Two UCLA professors of medicine encourage people “rather than thinking in terms of supplements, add some fermented foods to your diet.” In a Q&A, the doctors say the popularity of probiotics, postbiotics and the gut microbiome has blurred their value, despite the plethora of reputable scientific research. Product manufacturers — as has happened before, with terms like “gluten-free” — have begun labelling everything as containing -biotics or benefitting the gut microbiome.
“The word probiotics refers to the beneficial microbes found in certain fermented foods and beverages, as well [as] in specially formulated nutritional supplements,” write UCLA doctors Eve Glazier and Elizabeth Ko. “That means that any fermented food that contains or was made by live bacteria contains postbiotics. … Initial findings suggest that postbiotics may play a role in maintaining a balanced and robust immune system, support digestive health and help to manage the health of the gut microbiome.”
Read more (Journal Review)
The kefir brands recently tested for their probiotic claims are challenging the results.
In May, a study found 66% of commercial kefir products overstated probiotic counts and “contained species not included on the label.” The Journal of Dairy Science Communications published the peer-reviewed work by researchers at the University of Illinois and Ohio State University.
“Based on the results…there should be more regulatory oversight on label accuracy for commercial kefir products to reduce the number of claims that can be misleading to consumers,” reads the study. “Classification as a ‘cultured milk product’ by the FDA requires disclosure of added microorganisms, yet regulation of ingredient quality and viability need to be better scrutinized. All 5 kefir products guaranteed specific bacterial species used in fermentation, yet no product matched its labeling completely.”
Researchers tested two bottles of each of five major kefir brands: Maple Hill Plain Kefir, Siggi’s Plain Filmjölk, Redwood Hill Farm Plain Goat Milk Kefir, CoYo Kefir and Lifeway Original Kefir. Bottles were measured for microbial count and taxonomy to validate label claims.
The Fermentation Association reached out to the five brands involved and asked for their responses to the results. Redwood Hill and Lifeway both submitted detailed statements. Maple Hill, Siggi’s and CoYo did not return multiple requests for comment.
Probiotics in fermented products are listed in colony-forming units (CFUs), and the study found kefir from both Lifeway and Redwood Hill contained fewer CFUs than what was claimed on the label. But these brands — who send their products to third-party labs for testing — said the results are not accurate.
Lifeway refutes the assertion that their Original Kefir did not meet the claimed probiotic count. Lifeway references U.S. Food and Drug Administration food labeling laws, which dictate that a product “must provide all nutrient and food component quantities in relation to a serving size.” Lifeway’s label on their 32-ounce bottle says that the serving size of kefir is 1 cup, making the claim of 25-30 billion CFUs per serving size accurate.
The study results, Lifeway notes in their statement, were “premised upon an erroneous assumption that Lifeway claims it has 25-30 billion CFUs per gram” rather than per serving size.
“The authors’ flawed assumption is perhaps a result of their lack of familiarity with FDA labeling requirements or a result of merely overlooking the details in order to support their intended conclusions going into the testing,” reads a statement from Lifeway.
In fact, Lifeway points out, the study’s “erroneous conclusion premised upon the flawed assumption…actually proves the accuracy of Lifeway’s claim of 25-30 billion CFUs per (8 ounce) serving.”
Redwood Hill Farm, too, refutes the study’s conclusion. Their Goat Milk Kefir currently includes the phrase “millions of probiotics per sip” on its label. The label referenced in the study was an old version that claimed “hundreds of billions” of probiotics, which was discontinued last year. According to Redwood Hill Farm, that old label was based on third-party testing that confirmed hundreds of billions of CFUs per 8-ounce serving. But careful review of the kefir’s probiotic counts in 2019-2020 found some CFUs in the hundreds of billions and others in the tens of billions. Redwood Hill changed their label to millions rather than billions “to be absolutely sure that we could meet our target claim on a consistent basis.”
Variation in CFU counts is common in traditional plating testing techniques. Redwood Hill referenced a study published in Nutritional Outlook that found that plating results can vary 30-50%.
“Given the challenges around probiotic CFU enumeration, we were not too surprised to see a discrepancy between the number of CFUs in our Goat Milk Kefir found in the study and our past analyses,” reads the statement from Redwood Hill Farm. “Like all living organisms, probiotics are challenging to control and measure. A particular microorganism’s ability to reproduce is impacted by a variety of factors, including temperature, oxygen level, variations in the nutrient composition of the milk, and pH level. Our kefir has a sixty-day shelf life and during that time the different types of bacteria in the product will peak and die-off in relation to the conditions those particular bacteria like. For example, fermented dairy products naturally become more acidic (lower pH) as they age and while some bacteria thrive in acidic environments, others’ reproduction is stunted. This makes the exact CFU count rather volatile not only from bottle to bottle, but also throughout the timespan between when that bottle leaves our facility and when it expires.”
