Fermented foods continue to top nutritionists’ lists as a key healthy and functional component in the ideal human diet. In a new article in Runner’s World, a registered dietician recommends runners eat fermented foods to meet nutrition needs, improve their health and better support their training.
The author lists four reasons to eat fermented foods: improve the gut microbiome, add a nutritional upgrade, aid digestion and improve protein intake.
“Recent research even suggests that the makeup of our microbiome may also play a role in how our muscles adapt and develop in response to exercise. And fertilizing your gut with more desirable bacteria via fermented foods may payoff with better digestive functioning during periods of hard training and throughout long races (read: fewer sprints to the nearest port-a-potty),” the article reads. “To date, the literature suggests that probiotic foods (like fermented foods) are still the preferred method of obtaining probiotics rather than relying on supplements.”
Read more (Runner’s World)
Consumers want foods that aid gut health, but brands face a major challenge. How can they educate buyers about microbiome health benefits without getting into trouble with regulators?
“It’s no longer enough to just say ‘healthy,’” says Alon Chen, CEO and co-founder of Tastewise, an “AI platform for food brands.” “We are absolutely more critical of health claims in general. We want to know how, we want to know why and we want it backed by science.”
The term “healthy” is no longer resonating with consumers. Over 30% are looking for products with multifunctional benefits, according to research by Tastewise. They want more detail, on topics such as gut health, sleep improvement, brain function, anti-bloating and energy.
“Food is no longer just about nutrition, nor is it about general health,” says Flora Southey, editor at Food Navigator. “Consumers want more from the food they consume – and they want to be specific about it.”
What are the challenges and opportunities for brands trying to deliver gut health? A panel of food and nutrition experts tackled the issue during a Food Navigator webinar: “From Fermentation to Fortification: How is Industry Supporting Gut Health and Immunity?” Here are highlights.
There are trillions of microbes in our gut, but science has only scratched the surface of their power. Gut health is an ambiguous – and often confusing – subject for consumers.
Regulations on gut health claims are evolving. A year ago, the European Food Standard Authority asked food producers to help evaluate microbiome-based product claims.
“In order for us to assert ourselves in the industry, we have to be able to defend and support these claims,” says Anthony Finbow, CEO of Eagle Genomics, a software company incorporating microbiome research into their data analysis.
It’s “the dawn of a new age,” according to Finbow. Major food companies are now valued for delivering nutrition in addition to caloric content. “There is greater consumer understanding that food is a mechanism for better health.”
Southey feels brands need to do more for consumer education “I’m not convinced [the message is] getting to the consumer as well as it should be.”
Nutrition drink brand MOJU is attempting to tackle the regulatory stumbling block of health benefits on a label. Strict rules requiring detailed substantiation have resulted in few gut health claims“We’ve got a long way to go from an education point of view,” says Ross Austen, research and nutrition lead at MOJU.
MOJU can’t use the term “gut health,” but they can say a drink contains vitamin C or D, which have been proven to boost the immune system. They can’t say their drink is anti-inflammatory, but they can say it contains turmeric, known for its anti-inflammatory properties.
More consumers want the presumed gut health benefits of probiotics, prebiotics and postbiotics to power their microbiome. Probiotics “have largely stolen the headlines over the past few years,” Austen says, but prebiotics are appearing in more and more products. MOJU puts prebiotic fiber in their drinks because probiotics are a challenge for packaged food products. Because probiotics contain live and active cultures, they must be refrigerated and their efficacy tested.
Ashok Dubey, Phd, senior scientist and lead for nutrition sciences at TATA Chemicals (a supplier of chemical ingredients to food and drink producers), agrees. Dubey feels that the benefits of probiotics have been diminished in the minds of consumers. He notes that when probiotics first began appearing in foods 20 years ago, they were claimed to be able to solve any and all health ailments.
