When Moni Schifler’s son Rudi developed digestive issues as a teenager, doctors seemed incapable of helping him. His IBS was initially misdiagnosed as acid reflux and despite trying various treatments, it grew so bad over time that he could hardly keep down any food. By the age of 22 he had lost 70 pounds and was so weak he couldn’t stand on his own.

In desperation, Schifler turned to a type of food common in Jewish and many traditional cultures: fermented vegetables.

These foods, from sauerkraut to pickles, have seen a resurgence in recent years thanks to fermented-food evangelists such as Sandor Katz and the popularity of fermentation with top chefs like Noma owner René Redzepi. But the comeback is also due, at least in part, to a growing understanding of the potential health benefits to be gained from eating fermented foods. (I write about some of these possible benefits in The Good Vices: From Beer to Sex, the Surprising Truth About What’s Actually Good for You, which I co-authored with my dad, Dr. Harry Ofgang.)

Fermentation is an early form of food preservation and occurs when food or beverages undergo controlled microbial growth or enzymatic conversions. Fermented products range from beer and kombucha to yogurt and the traditionally made pickles of Jewish lore that once filled wooden vats at appetizing stores in New York City and elsewhere. Fruits and vegetables start out teeming with vitamins and nutrients, which are enhanced and increased through the fermentation process.

When not pasteurized or made through modern shortcuts, fermented foods and drinks are often rich in probiotics. These good microorganisms have the potential to increase our gut health by strengthening our microbiomes, the system of trillions of microbes that live on and in our bodies.

“The definition of probiotics requires them to confer a health benefit to humans,” said Kerry Ivey, a researcher at the Harvard T.H. Chan School of Public Health who studies fermented foods. “Because even different yogurt brands use different probiotic bacteria, and no one really knows what probiotic bacteria are the best, what I generally recommend is eating a variety of foods rich in probiotics, so that you’re getting lots of different types of probiotics, some of which may confer a health benefit.”

While consumption of probiotics has also been shown to improve conditions like high cholesterol, there is evidence that different people respond differently to the same probiotics. “The microbiome is made up of trillions of different bacteria,” said Ivey, “so to understand how one individual bacteria type plays a role in the microbiome is really complex.”

To help Rudi with his digestive problems, Schifler started buying fresh cabbage and making sauerkraut with an old family recipe. She said that little by little, eating sauerkraut replenished the microbes of her son’s gut. “After a couple of months, he started feeling better,” Schifler said.

The positive effect that sauerkraut seemed to have on her son inspired Schifler to start Superkrauts, a line of kosher-certified probiotic sauerkraut she makes in New York’s Hudson Valley. Store-bought sauerkrauts may not have conferred a similar benefit, Schifler said, because many modern sauerkrauts are pickled, not fermented. The same is true of many modern cucumber pickles, though both items were traditionally fermented.

“Pickling and fermentation are 180-degree opposites,” she said. “Pickled vegetables use vinegar. And the reason they use vinegar is because it’s an acid. And generally when you pickle something you kill off as many of the microorganisms as you can. The wonderful microorganisms that I try to grow, in pickling you kill them off and then try to suspend the vegetable in vinegar so it doesn’t degrade. We’re trying to get the microorganisms to proliferate, drive off and out anything else that would be harmful, and we do it with the use of salt.”

The original pickles in the wooden barrel of old were fermented, but as food became more industrialized in the 1950s, a vinegar-led pickling process replaced traditional fermentation. Fermented vegetables are full of live organisms that can cause glass jars to crack, which was unappealing for the large grocery stores that sprouted up in the post-WWII United States.

When it comes to sauerkraut, Schifler said, at many stores you have “this dead product that looks a little bit like sauerkraut, somewhat tastes like it, but has absolutely none of the benefits.”

She’s dedicated to creating authentic raw sauerkraut and helping spread awareness of the health potential of fermented foods, which for certain fermented products may go well beyond digestive health.

“It is increasingly understood that some fermented foods also promote human health in ways not directly attributable to the starting food materials,” researchers wrote in a 2017 analysis in Current Opinion in Biotechnology, a peer-reviewed journal. “Large cohort investigations have revealed strong associations between consumption of fermented dairy foods and weight maintenance. Likewise, other long-term prospective studies show reductions in risk of cardiovascular disease (CVD), Type 2 diabetes, and overall mortality from frequent yogurt consumption.” The authors note that “evidence is accumulating for anti-diabetic and anti-obesity benefits of kimchi,” and that there are indications that fermented food consumption may alter mood and brain activity.

Maria Marco, the lead author of the study and professor in the department of Food Science and Technology at the University of California, Davis, is quick to point out that more research is needed. She notes that when it comes to fermented vegetables and fruits, “there are very few human studies.” She says that even if one type of sauerkraut is healthy, that wouldn’t necessarily mean another would be. “And moreover, if I make sauerkraut, it’s going to have a different consortia of bacteria. They’re all going to be the same species probably, but can we feel confident that my sauerkraut will give me the same health benefits as your sauerkraut?”

Marco added, “The more we understand about how these microbes can benefit our health, the more confident we might be in saying that, ‘Yeah, my sauerkraut is as good as yours.’ Or we might pull back and say, ‘In order for this sauerkraut to really benefit my health it should have properties X, Y, and Z.’”

While miraculous cures may not be proven, at the very least, fermented vegetables have the nutrients and health-giving qualities of all vegetables. “[Fermented vegetables] increase the amount of fruit and vegetables that we’re eating and that to me is a win-win,” Marco said. “If they taste good, and you enjoy eating them, there’s no harm in doing that.”

To have any chance of conferring a benefit through probiotics, fermented foods need to be raw, so the bacteria are still active. When shopping for fermented foods, Schifler says to look for the word “unpasteurized” on the label. “That is your most important feature,” she said. “Somewhere it should talk about live cultures. Listing the strains of probiotics, which looks impressive, is not that impressive to me, because it probably means those strains were added.”

Also keep an eye out for vinegar. “It most certainly is not sauerkraut if it has vinegar as an ingredient,” Schifler said.

Schifler’s son Rudi continues to be a fan of the product. Now 28 and living in New Paltz, New York, Rudi said he and his 5-year-old son eat it daily: “I, for maintenance, because I like it and need it, my son because he loves it,” he said. “We hold sauerkraut parties where we compare different flavors. We can’t get enough of it—and my son thinks everyone’s grandmother makes sauerkraut.”

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