Fermented Foods: Benefits, Best Types & How Much to Eat

Pack shredded cabbage and salt into a jar, press it under its own brine and wait. Within days, the bacteria already living on the leaves wake up, eat the cabbage's natural sugars and turn them into lactic acid. Plain cabbage becomes sauerkraut: sour, crunchy, slow to spoil and full of living microbes.2

That quiet change is why fermented foods have been part of traditional diets for thousands of years,2 and it's why I rank traditional ferments like sauerkraut, kimchi, kvass, kefir, yogurt and miso among the most anti-inflammatory foods you can eat.3 If your digestion feels off, if you're rebuilding your gut after a course of antibiotics, or if you simply want every meal to do more for you, fermented foods are one of the easiest places to start. They cost little, they keep for weeks in the fridge, and a few tablespoons a day is enough to begin.

The habit is older than you might think. When chemists analyzed the residue inside pottery jars from a Neolithic village in China, they found a fermented drink of rice, honey and fruit made as early as the seventh millennium B.C.4 What's new is the research. A landmark Stanford trial, pooled studies on digestion and blood sugar, and head-to-head tests of fresh and pasteurized sauerkraut now show what fermentation does in your body, what it doesn't, and which jar on the shelf is worth your money.

Did you know?

• Under U.S. rules, yogurt can carry the optional live and active cultures claim only if it has at least 10 million colony-forming units per gram when it's made, with a reasonable expectation of at least 1 million through its shelf life. Yogurt treated after culturing to inactivate its microbes must say it doesn't contain live and active cultures.5

• Natto, the sticky fermented soybean dish from Japan, carries about 775 micrograms of vitamin K2 (MK-7) per 100 grams.6

• In an 87-person trial, systolic blood pressure dipped slightly on pasteurized sauerkraut, with no live bacteria left, just as it did on fresh sauerkraut.7

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What is a fermented food?

Fermented foods and probiotic foods overlap, but they aren't the same thing. A fermented food is defined by how it was made. Refrigerated sauerkraut may contain live microbes without meeting the scientific criteria for a probiotic food, because probiotic status requires identified live microorganisms with evidence of a health benefit at the amount you eat.2 A loaf of sourdough is fermented and no longer alive at all, because baking kills the microbes that raised it. Both kinds can be worth eating.

The same goes for pickles, and this is where labels can mislead you. A true fermented pickle is a cucumber left in salt brine until lactic acid bacteria turn it sour on their own. Other pickles are acidified with vinegar without ever fermenting, so they taste tart for a different reason.2 The live-cultures shopping guide below shows how to tell them apart. You've probably been eating fermented food longer than you realized, too. Chocolate is made from fermented cacao beans, and researchers now study it alongside yogurt and cheese.12

A short history of fermented foods

Before refrigerators, fermentation was how families kept food through the seasons, and over time it became a way of eating people treasured for its own sake. In biblical times, milk was often fermented to keep it longer. Milk from sheep and cows became yogurt or kefir, was curdled into cheese or was churned into butter, and bread dough rose slowly with wild yeasts from the environment.15 Kimchi remains a traditional staple of Korean cooking,16 and natto has long been part of the Japanese diet.17

Fermented foods nutrition facts

Here's how to read that table. Yogurt and natto are real sources of protein and minerals, so they can carry part of a meal. A forkful of sauerkraut or kimchi is more about the living microbes and the compounds they leave behind than about vitamins, which is why a little goes a long way. Serving values are calculated from the gram weights shown, and brands and packing density vary. Daily values follow the FDA's label standards,23 and the natto vitamin K2 figure comes from a Japanese study that measured regular natto at 775 micrograms per 100 grams.6 The one number to keep an eye on is sodium, which adds up faster than anything else on the table.

What are fermented foods good for?

How do fermented foods work in your body?

Fermented foods work in three main ways: they bring live microbes into your gut, fermentation predigests the food so nutrients are easier to use, and the microbes leave useful compounds behind that keep working even after the food has been heated.

