015 Aug 12. PMID: 26264374

[xii] Dae-Bang Seo, Hyun Woo Jeong, Yeon-Ji Kim, Sukyung Kim, Jeongkee Kim, Ji Hae Lee, Kyungmi Joo, Jin Kyu Choi, Song Seok Shin, Sung-Joon Lee. Fermented green tea extract exhibits hypolipidaemic effects through the inhibition of pancreatic lipase and promotion of energy expenditure. Br J Nutr. 2017 Jan 30:1-10. Epub 2017 Jan 30. PMID: 28132656

[xiii] Yu Li, Sajid Ur Rahman, Yingying Huang, Yafei Zhang, Pengfei Ming, Lei Zhu, Xiaoyan Chu, Jinchun Li, Shibin Feng, Xichun Wang, Jinjie Wu. Green tea polyphenols decrease weight gain, ameliorate alteration of gut microbiota, and mitigate intestinal inflammation in canines with high-fat-diet-induced obesity. J Nutr Biochem. 2019 Dec 20 ;78:108324. Epub 2019 Dec 20. PMID: 32004926

[xiv] Kuzmich NN, Sivak KV, Chubarev VN, Porozov YB, Savateeva-Lyubimova TN, Peri F. TLR4 Signaling Pathway Modulators as Potential Therapeutics in Inflammation and Sepsis. Vaccines (Basel). 2017 Oct 4;5(4):34. doi: 10.3390/vaccines5040034. PMID: 28976923; PMCID: PMC5748601.

[xv] Qiubing Chen, Qian Li, Yuqi Liang, Menghang Zu, Nanxi Chen, Brandon S B Canup, Liyong Luo, Chenhui Wang, Liang Zeng, Bo Xiao. Natural exosome-like nanovesicles from edible tea flowers suppress metastatic breast cancerROS generation and microbiota modulation. Acta Pharm Sin B. 2022 Feb ;12(2):907-923. Epub 2021 Aug 18. PMID: 35256954

[xvi] Grzanna R, Lindmark L, Frondoza CG. Ginger--an herbal medicinal product with broad anti-inflammatory actions. J Med Food. 2005 Summer;8(2):125-32. doi: 10.1089/jmf.2005.8.125. PMID: 16117603.

[xvii] Giuffrida P, Cococcia S, Delliponti M, Lenti MV, Di Sabatino A. Controlling Gut Inflammation by Restoring Anti-Inflammatory Pathways in Inflammatory Bowel Disease. Cells. Cells 2019 Apr 30;8(5):397. doi: 10.3390/cells8050397. PMID: 31052214; PMCID: PMC6562982.

[xviii] Naser-Aldin Lashgari, Nazanin Momeni Roudsari, Danial Khayatan, Maryam Shayan, Saeideh Momtaz, Basil D Roufogalis, Amir Hossein Abdolghaffari, Amirhossein Sahebkar. Ginger and its constituents: Role in treatment of inflammatory bowel disease. Biofactors. 2021 Dec 9. Epub 2021 Dec 9. PMID: 34882874

[xix] Sarah W Matthews, Margaret M Heitkemper, Kendra Kamp. Early Evidence Indicates Vitamin D Improves Symptoms of Irritable Bowel Syndrome: Nursing Implications and Future Research Opportunities. Gastroenterol Nurs. 2021 Oct 21. Epub 2021 Oct 21. PMID: 34690298

Jane Fletcher, Sheldon C Cooper, Subrata Ghosh, Martin Hewison. The Role of Vitamin D in Inflammatory Bowel Disease: Mechanism to Management. Nutrients. 2019 May 7 ;11(5). Epub 2019 May 7. PMID: 31067701

[xx] Głąbska D, Kołota A, Lachowicz K, Skolmowska D, Stachoń M, Guzek D. Vitamin D Supplementation and Mental Health in Inflammatory Bowel Diseases and Irritable Bowel Syndrome Patients: A Systematic Review. Nutrients. 2021 Oct 19;13(10):3662. doi: 10.3390/nu13103662. PMID: 34684663; PMCID: PMC8540769.

