Advances in Nutrition 14 (2023) 22–29

journal homepage: www.journals.elsevier.com/advances-in-nutrition

Review

Nutritional benefits of sourdoughs: A systematic review

L
ea Ribet 1, y, Robin Dessalles 2, y, Corinne Lesens 1, Nele Brusselaers 3, 4, 5,
Micka€el Durand-Dubief 6, *
1
Baking Science, Lesaffre Institute of Science & Technology, Lesaffre, Marcq-en-Barœul, France; 2 Robin Dessalles EI, Lyon, France; 3 Global Health
Institute, Antwerp University, Antwerp, Belgium; 4 Centre for Translational Microbiome Research (CTMR), Department of Microbiology, Tumor and
Cell Biology, Karolinska Institute, Karolinska Hospital, Stockholm, Sweden; 5 Department of Head and Skin, Ghent University, Ghent, Belgium;
6
Discovery & Front End Innovation, Lesaffre Institute of Science & Technology, Lesaffre, Marcq-en-Barœul, France

A B S T R A C T

Food fermentation using sourdough—i.e., consortia of lactic bacteria and yeasts—is increasingly considered among the public as a natural
transformation yielding nutritional benefits; however, it is unclear whether its alleged properties are validated by science. The aim of this
study was to systematically review the clinical evidence related to the effect of sourdough bread on health. Bibliographic searches were
performed in 2 different databases (The Lens and PubMed) up to February 2022. Eligible studies were randomized controlled trials
involving adults, healthy or not, given any type of sourdough bread compared with those given any type of yeast bread. A total of 573
articles were retrieved and investigated, of which 25 clinical trials met the inclusion criteria. The 25 clinical trials included a total of 542
individuals. The main outcomes investigated in the retrieved studies were glucose response (N ¼ 15), appetite (N ¼ 3), gastrointestinal
markers (N ¼ 5), and cardiovascular markers (N ¼ 2). Overall, it is currently difficult to establish a clear consensus with regards to the
beneficial effects of sourdough per se on health when compared with other types of bread because a variety of factors, such as the microbial
composition of sourdough, fermentation parameters, cereals, and flour types potentially influence the nutritional properties of bread.
Nonetheless, in studies using specific strains and fermentation conditions, significant improvements were observed in parameters related to
glycemic response, satiety, or gastrointestinal comfort after bread ingestion. The reviewed data suggest that sourdough has great potential to
produce a variety of functional foods; however, its complex and dynamic ecosystem requires further standardization to conclude its clinical
health benefits.

Keywords: bread, clinical trials, fermentation, glycemic response, lactic bacteria, microbiota, satiety, sourdough, yeast

Introduction
Statements of significance Fermentation is used as a means of natural transformation for
Scientific studies have already highlighted that sourdough enhancing food properties such as preservation or palatability,
fermentation can improve nutrient bioaccessibility or reduce the GI i.e., flavor or texture [1]. It involves the controlled growth of
of bread; however, it remains unclear whether the effect of sour-
dough fermentation on cereals translates to beneficial effects in a microorganisms in conditions allowing enzymatic conversions of
clinical setting. Our systematic review reveals the difficulty in specific food components [2,3]. Among the different types of
establishing a clear consensus with regards to the beneficial effects food fermentation, the sourdough process, using a combination
of sourdough per se on health and suggests that sourdough has of lactic acid bacteria (LAB) and yeast, has been traditionally
great potential to produce a variety of functional foods; however,
used as a leavening agent in baking. Initially, sourdough was
its complex and dynamic ecosystem requires further standardiza-
tion to conclude its clinical health benefits. prepared by letting the microorganisms naturally present in the
raw food or the direct environment develop within a mixture of
flour and water, generally at the ambient temperature over

Abbreviations used: AUC, area under curve; CVD, cardiovascular disease; FODMAP, fermentable, oligosaccharides, disaccharides, monosaccharides and polyols; GI,
glycemic index; iAUC, incremental AUC; IBS, irritable bowel syndrome; LAB, lactic acid bacteria; SS, severity score; VAS, visual analog scale.
* Corresponding author. E-mail addresses: [email protected], [email protected] (M. Durand-Dubief).
y
LR and RD contributed equally to this work.

