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This concept represents a targeted evolution of probiotics, focusing on strains with specific neuroactive mechanisms, such as the ability to produce neurotransmitters (e.g., GABA, serotonin), modulate the HPA axis, or exert potent immunomodulatory effects (Akkasheh et al., 2016

Since then, many small, short-term studies have reported an increased risk for biochemical vitamin B12 deficiency in patients taking metformin, with an incidence ranging from 5.6% to 36%.2-4 A large long-term study published in 2016 reaffirmed that B12 deficiency affects a small but significant proportion of patients taking metformin.5 This study analyzed data on 1,800 participants from the Diabetes Prevention Program and the Diabetes Prevention Program Outcomes Study who were at high risk for T2DM

It is important to note that these early improvements are not universal

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Patch tests and hand eczema: retrospective study in 173 patients and literature review