• Live microbes pass through. Unheated ferments deliver lactic acid bacteria and yeasts, and they tend to pass through rather than settle in: in a trial in which each of the 110 healthy adults tried both diets, a bacterium found in yogurt appeared in stool during daily yogurt and then faded, so regular intake is what keeps them present.27

• Fermentation predigests the food. The bacteria in yogurt carry their own lactase, which survives stomach acid and helps digest the milk sugar in the small intestine.28 Long fermentation also breaks down phytic acid in grain: leavening cut the phytate in bran bread to about 15% of its starting level after two days, and zinc absorption rose in 42 volunteers.29

• Useful compounds stay behind. Fermentation creates organic acids, peptides and vitamins such as the K2 in natto.26 Some preparations of inactivated microbes or their parts have shown health benefits and qualify as postbiotics, though heating a fermented food doesn't automatically make it one.30 In one trial, only pasteurized sauerkraut raised short-chain fatty acids in the blood, a finding researchers are still working to explain.31

Short-chain fatty acids are the thread that ties much of this together. When gut bacteria ferment fiber, they make acetate, propionate and butyrate, which fuel the cells lining your colon and act as signals that affect metabolism and other body processes.32 That's why fiber-rich plants and fermented foods work together. In the Stanford trial, the high-fiber diet boosted the microbial enzymes that break down fiber, with immune responses that depended on the microbes each person started with, while the fermented diet widened the range of species.1 Feed the gut with plants, seed it with ferments, and you give it both halves of what it needs.

Health benefits of fermented foods, ranked by evidence

These are the best-supported benefits of fermented foods, ranked by the strength of the human research. Each card names the food and the people studied.

Can fermented foods lower inflammation?

Here's why researchers think it works. The lining of your intestine is a single layer of cells, and it's the border between what you eat and your immune system. Researchers propose that the live microbes, acids and other compounds in fermented foods support that lining and calm the immune activity behind low-grade inflammation.2 The human trial below measured the result directly in the blood.

The trial analyzed 36 healthy adults, 18 on each diet. The fermented-food group built up over four weeks and held the diet for six more, and the trial's main immune-response measure didn't change.1

When researchers pooled 26 trials in 1,461 adults, fermented foods lowered TNF-alpha, one of the body's main inflammatory messengers, though CRP and IL-6 didn't change.10 In a 2026 German trial, 87 healthy adults ate 100 grams of fresh or pasteurized sauerkraut a day for four weeks; systolic blood pressure dipped slightly on both, while their inflammation markers didn't broadly change.7 Kefir told a similar story. In 65 young adults, a daily 250-milliliter glass of lactose-free kefir eased digestive symptoms within six weeks without moving inflammation markers.36

Live cultures matter more for some benefits than for others. Lactose digestion depends on live yogurt cultures,9 while that blood pressure dip and the IBS improvement in the Norwegian pilot showed up with pasteurized sauerkraut too, and the rise in blood short-chain fatty acids came only with the pasteurized version.73331 So enjoy both kinds, buy the refrigerated jar when live cultures are the point, and don't pay extra for a shelf-stable jar labeled "probiotic."

Which fermented foods still have live cultures?

At the store, four quick checks cover the important decisions. First, look for explicit fermentation and live-culture information on the package. Second, check whether the product was heated after it fermented, since refrigeration alone doesn't confirm it. Third, don't mistake pasteurized milk for a dead product: yogurt can be made from pasteurized milk and still contain live cultures, because heating before fermentation is different from heating afterward.5 Fourth, check the sodium and the added sugar, since a sweetened kombucha or flavored kefir can carry more sugar than you'd guess.

What are the best fermented foods to eat?

The best fermented foods for your gut are the live ones you'll eat most days: yogurt and kefir first, then sauerkraut and kimchi, kvass, miso and natto, and raw or aged cheese, with real sourdough as the best fermented bread. Each one brings something a little different.

