Probiotic yogurt, comprised of a Fiti sachet containing Lactobacillus rhamnosus GR-1 and Streptococcus thermophilus C106, has been used in the developing world, notably Africa, to alleviate malnutrition and disease. In sub-Saharan African countries, fermentation of cereals such as millet, is culturally significant. The aim of this study was to investigate the fermentation capability of millet when one gram of the Fiti sachet consortium was added. An increase of 1.8 and 1.4 log CFU/mL was observed for S. thermophilus C106 and L. rhamnosus GR-1 when grown in 8% millet in water. Single cultures of L. rhamnosus GR-1 showed the highest μ_max when grown in the presence of dextrose, galactose and fructose. Single cultures of S. thermophilus C106 showed the highest μ_max when grown in the presence of sucrose and lactose. All tested recipes reached viable counts of the probiotic bacteria, with counts greater than 10⁶ colony-forming units (CFU)/mL. Notably, a number of organic acids were quantified, in particular phytic acid, which was shown to decrease when fermentation time increased, thereby improving the bioavailability of specific micronutrients. Millet fermented in milk proved to be the most favorable, according to a sensory evaluation. In conclusion, this study has shown that sachets being provided to African communities to produce fermented milk, can also be used to produce fermented millet. This provides an option for when milk supplies are short, or if communities wish to utilize the nutrient-rich qualities of locally-grown millet.

Typically, probiotics are consumed in dairy based products such as yogurt. However, given the rise in various diet types, non-dairy alternatives have been developed, such as inoculating fruit juices with probiotics. Lactobacillus rhamnosus GR-1 is a probiotic strain exerting a number of human health benefits such as the prevention of urinary tract infections. Therefore, the objective of this study was to determine the viability of L. rhamnosus GR-1 in apple cider, orange, and grape juice when fortified with either 4% short chain or 4% long chain inulin fiber over 72 h of fermentation and 30 days of refrigerated storage. The secondary objective was to determine consumer acceptability of apple cider and orange juice samples using the hedonic scale. All of the fruit juice samples achieved a mean viable count of at least 10⁷ CFU/mL during 72 h of fermentation and 30 days of refrigerated storage. According to the sensory evaluation, which evaluated samples according to appearance, flavor, texture, and overall acceptability, apple cider juice with long chain inulin fiber proved to have the highest score for all characteristics except appearance. Therefore, this study indicated a potential for probiotic fruit juices as a valid alternative to dairy based probiotic products.

Chronic kidney disease (CKD) disproportionately affects populations in developing countries. In sub-Saharan Africa, CKD prevalence is high (12–23%) and is associated with cardiovascular manifestations. Uremic toxins, especially p-cresol and p-cresyl sulfate, are associated with the disease. Reducing uremic toxins in the body slows disease progression and improves patient outcomes. Probiotic Bifidobacterium breve HRVD521-US, B. animalis HRVD524-US, B. longum SD-BB536-JP, and B. longum SD-CECT7347-SP internalize p-cresol and improve longevity in vivo. In 2002, Tanzanian communities were taught to produce probiotic yogurt (Fiti^®) supplemented with Lacticaseibacillus rhamnosus GR-1. This has expanded to over 100 community producers across the country. To produce yogurt that could reduce the burden of CKD by sequestering uremic toxins, we decided to test the addition of p-cresol-clearing bifidobacterial strains. By repeating the Fiti^® production process performed in Tanzanian communities and adding a bifidobacterial strain, we found that they were successfully incorporated into the yogurt without any detrimental effect on sensory properties or viable counts. Three of the four strains significantly reduced p-cresol when added to a simulated colonic environment. In conclusion, this study has shown that Fiti^® sachets provided to Tanzanian communities to produce yogurt can be supplemented with strains that can potentially confer additional health benefits.

The recognition that microbes are integral to human life has led to studies on how to manipulate them in favor of health outcomes. To date, there has been no conjoint recommendation for the intake of dietary compounds that can complement the ingested organisms in terms of promoting an improved health outcome. The aim of this review is to discuss how beneficial microbes in the form of probiotics, fermented foods, and donor feces are being used to manage health. In addition, we explore the rationale for selecting beneficial microbial strains and aligning diets to accommodate their propagation in the gut. A pilot clinical trial design is presented to examine the effects of probiotics and exercise in patients with phenylketonuria (PKU); it is the most common inborn error of amino acid metabolism, and it is a complication that requires lifelong dietary intervention. The example design is provided to illustrate the importance of using omics technology to see if the intervention elevates neuroactive biogenic amines in the plasma; increases the abundance of Eubacterium rectale, Coprococcus eutactus, Akkermansia muciniphila, or Butyricicoccus; and increases Escherichia/Shigella in the gut, all as markers of improved health. By emphasizing the combined importance of diet, microbial supplements, and the gut microbiome, we hope that future studies will better align these components, not only to improve outcomes, but also to enhance our understanding of the mechanisms.