Dear Mark: How Do Fermented Food and Meat Interact?

For this week’s Dear Mark, I’m answering a question from a reader about a topic I thought I’d covered (so did they) already. A quick look through the archives (hey, I can’t remember absolutely everything I ever wrote) showed that I had not, so here we go. It’s all about whether fermented foods—sauerkrauts, kimchis, pickles, yogurts, and any other food that has been acted upon by probiotic bacteria—make eating meat healthier and more enjoyable. From the start, I suspected that they do, but I had to confirm it in the scientific literature.

Let’s find out:

Hi Mark,
I’m trying to find an article on why you should eat ferments with meat, (how it breaks down the fats) our mutual friend Hilary, AKA #thelunchlady ? and I are working on getting some of the high end butcher’s around LA to understand this, so they can help educate their customers. I was hoping to find info on your site, but now hoping you might write one for us

As for the effect you mention—fermented food breaking down the fat in meat—I’m unaware of any evidence. I am aware of a beneficial effect of fermented food on carbohydrate metabolism though. See, lactofermentation produces acetic acid as a byproduct. Acetic acid provides the “sour” flavor, the acidity of a batch of sauerkraut or pickles. It’s also what makes vinegar so sour, and there’s a long line of evidence showing that vinegar improves glucose tolerance and reduces the blood glucose load of high carb meals.

  • A 2017 review of the evidence found that vinegar was significantly effective at reducing both postprandial blood sugar and insulin levels.
  • It works in type 2 diabetics who eat vinegar with their high-carb meals, lowering the blood glucose response.
  • Research shows that acetic acid, rather than some other component in the vinegar, is the active component responsible for the effect on blood sugar. Anything with acetic acid should work, like food ferments.

That’s carbohydrate, and it’s good info, but you didn’t ask about carbs. You asked about meat. So, is fermented food pointless when eating meat? Not at all.

There are many examples of traditional cultures and cuisines making it a point to serve fermented foods with meats:

Koreans, kimchi, BBQ.

Germans, sauerkraut, sausage.

Japanese, pickles/natto/miso, meat/fish.

Indians, yogurt/pickles/chutneys, meat curry/tandoori chicken.

Italians, cheese, salami (itself a fermented meat).

They may not have “known” about the biochemistry. They weren’t citing PubMed studies. But over the many hundreds of years, these pairings emerged as combinations that just worked and made people feel good and the food go down more easily.

What could be going on here?

One thing I’ve stressed over the years is the importance of consuming foods high in polyphenols, not only for their isolated health benefits but for their ameliorative effects on the potential carcinogenicity of meats—particularly high-heat cooked meats (barbecue, grilling, searing). If you eat foods high in polyphenols, like blueberries or leafy greens, with your meat, that meal becomes healthier. It reduces the formation of carcinogenic compounds and reduces the peroxidative damage done to the fat.

And if you take a food high in polyphenols and subject it to fermentation, those polyphenols change and actually become more effective.

Red wine is one such fermented food that is higher in polyphenols than its non-fermented counterpart. The fermentation process alters the polyphenols already present in the grapes, making them more bioavailable and more effective, and creating entirely new compounds in the process. One reason red wine pairs so well with steak on a subjective level is that it actually reduces the formation of toxic lipid oxidation byproducts in “simulated digestion” studies that attempt to recreate the stomach environment after a meal, inhibits the absorption of those toxic lipid byproducts, and, when added to meat marinades, reduces the formation of heat-related carcinogens when you cook the meat, even over open flame. The responsible compound for these effects in red wine isn’t the alcohol, it’s the polyphenols. Grape juice doesn’t have the same effect.

This applies to everything. Fermentation of almost any other food, from beans to cabbage to garlic, also changes and improves the antioxidative capacity of the polyphenols. And the more polyphenols a food has, and the more effective they are at reducing oxidation, the healthier they’ll make any meat we eat.

Fermented foods also contain probiotic bacteria, and there’s some limited evidence that certain bacterial strains can actually enhance metabolism of cooked meat carcinogens.

So, in a roundabout way, fermented foods actually are improving the way we digest the fats in meat. They aren’t quite “breaking them down,” but they are allowing us to metabolize them in a healthier way that produces fewer toxic byproducts and inhibits our absorption of the toxic byproducts that do slip by.

