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Cited by 277Probiotics and Fermented FoodsGut microbiota and healthAnimal Nutrition and Physiology

International Society of Sports Nutrition Position Stand: Probiotics

Open access
Jäger, Ralf, Mohr, Alex E., Carpenter, Katie C., Kerksick, Chad M., Purpura, Martin, Moussa, Adel, Townsend, Jeremy R., Lamprecht, Manfred +17 more·2019·Journal of the International Society of Sports Nutrition
DOI 10.1186/s12970-019-0329-0PMC PMC6925426
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Abstract

Position statement: The International Society of Sports Nutrition (ISSN) provides an objective and critical review of the mechanisms and use of probiotic supplementation to optimize the health, performance, and recovery of athletes. Based on the current available literature, the conclusions of the ISSN are as follows: 1)Probiotics are live microorganisms that, when administered in adequate amounts, confer a health benefit on the host (FAO/WHO).2)Probiotic administration has been linked to a multitude of health benefits, with gut and immune health being the most researched applications.3)Despite the existence of shared, core mechanisms for probiotic function, health benefits of probiotics are strain- and dose-dependent.4)Athletes have varying gut microbiota compositions that appear to reflect the activity level of the host in comparison to sedentary people, with the differences linked primarily to the volume of exercise and amount of protein consumption. Whether differences in gut microbiota composition affect probiotic efficacy is unknown.5)The main function of the gut is to digest food and absorb nutrients. In athletic populations, certain probiotics strains can increase absorption of key nutrients such as amino acids from protein, and affect the pharmacology and physiological properties of multiple food components.6)Immune depression in athletes worsens with excessive training load, psychological stress, disturbed sleep, and environmental extremes, all of which can contribute to an increased risk of respiratory tract infections. In certain situations, including exposure to crowds, foreign travel and poor hygiene at home, and training or competition venues, athletes' exposure to pathogens may be elevated leading to increased rates of infections. Approximately 70% of the immune system is located in the gut and probiotic supplementation has been shown to promote a healthy immune response. In an athletic population, specific probiotic strains can reduce the number of episodes, severity and duration of upper respiratory tract infections.7)Intense, prolonged exercise, especially in the heat, has been shown to increase gut permeability which potentially can result in systemic toxemia. Specific probiotic strains can improve the integrity of the gut-barrier function in athletes.8)Administration of selected anti-inflammatory probiotic strains have been linked to improved recovery from muscle-damaging exercise.9)The minimal effective dose and method of administration (potency per serving, single vs. split dose, delivery form) of a specific probiotic strain depends on validation studies for this particular strain. Products that contain probiotics must include the genus, species, and strain of each live microorganism on its label as well as the total estimated quantity of each probiotic strain at the end of the product's shelf life, as measured by colony forming units (CFU) or live cells.10)Preclinical and early human research has shown potential probiotic benefits relevant to an athletic population that include improved body composition and lean body mass, normalizing age-related declines in testosterone levels, reductions in cortisol levels indicating improved responses to a physical or mental stressor, reduction of exercise-induced lactate, and increased neurotransmitter synthesis, cognition and mood. However, these potential benefits require validation in more rigorous human studies and in an athletic population.

AI snapshot

Written from the paper’s full text.

TL;DR

This ISSN position stand critically reviews probiotic supplementation for athletes and concludes that benefits are strain- and dose-dependent, with the strongest evidence for immune and gut health and mixed evidence for performance. Specific strains may reduce upper respiratory tract infection episodes/severity and improve recovery, but more rigorous athlete studies are needed.

Key findings

  • Of 24 studies assessing athletic performance, 17 reported a null effect and 7 reported significant improvement; single-strain probiotics produced a significant aerobic performance benefit in only one study, while multi-strain results were mixed.
  • Of 22 studies assessing immune outcomes, 14 reported significant improvement and 8 reported no effects. In 465 active individuals, daily *B. animalis* ssp. *lactis* Bl-04 for 150 days was associated with a 27% reduction in risk of any URTI episode; a double-strain probiotic produced a 19% decrease that was not statistically significant, and both probiotic groups showed a ~0.8-month delay in time to illness.
  • Of 10 studies assessing GI benefit, the majority reported no effect, but four reported positive results, including decreased zonulin, decreased endotoxin, reduced intestinal hyperpermeability, and shorter duration of GI-symptom episodes.
  • Safety data were limited: 11 studies measured adverse events and general supplementation tolerance, while 30 did not; supplementation was generally well tolerated, with one instance of mild GI symptoms (5 episodes) reported in 22 active individuals taking a multi-strain probiotic.

Methods

  • Design: International Society of Sports Nutrition position stand providing an objective and critical review of mechanisms and use of probiotic supplementation to optimize athlete health, performance, and recovery.
  • Data: Review of studies in athletes and physically active individuals, including performance, immune, and GI outcomes; doses and durations varied widely, and a PubMed search in October 2019 yielded 145 listings for “probiotic and athlete” versus 3407 for “probiotic and rodent.”
  • Analysis: Narrative synthesis of the available literature; no meta-analysis or pooled effect estimates are reported.

Limitations

  • The paper states there is no clear set of recommendations or guidelines on probiotic use for athletes; effects are strain- and dose-specific, and studies vary considerably in species/strains, duration, dosage, and outcome measures, making comparison difficult.
  • The paper states there are a small number of studies with substantial variation in experimental approaches, dependent measures, and outcomes; most studies do not control for previous physical activity, long-term effects are unclear because most supplementation periods were 4–16 weeks, and sex differences and small sample sizes require further study.
  • The paper states adverse events are often not well recorded in nutritional studies, including probiotics (11 studies measured AEs; 30 did not); evident from the text, this is a narrative position stand rather than a systematic review or meta-analysis, so it does not provide formal risk-of-bias assessment or pooled effect estimates.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1186/s12970-019-0329-0

Cites

288 of 288 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 197 cited sources checked · 0 supported · 0 flagged

  • Findingnone given

    Currently, there are more studies showing a benefit for multi-strain probiotics in relation to performance measures compared to single-strain probiotics.

    “Currently, there are more studies showing a benefit for multi-strain probiotics in relation to performance measures compared to single-strain probiotics.”
    Quote in the paperNot a substantial claim
  • Findingcitation

    Null findings were similarly reported in several studies investigating the effects of multi-strain probiotics on aerobic performance.

    “Null findings were similarly reported in several studies investigating the effects of multi-strain probiotics on aerobic performance.”
    Quote in the paperNot a substantial claim
  • Findingnone given

    The effect of probiotic supplementation on body composition has been mixed.

    “The effect of probiotic supplementation on body composition has been mixed and requires further research.”
    Quote in the paperNot a substantial claim
  • Findingcitation

    The single strain interventions used in five studies did not produce an aerobic performance benefit.

    “The single strain interventions used in these five studies did not produce an aerobic performance benefit.”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [57] Cox AJ Pyne DB Saunders PU Fricker PA Oral administration of the probiotic Lactobacillus fermentum VRI-003 and mucosal immunity in endurance athletes Br J Sports Med 2010 44 222 226 10.1136/bjsm.2007.044628 18272539 source

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    • cites [61] West NP Pyne DB Cripps AW Hopkins WG Eskesen DC Jairath A Christophersen CT Conlon MA Fricker PA Lactobacillus fermentum (PCC(R)) supplementation and gastrointestinal and respiratory-tract illness symptoms: a randomised control trial in athletes Nutr J 2011 10 30 10.1186/1475-2891-10-30 21477383 PMC3083335 source

      Not checked in the free run.

    • cites [67] Sashihara T Nagata M Mori T Ikegami S Gotoh M Okubo K Uchida M Itoh H Effects of Lactobacillus gasseri OLL2809 and alpha-lactalbumin on university-student athletes: a randomized, double-blind, placebo-controlled clinical trial Appl Physiol Nutr Metab 2013 38 1228 1235 10.1139/apnm-2012-0490 24195623 source

      Not checked in the free run.

  • Findingown data

    Overall, the results of research specifically designed to investigate the effect of probiotic supplementation on performance are mixed.

    “Research specifically designed to investigate the effect of probiotic supplementation on performance has been less common and overall the results are mixed.”
    Quote in the paperSubstantial claim
  • May combine two claims. 90
  • Classified as probably not a substantial claim. 74
  • The quote only partly states this claim. 5

  • May combine two claims.

    Findingnone given

    Of the 24 studies that assessed some metric of athletic performance, 17 reported a null effect, while 7 reported significant improvement.

    “Of the 24 studies that assessed some metric of athletic performance, 17 reported a null effect, while 7 reported significant improvement.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingnone given

    While there are some encouraging results, a large majority of studies have found no effect on aerobic performance.

    “While there are some encouraging results, a large majority of studies have found no effect on aerobic performance.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingnone given

    Of the 22 studies reviewed in this Position Stand that assessed the effect of probiotics on outcomes related to the immune system, 14 reported significant improvement, whereas 8 reported no effects.

    “Of the 22 studies reviewed in this Position Stand that assessed the effect of probiotics on outcomes related to the immune system, 14 reported significant improvement, whereas 8 reported no effects.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingcitation

    Positive GI results included significantly decreased concentrations of zonulin and endotoxin, as well as intestinal hyperpermeability and duration of GI-symptom episode.

    “This latter group included significantly decreased concentrations of zonulin [63] and endotoxin [77], as well as intestinal hyperpermeability [132] and duration of GI-symptom episode.”
    • Also stated in: § Benefits of probiotic supplementation in athletes · plain
      “Positive results reported included decreases in concentrations of zonulin and endotoxin, intestinal hyperpermeability and duration of GI-symptom episodes.”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [63] Lamprecht M Bogner S Schippinger G Steinbauer K Fankhauser F Hallstroem S Schuetz B Greilberger JF Probiotic supplementation affects markers of intestinal barrier, oxidation, and inflammation in trained men; a randomized, double-blinded, placebo-controlled trial J Int Soc Sports Nutr 2012 9 45 10.1186/1550-2783-9-45 22992437 PMC3465223 source

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    • cites [77] Roberts Justin Suckling Craig Peedle Georgia Murphy Joseph Dawkins Tony Roberts Michael An Exploratory Investigation of Endotoxin Levels in Novice Long Distance Triathletes, and the Effects of a Multi-Strain Probiotic/Prebiotic, Antioxidant Intervention Nutrients 2016 8 11 733 10.3390/nu8110733 PMC5133117 27869661 source

      Not checked in the free run.

    • cites [132] Brennan, C.J.; Axelrod, C.; Paul, D.; Hull, M.; Kirwan, J.P. Effects of a novel probiotic on exercise-induced gut permeability and microbiota in endurance athletes (abstract). In proceedings of American College of Sports Medicine, Minneapolis, MN.

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    In this position stand, 11 studies measured adverse events and general supplementation tolerance, while 30 studies did not.

    “In this position stand, which reviews studies focused on probiotic supplementation in athletes and physically active individuals, 11 studies measured AEs and general supplementation tolerance, while 30 studies did not.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    Overall, probiotics have an excellent safety profile with a large majority of clinical trials involving probiotics not giving rise to major safety concerns.

    “Overall, probiotics have an excellent safety profile with a large majority of clinical trials involving probiotics not giving rise to major safety concerns [213].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [213] Sanders ME Akkermans LM Haller D Hammerman C Heimbach J Hormannsperger G Huys G Levy DD Lutgendorff F Mack D Safety assessment of probiotics for human use Gut Microbes 2010 1 164 185 10.4161/gmic.1.3.12127 21327023 PMC3023597 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    The current body of research has investigated a wide variety of species/strains, duration of use, and dosages with several different intended purposes.

