Stop for a moment and think about what really is and isn’t okay for you. That’s what this post is all about! Joshua Hoehne/Getty

This is a bit of a strange post for someone whose job it is to make people want to buy probiotic cultures from us, but I think we all know I don’t do a good job of that anyway since I mostly just talk about whatever is on my mind (which frequently has nothing to do with ferments or probiotics at all).

But, we get a lot of questions about whether or not x person with y condition can eat ferments, or can eat specific ferments. A lot of them. This means that we are normally annoying people when we punt y’all back to your doctors for this advice if there isn’t a clear cut answer or if I suspect information is being withheld. People withhold a lot of relevant and critical info when they know or believe they won’t get the answer they want if they tell the whole truth. I don’t really get this, because at that point you’re asking someone to be complicit in doing something you already know may harm you, but I definitely get the desire to do this. Absolutely. I don’t like being told no most of the time, either.

For the record, I don’t mind these questions and usually find them extremely interesting. It’s the herbalist in me, I suppose. Actually, it is the herbalist in me. When my own clients ask me similar #omgno questions, I either say “no absolutely not that is not for you,” or, in some cases, I give them the range of what I consider safe for them to consume, and sometimes I actually do punt them to a doctor. Other times I work directly with the client’s physician, because I think the situation merits physician oversight over what I think should happen.

If, however, a client tells me they’ve recently been diagnosed with cancer (or other omg situation), it doesn’t matter what medical question they’ve asked becuse I cannot answer them without first consulting with their oncologist. I mean, I guess I could, and there are certainly herbalists who feel comfortable working with herbal therapies for people with cancer without the oversight of a physician, but I am not one of them. As an exceptionally, irritatingly (I’m told), conservative practitioner, there are some conditions that I believe are not good candidates for an herbal approach and that I know or believe require allopathic care, and the extreme example of cancer is at the top of my list.

That said, since I know that people are going to do whatever they want no matter what we or their physicians say, I want to give y’all at least a partial list of when and why you absolutely should not, under any circumstances, consume specific ferments or possibly ferments at all. Every single condition I mention here is a condition I’ve been emailed about looking for workarounds, and most of them I’ve seen float through a lot of times. This list is not inclusive. I will not cover everything that ferments may be a problem with. As always, talk to your doc. Even if you decide my advice makes sense, still talk to your doc. They’re your partner in assisting you toward better health, so let them be your partners!

Thus, today we’ll have a partial listy-list of when you really need to not eat any ferments or when you need to not have certain ones. I’m not going to talk about cancer below, because you already know I have no opinions on that beyond speaking to the oncologist. Like I said, I’m extremely conservative and research-based in my practice, so I am never going to say that I am able to offer an opinion on something in a situation where a different type of professional is needed, and ditto if I’m just not sure what the answer is.

This intro is long and repetitive because it’s important that people with medical conditions get the right kind of care. The goal should not be “wellness through a specific ideology” but rather “wellness through the most appropriate channels for the situation at hand.” It’s important to me that y’all understand that, no matter your medical/health ideologies, some conditions require a doctor.

The tl;dr (too long; didn’t read) here is: we don’t want your money if taking it means that you get sick or sicker. We just don’t want it.

/lecture

I’m not a doctor, and neither is Sabrina. But even if we were doctors, we aren’t y’all’s doctors. Not being a/your doctor and still offering medical opinions is illegal in the States, so we’re really careful to not break those sorts of laws. And that’s before we even get into the ethics of it that would stop us from offering opinions even if it were legal to do so. Medical decisions, including big dietary changes, really should go through your physician before they come to us. You can still dodge the doc and try us first, but we’re gonna punt you back to your physician in the majority of instances. National Cancer Institute/Getty

Bringing out the big guns

Histamine intolerance, tyramine intolerance, other amine intolerance: you cannot eat fermented foods. Like, period. Don’t do it. You’re hurting yourself.

Fermented foods routinely cause adverse histamine reactions in people who don’t suffer this condition. Some people actively court this by going balls out and eating enough ferments that they can experience “die off,” but really… why? There’s no reason to produce visible harm to your body just so you can feel like you’re getting healthier. Wellness shouldn’t imply pain, and I really, really do not believe in harming the body so that it feels like it’s getting healthier.

Once you’ve moved past the “I don’t have histamine intolerance but I sure am going to try to make it seem like I do” and into the arena of diagnosable histamine intolerance, you just don’t get to eat ferments. That sucks a lot, and I am truly sorry for your loss of ability to enjoy these foods, but you are simply hurting your body rather than making it well if you do consume fermented foods, probiotic capsules, or anything with probiotics in them. Don’t do it. Love yourself more than you love the fermented foods, please. We will never want or need your money enough to want you to eat something that isn’t safe for you.

