From Kombucha to Kefir: Fermented Foods and Gut Health

Welcome to The Perfect Stool: Understanding and Healing the Gut Microbiome. This is your host, Lindsey Parsons, and today I'm going to be talking about fermented foods, their benefits, and whether they can be helpful with your gut health and for specific conditions like IBS, Candida, SIBO, and IBD. But before I get started, if you haven't yet followed or subscribed to the show, be sure to do so, and it would awesome if you could leave me a review if you are on Apple Podcasts. And if you want to get transcripts of the podcast, pop over to my website, HighDesertHealthCoaching.com, and sign up for my newsletter. You'll also get my free ebooklet, which is called Finding Your Root Cause Through Stool and Organic Acids Testing, when you sign up. And now a brief word from my sponsor, Comuso. How many times a day do you feel overly stressed or anxious? Do you know our thoughts are tied to our breath? When your mind is busy, your breath is shallow, which triggers anxiety and stress. You can reduce those negative feelings with a simple breath. That's why Camuso created the Shift, a minimalist necklace that helps you relax by extending your exhales as you blow through it. Sometimes I have no physical sense that I'm under stress, but I know I am because my gut health improves dramatically within a few days of starting every vacation I take. So wouldn't it be great to be able to modulate your stress response quickly and easily? The Shift is a beautiful necklace that helps you breathe better. Let's create a calmer world by learning to breathe better and a healthier gut. Use my code HDH15OFF for 15% off of a Shift necklace. You'll find a link in the show notes or Google the Shift necklace by Camuso. Now onto the show. Fermentation is an ancient tradition used to preserve food without refrigeration and to prevent spoilage, which uses microorganisms like bacteria and yeast to break down the nutrients into their most digestible form. Some examples of common fermented foods are yogurt, kefir, sauerkraut, kombucha, pickles, miso, tempeh, natto, kimchi, kvass, cured meats, sourdough bread, apple cider vinegar that contains the mother, which is that cloudy stuff at the bottom of the bottle, and unpasteurized cheeses. Goat's milk, sheep's milk, and soft cheeses made with A2 milk are especially rich in probiotic bacteria. Consuming fermented foods can help maintain healthy gut bacteria as they're filled with good microflora called probiotics, primarily lactobacilli, bifidobacteria, and one strain of Streptococcus called Streptococcus thermophilus, which have been shown to improve digestion and absorption of nutrients and help with a whole host of health issues. Despite fermented foods' rise in popularity, many people still only consume probiotics in pill form. There's good evidence to suggest that eating fermented foods has its advantages over getting probiotics and nutrients through supplements. First, a huge diversity of species live in fermented foods that you may not find in a supplement. In addition, during the fermentation process, yeast and bacteria interact with the carbohydrates in the foods, releasing byproducts called bioactives or bioactive compounds. Bioactives are chemicals that have a biological effect on our bodies and include the beneficial bacteria themselves, as well as compounds like plant sterols, carotenoids, polyphenols, oligosaccharides, fatty acids, and amino acid derivatives. And because fermented foods ferment for longer and interact with the nutrients in the food, as opposed to growing probiotics on one substrate in a factory setting as quickly as possible, there's a higher quantity of bioactives in fermented foods as compared to most probiotic supplements. Some examples of beneficial bioactive compounds that come from fermented foods are CLA, or conjugated linoleic acid, an essential fatty acid otherwise found in meat and dairy from grass-fed animals that's created through fermentation from linoleic acid found in plants. Genestein, an isoflavone that's phytoestrogenic and anti-cancer due to its anti-angiogenic properties, meaning it inhibits the formation of new blood vessels which feed tumors, and gamma-aminobutyric acid, or GABA, which is a calming neurotransmitter. So bioactives have numerous health benefits like reducing cholesterol and helping with immune response. Another benefit of probiotic foods is that they're already partially broken down into nutrients that are easier for your body to assimilate. One concrete example of that is how the probiotic bacteria in yogurt and kefir break down lactose, which many people struggle to digest, including myself, during the fermentation process. That's why people who are