Introduction

Fermentation is one of the oldest biotechnological processes in food systems around the world. Rooted in diverse cultural and geographical contexts, it has evolved from a rudimentary preservation technique to a scientifically recognised method that results in multiple benefits across food safety, nutritional enhancement, and functional bioactivity. Fermented foods have long constituted integral components of traditional diets worldwide, ranging from dairy-based products such as yogurt in Europe and Central Asia, to fermented legumes and grains like natto (a soybean-based breakfast preparation), miso (a soybean paste fermented with the koji mould), ogi (millet pap), and injera (a sourdough flatbread made with teff flour) in East Asia and Sub-Saharan Africa. This wide-ranging utilisation underscores the global relevance of fermentation not only as a cultural artefact but as a scientifically endorsed strategy aligned with the EAT-Lancet Commission’s call for sustainable, health-promoting diets—enhancing nutritional security while simultaneously mitigating food waste through the preservation and valorisation of perishable or surplus produce.^[1]

The renewed interest in fermented foods within nutritional science and public health stems largely from their capacity to modulate the gut microbiota to encourage or enhance systemic health effects. A growing body of evidence, including randomised controlled trials and meta-analyses,^[a] supports their role in enhancing gastrointestinal function, immune regulation, and the attenuation of chronic inflammation.^[2] These effects are attributed to fermentation by-products, such as organic acids, bioactive peptides, and short-chain fatty acids, which possess antihypertensive, hypocholesterolaemia, antidiabetic, and antioxidative properties. In contrast, diets high in fat, sugar, and salt (HFSS)—common in ultra-processed foods—contribute to gut dysbiosis and chronic low-grade inflammation, increasing the risk of non-communicable diseases (NCDs). In India, where NCDs such as Type 2 diabetes and cardiovascular disease are on the rise alongside dietary transitions, traditional fermented foods offer culturally rooted and proven interventions for managing metabolic and inflammatory disorders_.^[3]

Simultaneously, undernutrition and micronutrient deficiencies persist across low- and middle-income countries, necessitating nutrient-dense and culturally appropriate interventions.^[4] Fermentation enhances the bioavailability of critical micronutrients—including iron, folates, B-complex vitamins, and calcium—by degrading anti-nutritional factors such as phytates and oxalates.^[5] In West Africa and South Asia, household consumption of fermented cassava or cereal porridges improves digestibility, nutrient absorption, and food security where dietary diversity is limited.^[6] These foods are particularly valuable for pregnant and lactating women, whose nutritional demands are elevated. Fermented foods contribute to maternal iron, calcium, and probiotic intake, while potentially lowering the risk of gestational diabetes, preeclampsia, and bacterial vaginosis.^[7],[8]

Beyond nutrition, fermentation is increasingly recognised as an environmentally sustainable and climate-resilient food processing technique. Unlike industrial preservation, it requires minimal energy, water, and packaging infrastructure. By extending shelf life and giving value to surplus produce and agro-waste, fermentation reduces food spoilage and aligns with circular economy principles.^[b] Novel applications, including precision fermentation for dairy analogues and microbial nutrient fortifiers, are emerging as scalable, low-emission alternatives to conventional food production.

The Dietary Guidelines for Indians 2024 and Nordic Nutrition Recommendations 2022 encourage the consumption of fermented foods^.[9],[10] In countries like China, Japan and South Korea, fermented foods are culturally acceptable and form part of their traditional diets. Despite these multifaceted advantages, fermented foods remain underrepresented in many national dietary guidelines, food-based public policies, and sustainability agendas. Contributing factors include the globalisation of ultra-processed diets, limited public awareness, regulatory ambiguity regarding microbial safety and probiotic efficacy, and challenges in standardising artisanal preparations.

Given their cross-cutting contributions to health, culture, environment, and livelihoods, fermented foods warrant focused interdisciplinary enquiry and policy integration. They align well with food system supply chains, supporting local agriculture, enhancing post-harvest value, and sustaining rural economies, particularly women-led enterprises. To fully leverage their transformative potential, coordinated efforts are needed in microbial strain research, food safety regulation, and culturally sensitive dissemination within public health and sustainability frameworks.