Cancer: y’all already know my answer to this, since it’s detailed in the intro.

Cardiac conditions: talk to your doc.

Lupus and other autoimmune conditions: doc, doc, doc. Some people with autoimmune conditions can become very sick from probiotics, including infections in different organs, all sorts of no. Check with your doctor to see if your specific condition makes you a good candidate for fermented foods.

GERD: the specific manifestations of GERD vary a lot from person to person, so I typically recommend consultation with the doc to figure out what might be safest for you. Once your doc weighs in on that, we usually can find something good for you that fits with what you’re allowed to have.

Chron’s disease and other digestive disease: honestly, these can be tricky to decide what is and isn’t safe. Your doctor is in the best position to know if ferments are okay with you, because they’re most intimately familiar with the type and degree of severity for these conditions. In general, I favor an even more conservative than usual approach for people with diseases and disorders in this category.

Diabetes

Diabetes is a really complicated disease, and how it manifests varies from person to person. What you cannot have is kombucha/jun, ginger beer, and water kefir. If you need to add sugar to make it, it isn’t for you.

In general, yogurts, milk kefir, sour cream, vegetable ferments are safe for you if your doctor says so. Sourdough is going to depend on your personal situation, so ask your doc if you can eat limited amounts of this style of bread. Ditto fruit ferments. It’s possible your doc will say yes, but they may also say no. In general, you want to not consume things that are going to monkey with your insulin and glucose levels.

Alcoholism

This can be situationally dependent, but kombucha/jun are always a no. Some people who suffer from alcoholism also cannot handle water kefir. Some people can. Doctor time! I also recommend avoiding fruit ferments that have an added sugar source, because they’re usually kind of boozy. In fact, when I make crack berries (fruits fermented in honey), I know they’re done because they smell slightly boozy. Salt preserved fruits are probably just fine for you, since they really don’t get boozy due to the salt (they do often become pectin-y, though). Some people also cannot do vinegar, because having the wine/beer/whatever in the house to make it can be problematic.

It’s important here to be really honest with yourself, where you are in your recovery, what your triggers are, and so forth. Consult with your doctor and your sponsor, too! It’s literally what they’re there for. If you suffer from alcoholism, can’t have alcohol in the house to make vinegar, and just really want homemade vinegar, use the buddy system and have a friend who isn’t in recovery make it for you. Vinegar-making is pretty low-fuss, so your partner-in-vinegar can bring you the finished product so you can have yums free from temptation. You’ve worked hard to get to this point you’re in with your recovery recovery, so let’s not see ferments derail that!

Lactose Intolerance, Dairy Allergy, and Other Such

If you’re lactose intolerant, maybe you can eat fermented milks, and maybe you can’t. Some people have a mild form of intolerance and can totally handle mild yogurts or even milk kefir, but some people have it bad enough that the tiny amount of lactose left will make them sick. You know your body, and you know what makes you sick, so talk to your doc and see what their feedback is before trying to find a milk-based culture that works for you. I personally (conservative!) prefer to not see people with LI buying dairy cultures from us. We have lots of other yummy stuff you can eat, so I don’t personally see a reason to take the risk of discomfort.

If you have a dairy allergy, no amount of fermentation is going to change that. Just Say No, all Nancy Reagan style.

Other dairy intolerances sometimes are related to the type of milk (A1 versus A2), and if you know the details of that, that’s the kind of info you need in order to find the best fit. In general, though, any dairy-related medical intolerance, allergy, or similar is going to cause me to recommend something without dairy in it. Just know that.

Also: if you really do need a yogurt and can’t do dairy, we do have a vegan yogurt you can try instead. It’s my opinion that anyone who’s convinced they need a dairy-like ferment without being able to consume dairy should use that, or you can do milk kefir that ferments vegan milks using date paste. Yes, you can have your milk kefir and drink it too! You just need to do it without animal milk.

Medical Conditions Related to Fibre Consumption

You can’t have fruit or vegetable ferments unless your doctor says you can. Check with them, but assume they’re gonna say no.

If you are taking antibiotics

You really have to talk to your physician about this. Some probiotics are associated with antibiotic resistance. That’s obviously a problem if you’re eating a ferment that causes resistance to the drug you’ve been prescribed.

Generally speaking, probiotics are considered helpful to those who are taking antibiotics, but there really are some exceptions here. This isn’t super common, but it is well-documented that in some instances, probiotics are tied to antibiotic resistance. If your prescription is for erythromycin, ampicillin, tetracycline, vancomycin, or penicillin, your doctor may want you to swap out your whole food probiotics to capsules that are formulated to work with the antibiotic you’re taking. They may want that even if it’s not one of those drugs, but there’s ample documentation about probiotics and antibiotic resistance with those specific antibiotics.

