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. 2016 Dec;15(6):22–30.

Probiotics and Disease: A Comprehensive Summary—Part 2, Commercially Produced Cultured and Fermented Foods Commonly Available in the United States

Emily C Parker 1,✉, Crystal M Gossard 1, Keren E Dolan 1, Heather J Finley 1, Cathleen M Burns 1, Margaret G Gasta 1, Jessica M Pizano 1, Christy B Williamson 1, Elizabeth A Lipski 1
PMCID: PMC5312833  PMID: 28223894

Abstract

This article series provides a literature review of the disease-specific probiotic strains studied in published clinical trials in humans and animals. The goal of the series is to provide clinically useful tools. The table design allows for quick access to supportive data and will be helpful as a guide for both researchers and clinicians. The first article (part 1) focused on mental health and neurological conditions. This second article (part 2) explores cultured and fermented foods that are commonly available in the United States. Future articles will review conditions related to cardiometabolic and fatigue syndromes; ear, nose, throat, respiratory, and infectious diseases; immune and dermatological conditions; cancer; gastrointestinal and genitourinary; followed by an article focused on probiotic supplements. This literature review is specific to disease conditions, probiotic classification, and individual strains. In part 1, we explored foods, brands, bacterial strains, and the number of organisms at end of production (in colony-forming units). In part 2, we investigate many of the commercially available cultured and fermented probiotic rich foods that are currently available in the United States. This summary can serve as a quick reference guide for recommending probiotic rich foods to patients.

The purpose of this summary is to provide nutritionists and other medical practitioners with a reference guide for recommending health-promoting commercially produced cultured and fermented food products to patients. Research was conducted via grocery stores trips, company Web site reviews, personal communication with food company personnel, along with PubMed and EBSCO Research Premier searches. The lists contained herein are not exhaustive; however, they represent items that are commonly accessible to US consumers.

Foods Containing Live Active Cultures and Probiotic Foods

Cultured and fermented foods contain live active bacteria. One caveat is that pasteurization destroys bacteria; thus, for foods to retain their active cultures, foods must be pasteurized before fermentation.1

In some, but not all cases, foods may be classified as a probiotic. Owing to the inconsistency of the internationally recognized definition of probiotic foods, this article uses the standards set forth by the International Scientific Association for Probiotics and Prebiotics (ISAPP). In accordance with the ISAPP definition, there must be viable scientific evidence to support the generalized benefit in human subjects, proof of viability/quantity of specific strains, and shelf-life viability. As such, the ISAPP classifies some traditionally probiotic foods, such as yogurt, not as probiotic but as fermented foods “containing live and active bacteria.” This delineation is due to the potential diversity and variability of strains found in such traditional cultured foods.2

Table 1 shows a variety of fermented foods containing live and active cultures that are prepared using specific bacteria. The foods listed herein are commercially produced and commonly available in the refrigerated sections of grocery and health food stores in the United States. Research shows that many of these foods have health-promoting and medicinal qualities.3 Specific benefits range from improved immune system function, better gastrointestinal health, improved mood, and increased bone mineral density among those with osteoporosis.4,5 This detailed information can be found in the Notes section in Table 1. Caution is advised for those with histamine sensitivity as fermented foods are high in histamine and may exacerbate symptoms of histamine intolerance.6

Table 1.

Foods Commercially Available in the United States That Contain Specific Bacterial Cultures

