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Cited by 99Probiotics and Fermented FoodsExercise and Physiological ResponsesGastrointestinal motility and disorders

An Exploratory Investigation of Endotoxin Levels in Novice Long Distance Triathletes, and the Effects of a Multi-Strain Probiotic/Prebiotic, Antioxidant Intervention

Open access
Roberts, Justin, Suckling, Craig, Peedle, Georgia, Murphy, Joseph, Dawkins, Tony, Roberts, Michael·2016·Nutrients
DOI 10.3390/nu8110733PMC PMC5133117
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Abstract

Gastrointestinal (GI) ischemia during exercise is associated with luminal permeability and increased systemic lipopolysaccharides (LPS). This study aimed to assess the impact of a multistrain pro/prebiotic/antioxidant intervention on endotoxin unit levels and GI permeability in recreational athletes. Thirty healthy participants (25 males, 5 females) were randomly assigned either a multistrain pro/prebiotic/antioxidant (LAB4ANTI; 30 billion CFU·day−1 containing 10 billion CFU·day−1 Lactobacillus acidophilus CUL-60 (NCIMB 30157), 10 billion CFU·day−1 Lactobacillus acidophillus CUL-21 (NCIMB 30156), 9.5 billion CFU·day−1 Bifidobacterium bifidum CUL-20 (NCIMB 30172) and 0.5 billion CFU·day−1 Bifidobacterium animalis subspecies lactis CUL-34 (NCIMB 30153)/55.8 mg·day−1 fructooligosaccharides/ 400 mg·day−1 α-lipoic acid, 600 mg·day−1 N-acetyl-carnitine); matched pro/prebiotic (LAB4) or placebo (PL) for 12 weeks preceding a long-distance triathlon. Plasma endotoxin units (via Limulus amebocyte lysate chromogenic quantification) and GI permeability (via 5 h urinary lactulose (L): mannitol (M) recovery) were assessed at baseline, pre-race and six days post-race. Endotoxin unit levels were not significantly different between groups at baseline (LAB4ANTI: 8.20 ± 1.60 pg·mL−1; LAB4: 8.92 ± 1.20 pg·mL−1; PL: 9.72 ± 2.42 pg·mL−1). The use of a 12-week LAB4ANTI intervention significantly reduced endotoxin units both pre-race (4.37 ± 0.51 pg·mL−1) and six days post-race (5.18 ± 0.57 pg·mL−1; p = 0.03, ηp2 = 0.35), but only six days post-race with LAB4 (5.01 ± 0.28 pg·mL−1; p = 0.01, ηp2 = 0.43). In contrast, endotoxin units remained unchanged with PL. L:M significantly increased from 0.01 ± 0.01 at baseline to 0.06 ± 0.01 with PL only (p = 0.004, ηp2 = 0.51). Mean race times (h:min:s) were not statistically different between groups despite faster times with both pro/prebiotoic groups (LAB4ANTI: 13:17:07 ± 0:34:48; LAB4: 12:47:13 ± 0:25:06; PL: 14:12:51 ± 0:29:54; p > 0.05). Combined multistrain pro/prebiotic use may reduce endotoxin unit levels, with LAB4ANTI potentially conferring an additive effect via combined GI modulation and antioxidant protection.

AI snapshot

Written from the paper’s full text.

TL;DR

In 30 novice long-distance triathletes, a 12-week multistrain pro/prebiotic/antioxidant intervention (LAB4ANTI) significantly reduced plasma endotoxin units pre-race and six days post-race, while placebo did not. The same intervention did not significantly improve race times, though both pro/prebiotic groups tended to finish faster than placebo.

Key findings

  • Baseline endotoxin units did not differ significantly between groups: LAB4ANTI 8.20 ± 1.60 pg·mL−1, LAB4 8.92 ± 1.20 pg·mL−1, and placebo 9.72 ± 2.42 pg·mL−1.
  • LAB4ANTI significantly reduced endotoxin units both pre-race (4.37 ± 0.51 pg·mL−1) and six days post-race (5.18 ± 0.57 pg·mL−1; p = 0.03, ηp2 = 0.35); LAB4 reduced endotoxin units only six days post-race (5.01 ± 0.28 pg·mL−1; p = 0.01, ηp2 = 0.43), while placebo remained unchanged.
  • Urinary lactulose:mannitol increased significantly with placebo only, from 0.01 ± 0.01 at baseline to 0.06 ± 0.01 (p = 0.004, ηp2 = 0.51); increases with LAB4ANTI and LAB4 were non-significant.
  • Mean race times were not statistically different between groups despite faster times with both pro/prebiotic groups: LAB4ANTI 13:17:07 ± 0:34:48, LAB4 12:47:13 ± 0:25:06, placebo 14:12:51 ± 0:29:54 (p > 0.05).

Methods

  • Randomized, repeated-measures, double-blind, placebo-controlled study in 30 recreationally active participants (25 males, 5 females; age 35 ± 1 years; initial VO2max 48.93 ± 0.99 mL·kg−1·min−1) training for their first long-distance triathlon.
  • Participants received 12 weeks of LAB4ANTI (30 billion CFU·day−1 multistrain pro/prebiotic plus 55.8 mg·day−1 fructooligosaccharides, 400 mg·day−1 α-lipoic acid, 600 mg·day−1 N-acetyl-carnitine), matched LAB4 pro/prebiotic, or placebo; assessments occurred at baseline, pre-race, and six days post-race.
  • Main measures included plasma endotoxin units via Limulus amebocyte lysate chromogenic assay, IgG endotoxin-core antibodies via ELISA, GI permeability via 5 h urinary lactulose:mannitol recovery, GI symptom questionnaires, training diaries, and official race times; analysis used 3 × 3 factorial ANOVA with LSD post hoc, repeated-measures ANOVA, and chi-squared tests, with α ≤ 0.05.

