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.”
Miso, frozen yogurt and pickled and fermented vegetables are driving growth in the $10.97 billion fermented food and beverage category. The fermented products space grew 3.3% in 2021, outpacing the 2.1% growth achieved by natural products overall.
“It really highlights how functional products have become the norm for shoppers when they’re in stores,” says Brittany Moore, Data Product Manager for Product Intelligence at SPINS LLC, a data provider for natural, organic and specialty products. Moore notes there’s an “explosion of functional products” in the market — “[they] are appearing everywhere. And fermented products have been leading that space in the natural market for years.”
The data was shared during TFA’s conference, FERMENTATION 2021. SPINS worked with TFA to drill into data covering 10 fermented product categories and 64 product types (an increase from last year). [A note that wine, beer and cheese sales are excluded from the data. These categories are very large, and would obscure trends in smaller segments. Wine, beer and cheese are also well-represented by other organizations.]
Yogurt dominates the fermented food and beverage landscape with 75% of the market, but sales growth is soft. Frozen yogurt and plant-based offerings, though small portions of the yogurt category, are fueling what growth there is. “Novelty products are catching shopper’s eyes,” Moore notes.
Kombucha, the fermented tea which led the U.S. retail revival of fermented products, still rules the non-alcoholic fermented beverages market, with 86% of sales. But growth is slowing. Moore points out that this slowdown is due to kombucha having penetrated the mass market with lots of brands on grocery shelves.
“There’s opportunity in kombucha for new innovations to catch the progressive shopper’s eye,” Moore says. “Shoppers are looking for an innovative twist to their functional product.”
Moore points to successful twists like hard kombucha, which grew nearly 60%, and probiotic sodas, which grew 31%.
Growth is slowing for hard cider, too, though hard cider leads the alcoholic beverages category with 83% share of sales.
All sectors of the pickled and fermented vegetables category are growing, totalling nearly $563 million in sales. Refrigerated products are nine of the top 10 subcategories here. The “other” pickled vegetable subcategory is increasing at a 60% growth rate, “other” being the catch-all for vegetables that are not cucumbers, cabbage, carrots, tomatoes, beets or ginger. Fermented radish, garlic and seaweed fall into this subcategory.
Soy sauce is not surprisingly still the largest product in sauces, representing 58% of the category. But that share is dropping. Gochujang is the growth leader, increasing at rate of nearly 20%.
Miso and tempeh are also performing well, which Moore attributes to the growing plant-based movement and the Covid-19 pandemic pantry stocking boom. Miso products — soups, broths, pastes and mixes — totaled over $24 million in sales in 2021. Though instant soups and meal cups represented only 8% of sales, they grew more than 110%.
In the latest issue of Popular Science, a creative infographic illustrates “the wonderful world of fermented foods on one delicious chart.” It represents “a sampling of the treats our species brines, brews, cures, and cultures around the world,” and is particularly interesting as it shows mainstream media catching on to fermentation’s renaissance. Fermentation fit with the issue’s theme of transformation in the wake of the pandemic.
Read more (Popular Science)
Kimchi, fermented sauces and tempeh are driving growth in the fermented food and beverage category, a $9.2 billion industry that’s grown 4% in the last year.
“We’re excited about the growth potential for fermented food. While fermented food represents about 1.4% of the market today, there are segments that are tracking well above the growth of food and beverage [overall] that are poised for disruption in the future,” says Perteet Spencer, vice president of strategic solutions at SPINS. Spencer shared this information in a recent webinar hosted by The Fermentation Association. “There’s a ton of opportunity to scale and increase the footprint of these products.”
SPINS spent weeks working with TFA to define the fermentation industry’s sales, drilling into 10 fermented product categories and 57 product types. Wine, beer and cheese sales were excluded from the data — those categories are very large, and would obscure trends in smaller categories. (All three are also well-represented by other organizations.)
Pickles and fermented vegetables “is a space that’s seen [a] pretty explosive uptick in growth over the past year,” Spencer says. Every segment is growing — kimchi, sauerkraut, beets, carrots, green beans, sliced and speared pickles and all other vegetables — with pickles the largest, nearly 60% of the category.
The biggest growth, though, is coming from products other than pickled cucumbers. Kimchi is at the center of numerous consumer retail trends. Consumers are purchasing healthier food made with fewer ingredients, and they want food with international flavors. Kimchi makes up only 7% of the category, but sales are increasing at an explosive 90% growth rate.
More people are experimenting with fermenting while they’re at home during the coronavirus pandemic, but these kitchen DIYers do not appear to be detracting from sales.
“The more people make fermented foods, they appreciate what’s available in the store that maybe didn’t exist five or 10 years ago,” notes Alex Lewin, author and TFA advisory board member who moderated the webinar. “Anyone who has made kimchi knows it takes a lot, it makes a big mess, you get red pepper powder stuck under your fingernails and onion in your eyes. I can make kimchi (at home), and then once I’ve made kimchi, I’m like ‘Ok, maybe next time I’ll buy it.’”
Fermented sauces are also growing, up 24% in 2020. The largest segment in sauces is, of course, soy sauce, almost 85% of the category. But gochujang, less than 2% of the category, is increasing at over a 56% growth rate.
Versatility is helping sauces, pickles and fermented vegetables, Spencer says. Any food product with multiple uses is selling well. The condiments and sauces can be used as a topping on eggs, hamburgers or pizza, or mixed-in a salad, rice dish or soup.
Sake, plant-based meat alternatives and miso had combined annual growth of $75 million in 2020. Sake grew 16%, and both plant-based meat alternatives and miso each grew 26%.