    “The current body of research has investigated a wide variety of species/strains, duration of use, and dosages with several different intended purposes (Table 4).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    In studies investigating specific probiotic genera in athletes and physically active individuals, dosage ranges were: Lactobacillus 1×10^9-10×10^10 CFU; Bifidobacterium 7×10^7-9.5×10^9 CFU; Streptococcus 5×10^9-4.5×10^10 CFU; Bacillus 5×10^8-5×10^9 CFU; multi-species/strain 2×10^9-4.5×10^10 CFU.

    “| Lactobacillus (n = 35) | 1 × 109 – 10 × 1010 CFU |”
    • Also stated in: § Regulation · plain
      “| Bifidobacterium (n = 18) | 7 × 107–9.5 × 109 CFU |”
    • Also stated in: § Regulation · plain
      “| Streptococcus (n = 8) | 5 × 109–4.5 × 1010 CFU |”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The studies included in this position stand are representative of probiotic supplementation in athletes and physically active individuals.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    In our review, we report a wide range of doses, and in several studies the dosage was not reported.

    “In our review, we report a wide range of doses (Table 4), and in several studies the dosage was not reported.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The studies included in this position stand are representative of probiotic supplementation in athletes and physically active individuals.

  • May combine two claims.

    Findingcitation

    The duration of probiotic supplementation has been variable in the studies reviewed; the shortest duration lasted 7 days and the longest lasted 150 days.

    “Similar to the type of probiotic used, the duration of supplementation has also been variable in the studies reviewed (Table 3). The shortest duration lasted 7 days [75, 76] and the longest lasted 150 days [68].”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [75] Gill SK Teixeira AM Rosado F Cox M Costa RJ High-dose probiotic supplementation containing Lactobacillus casei for 7 days does not enhance salivary antimicrobial protein responses to exertional heat stress compared with placebo Int J Sport Nutr Exerc Metab 2016 26 150 160 10.1123/ijsnem.2015-0171 26479711 source

      Not checked in the free run.

    • cites [76] Gill SK Allerton DM Ansley-Robson P Hemmings K Cox M Costa RJ Does short-term high dose probiotic supplementation containing Lactobacillus casei attenuate exertional-heat stress induced Endotoxaemia and Cytokinaemia? Int J Sport Nutr Exerc Metab 2016 26 268 275 10.1123/ijsnem.2015-0186 26568577 source

      Not checked in the free run.

    • cites [68] West NP Horn PL Pyne DB Gebski VJ Lahtinen SJ Fricker PA Cripps AW Probiotic supplementation for respiratory and gastrointestinal illness symptoms in healthy physically active individuals Clin Nutr 2014 33 581 587 10.1016/j.clnu.2013.10.002 24268677 source

      Not checked in the free run.

    • Rests on an assumption: The studies included in this position stand are representative of probiotic supplementation in athletes and physically active individuals.

  • May combine two claims.

    Findingown data

    A PubMed search conducted in October 2019 yielded listings: probiotic and athlete n=145; probiotic and rodent n=3407; probiotic and diabetes n=844; probiotic and child n=2930; probiotic and elderly n=2257.

    “A PubMed search conducted in October 2019 yielded the following listings for various combinations of key terms: probiotic and athlete, n = 145; probiotic and rodent, n = 3407; probiotic and diabetes, n = 844; probiotic and child, n = 2930; probiotic and elderly, n = 2257.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The PubMed search terms used capture the relevant literature on probiotics in athletes.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Several studies used a combination of species and strains (n=17), ranging from two up to 14 different species/strains.

    “In addition, several studies used a combination of species and strains (n = 17), ranging from two up to 14 different species/strains.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The studies included in this position stand are representative of probiotic supplementation in athletes and physically active individuals.

  • May combine two claims.

    Premisecitation

    Despite the existence of shared, core mechanisms for probiotic function, health benefits of probiotics are strain- and dose-dependent.

    “Despite the existence of shared, core mechanisms for probiotic function, health benefits of probiotics are strain- and dose-dependent.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [10] Pyne DB West NP Cox AJ Cripps AW Probiotics supplementation for athletes - clinical and physiological effects Eur J Sport Sci 2015 15 63 72 10.1080/17461391.2014.971879 25339255 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Athletes have varying gut microbiota compositions that appear to reflect the activity level of the host in comparison to sedentary people, with the differences linked primarily to the volume of exercise and amount of protein consumption.

    “Athletes have varying gut microbiota compositions that appear to reflect the activity level of the host in comparison to sedentary people, with the differences linked primarily to the volume of exercise and amount of protein consumption.”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [15] Bressa C Bailen-Andrino M Perez-Santiago J Gonzalez-Soltero R Perez M Montalvo-Lominchar MG Mate-Munoz JL Dominguez R Moreno D Larrosa M Differences in gut microbiota profile between women with active lifestyle and sedentary women PLoS One 2017 12 e0171352 10.1371/journal.pone.0171352 28187199 PMC5302835 source

      Not checked in the free run.

    • cites [16] Clarke SF Murphy EF O'Sullivan O Lucey AJ Humphreys M Hogan A Hayes P O'Reilly M Jeffery IB Wood-Martin R Exercise and associated dietary extremes impact on gut microbial diversity Gut 1913 2014 63 10.1136/gutjnl-2013-306541 25021423 source

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    • cites [17] Petersen LM Bautista EJ Nguyen H Hanson BM Chen L Lek SH Sodergren E Weinstock GM Community characteristics of the gut microbiomes of competitive cyclists Microbiome 2017 5 98 10.1186/s40168-017-0320-4 28797298 PMC5553673 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In 33 trained athletes, 12 weeks of winter training supplementation with a multi-species probiotic did not benefit athletic performance, but training load was higher in those who supplemented with the probiotic blend vs. the placebo group.

    “In thirty-three trained athletes, 12 weeks of winter training supplementation with a multi-species probiotic did not benefit athletic performance; however, the training load (hours per week) was higher in those who supplemented with the probiotic blend vs. the placebo group [78].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [78] Strasser Barbara Geiger Daniela Schauer Markus Gostner Johanna Gatterer Hannes Burtscher Martin Fuchs Dietmar Probiotic Supplements Beneficially Affect Tryptophan–Kynurenine Metabolism and Reduce the Incidence of Upper Respiratory Tract Infections in Trained Athletes: A Randomized, Double-Blinded, Placebo-Controlled Trial Nutrients 2016 8 11 752 10.3390/nu8110752 PMC5133134 27886064 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Diet is an established modulator of gut microbiota composition, with significant change reported within 24 h of a dietary modification.

    “Diet is an established modulator of gut microbiota composition, with significant change reported within 24 h of a dietary modification [32].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [32] David LA Maurice CF Carmody RN Gootenberg DB Button JE Wolfe BE Ling AV Devlin AS Varma Y Fischbach MA Diet rapidly and reproducibly alters the human gut microbiome Nature 2014 505 559 563 10.1038/nature12820 24336217 PMC3957428 source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    Probiotic supplementation as an ergogenic aid for performance enhancement may be indirect via modulation of other systems.

    “Probiotics supplementation as an ergogenic aid for performance enhancement requires further investigation and may be indirect via modulation of other systems.”
    Quote in the paperSubstantial claim

  • The quote only partly states this claim.

    Premisecitation

    In 30 endurance athletes, a yogurt drink containing Streptococcus thermophilus or Lactobacillus delbrueckii ssp. bulgaricus over 30 days during intense aerobic training significantly increased VO2max and aerobic power in the Cooper aerobic test.

    “However positive results were reported in thirty endurance athletes supplementing with a yogurt drink, either containing Streptococcus thermophilus or Lactobacillus delbrueckii ssp. bulgaricus or no probiotics over 30 days during intense aerobic training. There was a significant increase in VO2max and aerobic power in the Cooper aerobic test [45].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [45] Salehzadeh K The effects of probiotic yogurt drink on lipid profile, CRP, and record changes in aerobic athletes Life Sci 2015 9 32 37

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In highly trained athletes, 12 weeks of a multi-strain probiotic reduced the incidence of URTI compared to placebo and limited exercise-induced reductions in tryptophan levels.

    “Daily supplementation with probiotics reduced the incidence of URTI compared to placebo. In addition, supplementation limited exercise-induced reductions in tryptophan levels, which may reduce the risk of developing an infection.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [78] Strasser Barbara Geiger Daniela Schauer Markus Gostner Johanna Gatterer Hannes Burtscher Martin Fuchs Dietmar Probiotic Supplements Beneficially Affect Tryptophan–Kynurenine Metabolism and Reduce the Incidence of Upper Respiratory Tract Infections in Trained Athletes: A Randomized, Double-Blinded, Placebo-Controlled Trial Nutrients 2016 8 11 752 10.3390/nu8110752 PMC5133134 27886064 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In recreationally-trained individuals, 20 g casein protein co-administered with B. coagulans GBI-30, 6086 for 2 weeks increased recovery and decreased soreness after a muscle-damaging single-leg training bout.

    “In a follow up study, 20 g of casein protein co-administered with B. coagulans GBI-30, 6086 (BC30) or a placebo in recreationally-trained individuals for 2 weeks increased recovery and decreased soreness after a muscle-damaging single-leg training bout [43].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [43] Jäger Ralf Shields Kevin A. Lowery Ryan P. De Souza Eduardo O. Partl Jeremy M. Hollmer Chase Purpura Martin Wilson Jacob M. ProbioticBacillus coagulansGBI-30, 6086 reduces exercise-induced muscle damage and increases recovery PeerJ 2016 4 e2276 10.7717/peerj.2276 27547577 PMC4963221 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In competitive cyclists, L. fermentum (PCC®) over an 11-week winter training period reduced severity of self-reported symptoms of lower respiratory illness and use of cold and flu medication compared to placebo, but this effect was only noted in males and not females.

    “In competitive cyclists, West et al. [61] reported reduced severity of self-reported symptoms of lower respiratory illness and use of cold and flu medication over an 11-week winter training period with L. fermentum (PCC®) compared to placebo. Interestingly, this effect was only noted in males and not females.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [61] West NP Pyne DB Cripps AW Hopkins WG Eskesen DC Jairath A Christophersen CT Conlon MA Fricker PA Lactobacillus fermentum (PCC(R)) supplementation and gastrointestinal and respiratory-tract illness symptoms: a randomised control trial in athletes Nutr J 2011 10 30 10.1186/1475-2891-10-30 21477383 PMC3083335 source

      Not checked in the free run.

  • The quote only partly states this claim.

    Premisecitation

    In Division I female volleyball and soccer athletes, 10 weeks of B. subtilis DE111 probiotic supplementation with a post-workout recovery drink yielded greater reductions in body fat and increases in fat free mass than placebo.

    “Probiotic supplementation with the post-workout recovery drink yielded greater reductions in body fat and increases in fat free mass after 10 weeks of resistance training than a placebo.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [103] Toohey JC, Townsend JR, Johnson SB, Toy AM, Vantrease WC, Bender D, Crimi CC, Stowers KL, Ruiz MD, VanDusseldorp TA, et al. Effects of probiotic (Bacillus subtilis) supplementation during offseason resistance training in female division I athletes. J Strength Cond Res. 2018. 10.1519/JSC.0000000000002675. 33105368 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In Division I collegiate baseball players, 12 weeks of B. subtilis DE111 supplementation showed no group differences in strength, performance, or body composition, but significantly lower serum TNF-α concentrations than placebo.

    “There were no group differences observed between those who took the probiotic and placebo for any measure of strength, performance, or body composition. However, those athletes who did supplement with probiotics had significantly lower serum TNF-α concentrations than the placebo group.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [83] Townsend Jeremy Bender David Vantrease William Sapp Philip Toy Ann Woods Clint Johnson Kent Effects of Probiotic (Bacillus subtilis DE111) Supplementation on Immune Function, Hormonal Status, and Physical Performance in Division I Baseball Players Sports 2018 6 3 70 10.3390/sports6030070 PMC6162611 30049931 source

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  • May combine two claims.

