Dispelling Myths: Do Fermented Foods Replace the Need for a Probiotic?

Fermented foods and beverages, such as sauerkraut, kimchi and kombucha, were a regular part of our ancestors’ diets for thousands of years. Originally a method of preserving produce from harvest time through the cold days of winter;[¹] fermentation involves adding a bacterial or yeast starter to a food. These organisms convert starches and sugars to alcohol or acids, lengthening the food’s shelf life and producing the unique and tangy flavours we associate with fermented foods. Recently, these foods have seen a resurgence in popularity, not for their shelf lives but for their claimed digestive health benefits. As probiotics have also risen in popularity for similar reasons, let us explore how fermented foods stack up against a high-quality probiotic. 

It All Begins In The Gut

Our interest in strategies to improve digestive health has been fuelled by an expanding body of research indicating that poor gut health negatively affects many other body systems.[²] Specifically, imbalances in the microbiome, the ecosystem of approximately 38 trillion bacteria and other organisms living in your digestive tract, have been connected not only to gut disorders but to mood, immune, inflammatory and autoimmune diseases, cancer and even cardiovascular disease.[³],[⁴] 

Research shows that taking live beneficial bacteria, such as probiotics, can improve microbiome health, reducing the symptoms of many health conditions,[⁵],[⁶] improving general health and lowering the risk of diseases such as those mentioned above.[⁷] In light of this, probiotic supplements and fermented foods, both sources of potentially beneficial bacteria, have been put forward as effective options for improving microbiome health. Consequently, there is a misconception that they are interchangeable; however, there are fundamental differences between them.

The Pros of Probiotics

Probiotics are defined as “live microorganisms that, when administered in adequate amounts, confer a health benefit on the host”.[⁸] Research has shown that specific types (strains) of probiotics, at defined doses, can help manage particular health conditions or symptoms, such as hayfever[⁹] or bloating. 

To understand this further, let us use irritable bowel syndrome (IBS), a painful digestive disorder, as an example. Research indicates that the specific probiotic strain, Lactobacillus plantarum 299v, can relieve the bloating, intestinal pain and inflammation of medically diagnosed IBS.[¹⁰],[¹¹] This benefit occurs when the probiotic is taken at a dose of 20 billion colony-forming units (CFU), which is a way of expressing the amount of live bacteria contained per probiotic capsule or dose of powder. 

Scientists give probiotic bacteria three names we can use to identify them and connect them to their health benefits: genus (e.g. Lactobacillus), species (e.g. plantarum), and strain (e.g. 299v). To get the health benefits associated with that strain, all three names must match the probiotic used in the scientific research, as well as the dose.

Luckily, you can find information on strains and doses in a probiotic supplement just by reading the label. By choosing a probiotic from a reputable brand committed to quality, you can feel confident that you will receive: 

• A guaranteed strain of bacteria effective for your health condition
• A correct quantity of live bacteria necessary for the benefit you require
• Bacteria that are alive at the label dosage until the expiry date

So, if you are looking to improve a particular health condition, choose a strain-specific probiotic for best results.

Fermented Foods Vs Probiotics 

Although fermented foods contain live bacteria, the microbes responsible for fermentation do not confer the same health benefits as a probiotic supplement. In fact, an expert panel of scientists concluded that fermented foods have unidentified microbial content, meaning there is no guarantee of what bacterial strains or doses will be present in them. For this reason, they are fundamentally different from probiotics.[¹²] 

That being said, many people experience non-specific digestive health benefits from including fermented foods in their diet, which could be related to the bacteria present, however, more research is needed to confirm this. Since fermentation breaks ingredients down into simpler parts, these foods are generally easier to digest, and fermentation also increases the nutritional value of the food.[¹³] If you are healthy and do not require specific health benefits, fermented foods may be appropriate for you. 

Be aware that, while fermenting at home can be fun, it is not a risk-free process. Exposure to oxygen, for example, can allow mould, yeast and less beneficial bacteria to grow. High-quality probiotics, on the other hand, are produced under strict hygienic conditions that minimise the risk of introducing ‘bad’ microorganisms into your gut. If your digestive system is sensitive, you may be better off taking a probiotic. 

