Why Vita Biosa?

By Cliff Harvey PhD, DipFit, DipNat

Vita Biosa is a complete, living, active ecosystem of health-promoting herbs, cellular fuels, organic acids, and a range of the most beneficial bacteria for the gut and overall health.

recon_cliff_image-removebg.png

Why is Gut Health Important?

The gut is the gateway to the body. It allows us to take in nutrients from food while keeping out pathogens and harmful chemicals that can cause disease and ill-health, and the impact of gut health on immunity, inflammation, brain, and overall health is now becoming very well known.

The balance of ‘good’ and ‘bad’ microbes in the gut (known as dysbiosis) can affect nourishment and growth and contribute to health conditions ranging from metabolic states like obesity and type 2 diabetes,1 gut issues,2 inflammatory conditions,3-7 cardiovascular disease, and mental health challenges.8-17 The gut microbiome also affects (and is affected by) hunger, satiety, inflammation and immunity, and this also affects our likelihood of developing diseases of the metabolic spectrum.1, 3, 18, 19 The gut microbiome also has an interplay with sleep and stress, co-factors for the development of diabetes, obesity, mental health challenges, and other health conditions. [a]

What are ‘Synbiotics’?

Synbiotics are foods or supplements that combine probiotics and prebiotics (and sometimes post-biotics). The term derives from the synergy of these components, i.e., synergistic biotics. In common usage, the term synbiotic refers to products that include isolated probiotics in combination with prebiotics and to ‘live’ foods and beverages (such as Vita Biosa) that contain pre-, pro-, and postbiotics in an ‘ecosystem’ in which there is fuel substrate (prebiotics) for live organisms (probiotics) which in turn produce organic acids and short-chain fatty acids that are beneficial to the health of the microbiome and the host subject (post-biotics).

What is the microbiome?

Before looking into what the various biotics are, it is important to understand common terms like microbiome and microbiota.

The microbiome is the community of microbes found in the body. Technically, the microbiome refers to collective genomes of these microbes with microbiota used to describe the communities of microbes, but these terms are often used interchangeably. In common usage, microbiome refers to the community of bacteria in the gut, but it also includes other microbes like fungi, protozoa, and viruses (there is also distinct microbiota of the skin, oral cavity, and other surfaces).

[a] More information on gut health can be found at https://cliffharvey.com/?s=gut+health

The various 'biotics'

What are prebiotics?

Prebiotics feed (beneficial) microbes in the gut. Usually, these are various sugars, fibres and resistant starches that feed particular varieties of bacteria (or in some cases beneficial yeasts).

What are probiotics?

Probiotics are microbes (usually bacteria but also some yeasts) that can be taken in supplemental form and are purported to improve the balance of the microbiome.

What are postbiotics?

Postbiotics are chemicals produced by bacteria (like probiotic bacteria) that have additional benefits to the gut and overall health. They are also known as organic acids and include short-chain fatty acids which feed cells of the digestive wall, other bacteria, and can be absorbed by the body for use as fuel (i.e., acetic acid, butyric acid, and lactic acid). These and other chemicals produced by bacteria in the gut also act as messengers that provide a ‘metabolic interaction’ between the host (you) and the microbiota and digestive environment.20

Short-chain fatty acids

Fatty acids are made up of chains of carbon. Short-chain fatty acids have carbon chains between two and five in length. These fatty acids include acetic acid (C:2), propionic acid (C:3), butyric acid (C:4), and valeric acid (C:5). Short-chain fatty acids, especially butyric acid, are used extensively as fuel by cells of the intestinal wall.21 Those that aren’t used directly by the gut (or bacteria in the gut) escape the usual digestion route of other fats and are instead transported directly to the liver where they can be easily converted to ketone bodies,22-27 which function as a source of fuel for most tissue in the body.

Lactic acid

Lactic acid is an alpha-hydroxy acid produced by metabolism on lactic acid bacteria and during high intensity activities within the body. While much of the research relating to lactic acid is associated with lactic-acid-producing bacteria and summarised in the rest of this article, lactic acid itself is known to be an important part of the human energy cycle, being converted into pyruvate (and used in the Krebs cycle) and converted to glucose. Lactic acid itself is used as an important fuel in the brain and nervous system34-36 and might be an important compound supporting brain development,37 and also serves as an important fuel for heart and liver tissue. 

Acetic acid

Acetic acid is a two-carbon short-chain fatty acid. It makes up around 4-20% of vinegar (and is found plentifully in Vita Biosa). It has been demonstrated to improve blood sugar and insulin regulation after meals.28-30 

Butyric acid

Butyric acid (butyrate) is a four-carbon, short-chain fatty acid found in the milk of ruminants and is present in small amounts in many dairy foods (the term butyrate comes from the same root as ‘butter’). Butyrate in humans is primarily produced by microbial intestinal fermentation of dietary fibre and resistant starches. Much of this is absorbed and used directly by colonocytes, with most of the remainder absorbed into the hepatic portal vein, and transported to the liver and converted into ketone bodies.26, 27 A small amount is absorbed directly from the large colon and enters systemic circulation, to be used directly by peripheral tissue.26

Butyrate inhibits inflammation and intestinal cancers, decreases oxidative stress, and promotes satiety.31, 32 Thus, it serves an important role in preserving the health of the colon, microbiota, and general and systemic health.

Vita Biosa contains organic acids, including lactic acid, acetic acid, and lesser amounts of butyric acid.

General Health Effects of Synbiotics

Synbiotics significantly increase gut levels of beneficial Bifidobacteria,34 and reduces inflammation,35-39 with even more pronounced anti-inflammatory effects in inflammatory bowel diseases, arthritis, and non-alcoholic fatty liver disease.35 Synbiotic supplementation may also increase the total antioxidant capacity of the body,37, 38 and has been clearly demonstrated to increase one of the body’s most important antioxidants; glutathione.37, 38, 40 Supplementation also significantly reduces levels of gut-derived endotoxins41 which are implicated in cardiovascular and other diseases.
Synbiotic supplementation might also help to maintain healthy body weight and cardiovascular system, with studies showing that supplementation can help to reduce body mass,
42 blood glucose,43 cholesterol, triglycerides, LDL-cholesterol, and increase HDL-cholesterol (compared to a placebo).44 These effects are most pronounced when synbiotics are supplemented for more than 8 weeks.44 
Synbiotics might also have a role in reducing the negative effects of a ‘leaky gut’. While the gut wall is supposed to be permeable (for example, to allow for the uptake of nutrients) excessive intestinal permeability (a ‘leaky’ gut) can promote immune issues, allergies, and inflammation. Intestinal permeability is influenced by diet and lifestyle factors such as gluten and dysbiosis.
45 Synbiotic supplementation reduces the key signal for a leaky gut (zonulin),46 and so, might play a role in reducing excessive intestinal permeability. 
Reviews of the research show that synbiotic supplementation has a range of benefits including:

