Fermented foods
Fermented foods have been bringing live cultures to our plates for thousands of years. This week you'll learn why they can be allies of your flora, and how to introduce them sensibly, in small steps — paying attention to what suits your healing gut.
Fibre is your flora's food — and fermented foods are like guests who bring live cultures and beneficial substances along with them. Yoghurt, kefir, sauerkraut and their companions have been part of the human diet for thousands of years, and many of them contain live, beneficial microbes. This week you'll learn why they can be useful alongside your engrafting flora, and how to introduce them sensibly, bit by bit. Important: a fermented food is not the same as a shop-bought probiotic capsule, which we avoid during the course — we'll clarify this difference too.
What are fermented foods, and why are they useful?
Fermentation is an ancient method of preservation: beneficial microbes — bacteria, yeasts — "work" the food and transform it in the process. This is what gives yoghurt its tangy taste, sauerkraut its crisp freshness, kefir its fizz. These fermented foods[G] can help your gut in two ways: on the one hand, many of them contain live microbes; on the other, fermentation produces substances that nourish and soothe the gut environment.
It is important, however, to draw a distinction. A shop-bought probiotic capsule contains one or two selected bacterial strains in large, concentrated amounts — which is precisely why we ask you to avoid them during the DiffBiome course, so they don't disturb the freshly forming balance. A traditional fermented food, by contrast, introduces many kinds of microbe in small amounts, in natural form, as part of a food. This is closer to how humans ate for thousands of years, and is generally gentler.
Not every "sour" food is fermented, and not every fermented food contains live cultures. Pickled gherkins, for example, are often simply soaked in vinegar, not live-fermented. In heat-treated or pasteurised products (many shop-bought sauerkrauts, some yoghurts) the heat may destroy the live microbes. Products stored in the chiller and labelled "live cultures" are generally better — but the details come later; for now, the point is to get acquainted cautiously.
How to introduce them sensibly?
Here too, gradualness and observation are the key, perhaps even more so than with fibre. Your healing gut is more sensitive now, so introduce a single new fermented food at a time, in a very small portion: a few spoonfuls of plain yoghurt, a small sip of kefir, a forkful of sauerkraut. Watch for a day or two how you respond, and only then increase the portion or try something new.
The gentlest entry points are usually the dairy-based, live-culture products: plain (unsweetened) yoghurt and kefir, provided you tolerate dairy well. Plant ferments — sauerkraut, kimchi — can be stronger, so start with a very small amount, and rather as a side dish, not a main. Leave the very hot, spicy versions (strong kimchi) for later.
Most importantly: discuss the introduction of any new fermented food with your treating physician, especially while the course is ongoing. There are situations — for example a weakened immune system — when live cultures call for greater caution. Your physician knows your condition and can tell you when and what is worth trying. Your diary helps here too: note what you ate and how you tolerated it, so you can see what does you good.
Intake of fermented foods has shown an association with increased microbiota diversity and reduced inflammatory markers; the effect operates partly through the live microbes and partly through bioactive metabolites formed during fermentation. The matrix of a fermented food (food carrier, many strains, low individual dose) is pharmacologically distinct from concentrated, monotonous probiotic preparations, whose gut recolonisation can be transient and inter-individually variable (Zmora et al., 2018; Suez et al., 2018).
In the post-FMT period, avoiding probiotic preparations is warranted (datasheet protocol), because in a perturbed ecosystem probiotic recolonisation can delay the restoration of the native/donor microbiota (Suez et al., 2018). Traditional fermented foods have a different risk profile, but in immunosuppressed patients, or those with suspected toxic megacolon / fulminant colitis, the introduction of live cultures requires individual medical judgement — in line with the datasheet's recommendation for heightened observation in immunodeficiency.
Today we introduce a single, gentle fermented food in a very small portion. The goal is observation, not quantity.
- Check with your treating physician whether you may add a fermented food, if the course is still ongoing
- Start with a few spoonfuls of plain, unsweetened yoghurt (if you tolerate dairy)
- Watch all day how you feel afterwards
- Diary: stool count, Bristol, bloating, fluids; the fermented food and its tolerability
Today we build on yesterday's experience: if you tolerated it well, we can raise it a little; if not, we slow down. Your body leads.
- If yesterday went well, raise the portion slightly, or try kefir in a sip-sized amount
- If you bloated or it was uncomfortable, stay at yesterday's small portion, or take a break
- Don't introduce another new fermented food today — only one novelty at a time
- Diary: stool count, Bristol, bloating, fluids; tolerability
Today — if things have gone well so far — we get acquainted with a plant ferment, in a very small portion, as a side dish.
- Try a forkful of plain sauerkraut (live cultures, not pasteurised), as a side
- Keep the yoghurt or kefir that already worked for you, if it agreed with you
- Leave hot, heavily spiced versions (strong kimchi) for later
- Keep the few minutes of daily walking, and on a good day extend it a little
- Diary: stool count, Bristol, bloating, fluids; the new ferment's tolerability
🍽️ Eating during these days
This week's theme is the cautious introduction of fermented foods, and the three days' concrete eating task is exactly about this: a single gentle fermented food — a few spoonfuls of plain, unsweetened yoghurt — in a very small portion, observing tolerance (day 34); based on yesterday's experience, a cautious increase or a sip of kefir, or slowing down if it caused bloating (day 35); and finally a plant fermented food — a forkful of live-culture sauerkraut — as a side dish (day 36). The guiding principle is only one novelty at a time, in a small portion, tracked in the diary.
The Plant Calendar (Appendix F) recommends gentle, steamed vegetables and leafy greens for these days: cooked celeriac (day 34), steamed spinach (day 35) and steamed chard (day 36) — these days fall into the calendar's "gradual expansion" (days 31–50) phase, where the goal is to gradually increase steamed vegetables and plant diversity. These sources provide gentle, fermentable fibre and folate; fibre is substrate for fibre-degrading bacteria (towards short-chain fatty acids, butyrate), so the live cultures of fermented foods and the steamed vegetable fibres complement one another in supporting the diversity and resilience of the engrafting flora.
Record daily this week:
- DiffBiome dose (capsules/day) and LOT number, if the course is still ongoing;
- daily stool count;
- stool Bristol scale (1–7), with 3–4 as the target;
- bloating (0–5);
- bloody stool (yes/no);
- fluid intake (litres);
- the day's fermented food(s) and their tolerability;
- wellbeing (1–5).
- Movement: type + minutes, step count (target/actual)
- Stress level (1–5) and mood (1–5)
- Sleep (hours + quality 1–5)
Fermented foods can be valuable allies of your engrafting flora: they bring live cultures and beneficial substances into your gut, in natural, food form. This week you learned the most important difference between a fermented food and a concentrated probiotic capsule, and that the secret of sensible introduction is one novelty at a time, in a small portion, with observation — all in consultation with your treating physician. Your diary shows what does you good right now. Next week we'll talk about protein and the gentle diet.
#Cdifficile #DiffBiome #fermentedfoods #livecultures #microbiota #nutrition