Spirulina

What it is

Spirulina is dried biomass of photosynthetic cyanobacteria of the genus Arthrospira, sold as powder, tablets or an ingredient in greens blends. It is a prokaryotic bacterium rather than a true alga, and is roughly 65% to 70% protein, with vitamins, calcium, iron, polyunsaturated fatty acids and the blue pigment phycocyanin, which makes up as much as a fifth of its dry weight. It is grown in warm, alkaline open ponds, which can be colonised by other cyanobacteria that produce microcystin liver toxins.

What the research says

Spirulina is sold for cholesterol, blood pressure, energy and immunity. The human evidence is real but modest and comes from small trials: meta-analyses report lower triglycerides and total cholesterol, and lower blood pressure, but the trials pooled are mostly under 100 people and heterogeneity is substantial. Other outcomes are consistently null: one meta-analysis found no significant effect on LDL cholesterol, fasting glucose or HbA1c, and an umbrella review found no significant effect on the inflammatory markers TNF-alpha and IL-6. The clearest documented risks are not from the organism but from what grows with it: laboratory analyses of retail supplements have found microcystins in a substantial share of samples, in some cases at levels that would push consumers past the WHO tolerable daily intake. There are also case reports linking spirulina to autoimmune disease onset or flare, and a French agency has logged dozens of adverse event reports.

Evidence grade: Limited evidence.

What goes wrong

Microcystin liver toxins were quantified in nine of 35 algal food supplements from the Belgian market, with three samples above a proposed guideline value. (Source 1)

• Survey study, Moderate certainty.
• Size: 35 algal food supplement samples.
• Who: commercial algal food supplements on the Belgian market.
• How long: not applicable.
• Result: 9 of 35 samples contained microcystin congeners; 3 exceeded 1 microgram per gram, a previously proposed guideline value; the toxin-producing gene was traced to Microcystis in seven of ten products tested.
• Funding: not stated; work conducted at Sciensano, the Belgian national health institute.

Nine out of these samples contained microcystin congeners, of which three exceeded 1 µg g−1, a previously proposed guideline value.

The Belgian analysis used a validated mass-spectrometry method on 35 samples and combined the results with consumption data to model exposure. (Source 1)

• Survey study, Moderate certainty.
• Size: 35 samples.
• Who: algal food supplements including spirulina products.
• How long: not applicable.
• Result: eight microcystin congeners and nodularin quantified by UHPLC tandem mass spectrometry.
• Funding: not stated.

Our analytical method was successfully validated and applied on 35 food supplement samples.

In a separate analysis of five retail spirulina products and spirulina-containing foods, microcystins were found in every sample. (Source 2)

• Survey study, Low certainty.
• Size: 5 products (2 supplements, 3 foods)
• Who: commercially available spirulina products.
• How long: not applicable.
• Result: all samples contaminated with microcystins at 143 to 321 ng per gram.
• Funding: not stated.

All samples were contaminated with MCYSTs at concentrations ranging from 143 to 321 ng g−1.

The authors of that analysis judged the microcystin levels sufficient for consumers to exceed recommended daily limits, and also found potentially pathogenic bacteria. (Source 3)

• Survey study, Low certainty.
• Size: 5 products.
• Who: retail spirulina supplements and spirulina-supplemented foods.
• How long: not applicable.
• Result: Bacillus cereus and Klebsiella pneumoniae detected among other potentially pathogenic bacteria.
• Funding: not stated.

Several potentially pathogenic bacteria were detected in the products, including Bacillus cereus and Klebsiella pneumoniae. Microcystin toxins were detected in all the products at levels that could lead to consumers exceeding their recommended daily limits.

The French food safety agency reports that trace metals including lead, mercury and arsenic have been found in commercial spirulina samples above European Union or USP limits. (Source 4)

• Official position, Certainty not rated.
• Size: not quantified in the opinion text retrieved.
• Who: commercial spirulina samples.
• How long: not applicable.
• Result: concentrations exceeding EU limits or USP Dietary Supplements Compendium specifications have been reported.
• Funding: government body, ANSES opinion of 4 August 2017.

