## 6 Prebiotics, Synbiotics, Paraprobiotics, Postbiotics, and Psychobiotics
High-intensity ultrasound can also be used to inactivate probiotics for generating paraprobiotics by adjusting process parameters resulting in a high level of sonoporation within the cell, leakage of cellular content, and fluctuation of the cell membrane lipid bilayer [330]. Health benefits provided by the use of paraprobiotics include immunomododulation, pathogen inhibition, intestinal microbiota modulation, intestinal injury recovery, reduction of bacterial translocation and preservation of the intestinal barrier, treatment of diarrhea, inflammation modulation, reduction of lactose intolerance, cholesterol reduction, respiratory disease reduction, treatment of alcohol-induced liver diseases, cancer growth inhibition, atopic dermatitis treatment, visceral pain response modulation, colitis treatment, suppression of certain age related diseases, and dental caries inhibition [329]. Paraprobiotics have been incorporated into yogurt. Parvarei et al. [333, 334, 335] incorporated heat-killed or viable _L. acidophilus_ ATCC SD 5221 or heat-killed or viable _B. lactis_ BB-12 into yogurt either before or after fermentation and compared the properties to a control yogurt. Viability of starter cultures was increased with the addition of paraprobiotics [333]. They typically found less syneresis and greater water holding capacity for yogurts containing the paraprobiotics added before fermentation compared to the remaining yogurts due to the presence of exopolysaccharides derived from the inactivated cells [333]. There were pores and void spaces within the microstructure of these yogurts containing paraprobiotics \begin{table}
\begin{tabular}{l l l} \hline \hline
**Probiotic** & **Prebiotic** & **Reference** \\ \hline _L. acidophilus_ and _Bifidobacteria_ & Citrus peels of sour orange, sweet orange, and lemon & [312] \\ _L. acidophilus_ and _L. casei_ & Stachyose & [313] \\ _L. casei_ 01 & Inulins of varying chain lengths: short (P95), medium & [314] \\ _L. casei_ 01 & Inulin, polyedxtrose, and modified starch & [315] \\ _L. casei_ strain Shirota & Inulin or fructans from _Agave salmiana_ Otto & [316] \\ _L. casei_ and _L. gasseri_ & Banana fiber and peel banana fiber & [317] \\ _L. casei_ 431, _L. rhamns_ LGG, and & Banana peel powder and Mango peel powder & [318] \\ _B. animalis_ subsp. _lactis_ BB-12 & Inulin & [204] \\ _L. paramcuses_\({}^{1}\) & Latitol 1 & [319] \\ _L. paracasei_ & Galactofractose, inulin, soy protein isolate, and spirulina & [320] \\ _L. plantarum_ CFR 2194 and _L. fermentum_ CFR 2192 & Fructooligosaccharides & [321] \\ _L. plantarum_\({}^{1}\) & Sorbitol & [322] \\ _L. plantarum_ TISTR 1465 & Black waxy rice & [323] \\ _L. reuteri_ DPC16 & Manuka honey & [324] \\ _B. longum_ ATCC 15707 & Rosemary extract & [325] \\ _B. animals_ BB-12 & Inulin & [56] \\ _B. infants_ BB02 & Gluten Friendly Flour\({}^{\dagger\text{TM}}\) & [326] \\ _Propinibacterium freudenreichii_ ssp. _shermanii_ (PS-4) & Inulin & [327] \\ \hline \hline \end{tabular} \({}^{1}\) Synbiotic microcapsules.  
\end{table} 
Table 4: _Cont._added before fermentation [334]. Yogurts incorporating heat-killed _B. lactis_ BB-12 into yogurt before fermentation had the highest flavor and mouthfeel sensory scores [335]. Postbiotics have been defined by a panel from the International Scientific Association for Probiotics and Prebiotics as a \"preparation of inanimate microorganisms and/or their components that confers a health benefit on the host\" [336]. Guimaraes et al. [330] suggested that postbiotics can be produced by high-intensity ultrasound. Advantages of using postbiotics are their inability to cause infections because they are not alive and their long shelf-life. Depommier et al. [337] administered pasteurized (killed) _Akkermansia muciniphila_ to individuals who were overweight or obese with insulin resistance and found improved insulin sensitivity but reduced insulinemia and plasma total cholesterol. Darwish et al. [338] produced a functional yogurt incorporating the postbiotic _E.