“There’s a greater understanding that our gut microbiota is so complex, if the food we eat is so complex, then the solution we should provide should be a combination of all of this,” he says. Dubey is seeing more patents combining probiotics and prebiotics, a complex solution that he says looks at whole health.
But, he notes, any claim with -biotics must be validated by scientific research.
Traditional Foods vs. Clinical Trials
Hannah Crum, president of Kombucha Brewers International (KBI), takes issue with the need to validate every health claim with scientific research. “We shouldn’t displace a huge body of traditional knowledge in favor of pharmaceuticals,” she says.
Making health claims around -biotics has been challenging for the kombucha industry. “It doesn’t honor what food does for us nutritionally,” she adds. Today’s food industry is so heavily regulated that foods traditionally consumed by humans for centuries – like kombucha – can’t put a health claim on a label without proving benefits in a human clincal trial.
“It’s frustrating,” Crum says. ““In fact, because there is no definition of the word probiotic from a legal perspective, it leaves our brands vulnerable to be attacked by parasitic lawyers who just want to extract value from large corporations because they can.”
“In my opinion, we need to honor the fact that all traditionally fermented foods are probiotic by nature instead of saying ‘Well you need the research to prove it,’” she says.
Adding fermented pickles to sour cream increases the health benefits of the cream, lowering cholesterol and increasing antioxidant properties, according to new research.
Scientists from the Poznań University of Life Sciences in Poland based their research on the French paradox, “the observation that… reduced heart disease is associated with a diet high in saturated fat and cholesterol.” They picked sour cream because of its high levels of saturated fat and cholesterol.
“The results also show that the health-promoting potential of sour cream is enhanced by the presence of metabolically active LAB,” continues the study, published in the Journal of Dairy Science.
The scientists note future work will revolve around characterizing the properties of specific lactic acid bacteria produced by spontaneous fermentation.
Read more (Medical and Life Sciences)
Nutrition professionals need to share the details when recommending fermented products to clients. What are the health benefits of the specific food or beverage ? Does the product contain probiotics? Live microbes?
“There are a vast array of fermented foods. This is important because it means there can be tasty, culturally appropriate options for everyone,” says Hannah Holscher, PhD and registered dietitian (RD). But, she adds, remember that these are complex products.
Holscher spoke at a webinar produced by the International Scientific Association for Probiotics and Prebiotics (ISAPP) and Today’s Dietitian. Joined by Jennifer Burton, RD and licensed dietitian/nutritionist (LDN), the two addressed the topic Fermented Foods and Health — Does Today’s Science Support Yesterday’s Tradition? Hosted by Mary Ellen Sanders, executive director of ISAPP, the presentation touched on the foundational elements of fermented foods, their differences from probiotics, the role of microbes in fermentation, current scientific evidence supporting health claims and how to help clients incorporate fermented foods in their diets.
Sanders called fermented foods “one of today’s hottest food categories.” Today’s Dietitian surveys show they are a top interest to dietitians, as the general public often turns to them with questions about fermented foods and digestive health.
Here are three factors highlighted in the webinar that dietitians should consider before recommending fermented foods and beverages.
Does It Contain Live Microbes?
Fermentation is a metabolic process – microorganisms convert food components into other substances.
In the past decade, scientists have applied genomic sequencing to the microbial communities in fermented foods. They’ve found there’s not just one microbe involved in fermentation, Holscher explained, there may be many. The most common microbes in fermented foods are streptococcus, lactobacillaceae, lactococcus and saccharomyces.
But deciphering which fermented food or beverages contains live microbes can be difficult.
Live microorganisms are present in foods like yogurt, miso, fermented vegetables and many kombuchas. But they are absent in foods that were fermented then heat-treated through baking and pasteurization (like bread, soy sauce, most vinegars and some kombucha). They’re also absent in fermented products that are filtered (most wine and beers) or roasted (coffee and cacao). And there are foods that are mistakenly considered fermented but are not, like chemically-leavened bread, vegetables pickled in vinegar and non-fermented cured meats and fish.
