Rebuild Your Gut Microbiome With Kefir and Kefir Alternatives | Ulcerative Colitis Clinical Remission

Kefir, properly pronounced kuh-feer, is an incredibly powerful probiotic fermented beverage that is typically made from different types of animal milk, but can be made from plant-based milk and even water. The fermentation of milk into kefir was traditionally used as a way to preserve the milk, but it’s now recognized and more commonly used as a way to obtain beneficial probiotic microorganisms. The fermentation process is catalyzed by kefir grains, which consist of a matrix of polysaccharides that contain a mixture of lactic acid bacteria, yeast, and acetic acid bacteria that all interact symbiotically with one another (1). The result of this fermentation is milk kefir, which played an instrumental role in helping me to achieve total resolution of a severe case of inflammatory bowel disease over 5 years ago. After discovering that there seems to be a relationship between a dysbiotic gut microbiome and the pathogenesis of IBD, I decided to implement my own gut microbiome optimizing protocol with the aim to return my gut microbiome to eubiosis (2,3). Kefir was an essential component of this protocol because of its probiotic properties and its potential to positively impact the human gut microbiome.

Quick disclaimer

Just want to be explicitly clear that I am not a doctor, or a dietician, and that the information on this blog and in my videos is based on my personal opinion and should not be taken as medical advice. If you have, or suspect you have, a health condition, you should contact your doctor, or other healthcare practitioner. You should consult with your doctor before making any dietary changes with the intent to treat an illness. I recommend that you follow your doctor’s advice and take medication as prescribed.

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Health Benefits of Kefir

We know from the literature that kefir helps to optimize the gut microbiome by proliferating probiotic microorganisms while simultaneously decreasing pathogenic microorganisms. The probiotics are able to cause this decrease in pathogens by competitively excluding them and acting as an antimicrobial (4).

Probiotic competitive exclusion can be simplistically explained as out-competing the pathogens for living space and nutrients within the intestinal tract (5). Probiotics also act as natural antimicrobials that have antibacterial and anti-fungal properties. Kefir and kefir-associated microorganisms have specifically been shown to have antibacterial activity against E. coli and Clostridium difficile, and anti-fungal activity against Candida albicans (4). These are just a few of the pathogenic microbes that kefir is effective against, and there’s a long list. Over time, the consistent consumption of kefir can help bring the gut microbiome back to eubiosis by promoting the proliferation of good probiotic microorganisms and decreasing the proliferation of pathogenic microorganisms.

In this randomized controlled trial, a treatment group of 25 patients with IBD were given 800 mL of kefir per day for a duration of four weeks. The results of the trial showed that there was a statistically significant increase in lactobacillus, well known probiotic bacteria, for both Ulcerative Colitis and Crohn’s Disease patients. The study concludes that kefir consumption may modulate the gut microbiome, and regular consumption of kefir may improve IBD patients’ quality of life in the short term. The sample size of this study is admittedly small and the findings are far from conclusive, however, this is really exciting to me because it mirrors the experience I had using kefir as part of a gut microbiome optimizing protocol to find relief from IBD (6).  

Each individual batch of kefir can vary in the number of probiotic CFUs it contains. A 2017 review states that milk kefir can have a bacterial population ranging between 64,000 (6.4x10^4) and 850,000,000 (8.5x10^8) CFUs/g and a yeast population ranging between 150,000 (1.5x10^5) and 370,000,000 (3.7x10^8) CFUs/g (7). That’s a huge variation in CFUs, however, it’s beginning to seem in research that it’s not necessarily the number of probiotic CFUs that determine probiotic efficacy. Rather, the efficacy of probiotics are determined in a strain-specific and disease-specific manner (8). Meaning the type of probiotics consumed may be more important than the quantity of probiotics consumed. There are up to 50 strains of probiotic bacteria and yeasts that have been found in milk kefir, many of which have been extensively studied and found to be helpful in promoting several health benefits and improving different diseases (1,4,9). 

