Universa Medicina January-April - Vol.42- No.1, 2023 Invited Editorial Potential role of probiotic supplementation in cognitive improvement and other metabolic biomarkers Phakkharawat Sittiprapaporn Head, Neuropsychological Research Laboratory Head, Neuroscience Research Center School of Anti-Aging and Regenerative Medicine, Mae Fah Luang University, Bangkok, Thailand Gut dysbiosis and changes in gut homeostasis, which are linked to a number of physical and mental problems, affect the connection between the gut and the brain. Probiotics are considered dietary supplements that can be used to treat mental illnesses and cognitive issues. Probiotics are live bacteria that, when consumed in sufficient quantities, benefit the host's health. Probiotics can improve cognitive performance by improving the gut-brain axis and the microbial environment in the gut.(1) Cognitive development refers to a child's ability to think, reason, and use language, all of which are necessary for their overall development. Attention deficit/ hyperactivity disorder (ADHD) is the most common problem with a child's brain development, which occurs in parallel to the child's cognition. Attention deficit/hyperactivity disorder is caused by a number of factors, of which gut homeostasis and gut microbiota are two of the most important ones.(1) Fukngoen et al.(1) recently investigated the effect of Lactobacillus paracasei HII01 on the attention state of healthy children as well as changes in representative neuroinflammatory markers. They predicted that taking Lactobacillus paracasei HII01 could reduce the risk of developing neuropsychiatric disorders. Ten healthy young Thai children were given 109 CFU of Lactobacillus paracasei HII01 daily for 12 weeks in this study. The go/no-go activities were used to assess changes in attention state. Changes in brain waves were also tracked using electroencephalographic (EEG) recordings. Quinolinic acid (QA, a tryptophan metabolite), and 5-hydroxyindoleacetic acid (5-HIAA, a serotonin metabolite), were measured in urine at the start of the study and 12 weeks later. Both the QA and 5-HIAA concentrations significantly decreased and increased, respectively. The QA/5- HIAA ratio also decreased significantly. According to the go/no-go test, the percentages of go accuracy and go error increased and decreased dramatically, respectively. In terms of EEG data, theta, alpha, and beta waves were significantly changed between the study's baseline and 12th week. The data revealed that Lactobacillus paracasei HII01 may improve gut flora and oscillatory brain activity, hence preserving the attention states of persons.(1) Urbanization influences our way of life, especially in fast-paced environments where we are more prone to stress. It is believed that stress management increases longevity. The use of probiotics for psychological treatment is supported by a small body of diversely established evidence.(2) There are currently few studies on the use of synbiotics to reduce stress in stressed subjects. Lalitsuradej et al.(2) recently investigated how synbiotics affected stress levels in a Thai population. A Thai Stress Test (TST) was used to screen 32 people and determine how stressed they were. Participants were divided into two groups: stressed and *Email: wichian.sit@mfu.ac.th ORCID ID: 0000-0002-4103-9396 1 mailto:wichian.sit@mfu.ac.th https://orcid.org/0000-0002-4103-9396 2 non-stressed. Synbiotic preparation contained 10g of prebiotics (5g galacto-oligosaccharides (GOS) and 5g oligofructose (FOS)), and a combination of 2 probiotic strains at a total concentration of 1 x 1010 CFU/day (5.0 x 109 CFU of Lactobacillus paracasei HII01 and 5.0 x 10 9 CFU of Bifidobacterium animalis subsp. lactis). All parameters were measured at the start of the trial and again after the 12th week. Synbiotics significantly reduced the negative and positive TST scale scores in the stressed group, but increased the corresponding scores in the non- stressed group (p<0.05).(2) Synbiotics significantly decreased tryptophan levels in the non-stressed group (p<0.05), but significantly increased levels of dehydroepiandrosterone sulfate (DHEA-S), tumor necrosis factor-α ( TNF-α), 5- hydroxyindoleacetic acid (5-HIAA), short-chain fatty acids (SCFAs), acetate, and propionate. Both gr oups had lower levels of cortisol and lipopolysaccharide (LPS), but higher levels of interleukin-10 (IL-10) and immunoglobulin A (IgA). The synbiotics administration slightly improved stress status in the stressed group but not in the non-stressed group.(2) Obesity, dyslipidemia, hypertension, and glucose intolerance are metabolic conditions that incr ease the risk of type 2 dia betes and cardiovascular disease. According to emerging evidence, microbiota may play an important role in human health and disease, including digestion, energy and gluc ose metabolism, immunomodulation, and brain function. Obesity is becoming more common, and the primary causes are overly processed diets and sedentary lifestyles. Furthermore, hypercholesterolemia is a major contributor to cardiovascular disease. Probiotics may ben efit patients with hypercholesterolemia by lowering their high blood lipid levels.(3) Chaiyasut et al.