Food Category Specific Food Brands Product Examples Bacterial Strains Number of Organisms at End of Production (CFU) Notes
Fermented Dairy-free Beverages Kvass Zukay Live Foods Kvass is a traditional fermented fruit and/or vegetable juice product from Eastern Europe.7
Veggie Kvass, Fruit Kvass L casei,
L mesenteroides (specifically Ln mesenteroides FUA 3086),
S cerevisiae (yeast)		 7.3 × 107/mL = 17.52 billion/240 mL,
6.0 × 107/mL = 14.4 billion per 240 mL,
3.0 × 107/mL = 7.2 billion/240 mL		 See Dlusskaya et al8 (2008)
Fermented Dairy Alternatives Almond Yogurt Almond Dream
Nondairy Yogurt S thermophilus,
B lactis,a
L acidophilus,
L rhamnosus,
L casei,
L delbrueckii,
L lactis,
L bulgaricus 		Not specified; contains live and active cultures,a,b at least 100 million CFU/g
Amande Cultured Almond Milk L acidophilus,
L rhamnosus,
L casei,
L bulgaricus,
S thermophilus,
B bifiduma 		Not specified; contains live and active cultures, at least 100 million CFU/g
Kite Hill
Almond Milk Yogurt S thermophilus,
L bulgaricus,
L acidophilus,
Bifidobacteriaa (species not specified)		 Not specified; contains live and active cultures, at least 100 million CFU/g
Cashew Yogurt Forager Project
Creamy, Dairy-free Cashew Yogurt L plantarum LM,
L acidophilus,
B bifidum,
L bulgaricus,
S thermophilus,
L delbruekii LE		 Not specified; contains live and active cultures, at least 100 million CFU/g
Coconut Milk Yogurt Coconut Grove
Organic Cultured Coconut Milk S thermophilus,
L bulgaricus,
L acidophilus,
Bifidobacteriuma (species not specified)		 Not specified; contains live and active cultures, at least 100 million CFU/g
Trader Joe’s
Cultured Coconut Milk L bulgaricus,
S thermophilus,
L rhamnosus,
L acidophilus,
B bifiduma 		Not specified; contains live and active cultures, at least 100 million CFU/g
Soy Yogurt Springfield Creamery
Nancy’s Organic Cultured Soy L acidophilus,
B lactis,
L casei,
L rhamnosus,
L bulgaricus,
S thermophilus 		Not specified; contains live cultures, at least 100 million CFU/g
Stonyfield Organic
O’Soy Soy Yogurt S thermophilus,
L bulgaricus,
L acidophilus,
Bifidusa (species not specified)		 Not specified; contains live and active cultures, at least 100 million CFU/g
Fermented Dairy Products
Lassi Dahlicious Lassi is a traditional Indian fermented cow’s milk product that contains fruits or grains and a variety of medicinal herbs and spices.9
Cow’s Milk Lassi S thermophiles,
L acidophilus,
B lactis,a
L casei,
P freudenreichii 		15 billion/240 mL
Yogurt All Yogurt Containing “Live and Active Cultures” L bulgaricus,
S thermophilus 		At least 100 million CFU/g
Cow’s Milk Yogurt Springfield Creamery
Nancy’s Organic Yogurts L acidophilus LA-5,
S thermophilus,
L bulgaricus,
L casei,
L rhamnosus,
B bifiduma 		56 billion CFU/225 g/mL
Wallaby Yogurt Company
Goat’s Milk Yogurt Redwood Hill Farm
Goat Milk Yogurt B lactis,a
S thermophilus,
L acidophilus,
L delbrueckii sbps lactis,
L delbrueckii sbps bulgaricus 		Not specified; contains live and active cultures,b at least 100 million CFU/g
Sheep’s Milk Yogurt Bellwether Farms
L bulgaricus,
S thermophilus,
L acidophilus,
Bifidus a (species not specified)		 Not specified; contains active cultures,b at least 100 million CFU/g
Probiotic Dairy Foodsc Cow’s Milk Probiotic Yogurt Dannon, Inc
Activia,
Activia Light,
Activia Greek,
Activia Fruit Fusion,
Activia Dairy Drink		 B animalis lactis DN-173 010/CNCM I-2494,a
S thermophilus,
L bulgaricus,
L lactis 		Not specified; contains live and active cultures,b at least 100 million CFU/g Health Claim

  • “Activia may help reduce the frequency of minor digestive issues like bloating, gas, discomfort and rumbling, when consumed twice per day for two weeks as part of a balanced diet and healthy lifestyle.”10

Human Studies in Support of Activia

  • Improved bowel evacuation in women with constipation.11

  • Improved gastrointestinal well-being and digestive symptoms among women without gastrointestinal disorders.12
Cow’s Milk Probiotic Beverages Dannon
DanActive L bulgaricus,
S thermophiles,
L casei immunitas (L casei DN-114001)		 Not specified; contains live and active cultures,b at least 100 million CFU/g Health Claim

  • “DanActive helps support your immune system when consumed regularly as part of a balanced diet and healthy lifestyle.”13

Studies in Support of Danactive

  • Improved immune response.14,15
Yakult USA
Yakult,
Yakult Light		 L casei shirota 8 billion/80 mL Health Claim

  • “Drinking Yakult daily may help balance your digestive system.”16

Human Studies in Support of Yakult

  • Preservation of diversity of gut microbiota and decreased abdominal dysfunction in the context of high-stress situations.17

  • Improved natural killer cell activity and increased anti-inflammatory cytokine production among elderly subjects.18

  • Immunomodulation in HIV-positive patients.19

  • Decreased duration of fever associated with norovirus.20

  • Decreased incidence of hard, lumpy stool.21

  • Decreased frequency and duration of upper respiratory tract infections.22

  • Decreased cortisol secretion during times of stress.23
Cow’s Milk Kefir Human Studies in Support of Kefir

