“…In particular, fermented foods are known to contain high amounts of d -amino acids, which are produced during microbial fermentation [ 22 ]. Furthermore, some lactic acid bacteria synthesize d -alanine and encode alanine racemase, which catalyzes the conversion of l -alanine to d -alanine [ 23 , 24 ]. Although we did not evaluate the d -alanine levels in stool, the protocol of the current study restricted the intake of fermented foods and the use of antimicrobial agents and lactic acid preparations during the follow-up period to minimize their influences.…”