From ‘alcoholic yogurt’ to DIY fermentation, patients are exploring potentially risky new ways to ease stress
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Beneficial bacteria can easily become pathogenic, damaging bacteria if exposed to the wrong temperature, oxygen, or substrates like sugar or salt.
—Megan Wroe, MS, RD, CNE, CLEC, registered dietitian at Providence St. Jude Medical Center
The internet is never without a trend purporting to improve physical and mental health, and one that has been sticking around for a while is the practice of fermenting foods at home.
Fermented foods have been associated with many health benefits, including supporting gut health, immune function, bone health, cognition and brain health, heart health, and more.[]
But as more people take up home fermentation, it needs to be asked: Are there any bonus benefits to fermenting foods at home, and do they come with hidden, unconsidered risks? Ahead, experts weigh in.
A healthy habit not without health risks
“The biggest concern with practicing fermenting at home is the risk of creating pathogenic bacteria in the process,” says Megan Wroe, MS, RD, CNE, CLEC, Wellness Manager & Registered Dietitian, Providence St. Jude Medical Center. “Beneficial bacteria can easily become pathogenic, damaging bacteria,” she continues, “if exposed to the wrong temperature, oxygen, or substrates like sugar or salt.”
Daniel Kim, DO, board-certified physician with Medical Offices of Manhattan and contributor to LabFinder.com, agrees, adding that the biggest harm is the potential for growing harmful bacteria such as Clostridium botulinum, Salmonella, and E. coli. Eating foods with harmful bacteria could lead to stomach flu and even more serious—and sometimes life-threatening—illnesses like botulism.
Has the fermentation trend gone too far?
As the gut-health boom continues, some companies are pushing fermented drinks into riskier territory. One of the most striking examples: "water kefir," from the brand Fermenteria—available in both alcoholic and non-alcoholic versions.
Marketed as a “gut-friendly” alcoholic alternative, doctors may side-eye the clever branding as predatory marketing that masks real health risks.
Instead of using dairy like classic milk kefir, water kefir relies on a simple mixture of sugar and water. The grains—clusters of beneficial bacteria and yeast—feed on the sugars during fermentation, producing a refreshing, probiotic-rich beverage.[]
Fermenteria uses a mixed wild culture plus “specialty yeast” in a “fermentation champagne,” giving their drinks a naturally higher alcohol content than traditional water kefir. They promote these drinks as having no added sugar and “naturally occurring enzymes, probiotics, vitamins, minerals, and antioxidants.”
Their "hard" water kefir is 5% ABV, yet they claim there are 20 billion CFUs of probiotics in some of their alcoholic versions. By branding an alcoholic beverage as a “probiotic wellness” item, there may be a risk of misleading consumers—especially those who prioritize gut health. The presence of live cultures and “no sugar” doesn’t negate the risks of alcohol, which negatively affect gut integrity, liver function, and more.
Physicians should caution patients who are drawn to functional or “wellness” alcoholic drinks that probiotic content doesn’t eliminate the harms of alcohol. While there's a place for hard water kefir, like any other alcoholic beverage, in moderation, it's not without its risks.
Related: 'Adaptogenic mocktails' are the latest health craze—but may come with their own set of health risksTalking to patients: How to minimize risks
Fermentation is a fairly simple process, but you do need to pay attention to environmental exposures, adds Wroe. “For example, making kombucha in a space that is too hot or has direct sunlight can cause the mother bacteria to go bad.”
However, these risks can be avoided when patients follow instructions from reliable sources and maintain proper hygiene throughout the fermentation process. Doing this, according to Sotiria Everett, EdD, RD, CDN, CSSD, clinical assistant professor at Stony Brook University, helps ensure that overgrowth of harmful bacteria doesn't happen.
Better still, Dr. Everett suggests opting for readily available, fermented foods like yogurt, kefir, kimchi, or pickled vegetables. Nevertheless, for those interested in fermenting foods at home, she says that using the pickling process for vegetables, including pickled onions or pickled cabbage, is a safer way to ferment foods. The main thing is to be sure to follow the basic food safety preparation guidelines to reduce the risk of foodborne illness.
Regarding whether there are any extra advantages of fermenting foods at home, experts agree that at-home fermented foods provide the same benefits as those bought in the market. Choosing whether to ferment your foods yourself, or not, all boils down to cost and convenience. “There are some amazing fermented foods in markets now that are yummy and high quality. However, they do cost more than homemade versions,” says Wroe. From a practical standpoint, regularly fermenting foods may be unrealistic for some people because it takes up so much time.
One point in favor of fermenting foods at home is being able to choose exactly what goes into them. “Some [store-bought fermented foods] may have more sugar or salt than you would add at home, so in fermenting at home, consumers can save money and have complete control over their ingredients,” adds Wroe.
Fermenting is a science with steps that need to be followed, according to Wroe. That said, given the wide variety of options available at the market now—including ready-to-drink options like Fermenteria’s water kefir—"I don’t think people should stress about fermenting at home on their own if it doesn’t interest them," Wroe says. "Just buy some sauerkraut, throw two tablespoons into your daily salad, or enjoy a glass of water kefir, and you can easily meet basic needs without the home preparation.”