“The main take-home message is that it’s not always easy to tell if a food is a fermented food or not. So you may need to do more digging, either by reading the label more carefully or potentially contacting the food manufacturer,” Holscher said. “When we just think of if live microbes are present or not, a good rule of thumb is if that food is on the shelf at your grocery store, it’s very likely that it does not contain live microbes.”
Does It Contain Probiotics?
The dietitians stressed: probiotics are not the same as fermented foods.
“Probiotics are researched as to the strains and the dosages to be able to connect consumption of a probiotic to a health outcome,” Holscher said. “These strains are taxonomically defined, they’ve been sequenced, we know what these microorganisms can do. They also have to be provided in doses of adequate amounts of the live microbes so foods and supplements are sources of probiotics.”
Though fermented foods can be a source of probiotics, Holscher notes: “In most fermented foods, we don’t know the strain level designation.”
“For most of the microbes in fermented foods, we’ve just really been doing the genomic sequencing of those over the last 10 years and so we may only know them to the genus level right,” she said. For example, we know lactic acid bacteria are present in kimchi and sauerkraut.
Holscher suggests, if a client has a specific health need, a probiotic strain should be recommended based on its evidence-based benefits. For example, the probiotic strain saccharomyces boulardii is known to help prevent travel-related diarrhea, and so would be good for a patient to take before a trip.
“If you’re looking to support health and just in general, fermented foods are a great way to go,” Holscher says.
The speakers recommended looking for probiotic foods in the Functional Food Section of the U.S. Probiotic Guide.
Does Research Support Health Claims?
Fermentation contributes to the functional and nutritional characteristics of foods and beverages. Fermented foods can: inhibit pathogens and food spoilage microbes, improve digestibility, increase vitamins and bioactives in food, remove or reduce toxic substances or anti-nutrients in food and have health benefits.
But research into fermented foods has been minimal, mostly limited to fermented dairy. Dietitians should be careful making strong recommendations based on health claims unless those claims are supported by research. And food labels should always be scrutinized.
“There’s a lot of voices out there that are trying to answer this question [Are fermented foods good for us?],” says Burton. “Many food manufacturers have published health claims on their labels talking about these benefits and, while those claims are regulated, they’re not always enforced. Just because it has a food health claim on it, that claim may not be evidence-based. There’s a lot of anecdotal accounts of benefits coming from eating fermented foods and the research is suggesting some exciting potential mechanisms. But overall we know as dietitians we have an ethical responsibility to practice on the basis of sound evidence and to not make strong recommendations if those are not yet supported by research.”
Reputable health claims are documented in randomized control trials. But only “possible benefits” can be linked to nonrandomized controlled trials. And non-controlled trials are the least conclusive studies of all.
For example, Burton puts miso in the “possible benefits” category because, with its high sodium content, there’s not enough research indicating it’s safe for patients with heart disease. Similarly, she does not recommend kombucha because of its extremely limited clinical research and evidence.
“We have to use caution in making these recommendations,” Burton says.
This is why Burton advises dietitians to be as specific as possible. Don’t just tell patients “eat fermented foods” — list the type of fermented food and its brand name. She also says to give patients the “why” — what is the benefit of this fermented food? Does it increase fiber or boost bioavailability of nutrients?
“Are fermented foods good for us? It’s safe to say yes,” Burton says. “There’s a lot that we don’t know, but the body of evidence suggests that fermentation can improve the beneficial properties of a food.”
Doctors and microbiologists warn: despite what the latest social media trends proclaim, there’s no quick fix for better gut health. More influencers are promoting their “cures” — from drinking aloe vera juice to boiling apples — on TikTok. Their videos are getting millions of views — and are raising concerns from medical and scientific authorities.