Fermented dairy: yogurt, kefir and cheese

Yogurt and kefir are my top two probiotic foods, because they tend to carry the most bacteria.37 If you choose dairy yogurt or kefir, I recommend one made from A2 milk, from an A2 cow, a sheep or a goat.37 Kefir is fermented by both bacteria and yeasts from kefir grains,26 and plain versions skip the added sugar that flavored cups carry. If you avoid dairy, coconut yogurt, coconut kefir and water kefir offer other fermented options. Check their live cultures and nutrition labels, since the dairy studies described here don't establish identical benefits for these alternatives. Raw and aged cheeses and cultured cottage cheese can carry live cultures too, in smaller amounts. See kefir vs. yogurt for a closer comparison, and A2 milk for why the milk matters.

Fermented vegetables: sauerkraut, kimchi, kvass and brine pickles

Sauerkraut and kimchi are inexpensive, easy to find and easy to make at home. Kvass, a fermented beet or vegetable juice, is a drinkable option if you'd rather sip than chew,37 and brine pickles made with only salt and water count too. One kimchi note: many traditional recipes are seasoned with jeotgal, a salted seafood that can be shrimp (saeu-jeot) or anchovy (myeolchi-jeot).39 Shrimp doesn't meet the fins-and-scales standard I follow from The Biblio Diet,15 so read the label and choose kimchi seasoned with anchovy or anchovy fish sauce (check that the label lists no shrimp), or a seafood-free style like Korean temple kimchi.16 Or make it yourself with our kimchi recipe.

Fermented soy: natto, miso and tempeh

Fermented organic soy, meaning natto, miso and tempeh, is the soy I recommend, especially for women going through or past menopause, while processed soy like soy milk is the kind I steer away from.40 Natto is sticky, strong and worth getting used to for its vitamin K2. For live cultures from miso, choose one that contains them and follow the maker's serving instructions, since soup can remain very hot after the heat is switched off. Tempeh is cooked before you eat it, so enjoy it as a fermented protein rather than a probiotic.

Sourdough, kombucha and apple cider vinegar

Real whole-grain sourdough, ideally made from an ancient grain such as einkorn, is the bread I rank first.15 Its long fermentation breaks down phytic acid, the same effect longer leavening had in the bran bread study above.29 In single-meal studies, fermented breads raised iron uptake, especially low-phytate ones, though longer trials haven't yet shown higher iron stores.41

Kombucha is fermented sweet tea, and it's easy to find, but I consider it less beneficial than the fermented foods above. A little on occasion is fine for a lot of people; skip it if you're dealing with Candida.37 The trials so far are modest. In 59 adults with excess weight, adding 200 milliliters of green tea kombucha a day to a calorie-controlled diet didn't add weight loss over 10 weeks, though it lowered a measure of body-fat accumulation and kept IL-6 from rising as it did in the diet-only group, while four weeks of kombucha in 24 healthy adults brought no significant change in blood markers or inflammation.4243 If you enjoy it, choose one low in sugar and keep it an occasional drink. Apple cider vinegar is fermented as well; it's low in live probiotics, and its value comes from its organic acids.37

How much fermented food should you eat a day?

I recommend 2 to 3 tablespoons a day of fermented vegetables like sauerkraut or kimchi, or cultured dairy like kefir, if you tolerate them; it's the amount built into my Anti-Inflammatory Reset.13 The build-up matters more than the target. The Stanford trial built up to about six servings a day over four weeks, where a serving was 6 ounces of yogurt, kefir or kombucha, or a quarter cup of sauerkraut or kimchi. Bloating rose during that build-up and was no longer significant by the end of the maintenance weeks.1 The plan below starts smaller and builds more gently than the trial did.

If gas or bloating shows up, hold at your current amount for another week rather than quitting, and choose milder, less sour ferments for a while. If you don't tolerate fermented foods well, you don't need to force them; I'd use a probiotic supplement instead.14 Pair your ferments with prebiotic fiber from garlic, onions, asparagus, oats and slightly green bananas, since the microbes you add need food too.37 Our prebiotic foods guide has the full list.

Easy ways to eat more fermented foods

Fermented foods work best as small, daily additions to meals you already eat: a spoonful beside your eggs, a cup of kefir in a smoothie, miso stirred into soup at the end.

Are fermented foods better than probiotic supplements?