    Premisecitation

    In 141 non-elite marathon runners, 12 weeks of L. rhamnosus GG did not significantly affect allergic markers or incidence of URTI episodes.

    “For example, a 12-week study on 141 non-elite marathon runners during pollen season supplementing daily with L. rhammnosus GG (LGG) did not find a significant effect on allergic markers [54] or on the incidence of UTRI episodes [55].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [54] Moreira A Kekkonen R Korpela R Delgado L Haahtela T Allergy in marathon runners and effect of Lactobacillus GG supplementation on allergic inflammatory markers Respir Med 2007 101 1123 1131 10.1016/j.rmed.2006.11.015 17196811 source

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    • cites [55] Kekkonen RA Vasankari TJ Vuorimaa T Haahtela T Julkunen I Korpela R The effect of probiotics on respiratory infections and gastrointestinal symptoms during training in marathon runners Int J Sport Nutr Exerc Metab 2007 17 352 363 10.1123/ijsnem.17.4.352 17962710 source

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  • May combine two claims.

    Premisecitation

    In 465 active individuals, supplementation with a double-strain probiotic (Lactobacillus acidophilus NCFM and B. animalis subsp. lactis Bi-07) resulted in a 19% decrease of URTI risk, although this was not statistically significant.

    “Supplementation with the double-strain probiotic resulted in a 19% decrease of URTI risk, although this was not statistically significant.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [68] West NP Horn PL Pyne DB Gebski VJ Lahtinen SJ Fricker PA Cripps AW Probiotic supplementation for respiratory and gastrointestinal illness symptoms in healthy physically active individuals Clin Nutr 2014 33 581 587 10.1016/j.clnu.2013.10.002 24268677 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    One month of daily L. acidophilus supplementation significantly increased secretion of interferon (IFN)-γ from T cells in fatigued athletes to levels found in healthy athletes and increased the concentration of IFN-γ in saliva of healthy control athletes.

    “One month of daily L. acidophilus supplementation significantly increased secretion of interferon (IFN)-γ from T cells in fatigued athletes to levels found in healthy athletes and increased the concentration of IFN-γ in saliva of healthy control athletes.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [53] Clancy RL Gleeson M Cox A Callister R Dorrington M D'Este C Pang G Pyne D Fricker P Henriksson A Reversal in fatigued athletes of a defect in interferon gamma secretion after administration of Lactobacillus acidophilus Br J Sports Med 2006 40 351 354 10.1136/bjsm.2005.024364 16556792 PMC2577537 source

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  • May combine two claims.

    Premisecitation

    In endurance-based recreational athletes, Lactobacillus casei Shirota during 4 months of winter training significantly reduced URTIs compared to placebo, and salivary IgA concentration was significantly higher in those consuming the probiotic.

    “Similarly, Gleeson et al. [60] examined the effects of Lactobacillus casei Shirota during 4 months of winter training in endurance-based recreational athletes and observed a significant reduction in URTIs compared to placebo. In addition, salivary IgA concentration was significantly higher in those consuming the probiotic.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [60] Gleeson M Bishop NC Oliveira M Tauler P Daily probiotic's (Lactobacillus casei Shirota) reduction of infection incidence in athletes Int J Sport Nutr Exerc Metab 2011 21 55 64 10.1123/ijsnem.21.1.55 21411836 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In elite athletes, L. helveticus Lafti L10 over 14 weeks significantly reduced the length of URTI episodes and lowered the number of symptoms per episode compared to placebo, and significantly increased CD4+/CD8+ cell ratio.

    “Supplementation with the probiotic significantly reduced the length of URTI episodes and lowered the number of symptoms per episode compared to placebo. Moreover, there was a significant increase of CD4+/CD8+ (T helper/T suppressor) cells ratio in the probiotic group.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [79] Michalickova D Minic R Dikic N Andjelkovic M Kostic-Vucicevic M Stojmenovic T Nikolic I Djordjevic B Lactobacillus helveticus Lafti L10 supplementation reduces respiratory infection duration in a cohort of elite athletes: a randomized, double-blind, placebo-controlled trial Appl Physiol Nutr Metab 2016 41 782 789 10.1139/apnm-2015-0541 27363733 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Shared, core mechanisms for probiotic function are evident, although some mechanisms, including those related to immunomodulation, may be more narrowly distributed.

    “Shared, core mechanisms for probiotic function are evident, although some mechanisms may be more narrowly distributed, including those related to immunomodulation [121].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [121] Sanders M Merenstein D Merrifield C Hutkins R Probiotics for Human Use Nutr Bull 2019 43 212 225 10.1111/nbu.12334 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In 30 elite union rugby players, a multi-strain probiotic over 4 weeks resulted in lower incidence of infection-related symptoms compared to placebo, although there was no difference in the severity of the symptoms.

    “The probiotic group had lower incidence of infection-related symptoms compared to placebo, although there was no difference in the severity of the symptoms between the two treatment groups.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [69] Haywood BA Black KE Baker D McGarvey J Healey P Brown RC Probiotic supplementation reduces the duration and incidence of infections but not severity in elite rugby union players J Sci Med Sport 2014 17 356 360 10.1016/j.jsams.2013.08.004 24045086 source

      Not checked in the free run.

  • The quote only partly states this claim.

    Premisecitation

    In 20 elite male distance runners, L. fermentum VRI-003 (PCC) over 16 weeks of winter training significantly reduced URTI incidence and severity compared to placebo.

    “Probiotic supplementation significantly reduced URTI incidence and severity compared to placebo.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [57] Cox AJ Pyne DB Saunders PU Fricker PA Oral administration of the probiotic Lactobacillus fermentum VRI-003 and mucosal immunity in endurance athletes Br J Sports Med 2010 44 222 226 10.1136/bjsm.2007.044628 18272539 source

      Not checked in the free run.

  • The quote only partly states this claim.

    Premisecitation

    L. gasseri OLL2809 supplementation for 4 weeks prevented reduced NK cell activity after strenuous exercise in 44 university-student athletes.

    “The probiotic supplementation prevented reduced NK cell activity after strenuous exercise which may enhance resistance against infections.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [67] Sashihara T Nagata M Mori T Ikegami S Gotoh M Okubo K Uchida M Itoh H Effects of Lactobacillus gasseri OLL2809 and alpha-lactalbumin on university-student athletes: a randomized, double-blind, placebo-controlled clinical trial Appl Physiol Nutr Metab 2013 38 1228 1235 10.1139/apnm-2012-0490 24195623 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The GI tract and particularly the gut are quite adaptable and can be targeted to improve the delivery of nutrients during exercise while at the same time alleviating some or all of the symptoms.

    “The GI tract and particularly the gut are quite adaptable and can be targeted to improve the delivery of nutrients during exercise while at the same time alleviating some (or all) of the symptoms [131].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [131] Jeukendrup AE Training the gut for athletes Sports Med 2017 47 101 110 10.1007/s40279-017-0690-6 28332114 PMC5371619 source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    The overall result of GI probiotic studies is not conclusive as four studies reported positive results.

    “Further, the overall result is not conclusive as four studies reported positive results.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Athletes may compromise their immune status with high training loads (over-reaching, over-training), which can increase the risk of illness such as URTIs.

    “Athletes may compromise their immune status with high training loads (over-reaching, over-training) which can increase the risk of illness such as URTIs.”
    • Also stated in: § Mechanism of action · boosted
      “Numerous studies have shown that prolonged intense physical exercise is associated with a transient depression of immune function in athletes.”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [116] Schwellnus M Soligard T Alonso JM Bahr R Clarsen B Dijkstra HP Gabbett TJ Gleeson M Hagglund M Hutchinson MR How much is too much? (part 2) International Olympic Committee consensus statement on load in sport and risk of illness Br J Sports Med 2016 50 1043 1052 10.1136/bjsports-2016-096572 27535991 PMC5013087 source

      Not checked in the free run.

    • cites [199] Gleeson M Bishop NC URI in athletes: are mucosal immunity and cytokine responses key risk factors? Exerc Sport Sci Rev 2013 41 148 153 10.1097/JES.0b013e3182956ead 23792489 source

      Not checked in the free run.

    • cites [200] Walsh NP Recommendations to maintain immune health in athletes Eur J Sport Sci 2018 18 820 831 10.1080/17461391.2018.1449895 29637836 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    GI problems often occur in endurance athletes and particularly during prolonged events such as cycling, triathlons and marathons.

    “GI problems often occur in endurance athletes and particularly during prolonged events such as cycling, triathlons and marathons [41, 127].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [41] de Oliveira EP Burini RC Jeukendrup A Gastrointestinal complaints during exercise: prevalence, etiology, and nutritional recommendations Sports Med 2014 44 Suppl 1 S79 S85 10.1007/s40279-014-0153-2 24791919 PMC4008808 source

      Not checked in the free run.

    • cites [127] Rehrer NJ van Kemenade M Meester W Brouns F Saris WH Gastrointestinal complaints in relation to dietary intake in triathletes Int J Sport Nutr 1992 2 48 59 10.1123/ijsn.2.1.48 1338583 source

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    Supplemented probiotics may activate the TLR2 signaling pathway, resulting in improved intestinal barrier function and reduced susceptibility to endotoxemia and associated cytokine production.

    “Lamprecht et al. [63] suggested that the supplemented probiotics may activate the TLR2 signaling pathway resulting in improved intestinal barrier function, thus reducing an athlete’s susceptibility to endotoxemia and associated cytokine production [137].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [63] Lamprecht M Bogner S Schippinger G Steinbauer K Fankhauser F Hallstroem S Schuetz B Greilberger JF Probiotic supplementation affects markers of intestinal barrier, oxidation, and inflammation in trained men; a randomized, double-blinded, placebo-controlled trial J Int Soc Sports Nutr 2012 9 45 10.1186/1550-2783-9-45 22992437 PMC3465223 source

      Not checked in the free run.

    • cites [137] Jeukendrup AE Vet-Joop K Sturk A Stegen JH Senden J Saris WH Wagenmakers AJ Relationship between gastro-intestinal complaints and endotoxaemia, cytokine release and the acute-phase reaction during and after a long-distance triathlon in highly trained men Clin Sci (Lond) 2000 98 47 55 10.1042/cs0980047 10600658 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The physical up-and-down movement of the gut during running could also explain an increase in the frequency of gut symptoms.

    “The physical up-and down movement of the gut during running could also explain an increase in the frequency of gut symptoms [41].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [41] de Oliveira EP Burini RC Jeukendrup A Gastrointestinal complaints during exercise: prevalence, etiology, and nutritional recommendations Sports Med 2014 44 Suppl 1 S79 S85 10.1007/s40279-014-0153-2 24791919 PMC4008808 source

      Not checked in the free run.

  • May combine two claims.

    Interpretationnone given

    Many studies reporting adverse events either do not utilize appropriate biological sampling and identification techniques or adverse events are poorly reported.

    “Many of the studies reporting AEs (rarely serious AEs) either do not utilize the appropriate biological sampling and identification techniques or AEs are poorly reported.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Well-studied probiotic species include Bifidobacterium (ssp. adolescentis, animalis, bifidum, breve, and longum) and Lactobacillus (ssp. acidophilus, casei, fermentum, gasseri, johnsonii, reuteri, paracasei, plantarum, rhamnosus, and salivarius).

    “well-studied probiotic species include Bifidobacterium (ssp. adolescentis, animalis, bifidum, breve, and longum) and Lactobacillus (ssp. acidophilus, casei, fermentum, gasseri, johnsonii, reuteri, paracasei, plantarum, rhamnosus, and salivarius) [211].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [211] de Simone Claudio The Unregulated Probiotic Market Clinical Gastroenterology and Hepatology 2019 17 5 809 817 10.1016/j.cgh.2018.01.018 29378309 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationnone given

    Consumption of some probiotic strains may improve intestinal barrier function by modulating tight junction permeability.