lactose intolerant can still sometimes tolerate yogurt and kefir. In addition, even if the microbes in probiotic foods don't survive your stomach acid, they can still release enzymes as they die, which will help you digest your food better, leading to increased nutrient absorption. They can also break down anti-nutrients like phytic acid, which is found in grains, legumes, and seeds, and bind up minerals such as iron. And then after fermentation, those minerals become more absorbable. So for example, 8 hours of sourdough bread fermentation almost completely breaks down phytic acid in wheat and rye breads. So even though live bacteria are killed during the cooking, the nutrients in the fermented sourdough bread are still more available because of the fermentation process. To make sure you're getting the maximum benefits from live fermented foods, be sure to choose non-pasteurized or raw fermented foods, or foods marked lacto- fermented. So for example, the bags of sauerkraut you find in the supermarket are not raw and will have been cooked, killing the bacteria, which doesn't mean they're devoid of benefit because they'll still have those bioactives, but they won't have the live bacteria. You'll find the much more expensive raw fermented sauerkraut in the refrigerated section of health food stores, and of course you need to eat it cold to keep from killing the beneficial bacteria. Same with the typical pickles found in grocery stores versus the more expensive fermented pickles found in the refrigerated section. Which of course leads to the question of whether these bacteria actually survive the stomach acid and are delivered to the colon, where most of the fermentation in your own gut takes place. It turns out that Lactobacilli and Bifidobacteria, the strains that are most common in fermented foods, are especially resistant to stomach acid and have special strategies to ensure their survival, in particular when they're traveling on food. Which doesn't mean they're all going to arrive intact, but some portion of them will. In terms of quantities of probiotics and fermented foods, a typical serving of yogurt or kefir fermented beverages like kombucha will have around 10 to 40 billion CFUs, or colony-forming units, which is comparable to many commercial probiotics. Although when I recommend lactobifido probiotics to clients, I often shoot for 100 billion CFU per day. And one of the most studied probiotics, VSL number 3, which is now sold under the name VisBiome, is 450 billion CFU per packet. There's a wide range of CFU for other probiotic foods, so I'll link to an article in the show notes that gives you the range of possibilities., but for packaged foods, they should list the CFUs on the containers. So you may be wondering whether you should eat fermented foods if you have SIBO, or small intestine bacterial overgrowth, dysbiosis, or IBS. So I've heard, and, and I personally felt like I've experienced bloating and issues from eating fermented foods and probiotics while dealing with bloating from SIBO. That being said, there is one small study supporting probiotics as a treatment for SIBO in which probiotics outperformed standard antibiotics. And by that, I don't mean the $2,000 antibiotic Rifaximin or Xifaxan, which is often prescribed for SIBO. I mean the other antibiotics that are cheap. They believe that this probably was because the probiotic bacteria outcompetes the overgrown bacteria that's pathogenic, but those bacteria in the probiotics are generally transient and pass through your digestive system rather than colonize it. So I'll link to that study and all the others that I'm going to mention in the show notes, and also we'll put them in the transcript, which will come out in a week on my blog. Another small study showed improvement in diarrhea from bacterial overgrowth with treatment using two strains of Lactobacilli, but it did show that ongoing treatment with them was necessary to maintain the improvements. This is much more practical when you're considering eating fermented foods versus taking probiotics in the long term. Other reasons that fermented foods may be beneficial in SIBO are due to their anti-inflammatory and immunomodulatory effects, which may help your immune system clear the SIBO as well as helping to promote a healthy mucus lining in your intestines. If you do feel like you're having a bloating response though to fermented foods and/or probiotics when you have SIBO, you can either start with very small quantities and build up to see if that helps, or stick to spore-based probiotics like Megaspore Biotic or Proflora4R, which are both found in my FullScript dispensary, or S. boulardii probiotics, which is a beneficial yeast, and hold off on fermented foods until