•    Reduced complications of surgery and hospitalisation47-58 
•    Improved blood lipids and blood sugar regulation, and reduced inflammation in prediabetes, diabetes, and metabolic syndromes
59-67 
•    Improved antioxidant capacity and glutathione in diabetes67
•    Improved insulin and blood lipids in people with obesity68
•    Reduced BMI, body weight, and waist circumference in people with obesity69-72 
•    Improved blood pressure73
•    Reduced incidence of respiratory infections74, 75
•    Reduced asthma risk76
•    Possible cancer-protective effects77 
•    Reductions in pregnancy-related anxiety78 S
•    Improved insulin homeostasis in pregnant women
79 
•    Reduced risk of hyperbilirubinemia in the new-born, and improved birth weight80
•    Improved irritable bowel syndrome (IBS) symptoms81 
•    Improved markers of health in people with kidney disease54, 82
•    Possible improvements in behavioural symptoms of autism spectrum disorder83
•    Reduced inflammation and improved insulin homeostasis in people with autoimmune conditions84
•    Improved rates of remission, reduced inflammation, and reduced disease activity in inflammatory bowel disease like ulcerative colitis85, 86
•    Improved hormone profiles and insulin sensitivity and homeostasis in polycystic ovary disease87-90
•    Reduced duration of diarrhoea,91, 92 hospitalisations,91 and hospital stay-length92 in severe cases of diarrhoea in children
•    Early studies in elderly people with cognitive decline suggest that pro- and synbiotics might improve cognition
93
•    A meta-analysis of 6 randomised controlled trials found significant reductions in the clinical severity of atopic eczema in children when mixed bacteria were used and by children over 1 year of age94

Vita Biosa contains strains of bacteria demonstrated to be beneficial for human health: Bifidobacterium lactis, Bifidobacterium longum, Lactobacillus acidophilus, Lactobacillus casei, Lactobacillus rhamnosus, Lactobacillus salivarius, Lactococcus lactis, Streptococcus thermophilus

Health Effects of Herbs Contained in Vita Biosa

The herbal blend in Vita Biosa acts in synergy with the pre-, pro-, and postbiotics.

Basil 

Basil (Ocimum basilicum) has traditionally been used to aid kidney problems, earache, menstrual irregularities, arthritis, anorexia, treatment of fevers, colds, and malaria. Pharmacological evidence suggests potential roles for basil as an anti-cancer, anti-microbial, anti-inflammatory, immunomodulatory, anti-diabetic, antipyretic, anti-arthritic, and antioxidant herb.96, 97
 

Fenugreek

Fenugreek (Trigonella foenum-graecum) is widely purported to be antidiabetic, anticarcinogenic, anti-inflammatory, hypocholesterolaemic, antioxidant, and immunomodulating.98, 99 Fenugreek supplementation significantly improves blood sugar and lipids,100-102 and there is also evidence that it might help to improve neurological disorders.103 Many of its benefits are thought to be due to the antioxidant, anti-inflammatory, and tumour suppressing activities of fenugreek compounds.104
 

Juniper berry

Juniper berries come from Juniper trees, particularly Juniperus communis. Oils from Juniper berries have antimicrobial (especially anti-fungal) actions.166 in larger amounts, Juniper berries have been used traditionally as a form of birth control and might also result in miscarriage and affect blood pressure, however, in smaller amounts found in foods and beverages as a flavour or additive, it is generally recognised as safe (according to unreferenced information on WebMD[1]). 

Note: in Vita Biosa the volumes of Juniper berry extracts are well within the safe limits

[1] JUNIPER: Overview, Uses, Side Effects, Precautions, Interactions, Dosing and Reviews (webmd.com)

Dill

Dill (Anethum graveolens) is a common culinary herb used throughout Eurasia. Reviews suggest the dill can promote significant improvements in insulin sensitivity and blood lipids.105, 106
 

Fennel

Fennel (Foeniculum vulgare) is a herb traditionally used to help treat female hormonal issues, including those related to menstrual irregularities and pain. Reviews of the evidence show that fennel might be as effective as pain medication for reducing menstrual pain107 and can help to treat other menstrual symptoms.108
 

Elderberry

Elder (Sambucus spp.) have been traditionally used to help prevent colds and respiratory infections. While elderberry may not reduce the risk of developing the common cold, it may reduce the duration, severity and adverse events arising from colds and influenza.109
 

Ginger

Ginger (Zingiber officinale) is one of the most studied medicines in the herbal materia medica. It has a long history of use in traditional medicine for pain and diabetes treatment,110 and It has been demonstrated to possess anti-inflammatory, antioxidant, anti-tumour, anti-ulcer,111 and anti-ageing effects.112 Comprehensive reviews of the effects of ginger on human health show that improvements in nausea and vomiting, inflammation, body weight and blood sugar and insulin control in metabolic syndromes, digestive function, and colorectal cancer markers were consistently supported by the research.110, 113-116 Also generally supported by the research is the traditional use of ginger for pain reduction with the weight of evidence suggesting that ginger improves delayed onset muscle soreness, osteoarthritic pain, migraine, and menstrual pain.117
Ginger also reduces inflammation,118-122 and increases glutathione and the body’s total antioxidant capacity,118, 120 and is purported to help protect against environmental challenges to health such as heavy metals, pesticides, pollutants, and radio- and chemotherapy.123 Studies also suggest that ginger can improve blood pressure.124 
 

Oregano

Oregano (Origanum vulgare) is a common culinary herb traditionally also used as an anti-microbial. It contains several compounds (esp. thymol and carvacrol) which have demonstrated microbial activity against disease-causing bacteria and yeasts.132, 133

Thyme

Thyme (Thymus vulgaris) plant is a member of the mint family commonly used as a culinary and medicinal herb. Several chemicals from thyme such as carvacrol and thymol have been well-studied and have been identified as antioxidant, anti-oxidative and anti-inflammatory substances that could help to support the health of the brain, liver, and kidneys.149, 150

Peppermint

Peppermint (Mentha × piperita) has been traditionally used to treat fever, colds, digestive issues, mouth and throat infections, and as an antimicrobial, antiviral, and anti-inflammatory herb.134 Various effects are suggested by emerging evidence including application as an antimicrobial, antioxidant, anti-inflammatory, anti-cancer, and antidiabetic.134 The primary use for peppermint though is due to its tonic effects on the muscular and digestive systems. For example, in treating muscle spasms and irritable bowel syndrome,135 and reducing spasticity of the colon (i.e., during colon surgery136).
 

Parsley

Parsley (Petroselinum crispum) has a long tradition of use in the treatment of urinary tract disorders. Studies demonstrate that parsley may have antioxidant and anti-inflammatory effects and might also aid blood sugar and lipid control.137
Roman chamomile
Roman chamomile (Chamaemelum nobile) is traditionally used as a calming herb and for sleep promotion. It has also been used to aid recovery from respiratory tract infections. It is known to have antibacterial and antifungal, anti-inflammatory, and antioxidant properties.
138
 

Rosemary

Rosemary (Salvia rosmarinus) is a common culinary and medicinal herb. Several studies have reported that rosemary extracts might help support brain health and protect against cancer and fungal, viral, and bacterial pathogens.139-142 Studies suggest that rosemary can also help to improve cognition and alertness.143, 144 
 

Sage

Sage (Salvia officinalis) has a long history of use as an aid to mental acuity, alertness, and memory. Modern research is beginning to show that sage might be a useful aid to the brain and overall health by reducing damage to the brain, encouraging the formation of new neurons, reducing inflammation, and improving functional outcomes like depression and anxiety, while also improving cognition.145 Randomised controlled trials have demonstrated improvements in mood and cognition (memory and attention) from both acute and chronic use of sage.145 A 2019 review has also highlighted promising effects on cardiovascular health with studies to date showing improvements in blood lipids.146
 

Nettle

Nettle (Urtica dioica) has been used in various traditional systems of medicines since ancient times for joint pain, arthritis, prostate problems and as a general health tonic (and especially for blood sugar regulation). Its roots and leaves contain a wide variety of constituents with blood-sugar and lipid regulating, anti-inflammatory, antioxidant, anti-cancer and antiviral activities.147 A review of trials up to 2019 found a significant reduction in fasting blood glucose among those using nettle compared to controls.148 

Angelica

Angelica spp. have anti-inflammatory and antioxidant properties.125 Emerging evidence suggests that the herb might offer cognitive (i.e., memory and attention) and brain health benefits.126
 

Liquorice root

Liquorice (Glycyrrhiza glabra) root has traditionally been used as a nervine tonic to help combat fatigue and treat lung diseases, arthritis, kidney diseases, eczema, heart diseases, gastric ulcer, low blood pressure, allergies, liver toxicity, and certain microbial infections.127 Compounds from liquorice have a range of antimicrobial and antiviral, anti-inflammatory, antioxidant, antidiabetic, anti-cancer, anti-depressive, and neuroprotective activities.128, 129 A 2018 review of the available evidence also found that liquorice use is associated with reduced body weight and BMI.130 Liquorice might also help to improve markers of non-alcoholic fatty liver disease also reduced by probiotics,131 suggesting a plausible synergistic role for liquorice in a synbiotic supplement.