The presence of trace metal elements (lead, mercury, arsenic) at concentrations exceeding the limits laid down by the European Union or the specifications of the USP Dietary Supplements Compendium has been reported in commercial samples of spirulina.

ANSES received 49 reports of adverse effects possibly linked to spirulina supplements up to February 2017, including a severe allergic facial angioedema and a case of acute rhabdomyolysis. (Source 4)

• Case series, Very low certainty.
• Size: 49 reports, of which ten were analysed for causality.
• Who: consumers of spirulina-containing food supplements in France.
• How long: from the start of the nutrivigilance scheme to February 2017.
• Result: one published case of allergic facial angioedema of great severity; a case of acute rhabdomyolysis in a 28-year-old man with myalgia and muscle weakness.
• Funding: government body (ANSES)

Between the establishment of the nutrivigilance scheme and the month of February 2017, ANSES received 49 reports of adverse effects likely to be associated with the consumption of food supplements containing spirulina.

ANSES advises against spirulina supplements for people with phenylketonuria, allergic predisposition, or muscle or liver vulnerability, while saying the main risk is contamination rather than spirulina itself. (Source 4)

• Official position, Certainty not rated.
• Size: not applicable.
• Who: general French population.
• How long: not applicable.
• Result: no apparent health risk at low doses up to several grams per day, apart from contamination risk.
• Funding: government body (ANSES), 2017.

ANSES advises against the consumption of these food supplements by individuals suffering from phenylketonuria or with an allergic predisposition, or a muscle or liver vulnerability.

A 2025 letter to the editor that searched the literature found five published cases of autoimmune disease starting or flaring after spirulina, with onset from 1 to 2 days to 1 year after ingestion. (Source 5)

• Case series, Very low certainty.
• Size: four articles reporting five cases.
• Who: people who developed or flared autoimmune disease after taking spirulina.
• How long: time from ingestion to onset varied from 1 to 2 days up to 1 year.
• Result: autoimmune disease onset or flare; the authors single out dermatomyositis and pemphigus.
• Funding: not stated.

The time between spirulina ingestion and autoimmune onset varied from 1 to 2 days to 1 year.

The authors of that letter advise caution with spirulina in people who already have autoimmune disease, and monitoring of people who take it. (Source 6)

• Case series, Very low certainty.
• Size: five cases.
• Who: patients with autoimmune disease.
• How long: not applicable.
• Result: recommendation for monitoring rather than a quantified risk.
• Funding: not stated.

We concluded that Spirulina should be used with caution in patients with autoimmune diseases, especially dermatomyositis and pemphigus.

LiverTox records at least one published case and several national registry reports of liver injury linked to spirulina, notes the published case was also taking other liver-toxic drugs, and describes such injury as quite rare. (Source 7)

• Official position, Low certainty.
• Size: one detailed published case plus registry reports.
• Who: spirulina users.
• How long: latency to jaundice of 5 weeks in the reported case.
• Result: hepatocellular injury without immunoallergic or autoimmune features, with rapid and complete recovery on withdrawal; the patient was also taking acarbose and simvastatin.
• Funding: government body (NIH)

Despite its long history of use and safety, spirulina has recently been implicated in at least published case of clinically apparent liver injury and in several reports of hepatic injury to national registries of adverse drug events. In the single case report, the latency to onset of jaundice was 5 weeks and the injury was hepatocellular, without immunoallergic or autoimmune features and with rapid and complete recovery on withdrawal. The patient was also taking several other drugs that can cause liver injury which were stopped at the same time including acarbose and simvastatin. Thus, spirulina may cause clinically apparent liver injury, but it is quite rare.

LiverTox notes that spirulina is grown in open lakes and can be contaminated by toxin-producing blue-green algae. (Source 7)

• Official position, Certainty not rated.
• Size: not applicable.
• Who: not applicable.
• How long: not applicable.
• Result: contamination with microcystin-producing cyanobacteria described as a known risk of production.
• Funding: government body (NIH)

Spirulina typically grows in warm open lakes with high alkalinity and can be contaminated with other blue-green algae that produce toxins (microcystins).