[xxi] André Silva Franco, Thiago Quadrante Freitas, Wanderley M Bernardo, Rosa Maria R Pereira. Vitamin D supplementation and disease activity in patients with immune-mediated rheumatic diseases: A systematic review and meta-analysis. Medicine (Baltimore). 2017 Jun ;96(23):e7024. PMID: 28591033

[xxii] A J Joseph, Biju George, A B Pulimood, M S Seshadri, Ashok Chacko. 25 (OH) vitamin D level in Crohn's disease: association with sun exposure&disease activity. Indian J Med Res. 2009 Aug;130(2):133-7. PMID: 19797809

[xxiii] Erin A Yamamoto, Trine N Jørgensen. Relationships Between Vitamin D, Gut Microbiome, and Systemic Autoimmunity. Front Immunol. 2019 ;10:3141. Epub 2020 Jan 21. PMID: 32038645

[xxiv] Lucia Malaguarnera. Vitamin D and microbiota: Two sides of the same coin in the immunomodulatory aspects. Int Immunopharmacol. 2019 Dec 23 ;79:106112. Epub 2019 Dec 23. PMID: 31877495

[xxv] Vassil Dimitrov, John H White. Vitamin D signaling in intestinal innate immunity and homeostasis. Mol Cell Endocrinol. 2017 09 15 ;453:68-78. Epub 2017 Apr 12. PMID: 28412519

[xxvi] Lichao Zhang, Xiaoying Wu, Ruibing Yang, Fang Chen, Yao Liao, Zifeng Zhu, Zhongdao Wu, Xi Sun, Lifu Wang. Effects of Berberine on the Gastrointestinal Microbiota. Front Cell Infect Microbiol. 2020 ;10:588517. Epub 2021 Feb 19. PMID: 33680978

[xxvii] Francesco Di Pierro, Alexander Bertuccioli, Rosanna Giuberti, Mariella Saponara, Leandro Ivaldi. Role of a berberine-based nutritional supplement in reducing diarrhea in subjects with functional gastrointestinal disorders. Minerva Gastroenterol Dietol. 2020 Mar ;66(1):29-34. PMID: 32283882

[xxviii] Xiaofan Xu, Wei Li, Zhendong Yu, Le Zhang, Ting Duo, Ya Zhao, Wenxia Qin, Wenbo Yang, Libao Ma. Berberine Ameliorates Dextran Sulfate Sodium-Induced Ulcerative Colitis and Inhibits the Secretion of Gut Lysozyme via Promoting Autophagy. Metabolites. 2022 Jul 23 ;12(8). Epub 2022 Jul 23. PMID: 35893243

[xxix] Tao Yang, Xiao Ma, Ruilin Wang, Honghong Liu, Shizhang Wei, Manyi Jing, Haotian Li, Yanling Zhao. Berberine inhibits IFN-γ signaling pathway in DSS-induced ulcerative colitis. Saudi Pharm J. 2022 Jun ;30(6):764-778. Epub 2022 Apr 1. PMID: 35812150

[xxx] Yue Hu, Liyuan Tao, Bin Lyu. A meta-analysis of probiotics for the treatment of irritable bowel syndrome. Zhonghua Nei Ke Za Zhi. 2015 May ;54(5):445-51. PMID: 26080826

[xxxi] Vincenzo Davide Palumbo, Marcello Romeo, Antonella Marino Gammazza, Francesco Carini, Provvidenza Damiani, Giuseppe Damiano, Salvatore Buscemi, Attilio Ignazio Lo Monte, Alice Gerges-Geagea, Abdo Jurjus, Giovanni Tomasello. The long-term effects of probiotics in the therapy of ulcerative colitis: A clinical study. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2016 Sep 13. Epub 2016 Sep 13. PMID: 27623957

