2020 - Fermentation and Whole Grain Phenolics
2020 - Fermentation and Whole Grain Phenolics
2020 - Fermentation and Whole Grain Phenolics
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Keywords: fermentation; fermented foods; whole grains; health benefits; phenolic compounds;
antioxidant activity
1. Introduction
Foods in the past were known to conventionally provide nutrients necessary for basic physiological
functions. This assumption has changed with available knowledge at the disposal of consumers,
changes in food regulations, and an ever-growing health-conscious population, which are factors
resulting in an increasing desire for foods with additional physiological benefits. The 2500-year-old
concept of “Let food be thy medicine and medicine be thy food” by Hippocrates is now being embraced
better than ever as consumers are gradually becoming aware of the importance of diet in health
promotion and disease prevention. Such a concept of food as medicine could have led to the trend of
what is now known as “functional foods,” which is a concept first created in Japan in the 1980s [1].
Supporting this perspective of food as medicine are several studies on whole grains (WGs) and
WG-diets having positive effects on disease markers such as blood pressure, diabetes, and obesity [2–11].
WGs are essentially made up of the germ, bran, and endosperm and contains all the important parts
of the entire grain seed in their original proportions. A more detailed and approved definition by
the American Association of Cereal Chemists (AACC) says “WGs shall consist of the intact, ground,
cracked, or flaked caryopsis, whose principal anatomical components—the starchy endosperm, germ,
and bran—are present in the same relative proportions as they exist in the intact caryopsis” [12]. On the
contrary, refined grains (RGs) are products obtained after the refining process involving the removal of
the most potent protective components of the grains found in the bran and germ. This consequently
leaves only the starchy-rich endosperm. The retained protective components in WGs make them better
constituents of beneficial components as compared to their refined counterparts.
Health beneficial constituents of WGs include phytochemicals, bioactive carbohydrate fractions,
peptides, and other phytonutrients [11,13–16]. WGs contain high amounts of phytochemicals, which are
plant secondary metabolites that have shown biological activity and have been broadly investigated as
health beneficial groups of compounds in food [17–19]. Particularly important are phenolic constituents,
which are major forms of these phytochemicals and vital with reference to their unique contribution to
the health benefits of WGs. The major sources of these phytochemicals are phenolic compounds (PCs)
due to the high concentrations of bioactive constituents in the bran and germ layer [17,20,21] and the
fact that they are largely one of the most important dietary sources of energy intake worldwide.
Phenolic
compounds
Molecules 2020, 25, x FOR PEER REVIEW 3 of 18
Phytosterols Carotenoids
Phenolic
compounds
Tocols
Whole grain CarotenoidsInulin
Phytosterols
phytochemicals
Tocols
Whole grain Inulin
Vitamin E- phytochemicals
related β-glucan
compounds
Vitamin E- Lignans
related β-glucan
compounds
Lignans
Figure
Figure 1. Whole
1. Whole grain grain phytochemicals.
phytochemicals.
As stated
As stated by Singhby Singh et al.flavonoids
et al. [40], [40], flavonoids
are theare the largest
largest group of group of phenolics
phenolics and account
and account for the for
Figure 1. Whole grain phytochemicals.
the half of known PCs in plants. These compounds are
half of known PCs in plants. These compounds are equally low molecular weight compoundsequally low molecular weight compounds
consisting
consisting Asofstated
of two two aromatic
aromatic rings
by Singh etrings
(A (Aflavonoids
and
al. [40], and
B) B) joined
joined a by
by the
are a three-carbon
three-carbon
largest group of bridge bridge
(C6–C
phenolics (C3–C
and –C 3 –C6for
structure)
the [40]. [40].
6 structure)
6account
Tannins,
Tannins, on on
halfthe the other
of other
known PCs hand,
hand, inare areThese
plants.
high high molecular
compounds
molecular weight weight
are polymeric
equally
polymeric low phenolicphenolic
molecular compounds
weight
compoundscompounds
known known
to to
contribute to
consisting the
of pericarp
two aromatic(seed coat)
rings (A color
and B) of cereals.
joined by a These
three-carbonpolyphenolic
bridge
contribute to the pericarp (seed coat) color of cereals. These polyphenolic compounds have molecular (C 6–Ccompounds
3–C6 structure)have
[40].molecular
Tannins,
weights on the other
of between hand, are
500–3000 high molecular
g/mol, containing weight polymeric
sufficient phenolic compounds
hydroxyls and other known
groups toincluding
weights of between 500–3000 g/mol, containing sufficient hydroxyls and other groups including
contribute to the pericarp (seed coat) color of cereals. These polyphenolic compounds have molecular
carboxyl
carboxyl [41–43].