Chervil

Chervil (Anthriscus cerefolium) or French Parsley is a culinary herb that has been used in traditional folk medicine as a digestive aid, mild stimulant, and to support blood pressure.165

Anise

Anise (Pimpinella anisum) is traditionally used to calm the gut and reduce flatulence. Modern research has demonstrated the antifungal and antioxidant properties of anise.95

Want to learn more about the benefits of Synbiotics?

Check out the article below:

What else can I learn about

Vita Biosa?

NZ_VB_ORI_500ml_packshot_shadow CROPPED.png
References

1.    Wilson AS, Koller KR, Ramaboli MC, Nesengani LT, Ocvirk S, Chen C, et al. Diet and the Human Gut Microbiome: An International Review. Digest Dis Sci. 2020;65(3):723-40.
2.    Simpson CA, Mu A, Haslam N, Schwartz OS, Simmons JG. Feeling down? A systematic review of the gut microbiota in anxiety/depression and irritable bowel syndrome. Journal of Affective Disorders. 2020;266:429-46.
3.    van den Munckhof ICL, Kurilshikov A, ter Horst R, Riksen NP, Joosten LAB, Zhernakova A, et al. Role of gut microbiota in chronic low-grade inflammation as potential driver for atherosclerotic cardiovascular disease: a systematic review of human studies. Obesity Reviews. 2018;19(12):1719-34.
4.    Damiani G, Bragazzi NL, McCormick TS, Pigatto PDM, Leone S, Pacifico A, et al. Gut microbiota and nutrient interactions with skin in psoriasis: A comprehensive review of animal and human studies. World J Clin Cases. 2020;8(6):1002.
5.    Hidalgo-Cantabrana C, Gómez J, Delgado S, Requena-López S, Queiro-Silva R, Margolles A, et al. Gut microbiota dysbiosis in a cohort of patients with psoriasis. British Journal of Dermatology. 2019;181(6):1287-95.
6.    Alesa DI, Alshamrani HM, Alzahrani YA, Alamssi DN, Alzahrani NS, Almohammadi ME. The role of gut microbiome in the pathogenesis of psoriasis and the therapeutic effects of probiotics. J Family Med Prim Care. 2019;8(11):3496-503.
7.    Coit P, Sawalha AH. The human microbiome in rheumatic autoimmune diseases: A comprehensive review. Clinical Immunology. 2016;170:70-9.
8.    Hélѐne-Zanin J. Gut feelings: a thematic review of the links between acute gastrointestinal illness and anxiety and depressive disorders. Global Health: Annual Review. 2015;1(1).
9.    Rong H, Xie X-h, Zhao J, Lai W-t, Wang M-b, Xu D, et al. Similarly in depression, nuances of gut microbiota: Evidences from a shotgun metagenomics sequencing study on major depressive disorder versus bipolar disorder with current major depressive episode patients. Journal of psychiatric research. 2019;113:90-9.
10.    Zheng P, Yang J, Li Y, Wu J, Liang W, Yin B, et al. Gut Microbial Signatures Can Discriminate Unipolar from Bipolar Depression. Advanced Science. 2020;7(7):1902862.
11.    Evans SJ, Bassis CM, Hein R, Assari S, Flowers SA, Kelly MB, et al. The gut microbiome composition associates with bipolar disorder and illness severity. Journal of psychiatric research. 2017;87:23-9.
12.    McIntyre RS, Subramaniapillai M, Shekotikhina M, Carmona NE, Lee Y, Mansur RB, et al. Characterizing the gut microbiota in adults with bipolar disorder: a pilot study. Nutritional neuroscience. 2019:1-8.
13.    Dickerson F, Severance E, Yolken R. The microbiome, immunity, and schizophrenia and bipolar disorder. Brain, behavior, and immunity. 2017;62:46-52.
14.    Coello K, Hansen TH, Sørensen N, Munkholm K, Kessing LV, Pedersen O, et al. Gut microbiota composition in patients with newly diagnosed bipolar disorder and their unaffected first-degree relatives. Brain, behavior, and immunity. 2019;75:112-8.
15.    Gondalia S, Parkinson L, Stough C, Scholey A. Gut microbiota and bipolar disorder: a review of mechanisms and potential targets for adjunctive therapy. Psychopharmacology. 2019;236(5):1433-43.
16.    Flowers SA, Ward KM, Clark CT. The Gut Microbiome in Bipolar Disorder and Pharmacotherapy Management. Neuropsychobiology. 2020;79(1-2):43-9.
17.    Nguyen TT, Kosciolek T, Eyler LT, Knight R, Jeste DV. Overview and systematic review of studies of microbiome in schizophrenia and bipolar disorder. Journal of Psychiatric Research. 2018;99:50-61.
18.    Singer-Englar T, Barlow G, Mathur R. Obesity, diabetes, and the gut microbiome: an updated review. Expert review of gastroenterology & hepatology. 2019;13(1):3-15.
19.    Zheng P, Li Z, Zhou Z. Gut microbiome in type 1 diabetes: A comprehensive review. Diabetes/metabolism research and reviews. 2018;34(7):e3043.
20.    Yadav M, Verma MK, Chauhan NS. A review of metabolic potential of human gut microbiome in human nutrition. Archives of Microbiology. 2018;200(2):203-17.
21.    Wong JMW, de Souza R, Kendall CWC, Emam A, Jenkins DJA. Colonic health: fermentation and short chain fatty acids. J Clin Gastroenterol. 2006;40(3):235-43.
22.    Mu H, Høy C-E. The digestion of dietary triacylglycerols. Prog Lipid Res. 2004;43(2):105-33.
23.    Kuksis A. Biochemistry of glycerolipids and formation of chylomicrons. Champaign: AOCS Press; 2000. p. 119-81.
24.    Cummings JH, Pomare EW, Branch WJ, Naylor CP, Macfarlane GT. Short chain fatty acids in human large intestine, portal, hepatic and venous blood. Gut. 1987;28(10):1221-7.
25.    Bugaut M. Occurrence, absorption and metabolism of short chain fatty acids in the digestive tract of mammals. Comp Biochem Physiol Part B: Comparative Biochemistry. 1987;86(3):439-72.
26.    Bourassa MW, Alim I, Bultman SJ, Ratan RR. Butyrate, neuroepigenetics and the gut microbiome: Can a high fiber diet improve brain health? Neuroscience Letters. 2016;625:56-63.
27.    Stilling RM, van de Wouw M, Clarke G, Stanton C, Dinan TG, Cryan JF. The neuropharmacology of butyrate: The bread and butter of the microbiota-gut-brain axis? Neurochem Int. 2016;99:110-32.
28.    Johnston CS, Kim CM, Buller AJ. Vinegar improves insulin sensitivity to a high-carbohydrate meal in subjects with insulin resistance or type 2 diabetes. Diabetes Care. 2004;27(1):281-2.
29.    Liljeberg H, Björck I. Delayed gastric emptying rate may explain improved glycaemia in healthy subjects to a starchy meal with added vinegar. Eur J Clin Nutr. 1998;52(5):368-71.
30.    Brighenti F, Castellani G, Benini L, Casiraghi MC, Leopardi E, Crovetti R, et al. Effect of neutralized and native vinegar on blood glucose and acetate responses to a mixed meal in healthy subjects. Eur J Clin Nutr. 1995;49(4):242-7.
31.    Hamer HM, Jonkers D, Venema K, Vanhoutvin S, Troost FJ, Brummer RJ. Review article: the role of butyrate on colonic function. Aliment Pharmacol Ther 2008;27(2):104-19.