https://doi.org/10.1016/j.advnut.2022.10.003
Received 28 April 2022; Received in revised form 14 September 2022; Accepted 5 October 2022; Available online 16 December 2022
2161-8313/© 2022 The Author(s). Published by Elsevier Inc. on behalf of American Society for Nutrition. This is an open access article under the CC BY license
(http://creativecommons.org/licenses/by/4.0/).
L. Ribet et al. Advances in Nutrition 14 (2023) 22–29

several hours. A sample of this fermented dough is then reino- gastrointestinal markers (N ¼ 5), and cardiovascular markers (N
culated in a new mixture of flour and water, and the process is ¼ 2). Most studies were from the European Region (N ¼ 18),
repeated; this method is referred to as “backslopping” [4]. Public mostly from Italy (N ¼ 8), Finland (N ¼ 4), and Sweden (N ¼ 3),
awareness regarding nutrition and health as well as the renewed with the 3 remaining studies being conducted in Denmark,
interest in simple traditional food processes, such as sourdough Croatia, and the United Kingdom. The other works were from
bread, has increased over the past decades. Along with this Canadian (N ¼ 5), Israeli (N ¼ 1), and New Zealander (N ¼ 1)
increased popularity, sourdough bread fermentation is claimed research teams. In terms of the risk of bias, 16 studies were
to promote various health benefits, such as better digestibility considered low risk, 5 studies were considered medium risk, and
and enhanced nutritional content. Although scientific studies 4 studies were considered high risk (Supplementary Table 2 and
have already highlighted that sourdough fermentation can Supplementary Fig. 2). Studies’ sample sizes ranged from 8 to 87
improve nutrient bioaccessibility and reduce the GI of bread [1, subjects, representing a total of 542 individuals.
4,5], it remains unclear whether the effect of sourdough
fermentation on cereals translates to beneficial effects in a clin-
ical setting and, if so, whether these clinical benefits apply in a Postprandial glucose response
real-life situation given that study design and comparator choice Among the 20 studies assessing the effect of sourdough bread
often limit extrapolation of results. Therefore, the objective of on glucose response, either as a primary (N ¼ 15) or secondary
this work was to systematically review the clinical evidence outcome (N ¼ 5), 14 focused on healthy individuals, 2 focused
related to the benefits of sourdough-fermented bread on health. on individuals with obesity or who were overweight, 2 focused
on both healthy and hyperglycemic individuals, 1 focused on
subjects with impaired glucose tolerance, and 1 focused on in-
Methods
dividuals with type 2 diabetes. In total, measures of glucose
response were available for 369 individuals (Supplementary
Bibliographic searches were performed with no time restric-
Table 2). Studies usually reported results as AUC or incremental
tion on PubMed and The Lens databases [6] (https://www.lens.
AUC (iAUC) (to account for the variations in baseline values) for
org/) using the following keywords in a number of combina-
outcomes such as glucose and insulin response.
tions: “sourdough AND bread AND (human OR subjects OR
Among 8 studies mentioning starter composition, most re-
volunteers)” (see Supplementary Table 1). In this work, 2 re-
ported the use of Lactobacillus strains Lactobacillus plantarum (N
searchers (RD, MD-D) independently evaluated the quality of the
¼ 6) and Lactobacillus brevis (N ¼ 4). Other mentioned strains