(3) recently proposed a method for comprehending and elucidating the synergistic role of prebiotics and probiotics in the treatment of obesity. Obese Thai people were tested for biomarkers of obesity such as cholesterol, gut permeability, oxidative stress, bacterial toxins, cytokines, and short-chain fatty acids after being given a synbiotic supplement containing Lac tobacillus paracasei, Bifidobacterium longum, Bifidobacterium breve, inulin, and fructooligosaccharide. The results showed that including synbiotics in one's diet had a significant and positive effect on biomarkers linked to obesity.(3) In another study, Chaiyasut et al.(4) investigated 52 subjects randomly divided into two gr oups, the Lactobacillus paracasei HII01 treatment group and the placebo group, to understand how Lac tobacillus paracasei HII01 affec ts cholesterol, oxidative stress, and other indicators. The study was conducted over a 12-week supplemental intervention period. Lactobacillus paracasei HII01 significantly improved the subjects' high density lipoprotein (HDL), total antioxidant capacity (TAC), and propionic acid levels while significantly lowering their total cholesterol (TCH), triglycerides (TGs), tumor necrosis factor-α (TNF), and lipopolysaccharide (LPS). The findings suggest that Lactobacillus paracasei HII01 improves blood lipid profiles and reduce s oxidative stress in Thai hypercholesterolemic subjects.(4) Bacteria, poisons, and allergens are prevented from diffusing into surrounding tissue and the circulatory system by the integrity of the intestines. Inflammation, gastrointestinal issues, neurological diseases, and neurodegenerative disorders are just a few of the minor to major health issues that can arise as a result of intestinal integrity damage.(5) It is essential to maintain a healthy gut barrier function in order to preserve health. Protecting and restoring intestinal permeability in vitro and in vivo are known features of probiotics. Multiple strains of probiotics are more effective in protecting the body than a single strain. The e ff ects of pr obiotic supplementation on intestinal permeability, lipid profile, obesity index, and metabolic indicators in elderly Thai participants were recently analyzed by Chaiyasut et al. (5 ) T he pr obiotic supplementation included Lac toba cillus paracasei HII01, Bifidobacterium breve, and Bifidobacterium longum. The r esults Universa Medicina 3 Univ Med 2023;42:1-3. DOI: http://dx.doi.org/10.18051/UnivMed.2023.v42.1-3 demonstrated that supplementation with the investigated probiotics significantly boosted high- density lipoprotein (HDL) cholesterol (up to 48%) and enhanced the function of the intestinal barrier. Furthermore, the intervention increased short- chain fatty acid levels as well as anthropometric indicators associated with obesity in humans. This study began with the goal of developing probiotic- based health supplements as an adjunctive therapy for a variety of metabolic diseases.(5) In contrast, a randomised, double-blind, placebo- controlled trial to assess whether a 12-week B. breve A1 supplementation could affect the cognitive function of elderly subjects with memory complaints, showed that no significant intergroup difference was observed in terms of changes in scores from the baseline scores.(6) The recent studies' restricted sample size, the questionnaire about eating habits, exercise, work activity, and overcoming the disease, the lack of extended follow-up, and microbiome analysis, must be supported by further studies. To prove probiotics' benefits and develop health supplements to treat metabolic illnesses, more research is needed. REFERENCES 1. Fukngoen, P, Sivamaruthi, BS, Sirilun, S, et al. The influence of Lactobacillus paracasei HII01 supplementation on performance in attention (Go/ No-Go) tasks and quinolinic acid and 5- hydroxyindoleacetic acid levels in Thai children- a preliminary study. Appl Sci 2022;12:5658. https:/ /doi.org/10.3390/app12115658. 2. Lalitsuradej E, Sirilun S, Sittiprapaporn P, et al. The effects of synbiotics administration on stress related parameters in Thai subjects: a preliminary study. Foods 2022;11:759. https://doi.org/10.3390/ foods11050759. 3. Chaiyasut C, Sivamaruthi BS, Kesika P, et al. Synbiotic supplementation improves obesity index and metabolic biomarkers in Thai obese adults: a randomized clinical trial. Foods 2021; 10:1580. https://doi.org/10.3390/foods10071580. 4. Chaiyasut C, Tirawat Y, Sivamaruthi BS, et al. Effect of Lactobacillus paracasei HII01 supplementation on total cholesterol, and on the parameters of lipid and carbohydrate metabolism, oxidative stress, inflammation and digestion in Thai hypercholesterolemic subjects. Appl Sci 2021;11:4333. https://doi.org/10.3390/ app11104333. 5. Chaiyasut C, Sivamaruthi BS, Lailerd N, et al. Probiotics supplementation improves intestinal permeability, obesity index and metabolic biomarkers in elderly Thai subjects: a randomized controlled trial. Foods 2022;11:268. https:// doi.org/10.3390/foods11030268. 6. Kobayashi Y, Kuhara T, Oki M, Xiao JZ. Effects of Bifidobacterium breve A1 on the cognitive function of older adults with memory complaints: a randomised, double-blind, placebo-controlled trial. Benef Microbes 2019;10:511-20. https:// doi.org/10.3920/BM2018.0170. January-April 2023 - Vol.42 - No.1 Copyright@Author(s) - https://univmed.org/ejurnal/index.php/medicina/article/view/1410