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The Fermented Food Frenzy Dairy CNE, Oct 2017 Monique Piderit, RD (SA) @MoniquePiderit

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The Fermented Food

FrenzyDairy CNE, Oct 2017

Monique Piderit, RD (SA)

@MoniquePiderit

1. Defining the Fermented Food

– History of Fermented Foods

– Fermented Food Around the World

– Fermented food with and without live culture

2. Fermented Dairy

– Kefir

– Maas

– Yoghurt

3. The Role of Fermented Dairy Foods in Health

– Hypertension

– Cardiovascular disease

– Cancer

– Weight

– Gut Health

4. Conclusion

Outline

Type of food or beverage made by extensive microbial growth

Defining Fermented Foods

Lactic acid bacteria, moulds and yeasts (present or added)

Improve preservation, taste, structure and nutritional value

Fermented

Foods

Salameh et al, 2016; Praagman et al, 2015; Chilton et al, 2015

The science of fermentation is called

zymology.

The first zymologist was Louis

Pasteur.

Oldest and most economical

method of production and

preservation of food.

History of Fermentation

Foods underwent fermentation naturally, but today the addition of a

starter culture has helped make fermentation more automated,

reproducible, reliable and controlled.Chilton et al, 2015

Over 3500 fermented foods, divided into 250 groups, make up 1/3 of

foods in the human diet Tamang et al, 2016

8000 years ago: Cheese making started in Tigris and Euphrates

2000 – 4000 years ago: Wine making started in Ancient Egypt

7000 years ago: Fermented foods consumed in Babylon

Kimchi

Korean

condiment

made from

cabbage

Sauerkraut

Germany

Sour cabbage

Kefir

Russia

Alcoholic milk

with added

kefir grains

Kombucha

Russia and

China

Black, green,

white, oolong

tea with sugar Maas

South African

sour milk

Miso

Japanese

soybeans

Yoghurt

Greece or

Turkey

Around the World With Fermented Foods

Cheddar and

Stilton

UK

Fermented

sausage

Spain,

Portugal, Italy

and Greece

Tamang et al, 2016; Chilton et al, 2015

Value of Fermented Foods

Source of live,

active cultures

Improved

taste, texture

and

digestibility of

food

Increase food

safety and

shelf-life

Increase

vitamins and

bioactive

compounds

Remove/

reduce toxins

(mycotoxins)

or anti-

nutrients

(tannins,

phytic acid)

Chelule et al, 2010; International Scientific Association for Probiotics and Prebiotics, 2016

▪ Softens food texture and alters composition:▪ Less energy/fuel for cooking

▪ Eliminates need of preservation (lowered pH improves

shelf-life without refrigeration)

▪ Highly desirable where resources for cooking and

preservation scarce

▪ Improves food quality: essential amino acids,

vitamins and protein

▪ Generates income, improves food security

▪ Low cost technology in food preservation

increases accessibility and availability

▪ Malnutrition:▪ Complete food fortification programs from WHO

▪ Contribute to protein requirements

▪ Reduce childhood mortality

Fermented food products play a significant socio-economic role in Africa

Why Africa Needs Fermented Foods

Franz et al, 2014; Chelule et al, 2010

Not all fermented

foods are equal

Fermented foods retaining live cultures

Yoghurt and maas

Kimchi and kefir

Some cheeses

Fresh sauerkraut

Fresh sour dill pickles

Traditional salami

Water/ brine cured olivesFermented foods consumed without

living cultures

Most beer and wine

Most soy sauce

Chocolate

Sourdough bread

TempehInternational Scientific Association for Probiotics and Prebiotics, 2016

Maj

or G

roup

s of

Fer

men

ted

Foo

ds Fermented cereals

Fermented legumes

Fermented roots and tubers

Fermented vegetables and bamboo shoots

Fermented and preserved meat products

Fermented, dried and smoked fish products

Miscellaneous fermented products

Alcoholic beverages

Fermented milk products: kefir, maas, yoghurt

Tamang et al, 2015

Kefir

Originated in the Tibetan or Mongolian mountains over 2000 years BC.

Keif: Well-being or living well; considered a source of family wealth.

Kefir grains with specific and complex mixture in a symbiotic relationship:

LAB, acetic acid bacteria, lactose fermenting and non-fermenting yeast.