This actually gives me a good idea for a post: A series of elevator pitches that inspired readers can use to lobby restaurant owners, butchers, doctors, and anyone else about the otherwise complicated health and nutrition topics we’ve bandied about on this blog for a decade. Most folks’ brains will glaze over when you start talking “omega-3s” or “peroxidized lipids” or “oxidized LDL particles” or “high heat carcinogens,” but it’s still important information. I think I’ll start putting that together in the next few weeks, starting with today’s topic, and I could really use your help. What other topics have you wanted to broach but can’t figure out how to make relatable, simplistic, or elegant enough to drop in casual conversation with professionals (or friends) who could help make a difference?

Let’s get a list going and try to knock this out.

That’s it for today, folks. Take care and be well. Thanks for reading!


Shishehbor F, Mansoori A, Shirani F. Vinegar consumption can attenuate postprandial glucose and insulin responses; a systematic review and meta-analysis of clinical trials. Diabetes Res Clin Pract. 2017;127:1-9.

Liatis S, Grammatikou S, Poulia KA, et al. Vinegar reduces postprandial hyperglycaemia in patients with type II diabetes when added to a high, but not to a low, glycaemic index meal. Eur J Clin Nutr. 2010;64(7):727-32.

Mettler S, Schwarz I, Colombani PC. Additive postprandial blood glucose-attenuating and satiety-enhancing effect of cinnamon and acetic acid. Nutr Res. 2009;29(10):723-7.

Gorelik S, Ligumsky M, Kohen R, Kanner J. The stomach as a “bioreactor”: when red meat meets red wine. J Agric Food Chem. 2008;56(13):5002-7.

Gorelik S, Ligumsky M, Kohen R, Kanner J. A novel function of red wine polyphenols in humans: prevention of absorption of cytotoxic lipid peroxidation products. FASEB J. 2008;22(1):41-6.

Kanner J, Gorelik S, Roman S, Kohen R. Protection by polyphenols of postprandial human plasma and low-density lipoprotein modification: the stomach as a bioreactor. J Agric Food Chem. 2012;60(36):8790-6.

Harbaum B, Hubbermann EM, Zhu Z, Schwarz K. Impact of fermentation on phenolic compounds in leaves of pak choi (Brassica campestris L. ssp. chinensis var. communis) and Chinese leaf mustard (Brassica juncea coss). J Agric Food Chem. 2008;56(1):148-57.

Kimura S, Tung YC, Pan MH, Su NW, Lai YJ, Cheng KC. Black garlic: A critical review of its production, bioactivity, and application. J Food Drug Anal. 2017;25(1):62-70.

Nowak A, Libudzisz Z. Ability of probiotic Lactobacillus casei DN 114001 to bind or/and metabolise heterocyclic aromatic amines in vitro. Eur J Nutr. 2009;48(7):419-27.

TAGS:  dear mark

About the Author

Mark Sisson is the founder of Mark’s Daily Apple, godfather to the Primal food and lifestyle movement, and the New York Times bestselling author of The Keto Reset Diet. His latest book is Keto for Life, where he discusses how he combines the keto diet with a Primal lifestyle for optimal health and longevity. Mark is the author of numerous other books as well, including The Primal Blueprint, which was credited with turbocharging the growth of the primal/paleo movement back in 2009. After spending three decades researching and educating folks on why food is the key component to achieving and maintaining optimal wellness, Mark launched Primal Kitchen, a real-food company that creates Primal/paleo, keto, and Whole30-friendly kitchen staples.

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34 thoughts on “Dear Mark: How Do Fermented Food and Meat Interact?”

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  1. Doesn’t lactofermentation produce primarily LACTIC acid, not acetic acid?

    Lactofermented (real!) pickles taste a lot better than the fake store “pickles” that are just soaked in vinegar (water + acetic acid) to make them artificially sour without any real fermentation.

    1. Some acetic will be made from the resulting alcohol because acetobacter is everywhere, but yeah lactic is the main product.

      1. Depending on the temperature and salt concentration, acetic acid produced will be about 1/5th to 1/4th that of lactic acid in the vegetable ferment. Fermenting wine or other alcoholic beverages to make vinegar obviously makes much more acetic acid than lactic acid.

  2. I know you have posts on them, but I think the topics that come to mind when you talk about tough subjects for people to get their heads around are
    -replacing the fiber in grains with veggies
    -misperceptions about cholesterol
    -debunking CICO
    -the idea that fasting or restricted window eating is healthy
    -embracing fat
    -exercise and weight loss not being linear

    1. i second the ‘exercise and weight loss not being linear’ idea. we are doing a new year’s challenge at my gym and although i’ve long known this it’s still frustrating when you work hard the scale gives you the finger. but, you know you’re making solid gains because your clothes fit better and you feel and sleep better. the scale is the most overused and least effective tool in the toolbox for me.