Redwood Hill Farm’s most recent testing measured 400 million CFUs per gram or 96 billion per serving (1 cup). These figures compare with what the study found — 193 million CFUs per gram or 46 billion per serving.
“Although the University of Illinois study found only half the probiotic cells that our study did, this is actually not that wide of a variation in bacteria reproduction based on all of the conditional factors outlined above,” their statement reads.
The study’s test results found all kefir brands contained species not on the label. Lifeway notes their culture claims are based on the time of manufacture, not on expiration date. “Moreover, the authors validate that all of the claimed culture species except for the bifidos, Leuconostoc and L. reuteri, (which could be at a low concentration due to time of shelf-life), were identified in their testing,” reads Lifeway’s statement.
Redwood Hill Farm says that, based on the study results (that “2 Lactobacillus delbrueckii subspecies or 3 Lc. lactis subspecies could not be identified” in their kefir), they are pursuing further analysis. They’ve contacted their culture supplier for further insight, and are sending new samples to a third-party lab.
“These cultures are at the heart of the product and are what transforms the goat milk into a yogurt drink with its characteristic thick and creamy texture and tart flavor,” reads the Redwood Hill Farm statement. “It’s difficult to understand how these core active agents in the kefir could not be present in the product at any stage in its lifecycle.”
DNA vs. Plating Methodology
The study utilized both DNA sequencing and traditional plating methodologies, even though plating testing alone is considered the industry standard for kefir. Plating testing for kefir is done in a microbiology laboratory where it’s incubated to determine bacteria colony growth.
The study itself notes: “Limitation of DNA-based sequencing methods could explain why taxa stated on labels were not detected and why unclaimed viable species were identified.”
Lifeway points out: “This concession as to testing limitations is critical to note as it is but one explanation of many as to why various species may have not been detected. First and foremost, the authors fail to validate the DNA extraction method to establish that it delivers all the available DNA in the type of dairy product analyzed; for example, they do not appear to have broken down the calcium bonds. Further, they appear to not have undertaken the required extra enzymatic treatments. Moreover, for their microanalysis, they are using MRS [a method for cultivation of lactobacilli] but only incubating for 48 hours. As most kefir products would contain a significant amount of Lactococci, there is a high chance of not detecting this species unless you go to 72 hours of incubation. Another unknown important factor in the testing is the time period within the cycle of the shelf-life of the product that was tested. This is critical as the longer the product sits on a shelf, the fewer number of live and active bacteria will be present.”
Meanwhile, Redwood Hill Farm says “our team will continue to educate ourselves on the application of DNA sequencing technology to fermented food product probiotic count analysis and what opportunities and limitations this methodology may offer versus traditional plating techniques.”
A new peer-reviewed study from researchers at the University of Illinois and Ohio State University found 66% of commercial kefir products overstated probiotic count and “contained species not included on the label.”
Kefir, widely consumed in Europe and the Middle East, is growing in popularity in the U.S. Researchers examined the bacterial content of five kefir brands. Their results, published in the Journal of Dairy Science, challenge the “probiotic punch” the labels claim.
“Our study shows better quality control of kefir products is required to demonstrate and understand their potential health benefits,” says Kelly Swanson, professor in human nutrition in the Department of Animal Sciences and the Division of Nutritional Sciences at the University of Illinois. “It is important for consumers to know the accurate contents of the fermented foods they consume.”
Probiotics in fermented products are listed in colony-forming units (CFUs). The more probiotics, the greater the health benefit.
According to a news release from the University of Illinois: “Most companies guarantee minimum counts of at least a billion bacteria per gram, with many claiming up to 10 or 100 billion. Because food-fermenting microorganisms have a long history of use, are non-pathogenic, and do not produce harmful substances, they are considered ‘Generally Recognized As Safe’ (GRAS) by the U.S. Food and Drug Administration and require no further approvals for use. That means companies are free to make claims about bacteria count with little regulation or oversight.”
To perform the study, the researchers bought two bottles of each of five major kefir brands. Bottles were brought to the lab where bacterial cells were counted and bacterial species identified. Only one of the brands studied had the amount of probiotics listed on its label.
“Just like probiotics, the health benefits of kefirs and other fermented foods will largely be dependent on the type and density of microorganisms present,” Swanson says. “With trillions of bacteria already inhabiting the gut, billions are usually necessary for health promotion. These product shortcomings in regard to bacterial counts will most certainly reduce their likelihood of providing benefits.”