Codex Alimentarius

▪ 2.7% protein

▪ 0.6% lactic acid

▪ <10% fat

▪ 107 CFU/ml

▪ Alcohol % not established

Kefir grains produce acidic

fermented milk

Slightly carbonated with small

amounts of alcohol

Similar in taste to maas

Rosa et al, 2017; Affane et al, 2015

Over 300

different

microbial

species in

kefir

Production of Kefir

Whole, low fat or fat free,

pasteurised milk from cow, buffalo,

goat, camel or sheep

8 - 10C

for 10 – 40 hours

Grains separated from fermented milk by a sieve

May be reused and thus more cost-effective

During cooling, accumulation of

CO2, ethanol and B complex

vitamins and reduction of

lactose content (30%)

Rosa et al, 2017

Phy

siol

ogic

al E

ffect

s of

Kef

irRosa et al, 2017

Kefir

Insulin

resistance

Blood

Pressure

Colon

cancer

IBS

Cholesterol

Amasi by Numbers (per 100g)

3,7g total

fat

2.35g SFA

At least

1 x 107

CFU/g of

viable lactic

acid

162mg

calcium

190g

potassium

270kJ

3.3g protein

(R260: Min

3.0g/100g)

4.5g

carbohydrate

Per 100g

Vorster et al, “Have milk, mass or yoghurt every day”: a food-based dietary guideline for South Africa, SAJCN, 2013

R260 Regulations relating to the classification, packing and marking of diary.

pH of less

than 4.6

▪ Lactic acid bacteria is the dominating

microbe in maas:▪ Leuconostoc

▪ Lactococcus

▪ Lactobacillus

▪ Commercial maas production:▪ Lactococcus lactis lactis

▪ L. lactis cremoris

▪ Lb. plantarum

▪ E. faecalis

▪ Maas pasteurised after fermentation

▪ Shelf life of 21 days at 4C

First scientific record of traditional maas production: 1939

Originally prepared by storing unpasteurized cow's milk in calabashes,

clay pots, milk-sacks, stone jars or baskets.

Amazing Amasi

Chelule et al, 2010; Osvik et al, 2013; Jans et al, 2014; Vorster et al, 2014

11.00

11.20

11.40

11.60

11.80

12.00

12.20

12.40

320 000

340 000

360 000

380 000

400 000

420 000

440 000

460 000

Jun

. 2

01

5

Jul.

20

15

Au

g 2

01

5

Se

p.

20

15

Oct.

20

15

No

v.

20

15

De

c.

20

15

Jan

20

16

Fe

b 2

01

6

Ma

r 2

01

6

Ap

r. 2

01

6

Me

i 2

01

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Jun

. 2

01

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Jul.

20

16

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g 2

01

6

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p.

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Oct.

20

16

No

v.

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Jan

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b 2

01

7

Ma

r 2

01

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r. 2

01

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i 2

01

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Jun

. 2

01

7

R/litreLitres per dayMaas average sales volume per day and Average price per month

Sales Volume per day Average price

Amasi Average Sales Volume and Price

Nielson, June 2017

Volume : source Danone.

Yoghurt

PCC

4.66 Kg

66%

10%

19%

61.7%

26.6%

10.8 kg

7.2 kg

3.9 kg

Population

Avg HH monthlyIncome

LSM 8-9

LSM 4-7

LSM 1-3

10.1M

36.3M

5.2M

Maas

PPC

2.8 kg

4.7 kg

4.2 kg

3.84 Kg

LSM 10 6%3.4M

1.9%

9.9%

0.9 kg 0.8 kg

R 38200

R 21300

R7300

R 38200

Total Population Category Consumption

Low PCC

of maas

73g per

week

Low PCC

of yoghurt

<100g

per week

Danone Southern Africa, August 2017

Starter cultures added to

milk

Milk deliveredto factory

Lactobacillus Bulgaricus

and Streptococcus thermophilus

Milk ferments for

8 hrs

(up to 15 hr for maas)

Whey protein,

Stabilisers, flavours, skim

milk powder, and sugar added

Converts lactose to lactic acid

(hence acidity of yoghurt)

Packaged in various

units

Shelf life of 21 days

How

Yog

hurt

is M

ade

▪ 53% eating more yogurt than 3

years ago.

▪ Yoghurt is a dessert in France,

a snack in Poland , and a

beverage in China.

▪ Drinking yoghurt dominates

the Chinese yoghurt market

▪ 49% prefer it as a drink

▪ 11% prefer yoghurt as a

spoonable yoghurt

▪ Greek yoghurt is increasingly

popular in the United States

▪ The Chinese have been eating

more probiotic yoghurt over

the last three years.

http://www.dairyfoods.com/articles/91062-yogurt-is-a-dessert-in-france-a-snack-in-poland

March 2015

Altered gut

microbiota & gut

hormone response

Decrease in

glycaemic and

insulin response

Replacement/

displacement

of less healthy

snack foods

Low kJ

Whey protein

induces

satiety

Health Benefits of Yoghurt

Phanahi et al, 2016; Eales et al, 2016

Low pH delays

gastric

emptying

Low GI

Cardioprotective

effects of dairy

Increase in

body fat loss

and lean body

mass gain

The Role of Fermented

Dairy in Health

Fermented Milk as an Anti-Hypertensive

Bioactive peptides: hydrolysates with specific amino acid sequences that

exert a positive physiological influence on the body.

Fermented dairy are potential sources of bioactive peptides

Inhibition of ACE: angiotensin I angiotensin II (potent vasoconstrictor)

lowers blood pressure

Milk contains potassium and calcium, minerals known to have a positive effect on

blood pressure.