  3. I’m curious if eating fermented foods with meat would have any effect on trimethylamine-N-oxide (TMAO) production by the gut microbiome?

  4. A few topics that are tough for me to explain to the average SAD eater and my doctor:
    Why I don’t wear sunscreen regularly.
    Why eating grass fed meat is so important, and why if you can’t eat grass fed you should eat lean, but if you are eating grass fed, that isn’t as important.
    Why it’s actually good/okay to be low carb.
    Fat doesn’t make you fat.
    Even though the label says there is no sugar and it says sugar free, there are so many things in it that are actually sugar, just a science-y name or another type of sugar that allows them to get away with the label. Explaining why those sugars are still bad for you and how your body processes sugars is so confusing for people.
    Why eating so many times a day so you’re never hungry isn’t a good thing for your body – why being hungry is good for you. And why fasting is good.
    Why soy products are bad for you.
    Why corn and peas are neutral – they aren’t amazingly good for you just because they are “vegetables.”
    How sleep affects weight loss.
    Why going barefoot outside is so good for you.

    1. Why “organic” flats of eggs aren’t quite the same as local free-range eggs, and how all the terms are used/abused.

      Why we don’t need added sugar.

  5. One subject about which I am quite curious is what “natural,” pre-industrialization menstrual cycles truly looked like. I know we say something like 25-35 days for a normal, healthy cycle, but would this have been realistic hundreds of years ago? Is a little bit of amenorrhea okay? How much is too much? I just think that hundreds and thousands of years ago, women were just as likely as men to experience stretches of time without food, and Mark has previously described how women can be more sensitive to fasting.

    I know this isn’t exactly what Mark was requesting, but my brain has been ping-ponging thoughts on this for some time.

  6. My husband and I make old-fashioned Italian salami and salumi (prosciutto, capicola, etc). We also make our own sauerkraut and yogurt. We are pretty familiar and comfortable with the microbial action of fermentation. But I have never been able to find any information on the nutritional aspects of fermented meats, and I am very curious.
    I know that our own, cellar-aged salami does not have the levels of nitrites or nitrates that commercial salami does, as over the time of aging, it tends to get blown off as nitric oxide. I also know that it is not a big concern ( ).
    I have noticed myself that our salami is very quickly digestible. I suspect that the breakdown of various compounds by the microbes makes the meat easier to digest. I also wonder about what might be made more or less available in the meat. Has anyone out there found any information along these lines?

  7. On the fermented foods – my husband and I make our own old-fashioned salami and salumi (salt-cured meats, like prosciutto). These are fermented meat products. (And delicious!!) I have looked several times to find information on the nutritional aspects of fermented meats, but I find nothing.
    There is a ton of information out there about fermented vegetables, fruits (wines, etc.), and grains, but meats?
    From personal experience, I can say that they are very digestible. Conventional wisdom would lead you to think they would be hard to digest, since they are salty and fatty. But that does not seem to be the case. I am guessing that the fermentation process has broken down some of the more difficult-to-digest compounds. But I would love to know more.
    Has anyone run into this kind of information?

  8. Are my comments being blocked?? I have tried twice now to post comments about salami, but my comments do not appear…

  9. OK, trying this again… (Some of my attempted comments have vanished today…)
    My family makes old-fashioned Italian-style salami and salumi (salt-cured meat, like prosciutto). These are actually fermented meats. The salt, and temperature control, limits the bacteria that can live in the meat to the safe types.
    However, I have never found any scientific discussion of nutritional benefits from fermented meats. I have seen LOTS of material warning of the dangers of nitrites and nitrates in cured meats. I have also seen the more recent science saying that there are equivalent amounts naturally occurring inn vegetables like celery and spinach. I see lots of literature about the nutritional benefits of fermented vegetables, grains, fruits (wine, etc.), and even milk (yogurts, kefir). But nothing about the meats. Has anyone else seen any information in this direction?

  10. This is very interesting information. We make our own sauerkraut and yogurt, and this is rather validating!

  11. Hi, Mark! My partner and I love all of your work, and we think the elevator pitch idea is great!
    We’d like to be able to condense the concept of immunity, and the role pharmaceuticals such as antibiotics have on it into something a bit more digestible.
    I’d like to sharpen up my bit about the effects high carb diets have on insulin resistance, and some of the effects people experiencing it may be feeling, then tying those symptoms back to the insulin resistance in a sensible way that may inspire them to rethink their food paradigm

  12. A simple and quick way to explain what’s bad with PUFA’s and vegetable oils to people, as most seem to think that stuff is healthy!

