Polycaprolactone (PCL)-based films integrated with hairy cellulose nanocrystals and silver nanoparticles for active Tilapia packaging applications.

The migration of metal ions to the food matrix has been always a challenge in the production of active food packaging films. In this study, it was tried to evaluate the idea of using hairy cellulose nanocrystals (HCNs) in controlling the migration of Silver Nanoparticles (AgNPs) from polycaprolactone (PCL)-based films to the Tilapia fish. HCNs and the final films (integrated with various amounts of HCNs and AgNPs) were evaluated physicochemically and mechanically. Tilapia fish were packed using the films and after specific periods, the fish samples were assessed microbiologically and physiochemically. According to the results, incorporating NPs into PCL films enhanced tensile strength, elasticity, and toughness making the films more resistant to breakage and deformation under stress. The introduction of HCNs reduced the surface roughness level, decreasing AgNPs migration, but also accelerated the degradation rate. Films with [1% AgNPs +2% HCNs] and [1% AgNPs] had the lowest and highest water vapor transmission rate. The use of AgNPs (1%) + HCNs (2%) incorporated into PCL films resulted in a lower pH value, TVB-N, TBARs, and PV. It also decreased microbial activities in samples in comparison to the control. Therefore, the idea of using HCNs along with antibacterial metal-based nanoparticles can control the rate of ion migration.

The roles of Saccharomyces cerevisiae on the bioaccessibility of phenolic compounds.

Phenolic compounds are a group of non-essential dietary compounds that are widely recognized for their beneficial health effects, primarily due to their bioactive properties. These compounds which found in a variety of plant-based foods, including fruits, vegetables, and grains are known to possess antimicrobial, antioxidant, anti-inflammatory, and anti-carcinogenic properties. However, the health effects of these compounds depend on their bioaccessibility and bioavailability. In recent years, there has been growing interest in the use of probiotics for promoting human health. Saccharomyces cerevisiae is a yeast with potential probiotic properties and beneficial health effects. Biosorption of phenolic compounds on Saccharomyces cerevisiae cell walls improves their bioaccessibility. This characteristic has also allowed the use of this yeast as a biosorbent in the biosorption process due to its low cost, safety, and easy availability. S. cerevisiae enhances the bioaccessibility of phenolic compounds as a delivery system under in vitro digestion conditions. The reason for this phenomenon is the protective effects of yeast on various phenolic compounds under digestion conditions. This article shows the role of S. cerevisiae yeast on the bioaccessibility of various phenolic compounds and contributes to our understanding of the potential impact of yeasts in human health.

Investigation of the simulated microgravity impact on heavy metal biosorption by Saccharomyces cerevisiae.

Heavy metals are one of the most dangerous environmental pollutions, and their elimination is one of the health system's priorities. Microorganisms have been introduced as a safe absorber of such pollution and this ability is related to the characteristics of their surface layers. There are reports about some bacteria's increment of cell envelope thickness in space conditions. Therefore, this study investigated SMG effect on heavy metals biosorption using Saccharomyces (S.) cerevisiae. Furthermore, the stability of complex, isotherm, and kinetic absorption models has been investigated. The results showed that the SMG positively affected the biosorption of mercury (Hg) 97% and lead (Pb) 72.5% by S. cerevisiae. In contrast, it did not affect cadmium (Cd) and arsenic (As) biosorption. In gastrointestinal conditions, Hg, Cd, and As-yeast complexes were stable, and their biosorption increased. In the case of the Pb-yeast complex, in simulated gastric exposure, the binding decreased at first but increased again in simulated intestinal exposure in both SMG and normal gravity (NG). The metals' biosorption by yeast followed the pseudo-second-order kinetic and the Langmuir isotherm models for all metals (As) matched with Langmuir and Freundlich. The current research results demonstrate that microgravity provides desirable conditions for heavy metal biosorption by S. cerevisiae. Furthermore, the biosorbent-heavy metal complex remains stable after simulated gastrointestinal conditions. Altogether, the results of this study could be considered in detoxifying food and beverage industries and maintaining astronauts' health.

Kombucha as a Health-Beneficial Drink for Human Health.