Limitations

  • Stated by the authors: logistical difficulty collecting samples immediately or 24 h post-event meant the post-race timepoint was six days; exercise performance was not assessed because baseline measures could not be ascertained; cytokine profiles were not assessed; inter-individual variability in IgG anti-EU was noted.
  • Evident from the text: the sample was small (30 participants, only 5 females) and recreationally trained, limiting generalizability; the six-day post-race sampling likely missed acute endotoxin responses; race-time comparisons were between groups only and not controlled for baseline performance.

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

Integrity signals

Registry

Crossref · 10.3390/nu8110733

Cites

73 of 73 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 63 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    Endotoxin unit levels were not significantly different between groups at baseline.

    “Endotoxin unit levels were not significantly different between groups at baseline (LAB4ANTI: 8.20 ± 1.60 pg·mL−1; LAB4: 8.92 ± 1.20 pg·mL−1; PL: 9.72 ± 2.42 pg·mL−1).”
    • Also stated in: § 3.2. Endotoxin Unit (EU) Assessment · plain
      “At baseline, whilst EU levels were highest with PL (9.72 ± 2.42 pg·mL−1), no significance was found in comparison to either LAB4ANTI (8.20 ± 1.60 pg·mL−1) or LAB4 (8.92 ± 1.20 pg·mL−1, p > 0.05).”
    Quote in the paperNot a substantial claim
  • Findingown data

    A similar interaction effect for time was observed with per cent recovery of lactulose.

    “A similar interaction effect for time was also observed with the per cent recovery of lactulose (F = 5.66, p = 0.005, ηp2 = 0.14), as shown in Table 4.”
    Quote in the paperNot a substantial claim
  • Findingown data

    Mean race times were not statistically different between groups.

    “Mean race times (h:min:s) were not statistically different between groups despite faster times with both pro/prebiotoic groups (LAB4ANTI: 13:17:07 ± 0:34:48; LAB4: 12:47:13 ± 0:25:06; PL: 14:12:51 ± 0:29:54; p > 0.05).”
    Quote in the paperNot a substantial claim
  • Findingown data

    No significant differences were found for per cent recovery of mannitol either between or within groups.

    “No significant differences were found for per cent recovery of mannitol either between or within groups (p > 0.05).”
    Quote in the paperNot a substantial claim
  • Findingown data

    Within PL only, per cent recovery of lactulose increased from baseline to six days post-race.

    “Within group, for PL only, the per cent recovery of lactulose increased from 0.35% ± 0.18% at baseline to 0.94% ± 0.12% six days post-race (p = 0.01).”
    Quote in the paperNot a substantial claim
  • May combine two claims. 47
  • Classified as probably not a substantial claim. 29

  • May combine two claims.

    Findingown data

    Within PL, IgG anti-EU decreased from baseline to pre-race and returned post-race, but overall changes were not statistically significant.

    “In a converse manner, average plasma IgG anti-EU concentrations decreased from 223.98 ± 51.46 MU·mL−1 at baseline to 181.56 ± 58.19 MU·mL−1 pre-race with PL, returning to 207.94 ± 31.96 MU·mL−1 six days post-race; however, overall changes in IgG anti-EU for PL were not statistically significant (F = 0.30, p = 0.746, ηp2 = 0.04).”
    Quote in the paperNot a substantial claim

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

    Findingown data

    For LAB4, training load at Month 2 was 4311 ± 348 AU, significantly higher than Month 1, and training strain was 4065 ± 381 AU.

    “For LAB4 in particular, training load was noted at 4311 ± 348 AU (F = 8.21, p = 0.006, ηp2 = 0.58 compared to Month 1), further reflecting the increased strain (4065 ± 381 AU) in this month (F = 6.79, p = 0.011, ηp2 = 0.53).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    A 12-week LAB4ANTI intervention significantly reduced endotoxin units both pre-race and six days post-race.

    “Within group, LAB4ANTI resulted in a significant reduction in endotoxin units both pre-race (4.37 ± 0.51 pg·mL−1) and six days post-race (5.18 ± 0.57 pg·mL−1; F = 4.27, p = 0.033, ηp2 = 0.35).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Within LAB4, IgG anti-EU increased from baseline to pre-race and decreased post-race, but overall changes were not statistically significant.

    “For LAB4, IgG anti-EU also increased from 209.23 ± 59.73 MU·mL−1 at baseline to 251.73 ± 60.72 MU·mL−1 pre-race in relative contrast to the decrease in endotoxin unit levels observed for this group. Post-race IgG anti-EU concentrations decreased to 161.61 ± 50.16 MU·mL−1, but overall changes were not deemed statistically significant (F = 1.95, p = 0.174, ηp2 = 0.20) for LAB4.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    LAB4 intervention significantly reduced endotoxin units six days post-race but not pre-race.

    “but only six days post-race with LAB4 (5.01 ± 0.28 pg·mL−1; p = 0.01, ηp2 = 0.43).”
    • Also stated in: § 3.2. Endotoxin Unit (EU) Assessment · plain
      “For LAB4, there was a significant reduction in endotoxin units over time (F = 6.04, p = 0.011, ηp2 = 0.43), with post-hoc analysis indicating EU levels of 5.01 ± 0.28 pg·mL−1 six days post-race being significantly lower than baseline (p = 0.047) only.”
    Quote in the paperSubstantial claim

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

    Findingown data

    No significant differences in GI permeability were reported between groups.

    “No significant differences were reported between groups (p > 0.05).”
    Quote in the paperNot a substantial claim

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

    Findingown data

    Peak training loads at Month 2 were greater than the high end target set at 3278 AU.

    “Interestingly, however, peak training loads at Month 2 were all greater than the high end target set at 3278 AU (arbitrary units).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    A significant group interaction effect was reported for IgG anti-EU, with LAB4ANTI demonstrating lower concentrations at baseline compared to both LAB4 and PL.