Fermented Foods for Climate Resilience and Public Health

Traditional Indian fermented foods—such as idli (steamed rice cake), dosa (rice and lentil crepe), dahi (curd), kanji (fermented rice porridge), kinema (a fermented soybean dish from the Eastern Himalayan belt), and fermented bamboo shoots—are deeply embedded in the country’s culinary heritage, and provide rich sources of probiotics, bioactive compounds, and micronutrients.^[11] Exhibiting regional diversity, these foods are prepared using a wide range of raw materials, including cereals, dairy, legumes, vegetables, and fruits, and are subjected to either natural or controlled fermentation processes.^[12] The dominant microbial agents—lactic acid bacteria (LAB), bifidobacteria, and yeast—facilitate the production of health-promoting metabolites, such as bioactive peptides, essential vitamins, and antioxidants. These compounds modulate gut microbiota, enhance the immune system, and regulate metabolism. Fermentation also offers climate-adaptive advantages by minimising energy use, reducing post-harvest losses, and enhancing food security amid climatic variability.^[13] Table 1 illustrates some common Indian fermented foods and their health benefits.

Table 1: Common Indian Fermented Foods and their Health Benefits

Category	Fermented Foods	Descriptions	Key Microorganisms	Health Benefits
Cereal-Based Ferments[14],[15]	Idli and Dosa	A steamed cake (idli) and crepe (dosa) made of fermented rice and black gram batter, a South Indian staple.	Leuconostoc mesenteroides, Lactobacillus spp.	Enhanced B-vitamin content, improved digestibility and amino acid bioavailability.
	Dhokla	A savoury sponge-like dish made with fermented chickpea or rice batter, popular in western India.	Lactic Acid Bacteria (LAB)	Improved protein digestibility and antioxidant levels.
	Kanji	Fermented probiotic drink made from black carrots, mustard seeds, and water.	LAB, Anthocyanin-producing bacteria	Rich in antioxidants, it promotes gut microbiota diversity.
Dairy-Based Ferments[16]	Dahi (Yogurt)	A probiotic-rich yogurt that is widely consumed across India.	Lactobacillus bulgaricus, Streptococcus thermophilus	Enhances gut microbiota, immune response, and nutrient absorption.
	Lassi & Chaas	Fermented buttermilk-based beverages that aid digestion and hydration.	LAB	Supports gut health, metabolic balance, and hydration.
	Shrikhand	Strained yogurt-based dessert with probiotic properties.	LAB	High in calcium, phosphorus, and bioavailable proteins.
Legume-Based Ferments[17],[18],[19]	Kinema	A fermented soybean dish from Northeast India.	Bacillus spp.	Anti-inflammatory, gut-protective properties.
	Papad	Fermented lentil wafers that are commonly consumed in India.	LAB	Improved digestibility, extended shelf life.
	Akhuni	Fermented soybean product from Nagaland, known for its strong flavour.	LAB, Bacillus spp.	Probiotic-rich, enhances gut health.
Vegetable & Fruit-Based Ferments[20],[21],[22]	Pickles	Mango, lime, and mixed-vegetable pickles fermented using LAB.	LAB	Antimicrobial properties, aids digestion.
	Fermented Bamboo Shoots	Common in Northeast India, high in prebiotics.	LAB	Supports gut microbiome health and metabolic function.
	Gundruk	Fermented leafy vegetable dish from the Himalayan region.	LAB	High antioxidant content, which improves iron absorption.

