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Those taking warfarin should exercise caution and monitor INR levels when starting or stopping probiotics, as some bacterial strains might theoretically affect vitamin K production, though evidence is limited and this concern does not apply to direct oral anticoagulants (DOACs)
Since most ingested allulose is absorbed and excreted in urine, with only a fraction reaching the colon, the direct microbiome effects may be less significant than initially hypothesized
It is believed that this increased bleeding risk is due to a alpha-tocopherol metabolite that has anti-vitamin K activity
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Interestingly, the magnitude of reduction decreased after 6 months, though its not clear why
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