    “Overall, a significant group interaction effect was reported for IgG anti-EU, with LAB4ANTI demonstrating lower concentrations of IgG endotoxin core-antibodies in comparison to both LAB4 and PL (F = 10.82, p < 0.0001, ηp2 = 0.25) at baseline.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    IgG anti-EU levels remained significantly lower pre-race with LAB4ANTI compared to LAB4, but not compared to PL.

    “Whilst IgG anti-EU levels remained significantly lower pre-race with LAB4ANTI compared to LAB4 (p = 0.003), there was no statistical difference in comparison to PL.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Within LAB4ANTI, IgG anti-EU increased from baseline to pre-race and post-race, but overall change was not significant.

    “Within group, IgG anti-EU levels for LAB4ANTI increased from 40.42 ± 12.39 MU·mL−1 at baseline, to 58.83 ± 22.94 MU·mL−1 pre-race in contrast to the decrease in endotoxin unit levels observed. However, the overall increase in IgG anti-EU to 77.93 ± 26.03 MU·mL−1 post-race was not deemed significant (F = 1.01, p = 0.387, ηp2 = 0.11) overall.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Both GI symptom count and severity were significantly lower in both LAB4 interventions compared with placebo by the end of the training period.

    “Additionally, both GI symptom count and severity were significantly lower in both LAB4 interventions compared with PL by the end of the training period, observations similar to those reported elsewhere employing probiotic strategies [21,46,47].”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Altered GI permeability was only observed in the placebo condition, representing a 4.2 fold increase over the intervention and recovery periods, compared to 0.7 fold for LAB4ANTI and 0.6 fold for LAB4.

    “Altered GI permeability was only observed in the PL condition, which whilst not reaching clinical significance (i.e., L:M ≥ 0.09; [44,45]), represented a 4.2 fold increase over the intervention and recovery periods (compared to a 0.7 fold increase in the L:M ratio for LAB4ANTI and 0.6 fold increase for LAB4).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Average stage times were not significantly different between groups for either swim or cycle stages.

    “However, average stage times were not significantly different between groups for either swim (F = 0.45, p = 0.642) or cycle (F = 2.30, p = 0.129) stages.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The LAB4ANTI intervention resulted in a significant 46.6% reduction in endotoxin units, with pre-race levels reducing to 4.37±0.51 pg/mL.

    “In contrast, the LAB4ANTI intervention resulted in a significant 46.6% reduction in endotoxin units, with pre-race levels in this group reducing to 4.37± 0.51 pg·mL−1.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    No differences were reported for average symptom severity within group across the intervention or between LAB4 groups.

    “No differences were reported for average symptom severity within group across the intervention (p > 0.05) or between LAB4 groups (p > 0.05).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The use of a 12-week LAB4 strategy reduced average endotoxin units by 26.0%, but was not statistically significant.

    “The use of a 12-week LAB4 strategy reduced average endotoxin units by 26.0%, but was not statistically significant.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    At Month 2, symptom counts for LAB4ANTI significantly increased within group and were greater than LAB4.

    “At Month 2, there was a significant increase in symptom counts for LAB4ANTI (10.70 ± 2.88, p = 0.015 within group), which was also greater than LAB4 (p = 0.036).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Both LAB4 groups completed the marathon stage in similar times, in contrast to placebo, but the difference was not significant.

    “This was further reflected in the marathon stage, despite both LAB4 groups completing the marathon course in similar times (285.8 ± 13.1 min for LAB4ANTI vs. 287.41 ± 16.04 min for LAB4) in contrast to PL (320.8 ± 21.1 min; F = 1.06, p = 0.368).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The general trend in IgG anti-EU supported these findings, but inter-individual variability resulted in non-significant findings.

    “Whilst the general trend in IgG anti-EU supported these findings, the inter-individual variability observed resulted in non-significant findings.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    At six days post-race, endotoxin units remained unchanged with placebo, but were significantly lower for both intervention groups.

    “At six days post-race, endotoxin units remained unchanged with PL (8.02 ± 1.14 pg·mL−1), but were significantly lower for both intervention groups (5.18 ± 0.57 pg·mL−1 for LAB4ANTI, and 5.01 ± 0.28 pg·mL−1 for LAB4).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    This represented an overall reduction in endotoxin units from baseline of 36.8% for LAB4ANTI and 43.9% for LAB4 strategies.

    “This represented an overall reduction in endotoxin units from baseline of 36.8% for LAB4ANTI and 43.9% for LAB4 strategies.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    This is despite a 6.5% (~56 min) faster overall time for LAB4ANTI compared to placebo, and 10.0% (~86 min) faster for LAB4 compared to placebo.

    “This is despite a 6.5% (~56 min) faster overall time for LAB4ANTI compared to PL, and 10.0% (~86 min) faster for LAB4 compared to PL.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Faster times were reported for LAB4 during both swim and cycle stages, with a trend towards an overall difference compared to placebo (p = 0.058).

    “However, it was noted that faster times were reported for LAB4 during both swim and cycle stages, with a trend towards an overall difference compared to PL (p = 0.058).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Alpha lipoic acid is proposed to act as a multi-functional antioxidant, regenerating endogenous glutathione, and minimising GI mucosal injury.

    “Alpha lipoic acid in particular is proposed to act as a multi-functional antioxidant, regenerating endogenous glutathione, and minimising GI mucosal injury [31,32,33].”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [31] Hussein, 2014, Gastro protective, antiapoptotic and anti-inflammatory effect of alpha-lipoic acid on ethanol induced gastric mucosal lesions in rats, Am. J. Biochem. Mol. Biol. source

      Not checked in the free run.

    • cites [32] Sung, 2005, Protective effect of α-lipoic acid in lipopolysaccharide-induced endothelial fractalkine expression, Circ. Res. source

      Not checked in the free run.