  • Anticariogenicity24

  • Attenuation of inflammatory process associated with athletic training.25

  • Improved outcomes in H pylori infection treatment.26

  • Improved regulation of emotions, modulation of sensory and task responses.27

  • Increased bone mineral density in patients with osteoporosis.28

  • Relief of constipation.29
Green Valley Organics
Lactose-Free Kefir L bulgaricus,
L acidophilus,
L casei,
L rhamnosus,
L lactis,
L diacetylactis,
S thermophilus,
L cremoris,
L cremoris,
B bifiduma 		589.68 billion/240 mL
Springfield Creamery
Nancy’s Organic Lowfat Plain Kefir B lactis BB-12,
L acidophilus LA-5,
L casei,
L rhamnosus LB3		 Not specified; contains live and active cultures,b 233 billion live cultures/240 mL, 64 Billion live probiotic cultures cultures/240 mL
Goat’s Milk Kefir Redwood Hill Farm
Goat Milk Kefir B lactis,a
S thermophiles,
L casei,
L rhamnosus,
L acidophilus,
L delbrueckii sbsp lactis,
L delbrueckii sbsp bulgaricus,
L lactis sbsp cremoris,
L lactis sbsp lactis,
L lactis sbsp lactis biovar diacerylactis,
L mesenteroides sbsp cremoris 		589.68 billion/240 mL
Probiotic Drinks (Dairy-free)c Kombucha Health Claims

  • “Bolsters your immunity.”30

  • “Reinvigorating.”31

  • “Naturally Energizing.”31

  • “Restorative.”31

Human Studies in Support of Kombucha

  • None found via PubMed search.

  • Lack of experimental evidence in human subjects had been noted.32
GT’s Kombucha
Classic Kombucha,
Classic Synergy		 Lactobacillus (no species specified),
S boulardii 		1 billion/240 mL, 1 billion/240 mL May contain over 0.5% alcohol.
Enlighted Kombucha,
Enlightened Synergy		 B coagulans GBI-30 6086,
S boulardii 		1 billion/240 mL, 1 billion/240 mL
Kevita Kombucha
Masterbrew B coagulans (LactoSporeMTCC 5826),
L rhamnosus 		Not specified,
“Live probiotic”		 Contains caffeine.
Cleansing Probiotic Drink,
Sparkling Probiotic Drink		 Kevita Probiotic Culture:
B coagulans GBI-30 6086,
L rhamnosus,
L plantarum,
L paracasei 		Not specified Cleansing Probiotic Drink contains trace amounts of alcohol.
Juice Drinks NextFoods
GoodBelly By the Glass,
GoodBelly Gluten Free By the Glass,
Good Belly
Plus Shot, GoodBelly Straight Shot,
GoodBelly Supershot		 L plantarum 299V 20 billion/240 mL,
20 billion/240 mL,
20 billion/81 mL,
20 billion/81 mL, 50 billion/81 mL		 Health Claims

  • “Promotes healthy digestion.”33

Human Studies in Support of Drink Containing Lactobacillus plantarum 299V:

  • Decreased gastrointestinal permeability and inflammatory response following biliary drainage in patients with obstructive jaundice.34

  • Decreased gastrointestinal symptoms during antibiotic therapy.35
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Note: These foods are all refrigerated and not pasteurized after culturing.

a

Viability of Bifidobacterium strains in yogurt has been shown to decline after 4 weeks in refrigerated (4°C) storage.36

b

According to the National Yogurt Association, a yogurt that claims to contain “live and active cultures” must contain at least 100 million cultures per gram at the time of manufacture.1 According to the International Scientific Association for Probiotics and Prebiotics,2 the terms live and active cultures do not always imply probiotic activity; scientific evidence of general beneficial effect in humans and proof of viability of specific strains at the end of product shelf life are required for “probiotic” food classification.

c

According to the International Scientific Association for Probiotics and Prebiotics,2 scientific evidence of general beneficial effect in humans and proof of viability of specific strains at the end of product shelf life are required for “probiotic” food classification.

Abbreviation: CFU, colony-forming unit.

Fermented Foods

Historically, fermented foods have been traditional staples for populations in all parts of the globe.37 Fermenting food, often via lactic acid bacterial fermentation, enhances digestibility, improves nutrient content (eg, enhances B complex vitamins, increases vitamin A and K levels, decreases mineral-binding phytates) and is an effective means of biopreservation.38,38,39 Certain types of flora have been shown to be predominant in many foods; however, some geographic variation exists owing to traditions and cultural preferences.37 Table 2 displays commercially produced refrigerated (with the exception of olives) fermented foods commonly found in grocery stores in the United States; this list is not exhaustive.

Table 2.