What the evidence supports

A meta-analysis of seven randomised trials found spirulina lowered triglycerides and total cholesterol modestly. (Source 8)

• Meta-analysis, Low certainty.
• Size: 7 trials, 338 participants.
• Who: adults with obesity, diabetes or dyslipidaemia.
• How long: not stated in the abstract.
• Result: triglycerides mean difference -15.34 mg/dL (95% CI -29.76 to -0.91); total cholesterol -11.83 mg/dL (95% CI -20.56 to -3.10)
• Funding: not stated.

We found that spirulina supplementation significantly reduced the triglycerides (TG) (mean difference (MD): −15.34 mg/dL; 95% CI: −29.76 to −0.91) and total cholesterol (TC) levels (MD: −11.83 mg/dL; 95% CI: −20.56 to −3.10).

A meta-analysis of five trials in 230 people found lower blood pressure with spirulina, but the trials were small and the systolic estimate was statistically heterogeneous. (Source 9)

• Meta-analysis, Low certainty.
• Size: 5 randomised controlled trials, 230 subjects.
• Who: adults, with a subgroup of hypertensive patients.
• How long: 2 to 12 weeks.
• Result: systolic -4.59 mmHg (95% CI -8.20 to -0.99, I2 = 65%); diastolic -7.02 mmHg (95% CI -8.86 to -5.18, I2 = 11%)
• Funding: not stated.

Data analysis indicated that Spirulina supplementation led to a significant lowering of SBP (Mean Difference (MD): −4.59 mmHg, 95% Confidence Interval (CI): −8.20 to −0.99, I square statistic (I2) = 65%) and significant lowering of DBP (MD: −7.02 mmHg, CI: −8.86 to −5.18, I2 = 11%), particularly in a subgroup of hypertensive patients.

An umbrella review of 12 meta-analyses found the largest effect on body fat, with smaller effects on lipids, systolic blood pressure, waist circumference and BMI. (Source 10)

• Review of reviews, Low certainty.
• Size: 12 meta-analyses covering 5 to 17 RCTs each, 240 to 1,500 participants.
• Who: adults across cardiometabolic, inflammatory and oxidative stress outcomes.
• How long: 2 to 52 weeks.
• Result: body fat Hedges' g -0.811 (P < 0.001); TC, TG and LDL all Hedges' g -0.600 (P = 0.001); SBP -0.432 (P < 0.001); waist circumference -0.247 (P < 0.001); BMI -0.058 (P = 0.008)
• Funding: not stated.

Limit of this finding: The same abstract says spirulina 'enhanced' SOD activity (an antioxidant enzyme) with P = 0.057. That is above the review's own cut-off of P < 0.05, so by the review's own rule the SOD result is not statistically significant and should not be read as a demonstrated benefit. The review's closing claim that spirulina 'enhances immune function' leans partly on results like this and on IL-2 alone.

Spirulina exerted its greatest and most significant effect on body fat reduction (Hedges' g = −0.811, P < 0.001).

In the same trial, fewer children were anaemic after spirulina than after placebo: the number of anaemic children fell by 11 on spirulina and by 6 on placebo. (Source 11)

• Randomized trial, Low certainty.
• Size: 179 children completed the trial; 99 completed all haematological measures.
• Who: young pre-school Cambodian children in deprived settings.
• How long: 100 g in total given at 2 g per day in each period, 5-week washout, then crossover.
• Result: anaemic children decreased by 11 (11.11%) on spirulina versus 6 (6.06%) on placebo, p = 0.004.
• Funding: non-commercial: PSE Cambodia supplied the spirulina and care costs, Antenna France supported follow-up (per the paper)

The number of anemic children decreased by 6 (6.06%) and 11 (11.11%) on Placebo or SP, respectively (p = 0.004).