[41–43]. TanninsTanninsbe canbroadly
be broadly classified into two, which include hydrolysable tannins
weights of betweencan 500–3000 classified
g/mol, containing into two,
sufficient which
hydroxyls include
and otherhydrolysable
groups including tannins
[esters of ellagic
[esters of carboxyl
ellagic acid acid (ellagitannins)
(ellagitannins) or gallic acid (gallotannins)] and condensed tannins [(called
[41–43]. Tannins can beorbroadly gallic classified
acid (gallotannins)]
into two, which and condensed
include tannins
hydrolysable [(called
tannins
polymeric
polymeric [esters proanthocyanidins)
proanthocyanidins) and known
and known
of ellagic acid (ellagitannins) togallic
or toacid
be (gallotannins)]
be composed composed ofand
of flavonoid flavonoid units)
units) [41,44].
condensed [41,44].
tanninsA [(calledA plethora
plethora of
of excellent
polymeric reviews and scientific
proanthocyanidins) and literature
known to are
be available
composed of in the
flavonoidliterature
units)
excellent reviews and scientific literature are available in the literature on detailed classifications, on detailed
[41,44]. A classifications,
plethora of
forms,excellent reviewsand
occurrences, and formation/generation
scientific literature are available
of these incompounds
the literature[15,16,40,41,45–50].
on detailed classifications,
forms, occurrences, and formation/generation of these compounds [15,16,40,41,45–50].
forms, occurrences, and formation/generation of these compounds [15,16,40,41,45–50].
Figure 2.2.Classification
Figure Classification ofofmajor
major phenolic
phenolic compounds
compounds in grains.
in whole whole grains.
3. Fermentation of WG Foods
Food processing is essential for the transformation of food crops into edible forms. Fermentation
is an old food processing technique that has been adopted for centuries around the world, especially
in developing nations. It involves an intentional conversion/modification of a substrate through
activities of microorganisms to get a desired product. This is usually completed through microbial
actions, which positively alter the appearance, flavor, functionalities, nutritional composition, color,
and texture. The fermentation process itself yields beneficial effects through direct microbial action
and production of metabolites and other complex compounds [51–53]. Conventional techniques of
fermentation include (i) natural (also called spontaneous) occurrences through the actions of endogenous
microorganisms, (ii) back slopping involves utilizing plenty of successful previous fermentation
batches) and (iii) controlled fermentation, which entails the inoculation of starter cultures/specific
strains. Subsequent fermented products are not only shelf stable through the preservative effect of this
process, but fermentation also improves bioavailability and palatability, confers desirable organoleptic
characteristics that impact aroma, texture, and flavor and improves the health beneficial components
in food [32–36]. Irrespective of the food substrate (cereal, legume, vegetable, fruit, RG, or WG),
fermentation results in the modification of inherent constituents, secondary metabolites, detoxification
of toxic components/residues, and improvement in the functionality of the food product [35,36,53–55].
The incorporation of WG into diet which, is influenced by cultural beliefs, disadvantages of longer
cooking time, the presence of phytates, tannins, and a limited variety of products made from them [56].
Additionally, some of their components may adversely affect the functional characteristics, taste, texture,
and sensory appeal of subsequent formulations. Viable options for addressing this and incorporating
WGs into diet would be completed through appropriate transformation into various other beneficial
food forms, which would ensure the possibility of obtaining various value-added products. Although
RGs are mostly used in fermented foods, the use of WGs as staple foods equally has a long history
of human consumption [23]. Findings from epidemiological studies and discoveries, therefore, have
triggered renewed interest among governmental bodies of different nations that WG should form part
of cereal servings [24,57,58]. Table 1 summarizes common fermented WG products obtained through
both solid-state fermentation (SSF) and liquid/submerged fermentation (SmF). While the former occurs
in the absence or near-absence of free water, the latter occurs in the presence of free flowing water (more
fluids compared to SSF). Subsequent fermented products are relatively few in contrast to numerous
other studies reporting the use of RGs for similar food products, which necessitates further intensified
research on the development of WG-fermented food products.