“If somebody is claiming to have something that will immediately turn gut health around, you should be skeptical of that,” says Justin Sonnenburg, a professor of microbiology and immunology at Stanford. The article in The New York Times notes Sonnenburg advocates for “long-term lifestyle habits that can benefit the gut — ones that rarely go viral or make their way to social media acclaim.”
Sonnenburg’s groundbreaking study last August showed fermented foods — like yogurt, kimchi, kefir, sauerkraut and kombucha — can increase the diversity of gut bacteria. “His research found that people who ate six servings of fermented foods each day saw these benefits — the equivalent of consuming one cup of yogurt, one 16-ounce bottle of kombucha and one cup of kimchi in a day,” the article continues.
The Times interviewed a panel of experts that included a dietitian, sociologist, gastroenterologist and Sonnenburg. They say, to improve your gut, change your lifestyle. They encourage eating more fiber, eating fermented foods, limiting processed foods and lowering stress levels.
Read more (The New York Times)
More and more food and beverages are labeling their product with -biotics – probiotics, prebiotics and postbiotics — confusing consumers as to what a -biotic is and its potential health benefit.
There’s an “overuse of the term probiotic as referring to any live microbe,” says Bob Hutkins, professor of food microbiology and the University of Nebraska (and a Science Advisor on TFA’s Advisory Board). Probiotics, according to the International Scientific Association of Probiotics and Prebiotics (ISAPP), require documentation of both a health benefit and the strain.
“It’s a high bar to call something a probiotic,” he continues. “I read labels that say ‘contains probiotics’ and I’d say, the vast majority of the time, they’re incorrectly named if they’re named at all.”
Hutkins was part of a panel hosted by Food Navigator on “Feeding the Gut Microbiome: From Pre-, Pro-, and Postbiotics.” Speakers included leaders of food brands and -biotic supplement brands.
Is a Fermented Food Probiotic?
The issues surrounding probiotics and fermented foods have long been debated. TFA hosted a webinar on the topic in 2021, and it was the focus of a keynote session at TFA’s FERMENTATION 2021 conference.
Using the example of kimchi, Hutkins explains the fermented cabbage may contain live microbes that closely resemble a probiotic strain. But, according to scientific-backed definitions by ISAPP and the World Health Organization (WHO), “you can’t call that kimchi probiotic unless you isolated the strain, characterized the strain, done a clinical study and then that kimchi is going to be different from the kimchi you’ll make tomorrow. So it’s a challenge for companies that are producing fermented foods that probably have live microbes that can provide some benefits, but you can’t call them probiotics.”
Hutkins encourages fermentation producers to use the term “rich in live microbes” on their label instead. If the product does include clinically tested probiotics (like in yogurt), “I really applaud the company that puts the genus and species on their package.”
Miguel Freitas, PhD, vice president of health scientific affairs at Danone North America, says the conversation in the industry needs to change from just probiotics to strain specificity.
“There are many consumers that are just seeking the word probiotic on the packaging. And they believe that probiotics will [help] everything from immune health to gut health,” Freitas says. “This is where I believe it can start to get tricky because there are so many products out there.”
Though the science around -biotics has evolved tremendously in the past two decades, consumers are overwhelmed and confused by all the choices.For example, he points to a new clothing brand that alleges the probiotics in their clothes are activated by heat.
This is why the food and beverage industry needs to play an active role in consumer education, says Todd Beckman, president of Verb Biotics.
“They have a platform to talk about health, these specific ingredients and health benefits,” he says. “They have the megaphone to talk to consumers in a true and authentic way.”
But Beckman warns: “the brands that don’t really know what they’re doing or don’t stand for anything or don’t stand for science, they’re not going to be there tomorrow.” Consumers will abandon brands with unsubstantiated health claims.
“If all of a sudden consumers aren’t believing in probiotics or what they can do, then it’s quite damaging,” he says.
