Sauerkraut, kimchi, kombucha, … and of course, fermented milks like yogurt are growing in popularity propelled by health claims and increasing knowledge about the gut microbiota. Several researchers around the world want therefore Health Organizations to add a new category to the National Food Guide that’s is fermented foods. For Seppo Salminen (University of Turku, Finland), it’s even time to go further!

1. Seppo Salminen
Improving your diet with fermented
foods: harmonizing dietary guidelines
including fermented milks
Seppo Salminen
Functional Foods Forum
Faculty of Medicine
University of Turku
Turku, Finland

2. Seppo Salminen
Conflict of Interest Statement
YINI sponsored the travel and accommodation to this meeting

3. The microbes we eat?
• Traditional foods often made with fermentation
• Intake of diverse fermentation bacteria has been important
• Fermentation served also as a way of improving shelf-life
• Fermented products varied according to the geographic area
LANG ET AL PEER
JOURNAL 2014
THE MICROBES WE EAT?

4. The microbes we eat?
• Abundance & taxonomy of microbes consumed in a day’s
meals for 3 diet types
• (1) the Average American (AMERICAN): focused on convenience
foods
• (2) USDA recommended (USDA): emphasizing fruits and
vegetables, lean meat, dairy, and whole grains
• (3) Vegan (VEGAN): excluding all animal products.
LANG ET AL PEER
JOURNAL 2014
THE MICROBES WE EAT?

5. The microbes we eat?
• Based on plate counts
• USDA meal plan had the highest total amount of microbes at
1.3 × 109 CFU per day
• the VEGAN meal plan 6 × 106 CFU per day
• The AMERICAN meal plan 1.4 × 106 CFU per day
LANG ET AL PEER
JOURNAL 2014
THE MICROBES WE EAT?

6. The microbes we eat?
• Exposure to live microbes decreased – hygiene hypothesis
• Is the current exposure enough?
• Should we use more fermented foods?
• Yogurt: one cup fills the gap
LANG ET AL PEER
JOURNAL 2014
THE MICROBES WE EAT?

7. Seppo Salminen
 Why is this important to us?
THE MICROBES WE EAT?

8. 100 MOST IMPORTANT SPECIES?

9. 100 MOST IMPORTANT SPECIES
FOR HUMAN EVOLUTION
Lactobacillus (5th most important)!
Food preservation (nutrition, shelf-life)
Preserving intestinal integrity,
barrier against harmful microbes

10. The microbes we eat?THE MICROBES WE EAT?
• Streptococcus thermophilus and Lactobacillus delbrueckii subsp
bulgaricus
• Streptococcus thermophilus
• Antipathogenic properties - Complementary to Lactobacillus

12. Científicos argentinos descubrieron un
antídoto natural para prevenir y curar la
gastritis
La clave podría estar en una bacteria probiótica
denominada Streptococcus thermophilus CRL1190.
Los especialistas del Centro de Referencia para
Lactobacilos (Cerela) de Tucumán junto al Conicet,

13. The microbes we eat?
• 1 Cup of yoghurt – 108-10 bacteria
• Other potential food sources:
• Fermented cabbage, Kimchi, Fermented beans
• Cheese, olives
• Salami type sausages
• Fermented oats
• Yogurt the best source of key bacteria
LANG ET AL PEER
JOURNAL 2014
FERMENTED FOODS?

14. Live yoghurt cultures – “Alleviate
symptoms of lactose maldigestion in those
who do not tolerate lactose”
Yoghurt and probiotic - ‘Live
microorganisms that, when administered in
adequate amounts, confer a health benefit
on the host’
Hill et al 2014
EFSA Scientific Opinion
Health Claims in European Union?

15. The term ‘probiotic’ is a health claim.
Stating ‘contains probiotic’ (or similar) on a product … implies that the product
contains a substance that may be beneficial for health…. For this reason, the
term ‘probiotic’, when used on a food label, is considered to be a health
claim.
Any terms that imply probiotic activity are health claims and are not
permitted. For example if terms like ‘live’ or ‘active’ are used to describe bacteria,
these imply a probiotic function and therefore are considered to be health claims.
You can give the name of the bacteria in the list of ingredients.
Live/Active Probiotic Health claim
http://www.fsai.ie/faqs/probiotic_health_claims.html
Term PROBIOTICS and Yoghurt in EU?

16. Seppo Salminen

17.  Yoghurt studies suggest a potential benefit
 Claim exists – could be called probiotic
 Yoghurt also provides good nutrient profile
Seppo Salminen
Guidelines for Health Professionals?

18. • Fermented products vary according to the
geographic area
• Yoghurt maybe the most common and
accepted one
THE MICROBES WE EAT?

19. Dietary Guidelines and Yoghurt?

20. • Most EU member states mention yoghurt
in dietary guidelines
• 5 EU member states mention yoghurt in
dietary guidelines with reference to
bacteria
• Estonia, Germany, Italy, Poland, Spain
Seppo Salminen
Dietary Guidelines and Yoghurt in EU?