Table 1. Cont.
Due to the protective pericarp/seed coat, the fermentation process might be slightly hindered.
Such has been reported in the literature and attributed to some of the antimicrobials and bioactive
constituents in the seed coat that might mitigate the activity of fermenting microorganisms [55,90,93,94].
The protective pericarp layer of cereal tends to alter the diffusion of nutrients such as amino acids and
sugars necessary for the growth of fermenting microorganisms. While this might result in a slightly
higher pH and likely longer fermentation periods (in the absence of a starter culture), fermentation still
modifies the phenolic constituents in WGs.
during fermentation. Similar authors earlier reported an increase in TPC during the fermentation of
WG-maize [95], reportedly through the activities of β-glucosidase, which is capable of hydrolyzing
phenolic phucosides to release free phenolics. Increased extractability of PCs, synthesis of new bioactive
compounds, and consequent liberation of PCs due to structural breakdown of cereal cell walls have all
been attributed to such increases in WG-PCs after fermentation (Table 2). Through metabolic activities
of microbes, fermentation also induces structural breakdown of the cell wall, which leads to synthesis
of various bioactive compounds [65]. Equally important are the roles of proteases, amylases, xylanases
derived from fermenting microorganisms, and the cereal grain that contributes to modification of the
grain and distorting of chemical bonds, which, consequently, releases bound phenolics (Figure 3).
Table 2. Cont.
hydrolases, reductases)
Fermentation
- Breakdown of cereal cell wall
- Enhanced bioavailability
- Reduced extractability
Figure 3. A summary of ways by which whole grain phenolic compounds are modified during
Figure 3. Afermentation.
summary of ways by which whole grain phenolic compounds are modified
during fermentation.
During fermentation, PCs are metabolized and modified by fermenting organisms into other
conjugates, glucosides, and/or related forms. Such a metabolism of PCs during fermentation have
During fermentation, PCs are
been reported to increase theirmetabolized and modified
bioavailability [104,105] by fermenting
and lead to generation organisms
of compounds that into other
impact flavor [106,107]. Fermentation of sorghum into sourdough using LAB strains [singly and in
conjugates, glucosides, and/or related forms. Such a metabolism of PCs during fermentation have
two binary combinations (L. plantarum and L. casei or L. fermentum and L. reuteri)] was reported to
been reportedhaveto increase their
resulted in the bioavailability
metabolism [104,105]
of PAs, PA-esters, andglucosides
and flavonoid lead to[108].generation
Most PCs inof compounds that
this
study were metabolized and most notable were the transformation of caffeic
impact flavor [106,107]. Fermentation of sorghum into sourdough using LAB strains [singly and in acid dihydrocaffeic
two binary combinations (L. plantarum and L. casei or L. fermentum and L. reuteri)] was reported to
have resulted in the metabolism of PAs, PA-esters, and flavonoid glucosides [108]. Most PCs in this
study were metabolized and most notable were the transformation of caffeic acid → dihydrocaffeic
acid, ethylcatechol, vinylcathechol, ferulic acid → dihydroferulic acid and naringenin-7-O-glucoside →
naringenin, reportedly an indication of the presence of esterase (tannase), glucosidase, PA decarboxylase,
and PA reductase [108]. The authors also suggested that the strains might have used different pathways
for PA and flavonoid metabolism. Fermentation of WG-sorghum have also been reported to have led
to the modification of PCs (catechin, gallic acid, and quercetin) into structurally related compounds,
which were not identified [85]. The authors suggested that the observed modification could be
attributed to decarboxylation, hydrolysis, and esterification reactions that might have occurred during
fermentation [85]. In a study on the metabolism of PAs in whole wheat and rye malt sourdoughs,
L. plantarum was observed to have metabolized free ferulic acid in wheat and rye malt sourdoughs,
while a strain of L. hammesii (DSM 16381) metabolized syringic and vanillic acids and reduced
levels of bound ferulic acid in wheat sourdoughs [102]. Co-fermentation of the LAB strains was also
noted to have aided the conversion of resultant-free ferulic acid to dihydroferulic acid and volatile
metabolites (vinyl-guaiacol and ethyl-guaiacol), which suggests that PA metabolism in sourdoughs
is more enhanced by co-fermentation due to complementary metabolic activities [102]. Carboxylase,
decarboxylase, esterase, and reductase activities in the LABs were reportedly responsible for PA
metabolism in this study [102]. It should, however, be noted that such metabolism could lead to an
increase in antimicrobial activities of resulting metabolic products [109], a decrease in antimicrobial
activities [104,110], or no alteration in antimicrobial activity levels [108].