    “Consumption of some probiotic strains may improve intestinal barrier function by modulating tight junction permeability.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Four classes of possible side effects of probiotic use are systemic infections, detrimental metabolic effects, cytokine-mediated immunologic adverse events in susceptible individuals, and transfer of antibiotic resistance genes.

    “Marteau [214] outlined four classes of possible side effects of probiotic use: systemic infections, detrimental metabolic effects, cytokine-mediated immunologic adverse events in susceptible individuals, and transfer of antibiotic resistance genes.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [214] Marteau P Safety aspects of probiotic products Naringsforskning 2001 45 22 24 10.3402/fnr.v45i0.1785 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The benefits of probiotics are not validated by EFSA, jeopardizing the use of the term probiotic without an approved claim, with some exceptions such as Italy, Czech Republic, and Bulgaria.

    “Moreover the benefits of probiotics are not validated by EFSA, jeopardizing the use of the term probiotic without an approved claim with some exceptions such as in Italy, Czech Republic, and Bulgaria [211].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [211] de Simone Claudio The Unregulated Probiotic Market Clinical Gastroenterology and Hepatology 2019 17 5 809 817 10.1016/j.cgh.2018.01.018 29378309 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S4 (based).

    Premisenone given

    Each probiotic strain is unique in how it responds to and affects the host.

    “However, each strain is unique with respect to how it responds to and affects the host.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisereasoning

    The QPS list concerns consumption by the general healthy population and does not take into consideration potential risks for vulnerable populations.

    “The QPS list concerns consumption by the general healthy population and does not take into consideration potential risks for vulnerable populations and this is clearly mentioned.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    The general consensus is that probiotic ingestion is safe, with large doses well tolerated and failing to exhibit any toxicity.

    “The general consensus is that probiotic ingestion is safe [221, 222], with large doses well tolerated and failing to exhibit any toxicity [223].”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [221] Boyle RJ Robins-Browne RM Tang ML Probiotic use in clinical practice: what are the risks? Am J Clin Nutr 2006 83 1256 1264 10.1093/ajcn/83.6.1256 16762934 source

      Not checked in the free run.

    • cites [222] Tapiovaara L Lehtoranta L Poussa T Makivuokko H Korpela R Pitkaranta A Absence of adverse events in healthy individuals using probiotics--analysis of six randomised studies by one study group Benefic Microbes 2016 7 161 169 10.3920/BM2015.0096 26689224 source

      Not checked in the free run.

    • cites [223] Larsen CN Nielsen S Kaestel P Brockmann E Bennedsen M Christensen HR Eskesen DC Jacobsen BL Michaelsen KF Dose-response study of probiotic bacteria Bifidobacterium animalis subsp lactis BB-12 and Lactobacillus paracasei subsp paracasei CRL-341 in healthy young adults Eur J Clin Nutr 2006 60 1284 1293 10.1038/sj.ejcn.1602450 16721394 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationnone given

    Probiotics can potentially modulate intestinal permeability and health of gut lining cells, improving nutrient absorption including minerals, peptides, and amino acids by decreasing inflammation and encouraging optimum development of absorptive area of villi.

    “Probiotics can potentially modulate intestinal permeability and health of the cells of the gut lining improving nutrient absorption including minerals, peptides, and amino acids by decreasing inflammation and encouraging optimum development of the absorptive area of the villi.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    The U.S. FDA classifies probiotics individually but has classified many as Generally Recognized As Safe (GRAS), safe for use in foods and infant products.

    “The U.S. Food and Drug Administration (FDA) classifies probiotics individually but has classified many as Generally Recognized As Safe (GRAS), safe for the use in foods and infant products [219].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [219] FDA. New Dietary Ingredients Notification Process. Washington; 2016.

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationnone given

    Adhesion of probiotics to the intestinal mucosa may be a mechanism for modulation of the immune system.

    “Adhesion of probiotics to the intestinal mucosa may be a mechanism for modulation of the immune system.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationnone given

    Probiotics cause alterations in intestinal mucins that prevent pathogen binding.

    “Probiotics also cause alterations in intestinal mucins that prevent pathogen binding.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Most probiotics in commercial use are derived from fermented foods with a long history of safe consumption, or from microbes that may colonize healthy humans.

    “However, most probiotics in commercial use are derived from fermented foods with a long history of safe consumption, or from microbes that may colonize healthy humans [212].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [212] World Gastroenterology Organisation. Global Guidelines: Probiotics and Prebiotics. World Gastroentereology Oganisation. Milwaukee; 2017.

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    An international consensus statement in 2014 indicated that these well-studied probiotic species are likely to provide general health benefits such as normalization of disturbed gut microbiota, regulation of intestinal transit, competitive exclusion of pathogens, and production of SCFAs.

    “An international consensus statement in 2014 indicated that these are likely to provide general health benefits such as normalization of disturbed gut microbiota, regulation of intestinal transit, competitive exclusion of pathogens, and production of SCFAs [1].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [1] Hill C Guarner F Reid G Gibson GR Merenstein DJ Pot B Morelli L Canani RB Flint HJ Salminen S Expert consensus document. The international scientific Association for Probiotics and Prebiotics consensus statement on the scope and appropriate use of the term probiotic Nat Rev Gastroenterol Hepatol 2014 11 506 514 10.1038/nrgastro.2014.66 24912386 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Interpretationnone given

    Adverse events are often not well recorded in nutritional studies in general and probiotics are no exception.

    “AEs are often not well recorded in nutritional studies in general and probiotics are no exception to this.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    A systematic literature review of probiotic safety published in 2014 reported that the overwhelming existing evidence suggests that probiotics are safe for the general population, and that critically ill patients, postoperative and hospitalized patients and immunocompromised patients were the most at-risk groups wherein adverse events occurred.

    “A systematic literature review of probiotic safety published in 2014 reported that “the overwhelming existing evidence suggests that probiotics are safe” for the general population, and that critically ill patients, postoperative and hospitalized patients and immunocompromised patients were the most at-risk groups wherein AEs occurred [220].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [220] Didari T Solki S Mozaffari S Nikfar S Abdollahi M A systematic review of the safety of probiotics Expert Opin Drug Saf 2014 13 227 239 10.1517/14740338.2014.872627 24405164 source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    Caution is warranted for those with serious health conditions, such as severe acute pancreatitis, inflammatory bowel diseases, liver diseases, and HIV.

    “Caution is warranted for those with serious health conditions, such as severe acute pancreatitis, inflammatory bowel diseases, liver diseases, and HIV.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Premisenone given

    There are dozens of bacterial strains that can be considered probiotics, particularly those that produce lactic acid.

    “There are dozens of bacterial strains that can be considered as probiotics, particularly those that produce lactic acid.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisenone given

    Some of the most common commercially available probiotic strains belong to the Lactobacillus and Bifidobacterium genera.

    “Some of the most common commercially available strains belong to the Lactobacillus and Bifidobacterium genera.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Premisenone given

    Probiotics have been used safely in foods and dairy products for over a hundred years.

    “Probiotics have been used safely in foods and dairy products for over a hundred years.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Interpretationnone given

    The mechanisms underlying the beneficial effects of probiotics in athletes are largely unknown but are likely multifactorial.

    “The mechanisms underlying the beneficial effects of probiotics in athletes are largely unknown but are likely to be multifactorial.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationnone given

    The mechanisms by which probiotics enhance intestinal barrier function are not sufficiently studied.

    “However, the mechanisms by which probiotics enhance intestinal barrier function are not sufficiently studied.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    There are two aspects to safety: establishing the adverse effect profile of specific single-strain and multi-strain supplements, and ensuring marketed supplements meet stringent quality standards to ensure correct strains are present and product is free of contamination.

    “There are two aspects to safety: establishing the adverse effect profile of specific single-strain and multi-strain supplements (i.e., the safety of the strain(s) per se), and ensuring that marketed supplements meet stringent quality standards to ensure the correct strains are present and the product is free of contamination [217].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [217] Sanders ME Merenstein DJ Ouwehand AC Reid G Salminen S Cabana MD Paraskevakos G Leyer G Probiotic use in at-risk populations J Am Pharm Assoc (2003) 2016 56 680 686 10.1016/j.japh.2016.07.001 27836128 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Probiotics have been studied in vulnerable groups including infants, patients with severe acute pancreatitis, inflammatory bowel diseases, liver diseases, HIV, and other conditions, with greater cause for concern for products containing high concentrations up to 450-900 billion live bacteria per dose.

    “Further, probiotics have been studied in vulnerable groups, including infants, patients with severe acute pancreatitis, inflammatory bowel diseases, liver diseases, HIV, and other conditions [213, 216–218] with even greater cause for concern with the small number of products that contain high concentrations of up to 450–900 billion live bacteria per dose [211].”
    Quote in the paperNot a substantial claim0 of 5 sources checked
    • cites [213] Sanders ME Akkermans LM Haller D Hammerman C Heimbach J Hormannsperger G Huys G Levy DD Lutgendorff F Mack D Safety assessment of probiotics for human use Gut Microbes 2010 1 164 185 10.4161/gmic.1.3.12127 21327023 PMC3023597 source

      Not checked in the free run.

    • cites [216] Besselink MG van Santvoort HC Buskens E Boermeester MA van Goor H Timmerman HM Nieuwenhuijs VB Bollen TL van Ramshorst B Witteman BJ Probiotic prophylaxis in predicted severe acute pancreatitis: a randomised, double-blind, placebo-controlled trial Lancet 2008 371 651 659 10.1016/S0140-6736(08)60207-X 18279948 source

      Not checked in the free run.

    • cites [217] Sanders ME Merenstein DJ Ouwehand AC Reid G Salminen S Cabana MD Paraskevakos G Leyer G Probiotic use in at-risk populations J Am Pharm Assoc (2003) 2016 56 680 686 10.1016/j.japh.2016.07.001 27836128 source

      Not checked in the free run.

    • cites [218] Vallabhaneni S, Walker TA, Lockhart SR, Ng D, Chiller T, Melchreit R, Brandt ME, Smith RM. Centers for Disease Control and Prevention, see https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6406a6.htm.

      Not checked in the free run.

    • cites [211] de Simone Claudio The Unregulated Probiotic Market Clinical Gastroenterology and Hepatology 2019 17 5 809 817 10.1016/j.cgh.2018.01.018 29378309 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisenone given

    Since 2007 EFSA lists species presumed safe for human consumption under the Qualified Presumption of Safety (QPS) concept.

    “Going beyond history of safe use, since 2007 the EFSA lists species presumed safe for human consumption under the “Qualified Presumption of Safety” (QPS) concept.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Under Japanese regulations, probiotic products are in a distinct category of foods known as Foods for Specific Health Uses (FOSHU); efficacy claims are prohibited on labeling unless special permission from MHLW is obtained, for which substantiation of efficacy and safety is mandatory.

    “Under Japanese regulations, probiotic products are in a distinct category of foods known as Foods for Specific Health Uses (FOSHU). For probiotic food products, efficacy claims are prohibited on the labeling.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [231] Amagase H Current marketplace for probiotics: a Japanese perspective Clin Infect Dis 2008 46 Suppl 2 S73 S75 10.1086/523338 18181727 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Safety assessment of a probiotic strain should at minimum determine patterns of antimicrobial drug resistance, metabolic activities, side effects in humans during clinical trials and after marketing, toxin production and hemolytic potential if known, and lack of infectivity in animal studies.

    “Additionally, safety assessment of the probiotic strain should at a minimum determine: 1) patterns of antimicrobial drug resistance, 2) metabolic activities, 3) side effects noted in humans during clinical trials and after marketing, 4) toxin production and hemolytic potential if the probiotic strain is known to possess those properties, and 5) lack of infectivity in animal studies [226].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [226] Food and Agriculture Organization of the United Nations and World Health Organization Joint FAO/WHO working group report on drafting guidelines fro the evaluation of probiotics in food 2002

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Premisenone given

    The FDA has recently agreed that in addition to weight, probiotic amounts can also be labelled in CFU.