Yogurt and kombucha still dominate the fermented food and beverage market. Yogurt is 81% of the market; if yogurt is removed, kombucha is 51% of the remainder.. Both have experienced slowdowns in sales from their peaks. Kombucha sales have slowed recently, as grab-n-go opportunities have shrunk during the pandemic.
Yogurt giant brands Chobani, Yoplait and Dannon still dominate the category, as do GT Kombucha, Health-Ade and Kevita reign for kombucha.
Spencer notes the 4% growth rate of fermented products overall would be higher without yogurt. It’s a large category that — despite an uptick in 2020 during the pandemic – has been fairly flat in recent years. Core (traditional) yogurt has been growing at a 1.6% rate; Greek yogurt, at about twice that pace. Those two segments account for roughly 80% of the category.
“This is an opportunity for disruption for emerging brands,” Spencer says. “We’re already seeing some of the legacy segments start to get disrupted by new innovation, so I’m excited to see the evolution of that innovation and where that goes and kind of what opportunities peek out of that.”
“Overall, we’re seeing historically small segments gaining traction in the marketplace,” Spencer adds. “The pandemic has brought a renewed consumer focus on the fermented space.”
Though fermented products have an added healthy benefit, customers are looking for delicious flavor first.
“In these fermented categories we covered today, taste first is always really important. I think people are going to these categories for different taste experiences,” Spencer says. “If you can level up with a functional benefit, that’s fantastic, but we have to balance the taste first. If it’s highly functional but doesn’t taste good, it just doesn’t have the same success.”
The world’s most famous fermentation restaurant is serving diners once again during the coronavirus pandemic. But Noma’s reservation-only tables and $400-500 world-class meal has radically changed. Noma is now serving wine and burgers in a walk-up, outdoor patio.
“It’s definitely new territory,” says Rene Redzepi, Noma founder. “I like this thing that it’s doing to us. We’ve become this place where you book, you plan your travels six months ahead of time. The spontaneity of going to a restaurant has completely disappeared for us. I like that people now can say ‘Let’s go to Noma for a glass of wine.’ So who knows, maybe this is part of our future in the long run.”
Redzepi spoke with Denmark-based food bloggers Anders Husa and Kaitlin Orr on Noma’s reopening.
The Noma burger is either a meat patty made with beef ferment, beef garum and smoked beef fat or a veggie burger made with quinoa tempeh patty with fermentation liquids.
Noma’s Nordic cuisine features fermented and foraged food that have earned Noma the World’s Best Restaurant award four times. Noma has been closed since March 14 because of the coronavirus.
Redzepi is one of the first chefs of his caliber to reopen a fine-dining restaurant during the coronavirus pandemic. The burger and wine menu is intended to transition Noma to the July summer season, when the restaurant hopes to again serve diners in the restaurant.
When the coronavirus first shutdown countries all over the globe, Redzepi said “it was really, really scary.” Would Noma have to wait six months to open? A year? About 3-4 weeks in, though, the atmosphere turned.
“There was a little positivity coming through,” Redzepi said. “I started asking myself ‘What do I want to do? What am I missing in my life?’ And the funny thing is I wasn’t at all missing going to a fine-dining restaurant, sitting for 3-4 hours. That was not on my mind at first. I wanted to be with people, I want to be out. … So when you have that feeling, it was just like, there was no way we can open Noma as it was before COVID-19.”
It’s an unusual sight at the exclusive restaurant – Noma is serving burgers in paper wrappers and chefs are wearing disposable gloves.
A burger was picked because Redzepi says: “I have yet to meet anybody that doesn’t like a burger.” In the future, Noma will add a deep-fried chicken burger to the menu as well as oysters and shrimp.
As tourism is still closed in Denmark, Redzepi envisions the new Noma bar as a place where Copenhagen locals can eat and visit with friends again.
“It’s not about us showing what we can do, it’s just about cooking the best we can so people feel great and feel alive again.”
Civil Eats declares: “Tempeh, the ‘OG of Fermented Foods,’ Is Having a Moment.” More artisanal tempeh producers are selling around the country, and restaurants are beginning to sell tempeh-based dishes. The founder of Tofurky (Seth Tibbott) says tempeh is one of the company’s fastest-growing product lines, increasing 17% from 2017 to 2018. Pictured is Tibbot in front of his first tempeh incubator, in 1980.
Read more (Civil Eats)
Western North Carolina is becoming “a hot spot for fermented goods” thanks to female entrepreneurs. These fermented product brand leaders credit the health-conscious culture of Asheville, N.C. with helping their businesses thrive in “Ferment City.” Sara Schomber of the Buchi Mamas tells Asheville’s Mountain Xpress: “Fermentation is all about the alchemy of ingredients normally found in the hearth and home where, for centuries, women have been the keepers. We believe fermentation is the expression of a natural tendency, the human spirit’s way of giving itself permission to heal and inviting all of us to extend beyond our own immediate mortality. It’s normal and natural for humans to want to preserve, put away and celebrate.” Local brands featured include: Shanti Elixirs Jun, Smiling Hara Tempeh, Yoga Bucha kombucha, Buchi Kombucha, Sister of Mother Earth cider and honey, Serotonin ferments ferments and Fermenti Foods ferments.
Read more (Mountain Xpress) http://bit.ly/2B61p0Q
Dietician Lisa Valente writes in Eating Well the seven must-eat fermented foods for a healthy gut. Her list features: sauerkraut, kimchi, kefir, kombucha, miso, tempeh and yogurt. She writes: “Fermented foods are a hot health topic—and for good reasons. These good bacteria—particularly those in our gut—may improve digestion, boost immunity and help us maintain a healthy weight. Research is still emerging on just how important these mighty microbes might be for our health, but the early results are promising. Take care of your gut, and in turn, it will take help take care of you.”
Read more (Eating Well)