    • cites [33] Szygula, 2009, Assessment of the antioxidant effectiveness of α-lipoic acid in healthy men exposed to muscle-damaging exercise, J. Physiol. Pharmacol.

      Not checked in the free run.

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

    Premisecitation

    One study reported an average increase in resting LPS levels of 60 pg/mL across a five-stage ultra-run, with daily average LPS changes of 30 pg/mL.

    “Conversely, one study reported an average increase in resting LPS levels of 60 pg·mL−1 across a five-stage ultra-run, with daily (pre–post stage) average LPS changes of 30 pg·mL−1 [15].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [15] Gill, 2015, Circulatory endotoxin concentration and cytokine profile in response to exertional-heat stress during a multi-stage ultra-marathon competition, Exerc. Immunol. Rev.

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    30 min of running at 80% VO2peak significantly increased luminal permeability in healthy volunteers.

    “with one study demonstrating that 30 min of running at 80% of peak oxygen uptake (VO2peak) significantly increased luminal permeability in healthy volunteers [7].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [7] Pals, 1997, Effect of running intensity on intestinal permeability, J. Appl. Physiol. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Chronic multistrain interventions reduce faecal zonulin levels by ~25% in endurance trained athletes, demonstrating improved GI barrier integrity.

    “Chronic multistrain interventions have also been shown to reduce faecal zonulin levels by ~25% in endurance trained athletes, demonstrating improved GI barrier integrity [26].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [26] Lamprecht, 2012, 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. source

      Not checked in the free run.

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

    Premisecitation

    LPS responses to exertional heat stress may be significantly higher in less trained individuals but still within normal limits.

    “It has also been shown that LPS responses to exertional heat stress may be significantly higher in less trained individuals [13], but still within normal limits.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [13] Selkirk, 2008, Mild endotoxemia, NF-κB translocation, and cytokine increase during exertional heat stress in trained and untrained individuals, Am. J. Physiol. Regul. Integr. Comp. Physiol. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In one study, 68% of highly trained athletes in a long-distance triathlon had endotoxin levels of 5-15 pg/mL in the first 16 h post-event, corresponding with elevated cytokine responses.

    “In one study, 68% of highly trained athletes taking part in a long-distance triathlon reported with endotoxin levels of 5–15 pg·mL−1 in the first 16 h post-event, corresponding with elevated cytokine responses in the same period [9].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [9] Jeukendrup, 2000, Relationship between gastro-intestinal complaints and endotoxemia, cytokine release and the acute-phase reaction during and after a long-distance triathlon in highly trained men, Clin. Sci. source

      Not checked in the free run.

  • May combine two claims.

    Interpretationown data

    Combined multistrain pro/prebiotic use may reduce endotoxin unit levels, with LAB4ANTI potentially conferring an additive effect via combined GI modulation and antioxidant protection.

    “Combined multistrain pro/prebiotic use may reduce endotoxin unit levels, with LAB4ANTI potentially conferring an additive effect via combined GI modulation and antioxidant protection.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Probiotic bacteria, particularly Lactobacillus and Bifidobacterium species, are known to modify GI microbiota and reduce GI episode severity and respiratory tract infections associated with training.

    “Probiotic bacteria, particularly the gram-positive genera Lactobacillus and Bifidobacterium species, are known to modify GI microbiota [17,18,19], and have been shown to reduce GI episode severity [20] and respiratory tract infections commonly associated with training [21].”
    Quote in the paperSubstantial claim0 of 5 sources checked
    • cites [17] Tuohy, 2003, Using probiotics and prebiotics to improve gut health, Drug Discov. Today source

      Not checked in the free run.

    • cites [18] Gareau, 2010, Probiotics and the gut microbiota in intestinal health and disease, Nat. Rev. Gastroenterol. Hepatol. source

      Not checked in the free run.

    • cites [19] Martin, 2013, Role of commensal and probiotic bacteria in human health: A focus on inflammatory bowel disease, Microb. Cell Fact. source

      Not checked in the free run.

    • cites [20] West, 2011, Lactobacillus fermentum (PCC®) supplementation and gastrointestinal and respiratory-tract illness symptoms: A randomised control trial in athlete, Nutr. J. source

      Not checked in the free run.

    • cites [21] Gleeson, 2011, Daily probiotic’s (Lactobacillus casei Shirota) reduction of infection incidence in athletes, Int. J. Sports Nutr. Exerc. Metabol. source

      Not checked in the free run.

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

    Premisecitation

    LAB4 multistrain high dose probiotic resulted in significant improvements in IBS responses and prevented an increase in antibiotic resistant enterococci.

    “In clinical trials, a multistrain high dose probiotic (LAB4—containing Lactobacillus acidophilus CUL60 and CUL21, Bifidobacterium lactis CUL34 and Bifidobacterium bifidum CUL20), resulted in significant improvements in irritable bowel syndrome responses [24] and prevented an increase in antibiotic resistant enterococci [25].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [24] Williams, 2008, Clinical trial: A multistrain probiotic preparation significantly reduces symptoms of irritable bowel syndrome in a double-blind placebo-controlled study, Aliment. Pharmacol. Ther. source

      Not checked in the free run.

    • cites [25] Plummer, 2005, Effects of probiotics on the composition of the intestinal microbiota following antibiotic therapy, Int. J. Antimicrob. Agents source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    81% of runners requiring medical attention at the end of an ultra-marathon had LPS concentrations >100 pg/mL, with 80.6% reporting GI symptoms.

    “In contrast, 81% of runners requiring medical attention at the end of an ultra-marathon were found to have LPS concentrations >100 pg·mL−1 [10], with 80.6% of these athletes reporting GI symptoms (nausea, diarrhoea, and vomiting).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [10] Gaffin, 1988, Endotoxemia in exhausted runners after a long-distance race, S. Afr. Med. J.