So in addition to improving the composition of the gut microbiome, probiotic microorganisms that are found in kefir have been shown to increase the speed of wound healing, promote anti-allergenic effects, to have significant anticancer activity against multiple types of cancer cells, and to generally improve the immune system response (4,10,11,12,13,14,15,16,17). Milk kefir is a truly incredible food.

How to Make Kefir

So how do you make it? I was spoiled during my recovery process because I was able to buy kefir by the gallon that was made in-house at a local raw dairy farm. So I didn’t start making my own kefir until a few years later. What I’ve learned since then, is that there are different methods of making kefir and that it’s more of an art than a science. This is my favorite and easiest method I’ve come across. To watch me go through the process, click on this video: Homemade Kefir | Rebuild Your Gut Microbiome.

First, you’re going to need kefir grains. You can find them online or at certain health food stores. Then you’re going to want a fermentation vessel. Typically, after each batch of kefir is finished fermenting, you strain out the kefir grains so you can use them for your next batch of kefir, and then you refrigerate the freshly fermented milk kefir so that you can drink it. But I’ve found a better method. A highly intelligent family member who is a fellow kefirite, brought this wonderful kefir fermentation vessel to my attention which simplifies the process by eliminating the straining step. So, once you have your kefir grains and the kefir fermenter, it’s time to start making milk kefir. I fill this 1 quart jar about ¾ of the way up with milk, and then I add 1 tablespoon of grains into the kefir grain container. Different ratios of kefir grains to milk can be used, for example Cultures for Health, an awesome resource on fermented foods, recommends 1-2 teaspoons of kefir grains for culturing about 4 cups of milk. I generally add higher amounts of kefir grains to my milk because it makes measuring a bit simpler, gives it a stronger flavor, and speeds up the fermentation process. I submerge the container into the milk, but not quite to the bottom of the jar, and then I screw the vented, breathable lid onto the jar. I let this sit on the counter for 48 hours at about 68-72°F. The length of time that milk kefir is allowed to ferment can vary quite a bit. I prefer 48 hours because that is how long the people at the dairy who sold me kefir allowed it to ferment, and I saw really great results with their kefir.

After 48 hours, I unscrew the lid, and easily remove the kefir grains without having to strain them. From here I can either store my kefir grains in some milk in the fridge until I’m ready to use them again, or I can immediately start another batch of kefir by placing them in a fresh jar of milk. I then put the finished milk kefir in the fridge to cool down before I start drinking it because I prefer drinking it cold. And that’s it. After it’s cold enough for my liking, it is ready to be consumed. 

So that’s my preferred method of making kefir, however, there are several ways to do it. Cultures for Health has been a great resource for me over the years that has explained how to make kefir in different ways, how to troubleshoot the kefir making process, how to store the kefir grains, how to incorporate second ferments, flavoring the kefir, and many other milk kefir nuances. I would definitely recommend checking out their website if you have questions regarding how to make kefir because they cover this topic extensively.

Kefir Alternatives

While kefir is an amazing probiotic beverage, there are a number of reasons why individuals might want a few alternative probiotic options instead of milk kefir. Here I’m going to list my current top 3 and perhaps I will add to this list later on in the future.

Coconut Milk Yogurt Hybrid Recipe

I learned about this coconut yogurt recipe from Ben Greenfield’s podcast and some articles he wrote (18). Ben learned about it from Dr. William Davis, author of Undoctored, and then he modified it by adding a few ingredients to it. I think this is a pretty decent probiotic alternative to milk kefir, and I like the ingredients Ben decided to add to the yogurt, so that’s why I’m going with his modified/hybrid version.