What the evidence does not support

The same meta-analysis found no significant effect of spirulina on LDL cholesterol, fasting blood glucose, HbA1c or HDL cholesterol. (Source 8)

• Meta-analysis, Low certainty.
• Size: 7 trials, 338 participants.
• Who: adults with obesity, type 2 diabetes, metabolic syndrome or overweight.
• How long: not stated in the abstract.
• Result: LDL-C -7.80 mg/dL (95% CI -16.94 to 1.33); fasting glucose -3.38 mg/dL (95% CI -9.88 to 3.12); HbA1c -0.27% (95% CI -0.94 to 0.39); HDL-C +0.73 mg/dL (95% CI -2.49 to 3.94)
• Funding: not stated.

However, low-density lipoprotein cholesterol (LDL-C) (MD: −7.80 mg/dL; 95% CI: −16.94 to 1.33), fasting blood glucose (FBS) (MD: −3.38 mg/dL; 95% CI: −9.88 to 3.12), and glycosylated hemoglobin (HbA1c) (MD: −0.27%; 95% CI: −0.94 to 0.39) levels were not significantly reduced.

The same umbrella review found no statistically significant effect of spirulina on the inflammatory markers TNF-alpha and IL-6. (Source 10)

• Review of reviews, Low certainty.
• Size: 12 meta-analyses of randomised trials.
• Who: adults.
• How long: 2 to 52 weeks.
• Result: TNF-alpha Hedges' g -0.070, P = 0.589; IL-6 Hedges' g -0.720, P = 0.071.
• Funding: not stated.

while effects on TNF-α (Hedges'g = − 0.070, P = 0.589) and IL-6 (Hedges' g = − 0.720, P = 0.071) were not statistically significant.

In a placebo-controlled crossover trial in pre-school Cambodian children, 2 g a day of spirulina did not significantly increase weight gain and had no effect on height. (Source 11)

• Randomized trial, Low certainty.
• Size: 179 children completed the trial (the paper reports 194 children included); 149 completed all anthropometrics and 99 all haematological measures.
• Who: young pre-school Cambodian children in deprived settings.
• How long: 100 g in total given at 2 g per day in each period, 5-week washout, then crossover.
• Result: weight gain 0.63 kg (95% CI 0.54 to 0.72) on spirulina versus 0.46 kg (95% CI 0.33 to 0.58) on placebo, p = 0.07; height increased similarly in both groups.
• Funding: non-commercial: PSE Cambodia supplied the spirulina and care costs, Antenna France supported follow-up (per the paper)

The weight gain of the SP group showed a modest higher trend compared to placebo (0.63 kg; 95%CI: 0.54–0.72 and 0.46 kg; 95%CI: 0.33–0.58, respectively; p = 0.07). Height increased similarly in both groups.

The NIH LiverTox monograph states spirulina has not been proven effective for any medical condition in humans. (Source 7)

• Official position, Certainty not rated.
• Size: not applicable.
• Who: not applicable.
• How long: not applicable.
• Result: no proven human indication; antioxidant, anti-inflammatory and analgesic effects demonstrated in animal experiments.
• Funding: government body (NIH), last updated 10 April 2019.

There have been limited studies in humans, but it has not been proven to be effective in treating any medical condition.

Where the evidence is mixed

Heterogeneity between the lipid trials in that meta-analysis was moderate to high, which weakens the pooled lipid estimates. (Source 8)

• Meta-analysis, Low certainty.
• Size: 7 trials, 338 participants.
• Who: adults with cardiometabolic disorders.
• How long: not stated.
• Result: moderate and high heterogeneity in all lipid meta-analyses; two of seven trials had some concerns of bias over randomisation and allocation concealment.
• Funding: not stated.

However, two RCTs had some concerns of bias regarding the randomization process and deviations from intended interventions due to a lack of information about allocation concealment and how participants were assigned to the experimental and control groups.