32.    Fung KY, Cosgrove L, Lockett T, Head R, Topping DL. A review of the potential mechanisms for the lowering of colorectal oncogenesis by butyrate. Br J Nutr. 2012;108(05):820-31.
33.    Pandey KR, Naik SR, Vakil BV. Probiotics, prebiotics and synbiotics- a review. Journal of Food Science and Technology. 2015;52(12):7577-87.
34.    Zilberter Y, Zilberter T, Bregestovski P. Neuronal activity in vitro and the in vivo reality: the role of energy homeostasis. Trends in Pharmacological Sciences. 2010;31(9):394-401.
35.    Wyss MT, Jolivet R, Buck A, Magistretti PJ, Weber B. In Vivo Evidence for Lactate as a Neuronal Energy Source. The Journal of Neuroscience. 2011;31(20):7477.
36.    Pellerin L, Bouzier-Sore A-K, Aubert A, Serres S, Merle M, Costalat R, et al. Activity-dependent regulation of energy metabolism by astrocytes: An update. Glia. 2007;55(12):1251-62.
37.    Holmgren CD, Mukhtarov M, Malkov AE, Popova IY, Bregestovski P, Zilberter Y. Energy substrate availability as a determinant of neuronal resting potential, GABA signaling and spontaneous network activity in the neonatal cortex in vitro. Journal of Neurochemistry. 2010;112(4):900-12.
38.    McFarlane C, Ramos CI, Johnson DW, Campbell KL. Prebiotic, Probiotic, and Synbiotic Supplementation in Chronic Kidney Disease: A Systematic Review and Meta-analysis. Journal of Renal Nutrition. 2019;29(3):209-20.
39.    Kazemi A, Soltani S, Ghorabi S, Keshtkar A, Daneshzad E, Nasri F, et al. Effect of probiotic and synbiotic supplementation on inflammatory markers in health and disease status: A systematic review and meta-analysis of clinical trials. Clinical Nutrition. 2020;39(3):789-819.
40.    McLoughlin RF, Berthon BS, Jensen ME, Baines KJ, Wood LG. Short-chain fatty acids, prebiotics, synbiotics, and systemic inflammation: a systematic review and meta-analysis. The American Journal of Clinical Nutrition. 2017;106(3):930-45.
41.    Pourrajab B, Fatahi S, Sohouli MH, Găman M-A, Shidfar F. The effects of probiotic/synbiotic supplementation compared to placebo on biomarkers of oxidative stress in adults: a systematic review and meta-analysis of randomized controlled trials. Critical Reviews in Food Science and Nutrition. 2020:1-18.
42.    Heshmati J, Farsi F, Shokri F, Rezaeinejad M, Almasi-Hashiani A, Vesali S, et al. A systematic review and meta-analysis of the probiotics and synbiotics effects on oxidative stress. Journal of Functional Foods. 2018;46:66-84.
43.    Sáez-Lara MJ, Robles-Sanchez C, Ruiz-Ojeda FJ, Plaza-Diaz J, Gil A. Effects of Probiotics and Synbiotics on Obesity, Insulin Resistance Syndrome, Type 2 Diabetes and Non-Alcoholic Fatty Liver Disease: A Review of Human Clinical Trials. International Journal of Molecular Sciences. 2016;17(6):928.
44.    Roshan H, Ghaedi E, Rahmani J, Barati M, Najafi M, Karimzedeh M, et al. Effects of probiotics and synbiotic supplementation on antioxidant status: A meta-analysis of randomized clinical trials. Clinical Nutrition ESPEN. 2019;30:81-8.
45.    March DS, Jones AW, Bishop NC, Burton JO. The Efficacy of Prebiotic, Probiotic, and Synbiotic Supplementation in Modulating Gut-Derived Circulatory Particles Associated With Cardiovascular Disease in Individuals Receiving Dialysis: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Journal of Renal Nutrition. 2020;30(4):347-59.
46.    Skonieczna-Żydecka K, Kaźmierczak-Siedlecka K, Kaczmarczyk M, Śliwa-Dominiak J, Maciejewska D, Janda K, et al. The Effect of Probiotics and Synbiotics on Risk Factors Associated with Cardiometabolic Diseases in Healthy People—A Systematic Review and Meta-Analysis with Meta-Regression of Randomized Controlled Trials. Journal of Clinical Medicine. 2020;9(6):1788.
47.    Hadi A, Ghaedi E, Khalesi S, Pourmasoumi M, Arab A. Effects of synbiotic consumption on lipid profile: a systematic review and meta-analysis of randomized controlled clinical trials. Eur J Nutr. 2020;59(7):2857-74.
48.    Nikbakht E, Khalesi S, Singh I, Williams LT, West NP, Colson N. Effect of probiotics and synbiotics on blood glucose: a systematic review and meta-analysis of controlled trials. Eur J Nutr. 2018;57(1):95-106.
49.    Fasano A. Zonulin and Its Regulation of Intestinal Barrier Function: The Biological Door to Inflammation, Autoimmunity, and Cancer. Physiological Reviews. 2011;91(1):151-75.
50.    Ramezani Ahmadi A, Sadeghian M, Alipour M, Ahmadi Taheri S, Rahmani S, Abbasnezhad A. The Effects of Probiotic/Synbiotic on Serum Level of Zonulin as a Biomarker of Intestinal Permeability: A Systematic Review and Meta-Analysis. Iran J Public Health. 2020;49(7):1222-31.
51.    van Krimpen SJ, Jansen FAC, Ottenheim VL, Belzer C, van der Ende M, van Norren K. The Effects of Pro-, Pre-, and Synbiotics on Muscle Wasting, a Systematic Review—Gut Permeability as Potential Treatment Target. Nutrients. 2021;13(4):1115.
52.    Skonieczna-Żydecka K, Kaczmarczyk M, Łoniewski I, Lara LF, Koulaouzidis A, Misera A, et al. A Systematic Review, Meta-Analysis, and Meta-Regression Evaluating the Efficacy and Mechanisms of Action of Probiotics and Synbiotics in the Prevention of Surgical Site Infections and Surgery-Related Complications. Journal of Clinical Medicine. 2018;7(12):556.
53.    Lytvyn L, Quach K, Banfield L, Johnston BC, Mertz D. Probiotics and synbiotics for the prevention of postoperative infections following abdominal surgery: a systematic review and meta-analysis of randomized controlled trials. Journal of Hospital Infection. 2016;92(2):130-9.
54.    Kasatpibal N, Whitney JD, Saokaew S, Kengkla K, Heitkemper MM, Apisarnthanarak A. Effectiveness of Probiotic, Prebiotic, and Synbiotic Therapies in Reducing Postoperative Complications: A Systematic Review and Network Meta-analysis. Clinical Infectious Diseases. 2017;64(suppl_2):S153-S60.
55.    Yang Z, Wu Q, Liu Y, Fan D. Effect of Perioperative Probiotics and Synbiotics on Postoperative Infections After Gastrointestinal Surgery: A Systematic Review With Meta-Analysis. Journal of Parenteral and Enteral Nutrition. 2017;41(6):1051-62.
56.    Kinross JM, Markar S, Karthikesalingam A, Chow A, Penney N, Silk D, et al. A Meta-Analysis of Probiotic and Synbiotic Use in Elective Surgery. Journal of Parenteral and Enteral Nutrition. 2013;37(2):243-53.
57.    Wu X-D, Liu M-M, Liang X, Hu N, Huang W. Effects of perioperative supplementation with pro-/synbiotics on clinical outcomes in surgical patients: A meta-analysis with trial sequential analysis of randomized controlled trials. Clinical Nutrition. 2018;37(2):505-15.