    “The FDA has recently agreed that in addition to weight, probiotic amounts can also be labelled in CFU.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    Labeling probiotic quantity by weight is not meaningful because it does not indicate viability of microorganisms throughout shelf life; CFU are more representative of quantity of viable microorganisms and give accurate information.

    “Labeling probiotic quantity by weight is not meaningful because this measure does not indicate the viability of the microorganisms in the product throughout shelf life. To the contrary, CFU are more representative of the quantity of viable microorganisms and gives consumers and healthcare professionals accurate information.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    In 2001, the FAO/WHO held an Expert Consultation to develop standardized guidelines for evaluating probiotics in food that could lead to substantiation of health claims.

    “In 2001, the FAO/WHO held the Expert Consultation on Evaluation of Health and Nutritional Properties of Probiotics, to develop standardized guidelines for evaluating probiotics in food that could lead to the substantiation of health claims [226].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [226] Food and Agriculture Organization of the United Nations and World Health Organization Joint FAO/WHO working group report on drafting guidelines fro the evaluation of probiotics in food 2002

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    In January 2017, the Council for Responsible Nutrition (CRN) and the International Probiotics Association (IPA) announced the development of scientifically-based best practices manufacturing guidelines for labeling, storing, and stability testing of dietary supplements and functional foods containing probiotics.

    “In January 2017, the Council for Responsible Nutrition (CRN) and the International Probiotics Association (IPA) announced the development of scientifically-based best practices manufacturing guidelines for the labeling, storing, and stability testing of dietary supplements and functional foods containing probiotics [235].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [235] Giordano-Schaefer, J.; Ruthsatz, M.; Schneider, H. Overcoming distinctive regulatory barriers for the development of medical foods. Availabe online: https://www.raps.org/regulatory-focus%E2%84%A2/news-articles/2017/10/overcoming-distinctive-regulatory-barriers-for-the-development-of-medical-foods (Accessed on Oct 2017).

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Health Canada uses a pre-market approval process for non-food like applications such as capsules, tablets, softgels and powders which requires companies to acquire a Natural Product Number (NPN) prior to bringing to market.

    “Health Canada uses a pre-market approval process for non-food like applications such as capsules, tablets, softgels and powders which requires companies to acquire a Natural Product Number (NPN) prior to bringing to market [3].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [3] de Vrese Michael Schrezenmeir J. Probiotics, Prebiotics, and Synbiotics Food Biotechnology 2008 Berlin, Heidelberg Springer Berlin Heidelberg 1 66

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    There appears to be little regulation of the manufacturing process and almost no post-marketing regulatory follow-up for probiotics.

    “While rigorous scrutiny of product claims is apparent, there appears to be little regulation of the manufacturing process and almost no post-marketing regulatory follow-up [233].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [233] Kolacek S Hojsak I Berni Canani R Guarino A Indrio F Orel R Pot B Shamir R Szajewska H Vandenplas Y Commercial probiotic products: a call for improved quality control. A position paper by the ESPGHAN working Group for Probiotics and Prebiotics J Pediatr Gastroenterol Nutr 2017 65 117 124 10.1097/MPG.0000000000001603 28644359 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S4 (based). May combine two claims.

    Interpretationnone given

    The effects of probiotics are strain specific, and therefore strain identity is important to link to a specific health effect as well as to enable accurate surveillance and epidemiological studies.

    “The effects of probiotics are strain specific, and therefore, strain identity is important to link to a specific health effect as well as to enable accurate surveillance and epidemiological studies.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationcitation

    The current approach to regulation is inadequate and can lead to problems of quality, safety, and claim validity in commercial probiotic products used in a medical context, including those used in vulnerable populations.

    “From the examples provided, it is apparent that the current approach to regulation is inadequate and can lead to problems of quality, safety, and claim validity in commercial probiotic products used in a medical context, including those used in vulnerable populations [233].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [233] Kolacek S Hojsak I Berni Canani R Guarino A Indrio F Orel R Pot B Shamir R Szajewska H Vandenplas Y Commercial probiotic products: a call for improved quality control. A position paper by the ESPGHAN working Group for Probiotics and Prebiotics J Pediatr Gastroenterol Nutr 2017 65 117 124 10.1097/MPG.0000000000001603 28644359 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Interpretationnone given

    Government regulatory organizations are highly varied across national borders and jurisdictions in regulation of probiotics, making uniform recommendations difficult.

    “Unfortunately, government regulatory organizations are highly varied across national borders and jurisdictions in regulation of probiotics, making uniform recommendations difficult.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    In two reviews related to dietary supplementation in athletes, dosing regimens were reported in the range between 1×10^9 to 4×10^10 CFU.

    “In two reviews related to dietary supplementation in athletes, dosing regimens were reported in the range between 1 × 109 to 4 × 1010 CFU [10, 40].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [10] Pyne DB West NP Cox AJ Cripps AW Probiotics supplementation for athletes - clinical and physiological effects Eur J Sport Sci 2015 15 63 72 10.1080/17461391.2014.971879 25339255 source

      Not checked in the free run.

    • cites [40] Rawson ES Miles MP Larson-Meyer DE Dietary supplements for health, adaptation, and recovery in athletes Int J Sport Nutr Exerc Metab 2018 28 188 199 10.1123/ijsnem.2017-0340 29345167 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisenone given

    These guidelines were designed to facilitate transparency and consistency in the probiotic sector.

    “These guidelines were designed to facilitate transparency and consistency in the probiotic sector.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    Currently there is no clear set of recommendation or guidelines on probiotic use for athletes.

    “Currently there is no clear set of recommendation or guidelines on probiotic use for athletes.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Interpretationnone given

    The regulation of probiotics differs between countries as there is no universally agreed framework.

    “The regulation of probiotics differs between countries as there is no universally agreed framework.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    With interruption of probiotic intake, there is a reduction in the microorganism administered in the colon, and with 8 days of supplementation discontinuation, the probiotic is no longer detectable in the gut.

    “With the interruption of probiotic intake, there is a reduction in the microorganism administered in the colon, and with 8 days of supplementation discontinuation, the probiotic is no longer detectable in the gut [236].”
    • Also stated in: § Future directions · plain
      “Further, with the interruption of probiotic intake, there is a reduction in the microorganism administered in the colon, and with 8 days of supplementation discontinuation, the probiotic is no longer detectable in the gut [236].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [236] Kullen MJ Amann MM O'Shaughnessy MJ O'Sullivan DJ Busta FF Brady LJ Differentiation of ingested and endogenous bifidobacteria by DNA fingerprinting demonstrates the survival of an unmodified strain in the gastrointestinal tract of humans J Nutr 1997 127 89 94 10.1093/jn/127.1.89 9040550 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    In the European Union, probiotics and food supplements are regulated under the Food Products Directive and Regulation, and all health claims for probiotics must be authorized by EFSA, which has issued a QPS list meaning they do not require safety assessments.

    “In the European Union, probiotics and food supplements are regulated under the Food Products Directive and Regulation (regulation 178/2002/EC; directive 2000/13/EU). All health claims for probiotics have to be authorized by EFSA which has issued a list of microbial cultures that have a Qualified Presumption of Safety [232]”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [232] European Food Standards Agency. Qualified Presumption of Safety. Available from: http://www.efsa.europa.eu/en/topics/topic/qualified-presumption-safety-qps. Access date: 10 Aug 2018.

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisereasoning

    A key element of the guidelines is labeling probiotic products in CFU, the scientifically accepted unit of measure for probiotics and used to report probiotic quantity in many studies conducted to assess safety or benefits of probiotics.

    “A key element of the guidelines is labelling probiotic products in CFU, the scientifically accepted unit of measure for probiotics and used to report probiotic quantity in many studies conducted to assess the safety or benefits of probiotics.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisenone given

    EFSA has rejected all submitted health claims for probiotics.

    “So far, EFSA has rejected all submitted health claims for probiotics.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Dietary supplements are required to comply with Good Manufacturing Practice guidelines, but these do not extend to testing quality or efficacy.

    “Further, dietary supplements are required to comply with Good Manufacturing Practice guidelines, but these do not extend to testing quality or efficacy [233].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [233] Kolacek S Hojsak I Berni Canani R Guarino A Indrio F Orel R Pot B Shamir R Szajewska H Vandenplas Y Commercial probiotic products: a call for improved quality control. A position paper by the ESPGHAN working Group for Probiotics and Prebiotics J Pediatr Gastroenterol Nutr 2017 65 117 124 10.1097/MPG.0000000000001603 28644359 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisereasoning

    CFU are commonly used on probiotic product labels in many jurisdictions around the world to help consumers and healthcare professionals identify products providing probiotics in amounts shown to have benefit.

    “Consistent with scientific literature, CFU are commonly used on probiotic product labels in many jurisdictions around the world to help consumers and healthcare professionals identify products providing probiotics in amounts shown to have benefit.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Japan is viewed by many to be a global market leader given that probiotics are available as both foods and drugs, and was the first global jurisdiction to implement a regulatory system for functional foods and nutraceuticals in 1991.

    “Japan is viewed by many to be a global market leader given that probiotics are available as both foods and drugs [230], and was the first global jurisdiction to implement a regulatory system for functional foods and nutraceuticals in 1991.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [230] Arora M Baldi A Regulatory categories of probiotics across the globe: a review representing existing and recommended categorization Indian J Med Microbiol 2015 33 Suppl 2 10 10.4103/0255-0857.150868 25657150 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    In Brazil, probiotics are considered functional foods, different from food, and legislation requires safety and efficacy demonstration, so all products must be registered and approved by ANVISA.

    “In Brazil, probiotics are considered as functional foods, and considered to be different from food. But legislation asks for safety and efficacy demonstration of food products and hence all these products must be registered and approved by a health authority called National Health Surveillance Agency Brazil (ANVISA) [230].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [230] Arora M Baldi A Regulatory categories of probiotics across the globe: a review representing existing and recommended categorization Indian J Med Microbiol 2015 33 Suppl 2 10 10.4103/0255-0857.150868 25657150 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisenone given

    Health Canada has provided a Natural Health Product monograph that includes dosage forms, uses, recommended minimum quantities for certain probiotic strains.

    “Health Canada has provided a Natural Health Product monograph that includes dosage form(s), use(s) or purpose(s) recommended as well as minimum quantities”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    Coqueiro et al. noted that in clinical practice probiotic supplementation should be implemented for at least 14 days prior to competition or important events for the athlete.

    “Coqueiro et al. [188] noted that in clinical practice probiotic supplementation should be implemented for at least 14 days prior to competition or important events for the athlete.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [188] Coqueiro AY de Oliveira Garcia AB Rogero MM Tirapegui J Probiotic supplementation in sports and physical exercise: does it present any ergogenic effect? Nutr Health 2017 23 239 249 10.1177/0260106017721000 29214927 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    In Canada, probiotics have two modes of sale on the market, Natural and Non-Prescription Health Products Directorate (NNHPD) and Food Directorate.

    “In Canada, probiotics have two modes of sale on the market, Natural and Non-Prescription Health Products Directorate (NNHPD) and Food Directorate [3, 228].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [3] de Vrese Michael Schrezenmeir J. Probiotics, Prebiotics, and Synbiotics Food Biotechnology 2008 Berlin, Heidelberg Springer Berlin Heidelberg 1 66

      Not checked in the free run.

    • cites [228] Zorzela L Ardestani SK McFarland LV Vohra S Is there a role for modified probiotics as beneficial microbes: a systematic review of the literature Benefic Microbes 2017 8 739 754 10.3920/BM2017.0032 28884589 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Many probiotics are sold as dietary supplements, which do not require FDA approval before marketing; dietary supplement labels may make structure/function claims without FDA approval but cannot make health claims without FDA approval.