Tom First, founder and CEO of Culture Pop probiotic soda, says that, though their brand has the clinical benefits of a verified and shelf-stable probiotic strain, they don’t lead with this complicated information in their marketing. Instead, they focus on flavor and it “being a fun drink,” figuring consumers can look to the Culture Pop website if they want to dive deeper.
Adding to consumer confusion: products on grocery shelves may now contain one of three -biotics – probiotics, prebiotics or postbiotics. Justin Green, PhD, director of scientific affairs at Cargill Health Technologies, says many think of -biotics as a daily supplement with a simple health benefit, like vitamin C.
“We really have to drive home there’s going to be different [-biotics] from different organisms, different fermentation techniques and most importantly different health benefits,” he says.
Probiotics are live bacteria; prebiotics are food for the bacteria; and postbiotics are metabolites produced by the probiotics.
For nearly two decades, the Mediterranean diet has been the food choice recommended by dietitians and the USDA.. This approach to eating has been proven to improve health and reduce risk of chronic disease.
But there’s a new contender: the Nordic diet.
This plan focuses on eating fermented foods and beverages, with less meat and more legumes than in the Mediterranean diet. Both approaches are plant-based and full of lean proteins, complex carbs and healthy fats.
“The nordic diet really does promote a lifelong approach to healthy eating,” says Valerie Agyeman, RDN (pictured). “It also really really focuses on seasonal, local, organic and sustainably sourced whole foods that are traditionally eaten in the Nordic region.”
Agyeman, founder of Flourish Heights, shared her research during a Today’s Dietitian webinar “Breaking Down the Nordic Diet: Why is it Gaining So Much Popularity?” The presentation was designed to help registered dietitians better counsel clients on healthy eating habits.
What is Nordic Eating?
The diet embraces traditional Nordic cuisine, with a focus on ingredients that are fresh and local. The core of the fare is from Sweden, Norway, Denmark, Finland and Iceland.
“Fresh, pure and earthly are the words used to describe this food movement that was born out of the landscape and culture,” Agyeman says. “The Nordic movement is all about using what is available.”
The goal is not to invent a new cuisine, but to get back to its roots. Seafood is central, but meat – scarce during the long Nordic winters – is treated as a side dish Fresh vegetables and berries – the most common Nordic fruit – are prevalent during the summer. Fermented foods were born out of the necessity to preserve food from the warmer months to eat during winter. The indigenous Nordic people traditionally fermented vegetables, fish and dairy.
“It really takes the focus off calories and puts it on healthy food,” Agyeman adds. “This way of eating is pretty nutrient-dense.”
Nordic foods, she continues, are served in their natural state with minimal processing. They’re high in antioxidants, prebiotics, probiotics, fiber, minerals and vitamins; low in saturated fats, trans fats, added sugars and added salts.
“The Nordic diet is really not that straightforward,” Agyeman says. “When you think of other cuisines, like Italian cuisine, they have signature flavors and various culinary techniques that make up Italian cuisine. When it comes to Nordic cooking, it’s very diverse.”
Key, too, is sustainability. Foods from the Nordic countries have a lower environmental impact because they’re sourced locally and eaten in season.
Sustainability is also partly why Nordic cuisine has become a staple at many restaurants. The farm-to-table style continues to expand in restaurant dining, along with fermentation. Restaurants around the world are following the lead of Copenhagen’s Noma and building their own labs to explore the flavors and textures fermentation adds to dishes.
“Today [fermentation] is not something that’s needed,” like it was before a global food scene made it simpler to eat fresh food year round, Agyeman says. “But culinary wise, fermentation has evolved. It’s become a big part of these new creations.”
Fermented foods and beverages add to the “epicurean experience,” adds Dr. Luiza Petre, a cardiologist and nutrition expert based in New York.
“Savory flavors and fermented food with spices make it a culinary experience,” she says.
Studies show eating the Nordic diet prevents obesity and reduces the risk of cardiovascular disease, type 2 diabetes, high blood pressure and high cholesterol.
