Thirty-two patients with cirrhosis and cognitive dysfunction or a history of falls were enrolled in a recent study by Soriano, Laghi, and colleagues. The scope of the trial was to explore new approaches to improve cirrhotic patients’ outcomes and health-related quality of life. Seventeen patients were supplemented with the multistrain probiotic De Simone Formulation (the DSF, Vivomixx®, 450 billion live bacteria daily) for 12 weeks, and 15 received a placebo. Blood and fecal samples were collected to analyze the serum metabolome and microbiota composition. Among the 54 blood metabolites identified using proton nuclear magnetic resonance (1H-NMR) spectroscopy, the probiotic group showed an increase in glutamine, a decrease in glutamate, and an increase in the glutamine/glutamate ratio. The placebo group showed increased glutamate and decreased glutamine/glutamate ratio. The increase in the serum glutamine/glutamate ratio could reflect a higher capacity of ammonia clearance that, together with a decrease in the pro-inflammatory state, would explain the improvement in cognitive function and risk of falls observed in patients supplemented with Vivomixx®. Interestingly, authors found that higher glutamine/glutamate ratio values in blood were associated with a lower abundance of Paraprevotella and Oscillospira in feces. The quantity of these bacteria has been associated with sedentarism, physical frailty, and sarcopenia.