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The most frequently reported adverse effects involve gastrointestinal symptoms, which typically emerge during the initial days to weeks of supplementation as the gut microbiome adjusts to the introduced bacterial strains

Upregulation of autophagy-related proteins (including BCL-1, ATG7, ATG5, and LC3-II) in synovial tissues contributes to synovial fibroblast proliferation, resistance to apoptosis, and chronic inflammatory activation

These are supported by decades of outcome data