included studies. Articles published up to February 2022 and
were (1 study each): Lactobacillus acidophilus, Lactobacillus casei,
written in the English language were screened. The Population,
Lactobacillus fermentum, Lactobacillus rossiae, and Lactobacillus
Intervention, Comparator, Outcomes, and Study Design method
sanfranciscensis. According to the different studies, Saccharo-
was used to define the selection criteria. Briefly, clinical studies
myces cerevisiae was the most commonly used yeast as a starter,
were eligible if they included healthy or unhealthy adult subjects
except for 1 study mentioning Saccharomyces exiguous. The
(aged >18 y) (Population); used any form of bread and baked
grains used for bread making were mostly wheat or rye; barley,
goods fermented with sourdough as intervention (Intervention)
oat, or corn flours were rarely used. Twelve studies allowed the
compared with any form of bread fermented with yeast only
comparison of a similar bread recipe, only varying in the pres-
(Comparator); evaluated the effect of the intervention on any
ence of sourdough rather than the presence of yeast fermenta-
clinical health outcome (Outcomes); and were randomized
tion, whereas the remaining 8 studies compared different
controlled or nonrandomized experimental clinical studies pub-
recipes, such as whole-grain sourdough bread with white wheat
lished in peer-reviewed journals (Study Design). The PRISMA
yeast bread. In addition, 6 studies focused on commercial breads,
methodology was applied [7].
with little or no information available on the bread-making
The risk of bias in each study was evaluated using a number of
process.
components known to be potential sources of bias in interven-
tional studies [8,9]. Studies were classified as being at low, Healthy subjects
medium, or high risk of bias on the basis of authors’ judgment of A total of 14 studies had measures of glycemic response
the potential bias arising from each individual component. Study available for 263 healthy subjects. In an early Swedish ran-
characteristics and quality assessment results are detailed in domized controlled study, the effects of whole-meal yeast bread
Supplementary Figs. 1 and 2 and Supplementary Table 2. on the glucose response of healthy subjects were compared to
Although the taxonomy of the genus Lactobacillus has recently those of the same bread with added sourdough containing
evolved [10], we decided to maintain the former nomenclature Lactobacillus plantarum A1. Bread was given as part of a macro-
for clarity purposes because most of the studies reviewed in this nutrient- and energy-matched breakfast. The iAUC related to the
work used this form. glucose response was significantly lower over the whole time
period (0–120 min) in the sourdough group than in the control
Results group [11]. In 2 other studies focusing on healthy subjects,
glucose response was significantly decreased over the whole
The PRISMA flow diagram is reported in Supplementary Fig. assessment period (lasting from 120 to 300 min, depending on
3. The searches yielded 573 articles, of which 25 clinical trials studies) in the sourdough group compared with that in the yeast
met the inclusion criteria, published between 1995 and 2022. group [12,13]. However, no significant differences in glucose
Glycemic control was investigated as a primary outcome in 15 response over the assessment period were observed in 5 other
studies. The remaining studies focused on appetite (N ¼ 3), trials [14–18].