58.    Arumugam S, Lau CSM, Chamberlain RS. Probiotics and Synbiotics Decrease Postoperative Sepsis in Elective Gastrointestinal Surgical Patients: a Meta-Analysis. Journal of Gastrointestinal Surgery. 2016;20(6):1123-31.
59.    Zeng J, Ji Y, Liang B, Zhang G, Chen D, Zhu M, et al. The effect of pro/synbiotics on postoperative infections in colorectal cancer patients: A systematic review and meta-analysis. Complementary Therapies in Clinical Practice. 2021;43:101370.
60.    Kahn J, Pregartner G, Schemmer P. Effects of both Pro- and Synbiotics in Liver Surgery and Transplantation with Special Focus on the Gut–Liver Axis—A Systematic Review and Meta-Analysis. Nutrients. 2020;12(8):2461.
61.    Manzanares W, Lemieux M, Langlois PL, Wischmeyer PE. Probiotic and synbiotic therapy in critical illness: a systematic review and meta-analysis. Critical Care. 2016;20(1):262.
62.    Khan MY, Mihali AB, Rawala MS, Aslam A, Siddiqui WJ. The promising role of probiotic and synbiotic therapy in aminotransferase levels and inflammatory markers in patients with nonalcoholic fatty liver disease – a systematic review and meta-analysis. European Journal of Gastroenterology & Hepatology. 2019;31(6):703-15.
63.    Khalesi S, Johnson DW, Campbell K, Williams S, Fenning A, Saluja S, et al. Effect of probiotics and synbiotics consumption on serum concentrations of liver function test enzymes: a systematic review and meta-analysis. Eur J Nutr. 2018;57(6):2037-53.
64.    Hadi A, Mohammadi H, Miraghajani M, Ghaedi E. Efficacy of synbiotic supplementation in patients with nonalcoholic fatty liver disease: A systematic review and meta-analysis of clinical trials: Synbiotic supplementation and NAFLD. Critical Reviews in Food Science and Nutrition. 2019;59(15):2494-505.
65.    Liu L, Li P, Liu Y, Zhang Y. Efficacy of Probiotics and Synbiotics in Patients with Nonalcoholic Fatty Liver Disease: A Meta-Analysis. Digest Dis Sci. 2019;64(12):3402-12.
66.    Tabrizi R, Moosazadeh M, Lankarani KB, Akbari M, Heydari ST, Kolahdooz F, et al. The Effects of Synbiotic Supplementation on Glucose Metabolism and Lipid Profiles in Patients with Diabetes: a Systematic Review and Meta-Analysis of Randomized Controlled Trials. Probiotics and Antimicrobial Proteins. 2018;10(2):329-42.
67.    Mahboobi S, Rahimi F, Jafarnejad S. Effects of Prebiotic and Synbiotic Supplementation on Glycaemia and Lipid Profile in Type 2 Diabetes: A Meta-Analysis of Randomized Controlled Trials. Adv Pharm Bull. 2018;8(4):565-74.
68.    Bock PM, Telo GH, Ramalho R, Sbaraini M, Leivas G, Martins AF, et al. The effect of probiotics, prebiotics or synbiotics on metabolic outcomes in individuals with diabetes: a systematic review and meta-analysis. Diabetologia. 2021;64(1):26-41.
69.    Tabrizi R, Ostadmohammadi V, Lankarani KB, Akbari M, Akbari H, Vakili S, et al. The effects of probiotic and synbiotic supplementation on inflammatory markers among patients with diabetes: A systematic review and meta-analysis of randomized controlled trials. European Journal of Pharmacology. 2019;852:254-64.
70.    Zheng HJ, Guo J, Jia Q, Huang YS, Huang W-J, Zhang W, et al. The effect of probiotic and synbiotic supplementation on biomarkers of inflammation and oxidative stress in diabetic patients: A systematic review and meta-analysis of randomized controlled trials. Pharmacological Research. 2019;142:303-13.
71.    Beserra BTS, Fernandes R, do Rosario VA, Mocellin MC, Kuntz MGF, Trindade EBSM. A systematic review and meta-analysis of the prebiotics and synbiotics effects on glycaemia, insulin concentrations and lipid parameters in adult patients with overweight or obesity. Clinical Nutrition. 2015;34(5):845-58.
72.    Hadi A, Alizadeh K, Hajianfar H, Mohammadi H, Miraghajani M. Efficacy of synbiotic supplementation in obesity treatment: A systematic review and meta-analysis of clinical trials. Critical Reviews in Food Science and Nutrition. 2020;60(4):584-96.
73.    Mohammadi H, Ghavami A, Hadi A, Askari G, Symonds M, Miraghajani M. Effects of pro-/synbiotic supplementation on anthropometric and metabolic indices in overweight or obese children and adolescents: A systematic review and meta-analysis. Complementary Therapies in Medicine. 2019;44:269-76.
74.    Suzumura EA, Bersch-Ferreira ÂC, Torreglosa CR, da Silva JT, Coqueiro AY, Kuntz MGF, et al. Effects of oral supplementation with probiotics or synbiotics in overweight and obese adults: a systematic review and meta-analyses of randomized trials. Nutrition reviews. 2019;77(6):430-50.
75.    Cao S, Ryan PM, Salehisahlabadi A, Abdulazeem HM, Karam G, Černevičiūtė R, et al. Effect of probiotic and synbiotic formulations on anthropometrics and adiponectin in overweight and obese participants: A systematic review and meta-analysis of randomized controlled trials. Journal of King Saud University - Science. 2020;32(2):1738-48.
76.    Hadi A, Pourmasoumi M, Kazemi M, Najafgholizadeh A, Marx W. Efficacy of synbiotic interventions on blood pressure: a systematic review and meta-analysis of clinical trials. Critical Reviews in Food Science and Nutrition. 2021:1-11.
77.    Chan CKY, Tao J, Chan OS, Li H-B, Pang H. Preventing Respiratory Tract Infections by Synbiotic Interventions: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Advances in Nutrition. 2020;11(4):979-88.
78.    Wawryk-Gawda E, Markut-Miotła E, Emeryk A. Postnatal probiotics administration does not prevent asthma in children, but using prebiotics or synbiotics may be effective potential strategies to decrease the frequency of asthma in high-risk children–a meta-analysis of clinical trials. Allergologia et Immunopathologia. 2021;49(4):4-14.
79.    Fan Q-L, Yu X-M, Liu Q-X, Yang W, Chang Q, Zhang Y-P. Synbiotics for prevention of ventilator-associated pneumonia: a probiotics strain-specific network meta-analysis. Journal of International Medical Research. 2019;47(11):5349-74.
80.    Yu C, Zhang Y, Yang Q, Lee P, Windsor JA, Wu D. An Updated Systematic Review With Meta-analysis: Efficacy of Prebiotic, Probiotic, and Synbiotic Treatment of Patients With Severe Acute Pancreatitis. Pancreas. 2021;50(2):160-6.
81.    Cruz BCS, Sarandy MM, Messias AC, Gonçalves RV, Ferreira CLLF, Peluzio MCG. Preclinical and clinical relevance of probiotics and synbiotics in colorectal carcinogenesis: a systematic review. Nutrition reviews. 2020;78(8):667-87.