The news release continues:
When the research team compared the bacteria in their samples against the ones listed on the label, there were distinct discrepancies. Some species were missing altogether, while others were present but unlisted. All five products contained, but didn’t list, Streptococcus salivarius. And four out of five contained Lactobacillus paracasei.
Both species are common starter strains in the production of yogurts and other fermented foods. Because those bacteria are relatively safe and may contribute to the health benefits of fermented foods, Swanson says it’s not clear why they aren’t listed on the labels.
Although the study only tested five products, Swanson suggests the results are emblematic of a larger issue in the fermented foods market.
“Even though fermented foods and beverages have been important components of the human food supply for thousands of years, few well-designed studies on their composition and health benefits have been conducted outside of yogurt. Our results underscore just how important it is to study these products,” he says. “And given the absence of regulatory scrutiny, consumers should be wary and demand better-quality commercial fermented foods.”
As postbiotics continue to trend among consumers, the International Scientific Association for Probiotics and Prebiotics (ISAPP) released a consensus definition on the category, published in Nature Reviews: Gastroenterology & Hepatology.
The panel of international experts that created the definition made it clear that postbiotics and probiotics are fundamentally different. Probiotics are live microorganisms; postbiotics are non-living microorganisms. The published definition states that postbiotics are a: “preparation of inanimate microorganisms and/or their components that confers a health benefit on the host.”
A postbiotic could be whole microbial cells or components of cells, “as long as they have somehow been deliberately inactivated,” according to the news release by ISAPP. And a postbiotic does not need to be derived from a probiotic.
“With this definition of postbiotics, we wanted to acknowledge that different live microorganisms respond to different methods of inactivation,” says Seppo Salminen, professor at the University of Turku and the lead author of the definition. “Furthermore, we used the word ‘inanimate’ in favor of words such as ‘killed’ or ‘inert’ because the latter could suggest the products had no biological activity.”
The definition has been in the works for almost two years by authors from various disciplines in the probiotics and postbiotics fields. These include: gastroenterology, pediatrics, metabolomics, functional genomics, cellular physiology and immunology.
“This was a challenging definition to settle,” says Mary Ellen Sanders, ISAPP’s Executive Science Officer. “There are some who think that any purified component from microbial growth should be considered to be a postbiotic, but the panel clearly felt that purified, microbe-derived substances, for example, butyrate or any antibiotic, should just be called by their chemical names. We are confident we captured the essential elements of the postbiotic concept, allowing for many innovative products in this category in the years ahead.”
Growing Scientific Interest
Sanders continues: “The definition will be a touchstone for scientists, both in academia and industry, as they work to develop products that benefit host health in new ways. We hope this clarified definition will be embraced by all stakeholders, so that when the term ‘postbiotics’ is used on a product, consumers will know what to expect.”
Postbiotics have been on the market in Japan for years, and fermented infant formulas with added postbiotics are sold commercially in South America, the Middle East and in some European countries. ISAPP, in a release, notes: “Given the scientific groundswell, postbiotic applications are likely to expand quickly.”
- Probiotics: Live microorganisms that, when administered in adequate amounts, confer a health benefit on the host.
- Prebiotics: A substrate that is selectively utilized by host microorganisms conferring a health benefit.
- Synbiotics: A mixture comprising live microorganisms and substrate(s) selectively utilized by host microorganisms that confers a health benefit on the host.
- Fermented foods: Foods made through desired microbial growth and enzymatic conversions of food components.
Scientists in Russia and Egypt have developed a functional drink that’s been proven to combat anemia and malnutrition. The juice is made from beet extract, milk and probiotic bacterial strains. The scientists developed a quinoa bread, too. The goal is to keep the beverage and bread affordably priced and get them offered at grocery stores internationally.
“One should bear in mind that we are not creating a medicine, but a natural, functional food product,” said Sobhi Ahmed Azab Al-Suhaimi, professor in the Department of Technology at South Ural State University (SUSU) in Russia. “However, this juice can make up for the lack of iron, zinc, manganese and calcium in the body. One serving of the drink will contain the whole rate [sic] of minerals. Its carbohydrate content is low. Fermented juice will help to overcome anemia and to improve digestion due to probiotics.”
Scientists at SUSU worked with scientists at the University of Alexandria in Egypt. Their findings were published in the Journal of Food Processing and Preservation and Plants.
Read more (Phys.org)
Do probiotic supplements deliver the same benefits as fermented foods? Dr. Gail Cresci says to be leery of prebiotic and probiotic pills.