      Not checked in the free run.

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

    Study design and conductcitation

    Sample size was justified by power calculation (G*power3, α=0.05; 1−β=0.80; based on observed data).

    “Following study approval from the University of Hertfordshire Life and Medical Sciences Ethics Committee (LMS/SF/UH/00011), and power calculation assessment for sample size (G*power3, Dusseldorf [34]; using α = 0.05; 1 − β = 0.80; based on observed data [9,14])”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [34] Faul, 2007, G*power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences, Behav. Res. Methods source

      Not checked in the free run.

    • cites [9] Jeukendrup, 2000, Relationship between gastro-intestinal complaints and endotoxemia, cytokine release and the acute-phase reaction during and after a long-distance triathlon in highly trained men, Clin. Sci. source

      Not checked in the free run.

    • cites [14] Yeh, 2013, Gastrointestinal response and endotoxemia during intense exercise in hot and cool environments, Eur. J. Appl. Physiol. source

      Not checked in the free run.

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

    Premisecitation

    The use of a 14 week multistrain probiotic strategy significantly decreased faecal zonulin levels elsewhere, supporting improved tight junction stability.

    “Additionally the use of a 14 week multistrain probiotic strategy significantly decreased faecal zonulin levels elsewhere, supporting improved tight junction stability [26].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [26] Lamprecht, 2012, 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. source

      Not checked in the free run.

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

    Interpretationcitation

    IgG anti-EU ranges observed were comparable to those reported elsewhere and most likely reflect variance in relation to individual gut microbiota profiles.

    “Although this possibly indicates an adaptive response in this group, IgG anti-EU ranges observed were comparable to those reported elsewhere [43] and most likely reflect variance in relation to individual gut microbiota profiles.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [43] Sharma, 2011, Role of probiotics on gut permeability and endotoxemia in patients with acute pancreatitis: A double-blind randomised controlled trial, J. Clin. Gastroenterol. source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Study design and conductown data

    Participants were randomly assigned to intervention groups.

    “Thirty healthy participants (25 males, 5 females) were randomly assigned either a multistrain pro/prebiotic/antioxidant (LAB4ANTI; 30 billion CFU·day−1 containing 10 billion CFU·day−1 Lactobacillus acidophilus CUL-60 (NCIMB 30157), 10 billion CFU·day−1 Lactobacillus acidophillus CUL-21 (NCIMB 30156), 9.5 billion CFU·day−1 Bifidobacterium bifidum CUL-20 (NCIMB 30172) and 0.5 billion CFU·day−1 Bifid”
    • Also stated in: § 2.4. Nutritional Interventions and Diaries · plain
      “Following baseline assessment, participants were allocated, in a double-blinded manner, to one of three intervention groups using a random number generator approach.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductown data

    The study was randomized, repeated-measures, double-blind, placebo controlled.

    “In a randomized, repeated-measures, double-blind, placebo controlled study design, participants attended the Human Physiology Laboratory, University of Hertfordshire 12 weeks prior to undertaking a long distance triathlon (Barcelona Challenge Triathlon) comprising a 3.8 km sea swim, 180.0 km road cycle course and a 42.2 km marathon run.”
    Quote in the paperSubstantial claim

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

    Interpretationown data

    If low grade endotoxemia occurs at values >10-50 pg/mL, then some individuals may be susceptible to repeated exposure.

    “However, the range for endotoxin units was 3.03–27.75 pg·mL−1, indicating that if “low grade endotoxemia” does occur at values >10–50 pg·mL−1, then some individuals may be susceptible to repeated exposure.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationcitation

    Such strategies may only apply to chronic interventions, as recent research has demonstrated no impact of acute (7 days) probiotic use on endotoxin levels following endurance exercise.

    “Although this supports previous findings [26,48], such strategies may only apply to chronic interventions, as recent research has demonstrated no impact of acute (7 days) probiotic use on endotoxin levels following endurance exercise at 60%VO2max under ambient or heat-stressed conditions [49].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [49] Gill, 2016, Does short-term high dose probiotic supplementation containing Lactobacillus casei attenuate exertional-heat stress induced endotoxemia and cytokinaemia?, Int. J. Sport Nutr. Exerc. Metab. source

      Not checked in the free run.

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

    Study design and conductnone given

    Adherence was checked via nutrition diaries and monthly briefings.

    “Adherence was checked via nutrition diaries and monthly briefings with all participants.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductcitation

    GI permeability was assessed via 5 h recovery of urinary lactulose and mannitol via a standard sugar absorption test.

    “Assessment of GI permeability was assessed via 5 h recovery of urinary lactulose and mannitol via a standard sugar absorption test [35].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [35] Johnston, 2000, Lactulose-mannitol intestinal permeability test: A useful screening test for adult coeliac disease, Ann. Clin. Biochem.

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    Direct exclusion of LPS translocation through maintained epithelial integrity and/or increased preponderance of gram-positive genera may offer potential therapeutic benefit.

    “Therefore, direct exclusion of LPS translocation through maintained epithelial integrity and/or increased preponderance of gram-positive genera may offer potential therapeutic benefit [51].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [51] Mach, N., and Botella-Fuster, D. (2016). Endurance exercise and gut microbiota: A review. J. Sports Health Sci., in press.

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Study design and conductown data

    Endotoxin units were quantified using an established endpoint chromogenic assay method.

    “Quantification of endotoxin units was derived from plasma samples using an established endpoint chromogenic assay method (Pierce® LAL Chromogenic Endotoxin Quantitation Kit, Thermo Fisher Scientific, Waltham, MA, US).”
    Quote in the paperSubstantial claim

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

    Premisecitation

    Some LPS are poorly sensed by TLR4 and may have more direct impact on NF-κ-B activation.