82.    He D, Wang H-Y, Feng J-Y, Zhang M-M, Zhou Y, Wu X-T. Use of pro-/synbiotics as prophylaxis in patients undergoing colorectal resection for cancer: A meta-analysis of randomized controlled trials. Clinics and Research in Hepatology and Gastroenterology. 2013;37(4):406-15.
83.    Desai V, Kozyrskyj AL, Lau S, Sanni O, Dennett L, Walter J, et al. Effectiveness of Probiotic, Prebiotic, and Synbiotic Supplementation to Improve Perinatal Mental Health in Mothers: A Systematic Review and Meta-Analysis. Frontiers in psychiatry. 2021;12:622181-.
84.    Luo C, Wan J, Rao Z, Zhang Y. Synbiotic supplementation for glycemic status in pregnant women: a meta-analysis of randomized clinical trials. Gynecological Endocrinology. 2021;37(2):146-51.
85.    Hao Y, Zhou L, Ding C, Wu J, Chen X, Ng DM, et al. Probiotics and synbiotics show clinical efficacy in treating gestational diabetes mellitus: A meta-analysis. Primary Care Diabetes. 2021.
86.    Vaghef-Mehrabany E, Maleki V, Behrooz M, Ranjbar F, Ebrahimi-Mameghani M. Can psychobiotics “mood” ify gut? An update systematic review of randomized controlled trials in healthy and clinical subjects, on anti-depressant effects of probiotics, prebiotics, and synbiotics. Clinical Nutrition. 2020;39(5):1395-410.
87.    Asha MZ, Khalil SFH. Efficacy and Safety of Probiotics, Prebiotics and Synbiotics in the Treatment of Irritable Bowel Syndrome: A systematic review and meta-analysis. Sultan Qaboos Univ Med J. 2020;20(1):e13-e24.
88.    Zheng HJ, Guo J, Wang Q, Wang L, Wang Y, Zhang F, et al. Probiotics, prebiotics, and synbiotics for the improvement of metabolic profiles in patients with chronic kidney disease: A systematic review and meta-analysis of randomized controlled trials. Critical Reviews in Food Science and Nutrition. 2021;61(4):577-98.
89.    Tian X, Pi Y-P, Liu X-L, Chen H, Chen W-Q. Supplemented Use of Pre-, Pro-, and Synbiotics in Severe Acute Pancreatitis: An Updated Systematic Review and Meta-Analysis of 13 Randomized Controlled Trials. Frontiers in Pharmacology. 2018;9(690).
90.    Tan Q, Orsso CE, Deehan EC, Kung JY, Tun HM, Wine E, et al. Probiotics, prebiotics, synbiotics, and fecal microbiota transplantation in the treatment of behavioral symptoms of autism spectrum disorder: A systematic review. Autism Research. 2021;14(9):1820-36.
91.    Askari G, Ghavami A, Shahdadian F, Moravejolahkami AR. Effect of synbiotics and probiotics supplementation on autoimmune diseases: A systematic review and meta-analysis of clinical trials. Clinical Nutrition. 2021;40(5):3221-34.
92.    Zhang X-F, Guan X-X, Tang Y-J, Sun J-F, Wang X-K, Wang W-D, et al. Clinical effects and gut microbiota changes of using probiotics, prebiotics or synbiotics in inflammatory bowel disease: a systematic review and meta-analysis. Eur J Nutr. 2021;60(5):2855-75.
93.    Rufino MN, da Costa AL, Jorge EN, Paiano VF, Camparoto ML, Keller R, et al. Synbiotics improve clinical indicators of ulcerative colitis: systematic review with meta-analysis. Nutrition reviews. 2021.
94.    Heshmati J, Farsi F, Yosaee S, Razavi M, Rezaeinejad M, Karimie E, et al. The Effects of Probiotics or Synbiotics Supplementation in Women with Polycystic Ovarian Syndrome: a Systematic Review and Meta-Analysis of Randomized Clinical Trials. Probiotics and Antimicrobial Proteins. 2019;11(4):1236-47.
95.    Shamasbi SG, Ghanbari-Homayi S, Mirghafourvand M. The effect of probiotics, prebiotics, and synbiotics on hormonal and inflammatory indices in women with polycystic ovary syndrome: a systematic review and meta-analysis. Eur J Nutr. 2020;59(2):433-50.
96.    Hadi A, Moradi S, Ghavami A, Khalesi S, Kafeshani M. Effect of probiotics and synbiotics on selected anthropometric and biochemical measures in women with polycystic ovary syndrome: a systematic review and meta-analysis. European Journal of Clinical Nutrition. 2020;74(4):543-7.
97.    Cozzolino M, Vitagliano A, Pellegrini L, Chiurazzi M, Andriasani A, Ambrosini G, et al. Therapy with probiotics and synbiotics for polycystic ovarian syndrome: a systematic review and meta-analysis. Eur J Nutr. 2020;59(7):2841-56.
98.    Miao C, Guo Q, Fang X, Chen Y, Zhao Y, Zhang Q. Effects of probiotic and synbiotic supplementation on insulin resistance in women with polycystic ovary syndrome: a meta-analysis. Journal of International Medical Research. 2021;49(7):03000605211031758.
99.    Yang B, Lu P, Li M-X, Cai X-L, Xiong W-Y, Hou H-J, et al. A meta-analysis of the effects of probiotics and synbiotics in children with acute diarrhea. Medicine. 2019;98(37):e16618-e.
100.    Kambale RM, Nancy FI, Ngaboyeka GA, Kasengi JB, Bindels LB, Van der Linden D. Effects of probiotics and synbiotics on diarrhea in undernourished children: Systematic review with meta-analysis. Clinical Nutrition. 2021;40(5):3158-69.
101.    Pourmasoumi M, Najafgholizadeh A, Hadi A, Mansour-Ghanaei F, Joukar F. The effect of synbiotics in improving Helicobacter pylori eradication: A systematic review and meta-analysis. Complementary Therapies in Medicine. 2019;43:36-43.
102.    Coutts L, Ibrahim K, Tan QY, Lim SER, Cox NJ, Roberts HC. Can probiotics, prebiotics and synbiotics improve functional outcomes for older people: a systematic review. European Geriatric Medicine. 2020;11(6):975-93.
103.    Chang Y-S, Trivedi MK, Jha A, Lin Y-F, Dimaano L, García-Romero MT. Synbiotics for Prevention and Treatment of Atopic Dermatitis: A Meta-analysis of Randomized Clinical Trials. JAMA Pediatrics. 2016;170(3):236-42.
104.    Yu C, Zhang J, Wang T. Star anise essential oil:chemical compounds, antifungal and antioxidant activities: a review. Journal of Essential Oil Research. 2021;33(1):1-22.
105.    Shahrajabian MH, Sun W, Cheng Q. Chemical components and pharmacological benefits of Basil (Ocimum basilicum): a review. International Journal of Food Properties. 2020;23(1):1961-70.
106.    Zhan Y, An X, Wang S, Sun M, Zhou H. Basil polysaccharides: A review on extraction, bioactivities and pharmacological applications. Bioorganic & Medicinal Chemistry. 2020;28(1):115179.
107.    Wani SA, Kumar P. Fenugreek: A review on its nutraceutical properties and utilization in various food products. Journal of the Saudi Society of Agricultural Sciences. 2018;17(2):97-106.
108.    Syed QA, Rashid Z, Ahmad MH, Shukat R, Ishaq A, Muhammad N, et al. Nutritional and therapeutic properties of fenugreek (Trigonella foenum-graecum): a review. International Journal of Food Properties. 2020;23(1):1777-91.
109.    Almatroodi SA, Almatroudi A, Alsahli MA, Rahmani AH. Fenugreek (Trigonella Foenum-Graecum) and its Active Compounds: A Review of its Effects on Human Health through Modulating Biological Activities. Pharmacognosy Journal. 2021;13(3).