Kombucha is a unique fermented beverage made from a symbiotic culture of yeast and bacteria. Kombucha is normally based on black tea added to water, then sugar is added as a substrate for fermentation in this beverage. This unique beverage is composed of amino acids, flavonoids, vitamins, and some active enzymes. Several beneficial health effects such as antioxidant, antimicrobial effects have been reported as a result of probiotics and prebiotics presence. These health effects of kombucha are attributed to its bioactive chemical and biological agents of probiotics bacteria e.g., Gluconobacter, Acetobacter and yeasts like Saccharomyces sps., along with glucuronic acid as the main sources of the health protection. This review focuses on the beneficial effects of Kombucha including antimicrobial, antioxidant, anti-cancer antidiabetic properties, as well as liver protection, treat of gastrointestinal problems, AIDS, gastric ulcers, obesity (and energy production), detoxification, and skin health.

Production of iron enriched Saccharomyces boulardii: impact of process variables.

About half of the 1.62 billion cases of anemia are because of poor diet and iron deficiency. Currently, the use of iron-enriched yeasts can be used as the most effective and possible way to prevent and treat anemia due to the ability of biotransformation of mineral compounds into the organic form. In this research, for the first time, Saccharomyces (S.) boulardii was used for iron enrichment with the aim that the probiotic properties of yeast provide a potential iron supplement besides improving the bioavailability of iron. Also, due to its higher resistance than other Saccharomyces strains against stresses, it can protect iron against processing temperatures and stomach acidic-enzymatic conditions. So, the effect of three important variables, including concentration of iron, molasses and KH2PO4 on the growth and biotransformation of yeast was investigated by the Box-Behnken design (BBD). The best conditions occurred in 3 g/l KH2PO4, 20 g/l molasses and 12 mg/l FeSO4 with the highest biotransformation 27 mg Fe/g dry cell weight (DCW) and 6 g/l biomass weight. Such yeast can improve fermented products, provide potential supplement, and restore the lost iron of bread, which is a useful iron source, even for vegetarians-vegans and play an important role in manage with anemia. It is recommended that in future researches, attention should be paid to increasing the iron enrichment of yeast through permeabilizing the membrane and overcoming the structural barrier of the cell wall.

A sustainable solution for alleviating hexavalent chromium from water streams using Lactococcus lactis AM99 as a novel Cr(VI)-reducing bacterium.

Chromium, extensively used in various industries, poses significant challenges due to its environmental impact. The threat of Cr(VI) causes critical concerns in aquatic ecosystems as a consequence of the fluidity of water. The conventional approach for the treatment of effluents containing Cr(VI) is reducing Cr(VI) to low-noxious Cr(III). This research is related to a Gram positive bacterium newly isolated from tannery effluent under aerobic conditions. To characterize functional groups on the isolate, Fourier transform infrared spectroscopy was utilized. The effect of different factors on Cr(VI) bioreduction was investigated, including temperature, initial Cr(VI) concentration, acetate concentration, and Tween 80 surfactant. Under optimal conditions (37 °C and 0.90 g/L sodium acetate), the bioreduction rate of the isolate, identified as Lactococcus lactis AM99, achieved 88.0 % at 300 mg/L Cr(VI) during 72 h (p < 0.05). It was observed that Cr(VI) bioreduction was enhanced by the acetate in both the quantity and intensity, while Tween 80 had no impact on the reaction. The strain AM99 exhibited remarkable characteristics, notably a marginal decrease in growth at elevated concentrations of hexavalent chromium and an exceptional potential to reduce Cr(VI) even at very low biomass levels, surpassing any prior findings in the associated research. Furthermore, The isolate could tolerate 1400 mg/L Cr(VI) in a solid medium. These distinctive features make the isolate a promising and well-suited candidate for remediating Cr(VI)-polluted environments. Additionally, the impact of biogenic extracellular polymer produced by the strain AM99 on reduction was examined at different temperatures.

Mycoprotein as chicken meat substitute in nugget formulation: Physicochemical and sensorial characterization.