    “Many probiotics are sold as dietary supplements, which do not require FDA approval before they are marketed. Dietary supplement labels are permitted to make claims about how the product affects the structure or function of the body without FDA approval, but they cannot make health claims (claims that the product reduces the risk of a disease) without the FDA’s approval [234].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [234] NIH. Probiotics: In Depth. https://nccih.nih.gov/health/probiotics/introduction.htm. 2016.

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    In a 2018 consensus statement, the International Olympic Committee noted moderate support for probiotic use in athletes with a daily dose of 1×10^10 live bacteria.

    “In a 2018 consensus statement, the International Olympic Committee noted moderate support for probiotic use in athletes with a daily dose of 1 × 1010 live bacteria [5].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [5] Maughan RJ Burke LM Dvorak J Larson-Meyer DE Peeling P Phillips SM Rawson ES Walsh NP Garthe I Geyer H IOC consensus statement: dietary supplements and the high-performance athlete Br J Sports Med 2018 52 439 455 10.1136/bjsports-2018-099027 29540367 PMC5867441 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Obesity and a high fat/high calorie diet can alter gut bacteria and intestinal wall permeability, leading to metabolic endotoxemia and systemic inflammation.

    “Obesity and a high fat/high calorie diet can alter gut bacteria and intestinal wall permeability, leading to the passage of LPS from within the gut lumen into the circulation (metabolic endotoxemia), where it initiates systemic inflammation [258].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [258] Tremellen K McPhee N Pearce K Metabolic endotoxaemia related inflammation is associated with hypogonadism in overweight men Basic Clin Androl 2017 27 5 10.1186/s12610-017-0049-8 28286655 PMC5341351 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In a six-week human double-blind placebo-controlled study, young healthy amateur runners supplemented with L. plantarum TWK10 had significantly higher endurance performance and glucose content in a maximal treadmill running test compared to placebo.

    “The TWK10 group had significantly higher endurance performance and glucose content in a maximal treadmill running test compared to the placebo group (P < 0.05), indicating that TWK10 supplementation may be beneficial to energy harvest.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [85] Huang WC Hsu YJ Li H Kan NW Chen YM Lin JS Hsu TK Tsai TY Chiu YS Huang CC Effect of Lactobacillus Plantarum TWK10 on improving endurance performance in humans Chin J Phys 2018 61 163 170 10.4077/CJP.2018.BAH587 29962176 source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Interpretationcitation

    Microbe therapy may have a potential impact for obese and/or aging athletes by imparting hormonal and gonadal features of reproductive fitness typical of younger healthy individuals.

    “These novel findings suggest a potential impact for microbe therapy in obese and/or aging athletes by imparting hormonal and gonadal features of reproductive fitness typical of much younger healthy individuals.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationcitation

    Certain probiotics may enhance energy harvesting and have health-promotion, performance-improvement, and anti-fatigue effects.

    “Together, these studies suggest a role in which certain probiotics may enhance energy harvesting, and have health-promotion, performance-improvement, and anti-fatigue effects.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Weight loss and physical activity seem to improve symptoms of reduced gonadal function in obese males.

    “Weight loss and physical activity seem to improve these symptoms [260].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [260] De Lorenzo Antonino Noce Annalisa Moriconi Eleonora Rampello Tiziana Marrone Giulia Di Daniele Nicola Rovella Valentina MOSH Syndrome (Male Obesity Secondary Hypogonadism): Clinical Assessment and Possible Therapeutic Approaches Nutrients 2018 10 4 474 10.3390/nu10040474 PMC5946259 29649106 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Probiotic supplementation, both with and without resistance training, can decrease body weight and fat mass in overweight and obese individuals, as well as female athletes.

    “Probiotic supplementation, both with and without resistance training, can decrease levels of body weight and fat mass in overweight and obese individuals, as well as female athletes [103, 241, 242].”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [103] Toohey JC, Townsend JR, Johnson SB, Toy AM, Vantrease WC, Bender D, Crimi CC, Stowers KL, Ruiz MD, VanDusseldorp TA, et al. Effects of probiotic (Bacillus subtilis) supplementation during offseason resistance training in female division I athletes. J Strength Cond Res. 2018. 10.1519/JSC.0000000000002675. 33105368 source

      Not checked in the free run.

    • cites [241] Kim J Yun JM Kim MK Kwon O Cho B Lactobacillus gasseri BNR17 supplementation reduces the visceral fat accumulation and waist circumference in obese adults: a randomized, double-blind, Placebo-Controlled Trial J Med Food 2018 21 454 461 10.1089/jmf.2017.3937 29688793 source

      Not checked in the free run.

    • cites [242] Sanchez M Darimont C Drapeau V Emady-Azar S Lepage M Rezzonico E Ngom-Bru C Berger B Philippe L Ammon-Zuffrey C Effect of Lactobacillus rhamnosus CGMCC1.3724 supplementation on weight loss and maintenance in obese men and women Br J Nutr 2014 111 1507 1519 10.1017/S0007114513003875 24299712 source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    The long-term effects of probiotic administration in athletes over several months or years on gut health, immune function and rates of illness are unclear.

    “The long-term effects of probiotic administration in athletes over several months or years on gut health, immune function and rates of illness are unclear, as in most studies the supplementation period was between 4 to 16 weeks.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    In mice, daily probiotic kefir over 4 weeks significantly increased swimming time-to-exhaustion and forelimb grip strength, and decreased serum lactate, ammonia, BUN, and creatine kinase after a swimming test.

    “In mice who consumed a probiotic kefir daily over 4 weeks, swimming time-to-exhaustion was significantly longer, forelimb grip strength was higher and serum lactate, ammonia, blood urea nitrogen (BUN), and creatine kinase levels were lower after the swimming test [248].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [248] Hsu Yi-Ju Huang Wen-Ching Lin Jin-Seng Chen Yi-Ming Ho Shang-Tse Huang Chi-Chang Tung Yu-Tang Kefir Supplementation Modifies Gut Microbiota Composition, Reduces Physical Fatigue, and Improves Exercise Performance in Mice Nutrients 2018 10 7 862 10.3390/nu10070862 PMC6073576 29973525 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationreasoning

    Probiotic supplementation may have potential to remove and utilize blood lactate after exercise.

    “Probiotic supplementation may have potential to remove and utilize blood lactate after exercise.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The classical pathway enzymes phosphotransbutyrylase and butyrate kinase convert butyryl-CoA to butyrate and coenzyme A with concomitant formation of ATP.

  • May combine two claims.

    Premisecitation

    Endotoxin can reduce testosterone production by the testes via direct inhibition of Leydig cell steroidogenic pathways and indirectly by reducing pituitary LH drive and sperm production.

    “Endotoxin can reduce testosterone production by the testes, both by direct inhibition of Leydig cell steroidogenic pathways and indirectly by reducing pituitary luteinizing hormone drive and sperm production [259].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [259] Tremellen K McPhee N Pearce K Benson S Schedlowski M Engler H Endotoxin-initiated inflammation reduces testosterone production in men of reproductive age Am J Physiol Endocrinol Metab 2018 314 E206 E213 10.1152/ajpendo.00279.2017 29183872 PMC5899218 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S1 (asserted), S3 (load-bearing). May combine two claims.

    Premisecitation

    Key structures in the cell or supernatant fractions may confer probiotic properties, mainly through immune-modulation, protection against pathogens, and fortifying mucosal barrier integrity.

    “Piqué et al. (2019) suggested the presence of key structures in the cell or supernatant fractions may confer probiotic properties, mainly through immune-modulation, protection against pathogens, and fortifying the mucosal barrier integrity [261].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [261] Piqué Núria Berlanga Mercedes Miñana-Galbis David Health Benefits of Heat-Killed (Tyndallized) Probiotics: An Overview International Journal of Molecular Sciences 2019 20 10 2534 10.3390/ijms20102534 PMC6566317 31126033 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Premisenone given

    Very few studies have evaluated performance in strength exercises after probiotic supplementation.

    “Finally, very few studies have evaluated the performance in strength exercises after supplementation with probiotics and this is an important area of sports and physical training to be studied.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    In animals, probiotics have been associated with benefits including normalizing age-related drops in testosterone levels, increasing neurotransmitter synthesis, reducing stress-induced cortisol levels, reducing inflammation, and improving mood.

    “In animals, probiotics have been associated with benefits including normalizing age-related drops in testosterone levels [237], increasing neurotransmitter synthesis [238], reducing stress-induced cortisol levels [239], reducing inflammation [100] and improving mood [240].”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [237] Poutahidis T Springer A Levkovich T Qi P Varian BJ Lakritz JR Ibrahim YM Chatzigiagkos A Alm EJ Erdman SE Probiotic microbes sustain youthful serum testosterone levels and testicular size in aging mice PLoS One 2014 9 e84877 10.1371/journal.pone.0084877 24392159 PMC3879365 source

      Not checked in the free run.

    • cites [238] Lyte M Probiotics function mechanistically as delivery vehicles for neuroactive compounds: microbial endocrinology in the design and use of probiotics Bioessays 2011 33 574 581 10.1002/bies.201100024 21732396 source

      Not checked in the free run.

    • cites [239] Bravo JA Forsythe P Chew MV Escaravage E Savignac HM Dinan TG Bienenstock J Cryan JF Ingestion of Lactobacillus strain regulates emotional behavior and central GABA receptor expression in a mouse via the vagus nerve Proc Natl Acad Sci U S A 2011 108 16050 16055 10.1073/pnas.1102999108 21876150 PMC3179073 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The range of oral probiotic supplementation is approximately 10^8-10^9 CFU per day, but this value varies by country.

    “The range of oral probiotic supplementation is, approximately, 108–109 CFU per day, however, this value varies in each country [249, 250]”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [249] ANVISA-Ministry of Health Technical Regulation of Bioeactive and Probiotic Substances Isolated with Allegations of Functional or Health Properties 2008

      Not checked in the free run.

    • cites [250] Ministerio della Salute Linee guida su probiotici e prebioticic 2013

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In mice, the microbiota can regulate testicular development and function, and androgen deficiency substantially alters the microbiome.

    “In mice, the microbiota can regulate testicular development and function [251], while androgen deficiency has substantially altered the microbiome [252].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [251] Al-Asmakh M Stukenborg JB Reda A Anuar F Strand ML Hedin L Pettersson S Soder O The gut microbiota and developmental programming of the testis in mice PLoS One 2014 9 e103809 10.1371/journal.pone.0103809 25118984 PMC4132106 source

      Not checked in the free run.

    • cites [252] Harada N Hanaoka R Horiuchi H Kitakaze T Mitani T Inui H Yamaji R Castration influences intestinal microflora and induces abdominal obesity in high-fat diet-fed mice Sci Rep 2016 6 23001 10.1038/srep23001 26961573 PMC4785334 source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    Chen and colleagues supplemented male ICR mice with L. plantarum TWK10 for 6 weeks, with daily doses of 0, 2.05×10^8, or 1.03×10^9 CFU.

    “Chen and colleagues [92] supplemented male Institute of Cancer Research (ICR) strain mice with L. plantarum TWK10 for 6 weeks. Mice were divided into three groups and daily doses of 0, 2.05 × 108, or 1.03 × 109 CFU were given to each group, respectively.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [92] Chen YM Wei L Chiu YS Hsu YJ Tsai TY Wang MF Huang CC Lactobacillus plantarum TWK10 supplementation improves exercise performance and increases muscle mass in mice Nutrients 2016 8 205 10.3390/nu8040205 27070637 PMC4848674 source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisenone given

    No specific probiotic recommendation has been established for athletes or physical activity practitioners.

    “notably, no specific probiotic recommendation has been established for athletes or physical activity practitioners.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    In mice, L. plantarum TWK10 supplementation over 6 weeks dose-dependently increased grip strength and endurance swimming time and decreased serum lactate, ammonia, creatine kinase, and glucose after an acute exercise challenge.

