Seppo Salminen

Improving your diet with fermented

foods: harmonizing dietary guidelines

including fermented milks

Seppo SalminenFunctional Foods Forum

Faculty of MedicineUniversity of Turku

Turku, Finland

Seppo Salminen

Conflict of Interest Statement

YINI sponsored the travel and accommodation to this meeting

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?

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?

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?

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?

Seppo Salminen

Why is this important to us?

THE MICROBES WE EAT?

100 MOST IMPORTANT SPECIES?

100 MOST IMPORTANT SPECIES FOR HUMAN EVOLUTION

Lactobacillus (5th most important)!

Food preservation (nutrition, shelf-life)

Preserving intestinal integrity,barrier against harmful microbes

The microbes we eat?THE MICROBES WE EAT?

• Streptococcus thermophilus and Lactobacillus delbrueckii subspbulgaricus

• Streptococcus thermophilus

• Antipathogenic properties - Complementary to Lactobacillus

Científicos argentinos descubrieron unantídoto 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,

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?

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?

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 claimhttp://www.fsai.ie/faqs/probiotic_health_claims.html

Term PROBIOTICS and Yoghurt in EU?

Seppo Salminen

Yoghurt studies suggest a potential benefit

Claim exists – could be called probiotic

Yoghurt also provides good nutrient profile

Seppo Salminen

Guidelines for Health Professionals?

• Fermented products vary according to the geographic area

• Yoghurt maybe the most common and accepted one

THE MICROBES WE EAT?

Dietary Guidelines and Yoghurt?

• 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?

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?

Seppo Salminen

Dietary Guidelines and Yoghurt in EU?

Seppo Salminen

Dietary recommendations for children in Russia?

The use of fermented milk products

the age of 1-3 years

biolakt, yoghurt, kefir, quark, cheeserecommended 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)

Seppo Salminen

Products recommended in Russia?

Lactobacillus bulgaricus

Lactobacillus acidophilus

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.

Seppo Salminen

Yogurt-type products and health in Russia?

Lactic-acidfermentation

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

• 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 sectioncorresponding to Dietary Fiber and its positive effect in intestinalfunction.

• Probiotics are only mentioned in the section corresponding to calciumabsorption

Seppo Salminen

GAPA - Guías Alimentarias para la Población Argentina

Fermented food and guidelines?

Fermented foods in Guidelines?

• Microbiota targeted foods?

• Fermented foods includingyoghurt

• Classification and recommendations have a greatpublic impact in the future

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?

Conclusions: Norway

Seppo Salminen

Bertelsen et al JACI 2014

Seppo Salminen

WAO RECOMMENDATIONS:

probiotics?

The Indian Food

Guide

Bell et al, Foods. 2017 Aug; 6(8): 65.

The Mediterranean Diet Pyramid.

Bell et al, Foods. 2017 Aug; 6(8): 65.

YOGURT IN DIETARY GUIDELINES

Bell et al, Foods. 2017 Aug; 6(8): 65.

Argentinian yoghurt reducedthe number of infections?

• 298 Children

• 2-5 years, yoghurt or placebo

• Yogurt group had significantly less infections

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!

• 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?

• 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?

“Fermented foods, including those that contain live microorganisms, should be

included as part of a healthy diet”

If I wrote the guidelines:

miso

Yogurt, the Gut Microbiome & Health:

From potential mechanism to dietary recommendations

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