According to Gänzle [104], metabolism of PCs may involve the removal of noxious compounds
as well as the release of hexosides as a source of metabolic energy. This metabolism could, however,
be influenced by composition and intrinsic factors of the matrices/substrate and can, thus, influence
the metabolic pathway, i.e., enzymatic activities can shift from decarboxylase action to reductase to
glucosidase activity [111]. Glycosyl hydrolases have also been implicated as a group of enzymes
responsible for such metabolism of PCs [104]. For example, L. hammesii was reported to have
metabolized hydroxybenzoic acids in wheat but not in rye malt sourdoughs, which possibly reflects
that the fermentation substrate influences the expression of enzymes active on PAs [111]. Likewise, in
a study on sorghum sourdough, the accumulation of dihydrocaffeic acid by only L. fermentum indicates
Molecules 2020, 25, 927 9 of 19
that decarboxylase and reductase enzymes of the other strains (L. fermentum and L. plantarum) have
different substrate specificities [108]. The study of Gaur et al. [112] also suggests that availability of
genes necessary for the metabolism of these PCs is also of importance and a significant contributor to
the metabolic potential of fermenting microorganisms.
Table 3. Documented studies on the effect of fermentation on antioxidant activity of whole grains.
Whole Fermented
Assay Mechanism(s) Reported References
Grain Product
Increase in ABTS and DPPH due to the
role of the hydrolytic enzyme that
Maize Fermented product ABTS, DPPH Salar et al. [95]
released/mobilized bound polyphenolic
compounds, which enhanced AAs.
Koji showed increased scavenging of
ABTS and DPPH radicals due to the
Millet Koji ABTS, DPPH release of a bound form of Salar et al. [62]
phytochemicals present and high levels of
TPC modulated during fermentation.
Increase in DPPH radical inhibition after
sourdough fermentation. The conversion
Millet Sourdough bread DPPH of bound to soluble PCs improved the Wang et al. [65]
health-related functionality of the final
products.
An increase in ABTS and DPPH values
was attributed to the soluble
Quinoa, Ayyash et al.
Fermented product ABTS, DPPH phytochemicals released during
wheat [69]
fermentation and to bioactive peptides
formed as a result of proteolytic activity.
The fermentation stage increased AA
Liukkonen et al.
Rye Baked sourdough DPPH likely due to an increased level of
[97]
extractable PCs.
Molecules 2020, 25, 927 10 of 19
Table 3. Cont.
Whole Fermented
Assay Mechanism(s) Reported References
Grain Product
Reduction in antioxidant levels after
fermentation attributed to changes
during processing that affected the
Fermented extraction of total phenols and tannins. Dlamini et al.
Sorghum ABTS, DPPH
porridge Such changes were hypothesized to have [79]
likely involved associations between the
tannins, phenols, proteins, and other
compounds in the grain.
Mohapatra et al.
Sorghum Fermented product CUPRAC, DPPH Increase in AAs investigated.
[100]
Increase in AA due to regenerated and
released bioactive compounds (including
non-phenolic components after
Adebo et al.
Sorghum Ting ABTS fermentation with the L. fermentum
[85]
strains), which might have contributed to
the radical scavenging properties of the
product.
Ðordevic et al.
Wheat Fermented product DPPH, FRAP, TBA Increase in the investigated AAs.
[101]
Increase in antioxidant properties
investigated attributed to the composition
ABTS, DPPH, FRAP, of PCs, unidentified compounds, and
Dey and Kuhad
Wheat Tempe HP-scavenging and other water-soluble bioactive compounds
[91]
OH-scavenging assays like small peptides and
xylo-oligosaccharides produced during
fermentation.
Increase in soluble antioxidant potential
as fermentation increased extractable
Starzyńska-
ABTS, OH-scavenging antiradical activity scavenging potential,
Wheat Tempe Janiszewska et
and FCRS-RP assays which might be due to the release of
al. [92]
peptides and other compounds during
fermentation.