    “In mice supplemented with L. plantarum TWK10 over 6 weeks, supplementation dose-dependently increased grip strength and endurance swimming time and decreased levels of serum lactate, ammonia, creatine kinase, and glucose after an acute exercise challenge [92].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [92] Chen YM Wei L Chiu YS Hsu YJ Tsai TY Wang MF Huang CC Lactobacillus plantarum TWK10 supplementation improves exercise performance and increases muscle mass in mice Nutrients 2016 8 205 10.3390/nu8040205 27070637 PMC4848674 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationcitation

    Oral supplementation with selective bacteria holds promise in positively affecting the endocrine system.

    “Oral supplementation with selective bacteria holds promise in positively affecting the endocrine system.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    In healthy adults, 6 weeks of a multi-strain probiotic improved mood and sleep quality with reduction in depressive mood state, anger, and fatigue.

    “Moreover, 6 weeks supplementation of 4 × 109 CFU/live cells of L. fermementum LF16, L. rhamnosus LR06, L. plantarum LP01, and B. longum BL04 improved mood and sleep quality with a reduction in depressive mood state, anger and fatigue [279].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [279] Marotta A Sarno E Del Casale A Pane M Mogna L Amoruso A Felis GE Fiorio M Effects of probiotics on cognitive reactivity, mood, and sleep quality Front Psychiatry 2019 10 164 10.3389/fpsyt.2019.00164 30971965 PMC6445894 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Inflammation has been implicated in probiotic supplementation impacting body fat levels in overweight and obese individuals, as well as athletic populations.

    “Inflammation has been implicated in probiotic supplementation impacting body fat levels in overweight and obese individuals, as well as athletic populations.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    In lean mice, A. muciniphila supplementation for 5 weeks significantly improved markers of low-grade chronic inflammation and alleviated gains in body weight and fat mass.

    “Zhao et al. [281] reported that supplementation of Akkermancia muciniphila in lean mice fed a chow diet for 5 weeks significantly improved markers of low-grade, chronic inflammation via measurement of LPS, and alleviated gains in both body weight and fat mass.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [281] Zhao S Liu W Wang J Shi J Sun Y Wang W Ning G Liu R Hong J Akkermansia muciniphila improves metabolic profiles by reducing inflammation in chow diet-fed mice J Mol Endocrinol 2017 58 1 14 10.1530/JME-16-0054 27821438 source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisenone given

    Little is known about the optimal timing of probiotic intake for improved microbial survival and nutrient absorption.

    “In relation, little is known pertaining to the optimal timing of probiotic intake for improved microbial survival and nutrient absorption.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    Interaction between A. muciniphila and inflammatory processes may subsequently impact metabolic health and body composition regulation.

    “Interaction between A. muciniphila and inflammatory processes may subsequently impact metabolic health and consequently body composition regulation.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Increasing plasma levels of choline could improve production of acetylcholine, increase muscular contraction, and possibly delay fatigue in endurance exercise.

    “Increasing plasma levels of choline could improve the production of acetylcholine, increase muscular contraction, and possibly delay fatigue in endurance exercise [282].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [282] Warber JP Patton JF Tharion WJ Zeisel SH Mello RP Kemnitz CP Lieberman HR The effects of choline supplementation on physical performance Int J Sport Nutr Exerc Metab 2000 10 170 181 10.1123/ijsnem.10.2.170 10861337 source

      Not checked in the free run.

    • Rests on an assumption: Choline is converted into acetylcholine via the enzyme choline acetyltransferase.

  • May combine two claims.

    Premisecitation

    In an in vitro digestive model, probiotic consumption 30 min before a meal or with a meal resulted in high bacterial survival, while consumption 30 min after a meal did not.

    “Results of this investigation showed that when a probiotic was consumed 30 min before a meal or with a meal, the bacteria survived in high numbers. Conversely, when the probiotic was taken 30 min after a meal, the bacteria did not survive in high numbers.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [287] Tompkins TA Mainville I Arcand Y The impact of meals on a probiotic during transit through a model of the human upper gastrointestinal tract Benefic Microbes 2011 2 295 303 10.3920/BM2011.0022 22146689 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    A systematic review and meta-analysis asserted that probiotics may help reduce anxiety.

    “More recently, a systematic review and meta-analysis of clinical and pre-clinical literature on the effects of probiotics on anxiety asserted that probiotics may help reduce anxiety [297].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [297] Reis DJ Ilardi SS Punt SEW The anxiolytic effect of probiotics: a systematic review and meta-analysis of the clinical and preclinical literature PLoS One 2018 13 e0199041 10.1371/journal.pone.0199041 29924822 PMC6010276 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S1 (asserted), S3 (load-bearing). May combine two claims.

    Premisecitation

    The gut microbiota acts as an endocrine organ, secreting neurotransmitters such as serotonin and dopamine, thereby controlling the hypothalamic-pituitary axis in athletes.

    “These authors concluded that the gut microbiota acts as an endocrine organ, secreting neurotransmitters such as serotonin and dopamine, thereby controlling the hypothalamic-pituitary axis in athletes.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [280] Clark A Mach N Exercise-induced stress behavior, gut-microbiota-brain axis and diet: a systematic review for athletes J Int Soc Sports Nutr 2016 13 43 10.1186/s12970-016-0155-6 27924137 PMC5121944 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Interpretationreasoning

    There is currently no research in athletes or active individuals on probiotics and choline, but increases in plasma choline could in theory support increases in acetylcholine and consequently power and endurance.

    “There is currently no research in athletes or active individuals, yet increases in plasma choline could (in theory) support increases in acetylcholine and consequently power, and endurance.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Choline is converted into acetylcholine via the enzyme choline acetyltransferase.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisenone given

    Research on probiotics and mood in athletic populations is lacking.

    “Overall, research on probiotics and mood in athletic populations is lacking.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    These compositional changes in the gut microbiota may have contributed to recovery of fatigue and moderation of stress and anxiety through the gut-brain axis.

    “These compositional changes in the gut microbiota may have contributed to the recovery of fatigue and moderation of stress and anxiety through the gut-brain axis.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The gut-brain axis is a bidirectional pathway via the neural, endocrine, and immune systems.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisenone given

    No research has been completed in athletic populations to clarify the impact of probiotic supplementation on body composition in athletes.

    “To date, no such research has been completed in athletic populations to clarify the impact of probiotic supplementation on body composition in athletes.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    CP2305 intake increased alpha- and beta-diversity and the compositions of Bifidobacterium and Faecalibacterium in the gut microbiota.

    “In relation to the gut microbiota, CP2305 intake increased the alpha- and beta-diversity, and the compositions of Bifidobacterium and Faecalibacterium.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [271] Sawada Daisuke Kuwano Yuki Tanaka Hiroki Hara Susumu Uchiyama Yoshihide Sugawara Tomonori Fujiwara Shigeru Rokutan Kazuhito Nishida Kensei Daily intake of Lactobacillus gasseri CP2305 relieves fatigue and stress-related symptoms in male university Ekiden runners: A double-blind, randomized, and placebo-controlled clinical trial Journal of Functional Foods 2019 57 465 476 10.1016/j.jff.2019.04.022 source

      Not checked in the free run.

  • The quote only partly states this claim.

    Premisecitation

    A. muciniphila supplementation increased anti-inflammatory factors α-tocopherol and β-sitosterol in mice.

    “Probiotic supplementation also increased anti-inflammatory factors α-tocopherol and β-sitosterol.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [281] Zhao S Liu W Wang J Shi J Sun Y Wang W Ning G Liu R Hong J Akkermansia muciniphila improves metabolic profiles by reducing inflammation in chow diet-fed mice J Mol Endocrinol 2017 58 1 14 10.1530/JME-16-0054 27821438 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In a randomized double-blind placebo-controlled trial, heat-killed L. lactis JCM 5805 supplementation in male athletes increased pDC maturation marker CD86 and decreased cumulative days of URTI symptoms and self-reported fatigue compared to placebo.

    “Compared to placebo, supplementation increased the maturation marker of plasmacytoid DC pDC (CD86), responsible for the antiviral response, and decreased the cumulative days of URTI symptoms. Furthermore, ingestion decreased cumulative days of self-reported fatigue.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [262] Komano Y Shimada K Naito H Fukao K Ishihara Y Fujii T Kokubo T Daida H Efficacy of heat-killed Lactococcus lactis JCM 5805 on immunity and fatigue during consecutive high intensity exercise in male athletes: a randomized, placebo-controlled, double-blinded trial J Int Soc Sports Nutr 2018 15 39 10.1186/s12970-018-0244-9 30071871 PMC6090876 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Premisenone given

    In humans, low-grade chronic inflammation is a marker of many disease states and aspects of the metabolic syndrome.

    “In humans, low-grade, chronic inflammation is a marker of many disease states and aspects of the metabolic syndrome.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Cortisol is a steroid hormone released by the adrenal glands in response to stress, and increased levels have been related to suppression of the immune system in athletes.

    “Cortisol is a steroid hormone released by the adrenal glands in response to stress and increased levels have been related to suppression of the immune system in athletes [288–290].”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [288] He CS Tsai ML Ko MH Chang CK Fang SH Relationships among salivary immunoglobulin a, lactoferrin and cortisol in basketball players during a basketball season Eur J Appl Physiol 2010 110 989 995 10.1007/s00421-010-1574-8 20668874 source

      Not checked in the free run.

    • cites [289] Li TL Lin HC Ko MH Chang CK Fang SH Effects of prolonged intensive training on the resting levels of salivary immunoglobulin a and cortisol in adolescent volleyball players J Sports Med Phys Fitness 2012 52 569 573 22976746

      Not checked in the free run.

    • cites [290] Tsai ML Li TL Chou LW Chang CK Huang SY Fang SH Resting salivary levels of IgA and cortisol are significantly affected during intensive resistance training periods in elite male weightlifters J Strength Cond Res 2012 26 2202 2208 10.1519/JSC.0b013e31823a4246 21997453 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Premisenone given

    Athletes have varying gut microbiota compositions that appear to reflect activity level compared to sedentary people, with differences linked primarily to volume of exercise and amount of protein consumption.

    “Athletes have varying gut microbiota compositions that appear to reflect the activity level of the host in comparison to sedentary people, with the differences linked primarily to the volume of exercise and amount of protein consumption.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisenone given

    Regular consumption of specific probiotic strains may assist with immune function and may reduce the number of sick days an athlete experiences when training or during competition.

    “Regular consumption of specific probiotic strains may assist with immune function and may reduce the number of sick days an athlete experiences when training or during competition.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based). May combine two claims.

    Premisenone given

    Studies investigating the effects of probiotics in athletic populations and on sports performance are limited and warrant further investigation.

    “Studies investigating the effects of probiotics in athletic populations and on sports performance are limited and warrant further investigation.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based). May combine two claims.

    Premisenone given

    Probiotic administration has been linked to a multitude of health benefits, with gut and immune health being the most researched applications.

    “Probiotic administration has been linked to a multitude of health benefits, with gut and immune health being the most researched applications.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    The difficulty in interpreting studies is illustrated by variations in clinical outcome measures and different strains used.

    “The difficulty in interpreting the studies is illustrated by variations in clinical outcome measures and most importantly, as probiotic benefits are strain-specific, by different strains used in these studies.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisenone given

    Intense, prolonged exercise, especially in the heat, has been shown to increase gut permeability which potentially can result in systemic toxemia.

    “Intense, prolonged exercise, especially in the heat, has been shown to increase gut permeability which potentially can result in systemic toxemia.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Premisenone given

    The minimal effective dose and method of administration of a specific probiotic strain depends on validation studies for that strain.

    “The minimal effective dose and method of administration (potency per serving, single vs. split dose, delivery form) of a specific probiotic strain depends on validation studies for this particular strain.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based). May combine two claims.