    “Indeed, as LPS types vary across gram-negative bacteria species, some LPS are poorly sensed by TLR4 and may have more direct impact on NF-κ-B activation [50].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [50] Munford, 2008, Sensing gram-negative bacterial lipopolysaccharides: A human disease determinant?, Infect. Immun. source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    LPS translocation across the GI tract provokes systemic immune reactions with varied consequences.

    “LPS translocation across the GI tract is known to provoke systemic immune reactions with varied consequences [41].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [41] Flynn, 2006, Toll-like receptor 4: Link to the anti-inflammatory effects of exercise?, Exerc. Sport Sci. Rev. source

      Not checked in the free run.

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

    Premisenone given

    LPS attachment to LPS-binding protein and its transference to an MD-2/toll-like receptor (TLR) 4/CD14 complex activates NF-kappa-B and various inflammatory modulators.

    “Specifically, LPS attachment to LPS-binding protein and its transference to an MD-2/toll-like receptor (TLR) 4/CD14 complex activates NF-kappa-B and various inflammatory modulators (TNF-α, IL-1β, IL-6 and CRP).”
    Quote in the paperNot a substantial claim

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

    Premisecitation

    The provision of Lactobacillus genus may work by activating TLR2 and hence more favourable innate immune responses.

    “Specifically, the provision of Lactobacillus genus may work by activating TLR2 and hence more favourable innate immune responses [52,53,54].”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [52] Nakamura, 2012, Metabolic disease and pro- and prebiotics: Mechanistic insights, Nutr. Metab. source

      Not checked in the free run.

    • cites [53] Lescheid, 2014, Probiotics as regulators of inflammation: A review, Funct. Foods Health Dis. source

      Not checked in the free run.

    • cites [54] Pagnini, 2010, Probiotics promote gut health through stimulation of epithelial innate immunity, Proc. Natl. Acad. Sci. USA source

      Not checked in the free run.

  • May combine two claims.

    Interpretationown data

    These results support the contention that a multistrain pro/prebiotic intervention maintains tight junction stability, potentially through interference with phosphorylation processes.

    “Collectively, these results support the contention that a multistrain pro/prebiotic intervention maintains tight junction stability, potentially through interference with phosphorylation processes.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationown data

    In the current study, a combined antioxidant in conjunction with a multistrain pro/prebiotic strategy appeared to confer an additive effect through reduced endotoxin unit levels at the end of the 12-week training period, as well as six days post-race.

    “In the current study, a combined antioxidant in conjunction with a multistrain pro/prebiotic strategy appeared to confer an additive effect through reduced endotoxin unit levels at the end of the 12-week training period, as well as six days post-race.”
    Quote in the paperSubstantial claim

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

    Interpretationreasoning

    This did not reflect the original hypothesis, and likely reflects the wider variance in capabilities observed with "recreationally trained" individuals.

    “This did not reflect our original hypothesis, and likely reflects the wider variance in capabilities observed with “recreationally trained” individuals.”
    Quote in the paperNot a substantial claim

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

    Premisecitation

    Various flavonoids and isoflavones have been shown to inhibit protein kinase C and protein tyrosine kinases respectively, although quercetin for seven days was shown to block the rise in heat shock protein 70, potentially restricting thermotolerant adaptation.

    “Various flavonoids (e.g., quercetin found in onions) and isoflavones (e.g., genistein found in soybeans) have been shown to inhibit protein kinase C and protein tyrosine kinases respectively, although the use of 2 g·day−1 quercetin for seven days was also shown to block the rise in heat shock protein 70, potentially restricting thermotolerant adaptation [71].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [71] Kuennen, 2011, Thermotolerance and heat acclimcation may share a common mechanism in humans, Am. J. Physiol. Regul. Integr. Comp. Physiol. source

      Not checked in the free run.

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

    Premisecitation

    Studies have demonstrated a significant increase in short-chain fatty acids with prebiotic use, supporting increased Bifidobacteria growth and decreased levels of bacteriodes and Fermicutes phyla.

    “Studies have demonstrated a significant increase in short-chain fatty acids (SCFA), with prebiotic use additionally supporting increased Bifidobacteria growth, and decreased levels of bacteriodes and Fermicutes phyla [57,58,59,60,61].”
    Quote in the paperNot a substantial claim0 of 5 sources checked
    • cites [57] Dehghan, 2014, Oligofructose-enriched inulin improves some inflammatory markers and metabolic endotoxemia in women with type 2 diabetes mellitus: A randomized controlled clinical trial, Nutrition source

      Not checked in the free run.

    • cites [58] Rastall, 2015, Recent developments in prebiotics to selectively impact beneficial microbes and promote intestinal health, Curr. Opin. Biotechnol. source

      Not checked in the free run.

    • cites [59] Delzenne, 2013, Gut microbiota and metabolic disorders: How prebiotic can work?, Br. J. Nutr. source

      Not checked in the free run.

    • cites [60] Dewulf, 2013, Insight into the prebiotic concept: Lessons from an exploratory, double-blind intervention study with inulin-type fructans in obese women, Gut source

      Not checked in the free run.

    • cites [61] Rajkumar, 2015, Effect of probiotic Lactobacillus salivarius UBL S22 and prebiotic fructo-oligosaccharide on serum lipids, inflammatory markers, insulin sensitivity, and gut bacteria in healthy young volunteers: A randomized controlled single-blind pilot study, J. Cardiovasc. Pharmacol. Ther. source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    As participants were entering their first long distance triathlon, comparison between groups only provided an insight into whether either intervention strategy offered potential race benefits.

    “As participants were entering their first long distance triathlon, comparison between groups only provided an insight into whether either intervention strategy offered potential race benefits.”
    Quote in the paperSubstantial claim

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

    Premisecitation

    Other dietary antioxidants such as ascorbic acid have been shown to blunt the endotoxin response to exercise, but with secondary effects on ascorbate radical production.