If swapping out to capsules is what they ask for, put your ferments on hold and take the capsules to avoid the side effects from the antibiotics you are trying to avoid.

Gluten Intolerance or Allergy

I feel like y’all already know that if this is you, glutinous sourdough starters aren’t for you. But some of you may be trying to dodge this due to the desire to make gluten-free bready type things more like the gluten-rich versions.

Let me be clear about this: you cannot replicate wheat bread without wheat. We spend a lot of time trying to work out methods, but the best choice here is to simply do some research on what indigenous and/or historical breads were made with your GF grains. I think if we can accept GF breads as something that are wonderful all on their own without trying to morph them into wheat, we’ll all be happier with what we’re eating. Also, traditionally GF breads are actually easier to make and involve a whole lot less chemistry and sorcery.

I personally get a lot of questions (and reminders from Sabrina) to develop recipes for GF breads that replicate glutinous breads. The tiny number of them we’ve put up in the blog is because they are so difficult to make due to those seeds/grains not really being for that sort of application. And really, other than the rye knock off, the breads are very difficult to make and never hit the target texture without the addition of a lot of costly extras.

That rye knock off is as good as it is specifically because the gluten in rye is pretty crappy, low-grade, may-as-well-not-be-there gluten. Because of that, you have a lot of the same PlayDoh attributes in rye bread that you do in GF loaves, so it’s really just working out how to fix the flavor problem to accomplish that. Trying to replicate wheat bread can be done, and I personally know a couple of people who are good at it, but I wish people would explore the beautiful breads that are already made all over the world that were always GF from the first time they were made through to today.

Y’all don’t have to listen to me, of course, but this part has made me realize that I need to see if I can’t enlist some talented GF bakers in some guest posts. They’re obviously better at wheat replication than I am, so let me look into that. Those of you who are good at this already? Please let me know in comments or email if you’d like to do a guest post! I will happily move stuff around in my writing roster to make space for giving the people what they want!

Dental Problems

Sorry, y’all, but if this is you, no kombucha/jun for you. Even with a straw. I would also recommend not consuming water kefir or uncooked vegetable and fruit ferments.

If you’re going to do it anyway, and I know with certainty many of you are, make sure you brush your teeth afterward to get all the extra acid out of your mouth.

Wrapping up

Honestly, this was an un-fun article to write. No one likes being the buzz kill, I guess! Okay, I do like being a buzz kill sometimes, but this isn’t one of them. The main take-away here is to consult with your doctor before making dietary changes. I think that should be the case even if you don’t have a serious (or not serious!) health condition, but it’s critical to take that extra step if you do.

While probiotics help a majority of people who engage with them achieve their health goals, they legitimately aren’t for everyone. You need to know your body and what’s safe and healthful for you, and leave off the other stuff. Even if it’s trendy (lookin’ at you, kombucha!) and even if it’s a food you really enjoy.

We really love sourcing high quality, diverse, and culturally relevant whole food probiotics for you, and we love the relationships we’ve formed with many of you. We do not want to exploit you, however, or make you sick just so we can make a quick buck. That’s the anti-Positively Probiotic business model, so please enjoy the ferments you can safely consume, and leave off the ones you can’t. We’re not gonna help you skirt the rules on this because we value you more than we will ever value your dollars.

Lastly, go slow when introducing a new probiotic, even if you have no known medical conditions. It’s certainly one way to find out that your body doesn’t like something by overdoing it, but turtle this with slow and steady, and see how things work. Enjoy the journey.

A Completely Unrelated Note

It’s time for my annual, but hopefully last, complaint about biblical plagues n the form of the white-marked tussock moth caterpillar. They’re raining down from the sky again, and now I can’t work outside anymore until it passes. I am hopeful that this will be the last year I complain about this, since we are moving next month. Thankfully. These caterpillars. I just can’t with them. It’s soooooo much work killing that much stuff each day.

My poor friend Kasey lives more south than I do, and she got hit hard this year. It was her first time, so I expect she’s enduring the same form of trauma I did last year. This year I have a different weapon, so now that I’ve adjusted to using my killing paddle (used to be a beer paddle) instead of a stick, it’s very fast work eradicating dozens of them in the space of a minute or two.

This year, I learned that they are native to Ohio. I don’t understand why you Ohioans had to send these down here! Actually, I do. Y’all don’t want them, either.

Here they are, in case you’ve forgotten.