Do Fermented Foods Help Lower Cholesterol? A Scientific Look

November 6, 2025 •

4 min read

According to the World Health Organization, cardiovascular diseases remain the leading cause of death globally, with hypercholesterolemia being a major risk factor. This has prompted research into dietary interventions, leading many to ask: do fermented foods help lower cholesterol effectively?

Quick Summary

Studies suggest that some fermented foods may help lower cholesterol, particularly total and LDL cholesterol, through various mechanisms involving gut bacteria. The effects depend on specific probiotic strains, dosage, and duration of consumption, with results varying among different products and individuals. Evidence is promising but also includes conflicting results.

Key Points

Probiotics are Key: The live bacteria (probiotics) in fermented foods, such as Lactobacillus and Bifidobacterium, are believed to be the primary agents behind any potential cholesterol-lowering benefits.
Impact on Bile Acids: Some probiotic strains can deconjugate bile acids in the gut, which increases their excretion. This forces the liver to use more cholesterol to produce new bile, thereby lowering circulating cholesterol levels.
Direct Cholesterol Assimilation: Certain bacteria can bind or absorb cholesterol directly in the intestines, preventing it from being absorbed into the bloodstream.
SCFA Production: The fermentation process produces short-chain fatty acids, like propionate, which may inhibit cholesterol synthesis in the liver.
Varied Effects: The cholesterol-lowering effects depend on specific probiotic strains, dosage, and overall health. Results from human studies are sometimes inconsistent, so effects can vary by individual.
Beyond Cholesterol: Even without a strong cholesterol-lowering effect for everyone, fermented foods offer general cardiovascular benefits through improved gut health and anti-inflammatory properties.
Whole Diet Matters: The benefits of fermented foods are best realized as part of an overall heart-healthy diet, rather than as a single 'miracle food'.
Examples: Kefir, yogurt, kimchi, and sauerkraut are some of the most studied fermented foods for potential cholesterol benefits.

The Fermentation Process and Its Probiotic Link

Fermentation is an ancient preservation method where microorganisms, such as bacteria and yeast, convert carbohydrates into acids or alcohol. In many cases, this process also results in a high concentration of beneficial microorganisms known as probiotics, which can positively influence gut health. It is these live, beneficial bacteria that are most often credited with the potential cholesterol-lowering effects associated with fermented foods.

The gut microbiome plays a critical role in overall health, and its composition is influenced by diet. A diverse and healthy microbiome is linked to a lower risk of metabolic problems, including high cholesterol. Probiotics from fermented foods can enhance this microbial diversity, which in turn can impact cholesterol metabolism.

Scientific Mechanisms Behind Fermented Foods and Cholesterol

Research points to several potential mechanisms by which the probiotics in fermented foods may influence cholesterol levels:

Bile Salt Deconjugation: In the intestine, bile acids are typically reabsorbed back into the liver. However, certain probiotic bacteria, particularly some strains of Lactobacillus and Bifidobacterium, produce an enzyme called bile salt hydrolase (BSH). BSH can deconjugate bile acids, making them less soluble and preventing their reabsorption. This leads to their increased excretion in feces. The liver then must draw on the body's cholesterol stores to produce new bile acids, which helps lower circulating cholesterol levels.
Assimilation of Cholesterol: Some probiotic strains have been shown to directly assimilate or bind cholesterol from the intestinal tract for incorporation into their own cell membranes. By consuming cholesterol during their growth phase, these bacteria make it unavailable for absorption by the body, leading to reduced blood cholesterol.
Short-Chain Fatty Acid (SCFA) Production: During fermentation of dietary fiber in the gut, probiotics produce SCFAs such as propionate. Some studies suggest that propionate can inhibit a key enzyme (HMG-CoA reductase) involved in cholesterol synthesis in the liver, thereby reducing the body's own cholesterol production.

Evidence on Specific Fermented Foods

Research into how specific fermented foods affect cholesterol shows mixed, yet promising, results, often dependent on the specific strains of bacteria and the duration of consumption.

Yogurt and Kefir: Several studies, particularly meta-analyses of randomized controlled trials, suggest that probiotic-rich fermented dairy products like yogurt and kefir can lead to modest reductions in total and LDL cholesterol, especially in individuals with high baseline levels. However, some studies find inconsistent or insignificant results, particularly regarding HDL cholesterol and triglycerides. The efficacy can depend heavily on the specific bacterial strains used in fermentation. A study in overweight or obese women showed kefir caused a significant improvement in cholesterol profiles compared to a control, but similar to low-fat milk, suggesting the overall diet and fat content are also key.
Sauerkraut and Kimchi: Vegetable-based fermented foods are also being studied for their cardiovascular benefits. Sauerkraut, made from fermented cabbage, is rich in antioxidants that help reduce harmful free radicals that damage blood vessels. It is also associated with lower LDL cholesterol. Kimchi, a Korean fermented dish, has also demonstrated hypocholesterolemic effects in animal and some human studies, partly due to the synergistic effects of its various ingredients and microbes.