A different GRADE-assessed meta-analysis pooling 20 studies reported that spirulina significantly reduced LDL cholesterol, contradicting the smaller meta-analysis. (Source 12)

• Meta-analysis, Certainty not rated.
• Size: 20 studies (23 arms, 1,076 participants)
• Who: adults in randomised trials of spirulina supplementation.
• How long: not stated in the abstract text retrieved.
• Result: LDL-C SMD -0.6 (95% CI -0.9, -0.2, P<0.05); TC SMD -0.6 (95% CI -0.9, -0.2, P<0.05); TG SMD -0.6 (95% CI -0.9, -0.2, P<0.05); HDL-C SMD 0.3 (95% CI 0.0, 0.6, P<0.05)
• Funding: not stated.

Spirulina intervention significantly reduced LDL-C (SMD: −0.6, 95% CI: −0.9, −0.2, P<0.05), TC (SMD: −0.6, 95% CI: −0.9, −0.2, P<0.05) and TG (SMD: −0.6, 95% CI: −0.9, −0.2, P<0.05) levels while HDL-C levels were significantly increased (SMD: 0.3, 95% CI: 0.0, 0.6, P<0.05).

The authors of the blood pressure meta-analysis said more precise trials are needed to clarify the effect. (Source 9)

• Meta-analysis, Low certainty.
• Size: 5 trials, 230 subjects.
• Who: adults.
• How long: 2 to 12 weeks.
• Result: doses ranged from 1 to 8 g per day.
• Funding: not stated.

More exact randomized controlled trials are needed to clarify the effect of Spirulina supplementation on blood pressure.

The umbrella review is built on small, short trials, with individual meta-analyses covering as few as five trials and 240 participants over as little as two weeks. (Source 10)

• Review of reviews, Low certainty.
• Size: 12 meta-analyses drawn from 131 identified studies.
• Who: adults.
• How long: 2 to 52 weeks.
• Result: doses ranged from 0.2 to 30 g per day.
• Funding: not stated.

From 131 identified studies, 12 meta-analyses (5–17 RCTs, 240–1500 participants, 2–52 weeks, 0.2–30 g/day Spirulina) were included.

One survey of 25 commercial spirulina products measured only six elements, not including lead, cadmium or arsenic, and found mercury below the WHO and FAO tolerable amount in every sample. (Source 13)

• Survey study, Very low certainty.
• Size: 25 spirulina products sold worldwide.
• Who: commercial spirulina products for direct human consumption.
• How long: not applicable.
• Result: six elements measured (Ni, Zn, Hg, Pt, Mg, Mn); mercury in all samples below the WHO/FAO tolerable amount of 50 micrograms per day; lead, cadmium and arsenic were not among the elements measured.
• Funding: not stated.

For all the products analysed, mercury level in all Spirulina samples does not exceed the legislation of UN World Health Organization/FAO i.e. the tolerable amount of 50 μg/day

Where the research disagrees

Whether spirulina lowers LDL cholesterol

• Bohorquez-Medina and colleagues, NFS Journal, 2021, meta-analysis of 7 trials, 338 participants: However, low-density lipoprotein cholesterol (LDL-C) (MD: −7.80 mg/dL; 95% CI: −16.94 to 1.33), fasting blood glucose (FBS) (MD: −3.38 mg/dL; 95% CI: −9.88 to 3.12), and glycosylated hemoglobin (HbA1c) (MD: −0.27%; 95% CI: −0.94 to 0.39) levels were not significantly reduced. (Source 8)
• Rahnama and colleagues, Pharmacological Research, 2023, GRADE-assessed dose-response meta-analysis of 20 studies (23 arms, 1,076 participants): Spirulina intervention significantly reduced LDL-C (SMD: −0.6, 95% CI: −0.9, −0.2, P<0.05), TC (SMD: −0.6, 95% CI: −0.9, −0.2, P<0.05) and TG (SMD: −0.6, 95% CI: −0.9, −0.2, P<0.05) levels while HDL-C levels were significantly increased (SMD: 0.3, 95% CI: 0.0, 0.6, P<0.05). (Source 12)

How worried to be about microcystin contamination of spirulina supplements

• ANSES, French Agency for Food, Environmental and Occupational Health and Safety, 2017, agency opinion reviewing published contamination studies and nutrivigilance reports: Most products containing exclusively spirulina (Arthrospira spp.) that have undergone contamination studies do not have a worrying level of cyanotoxins. (Source 4)
• Van Hassel and colleagues, Toxins, 2022, validated LC-MS/MS analysis of 35 market samples with exposure modelling: Nine out of these samples contained microcystin congeners, of which three exceeded 1 µg g−1, a previously proposed guideline value. (Source 1)