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L. Ribet et al. Advances in Nutrition 14 (2023) 22–29

In 7 studies, the effect of sourdough bread based on whole- croissant in healthy subjects than those found after ingestion of
grain wheat or rye flour on glucose response was compared its yeast counterpart [30].
with that of baker’s yeast white wheat bread in healthy subjects. Among 3 studies comparing different bread recipes with
A significant reduction in glucose response over the assessment that of white wheat bread, Italian researchers observed a
period was shown in 2 studies [12,19], whereas no differences significantly reduced ghrelin AUC and a significantly higher
between the 2 bread types could be identified in 5 other trials satiety AUC after consumption of sourdough organic einkorn
[14,18,20–22]. bread compared with those after consumption of white wheat
bread [19]. In a Swedish trial, sourdough-fermented whole--
Subjects with obesity or metabolic diseases grain (19 %) rye crispbread was found to generate lower
Among the 6 studies, including a total of 78 subjects with hunger and desire to eat than those generated by refined wheat
impaired glucose metabolism, in an Italian study, a significant crispbread [18].
reduction in glucose AUC was observed in the first 60 min after Another Swedish trial compared the effects of breads con-
sourdough bread intake compared with that with its yeast taining different combinations of sourdough (9%, 30%, or 51%)
counterpart but not thereafter [23]. A Canadian study high- with rye (35%, 42%, or 45%) on appetite ratings in healthy
lighted a significantly lower glucose iAUC (180 min) after the subjects. It was highlighted that breads with low rye content did
intake of sourdough whole-grain wheat bread than after the not induce a significant difference in hunger, fullness, or desire-
intake of refined wheat bread in hyperglycemic subjects but not to-eat ratings compared with those induced by white wheat
in normoglycemic subjects [24]. Two other Canadian studies bread, regardless of the sourdough content. However, breads
found no evidence of a difference in glycemic parameters be- with medium or high rye content did exert significant effects,
tween whole-grain sourdough bread and white wheat bread regardless of the sourdough levels. The different rye breads
whether in normoglycemic or hyperglycemic individuals [25] or tested did not differ significantly from one another with regards
individuals with type 2 diabetes [26]. In another Canadian trial to their effects on appetite ratings [29].
including subjects with obesity and those who were overweight,
the observed glucose iAUC with sourdough white wheat bread
Effect of sourdough on gastrointestinal health
was significantly lower than that observed with white wheat or
A total of 7 studies focused on gastrointestinal health pa-
whole wheat yeast bread [27]. Using commercial bread, the
rameters; among which, 4 focused on healthy subjects (n ¼ 90)
same research team found that sourdough white wheat bread
and 3 investigated the effects of sourdough breads with a
was not different from baker’s yeast white wheat bread
reduced content of fermentable oligosaccharides, disaccharides,
regarding its effect on glucose response in subjects who are
monosaccharides and polyols (FODMAP) or reduced gluten
overweight when breads were matched for delivering 50 g of
content, in individuals suffering with irritable bowel syndrome
carbohydrates. However, when breads were matched for mass,
(IBS) (n ¼ 170) (Supplementary Table 2). In the 4 studies in
the glucose iAUC of the sourdough bread was significantly
which information was available, the microorganisms reported
higher than that of the white wheat bread [28].
to be used in sourdough were mostly Lactobacillus san-
franciscensis (2 studies), Lactobacillus brevis (2 studies), Lactoba-
Effect of sourdough on appetite and satiety cillus alimentarius (1 study), Lactobacillus hilgardii (1 study) and
The 7 retrieved studies that focused on appetite markers as a Lactobacillus plantarum (2 studies). Other studies reported (1
primary or secondary outcome included a total of 147 healthy study each) the following microorganisms: Streptococcus sp.,
subjects (Supplementary Table 2). Five studies mentioned the Leuconostoc sp., and Lactobacillus rossiae. Of note, depending on
bacteria present in the sourdough. The strains reported were the study context, the strains were selected on the basis of their
Lactobacillus plantarum (3 studies), Lactobacillus brevis (2 known characteristics (e.g., fructan degradation).
studies), Lactobacillus acidophilus (1 study), Lactobacillus casei (1
study), Lactobacillus sanfranciscensis (1 study), Lactobacillus ros- Gastrointestinal comfort in healthy subjects
siae (1 study), Streptococcus sp. (1 study), and Leuconostoc sp. (1 Among the 4 studies including healthy subjects (n ¼ 90), it
study). The flours used for these studies were wheat or rye. One was reported that providing sourdough rather than baker’s yeast
study also used a mixture of barley and wheat or organic croissants did not affect gastric emptying but lowered both
einkorn flour. The markers of satiety in these studies were expired hydrogen AUC at 45–240 min and subjective gastroin-
usually scores calculated on the basis of visual analog scales testinal discomfort during the 0–240-min period in the sour-
(VAS) for different components related to satiety (“fullness,” dough group compared with in the control group [30]. In
“hunger,” and “desire to eat”), hormonal response (ghrelin another study, sourdough bread, either made spontaneously or
AUC), or EI at a subsequent meal. Most studies expressed the with a starter, significantly lowered the gastric emptying rate
VAS results as AUC. compared with that with baker’s yeast bread in healthy subjects.
In 5 studies comparing sourdough breads with their yeast No effects of bread on gastrointestinal symptoms were reported
counterparts, no significant differences in any of the satiety pa- [13]. In another study, when comparing rye sourdough bread to
rameters assessed were observed [11,15,18,19,29]. In an Italian white wheat bread, no significant differences were reported in
study, sourdough bread ingestion induced a significantly higher the gastric emptying rate in healthy subjects [20]. In a Finnish
appetite AUC and a significantly lower satiety AUC than those trial, the investigators reported a significantly increased fre-
induced by baker’s yeast bread [13]. In another trial, a signifi- quency of slight to moderate flatulence in subjects given sour-
cantly lower AUC for hunger and higher AUC for satiety were dough whole-grain rye bread or white wheat bread enriched
found between 45 and 240 min after ingestion of a sourdough with rye bran compared with that in subjects given white wheat