110.    Heshmat-Ghahdarijani K, Mashayekhiasl N, Amerizadeh A, Teimouri Jervekani Z, Sadeghi M. Effect of fenugreek consumption on serum lipid profile: A systematic review and meta-analysis. Phytotherapy Research. 2020;34(9):2230-45.
111.    Askarpour M, Alami F, Campbell MS, Venkatakrishnan K, Hadi A, Ghaedi E. Effect of fenugreek supplementation on blood lipids and body weight: A systematic review and meta-analysis of randomized controlled trials. Journal of Ethnopharmacology. 2020;253:112538.
112.    Khodamoradi K, Khosropanah MH, Ayati Z, Chang D, Nasli-Esfahani E, Ayati MH, et al. The Effects of Fenugreek on Cardiometabolic Risk Factors in Adults: A Systematic Review and Meta-analysis. Complementary Therapies in Medicine. 2020;52:102416.
113.    Zameer S, Najmi AK, Vohora D, Akhtar M. A review on therapeutic potentials of Trigonella foenum graecum (fenugreek) and its chemical constituents in neurological disorders: Complementary roles to its hypolipidemic, hypoglycemic, and antioxidant potential. Nutritional neuroscience. 2018;21(8):539-45.
114.    Mousavi SM, Beatriz Pizarro A, Akhgarjand C, Bagheri A, Persad E, Karimi E, et al. The effects of Anethum graveolens (dill) supplementation on lipid profile and glycemic control: a systematic review and meta-analysis of randomized controlled trials. Critical Reviews in Food Science and Nutrition. 2021:1-12.
115.    Mansoori A, Salimi Z, Hosseini SA, Hormoznejad R, Asadi M. The Effect of Anethum Graveolens L. (Dill) on Lipid Profile in Adults with Cardiovascular Risk Factors: A Systematic Review and Meta-Analysis of Controlled Clinical Trials. Critical Comments in Biomedicine. 2021;2(1):100-2.
116.    Lee HW, Ang L, Lee MS, Alimoradi Z, Kim E. Fennel for Reducing Pain in Primary Dysmenorrhea: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Nutrients. 2020;12(11):3438.
117.    Lee HW, Ang L, Kim E, Lee MS. Fennel (Foeniculum vulgare Miller) for the management of menopausal women's health: A systematic review and meta-analysis. Complementary Therapies in Clinical Practice. 2021;43:101360.
118.    Wieland LS, Piechotta V, Feinberg T, Ludeman E, Hutton B, Kanji S, et al. Elderberry for prevention and treatment of viral respiratory illnesses: a systematic review. BMC Complementary Medicine and Therapies. 2021;21(1):112.
119.    Huang F-Y, Deng T, Meng L-X, Ma X-L. Dietary ginger as a traditional therapy for blood sugar control in patients with type 2 diabetes mellitus: A systematic review and meta-analysis. Medicine. 2019;98(13):e15054-e.
120.    Nikkhah Bodagh M, Maleki I, Hekmatdoost A. Ginger in gastrointestinal disorders: A systematic review of clinical trials. Food Science & Nutrition. 2019;7(1):96-108.
121.    Mohd Sahardi NFN, Makpol S. Ginger (<i>Zingiber officinale</i> Roscoe) in the Prevention of Ageing and Degenerative Diseases: Review of Current Evidence. Evidence-Based Complementary and Alternative Medicine. 2019;2019:5054395.
122.    Anh NH, Kim SJ, Long NP, Min JE, Yoon YC, Lee EG, et al. Ginger on Human Health: A Comprehensive Systematic Review of 109 Randomized Controlled Trials. Nutrients. 2020;12(1):157.
123.    Rondanelli M, Fossari F, Vecchio V, Gasparri C, Peroni G, Spadaccini D, et al. Clinical trials on pain lowering effect of ginger: A narrative review. Phytotherapy Research. 2020;34(11):2843-56.
124.    Jalali M, Mahmoodi M, Moosavian SP, Jalali R, Ferns G, Mosallanezhad A, et al. The effects of ginger supplementation on markers of inflammatory and oxidative stress: A systematic review and meta-analysis of clinical trials. Phytotherapy Research. 2020;34(8):1723-33.
125.    Sheikhhossein F, Borazjani M, Jafari A, Askari M, Vataniyan E, Gholami F, et al. Effects of ginger supplementation on biomarkers of oxidative stress: A systematic review and meta-analysis of randomized controlled trials. Clinical Nutrition ESPEN. 2021;45:111-9.
126.    Morvaridzadeh M, Sadeghi E, Agah S, Fazelian S, Rahimlou M, Kern FG, et al. Effect of ginger (Zingiber officinale) supplementation on oxidative stress parameters: A systematic review and meta-analysis. Journal of Food Biochemistry. 2021;45(2):e13612.
127.    Morvaridzadeh M, Fazelian S, Agah S, Khazdouz M, Rahimlou M, Agh F, et al. Effect of ginger (Zingiber officinale) on inflammatory markers: A systematic review and meta-analysis of randomized controlled trials. Cytokine. 2020;135:155224.
128.    Askari G, Aghajani M, Salehi M, Najafgholizadeh A, Keshavarzpour Z, Fadel A, et al. The effects of ginger supplementation on biomarkers of inflammation and oxidative stress in adults: A systematic review and meta-analysis of randomized controlled trials. Journal of Herbal Medicine. 2020;22:100364.
129.    Hasani H, Arab A, Hadi A, Pourmasoumi M, Ghavami A, Miraghajani M. Does ginger supplementation lower blood pressure? A systematic review and meta-analysis of clinical trials. Phytotherapy Research. 2019;33(6):1639-47.
130.    Graudal N, Hubeck-Graudal T, Jurgens G. Effects of low sodium diet versus high sodium diet on blood pressure, renin, aldosterone, catecholamines, cholesterol, and triglyceride. Cochrane Database Syst Rev. 2011;11.
131.    Maharlouei N, Tabrizi R, Lankarani KB, Rezaianzadeh A, Akbari M, Kolahdooz F, et al. The effects of ginger intake on weight loss and metabolic profiles among overweight and obese subjects: A systematic review and meta-analysis of randomized controlled trials. Critical Reviews in Food Science and Nutrition. 2019;59(11):1753-66.
132.    Lu C, Chen X, Yan X, He J, Nie Z. The preventive and relieving effects of ginger on postoperative nausea and vomiting: a systematic review and meta-analysis of randomized controlled trials. International Journal of Nursing Studies. 2021:104094.
133.    Zhu W, Dai Y, Huang M, Li J. Efficacy of Ginger in Preventing Postoperative Nausea and Vomiting: A Systematic Review and Meta-Analysis. Journal of Nursing Scholarship.n/a(n/a).
134.    Alsherbiny MA, Abd-Elsalam WH, El badawy SA, Taher E, Fares M, Torres A, et al. Ameliorative and protective effects of ginger and its main constituents against natural, chemical and radiation-induced toxicities: A comprehensive review. Food and Chemical Toxicology. 2019;123:72-97.
135.    Sowndhararajan K, Deepa P, Kim M, Park SJ, Kim S. A Review of the Composition of the Essential Oils and Biological Activities of Angelica Species. Scientia Pharmaceutica. 2017;85(3):33.