Here is the recipe:

• 2 cans of coconut milk
• 6 droperfulls of Omica Organics Vanilla Liquid Stevia (Optional)
• 4 heaping scoops of Great Lakes Gelatin
• 2 tablespoons of acai fiber 
• 2 scoops of Vitamin C powder
• 1 tablespoon of cane sugar
• 10 BioGaia L. Reuteri Probiotic Tablets 
  ‍

So the way I typically make it is by mixing all of the ingredients into a glass or ceramic bowl, and then grinding the 10 tablets of L. Reuteri into powder using a mortar and pestle. I add the ground up L. Reuteri to the bowl with the other ingredients, mix thoroughly, and then cover the bowl with a cheesecloth or plastic wrap. Ben recommends putting the bowl in a food dehydrator for 24 hours at 115 °F (18). I don’t have a food dehydrator so I just let it sit on the counter for 24-48 hours before putting it in the fridge for another 24 hours. After 24 hours in the fridge it should have thickened up and have somewhat of a jello consistency. At this point the coconut milk yogurt should be ready to be consumed 1-2 tablespoons at a time with your smoothies, cooked meals, or straight off the spoon.

Coconut Milk Kefir

Another great alternative to milk kefir is its infamous cousin, coconut milk kefir. Cultures for Health shows 3 different ways to make coconut milk kefir in their article titled RECIPE: COCONUT KEFIR MILK – 3 WAYS! (19). If you want to add kefir to your daily protocol, but are trying to avoid dairy- this is one very good way it can be done. Checkout their article to learn how Cultures for Health recommends making coconut milk kefir.

Probiotic Supplementation

This is the least exciting alternative, but if you're looking for an alternative to milk kefir, and you don’t want to make either the coconut milk yogurt or the coconut milk kefir, then one of the next best options is to just get a really high quality probiotic supplement.

Here are my three favorite probiotic supplements at the moment:

1. Visbiome - This probiotic is awesome. It’s a medical grade probiotic that is specifically designed to help manage Ulcerative Colitis associated dysbiosis. Along with IBS, pouchitis, and hepatic encephalopathy per the label on the box. When I take it, I normally take 1-2 packets of the powdered version with meals. 
2. Floracor-GI by AST Enzymes - This probiotic was recommended to me sometime in 2015. I’ve used it off and on over the years. I don’t take it consistently now, but I definitely noticed an improvement in my bowel movements when I took it pretty consistently during the time that I was sick. 
3. P3-OM by BiOptimizers - This is the newest one I’ve added to my repertoire. This supplement only has one strain of probiotic bacteria and it’s called Lactobacillus Plantarum. This strain of bacteria seems to be well tolerated and able to reduce the clinical symptoms of Ulcerative Colitis per a 2013 randomized controlled trial (20).

So there you have it. Why milk kefir is great, and some alternatives to it!