Public Health Benefits 

The human gut microbiota is fundamental in sustaining digestive health, immune function, and metabolic regulation.^[23] Fermented foods represent a valuable source of probiotics, notably Lactobacillus, Bifidobacterium, and Bacillus spp., which are instrumental in restoring the gut microbial equilibrium and inhibiting the proliferation of pathogenic bacteria.^[24] The consumption of such fermented foods, including yogurt, kanji, and pickles, promotes an increase in beneficial gut bacteria, thereby facilitating the production of short-chain fatty acids (SCFAs). These SCFAs, particularly butyrate and acetate, are critical for colon health and metabolic stability, serving as an energy source for colonic epithelial cells and reducing the likelihood of gastrointestinal disorders.^[25],[26] Moreover, the regular intake of fermented foods has been associated with the prevention and management of various gastrointestinal disorders, including irritable bowel syndrome (IBS), constipation, diarrhoea, and inflammatory bowel diseases (IBD).^[27] Specifically, fermented dairy products, such as dahi and chaas, have demonstrated efficacy in reducing antibiotic-associated diarrhoea, alleviating bloating, and improving stool consistency among individuals experiencing gastrointestinal disturbances.^[28]

At present, there are over 101 million individuals with diabetes in India; the number could rise to 134 million by 2045, potentially making it the “diabetes capital” of the world.^[29] The increasing prevalence of type 2 diabetes mellitus (T2DM) is driven largely by rapid urbanisation, sedentary lifestyles, and dietary shifts toward high-glycaemic, ultra-processed foods. In this context, traditional fermented foods have demonstrated immense potential in promoting metabolic health, particularly through their beneficial effects on insulin sensitivity, lipid metabolism, and inflammatory pathways. In India, high cholesterol, or hypercholesterolemia, is a significant health concern. Approximately 25-30 percent of urban and 15-20 percent of rural populations experience elevated cholesterol levels. While lower than in high-income countries, these figures highlight a growing burden of lipid disorders, including high LDL (low-density lipoprotein) cholesterol and low HDL (high-density lipoprotein) cholesterol in India.

Traditional fermented foods promote metabolic health, particularly through their effects on insulin sensitivity, lipid metabolism, and inflammatory pathways.^[30] A growing body of literature indicates that the consumption of fermented foods may enhance glycaemic control, thereby mitigating the risk of T2DM.^[31] Fermented whole grains such as in the form of idli, dosa, and dhokla converts starch into resistant starches facilitated by probiotic bacteria, which ultimately augments insulin sensitivity.^[32] Furthermore, fermented foods help regulate cholesterol levels through the action of bile salt hydrolase enzymes, which promote the degradation and excretion of cholesterol, thereby enhancing lipid metabolism.^[33] Fermented dairy products, particularly lassi and dahi, have demonstrated efficacy in reducing LDL cholesterol levels, elevating HDL cholesterol, and improving blood pressure regulation, consequently diminishing the risk of hypertension and atherosclerosis.^[34]

The interaction between gut microbiota and immune responses is fundamental to the regulation of systemic inflammation and the prevention of diseases.^[35] Incorporating fermented foods into daily diets has been associated with measurable anti-inflammatory effects, reductions in circulating C-reactive protein (CRP) levels and in pro-inflammatory cytokines such as IL-6 and TNF-α.^[36] Fermented foods, particularly those containing Lactobacillus and Bifidobacterium species, have been demonstrated to modulate immune responses, thereby attenuating systemic inflammation and reinforcing mucosal barriers.^[37]

The regular intake of fermented foods has been shown to downregulate pro-inflammatory cytokines while simultaneously enhancing the production of anti-inflammatory cytokines, ultimately mitigating the risk of chronic inflammatory diseases.^[38] Furthermore, the fermentation of legumes, such as kinema and akhuni, promotes the synthesis of bioactive peptides that exhibit notable antioxidant and anti-inflammatory properties, thereby contributing to immune homeostasis.^[39] Additionally, fermented foods have the potential to alleviate allergic responses by modulating the Th1/Th2 immune balance, which may reduce the incidence of food allergies and intolerances.^[40] This is particularly advantageous for individuals with lactose intolerance, as fermented dairy products, such as dahi and chaas, undergo bacterial fermentation that diminishes the lactose content, thereby enhancing digestibility and promoting overall gut health.^[41]

Climate-Resilience and Sustainable Food Systems

Fermented foods are increasingly recognised for their contributions to climate resilience and the sustainability of food systems. These foods exemplify a low-carbon, resource-efficient, and waste-reducing strategy to address contemporary challenges in food production and consumption. In contrast to industrial food processing, which often involves energy-intensive operations, cold-chain dependence, and excessive packaging, traditional fermentation relies on ambient microbial activity with minimal external energy input. The process naturally extends shelf life without artificial preservatives, reduces the need for refrigeration, and is thus particularly suited to regions with limited electricity access—a common constraint in rural and peri-urban India.