the root cause of the SIBO is addressed. Another potential benefit of fermented foods is with candidiasis, which is an overgrowth of the yeast Candida, a normal resident in our bodies and our digestive tracts. But whenever grown, um, which can take place in the mouth, it's called thrush, the digestive tract, the vagina, that's called a yeast infection. And it can also be systemic, especially in people with weakened immune systems. A 2016 review of the research on the benefits of probiotics for candidiasis cited studies which found antifungal effects for Lactobacilli and Saccharomyces boulardii in vitro, meaning in Petri dishes. And for Lactobacilli in vivo, meaning in human studies. In vitro, S. boulardii, whose official name is actually Saccharomyces cervisiae subspecies boulardii, was particularly good at stopping Candida albicans from forming filaments called hyphae, which make it particularly pathogenic, while Lactobacilli were good at inhibiting its growth. Supplementing with selenium also enhanced the antifungal effects of the Lactobacilli. In vivo, Various strains of Lactobacilli were helpful in reducing Candida in the oral cavity, urogenital tract, and GI tract by inhibiting biofilm growth by reducing hyphal development. If you're wondering where to find S. boulardii in food, I discovered while researching for this podcast that it was actually first found in the fruits mangosteen and lychee, and that's pretty much the only place you'll find it in food. Typical Americans might not eat those fruit regularly, but funny story, my husband loves mangosteen and I have I had never heard of them when I met him, but I guess he remembers that from living in Malaysia and Panama as a child when his father was in the military. And we lived in Australia for a few years when I was doing my doctorate, and we took a trip to a small town in Northern Queensland called Port Douglas, and we were hosted by the mayor of Port Douglas who Doug knew from his work. And his property was only accessible via boat across crocodile-infested waters where he tragically had lost one of his dogs. And on his property, he had a mangosteen tree. And normally mangosteen were pretty expensive and not very good by the time they got to the store, but that evening after dinner, Doug got to just feast on mangosteen, as many as you could possibly have that were juicy and perfectly ripe. But anyway, if you don't eat mangosteen and lychee much, then you'll have to look at supplements for S. pylori. Those studies do point to the likely usefulness of probiotic foods in preventing candidiasis, which many women likely already knew, as we're often told to eat yogurt to prevent yeast infections, even by our traditional doctors. Now, a brief message from our sponsor, Banatrol. If you suffer from diarrhea caused by IBS or any other types of digestive issues that are preventing you from leaving your house, then you should check out the number one natural anti-diarrheal in the world, Banatrol Plus. Banatrol's all-natural formula contains only two ingredients: a combination of green and ripe dehydrated banana flakes paired with a clinically proven GOS prebiotic fiber. You can try Banatrol risk-free for 30 days by going to trybanatrol.com. If for any reason it doesn't work, you will receive a 100% refund of the purchase price. That's trybanatrol.com, T-R-Y-B-A-N-A-T-R-O-L dot com. In terms of fermented foods and inflammatory bowel disease, or IBD, one peer-reviewed article suggests that the increased prevalence of IBD in Western countries and developed Asian countries is due to rapid changes in the environment and diet. In Japan and Korea specifically, traditional fermented foods are consumed less by younger generations due to their strong smells and tastes, along with a reduction in fiber in the diet. And the researchers suggested that returning to a more traditional diet should be encouraged to protect public health, create a healthier gut microbiota, and decrease rates of IBD. There are also two studies on mouse models of chemically induced colitis that offer support for fermented foods. In one of the studies, colitis symptoms were alleviated in mice fed a mixture of fermented barley and soybeans. By increasing the levels of healthy bacteria like Lactobacilli and suppressing levels of pro-inflammatory cytokines, or chemical messengers, in colonic tissue. In another study, mice fed a novel yogurt obtained by fermenting two anti-inflammatory bacterial strains, Streptococcus thermophilus and Lactobacillus delbrueckii subspecies bulgaricus, which you will find in many yogurts, showed reduced inflammation and developed a healthier immune response compared to controls. And then I wanted to talk more in depth about one particular fermented