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L. Ribet et al. Advances in Nutrition 14 (2023) 22–29

bread alone; however, no significant differences in bloating, a significant decrease in both total and LDL cholesterol levels
rumbling of the stomach, abdominal pain, or heartburn were was found after consumption of whole wheat sourdough bread
reported between interventions [21]. compared with that after consumption of white wheat yeast
bread [22].
Effects of low-FODMAP or low-gluten sourdough bread in IBS
A total of 3 studies included 170 individuals with IBS. A Finish Discussion
research team investigated whether sourdough fermentation
using specific Lactobacillus strains could be used to decrease
The objective of the present paper was to systematically review
FODMAP content in bread and, thus, reduce abdominal discom-
the clinical evidence investigating the effects of sourdough bread
fort in patients with IBS. They did not report significant differ-
consumption on various health measurements relative to other
ences in IBS severity score (SS) or IBS quality of life values
sources of bread. The review included 25 interventional clinical
between traditional sourdough (1.1 g/100 g fructans) and low-
trials, mostly on healthy subjects, using commercial sourdough
FODMAP (0.3 g/100 g fructans) sourdough rye breads in 87
breads or laboratory-made sourdough, made either spontane-
subjects with IBS. However, abdominal symptom scores and
ously or with different combinations of LAB and yeast as a starter.
hydrogen breath concentrations significantly improved in the
The main health parameters assessed were glycemic response,
low-FODMAP bread group [31]. In another study, the same
satiety, and gastrointestinal and cardiovascular health. In
research team did not highlight significant differences in gastro-
weighing the evidence, it is currently not possible to conclude that
intestinal symptoms between subjects who were given a
using sourdough instead of baker’s yeast for fermentation during
low-FODMAP (0.06 g/100 g fructans) refined sourdough wheat
bread making would be sufficient to highlight significant benefits
bread and those who were given a refined yeast wheat bread (0.23
on health in a clinical setting. More than 50% of the studies
g/100 g fructans). However, the score related to non-GI symptoms
comparing sourdough bread with white wheat bread did not find
(such as tiredness, joint symptoms, and decreased alertness) was
significant differences in the glycemic response of healthy in-
significantly higher in the low-FODMAP sourdough group than in
dividuals between the groups. Several studies showed evidence of
the yeast group [32].
a significant effect of sourdough bread on some appetite ratings
A randomized controlled trial reportedly used sourdough
compared with control bread; however, the effect of sourdough
fermentation with specific Lactobacillus strains in combination
could not be separated from that of grain and flour type in these
with fungal proteases to reduce gluten content (50% reduction
studies. Regarding gastrointestinal outcomes, sourdough
of immune reactive gluten) in wheat bread and assessed
fermentation was shown to reduce FODMAP content in bread,
whether the resulting product would reduce gastrointestinal
making it more acceptable for patients with IBS, although the
symptoms in patients with IBS, compared with normal-gluten
strains mentioned were selected specifically for this purpose (see
bread. The authors reported a significant decrease in gastroin-
the summary of the results, Figure 1).
testinal symptoms measured through VAS in the gluten-reduced
This heterogeneity in the results of these studies is likely
sourdough bread compared with in the yeast bread with normal
because of the diversity of sourdough preparations across
gluten content but no changes in IBS-SS or IBS quality of life
studies, which may have yielded products with different nutri-
scores [33].
tional characteristics and metabolic effects. Indeed, sourdough is
a complex and dynamic ecosystem. Although the most
Effect of sourdough on cardiovascular outcomes commonly occurring microorganisms in sourdough made ac-
A total of 7 studies investigated the effects of sourdough bread cording to the traditional backslopping method are the associa-
on cardiovascular health parameters as a primary or secondary tion of the LAB Lactobacillus sanfranciscensis and the yeast
outcome (Supplementary Table 2). Four studies focused on Candida humilis, the spontaneous development of other species
healthy subjects (n ¼ 73), and 3 studies focused on individuals has extensively been reported. These notably include Lactoba-
with metabolic impairments (n ¼ 42). cillus fermentum, Lactobacillus plantarum, and Lactobacillus brevis
In a Canadian trial, the investigators examined the influence for LAB or Candida, Kazachstania, Rhodotorula, and Saccharo-
of whole-grain sourdough bread consumption compared with myces genera for yeast [2,4,5,35]. The presence of 1 type of
that of white wheat bread consumption on PAI-1, a biomarker of microorganism over another also depends on fermentation con-
CVD that may be altered by dietary carbohydrates. After a 6-wk ditions, notably time and temperature [36]. The starters used for
consumption period, no significant differences could be observed industrial or research purposes also vary widely and most
between the groups, neither in normoglycemic individuals nor in commonly contain Lactobacillus plantarum, Lactobacillus brevis,
hyperglycemic individuals [24]. and Lactobacillus sanfranciscensis; however, the use of other
In an Italian study, no differences in blood lipids or in- genera, such as Bifidobacterium, Enterococcus, or Leuconostoc, has
flammatory parameters were reported between the sourdough also been reported [5]. In the present work, when mentioned, the
and yeast bread groups; however, LDL cholesterol was signifi- strains reportedly used for sourdough preparation were mostly
cantly decreased compared with baseline in both groups by Lactobacillus plantarum and Lactobacillus brevis but also included
10.6% and 8.53%, respectively [34]. Accordingly, no impact of Lactobacillus acidophilus, Lactobacillus casei, Lactobacillus san-
sourdough bread compared with that of white wheat bread on franciscensis, or Lactobacillus fermentum, whereas the yeast strain
blood lipids was observed in other studies involving healthy in sourdough was mostly Saccharomyces cerevisiae. Unfortu-
subjects [15,19], individuals with impaired glucose tolerance nately, information was not available for nearly 50% of the
[23], or subjects who were overweight [26]. However, in studies. Hence, noting the diversity of the sourdough ecosystem
another randomized controlled trial including healthy subjects, and the wide variety of industrial practices, the attribution of a