“There are challenges to keeping microbes viable in encapsulated tablets,” says Cresci, director of Nutrition Research for the Cleveland Clinic’s Department of Pediatric Gastroenterology, Hepatology and Nutrition. “It’s also very, very important to know that each strain of bacteria is not the same as the next. For example, lactobacillus has hundreds of different strains, and each one may behave differently. People like to use supplements because they like to think one size fits all, but it doesn’t.”
“Take in prebiotics and probiotics through food sources. Yogurt with added probiotic bacterial strains is much better to consume than supplements also because as it’s been waiting for you to eat it, it’s been producing more beneficial metabolites. When you eat it, you get all that.”
Read more (American Heart Association/U.S. News & World Report)
After Dr. Bob Hutkins finished a presentation on fermented foods during a respected nutrition conference, the first audience question was from someone with a PhD in nutrition: “What are fermented foods?”
“I thought ‘Doesn’t everyone know what fermentation is?’ I realized, we do need a definition. Those of us that work in this field know what we’re talking about when we say fermented foods, but even people trained in foods do not understand this concept,” says Hutkins, a professor of food science at the University of Nebraska-Lincoln. He presented The New Definition of Fermented Foods during a webinar with TFA.
Hutkins was part of a 13-member interdisciplinary panel of scientists that released a consensus definition on fermented foods. Their research, published this month in Nature Reviews Gastroenterology & Hepatology, defines fermented foods as: “foods made through desired microbial growth and enzymatic conversions of food components.”
“We needed a definition that conveyed this simple message of a raw food turning into a fermented food via microorganisms,” Hutkins says. “It brings some clarity to many of these issues that, frankly, people are confused about.”
David Ehreth, president and founder of Alexander Valley Gourmet, parent company of Sonoma Brinery (and a TFA Advisory Board member), agreed that an expert definition was necessary.
“As a producer, and having started this effort to put live culture products on the standard grocery shelf, I started doing it as a result of unique flavors that I could achieve through fermentation that weren’t present in acidified products,” Ehreth says. “Since many of us put this on our labels, we should be paying close attention to what these folks are doing, since they are the scientific backbone of our industry.”
Hutkins calls fermented foods “the original shelf-stable foods.” They’ve been used by humankind for over thousands of years, but have mushroomed in popularity in the last 15. Fermented foods check many boxes for hot food trends: artisanal, local, organic, natural, healthy, flavorful, sustainable, innovative, hip, funky, chic, cool and Instagram-worthy.
Nutrition, Hutkins hypothesizes, is a big driver of the public’s interest in fermentation. He noted that Today’s Dietitian has voted fermented foods a top superfood for the past four years.
Evidence to make bold claims about the health benefits of fermentation, though, is lacking. Hutkins says there is observational and epidemiological evidence. But randomized, human clinical trials — “the highest evidence one can rely on” — are few and small-scale for fermented foods.
Hutkins shared some research results. One study found that Korean elders who regularly consume kimchi harbor lactic acid bacteria (LAB) in their GI tract, providing compelling evidence that LAB survives digestion and reaches the gut. Another study of cultured dairy products, cheese, fermented vegetables, Asian fermented products and fermented drinks found that most contain over 10 million LAB per gram.
Still, the lack of credible studies is “a barrier we have to get past,” Hutkins says. There are confirmed health benefits with yogurt and kefir, but this research was funded by the dairy industry, a large trade group with significant resources.
“I think there’s enough evidence — most of it through these associated studies — to warrant this statement: fermented foods, including those that contain live microorganisms, should be included as part of a healthy diet.”
Probiotics and fermented foods are not equivalent, says Mary Ellen Sanders, PhD and executive science officer of the International Scientific Association of Probiotics & Prebiotics (ISAPP). She advises fermented food producers that don’t meet the criteria of a probiotic to use descriptors such as “live active cultures” or “fermented food with live microbes” on their labels rather than “probiotic.”
“There are quite a few differences between probiotics and many fermented foods. You cannot assume a fermented food is a probiotic food even if it has live cultures present,” says Sanders. She highlighted her 30 years worth of insight into the field during a TFA webinar, Are Fermented Foods Probiotics?
Some fermented foods do meet these criteria, such as some yogurts and cultured milks that are well-studied. But many traditional fermented foods do not.
Using multiple peer-reviewed scientific studies and conclusion from expert panels in the fields of probiotics and fermented foods, Sanders shared the ways in which fermented foods and probiotics differ:
- Health benefits
By definition, a probiotic must have a documented health benefit. Many fermented foods have not been tested for a health benefit.
