# The Administration of Probiotics against Hypercholesterolemia: A Systematic Review
## 4 Discussion  
The results were correlated with the study of milk products fermented with _B. longum_, which reduces the serum lipids in healthy moderate hypercholesterolemia male adults [53]. The isoflav-supplemented soy product fermented with _E. faccum_ CRL 183 and _L. helevticus_ 416 significantly improves the lipid profile in moderately hypercholesterolemia men subjects. The fermented soy product has an anti-inflammatory effect and activates estrogen-receptor complex mechanisms, thereby reducing the LDL-c level. It reduces the serum LDL-c level, and no significant changes were noted in HDL-c and TG levels [43]. The reported results were established previously by [PERSON] et al. [54] and [PERSON] et al. [55]. However, this study does not include women subjects to estimate the estrogen effects in women. In addition, pickled mustard greens fermented with lactic acid bacteria were beneficial for lowering cholesterol [56]. The possible benefit of a natural health mixture containing B. longum BB536 and RYR (Red Yeast Rice) extract involves two different pathways to facilitate LDL-c and TC reduction. RYR extracts inhibit the liver's cholesterol production, and B. longum BB536, by its high bile salt hydrolase function, reduces intestinal cholesterol absorption [40]. In addition, the expression of LXRa and LXRb/NPC1L1 genes plays a critical role in the absorption of intestinal cholesterol in vitro [57; 58; 59]. _L. plantarum_ ECGC supports the bile acid function, which reduces the cholesterol in mildly hypercholesterolemia adults without any impact on gastrointestinal and gut microbiota that can be possibly the best natural cholesterol-lowering supplement [42]. However, available data indicate that the study does not target severe hypercholesterolemia patients to claim the results are accurate. _S. bouldardii_ var. _bouldardii_ CNCM I-1079 supplementation lowered remnant lipoprotein. TG-rich lipoproteins are linked to the incidence and development of coronary artery disease, regardless of LDL-c levels [43]. However, the precise lipoprotein lowering mechanisms of _S. bouldardii_ is undisclosed, and the safety and tolerance of the strain were also not evaluated in this study. The safety risk management criteria are required to measure the safety of probiotics. However, due to the wide variety of microorganisms, it is also important to determine the unique hazards connected with each probiotic, including the risk factors associated with the host and the complex interaction between the probiotic, host, and nutrition constituents [60; 61]. _L. reuteri_ NCIMB 30242 was found to raise bloodstream bile acid levels involved in several metabolic activities, including energy balance, lipid metabolism, and inflammatory control [62; 63]. The administration of _Bifidobacterium_ species claimed to be involved in the control of dyslipidemia in hypercholesterolemia children by improving lipid profile [48]. However, to elucidate the precise molecular mechanisms of action of _Bifidobacterium_ in dyslipidemic children, further studies and clinical examination are needed. _L. reuteri_ NCIMB lowers cholesterol and reduced sterol absorption. Authors have also analyzed the increased circulation of 25-hydroxyvitamin D in serum during _L. reuteri_ NCIMB administration and found that the level of vitamin D was increased at the end of the study. The increased vitamin D level improves the proper intestinal colonization of probiotics, prevents pathogenic bacterial invasion, reduces chronic inflammation, and maintains enterocyte cell integrity [45; 64; 65]. Women who consumed yogurt containing _L. acidophilus_ 145 and _B. longum_ 913 regularly for six months had higher HDL-c levels and improved LDL-c/HDL-c ratio [52]. [PERSON] and [PERSON] reported that a probiotic mixture diet containing Bacillus, Lactobacillus, Streptococcus, Clostridium, Saccharomyces, and Candida decreased cholesterol synthesis in rats' liver. The _L.