    1. Agreed! the problems PUFA’s – ideally with an easy way to summarize the Omega 3 & Omega 6 aspect to assessing an oil.

  13. Thank you for your fantastic work, Mark. I follow you regularly, and you always deliver – elegantly, and at eye level.

    I second all the below elevator pitch ideas. A couple more elevator pitch suggestions:-
    * ‘Eat as many carbs as you’re going to use’ (your quote). How can you measure how many you actually use?
    * ‘Carbs are cheap, fast but dirty fuel’ (also your quote, or some such) – why?
    * Why ‘max 2-3 eggs per week’ is seriously outdated
    * Total cholesterol/ HDL/ LDL/ vLDL/ triglycerides/ ratios etc. – which one should we care about, if any, and why?
    * Why vegetables are such an important part of our diet? (it’s taken for granted they are, but why? a ‘knock out’ proof)

    A simple, brief, elegantly formulated answer to the above would be very much appreciated.

    Carry on with your enlightening work, Mark. We’re behind you.

  14. Acid in the form of vinegar and fermented foods is harmful to teeth and soft tissues of the mouth and throat. I would expect primitive man would have avoided eating and drinking acid. There must have been some environmental disaster in evolution that brought on the desire to eat and drink it. To me it looks like the need to eat fermented foods is a defect in our evolution. Maybe it’s time to stop it and reverse the habit into a more natural state? Maybe today we no longer have the need to eat plant food, especially fermented, for health and survival? Perhaps the carnivore movement will provide some answers as to the benefits and/or necessity of fermented acid foods today.

    1. Naturally preserved foods are not nearly as acidic as the modern vinegar versions.

    2. On a nutrient dense primal diet, teeth remineralize themselves effectively. (see Weston Price’s research). Even primitive peoples who don’t brush their teeth, have a high starch intake (which can ferment on the teeth), and/or eat lactofermented foods, have few cavities despite the acid exposure, as long as they get plenty of minerals and vitamins A/D3/K2 to process the minerals. Amazingly, small cavities can actually heal, and larger ones can be arrested, solely by going primal or near-primal.

      Some of the healthy primitives in the Weston Price research, were heavy grain eaters but they still had good teeth, despite the acid-forming tendency of grains, as long as their diets were nutrient dense. (Generally they reduced the phytic acid level of the grains by soaking or fermenting, but they still got lactic acid exposure.) However, sadly, as soon as roads were built and sugar and white flour were introduced to these people, everything went to hell…

  15. I would love a pitch on fats and cholesterol and how they enable proper functioning of our cell membranes. And how trans-fats (and oxidized polyunsaturated oils?) affect it all negatively.

  16. I’d like an elevator talk on why wheat and gluten-containing grains are bad for you. I’ve tried explaining it, only to get the “yeah yeah I know but humans have been eating wheat for thousands of years blah blah” in response. I know it’s useless to try and convince people who won’t be convinced, but what’s a simple way to explain it to those who are interested?

  17. Instead of consuming those meats with fermented or polyphenol-rich sides to reduce the damage, why not just skip the damaging food to begin with?

  18. My uber healthy-looking vegan neighbors have a difficult time understanding that we do not eat gluten, even if it’s ancient, organic, sprouted, sourdough. I recognize that if one is going to eat wheat, one might be better off skipping the modern loaves of “whole wheat” in the stores and go for the less processed varieties. However, my oldest daughter and I do not tolerate any of it in any form. I often wonder if my digestion wouldn’t be so broken if I grew up eating things besides highly processed grain and dairy products. Maybe then we’d be able to tolerate the ancient grains better? Why do so many people seem to have healthy lives plus grains?

  19. As with several posts below, the things I have a hard time explaining are:
    >to my grocer: why I want more options for full fat yogurt (and in general the low-fat food craze falacy)
    >about the marketing of eggs and how best to choose between conventional, organic, what is labeled as free range, and pastured poultry
    >why soy is bad, especially for women
    >the gluten free frenzy-I have a family member who is diagnosed with celiac disease. How to know if you are gluten sensitive, that many gluten free prepared foods in the grocery are high in carbohydrates

  20. What about histamines?

    Fermented foods are loaded with histamines, more than any other food probably, and histamines can cause problems on their own.