The aim of this study was to replace chicken breast by mycoprotein in nuggets and optimizing the sensory and technological properties. In the first step of the study, 14 formulations were prepared by mixture design to evaluate the impact of three binding agents (as independent variables): soy protein isolate, phosphate, and carrageenan on sensory properties. Then, the optimized formulation of mycoprotein nugget (with higher acceptability) was characterized and compared to chicken nugget (control) from texture, color, and physicochemical aspects. The texture attributes including hardness, springiness, cohesiveness, and chewiness of the optimized sample (1.37 kg, 0.70 mm, 0.56, and 0.53 kg.mm) had no significant difference (p > .05) compared to control. Based on the results, optimized sample had a lower lightness and yellowness (a*, b*, and L* were 3.06, 18.62, and 59.23, respectively) rather than the similar value of the control (2.20, 21.27, and 79.10, respectively), which indicated carrageenan did not lead to any significant impact (p > .05) on the color. Also, mycoprotein nugget showed 33% lower cooking loss in comparison to control. Moisture, protein, lipid, and ash in optimized sample were 57.9 ± 1.9, 24.1 ± 1.0, 13.2 ± 1.2, and 2.1 ± 0.5, respectively. Investigation on physicochemical properties shows an acceptable characterization in optimized sample in comparison to control. The results of this study present an opportunity to produce nonmeat nuggets with similar texture and acceptable sensory and technological characteristics by using mycoprotein as meat alternative. The production of mycoprotein is eco-friendly, not dependent on climate (flood and drought) and landscape limitation, which is an important aspect in meat alternatives in the near future.

P3HB from CH4 using methanotrophs: aspects of bioreactor, fermentation process and modelling for cost-effective biopolymer production.

P3HB (poly-ß-hydroxybutyrate), an energy-storage compound of several microorganisms, can be used as bioplastics material. P3HB is completely biodegradable under aerobic and aerobic conditions, also in the marine environment. The intracellular agglomeration of P3HB was examined employing a methanotrophic consortium. Supplanting fossil, non-degradable polymers by P3HB can significantly reduce the environmental impact of plastics. Utilizing inexpensive carbon sources like CH4 (natural gas, biogas) is a fundamental methodology to make P3HB production less costly, and to avoid the use of primary agricultural products such as sugar or starch. Biomass growth in polyhydroxyalkanoates (PHA) in general and in Poly (3-hydroxybutyrate) manufacture in specific could be a foremost point, so here the authors focus on natural gas as a proper carbon source and on the selection of bioreactors to produceP3HB, and in future further PHA, from that substrate. CH4 can also be obtained from biomass, e.g., biogas, syngas methanation or power-to-gas (synthetic natural gas, SNG). Simulation software can be utilized for examination, optimizing and scale-up of the process as shown in this paper. The fermentation systems continuously stirred tank reactor (CSTR), forced-liquid vertical loop bioreactor (VTLB), forced-liquid horizontal tubular loop bioreactor (HTLB), airlift (AL) fermenter and bubble column (BC) fermenter were compared for their methane conversion, kLa value, productivity, advantages and disadvantages. Methane is compared to methanol and other feedstocks. It was discovered that under optimum processing circumstances and using Methylocystis hirsuta, the cells accumulated 51.6% cell dry mass of P3HB in the VTLB setup.

Impact of Microgravity on Virulence, Antibiotic Resistance and Gene Expression in Beneficial and Pathogenic Microorganisms.

During space missions, the impact of the space conditions (both microgravity and radiation) on physiologic and metabolic aspects of the microbiota of astronauts' bodies should be considered. Changes depend on the mission's duration, types of organisms, and ecology. Reported alterations are related to changes in morphology, growth, gene expression, and physiology of cells, resulting in increased virulence, acid, antibiotic resistance, biofilm formation, secondary metabolism, and microbial mutations. Accordingly, recent research indicates the impacts of simulated microgravity on human physiology and bacterial characteristics. This paper has reviewed the aspects of microgravity on changes in microbiota, including virulence, antibiotic resistance, and gene expression. Microgravity can undermine humans and makes influence bacterial pathogenicity. The review of papers shows that some microorganisms showed higher pathogenicity under microgravity conditions. Moreover, sulfamethoxazole had the highest resistance among Gram-positive microorganisms, and gentamicin had the highest resistance in Gram-negative bacteria. All antibiotics reviewed under microgravity conditions were robust in both groups of microorganisms compared to the gravity condition. Furthermore, some gene expression was altered in bacteria under microgravity conditions compared to Earth conditions (standard bacterial growth conditions). Changes in microbial behavior under microgravity directly influence astronauts' health conditions, and a detailed analysis of known facts can provide essential information for the selection of appropriate probiotics for these specific cases during the missions and after the recovery processes. Moreover, the study of microorganisms changes in the absence of gravity will help to understand the mechanisms of causing diseases on Earth and may be applied in clinical practice.