Fermented foods and probiotic supplements do different jobs, and you don't have to choose. Food brings a wide mix of microbes plus the compounds they made, inside a whole food. A supplement brings specific strains at a known dose, which is useful when a whole food doesn't agree with you or when you need more than food can give.

Fermented foods and antibiotics

When you truly need an antibiotic, take it exactly as prescribed, and let food help your gut through the course. In 202 hospitalized adults on antibiotics, adding 8 ounces of yogurt a day cut the rate of diarrhea in half, from 24% to 12%.45 When researchers pooled the two yogurt trials (314 people), the risk was 44% lower in one statistical model, a result that didn't hold in the second.46 In 82 people with H. pylori infection, adding 250 milliliters of kefir twice a day to standard triple therapy raised the clearance rate from 50% to 78% and made side effects milder.47 That's an add-on result: the kefir worked alongside the medication, not instead of it. Follow your antibiotic's food instructions, too.

Fermented foods side effects & who should be careful

Can fermented foods cause bloating or gas?

Yes, early on, which is why the four-week start plan above builds up slowly. With SIBO or heavy bloating, start with a teaspoon of sauerkraut juice and work up from there,14 and see our SIBO guide if bloating keeps coming back.

Are fermented foods high in histamine?

Many are. Fermentation raises histamine and related compounds, and when researchers compared 10 published low-histamine diets, fermented foods were the only group every one of them excluded.49 If fermented foods reliably bring on flushing, headaches, hives or a stuffy nose, choose milder, less sour ferments or take a break from them, use a probiotic supplement with soil-based organisms while the reaction calms down, then reintroduce small amounts.3 Hives can also signal a food allergy, so stop that food and see your doctor, and get emergency care for lip or throat swelling or trouble breathing. Our guide to histamine intolerance covers the rest.

Do fermented foods interact with medications?

Interaction check: high with MAOI antidepressants and with warfarin, plus a timing caution for ciprofloxacin. All three are easy to plan around. If you take an MAOI antidepressant, tyramine is the concern. Aged and fermented foods carry it, and in someone on an MAOI it can cause a dangerous spike in blood pressure. In lab testing, sauerkraut held 7.75 mg of tyramine per 250 grams, above the 6 mg-per-serving level considered dangerous, and a widely used MAOI diet restricts aged cheese, aged or air-dried meats, sauerkraut, soy sauce and tap beer.5051 Follow the food list from the doctor who prescribed your MAOI.

If you take warfarin, natto is the one to skip, because it's rich enough in vitamin K2 to counteract the drug.52 And if you're prescribed ciprofloxacin, don't take it with yogurt, kefir or milk alone, because dairy can lower its absorption; its label allows taking it with a meal that contains dairy.48

How much sodium is in fermented foods?

The nutrition table above shows how quickly sodium adds up, and miso leads at about 634 mg a tablespoon, more than a quarter of the daily value.22 At that rate, 2 to 3 tablespoons of miso would add about 1,268 to 1,902 mg of sodium, so use miso as a seasoning rather than as your daily ferment. If you're watching blood pressure, keep to small portions, look for lower-sodium versions, and lean on yogurt and natto, which are naturally low in sodium.

Are fermented foods safe during pregnancy or with a weakened immune system?

Pregnancy and a weakened immune system both call for extra care with unpasteurized foods. The FDA advises pregnant women, adults over 65 and people with weakened immune systems to avoid unpasteurized milk products and queso fresco–type cheeses because of listeria risk.38 Yogurt and kefir made from pasteurized milk can still contain live cultures.5 Live microbes also carry more risk for people with severe illness or a compromised immune system,53 so if your immune system is suppressed, such as during chemotherapy, follow your treatment team's food-safety instructions before adding live-culture foods.

The bottom line

Fermented foods: frequently asked questions

References

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Dr. Josh Axe, DC, DNM, CNS

Doctor of Natural Medicine · Founder, DrAxe.com

Dr. Axe is a certified doctor of natural medicine, clinical nutritionist, and multiple New York Times bestselling author. He has spent 20+ years in clinical practice helping people heal at the root cause and founded one of the most-visited natural-health platforms in the world.

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