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L. Ribet et al. Advances in Nutrition 14 (2023) 22–29

FIGURE 1. Summary of the reviewed clinical trials included in this study according to the health outcomes and target population.

nutritional or health effect to sourdough per se is currently not more available for digestion. This supposedly results in an
possible. Establishing this relationship is especially complex increased GI [43,44]. Conversely, it was found that sourdough
because studies also differed in fermentation, baking conditions fermentation of rye products results in the formation of an
and in the cereal and flour types used. amylose layer, which has been suggested to inhibit starch hy-
Most studies investigated whether sourdough bread could drolysis, thus potentially decreasing postprandial glucose
impact postprandial glucose response in adult subjects [37]. response [45]. Proofing, baking time and temperature, and
However, based on the studies reviewed in this article, whether storage have also been reported to affect starch structure and,
sourdough fermentation per se would have a significant impact on potentially, the glycemic response to bread [38,41,46,47].
postprandial blood glucose response is equivocal. This might be Different patterns of starch degradation during sourdough
explained by the differences in design, measurement methods, fermentation may also release several types of fermentation
and sample size and also by the presence of a variety of con- metabolites, notably dextrins, maltotriose, maltose, and
founding factors, modifications to which during the glucose, whose amount in the final bread could impact its GI in
bread-making process are known to influence the glycemic different directions [44].
response to bread. Independent of sourdough fermentation, the inclusion of fiber
Early studies have indeed suggested that the effect of sour- or fiber-rich whole-grain or whole-meal flour in the
dough on blood glucose response was mediated by the pro- manufacturing of breads is known to influence the postprandial
duction of organic acids during the fermentation process, which glucose response [48]. In this respect, the choice of flour is a
would decrease gastric emptying rate and, therefore, delay major determinant of the effect. The flour type and final bread
glucose response [11,38]. More recently, Darzi et al. [15] did density were reported to be larger contributors to the GI of bread
not report an effect of propionate added to sourdough bread on than the rising method or leavening agent [43,49]. Similarly, the
postprandial glycemic response. In addition, the impact of effect of sourdough bread on appetite ratings seems to be
sourdough bread on gastric emptying seemed inconsistent in mediated by the fiber content of the flour [29]. It is worth noting
other studies [13,20,30]. Variations in the starch content and that the nutritional content of the endosperm fraction of wheat
structure are known to influence glucose and insulin responses grain is not homogeneous; it varies according to a gradient from
[39]. Sourdough fermentation was reported to decrease the the inner to the outer parts, the latter having, for instance, a
rapidly digestible starch content in bread [40], and this starch higher amylose to amylopectin ratio. This indicates that grain
fraction was positively correlated to the estimated GI of sour- processing and milling could also affect the nutritional content of
dough bread, whereas the opposite was found for slowly the grain and may also act as a confounder in the relationship
digestible and resistant starch contents [41]. Interestingly, between sourdough bread and health [50]. Among the other
sourdough fermentation with a starter (Lactobacillus brevis, determinants of the glycemic response to bread, it was reported
Lactobacillus plantarum, and baker’s yeast) was found to yield a that the microbiota characteristics of each individual could
bread with a higher resistant starch content than that with predict the glycemic response to bread [22].
spontaneous sourdough fermentation; however, an impact of Because of all these potential determinants, it is difficult to
fermentation type on the estimated GI of bread was apparent establish that the sourdough process would be predictive of a
only for whole-grain wheat bread, and not for white wheat beneficial effect on glycemic control. It is well known that
bread [42]. Starch structure and organization also seem to play replacing high-GI diets with low-GI diets is useful for both the
a role: increased gelatinization and swelling of starch granules management of metabolic disease in unhealthy individuals and
may occur as a result of sourdough fermentation, making starch the prevention of disease progression in at-risk individuals