How much

• Reference intake: No dietary reference intake, recommended daily allowance or adequate intake exists for spirulina. It is a food and supplement rather than a required nutrient, and the NIH LiverTox monograph states it has not been proven effective for any medical condition. (Source 7)
• Upper limit: No tolerable upper intake level has been set for spirulina itself. ANSES states that apart from contamination, spirulina does not appear to present a health risk at low doses of up to several grams a day, and that an expert appraisal is needed to set a microcystin threshold for these supplements; the WHO tolerable daily intake for microcystins is 0.04 micrograms per kilogram of body weight per day. (Source 4)
• Studied: The blood pressure meta-analysis pooled trials giving 1 to 8 g a day for 2 to 12 weeks. (Source 9)
• Studied: The umbrella review covered meta-analyses of trials giving 0.2 to 30 g a day for 2 to 52 weeks. (Source 10)
• Studied: The Cambodian children's crossover trial gave 2 g a day, 100 g in total per period, with a 5-week washout between periods. (Source 11)

A common belief, and what the research shows

The belief: Spirulina is a clean natural superfood, so there is nothing in it to worry about.

What the research shows: Contamination is the documented risk. LiverTox notes that "Spirulina typically grows in warm open lakes with high alkalinity and can be contaminated with other blue-green algae that produce toxins (microcystins)." Market surveys bear that out: one found "Nine out of these samples contained microcystin congeners, of which three exceeded 1 µg g−1, a previously proposed guideline value." and another that "All samples were contaminated with MCYSTs at concentrations ranging from 143 to 321 ng g−1." ANSES adds that "The presence of trace metal elements (lead, mercury, arsenic) at concentrations exceeding the limits laid down by the European Union or the specifications of the USP Dietary Supplements Compendium has been reported in commercial samples of spirulina."

Questions and answers

What is it?

Spirulina is the commercial name for dried microalgae (cyanobacteria) of the genus Limnospira, formerly called Arthrospira. It is valued mainly for its nutrient content. (Source 14)

What does it do in the body?

Dried spirulina is mostly protein, with some carbohydrate, fat, vitamins and minerals. A 2025 review says its blue pigments, phycocyanin and phycocyanobilin, block an enzyme called NADPH oxidase and so reduce inflammatory signalling molecules. How much this matters in people is not established. (Source 14)

Is it good or bad for you?

Benefits are modest and the reviews rate the evidence differently. One 2025 meta-analysis of 17 trials reported small reductions in body weight and body fat and graded the evidence high. Another 2025 review in overweight adults graded body-weight evidence low and found little effect on blood sugar. Separately, contamination with algal toxins is a documented risk (see getRidOf). (Source 14)

How do you get more of it?

In trials, spirulina was given as a daily supplement. A 2025 meta-analysis found larger reductions in body weight and body fat at higher doses and over longer periods, especially in people with obesity or older people. (Source 15)

If it is harmful, what reduces it?

Spirulina products generally contain non-toxic cyanobacteria, but they can be contaminated with toxin-producing species when they are grown in natural waters without proper quality controls. In one study, 8 of 18 algae supplements contained toxins above tolerable daily intake values. (Source 16)

Why might someone be low in it or missing it?

Does not apply. Spirulina is not a nutrient or a normal part of the gut, so no one is deficient in it. It is an optional food or supplement. (Source 16)

Which whole foods contain it or feed it?

Spirulina is itself a food ingredient, eaten as dried biomass. It is high in protein and also contains carbohydrates, fats, beta-carotene and gamma-linolenic acid. (Source 14)

What happens if you do not have it?

Nothing is known to happen from not taking it. One common belief is wrong: spirulina is not a reliable vitamin B12 source. In a study of 57 algae products, the main form of B12 in spirulina supplements was 'pseudo-vitamin B12', not the physiologically active form found mainly in chlorella products. (Source 17)

How can you test for it?