Choose What’s Right For You 

Fermented foods are a tasty addition to the diet and do appear to provide some non-specific digestive benefits to relatively healthy people, on the proviso that they are prepared correctly. However, for support with specific health conditions, it is important to choose a specific probiotic strain, at the right dose, for your condition. 

[1] Chambers PJ, Pretorius IS. Fermenting knowledge: the history of winemaking, science and yeast research. EMBO Rep. 2010 Dec;11(12):914-20. doi: 10.1038/embor.2010.179.

[2] Alam R, Abdolmaleky HM, Zhou JR. Microbiome, inflammation, epigenetic alterations, and mental diseases. Am J Med Genet B Neuropsychiatr Genet. 2017 Sep;174(6):651-660. doi: 10.1002/ajmg.b.32567.

[3] Alam R, Abdolmaleky HM, Zhou JR. Microbiome, inflammation, epigenetic alterations, and mental diseases. Am J Med Genet B Neuropsychiatr Genet. 2017 Sep;174(6):651-660. doi: 10.1002/ajmg.b.32567.

[4] Maranduba CM, De Castro SB, de Souza GT, Rossato C, da Guia FC, Valente MA et al. Intestinal microbiota as modulators of the immune system and neuroimmune system: impact on the host health and homeostasis. J Immunol Res. 2015;2015:931574. doi: 10.1155/2015/931574.

[5] Niedzielin K,  Kordecki H, Birkenfeld B. A controlled, double-blind, randomised study on the efficacy of Lactobacillus plantarum 299v in patients with irritable bowel syndrome. Eur J Gastro Hepat 2001;13:1-5. PMID: 11711768.

[6] Costa DJ, Marteau P, Amouyal M, Poulsen LK, Hamelmann E, Czaaubiel M, et al. Efficacy and safety of the probiotic Lactobacillus paracasei LP-33 in allergic rhinitis: a double-blind, randomised, placebo-controlled trial (GA2LEN) study. Eur J Clin Nutr. 2014;1-6. doi: 10.1038/ejcn.2014.13.

[7] Kalliomäki M, Salminen S, Arvilommi H, Kero P, Koskinen P, Isolauri E. Probiotics in primary prevention of atopic disease: a randomised placebo-controlled trial. Lancet. 2001 Apr 7;357(9262):1076-9. doi: 10.1016/S0140-6736(00)04259-8. 

[8] Hill C, Guarner F, Reid G, Gibson GR, Merenstein DJ, Pot B et al. Expert consensus document. The International Scientific Association for Probiotics and Prebiotics consensus statement on the scope and appropriate use of the term probiotic. Nat Rev Gastroenterol Hepatol. 2014 Aug;11(8):506-14. doi: 10.1038/nrgastro.2014.66.

[9] Costa DJ, Marteau P, Amouyal M, Poulsen LK, Hamelmann E, Czaaubiel M, et al. Efficacy and safety of the probiotic Lactobacillus paracasei LP-33 in allergic rhinitis: a double-blind, randomised, placebo-controlled trial (GA2LEN) study. Eur J Clin Nutr. 2014;1-6. doi: 10.1038/ejcn.2014.13.

[10] Niedzielin K,  Kordecki H, Birkenfeld B. A controlled, double-blind, randomised study on the efficacy of Lactobacillus plantarum 299v in patients with irritable bowel syndrome. Eur J Gastro Hepat 2001;13:1-5. PMID: 11711768.

[11] Ducrotté P, Sawant P, Jayanthi V. Clinical trial: Lactobacillus plantarum 299v (DSM 9843) improves symptoms of irritable bowel syndrome. World J Gastroenterol. 2012 Aug 14;18(30):4012-8. doi: 10.3748/wjg.v18.i30.4012.

[12] Hill C, Guarner F, Reid G, Gibson GR, Merenstein DJ, Pot B et al. Expert consensus document. The International Scientific Association for Probiotics and Prebiotics consensus statement on the scope and appropriate use of the term probiotic. Nat RevGastroenterol Hepatol. 2014 Aug;11(8):506-14.doi: 10.1038/nrgastro.2014.66.

[13] Coyle D. What Is Fermentation? The Lowdown on Fermented Foods.

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