food, kefir, which is a probiotic drink made by fermenting milk, alternative milks, or water with kefir grains, because it has many big advocates for its positive health effects, and especially with gut health issues. Kefir contains more than 50 species of probiotic bacteria and yeasts and has been found to boost immune function, fight against harmful microbes, help with digestive issues, and much more. In addition, during the fermentation process, the bacteria from kefir grains produce the B vitamins B1, B2, B6, B12, folate, and biotin, some of which I find are commonly deficient in my clients. In terms of the evidence supporting kefir for gut health issues, in one study, 4 groups of mice received different doses of kefir over a 4-week period while the control group received a placebo. The results demonstrated a significant correlation between the amount of kefir administered and improvement in the ratio of Firmicutes to Bacteroidetes in the gut microbiome, which is considered a marker of microbiome health, improved athletic performance, and decreased fatigue. Other studies have identified additional benefits like building bone strength, decreasing proliferation of estrogen-dependent breast cancer cells, decreasing inflammation and allergies in a mouse model of asthma, fighting foodborne pathogens, and supporting skin health. Kefir may also be helpful with gastrointestinal symptoms. According to a randomized study of 15 healthy adults with lactose maldigestion, in which participants consumed milk, plain and flavored kefir, along with plain and flavored yogurt, the yogurt and kefir were shown to have a more positive effect on patients' GI symptoms than milk. Another small study on 10 people with chronic constipation matched with healthy controls showed significant improvement in stool frequency and consistency. Although another study found no significant improvement in antibiotic-associated diarrhea among 125 children after giving them kefir. But most importantly, in a 2019 study on inflammatory bowel disease with 10 Crohn's disease and 15 ulcerative colitis patients matched with 20 controls, where they received 400 milliliters a day of kefir over a 4-week period, they found significant improvements in scores on stool frequency, consistency, and abdominal pain. And so the researchers found that consuming kefir significantly improved the patient's symptoms and helped modulate their gut microbiota. But do keep in mind that not all kefir products are created equal. Kefir is made from the symbiotic relationship between bacteria and yeast found in kefir grains. Just as pasteurizing and mass-producing supplements can reduce the diversity of nutrients available, mass-producing kefir can lead to a less effective product resulting from a lack of microbial diversity in the kefir grains. In addition, the type of milk, the time, the temperature, and different methods of production all contribute to kefir's effectiveness. So if you decide to make your own kefir, be sure to invest in quality grains and get good instructions. And those grains can actually originate from different countries, which lead to different strains. So if you'd like to know more about the ones used in the studies mentioned, you can find those links in the show notes. But in summary, I just wanted to say that I'm really glad I undertook this podcast topic, as I personally haven't put a lot of emphasis on fermented foods lately, other than making my own sauerkraut. Since I stopped eating dairy and making my own yogurt, but I feel like it would probably be worth my time to figure out how to make kefir with a non-dairy milk or incorporate some good quality organic kefir into my diet. So I'd encourage those of you with gut health issues to start ramping up your consumption of fermented foods. And if you have gut health issues that haven't been responsive to fermented foods, diet changes, traditional medicine, etc., my specialty is helping people solve their gut health problems through lab tests that you can order yourself online., and then I educate you on what the results mean and the protocols used by doctors to fix the problems revealed. So if that interests you, you're welcome to set up a free 30-minute breakthrough session with me. We'll talk about what you've been going through, and I'll tell you about my 5-appointment gut health coaching program. Or if you're ready to jump in right away or can just afford one appointment at a time, you can set up an initial consultation with me. Both are linked in the show notes, or you can check out my website, High Desert Health Coaching.com, to read more about me and my work. So that's all for today. Hope you all start fermenting foods, and here's wishing you all the perfect stool.