Impact of simulated microgravity on bioremoval of heavy-metals by Lactobacillus acidophilus ATCC 4356 from water.

There are several reports about the effect of gravity removal on some characteristics of microorganisms due to possible change in surface layer thickness and adherence properties. In this study, bioremoval efficiency of Lactobacillus acidophilus ATCC 4356 from water under simulated microgravity conditions was investigated. Furthermore, pretreatment effects (untreated, NaOH, and heat pretreated) of L. acidophilus ATCC 4356 on heavy metal removal was evaluated on microgravity, as our previous research showed impact of pretreatment on adherence properties of probiotics to environmental metals. The results showed that ability of L. acidophilus for arsenic adsorption enhanced following heat-pretreatment in simulated and normal gravity. Moreover, in both conditions of simulated microgravity and normal gravity NaOH-treated L. acidophilus increased the removal of cadmium and lead. In none of the conditions, pretreatment of lactobacillus affects mercury removal. Evaluation of stability of binding of L. acidophilus-heavy metal was investigated to check irreversibility of complex formation between microorganisms and metals in simulated gastrointestinal conditions. Data showed release of heavy metals from complex in normal gravity. Obtained results of this research show the favorable potential of simulated microgravity condition to increase bioremoval capacity of L. acidophilus for heavy metals.

Beneficial features of pediococcus: from starter cultures and inhibitory activities to probiotic benefits.

Pediococci are lactic acid bacteria (LAB) which have been used for centuries in the production of traditional fermented foods. There fermentative abilities were explored by the modern food processing industry in use of pediococci as starter cultures, enabling the production of fermented foods with distinct characteristics. Furthermore, some pediococci strains can produce bacteriocins and other antimicrobial metabolites (AMM), such as pediocins, which are increasingly being explored as bio-preservatives in various food matrices. Due to their versatility and inhibitory spectrum, pediococci bacteriocins and AMM are being extensively researched not only in the food industry, but also in veterinary and human medicine. Some of the pediococci were evaluated as potential probiotics with different beneficial areas of application associated with human and other animals' health. The main taxonomic characteristics of pediococci species are presented here, as well as and their potential roles and applications as starter cultures, as bio-preservatives and as probiotic candidates.

Probiotic Oxalate-Degrading Bacteria: New Insight of Environmental Variables and Expression of the oxc and frc Genes on Oxalate Degradation Activity.

Oxalate, a compound produced by many edible plants and as a terminal metabolite in the liver of mammals, is a toxin that has a detrimental role to human health. Humans and other mammals do possess enzymatic systems to degrade oxalate. Moreover, numerous oxalate-degrading bacteria reside in the mammalian gut and, thus, provide an important function for hosts. The current review focuses on the environmental factors that influence the efficacy of probiotic oxalate-degrading bacteria, relative to oxalate metabolism. We describe the mechanism of oxalate catabolism and its consumption by obligate and facultative anaerobic oxalate-degrading bacteria, in both in vitro and in vivo environments. We also explore the environmental variables that impact oxalate degradation. Studies on single species degrade oxalate have not shown a strong impact on oxalate metabolism, especially in high oxalate conditions such as consumption of foods high in oxalate (such as coffee and chocolate for humans or halogeton in animal feed). Considering effective variables which enhance oxalate degradation could be used in application of effective probiotic as a therapeutic tool in individuals with hyperoxaluria. This study indicates probiotics can be considered a good source of naturally occurring oxalate degrading agent in human colon.

Risk of low stability Saccharomyces cerevisiae ATCC 9763-heavy metals complex in gastrointestinal simulated conditions.

The biosorption of heavy metals by microorganisms has attracted the interest of food researchers as the last approach to reduce the risk of their absorption in the human body. But the stability of yeast-metal complexes under simulated gastrointestinal conditions has not been investigated. In this study stability of complex as well as isotherm and kinetic models of biosorption have been studied. Also, the impact of some pretreatment on yeast biosorption was studied to check the possible impact of different environmental conditions in food processing. Data showed a risk of heavy metal release in simulated gastrointestinal conditions. The best biosorption of metals from aqueous solutions by Saccharomyces (S.) cerevisiae may be achieved after NaOH pretreatment for Mercury (Hg) 92.7%. While biosorption of Lead (Pb) 37.48%, Arsenic (As) 19.44%, and Cadmium (Cd) 39.9% by untreated yeast were better. In gastrointestinal conditions, Hg and Cd-yeast complexes were more stable and biosorption of Cd and Pb increased. Bonds of As and Hg-yeast complexes in digestion conditions were reversible. The metals biosorption by untreated yeast followed the pseudo-second-order kinetic and the Langmuir isotherm model for Hg, Pb, and Cd and Freundlich for As. Results showed that biosorption of heavy metals by S. cerevisiae, although may decrease metal bioavailability in fermented foods, the complex is not enough stable in gastrointestinal conditions.