Fermented Food vs. Probiotic Supplement for Cholesterol


Feature	Fermented Foods	Probiotic Supplements
Microbial Content	Diverse, complex mix of bacteria and yeast; depends on starter culture and process. Some commercial versions may contain fewer live organisms.	Specific, isolated strains of bacteria; dosage and strain type are controlled and clearly labeled.
Effectiveness	May have synergistic effects due to complex matrix of microbes and nutrients. Effectiveness varies by product, preparation, and baseline health.	Effects are strain-specific, with some studies showing significant reductions in total and LDL cholesterol.
Nutrient Profile	Naturally occurring vitamins, minerals, and enzymes that aid absorption. Can be part of a whole-foods diet.	Typically offer a concentrated dose of specific probiotic strains without other nutritional benefits.
Availability	Available as whole foods like yogurt, kefir, and kimchi.	Sold in capsules or powders at health food stores and pharmacies.

Navigating the Contradictory Evidence

It is important to note that studies on the effects of fermented foods on cholesterol, particularly in humans, can be inconsistent. These variations are often due to several factors:

Strain Specificity: Not all probiotic strains have the same effects. A strain of Lactobacillus effective in one study may have no significant impact in another.
Dosage and Duration: The amount of probiotics consumed and the length of the study intervention can influence outcomes. Meta-analyses often show stronger effects with longer treatment durations and higher dosages.
Baseline Health: The health status of participants can affect results. Some studies show more pronounced effects in individuals with already high cholesterol or metabolic conditions.
Dietary Context: The overall diet of participants is a significant factor. The effect of consuming a fermented food within a healthy diet may differ from its effects within an unhealthy diet.

Conclusion: Incorporating Fermented Foods for Heart Health

While fermented foods are not a magic bullet for lowering cholesterol, the scientific evidence suggests they can play a supportive role in a heart-healthy diet. The beneficial bacteria they contain, along with other fermentation byproducts, offer plausible mechanisms for modulating cholesterol levels, mainly by interfering with its absorption and synthesis. The most consistent evidence supports reductions in total and LDL cholesterol, particularly from certain probiotic-rich dairy products like kefir and yogurt. However, the effects are strain-dependent and can vary from person to person. Incorporating a variety of fermented foods into your regular diet can help promote a diverse and healthy gut microbiome, which is a key component of cardiovascular wellness. As with any dietary change for medical reasons, consulting with a healthcare provider is recommended, especially for individuals with existing conditions. Fermented dairy product consumption and blood lipid levels in adults, and children with or without cholesterol-lowering medication: a systematic review and meta-analysis of observational studies is an excellent resource for deeper research.

Frequently Asked Questions

Fermented dairy products like kefir and yogurt have the most studied and promising evidence, particularly those containing specific strains of Lactobacillus and Bifidobacterium. Other options include kimchi and sauerkraut, though more research is needed on their specific cholesterol-lowering potential.

Not all yogurt is the same. Look for plain yogurt with live and active cultures to get the most probiotic benefit. Flavored varieties often contain high amounts of added sugar, which can negatively impact overall health.

There is no official recommendation, and effective dosages vary by probiotic strain. However, many studies showing benefits involve regular, daily consumption. Increasing your intake gradually allows your body to adjust to the new influx of gut bacteria.

Yes, for the probiotic benefits, the foods must contain live and active cultures. Pasteurized versions, which have been heat-treated, will have killed the beneficial bacteria. Always check labels for 'live and active cultures'.

Research suggests that while both can have effects, the optimal choice depends on the specific goals. Supplements offer controlled dosages and strains, while fermented foods provide a wider range of nutrients and a more complex microbial matrix that may offer synergistic benefits.

For most healthy people, fermented foods are not harmful to the liver. In fact, they can support liver function by improving gut health. However, if you have a pre-existing liver condition, particularly fatty liver disease, consult a doctor before making major dietary changes, although some studies show benefits for liver health.

Yes. Non-dairy fermented foods like kimchi, sauerkraut, tempeh (fermented soybeans), and kombucha (fermented tea) can also contribute beneficial bacteria to your diet. Tempeh is particularly noted for its high protein and fiber content, both beneficial for heart health.