[xxxii] Ryo Aoki, Kohei Kamikado, Wataru Suda, Hiroshi Takii, Yumiko Mikami, Natsuki Suganuma, Masahira Hattori, Yasuhiro Koga. A proliferative probiotic Bifidobacterium strain in the gut ameliorates progression of metabolic disorders via microbiota modulation and acetate elevation. Sci Rep. 2017 Mar 2 ;7:43522. Epub 2017 Mar 2. PMID: 28252037

[xxxiii] F Pace, M Pace, G Quartarone. Probiotics in digestive diseases: focus on Lactobacillus GG. Minerva Gastroenterol Dietol. 2015 Dec ;61(4):273-92. PMID: 26657927

[xxxiv] Maria Wiese, Yuriy Bashmakov, Natalia Chalyk, Dennis Sandris Nielsen, Łukasz Krych, Witold Kot, Victor Klochkov, Dmitry Pristensky, Tatyana Bandaletova, Marina Chernyshova, Nigel Kyle, Ivan Petyaev. Prebiotic Effect of Lycopene and Dark Chocolate on Gut Microbiome with Systemic Changes in Liver Metabolism, Skeletal Muscles and Skin in Moderately Obese Persons. Biomed Res Int. 2019 ;2019:4625279. Epub 2019 Jun 2. PMID: 31317029

[xxxv] J L Rowles, K M Ranard, J W Smith, R An, J W Erdman. Increased dietary and circulating lycopene are associated with reduced prostate cancer risk: a systematic review and meta-analysis. Prostate Cancer Prostatic Dis. 2017 Apr 25. Epub 2017 Apr 25. PMID: 28440323

[xxxvi] Bo Song, Kai Liu, Yuan Gao, Lu Zhao, Hui Fang, Yusheng Li, Lulu Pei, Yuming Xu. Lycopene and risk of cardiovascular diseases: A meta-analysis of observational studies. Mol Nutr Food Res. 2017 Mar 20. Epub 2017 Mar 20. PMID: 28318092

[xxxvii] Mohsen Mazidi, Gordon A Ferns, Maciej Banach. A high consumption of tomato and lycopene is associated with a lower risk of cancer mortality: results from a multi-ethnic cohort. Public Health Nutr. 2020 Feb 27:1-7. Epub 2020 Feb 27. PMID: 32102720

[xxxviii] Shivani Sahni, Marian T Hannan, Jeffrey Blumberg, L Adrienne Cupples, Douglas P Kiel, Katherine L Tucker. Protective effect of total carotenoid and lycopene intake on the risk of hip fracture: a 17-year follow-up from the Framingham Osteoporosis Study. J Bone Miner Res. 2009 Jun;24(6):1086-94. PMID: 19138129

[xxxix] Umani S Walallawita, Frances M Wolber, Ayelet Ziv-Gal, Marlena C Kruger, Julian A Heyes. Potential Role of Lycopene in the Prevention of Postmenopausal Bone Loss: Evidence from Molecular to Clinical Studies. Int J Mol Sci. 2020 Sep 27 ;21(19). Epub 2020 Sep 27. PMID: 32992481

[xl] Ya-Nan Wang, Xiang-Chen Meng, Yi-Fan Dong, Xin-Hua Zhao, Jia-Ming Qian, Hong-Ying Wang, Jing-Nan Li. Effects of probiotics and prebiotics on intestinal microbiota in mice with acute colitis based on 16S rRNA gene sequencing. Chin Med J (Engl). 2019 Jul 1. Epub 2019 Jul 1. PMID: 31268903

[xli] Telma Noguera, Robert Wotring, Chris R Melville, Kara Hargraves, Jochen Kumm, John M Morton. Resolution of acute gastroenteritis symptoms in children and adults treated with a novel polyphenol-based prebiotic. World J Gastroenterol. 2014 Sep 14 ;20(34):12301-7. PMID: 25232265

[xlii] Alejandra Romo-Araiza, Antonio Ibarra. Prebiotics and probiotics as potential therapy for cognitive impairment. Med Hypotheses. 2019 Sep 26 ;134:109410. Epub 2019 Sep 26. PMID: 31627123