    “Other dietary antioxidants such as ascorbic acid have been shown to blunt the endotoxin response to exercise, but with secondary effects on ascorbate radical production [28].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [28] Ashton, 2003, Exercise-induced endotoxemia: The effect of ascrobic acid supplementation, Free Radic. Biol. Med. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    One study demonstrated raised (but effectively normal) endotoxin levels at 16 h following an ironman triathlon, but did not assess return to baseline levels.

    “One study demonstrated raised (but effectively normal) endotoxin levels at 16 h following an ironman triathlon, but did not assess return to baseline levels [9].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [9] Jeukendrup, 2000, Relationship between gastro-intestinal complaints and endotoxemia, cytokine release and the acute-phase reaction during and after a long-distance triathlon in highly trained men, Clin. Sci. source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Study design and conductreasoning

    A limitation of the current study was the logistical difficulty of collecting samples immediately or 24 h post event.

    “A limitation of the current study was the logistical difficulty of collecting samples immediately or 24 h post event.”
    Quote in the paperSubstantial claim

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

    Premisecitation

    A further study demonstrated that endotoxin levels had returned to baseline 1-3 weeks post event.

    “A further study demonstrated that endotoxin levels had returned to baseline 1–3 weeks post event, reflecting the exhaustive nature of the event [10].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [10] Gaffin, 1988, Endotoxemia in exhausted runners after a long-distance race, S. Afr. Med. J.

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Two other papers indicate that CUL-60 and CUL-21 strains prevented an increase in antibiotic resistant Enterococci and reduced the incidence of Clostridium difficle toxins.

    “Two other papers utilizing similar dosages to the current study also indicate that the CUL-60 and CUL-21 strains prevented an increase in antibiotic resistant Enterococci and reduced the incidence of Clostridium difficle toxins [25,56].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [25] Plummer, 2005, Effects of probiotics on the composition of the intestinal microbiota following antibiotic therapy, Int. J. Antimicrob. Agents source

      Not checked in the free run.

    • cites [56] Plummer, 2004, Clostridium difficile pilot study: Effects of probiotic supplementation on the incidence of C. difficile diarrhea, Int. Microbiol.

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Alpha lipoic acid, along with N-acetyl-carnitine, may act in a local antioxidant manner, and via phosphoinositide 3-kinase/Akt signalling may down-regulate LPS stimulation of NF-κ-B.

    “Alpha lipoic acid, along with N-acetyl-carnitine, may therefore act in a local antioxidant manner, and via phosphoinositide 3-kinase/Akt signalling may down-regulate LPS stimulation of NF-κ-B [68,69,70].”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [68] Goraca, 2009, Effect of alpha-lipoic acid on LPS-induced oxidative stress in the heart, J. Physiol. Pharmacol.

      Not checked in the free run.

    • cites [69] Heibashy, 2013, The curative effects of some antioxidants on endotoxin induced with lipopolysaccharides in the liver of rats, J. Am. Sci.

      Not checked in the free run.

    • cites [70] Zhang, 2007, α-lipoic acid attenuates LPS-induced inflammatory responses by activating the phosphoinositide 3-kinase/Akt signaling pathway, Proc. Natl. Acad. Sci. USA source

      Not checked in the free run.

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

    Premisecitation

    The "synbiotic" effect with a multistrain probiotic formula has been shown to confer improvements in gastrointestinal well-being elsewhere.

    “Although low dose FOS was employed in the current study, the “synbiotic” effect with a multistrain probiotic formula has been shown to confer improvements in gastrointestinal well-being elsewhere [63].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [63] Nova, 2011, Beneficial effects of a synbiotic supplement on self-perceived gastrointestinal well-being and immunoinflammatory status of healthy adults, J. Med. Food source

      Not checked in the free run.

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

    Premisecitation

    Endogenous glutathione peroxidase may be a crucial enzyme in the protection of the intestinal lumen from repetitive damage.

    “Endogenous glutathione peroxidase may be a crucial enzyme in the protection of the intestinal lumen from repetitive damage [67].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [67] Buffinton, 1995, Depleted mucosal antioxidant defences in inflammatory bowel disease, Free Radic. Biol. Med. source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Study design and conductreasoning

    Exercise performance was not assessed in the current study as baseline measures could not be ascertained.

    “It is acknowledged that exercise performance was not assessed in the current study as baseline measures could not be ascertained.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Prebiotic use has been shown to improve mucosal dendritic cell function associated with TLR2 activity and increase expression of glucagon-like peptide 2.

    “Additionally, prebiotic use has been shown to improve mucosal dendritic cell function associated with TLR2 activity [62], and increase the expression of glucagon-like peptide 2, associated with GI barrier regulation [59].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [62] Lindsay, 2006, Clinical, microbiological, and immunological effects of fructo-oligosaccharide in patients with Crohn’s disease, Gut source

      Not checked in the free run.

    • cites [59] Delzenne, 2013, Gut microbiota and metabolic disorders: How prebiotic can work?, Br. J. Nutr. source

      Not checked in the free run.

64 of 64

  • The paper relies on this without support.

    Research is relatively sparse on whether prolonged training or ultra-endurance events result in elevated LPS in recreationally active athletes.

    “Despite this, research is relatively sparse on whether prolonged training or ultra-endurance events actually result in elevated LPS, particularly in more “recreationally active” athletes; or whether targeted nutrition strategies offer beneficial support.”

  • The paper relies on this without support.

    Exercise-related GI symptoms may go unreported in preparation for events, which could impact training efficiency and race completion.

    “In preparation for such events, exercise-related GI symptoms may go unreported, which could impact on training efficiency and race completion.”

  • The paper relies on this without support.

    Exercise-related endotoxin-mediated cytokinemia may explain individual susceptibility to GI symptoms and recovery from endurance exercise.

    “Despite such diversity, the potential for exercise related endotoxin-mediated cytokinemia may explain individual susceptibility to GI symptoms and recovery from endurance exercise.”