India, for instance, faces considerable post-harvest and distribution losses due to infrastructural limitations. Nearly 30–40 percent of fruits and vegetables perish before reaching consumers due to gaps in cold chain logistics, storage, and market access.^[42] Against this backdrop, fermentation offers a decentralised, low-technology preservation method that can stabilise perishable foods such as milk, cereals, and vegetables into more shelf-stable forms like dahi, idli, dosa, and pickles. These foods not only retain or enhance nutritional quality and probiotic content but also provide year-round food availability, particularly in ecologically fragile and food-insecure regions vulnerable to climate disruptions.

A useful example can be drawn from the Northeastern states of India, where indigenous fermentation practices—such as the preparation of kinema and gundruk—enable communities to preserve seasonal produce for off-season consumption.^[43] These traditional methods require minimal infrastructure, rely on local biodiversity, and are central to cultural food heritage.

Indeed, in many Indian households and agrarian communities, fermentation has long been employed to preserve excess milk into curd or buttermilk, surplus vegetables into pickles, and grains into steamed or sun-dried preparations. This practice can therefore help mitigate food waste, as India wastes an estimated 74 million tonnes of food annually.^[44]

Moreover, fermented food enterprises—particularly at the micro and small-scale level—can promote local employment, reduce reliance on industrial food systems, and shorten supply chains. Such models not only decentralise food production but also build community-based resilience. The revival of millet-based fermentation under the Shree Anna Mission is a timely example of integrating climate-smart crops with sustainable food processing.^[45]

Challenges, Opportunities, and Policy Pathways

The widespread adoption of traditional fermented foods is confronted by multiple challenges, despite their numerous health, environmental, and economic benefits. Factors such as consumer perception, regulatory barriers, and commercialisation constraints impede their integration into dietary practices. Rapid urbanisation and dietary transitions have fostered a growing consumer preference for processed, convenience foods, which has impacted the prevalence of traditional dietary practices in current food consumption patterns.^[46] The pervasive influence of westernised diets and the proliferation of ultra-processed foods—often marketed for their convenience and immediate appeal—have diminished the consumption of fermented foods among the younger populations. Compounding this issue is a notable deficit in consumer awareness regarding the nutritional and probiotic advantages associated with these foods. Many traditional fermented foods remain undervalued in mainstream markets due to a variety of challenges. These include limited scientific validation, lack of product standardisation, absence of microbial safety benchmarks, and inadequate branding or packaging innovations.

Moreover, fragmented supply chains, poor cold storage infrastructure, and low consumer awareness—especially in urban settings—further constrain their scalability and integration into modern retail systems. These factors hinder their acceptance within urban consumption patterns and global health paradigms, despite their well-established cultural and nutritional significance. A critical barrier to the proliferation of traditional fermented products is the absence of established regulatory frameworks and quality control measures. In contrast to commercial probiotic offerings, which typically undergo rigorous safety evaluations and adhere to labelling regulations, traditional fermented products often suffer from inconsistent production methods. This inconsistency leads to variability in microbial composition and associated safety concerns.

To overcome these challenges, strategic policy interventions and scientific advancements are necessary to promote fermented foods as part of public health and sustainable food systems. This brief recommends the following actionable points:

