TNF and Insulin resistance: A randomized, double-blind, placebo-controlled clinical trial showed that multistrain probiotic supplementation can decrease insulin, insulin resistance, TNFα, and IL-6 in patients with NAFLD [178]; further, in the same line, treatment with Lactobacillus bulgaricus and Streptococcus thermophilus can decrease ALT and AST activity, and gamma glutamyl transferase (GGT) levels in NAFLD patients [179].