No test on the person applies. Products can be tested in a laboratory for cyanotoxins. A survey of 31 spirulina products sold in Greece found none over the adult tolerable daily intake for microcystins, but six were over the limit for children and 23 over the limit for infants. (Source 18)

References

1. Toxins. LC-MS/MS Validation and Quantification of Cyanotoxins in Algal Food Supplements from the Belgium Market and Their Molecular Origins. 2022. DOI 10.3390/toxins14080513. Read the source
2. Microorganisms. Microbiota and Cyanotoxin Content of Retail Spirulina Supplements and Spirulina Supplemented Foods. 2023. DOI 10.3390/microorganisms11051175. Read the source
3. Microorganisms. Microbiota and Cyanotoxin Content of Retail Spirulina Supplements and Spirulina Supplemented Foods. 2023. DOI 10.3390/microorganisms11051175. Read the source
4. ANSES (French Agency for Food, Environmental and Occupational Health & Safety). OPINION of the French Agency for Food, Environmental and Occupational Health & Safety on the "risks associated with the consumption of food supplements containing spirulina". 2017. Read the source
5. Advances in Rheumatology. Spirulina ingestion and autoimmune disease onset or flare. 2025. DOI 10.1186/s42358-025-00446-7. Read the source
6. Advances in Rheumatology. Spirulina ingestion and autoimmune disease onset or flare. 2025. DOI 10.1186/s42358-025-00446-7. Read the source
7. National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health. Spirulina - LiverTox: Clinical and Research Information on Drug-Induced Liver Injury. 2019. Read the source
8. NFS Journal. Impact of spirulina supplementation on obesity-related metabolic disorders: A systematic review and meta-analysis of randomized controlled trials. 2021. DOI 10.1016/j.nfs.2021.09.003. Read the source
9. Nutrients. Effect of Spirulina Supplementation on Systolic and Diastolic Blood Pressure: Systematic Review and Meta-Analysis of Randomized Controlled Trials. 2021. PMID 34578932, DOI 10.3390/nu13093054. Read the source
10. Algal Research. Spirulina supplementation and human health: An umbrella review of meta-analysis on randomized controlled trials. 2026. DOI 10.1016/j.algal.2026.104571. Read the source
11. BMC Pediatrics. Spirulina as a daily nutritional supplement of young pre-school Cambodian children of deprived settings: a single-blinded, placebo-controlled, cross-over trial. 2022. DOI 10.1186/s12887-022-03766-5. Read the source
12. Pharmacological Research. The effect of Spirulina supplementation on lipid profile: GRADE-assessed systematic review and dose-response meta-analysis of data from randomized controlled trials. 2023. PMID 37263369, DOI 10.1016/j.phrs.2023.106802. Read the source
13. Saudi Journal of Biological Sciences. Heavy metal analysis in commercial Spirulina products for human consumption. 2013. DOI 10.1016/j.sjbs.2013.04.006. Read the source
14. Frontiers in Nutrition. Effects of spirulina supplementation alone or with exercise on cardiometabolic health in overweight and obese adults: a systematic review and meta-analysis. 2025. DOI 10.3389/fnut.2025.1624982. Read the source
15. Nutrition & Metabolism. Effects of spirulina supplementation on body composition in adults: a GRADE-assessed and dose–response meta-analysis of RCTs. 2025. DOI 10.1186/s12986-025-00959-4. Read the source
16. Toxins. Detection of Cyanotoxins in Algae Dietary Supplements. 2017. PMID 28245621, DOI 10.3390/toxins9030076. Read the source
17. Journal of Food Composition and Analysis. Biologically active or just "pseudo"-vitamin B12 as predominant form in algae-based nutritional supplements?. 2022. DOI 10.1016/j.jfca.2022.104464. Read the source
18. Journal of Consumer Protection and Food Safety. Cyanotoxin contamination in commercial Spirulina food supplements. 2021. DOI 10.1007/s00003-021-01324-2. Read the source