Both ABTS and DPPH scavenging
properties were enhanced after
fermentation of the WG-cereals by all the
Wheat,
four micro-organisms (except R. Dey and Kuhad
brown rice, Fermented product ABTS, DPPH
oligosporus-fermented maize). Increases [103]
maize, oat
related to release of more soluble
bioactive compounds, such as peptides
and oligosaccharides.
ABTS-2,20 -azino-bis(3-ethylbenzothiazoline-6-sulfonic acid). CUPRAC—cupric reducing antioxidant capacity.
DPPH—2,2-diphenyl-1-picrylhydrazyl. FCRS-RP—Folin-Ciocalteu reacting substances-reducing power.
FRAP—ferric reducing antioxidant property. HP—hydrogen peroxide. HPLC—high performance liquid
chromatography. OH—hydroxyl.
Although the majority of the studies reviewed herein reported increases in PCs, this is not
always the case, as decreases in these health beneficial constituents have also been reported (Table 2).
Studies on fermented WG-sorghum reported a decrease in TNC and TPC with this attributed to the
ability of tannins to bind with proteins and other components, which reduces extractability as well
as tannin degradation [79,85]. Investigations into the metabolism of sourdough by Ripari et al. [102]
also suggested that reduction in some investigated PAs might be due to metabolism of PAs by lactic
acid bacteria (LAB) and the activities of decarboxylases, esterases, and reductases. In the study of
Dey and Kuhad [103] on fermentation of different WGs, both an increase and a decrease in TPC
was observed. While increases alluded to enhanced bioavailability of cereal phenolics, a decrease
observed in maize was associated with the specificity of the microbial strain to act on the PCs as well
as the grain composition. The effect of the microbial activity on the levels of individual phenolics
can differ, depending on the microbial strain. The genome of certain microorganisms might encode
genes responsible for the metabolism and/or degradation of phenolic compounds while some do
not [92,96,102]. This might, however, be difficult to ascertain or distinguish in spontaneous fermentation
processes or back-slopping that is characterized by a wide range of fermenting microorganisms.
Molecules 2020, 25, 927 11 of 19
During the estimation of AA of food products, using more than one analytical method is
better because food contains a myriad of constituents [92]. The frequently used techniques are
spectrophotometric assays and the 2, 20 -Azino-bis (3-ethylbenzothiazoline-6-sulfate) (ABTS) (also
called ABTS-radical cation depolarization) assay as well as the cupric-reducing antioxidant capacity
(CUPRAC), 2,2-Diphenyl-1-picrylhydrazyl (DPPH) and ferric-reducing antioxidant power (FRAP)
assay. Less frequently used techniques found in the course of this review are the lipid peroxidation
technique adopting the thiobarbituric acid (TBA) assay, which was used to determine the TBA reactive
substance from lipid peroxidation [101], as well as OH- and H2 O2 -scavenging assays. These are
both concerning due to their role in causing tissue damage and cell death, and could combine with
nucleotides to cause carcinogenesis [124].
Considering the general trend of increase in WG-PCs after fermentation and associated
mechanisms, it could, thus, be hypothesized that this should be tantamount to an increase in AAs.
While such increases were reported, some studies noted decreases in AAs of WG-fermented products.
As documented by Ðordevic et al. [101] and Sun and Ho [125], possible explanations for this ambiguous
relationship between AA and PCs are that: (i) quantified TPC values do not include other components
that can equally confer AAs, (ii) synergy in a mixture makes AA not only dependent on antioxidant
concentration but also on the structure and interactions among antioxidants, and (iii) different methods
used for measuring AA based on different mechanisms may lead to different observations. Such an
observation has also been buttressed by other authors suggesting that directly linking AAs in food and
a responsible component might be somewhat difficult, as methods of extraction, identification, and/or
quantification of AAs vary [126,127], which makes comparisons and, subsequently, extrapolating
conclusions quite tricky.
General increases in AA of fermented foods have been attributed to a release of bound PC due
to activities of hydrolytic enzymes and contents modulated during fermentation of a maize-based
product and koji from millet [62,95]. A likely conversion of bound PCs into health-related components,
a release of soluble phytochemicals and other non-PCs as well as increased extractability of AA-related
PCs have equally been implicated to have led to an increase in AA during the fermentation of WGs
into tempe, ting, and sourdough (from millet and rye) [65,69,85,92,97]. An addition to these could be
that the fermentation process facilitated cleavage/dissociation of the bonds between PCs and other
constituents leading to a release of PC-monomers, which yield AAs. Equally important and implicated
in other studies are products of protein hydrolysis through proteolytic actions through fermentation,
which could have led to components that contribute to increased PC and consequent antioxidant
potential of fermented WGs. Available enzymes during fermentation and/or produced by fermenting
microorganisms could also break down ester bonds, hydrolyse β-glucosidic bonds, and distort the
hydroxyl groups in phenolic structures liberating free PCs and other antioxidant-related compounds.