Potential application of probiotics in mycotoxicosis reduction in mammals and poultry.

Mycotoxins in feedstuffs are considered as a principal worry by food safety authorities worldwide because most of them can be transferred from the feed to food commodities of animal origin, and further consumed by humans. Therefore, effective alternatives for the reduction of the impact of mycotoxins need to be applied in the feed production industry. Applications of beneficial microorganisms (probiotics) can be alternative and applied as feed additives in order to reduce or eliminate the toxic effects of mycotoxins on animals. The aim of this article is to provide information on the role of beneficial microorganisms (probiotics) and point out their role in the reduction of the effect of mycotoxin toxicity in farming animals (mammals and poultry). The objective was to provide a summary of the existing knowledge based on the application of different strains belonging to the group of lactic acid bacteria (LAB) or yeasts that are already or can be future employed in the feed industry, in order to reduce mycotoxicosis presence in mammals and poultry exposed to mycotoxin-contaminated feed. Moreover, an overview of mycotoxins toxicity in mammals and poultry will be presented, and furthermore, the role of the beneficial microorganisms (including probiotics) in the reduction of mycotoxins toxicity (aflatoxicosis, deoxynivalenol, zearalenone, ochratoxin A, and fumonisin toxicities) will be described in detail.

Potential Dietary Interventions for COVID-19 Infection Based on the Gut-Immune Axis: An Update Review on Bioactive Component of Macronutrients.

Recently emerged coronavirus, known as SARS-CoV-2 or Covid-19 is considered as a serious threat for human health. Due to unavailable specific drugs for this virus, there is an urgent need for supportive cares. Epigenetic immune boosting approaches and developing anti-inflammatory agents by gut-associated bioactive macronutrients can be plausible protective cares for COVID-19. Suitable intake of bioactive macronutrients including prebiotics, fatty acids, proteins and branched-chain amino acids may result in anti-viral responses through modulating macrophages and dendritic cells via Toll-like receptors, decreasing viral load, inactivating the enveloped viruses, increasing the anti-inflammatory metabolites and inhibiting the proliferation of microbial organisms. Bioactive macronutrients may help in promotion of immunological responses and recovery acceleration against Covid-19. This review focuses on the mechanisms of bioactive macronutrients and related clinical trials on enveloped viruses with emphasis on gut-microbiome-immune axis. Macronutrients and this axis may be conducive strategies to protect host against the viral infection.

Role of the lactobacilli in food bio-decontamination: Friends with benefits.

Food contamination such as toxins and heavy metals has been increasing in the last few decades as a result of industrialization in general and as part of food production in particular. Application of microorganisms in toxins and heavy metals bio-removal has been documented and applied as a favorable decontamination approach due to being environmentally friendly, reasonably simple, and economically feasible. Lactobacilli have been proposed and applied as a beneficial biologic sorbent for toxins and heavy metals in processes of reducing their hazardous bio-availability. The purpose of this review is to summarize the known role of Lactobacillus bacterial species in food bio-decontamination processes. After a quick glimpse of the worthy properties of lactobacilli, their cell wall structure is mentioned. Then the potential role of Lactobacillus strains for mycotoxins (aflatoxins, patulin, ochratoxin A, fumonisins, zearalenone, cyanotoxins, and trichothecenes) and heavy metals (lead, arsenic copper, mercury, cadmium, zinc, aluminum, chromium, and iron) bio-removal were described. In addition, the role of various factors in removal yield and the decontamination mechanism were explained. Finally, the lactobacilli-contaminant stability, in vivo studies, and being a friend or foe of Lactobacillus bacteria are discussed.

Comparative study of salt, total fat and sugar contents of mayonnaise and salad dressings from the Iranian market.