21.  All 5 mention also probiotics
 Germany does not mention species of
probiotic bacteria
 All others mention Lactobacillus acidophilus,
Bifidobacterium, and/or L casei and L reuteri
 All suggest balancing intestinal microbiota as
one benefit
Seppo Salminen
Dietary Guidelines and Yoghurt in EU?

22. Seppo Salminen
Dietary Guidelines and Yoghurt in EU?

23. Seppo Salminen
Dietary recommendations for children in Russia?
The use of fermented milk products
the age of 1-3 years
biolakt, yoghurt, kefir, quark, cheese
recommended daily intake:
milk and milk beverages 400-450 ml/day,
quark 20-40 g/day.
cheese 5 g/day.
the 1st year of life
birth – adapted milk formulas,
from 6 months –quark (50 g/day)
8 months – biolact, yoghurt,
bioyoghurt, kefir, biokefir
(200 g/day)

24. Seppo Salminen
Products recommended in Russia?
Lactobacillus Lactobacillus Kefir starter culture
Yogurt is a fermented milk product produced using a mixture of starter
microorganisms - thermophilic lactic streptococci and Bulgarian lactic acid
Bacillus.
Biolakt is a fermented milk product made using starter culture
Streptococcus thermophilus + Lactobacillus acidophilus
Quark is a fermented milk product made using starter microorganisms -
lactococci or mixture Lactococcus and Streptococcus thermophilus and
methods of acid or acid-rennet coagulation proteins with subsequent
removal of whey .
Kefir is a fermented milk product made by mixed (lactic and alcohol)
fermentation using ferments prepared on kefir fungi without the addition of
pure cultures of lactate microorganisms and yeast.

25. Seppo Salminen
Yogurt-type products and health in Russia?
Lactic-acid
fermentation
Lactic acid
Acetic acid
Propionic acid
•Inhibits the growth of
pathogens
•Stimulates the growth of
normal flora
•Increases local immunity
•Stimulates the secretory
function of digestive
glands
•Improves absorption of
nutrients
•Stimulates peristalsis
•Activates phagocytosis
•Stimulates peristalsis
•Involved in the energy
supply of epithelium
•Blocks adhesion of
pathogens to enterocytes
•Has antibacterial action
•Increases local immunity

26. • Dietary Guide for the Argentinian population, Argentinian Health
Ministry
• Recommend 1) to consume 3 daily portions of milk, yogurt or cheese
• Food from this group are a source of calcium and are necessary for all age
• lactic acid bacteria and bifidobacteria, they are mentioned in the section
corresponding to Dietary Fiber and its positive effect in intestinal
function.
• Probiotics are only mentioned in the section corresponding to calcium
absorption
Seppo Salminen
GAPA - Guías Alimentarias para la Población Argentina

30. Fermented food and guidelines?

32. Fermented foods in Guidelines?

33. • Microbiota targeted foods?
• Fermented foods including
yoghurt
• Classification and
recommendations have a great
public impact in the future

34. Seppo Salminen
74000 mothers questionned on probiotic consumption during
2 and 3rd trimester of pregnancy and one year following delivery
Bertelsen et al JACI 2014
Norway?

35. Conclusions: Norway
Seppo Salminen
Bertelsen et al JACI 2014

36. Seppo Salminen
WAO RECOMMENDATIONS:
probiotics?

37. The Indian Food
Guide
Bell et al, Foods. 2017 Aug; 6(8): 65.

38. The Mediterranean Diet Pyramid.
Bell et al, Foods. 2017 Aug; 6(8): 65.

39. YOGURT IN DIETARY GUIDELINES
Bell et al, Foods. 2017 Aug; 6(8): 65.

41. Argentinian yoghurt reducedthe number of infections?
• 298 Children
• 2-5 years, yoghurt or placebo
• Yogurt group had significantly less infections

42. National Social Nutritional Program Argentina
• Since 2008 probiotic yoghurt in schools, Locally produced
• More than 200 000 children receive daily yoghurt, impact on wellness
• Local production activity
• Benefit to all!

43. • Consumption of yogurt and fermented milk products reduced
incidence of atopic eczema and rhinoconjunctivitis by 36 months of
age in a Norwegian study
• Elderly often report reduced constipation with yogurt
Seppo Salminen
Future Dietary Guidelines?

44. • Provides live beneficial bacteria to the human ecosystem
• Frequent yogurt consumption may contribute to improved diet
quality
• Public health impact needs to be assessed (also economic impact)
Seppo Salminen
Future Dietary Guidelines and Yoghurt?

45. “Fermented foods, including those that
contain live microorganisms, should be
included as part of a healthy diet”
If I wrote the guidelines:
miso

46. Yogurt, the Gut Microbiome &
Health:
From potential mechanism to dietary
recommendations

47. Nutrition, probiotics (and prebiotics) modulate
the gut microbiome
Fermented foods may also contribute
live microorganisms to the gut
microbiota
 Peptides released during fermentation may explain
some of the health benefits of yogurt consumption on
cardiometabolic diseases
 Consuming live microbes through fermented foods should
be recommended by official governmental channels. Yogurt
is one of the most readily available fermented foods
Fermented foods ≠ probiotics but they
have similar properties
Yogurt, the Gut Microbiome & Health: From potential mechanism to dietary recommendations