Sources

1. Prado MR, Blandón LM, Vandenberghe LP, et al. Milk kefir: composition, microbial cultures, biological activities, and related products. Front Microbiol. 2015;6:1177. Published 2015 Oct 30. doi:10.3389/fmicb.2015.01177 
2. Biedermann, L., Rogler, G. The intestinal microbiota: its role in health and disease. Eur J Pediatr 174, 151–167 (2015). 
3. Tomasello, G., Mazzola, M., Leone, A., Sinagra, E., Zummo, G., Farina, F., ... Carini, F. (2016). Nutrition, oxidative stress and intestinal dysbiosis: Influence of diet on gut microbiota in inflammatory bowel diseases. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub., 160(4), 461-466. doi: 10.5507/bp.2016.052.
4. Bourrie BC, Willing BP, Cotter PD. The Microbiota and Health Promoting Characteristics of the Fermented Beverage Kefir. Front Microbiol. 2016;7:647. Published 2016 May 4. doi:10.3389/fmicb.2016.00647
5. Plaza-Diaz J, Ruiz-Ojeda FJ, Gil-Campos M, Gil A. Mechanisms of Action of Probiotics [published correction appears in Adv Nutr. 2020 Jul 1;11(4):1054]. Adv Nutr. 2019;10(suppl_1):S49-S66. doi:10.1093/advances/nmy063
6. Yılmaz İ, Dolar ME, Özpınar H. Effect of administering kefir on the changes in fecal microbiota and symptoms of inflammatory bowel disease: A randomized controlled trial. Turk J Gastroenterol. 2019;30(3):242-253. doi:10.5152/tjg.2018.18227
7. Rosa D, Dias M, Grześkowiak L, Reis S, Conceicao L, Peluzio M. Milk kefir: nutritional, microbiological and health benefits. Nutrition Research Reviews. 2017; 30, 82-96. doi:10.1017/S0954422416000275
8. McFarland LV, Evans CT, Goldstein EJC. Strain-Specificity and Disease-Specificity of Probiotic Efficacy: A Systematic Review and Meta-Analysis. Front Med (Lausanne). 2018;5:124. Published 2018 May 7. doi:10.3389/fmed.2018.00124
9. Nejati F, Junne S, Neubauer P. A Big World in Small Grain: A Review of Natural Milk Kefir Starters. Microorganisms. 2020;8(2):192. Published 2020 Jan 30. doi:10.3390/microorganisms8020192
10. Farag MA, Jomaa SA, El-Wahed AA, El-Seedi AHR. The Many Faces of Kefir Fermented Dairy Products: Quality Characteristics, Flavour Chemistry, Nutritional Value, Health Benefits, and Safety. Nutrients. 2020;12(2):346. Published 2020 Jan 28. doi:10.3390/nu12020346
11. Huseini HF, Rahimzadeh G, Fazeli MR, Mehrazma M, Salehi M. Evaluation of wound healing activities of kefir products. Burns. 2012;38(5):719-723. doi:10.1016/j.burns.2011.12.005
12. Cetik Yildiz S, Demir C, Cengiz M, Ayhanci A. Protective properties of kefir on burn wounds of mice that were infected with S. aureus, P. auroginasa and E. coli. Cell Mol Biol (Noisy-le-grand). 2019;65(7):60-65. Published 2019 Sep 30.
13. Rafie N, Golpour Hamedani S, Ghiasvand R, Miraghajani M. Kefir and Cancer: A Systematic Review of Literatures. Arch Iran Med. 2015; 18(12): 852-857.
14. Khoury N, El-Hayek S, Tarras O, El-Sabban M, El-Sibai M, Rizk S. Kefir exhibits anti‑proliferative and pro‑apoptotic effects on colon adenocarcinoma cells with no significant effects on cell migration and invasion. Int J Oncol. 2014 Nov;45(5):2117-27. doi: 10.3892/ijo.2014.2635. Epub 2014 Sep 3. PMID: 25189203.
15. Jalali F, Sharifi M, Salehi R. Kefir induces apoptosis and inhibits cell proliferation in human acute erythroleukemia. Med Oncol. 2016 Jan;33(1):7. doi: 10.1007/s12032-015-0722-8. Epub 2015 Dec 26. PMID: 26708130.
16. Sharifi M, Moridnia A, Mortazavi D, Salehi M, Bagheri M, Sheikhi A. Kefir: a powerful probiotics with anticancer properties. Med Oncol. 2017 Sep 27;34(11):183. doi: 10.1007/s12032-017-1044-9. PMID: 28956261.
17. Ghoneum M, Gimzewski J. Apoptotic effect of a novel kefir product, PFT, on multidrug-resistant myeloid leukemia cells via a hole-piercing mechanism. Int J Oncol. 2014;44(3):830-837. doi:10.3892/ijo.2014.2258
18. Greenfield B. The Weekly Roundup: Your Go-To Guide For Everything You May Have Missed This Week & More! 3/09 – 3/15. Ben Greenfield Fitness. Accessed February 4, 2022. https://bengreenfieldfitness.com/article/weekly-roundup-articles/the-weekly-roundup-your-go-to-guide-for-everything-you-may-have-missed-this-week-more-3-09-3-15/.
19. RECIPE: COCONUT KEFIR MILK – 3 WAYS! Cultures for Health. Accessed February 4, 2022. https://www.culturesforhealth.com/learn/recipe/milk-kefir/coconut-milk-kefir-recipe/. 
20. Krag A, Munkholm P, Israelsen H, von Ryberg B, Andersen KK, Bendtsen F. Profermin is efficacious in patients with active ulcerative colitis--a randomized controlled trial. Inflamm Bowel Dis. 2013 Nov;19(12):2584-92. doi: 10.1097/01.MIB.0000437046.26036.db. PMID: 24108114.