Common Fermented Foods Commercially Available in the United States

Food Category Specific Food Brands Product Examples Prominent Bacterial Strains Present at End of Fermentation Notes
Soy Miso Marukome,
Miso Master		 Various lactic acid bacteria (primarily Lactococci and Enterococci)42 Miso, a traditional Japanese food, is a fermented soybean paste.42,43 Other beans or grains may be used to make miso.43
Tempeh Lightlife,
Tofurky,
West Soy		 R oligosporus (mold),
R oryzae (mold)43 		Tempeh, a traditional Indonesian food, is a fermented soybean cake; it is high in protein.37,49 Grains such as rice or barley are sometimes added to tempeh.49
Vegetables Kimchi King’s,
Ozuké,
Seoul,
Wildbrine,
Pickeled Planet		 Lactobacillus plantarum,
L mesenteroides, W koreensis,44
L plantarum,
L brevis 		Kimchi, a traditional Korean food, is fermented cabbage, traditionally made with radish, garlic, red pepper, green onion, ginger and salt.37
Ozuké brand kimchi is available at grocery stores in the central United States.50
Ozuké brand kimchi contains 88 million CFU/g (M. King, personal communication, October 7, 2016).
Mara King is the Chief Operating Officer of Esoteric Food Company.
Pickled Beets Ozuké,
PureLiving,
Wildbrine		 Lactic acid bacteria (M. King, personal communication, October 7, 2016), specifically
L plantarum,
L brevis (C. Glab, personal communication, July 11, 2016)		 Ozuké brand fermented beets are available at grocery stores in the Central United States.50
Ozuké brand fermented beets contain 10 million CFU/g. (M. King, personal communication, October 7, 2016).
Mara King is the Chief Operating Officer of Esoteric Food Company.
Christopher Glab is the owner of Wildbrine.
Pickled Cucumbers Bubbies,
Real Pickles,
Pickled Planet		 Lactobacillus,
Pediococcus,
Leuconostoc (species not specified)45
L plantarum
L brevis 		Real Pickles are available in the North Eastern United States.51
Pickled Ginger Wildbrine L plantarum
L brevis (C. Glab, personal communication, July 11, 2016)		 Christopher Glab is the owner of Wildbrine.
Sauerkraut Bubbies,
Farmhouse Culture,
PureLiving,
Wildbrine,
Pickled Planet		 L mesenteroides,
L plantarum,
P pentosaceus,
L brevis,46
L plantarum
L brevis (C. Glab, personal communication, July 11, 2016)
L plantarum
L brevis 		Sauerkraut, fermented cabbage, is a traditional German food.43
Christopher Glab is the owner of Wildbrine.
Other Fermented Juice Farmhouse Culture,
Gut Shot,
Wildbrine		 None specified,
L plantarum,
L brevis (C. Glab, personal communication, July 11, 2016)		 Christopher Glab is the owner of Wildbrine.
Black (Kalamata) Olives (Greek, in glass jars) DeLallo,
Mezzetta		 L pentosus,
L mesenteroides47
Green Olives (Greek and Spanish, in glass jars) Trader Joe’s,
Mezzetta		 L plantarum,
L pentosus47,48
Salad Dressings Zukay None specified Zukay salad dressing flavors include Carrot Ginger, Cucumber Mint, and Tomato Olive.
Pickled Beans Pickled Planet L plantarum,
L brevis
Salsa Wildbrine L plantarum,
L brevis (C. Glab, personal communication, July 11, 2016)		 Christopher Glab is the owner of Wildbrine.
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Note: No specific starter cultures added, and no specific CFUs reported.

Abbreviation: CFU, colony-forming unit.

None of these foods would be officially classified as probiotics by the ISAPP2 because they do not always contain specific strains of bacteria in stated quantities. However, all of the foods listed contain beneficial live bacteria that have health-promoting qualities.38 Caution is advised for those with histamine sensitivity as fermented foods are high in histamine and may exacerbate symptoms.6

There are many shelf-stable fermented foods available in the marketplace such as beer, chocolate, coffee, ginger beer, tamari soy sauce, and wine.39 These shelf-stable foods have been excluded from this list because temperature fluctuations through time could alter the level of surviving live bacteria in the food product.40 Cheeses, another category of fermented food, have also been excluded from this list. The purpose of the exclusion is due to the wide variety of cheese, all of which have their unique culture fingerprints.41

Conclusion

A variety of commercially produced cultured and fermented foods, requiring refrigeration, are available in the US marketplace. Consuming products by their respective expiration dates will ensure the presence of live and active cultures in the food(s).52 The purpose of this review was to inform patients and practitioners about specific strains of bacteria and corresponding food(s) that may benefit or harm their well-being.

Acknowledgements

Keren Dolan, Heather Finley, Cathleen Burns, Margaret Gasta, Crystal Gossard, Emily Parker, Jessica Pizano, and Christy Williamson are doctoral students in the doctor of clinical nutrition program at Maryland University of Integrative Health in Laurel, Maryland. The probiotics table was a class project under the direction of Professor Elizabeth Lipski. The authors wish to acknowledge their spouses for the late nights.

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