136.    Sowndhararajan K, Kim S. Neuroprotective and Cognitive Enhancement Potentials of Angelica gigas Nakai Root: A Review. Scientia Pharmaceutica. 2017;85(2):21.
137.    Mamedov NA, Egamberdieva D. Phytochemical Constituents and Pharmacological Effects of Licorice: A Review. In: Ozturk M, Hakeem KR, editors. Plant and Human Health, Volume 3: Pharmacology and Therapeutic Uses. Cham: Springer International Publishing; 2019. p. 1-21.
138.    Pastorino G, Cornara L, Soares S, Rodrigues F, Oliveira MBPP. Liquorice (Glycyrrhiza glabra): A phytochemical and pharmacological review. Phytotherapy Research. 2018;32(12):2323-39.
139.    Wang Z-F, Liu J, Yang Y-A, Zhu H-L. A Review: The Anti-inflammatory, Anticancer and Antibacterial Properties of Four Kinds of Licorice Flavonoids Isolated from Licorice. Current Medicinal Chemistry. 2020;27(12):1997-2011.
140.    Luís Â, Domingues F, Pereira L. Metabolic changes after licorice consumption: A systematic review with meta-analysis and trial sequential analysis of clinical trials. Phytomedicine. 2018;39:17-24.
141.    Rostamizadeh P, Mazloom Z. The Effect of Licorice and Probiotics on Nonalcoholic Fatty Liver Disease (NAFLD): A Systematic Review. International Journal of Nutrition Sciences. 2019;4(4):163-9.
142.    Nazari S, Rameshrad M, Hosseinzadeh H. Toxicological Effects of Glycyrrhiza glabra (Licorice): A Review. Phytotherapy Research. 2017;31(11):1635-50.
143.    A Review of the Pharmacological Efficacy and Safety of Licorice Root from Corroborative Clinical Trial Findings. Journal of medicinal food. 2020;23(1):12-20.
144.    Penninkilampi R, Eslick EM, Eslick GD. The association between consistent licorice ingestion, hypertension and hypokalaemia: a systematic review and meta-analysis. Journal of Human Hypertension. 2017;31(11):699-707.
145.    Araújo DL, da Silva Machado BA, Mascarenhas JMF, Alves SP, de Sousa SLF, de Moura LC, et al. Analysis of the antimicrobial activity of the essential oil of oregano (Origanum vulgare): a review study on the main effects on pathogens. Research, Society and Development. 2021;10(2):e36810212584-e.
146.    Chiș M, Muste S, Păucean A, Man S, Sturza A, Petruț G, et al. A comprehensive review about antimicrobial effects of herb and oil oregano (Origanum vulgare ssp. Hirtum). Hop and Medicinal Plants. 2017;25(1/2):17-27.
147.    Mahendran G, Rahman L-U. Ethnomedicinal, phytochemical and pharmacological updates on Peppermint (Mentha × piperita L.)—A review. Phytotherapy Research. 2020;34(9):2088-139.
148.    Seif sahandi M, Mehrafarin A, Khalighi-Sigaroodi F, Sharifi M, Naghdi badi H. Review on Anatomical, Phytochemical and Pharmacological Properties of Peppermint (Mentha piperita L.). Journal of Medicinal Plants. 2019;18(69):16-33.
149.    Aziz M, Sharma S, Ghazaleh S, Fatima R, Acharya A, Ghanim M, et al. The anti-spasmodic effect of peppermint oil during colonoscopy: a systematic review and meta-analysis. Minerva Gastroenterol Dietol. 2020;66(2):164-71.
150.    Punoševac M, Radović J, Leković A, Kundaković-Vasović T. A review of botanical characteristics, chemical composition, pharmacological activity and use of parsley. Archives of Pharmacy. 2021;71(Notebook 3):177-96.
151.    CHIȘ M-S, PĂUCEAN A, MAN S, POP A, MUREȘAN AE, FOSTOC G, et al. A COMPREHENSIVE REVIEW REGARDING THE BOTANICAL ORIGIN, MEDICINAL USES AND CHEMICAL COMPOSITION OF ROMAN AND GERMAN CHAMOMILE.
152.    Nieto G, Ros G, Castillo J. Antioxidant and Antimicrobial Properties of Rosemary (Rosmarinus officinalis, L.): A Review. Medicines. 2018;5(3):98.
153.    Chiș M, Muste S, Păucean A, Man S, Mureșan V, Călian I. A comprehensive review about anticancer and antimicrobial activities of rosemary oil (Rosmarinus officinalis L). Hop and Medicinal Plants. 2017;25(1/2):28-37.
154.    Xie J, VanAlstyne P, Uhlir A, Yang X. A review on rosemary as a natural antioxidation solution. European Journal of Lipid Science and Technology. 2017;119(6):1600439.
155.    Alavi MS, Fanoudi S, Ghasemzadeh Rahbardar M, Mehri S, Hosseinzadeh H. An updated review of protective effects of rosemary and its active constituents against natural and chemical toxicities. Phytotherapy Research. 2021;35(3):1313-28.
156.    Shinjyo N, Green J. Are sage, rosemary and lemon balm effective interventions in dementia? A narrative review of the clinical evidence. European Journal of Integrative Medicine. 2017;15:83-96.
157.    Hussain SM, Syeda AF, Alshammari M, Alnasser S, Alenzi N, Alanazi S, et al. Cognition Enhancing Effect of Rosemary Plant (Rosmarinus officinalis, L) in Preclinical Studies: A Systematic Review and Meta-Analysis. 2020.
158.    Shiravi A, Akbari A, Mohammadi Z, Khalilian M-S, Zeinalian A, Zeinalian M. Rosemary and its protective potencies against COVID-19 and other cytokine storm associated infections: A molecular review. Mediterranean Journal of Nutrition and Metabolism. 2021;Preprint:1-16.
159.    Lopresti AL. Salvia (Sage): A Review of its Potential Cognitive-Enhancing and Protective Effects. Drugs in R&D. 2017;17(1):53-64.
160.    Alasvand S, Bridges W, Haley-Zitlin V. Effectiveness of Salvia Officinalis on Mediation of Serum Lipid in Clinical Trials: Systematic Review and Meta-analysis (P12-004-19). Current Developments in Nutrition. 2019;3(Supplement_1).
161.    Semalty M, Adhikari L, Semwal D, Chauhan A, Mishra A, Kotiyal R, et al. A Comprehensive Review on Phytochemistry and Pharmacological Effects of Stinging Nettle (Urtica dioica). Current Traditional Medicine. 2017;3(3):156-67.
162.    Ziaei R, Foshati S, Hadi A, Kermani MAH, Ghavami A, Clark CCT, et al. The effect of nettle (Urtica dioica) supplementation on the glycemic control of patients with type 2 diabetes mellitus: A systematic review and meta-analysis. Phytotherapy Research. 2020;34(2):282-94.
163.    Kaeidi A, Rahmani MR, Hassanshahi J. The Protective Effect of Carvacrol and Thymol as Main Polyphenolic Compounds of Thyme on Some Biologic Systems in Disease Condition: A Narrative Review. Journal of Rafsanjan University of Medical Sciences. 2020;19(1):81-96.
164.    Patil SM, Ramu R, Shirahatti PS, Shivamallu C, Amachawadi RG. A systematic review on ethnopharmacology, phytochemistry and pharmacological aspects of Thymus vulgaris Linn. Heliyon. 2021;7(5):e07054.
165.    Rana M, Rani P. Garden Chervil.  Vegetable Crops Science: CRC Press; 2017. p. 953-8.
166.    Pepeljnjak S, Kosalec I, Kalođera Z, Blažević N. Antimicrobial activity of juniper berry essential oil (Juniperus communis L., Cupressaceae). Acta pharmaceutica. 2005;55(4):417-22.