• Integrate Fermented Foods into National Nutrition Programmes: Include nutrient-rich fermented foods in midday meals, Integrated Child Development Services (ICDS), and public food distribution programmes to improve dietary diversity and increase micronutrient intake, especially for vulnerable populations. Additionally, the development of region-specific dietary guidelines that incorporate traditional fermented foods based on local availability and cultural preferences would aid in faster uptake. Further, the consumption of fermented foods in the supplementary nutrition programmes should either be on the spot or within a defined shelf-life period based on scientific guidelines for safe storage, ensuring microbial stability and food safety. Standardised fermentation, preservation, and hygiene protocols must be followed to prevent spoilage and contamination.
• Establish Food Safety Standards and Probiotic Labelling Regulations: The establishment of comprehensive regulatory frameworks for traditional fermented foods is imperative to ensure microbial safety, standardisation, and quality control. Mandatory labelling of probiotic content in fermented products—highlighting strain-specific benefits and recommended intake—can enhance consumer awareness and industry credibility. However, many fermented foods are produced at the household or micro-enterprise level, where enforcement is challenging. To bridge this gap, simplified guidelines, decentralised testing, and training through local bodies and food safety authorities can support safe and standardised practices even in informal markets.
• Support Small-Scale Fermentation Industries and Indigenous Food Systems: Provide financial incentives, capacity-building programmes, and infrastructure support for local food entrepreneurs and small-scale fermentation industries. Promote the fermentation of indigenous crops (e.g., millets, legumes) through supply chain enhancements, promoting local brands, and technology-driven solutions to improve food security and climate resilience.
• Invest in Scientific Research and Public Awareness Initiatives: Fund clinical trials and microbiome research to validate the health benefits of traditional fermented foods in disease prevention and gut health. Including relevant awareness campaigns in existing programmes or launching nationwide awareness campaigns highlighting the nutritional, probiotic, and environmental benefits of fermented foods can foster consumer trust and market expansion.
• Encourage Innovation and Standardised Practices Within the Food Industry. This strategy can help scale production. Ready-to-eat fermented products, shelf-stable formulations, and functional food fortification can expand access and deliver health benefits across diverse population groups through formal supply chains.
• Support the Preservation and Transmission of These Indigenous Practices Through Training, Certification, and Market Linkages. Fermentation supports women’s livelihoods—especially through local Self-Help Groups (SHGs)—by enabling low-cost, skill-based micro-enterprises rooted in traditional knowledge. Policy frameworks should ensure that community-based food heritage translates into sustainable economic empowerment.

Conclusion

Traditional Indian fermented foods hold immense potential in promoting public health, nutrition security, and climate resilience, offering a sustainable, probiotic-rich, and nutritionally dense solution to contemporary health challenges in the country. Their role in gut microbiome diversity, metabolic health, immune modulation, and micronutrient bioavailability makes them a powerful dietary intervention against NCDs, malnutrition, and gastrointestinal disorders.

However, urbanisation, consumer perceptions, regulatory gaps, and commercialisation challenges hinder their widespread adoption. Integrating fermented foods into national nutrition programmes, enforcing food safety regulations, supporting small-scale fermentation industries, and investing in scientific validation can bridge these gaps. Additionally, leveraging fermentation as a climate-smart strategy can enhance food security, reduce waste, and promote sustainable agriculture.

A multi-sectoral approach, combining policy support, research advancements, and consumer awareness, is essential to fully harness the nutritional, economic, and environmental benefits of fermented foods. Their revival and mainstream adoption can transform food systems, making them healthier, more resilient, and ecologically sustainable for future generations.

Endnotes

^[a] Research (2018-2025) on fermented foods and their impact on gut health, immune regulation, and inflammation spans across the United States, Europe (Norway, Finland, and Germany), Asia (South Korea, Japan, and China)—reflecting the global consumption of fermented foods depending on cultural dietary practices.

^[b] A system where materials never become waste and nature is regenerated.

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^[3] Shahida Anusha Siddiqui et al., “An Overview of Fermentation in the Food Industry - Looking Back from a New Perspective,” Bioresources and Bioprocessing 10, no. 1 (2023), https://doi.org/10.1186/s40643-023-00702-y.

^[4] Pattanee Winichagoon et al., “The Double Burden of Malnutrition in Low- and Middle-income Countries,” in Energy Balance and Obesity, eds. Romieu I, Dossus L, Willett WC (IARC Working Group Reports, No. 10, 2017), https://www.ncbi.nlm.nih.gov/books/NBK565820/

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• Healthcare
• Climate, Food and Environment
• India
• fermented foods and climate resilience
• fermented foods benefits
• fermented foods for health
• Indian fermented foods
• national nutrition programmes in india
• sustainable food system

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