    Premisenone given

    In athletic populations, certain probiotic strains can increase absorption of key nutrients such as amino acids from protein, and affect pharmacology and physiological properties of multiple food components.

    “In athletic populations, certain probiotics strains can increase absorption of key nutrients such as amino acids from protein, and affect the pharmacology and physiological properties of multiple food components.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    These potential benefits require validation in more rigorous human studies and in an athletic population.

    “However, these potential benefits require validation in more rigorous human studies and in an athletic population.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisenone given

    Certain probiotic strains may reduce the severity of respiratory infection and GI disturbance when they occur.

    “Certain probiotic strains may reduce the severity of respiratory infection and GI disturbance when they occur.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisenone given

    Preclinical and early human research has shown potential probiotic benefits relevant to an athletic population including improved body composition and lean body mass, normalizing age-related declines in testosterone, reductions in cortisol, reduction of exercise-induced lactate, and increased neurotransmitter synthesis, cognition and mood.

    “Preclinical and early human research has shown potential probiotic benefits relevant to an athletic population that include improved body composition and lean body mass, normalizing age-related declines in testosterone levels, reductions in cortisol levels indicating improved responses to a physical or mental stressor, reduction of exercise-induced lactate, and increased neurotransmitter synthesis”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Premisenone given

    Immune depression in athletes worsens with excessive training load, psychological stress, disturbed sleep, and environmental extremes, contributing to increased risk of respiratory tract infections.

    “Immune depression in athletes worsens with excessive training load, psychological stress, disturbed sleep, and environmental extremes, all of which can contribute to an increased risk of respiratory tract infections.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Premisenone given

    Approximately 70% of the immune system is located in the gut and probiotic supplementation has been shown to promote a healthy immune response.

    “Approximately 70% of the immune system is located in the gut and probiotic supplementation has been shown to promote a healthy immune response.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationnone given

    Whether differences in gut microbiota composition affect probiotic efficacy is unknown.

    “Whether differences in gut microbiota composition affect probiotic efficacy is unknown.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisenone given

    Probiotic benefits are strain specific and dose dependent, and include improved gut-barrier function, nutrient absorption, recovery and performance in athletes.

    “Probiotic benefits are strain specific and dose dependent, and include improved gut-barrier function, nutrient absorption, recovery and performance in athletes.”
    Quote in the paperNot a substantial claim
143 of 143

  • The paper relies on this without support.

    Approximately 70% of the immune system is located in the gut.

    “Approximately 70% of the immune system is located in the gut”

  • The paper relies on this without support.

    Episodes of illness often occur during heavy exercise training periods, a time when athletes obtain the greatest improvements in fitness.

    “Episodes of illness often occur during heavy exercise training periods, a time when athletes obtain the greatest improvements in fitness.”

  • The paper relies on this without support.

    Illness that interrupts individual training sessions may prevent athletes from maximizing the effects of their training program.

    “Illness that interrupts individual training sessions may prevent athletes from maximizing the effects of their training program.”

  • The paper relies on this without support.

    Disruption in the GI system can impair the delivery of nutrients, and cause GI symptoms and decreased performance.

    “Disruption in the GI system can impair the delivery of nutrients, and cause GI symptoms and decreased performance.”

  • The paper relies on this without support.

    The studies included in this position stand are representative of probiotic supplementation in athletes and physically active individuals.

    “In this position stand, which reviews studies focused on probiotic supplementation in athletes and physically active individuals, 11 studies measured AEs and general supplementation tolerance, while 30 studies did not.”

  • The paper relies on this without support.

    The absence of reported adverse events in studies that did not measure them indicates that probiotic supplementation is safe.

    “In this position stand, which reviews studies focused on probiotic supplementation in athletes and physically active individuals, 11 studies measured AEs and general supplementation tolerance, while 30 studies did not.”

  • The paper relies on this without support.

    The PubMed search terms used capture the relevant literature on probiotics in athletes.

    “A PubMed search conducted in October 2019 yielded the following listings for various combinations of key terms: probiotic and athlete, n = 145; probiotic and rodent, n = 3407; probiotic and diabetes, n = 844; probiotic and child, n = 2930; probiotic and elderly, n = 2257.”

  • The paper relies on this without support.

    The classical pathway enzymes phosphotransbutyrylase and butyrate kinase convert butyryl-CoA to butyrate and coenzyme A with concomitant formation of ATP.

    “In the classical pathway, the enzymes phosphotransbutyrylase and butyrate kinase convert butyryl-CoA to butyrate and coenzyme A with concomitant formation of ATP.”

  • The paper relies on this without support.

    The gut-brain axis is a bidirectional pathway via the neural, endocrine, and immune systems.

    “The gut-brain axis is a bidirectional pathway via the neural, endocrine, and immune systems.”

  • The paper relies on this without support.

    Choline is converted into acetylcholine via the enzyme choline acetyltransferase.

    “Choline is converted into acetylcholine via the enzyme choline acetyltransferase.”

  • The paper relies on this without support.

    Findings from animal models of probiotic supplementation are indicative of effects in humans.

    “Several animal studies have been conducted with promising results.”

  • The paper relies on this without support.

    The outcome measures used in the cited studies are valid and reliable for assessing probiotic effects on athletic performance and health.

    “The difficulty in interpreting the studies is illustrated by variations in clinical outcome measures and most importantly, as probiotic benefits are strain-specific, by different strains used in these studies.”
12 of 12

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Summary gives a tenfold lower TWK10 dose

    Major

    The summary attributes the endurance benefit to 1 × 1010 CFU of L. plantarum TWK10, while Table 3 reports 1 × 1011 CFU for that study.

  • Cyclist sex counts exceed the reported sample size

    Minor

    The reported 64 men and 35 women total 99 participants, not 80.

    Reported 80 · recomputed 99

  • Multistrain dose falls outside Table 4's stated range

    Minor

    Table 4 gives an upper limit of 4.5 × 1010 CFU for multi-species/strain studies, but Table 3 includes a multistrain intervention providing 120 billion CFU daily.

  • Strasser study has two sample sizes

    Minor

    Table 3 reports 29 athletes, whereas the performance discussion describes the study as having 33.

  • Table 3 reverses the Jäger study references

    Minor

    Table 3 assigns reference [42] to the B. coagulans study, but reference [42] is the study of S. thermophilus FP4 and B. breve BR03. The B. coagulans study appears in the reference list as [43].

  • Carbuhn study has two sample sizes

    Minor

    Table 3 lists 17 female swimmers, but the immune-system discussion says there were 20.

  • Human fat-free-mass result contradicts animal-only claim

    Minor

    The paper says increases in fat-free mass have only been shown in animal models, despite earlier reporting such an increase in female athletes.

7 of 7

Cites

Flagged first, then by citations

3 of the 291 references couldn’t be matched to a known paper.

Research works printed but not linked: 10

  1. MetchnikoffE The prolongated of life; optimistic studies1908 New York G.P. Putnam’s Son
  2. CrampTBroadEMartinDMeyerBJEffects of preexercise carbohydrate ingestion on mountain bike performanceMed Sci Sports Exerc16022004 36 1609
  3. NazemianVShadnoushMManahejiHZaringhalamJProbiotics and inflammatory pain: a literature review studyMiddle East J Rehab Health20163 e36087
  4. AghaeeMKhosraviNHanachiPKordiMRAghaeeREffect of probiotic supplement on immune response in male athletesQom Univ Med Sci20147 27 33
  5. Narimani-Rad et al. Indian Journal of Fundamental and Applied Life Sciences (Online) An Open Access Online International Journal Available at www.cibtech.org/sp.ed/jls/2014/03/jls.htm. 2014;4(S3):231–5. ISSN: 2231–6345.
  6. NicolaSMognaLAllesinaSBarbaMDeiddaFLorenziniPRaiteriEStrozziGMognaGInteraction between probiotics and human immune cells. The prospective anti-inflammatory activity of Bifidobacterium breve BRO3Agro Food Ind Hi-Tech201021 9 13
  7. Brennan C.J.; Axelrod C.; Paul D.; Hull M.; Kirwan J.P. Effects of a novel probiotic on exercise-induced gut permeability and microbiota in endurance athletes (abstract). In proceedings of American College of Sports Medicine Minneapolis MN.
  8. BermonSPetrizBKajenieneAPrestesJCastellLFrancoOLThe microbiota: an exercise immunology perspectiveExerc Immunol Rev201521 70 79 25825908 25825908
  9. Food and Agriculture Organization of the United Nations and World Health Organization Joint FAO/WHO working group report on drafting guidelines fro the evaluation of probiotics in food2002
  10. ANVISA-Ministry of Health Technical Regulation of Bioeactive and Probiotic Substances Isolated with Allegations of Functional or Health Properties2008

Cited by

Sorted by citations

Related

Authors
Jäger, R., Mohr, A. E., Carpenter, K. C., Kerksick, C. M., Purpura, M., Moussa, A., Townsend, J. R., Lamprecht, M., West, N. P., Black, K., Gleeson, M., Pyne, D. B., Wells, S. D., Arent, S. M., Smith-Ryan, A. E., Kreider, R. B., Campbell, B. I., Bannock, L., Scheiman, J., Wissent, C. J., Pane, M., Kalman, D. S., Pugh, J. N., ter Haar, J. A., & Antonio, J.
Affiliations
  • Increnovo LLC (United States) (US)
  • Arizona State University (US)
  • Novita Healthcare (Australia) (AU)
  • Lindenwood University (US)
  • University of Münster (DE)
  • Lipscomb University (US)
  • University of Graz (AT)
  • Griffith University (AU)
  • University of Otago (NZ)
  • Loughborough University (GB)
  • University of Canberra (AU)
  • WGI
  • University of South Carolina (US)
  • Applied Physiology Laboratory, Department of Exercise and Sport Science
  • Texas A&M University (US)
  • University of South Florida (US)
  • Institute of Performance Nutrition
  • Fitbiomics, Inc
  • Jamieson Wellness Inc
  • Bioloab Research
  • Nutrasource (CA)
  • Liverpool John Moores University (GB)
  • International Probiotic Association
  • Exercise and Sport Science
Corresponding author
Jäger, Ralf
ORCID
Venue
Journal of the International Society of Sports Nutrition
Publisher
Informa UK Limited
Published
2019-01-15
Volume
16
Issue
1
Pages
62-62
ISSN
1550-2783 (ISSN-L)
DOI
10.1186/s12970-019-0329-0
PMC
PMC6925426
OpenAlex
W2996536203
Semantic Scholar
27ac0b0bb54b3cb210bd6933368dcbf87dc94adf
Cited by
277
References
291
Citations by year
2026: 40 · 2025: 48 · 2024: 36 · 2023: 42 · 2022: 46 · 2021: 36 · 2020: 28 · 2018: 1
FWCI
2.48
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of the International Society of Sports Nutrition (publishedVersion, other-oa)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Liverpool John Moores University (acceptedVersion, other-oa)
  • Griffith Research Online (submittedVersion, cc-by)
  • Rutgers University Community Repository (Rutgers University) (submittedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • Loughborough University Research Repository (Loughborough University) (submittedVersion, cc-by)
Topics
  • Life Sciences › Agricultural and Biological Sciences › Food Science › Probiotics and Fermented Foods
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Gut microbiota and health
  • Life Sciences › Agricultural and Biological Sciences › Animal Science and Zoology › Animal Nutrition and Physiology
Keywords
probiotics, probiotic supplementation, athletes, gut microbiota, immune function, upper respiratory tract infection, intestinal barrier, intestinal permeability, exercise-induced inflammation, muscle damage recovery, nutrient absorption, sports nutrition, post-exercise recovery, heat stress, training load, immune depression, respiratory infections
MeSH terms
Gastrointestinal Microbiome, Body Composition, Humans, Societies, Medical, Exercise, Probiotics, Athletic Performance, Athletes, Sports Nutritional Sciences

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-08.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-08.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

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