BACKGROUND: Dietary intake of fat, salt and sugar is important for prevention of noncommunicable diseases; therefore, evaluation of these constituents in industrial packaged foods is necessary. AIMS: To compare the levels of fat, salt and sugar in mayonnaise and salad dressings commercialized in the Islamic Republic of Iran in 2017 and 2019, and to monitor compliance with standard limits. METHODS: The levels of fat, salt and sugar in 12 mayonnaise and 47 salad dressing samples collected from an Iranian market were evaluated according to the Iranian Institute of Standards and Industrial Research of Iran (ISIRI) and compared between 2017 and 2019. RESULTS: We determined compliance with ISIRI limits and other standard targets. The salt content of mayonnaise samples significantly decreased from 2.03 (standard deviation; 0.3) g/100 g in 2017 to 1.61 (0.12) g/100 g in 2019 (P = 0.031). Total sugar level of mayonnaise samples significantly decreased from 5.97 (1.14) g/100 g in 2017 to 3.63 (0.53) g/100 g in 2019 (P = 0.005). The total sugar level of salad dressings significantly decreased from 8.97 (2.34) g/100 g in 2017 to 1.58 (2.65) g/100 g in 2019 (P = 0.039). Compliance of mayonnaise and salad dressing fat contents with ISIRI limits increased from 42.9% and 84.6% in 2017 to 100% and 90.5% in 2019, respectively. None of the mayonnaise samples met the British Food Standards Agency salt target (maximum 1.25 g/100 g) in 2017 and 2019. CONCLUSIONS: Reformulation of these products for reduction of salt and sugar content is necessary.

Production of polyhydroxyalkanoates using dairy processing waste - A review.

Bio-plastics are eco-friendly biopolymers finding tremendous application in the food and pharmaceutical industries. Bio-plastics have suitable physicochemical, mechanical properties, and do not cause any type of hazardous pollution upon disposal but have a high production cost. This can be minimized by screening potential bio-polymers producing strains, selecting inexpensive raw material, optimized cultivation conditions, and upstream processing. These bio-plastics specifically microbial-produced bio-polymers such as polyhydroxyalkanoates (PHAs) find application in food industries as packaging material owing to their desirable water barrier and gas permeability properties. The present review deals with the production, recovery, purification, characterization, and applications of PHAs. This is a comprehensive first review will also focus on different strategies adopted for efficient PHA production using dairy processing waste, its biosynthetic mechanism, metabolic engineering, kinetic aspects, and also biodegradability testing at the lab and pilot plant level. In addition to that, the authors will be emphasizing more on novel PHAs nanocomposites synthesis strategies and their commercial applicability.

Efficacy of a multispecies probiotic as adjunctive therapy in generalized anxiety disorder: a double blind, randomized, placebo-controlled trial.

ABSTRACT Objectives: Studies have shown that probiotics may decrease anxiety symptoms, but to our knowledge so far no trial has investigated the effects of probiotics in generalized anxiety disorder (GAD). The aim of the present study was to determine the effects of probiotics as adjunctive therapy on anxiety severity and quality of life (QOL) in patients with GAD. Methods: Forty-eight drug-free patients with a diagnosis of GAD based on DSM-V criteria were randomly assigned to two groups to receive daily either one capsule of probiotics or placebo in addition to 25 mg sertraline for 8 weeks. Probiotic capsules contained 18*109 CFU Bifidobacterium longom, Bifidobacterium bifidum, Bifidobacterium lactis and Lactobacillus acidophilus bacteria. Results: Intention to treat analysis was performed in 39 Patients who completed at least 4 weeks of the intervention. After 8 weeks, the score of Hamilton Rating Scale for anxiety (HAM-A) decreased more in the probiotics + sertraline (PS) group (p = 0.003). Although the reduction of Beck Anxiety Inventory (BAI) was also more in the PS group, it was not significantly different from that of the sertraline alone(S) group. Moreover, despite the greater reduction of State-Anxiety Inventory score in the PS group, the score of Trait-Anxiety Inventory was not statistically different between the two groups at week 8. With regard to QOL, there was no significant difference between the two groups in the change of the score of QOL domains. Conclusions: Probiotics + sertraline combination was superior to sertraline alone in decreasing anxiety symptoms after 8 weeks in patients with GAD, although it did not affect QOL.