Are Fermented Foods the Same as Probiotics?

Consider the fundamental change from milk to brie cheese or grapes to wine. Such is the power of fermentation. Fermented foods result from the growth and metabolism of live cultures, transforming a precursor food (such as milk) into a fermented food (cheese). The fermentation process may result in changes in taste, texture, aroma, nutritional value, microbial content and perhaps health benefits that extend beyond the basic nutritional value of the food. Because of this last property, some call fermented foods ‘probiotics’, but in fact they are not (necessarily) the same.

Probiotics are live microorganisms that, when administered in adequate amounts, confer a health benefit on the host. Unlike fermented foods, probiotics must have been tested in human studies and shown to have a beneficial health effect. Fermented foods don’t require such testing, although some have been. Further, some fermented foods are treated after they are made (for example, sourdough bread is baked), and do not contain live microbes at the point of consumption. To the extent a fermented food has been tested in human studies and shown to be beneficial and delivers a sufficient ‘dose’ of beneficial live microbes, it meets the bar of a probiotic. (See figure below). This is the case with several probiotic yogurts and fermented milks on the market today.

You likely have seen publicity and testimonials about how good for you fermented foods such as kombucha or sauerkraut are. Many of these foods may be good for your gut or immune system, but not as good as probiotics. If you enjoy them and they make you feel better, they are great additions to your diet. Scientists are now speculating that any source of live microbes may turn out to be beneficial.  To learn more about the benefits of probiotics read this review.
The body of evidence substantiating benefits of probiotics is quite extensive. Over 1800 human trials have been conducted using probiotics. See table below for a list of some benefits of probiotics shown in human trials. Keep in mind that benefits are tied to specific strains. It’s easy to grasp this concept if you look to the animal world. Different breeds of horses, for example, have quite different strengths and functions. You wouldn’t ride a pony in the Kentucky Derby.  Similarly, different strains of even the same species of a probiotic may have different benefits. In some cases, more than one independently tested probiotic product confers the same benefit. In other cases, only a single probiotic product has been shown to be effective. The best evidence for probiotic use is for prevention of antibiotic-associated diarrhea and C. difficile infection, management of certain gut symptoms, and prevention of necrotizing enterocolitis in preemie infants. People often wonder if probiotics have any benefit for healthy people. Benefits such as improved tolerance of dietary lactose for lactose intolerant people, management of blood lipids, improved oral health, reduced incidence of common infectious diseases such as the common cold, and management of gut symptoms all are demonstrated in reasonably healthy people.
The probiotic marketplace can be confusing for consumers. If you aren't being muscle tested for what probiotic your body needs here are some basic principles to guide your search:

• There is no one strain or one dose that is best. Sometimes lower dose products or products with fewer strains have the best evidence.
• One of the biggest challenges in the probiotic market is keeping the probiotic strain alive. Responsible manufactures go to great lengths to be sure their probiotics retain viability and deliver an efficacious dose through the end of the product’s shelf life. Unfortunately, not all products on the market are responsibly formulated. Consumers should buy products from companies they trust like I trust Standard Process. 

Benefit	Population
Treat colic in breastfed infants	Infants
Prevent atopic dermatitis/food hypersensitivity	Infants
Prevent necrotizing enterocolitis	Premature infants
Treat acute diarrhea	Infants, children
Manage symptoms of occasional constipation	Adults
Manage symptoms of lactose intolerance	Children, adults
Reduce incidence and duration of common infectious diseases (upper respiratory tract and gastrointestinal)	Children, adults
Prevent antibiotic-associated diarrhea	Children, adults
Extend remission of ulcerative colitis	Adults
Improve therapeutic efficacy of antibiotic treatment of bacterial vaginosis	Adult women
Reduce low density lipid cholesterol	Adults
Prevent Clostridium difficile diarrhea	Children, adults
Reduced prevalence of dental caries and gingivitis	Infants, children