  • The paper relies on this without support.

    Resting endotoxin units below 10 pg/mL are within normal limits.

    “Average resting endotoxin units in the current study remained within normal limits (<10 pg·mL−1), and were comparable to values observed (~11.0 ± 5.0 pg·mL−1) for healthy volunteers with similar fitness levels [14,39,40].”

  • The paper relies on this without support.

    Subclinical symptoms associated with exercise-mediated endotoxemia may vary in severity and duration, possibly lasting several days.

    “Subclinical symptoms associated with exercise-mediated endotoxemia may vary in both severity and duration (possibly lasting several days).”

  • The paper relies on this without support.

    The product used in the current study does not appear to have been used in a training context previously.

    “The product used in the current study does not appear to have been used in a training context previously.”

  • The paper relies on this without support.

    Effects of probiotics are strain specific.

    “However, effects of probiotics are strain specific.”
7 of 7

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?

  • In 30 recreational athletes, a multi-strain probiotic over 12 weeks of progressive triathlon training showed no significant differences in race times.

    “In another study assessing the effects of a multi-strain probiotic (along with 55.8 mg fructooligosaccharides, 400 mg alpha-lipoic acid, 600 mg N-acetyl-carnitine) in 30 recreational athletes over 12 weeks of progressive triathlon training no significant differences were found in race times [77].”

    From International Society of Sports Nutrition Position Stand: Probiotics (2019) · cites this paper as [77]

  • No difference was identified in the assessment of intestinal permeability from urinary lactulose:mannitol ratio in novice distance triathletes receiving a multi-strain probiotic/prebiotic.

    “However, no difference was identified in the assessment of intestinal permeability from urinary lactulose:mannitol ratio.”

    From International Society of Sports Nutrition Position Stand: Probiotics (2019) · cites this paper as [77]

  • Twelve weeks of supplementation with a multi-strain probiotic/prebiotic significantly reduced endotoxin levels in novice distance triathletes.

    “Conversely, Roberts et al. [77] reported 12 weeks of supplementation with a multi-strain probiotic/prebiotic significantly reduced endotoxin levels in novice distance triathletes.”

    From International Society of Sports Nutrition Position Stand: Probiotics (2019) · cites this paper as [77]

  • 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.”

    From International Society of Sports Nutrition Position Stand: Probiotics (2019) · cites this paper as [77]

  • Probiotic administration is associated with reduced GI symptom prevalence and severity.

    “There is evidence of reduced GI symptom prevalence and severity following the administration of probiotics [145, 146] although benefits may be individualized and strain-specific.”

    From International Society of Sports Nutrition Position Stand: nutritional considerations for single-stage ultra-marathon training and racing (2019) · cites this paper as [146]

Cites

Flagged first, then by citations

5 of the 78 references couldn’t be matched to a known paper.

Research works printed but not linked: 2

  1. Heibashy, 2013, The curative effects of some antioxidants on endotoxin induced with lipopolysaccharides in the liver of rats, J. Am. Sci., 9, 529
  2. Jeukendrup, 2013, Nutritional recommendations to avoid gastrointestinal complaints during exercise, Sports Sci. Exch., 26, 1

Cited by

Sorted by citations

Related

Authors
Roberts, J., Suckling, C., Peedle, G., Murphy, J., Dawkins, T., & Roberts, M.
Affiliations
  • Anglia Ruskin University (GB)
  • University of Hertfordshire (GB)
  • Cardiff Metropolitan University (GB)
Corresponding author
Roberts, Justin
ORCID
Venue
Nutrients
Publisher
MDPI AG
Published
2016-11-17
Volume
8
Issue
11
Pages
733
ISSN
2072-6643 (ISSN-L)
DOI
10.3390/nu8110733
PMC
PMC5133117
OpenAlex
W2552905751
Semantic Scholar
6369ba86c2a9c4aa7ca0c222239711cfcc2f541f
Cited by
99
References
78
Citations by year
2026: 7 · 2025: 9 · 2024: 11 · 2023: 8 · 2022: 16 · 2021: 10 · 2020: 16 · 2019: 15 · 2018: 5 · 2017: 2
FWCI
9.23
Type
journal article
Language
en
Open access
Licence
Locations
  • Nutrients (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Anglia Ruskin Research Online (Anglia Ruskin University) (submittedVersion)
  • University of Hertfordshire Research Archive (University of Hertfordshire) (submittedVersion, cc-by)
  • University of Hertfordshire Research Archive (University of Hertfordshire) (submittedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • Figshare (submittedVersion, cc-by)
  • Cardiff Metropolitan Research Repository (Cardiff Metropolitan University) (submittedVersion, cc-by)
Topics
  • Life Sciences › Agricultural and Biological Sciences › Food Science › Probiotics and Fermented Foods
  • Health Sciences › Medicine › Rehabilitation › Exercise and Physiological Responses
  • Health Sciences › Medicine › Gastroenterology › Gastrointestinal motility and disorders
Keywords
endotoxin, lipopolysaccharide, intestinal permeability, probiotics, prebiotics, antioxidants, long-distance triathlon, Lactobacillus acidophilus, Bifidobacterium bifidum, Bifidobacterium animalis subsp. lactis, fructooligosaccharides, alpha-lipoic acid, recreational athletes, dietary supplementation, post-exercise recovery
MeSH terms
Gastrointestinal Microbiome, Administration, Oral, Adult, Antioxidants, Bicycling, Capsules, Carnosine, Double-Blind Method, Drug Combinations, Endotoxins, England, Female, Gastrointestinal Diseases, Humans, Thioctic Acid, Male, Physical Endurance, Running, Swimming, Time Factors, Biomarkers, Treatment Outcome, Bacterial Translocation, Endotoxemia, Probiotics, Gastrointestinal Tract, Prebiotics

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.

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