50% of reduction in blood pressure of DASH diet attributed to dairy

Low milk intake in NHANES I associated with high incidence of hypertension

Low sodium to potassium ratio

Vorster et al, 2014; Beltran-Barrientos et al, 2015

Other reasons?

V

↓24.2% LDL-chol

s

↓13.8% Total-Chol

C

Fermented soy once

daily for 42 days

N=49

D

Canallini et al, 2016

Fermented Foods and Cancer Risk

▪ EPIC cohort in Netherlands >34 000 participants

▪ Investigate the relationship between fermented foods (dairy

products, cheeses, vegetables and meat) and mortality due to all

causes, cancer, and CVD.

✓ Fermented food intake not associated with mortality due to all

causes, cancer, and CVD.

✓ Cheese was moderately inversely associated with CVD mortality

and stroke mortality (p=0.046)

▪ No strong evidence that intake of fermented foods, particular

fermented dairy, is associated with mortality.

Praagman et al, 2015

Yog

hurt

in C

hron

ic D

isea

se

Yog

hurt

in C

hron

ic D

isea

se

Yog

hurt

in C

hron

ic D

isea

se

22

publications

6 cohorts

7 cross

sectional

6 RCTs

1 controlled

trial

Yoghurt in Weight Management

✓ In epidemiological studies, yoghurt consumption associated

with:▪ ↓ BMI

▪ ↓ Body weight/weight gain

▪ ↓ Waist circumference

▪ ↓ Body fat

✓Modest but beneficial effect of yoghurt consumption for

prevention of weight gain and management of obesity.

✓ Availability of yoghurt (a nutrient-dense food) and its ease of

introduction to most diets suggests that educating the public to

eat yoghurt as part of a balanced and healthy diet may

potentially contribute to improved public health.Eales et al, 2016

Dairy consumption associated with a lower risk of childhood

overweight/obesity.

For each 1 serving/day of dairy, risk of overweight/obesity ↓13%.

Similar results are being found more specifically with yoghurt consumption

Yoghurt in Children’s Weight

Children (8–18 years) who eat yoghurt

regularly (1 x/week) have a healthier diet:

▪ 23% more fruit.

▪ 30% more wholegrains.

▪ Higher intakes of Ca, vitamin D,

and potassium.

▪ Dec WC

▪ Dec BMI

▪ Dec %BFNHANES, Keast et al, 2015

National Food Consumption Survey sugar

intakes in the diets of children 1-9 years:

1. Sugar added at the table (62.7%)

2. Cold drink, sweets and jams (23.0%)

3. Fruit (3.4%)

4. Confectionary (2.90%)

5. Milk and milk products (2.5%)

6. Cocoa based products (1.2%)

Sugar in Yoghurt

Milk and milk products, including

flavoured milk and drinking

yoghurt are

not the drivers of sugar intake

in SA children

Milk SA, 2017

Organised Dairy Industry Submission On The Taxation Of Sugar-Sweetened Dairy Beverages

Source of Sugar in Children’s Diet

Moreno et al, 2016

% T

otal

Sug

ar

% A

dded

Sug

ar

Fermented Foods in Gut Health

Food matrix of dairy

plays a role in protecting

bacteria during passage

through gut and

enhanced delivery of

viable bacteria

Live cultures of

fermented foods

potentially

increase

microbes in gut

10 000-fold.

Marco et al, 2017; Uriot et al, 2016; Nichols 2007; Holzapfel et al, 2002; Pyne et al, 2012

>400 species of

bacteria in gut.

Gut is sterile at

birth, but this is

being

challenged

Gut home to

10x more bacterial

cells than human

cells.

Bacterial cells weigh

up to 2kg

The Functions of Gut Microbiota

▪ Enhances integrity of intestinal barrier

▪ Absorption and digestion

▪ Produces some vitamins (e.g. folate, B12, K)

▪ Secretion of immune cells (GALT)

▪ Produce anti-microbial agents

▪ Compete for binding sites

▪ Regulates energy balance: energy harvesting from the diet and energy

storage in the host

o Fermenting unavailable energy substrates such as fiber to short-

chain fatty acids (SCFAs).

o Glucose metabolism

Rad et al, 2016; Pyne et al, 2012

Cro

ssta

lk b

etw

een

Gut

and

Met

abol

ic H

ealth

of

Hos

t

Boulange et al, 2016

Gut Microbiota for Health

The Gut-Brain Axis

Fermented dairy considered

part of our South African

heritage and a supplementary

staple food, with great cultural

importance.

Healthcare professionals should offer patients/clients assistance in

ways to include fermented dairy as part of their daily diet.

The expansive use of, and benefits gained from, fermented foods

supports their greater inclusion in dietary guidelines around the world.

Conclusion

Well-established in the human

diet for thousands of years, with

or without appreciation for or

understating of their underlying

health benefit.

References

Available on request

Thank You!

@MoniquePiderit

[email protected]

Monique Piderit Registered Dietitian

Nutritional Solutions