“If you are interested in recommending health benefits from a fermented food in an evidence-based manner, many traditional fermented foods fall short. They don’t have the controlled randomized trials that will provide a causal link between the food and the health benefit,” she says. “A food may be nutritious, but probiotic benefits must stem from the live microbe, not the nutritional composition of the food. Otherwise you just have a nutritious food that happens to have live microorganisms in it. You don’t have a probiotic food.”
- Quality studies
In her presentation, Sanders shared multiple randomized clinical trials on human subjects with supported health evidence for probiotics. But there are few randomized, controlled studies on fermented foods. Most are cohort studies, which inherently have a higher risk of bias and cannot provide a causal link between consuming fermented foods and a health benefit.
“A strong hypothesis is not the same as proof,” Sanders says. “Evidence for probiotics must meet a higher standard than small associative studies, many of which are tracking biomarkers and not health endpoints.”
She noted, though, there are some studies on fermented milk and yogurt that show a conferred health benefit.
- Strain designation
Though many fermented foods do have live microbes, a probiotic is required to be identified to the strain level. The genus and species should also be properly named according to current nomenclature. Many fermented foods contain undefined microbial composition. Without that strain designation, one can’t tie the scientific evidence on that strain to the probiotic product.
- Microbe quantity
Another key differentiator is that probiotics must be delivered at a known quantity that matches the amount that results in a health benefit. Probiotics are typically quantified in colony forming units (or CFUs).
“A probiotic has a known effective dose. But fermented foods often contain unknown levels of microbes, especially at time of consumption,” Sanders says.
What Can Brands Do?
If food brands keep using the word probiotics as a catch-all to describe a fermented product, the term will lose its utility. Using “probiotics” on food with unsubstantiated proof of probiotics is a misuse of the term.
“When I see a fermented food that says probiotics on it, I very often think what they’re trying to communicate on that label [is that it] contains live microbes,” Sanders says, “because I’m doubting, at least some of the products I see, that they have any evidence of a health benefit. And so they’re just looking for a catchy, single word that will communicate to people that this has live microbes in it. ‘Live active cultures’ is something that resonates with people as well. So why not use that?”
Sanders encourages fermented brands to standardize the terms “live active cultures,” “live microbes,” “live microorganisms” or “fermented food with live microbes.” For products pasteurized after fermentation, there’s a term for them too: “Made with live cultures.”
Controlled human studies on fermented foods can be challenging, Sanders admits. Such studies can be difficult to properly blind, since placebos for foods are hard to design. The fermentation process affects the product taste so that study subjects may know what they are consuming. But the health benefits of fermented foods could be studied, though. She also advises producers to focus on the nutritional value of their food.
“That’s one thing that really has me excited about this concept of core benefits,” says Maria Marco, PhD, professor of food science and technology at University of California, Davis (and a member of TFA’s Advisory Board) and moderator of the webinar. “I think it kind of opens the doors to the possibility of fermented fruits and vegetables where there’s certain organisms, microorganisms that we’d expect to be there but again we need to know really if those microorganisms are needed to make those foods healthy.”
Researchers from the National University of Singapore (NUS) have created new fermented coffee and tea drinks. These drinks, invented by a professor and two doctoral students, are being labeled as “probiotic coffee and tea drinks that are packed with gut-friendly live probiotics.” They claim that the drinks can be stored for three months without altering the probiotics.
“Coffee and tea are two of the most popular drinks around the world, and are both plant-based infusions. As such, they act as a perfect vehicle for carrying and delivering probiotics to consumers. Most commercially available probiotic coffee and tea drinks are unfermented. Our team has created a new range of these beverages using the fermentation process as it produces healthy compounds that improve nutrient digestibility while retaining the health benefits associated with coffee and tea,” explained NUS Associate Professor Liu Shao Quan.
Read more (Science Daily)
The coronavirus continues to drive sales of fermented drinks. Lifeway’s kefir, Farmhouse Culture’s kraut juice, Probitat’s fermented planted-based smoothies, Flying Ember’s hard kombucha and Buoy Hydration’s fermented drinks all report increased sales as consumers take a bigger interest in the immune-enhancing benefits of fermented beverages.
“As demand ramps up for immune-enhancing products, manufacturers have an opportunity to innovate with immune-supporting ingredients and flavors,” says Becca Henrickson, marketing managed of Wixon, a flavor and seasoning company. “When flavoring beverages with immune support ingredients, selecting flavors that increase or complement a product’s health perception is optimal.”
Read more (Food Business News)