The health effects of the Nordic diet were always assumed to be solely due to weight loss. But results of the most recent study of the diet, published in the journal Clinical Nutrition in February, found the positive health effects are “irrespective of weight loss.”
“It’s surprising because most people believe that positive effects on blood sugar and cholesterol are solely due to weight loss. Here, we have found this not to be the case. Other mechanisms are also at play,” said Lars Ove Dragsted, of the University of Copenhagen’s Department of Nutrition, Exercise and Sports in a statement on the study.
The researchers from Denmark, Finland, Norway, Sweden and Iceland studied 200 people over 50 years of age with elevated BMI. All were at an increased risk of diabetes and cardiovascular disease. For six months, the group ate the Nordic diet while a control group ate their regular meals.
“The group that had been on the Nordic diet for six months became significantly healthier, with lower cholesterol levels, lower overall levels of both saturated and unsaturated fat in the blood, and better regulation of glucose, compared to the control group,” Dragsted said. “We kept the group on the Nordic diet weight stable, meaning that we asked them to eat more if they lost weight. Even without weight loss, we could see an improvement in their health.”
A new study found fermented dairy products reduce memory loss. The study, published in Nutritional Neurosciences, confirms there is a connection between the gut microbiome and the nervous system, known as the gut-brain axis
The adults in the test regularly consumed a dairy-based fermented drink, containing 25-30 billion colony forming units (CFUs). Drinking fermented dairy — like yogurt, kefir or fermented whey — “increased the presence of certain microorganisms in the gut and improved relational memory in healthy adults.”
Read more (Nutritional Neurosciences)
New research has explored how lactic acid bacteria (LAB) in sauerkraut and tibicos survive digestion and change gut microbiota composition.
This work, published in Frontiers in Microbiology, investigated how a fermentation production process affects LAB and yeast microbial viability and probiotic potential. Though there are studies that demonstrate health benefits of fermented foods, few “explore how being part of a whole fermented food matrix affects microbial viability during fermentation, storage and gastrointestinal (GI) transit.”
The study focused on non-dairy, botanical fermented foods, defined as “microbially transformed plant products rich in health-promoting components.” Tibicos and sauerkraut were chosen because recent research had found the microbial diversity of the two ferments “far exceeded that of dairy-based ferments, as well as containing the largest numbers of potential health-promoting gene clusters.” The tibicos studied was sugar-based while the sauerkraut was brine-based, and both contained various strains of LAB and bioactive components.
Ginger, cayenne pepper and turmeric added to tibicos were all found to have different survival rates in the digestion tract. These functional spices are often added to fermented products for their anti-inflammatory and sensory properties, but their microbial proliferation had never been adequately explored. Cayenne was the clear winner, as adding it to tibicos “significantly improved the survival rate of LAB during simulated gastric and small intestinal digestion compared to ginger and turmeric.” Ginger in tibicos had a higher rate of LAB survival than turmeric, though neither had a significantly higher LAB survival rate than plain tibicos. But adding ginger significantly increased and sustained microbial viability of LAB.
The research team — from University of Melbourne — did not perform the study on human subjects, but simulated upper gastrointestinal digestion and colonic fermentation tests using pig feces.
Some other significant findings:
- For an optimal microbial survival rate of 70-80%, tibicos should be consumed within 28 days, and sauerkraut within 7 weeks.
- Sauerkraut made with different salt concentrations did not show any significant variation in LAB counts.
- Inoculating sauerkraut with a starter culture increased LAB counts during fermentation and storage. But, by the end of storage, the LAB counts in the inoculated sauerkraut “dropped to undetectable levels.”
- Spontaneously-fermented sauerkraut LAB counts remained stable through the storage period.
“Botanical fermented foods are cheap, easily made, and consumed globally,” the study concluded. “This makes them excellent candidates for the dietary management of pro-inflammatory noncommunicable diseases, such as type 2 diabetes and metabolic syndrome.