On the contrary, a decrease in AA after fermentation was attributed to modifications that influenced
the extractability of compounds that confer AAs, especially the association between tannins, phenols,
proteins, and other compounds in the grain [79].
Although in vitro studies reflect potential AAs of WG-fermented cereals, these in vitro techniques
could underestimate physiological antioxidants, which necessitates in vivo studies. The use of in vivo
models in investigating the influence of fermentation on AA is largely desirable. According to
Benedetti et al. [128] and Alam et al. [129], in vivo protocols involve the administration of antioxidants
to testing animals for a specified period of time, after which the animals are sacrificed, and blood or
tissues are analyzed. Subsequently done are assays such as lipid peroxidation (LPO), thioredoxin
reductase activities, and glutathione peroxidase (GSHPx) in human patients [128,130]. Although such
in vivo studies are largely desirable, challenges related to ethical approvals, high costs, and daunting
logistics have led to the adoption of in vitro techniques. Few studies are available on in vivo assays
on fermented WG-cereal products with such studies focusing on AAs of the product. Breads made
from WG-Kamut Khorasan wheat and WG-durum wheat were both reported to protect rat liver from
Molecules 2020, 25, 927 12 of 19
oxidative stress [128]. An earlier study by similar authors reported a lower oxidative state in rats fed
with experimental diets of sourdough bread for seven weeks [131].
Phenolic compounds usually occur in an esterified form linked to the cell wall matrix in the
cereal bran and, as such, not readily available. Fermentation is considered a possible strategy to
not only increase AAs but also to release the insoluble bound phenolic acids and, thus, to improve
the poor bioavailability of grain phenolics [132]. This is particularly important as the antioxidant
potential of WGs could be restricted by low availability of compounds during digestion. Not
only does fermentation increases PCs and AA of WG-fermented products (Tables 2 and 3), it also
positively influences bioavailability, bio-accessibility, and PAs as demonstrated in a study on flours
from WG-barley fermented with probiotic strains [96].
6. Future Perspective
Fermentation positively alters food quality, confers organoleptic characteristics, and improves
phenolic constituents and antioxidant activity of WGs. Could this then translate to consumption
of more whole grains? Possibly not, considering the grittiness and associated sensory challenges
associated with whole grain foods. This might also contribute to fewer whole grain fermented foods
as compared to those from refined grains. This is in tandem with a study on the consumption of
WGs foods from brewers’ spent grain, which indicates that hereditary consumers of whole grain
foods will be more receptive to its consumption as compared to their refined foods counterpart [133].
Some studies have also indicated barriers for consuming WG foods such as the lack of knowledge about
its health benefits, challenges with cooking/preparation time, negative sensory perception, perceived
cost, and the lack of availability of whole grains [134–136].
7. Conclusions
Increasing whole grain consumption should, therefore, be a target for health organizations with
recommendations for intake proposed in many countries. As such, new strategies and partnerships
between researchers, industry, and relevant agencies are further needed to promote whole grain
consumption. Future studies are necessary in the area of phenolic compounds in fermented whole
grains along with effective techniques such as whole genome sequencing to investigate genes responsible
for the conversion of phenolic constituents and improvements in AAs. Such would largely assist in
choosing starter cultures that would further improve the quality of fermented WG foods. Deeper
investigation into the mechanisms of different forms of fermentation (solid state and liquid) on
single/pure phenolic compounds (in isolation) and antioxidant activities should equally be explored.
Additionally, studies are needed into the absorption and bioavailability of these phenolics in the gut,
preferably through in vivo models.
Funding: The University of Johannesburg Global Excellence and Stature (GES) 4.0 Catalytic Initiative Grant and the
National Research Foundation (NRF) of South Africa Thuthuka funding (Grant no: 121826) are duly acknowledged.
Conflicts of Interest: The authors declare no conflict of interest.
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