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L. Ribet et al. Advances in Nutrition 14 (2023) 22–29

[51–55]. Accordingly, there is evidence that decreased post- Conclusions

prandial glycemia has a role in the prevention of diabetes. How-
ever, what constitutes a healthy postprandial glycemic response The benefits of sourdough-fermented bread on glycemic
profile remains a subject of debate [37]. In this context, even in a response, satiety, or gastrointestinal distress were reported in
case in which sourdough bread would improve postprandial some studies but not in others, and the lack of sourdough (LAB
glycemic response compared with white wheat bread (which is and yeasts) characterization and the high diversity of bacterial
known to have a high GI), it is uncertain whether sourdough bread strains, fermentation conditions, or bread recipes used from one
would be an acceptable alternative resulting in health improve- study to another make it difficult to identify the main de-
ment because this is also influenced, as mentioned previously, by terminants of the effects. Consequently, in the current state of the
other components in bread as well as by other components in the scientific literature, it remains uncertain whether sourdough
diet. Sourdough fermentation with specific strains in combination fermentation per se could exert clinically significant benefits on
with other components, such as proteases, was shown to signifi- health. Additional studies, standardized in terms of design and
cantly reduce gluten in bread in vitro [56–60]. Such a combina- participants, with better characterization of sourdough-
tion has also been shown to reduce immunoreactivity in clinical fermented bread and other health outcomes are required to
trials [61,62]; however, more studies are needed to establish the determine the health benefits.
interest and safety of the resulting products in patients with celiac In the meantime, sourdough fermentation remains a valuable
disease. The use of this combination for bread production has also natural transformation for enhancing the texture, flavor, and
been shown to improve some gastrointestinal outcomes in pa- stability of foods. It is known to enhance mineral accessibility of
tients with IBS [33]. Similarly, in vitro trials showed the ability of cereal products, especially those with high fiber content, thus
sourdough fermentation to significantly reduce the FODMAP being a tool of choice to produce high-fiber, nutrient-dense
content in bread [3,63], although fermentation with baker’s yeast breads.
alone was also reported to be very effective in this respect [64,65].
However, clinical evidence supporting the safety of the resulting
Funding
low-FODMAP bread in patients with IBS remains to be confirmed
[31,32].
Supported in part by Lesaffre International, Marcq-en-Barœul,
Despite the lack of consistency in the scientific evidence
France. The sponsor had no role in the study design, data anal-
related to the clinical benefits of food fermented with sourdough
ysis, or interpretation of results.
on health, a significant body of evidence demonstrated that
sourdough fermentation improves micronutrient bioaccessibility,
notably for minerals such as iron, calcium, magnesium, or zinc, Disclosures
through the reduction of phytic acid content induced by the
phytate-degrading enzymes present in yeast and LAB isolated NB, no conflicts of interest. RD, has temporary consulting
from sourdough [66–70]. The effect is especially significant for activities for Lesaffre. LR, CL, and MD-D are employees of
whole-grain or rye flours, which are a rich source of minerals but Lesaffre International, Marcq-en-Barœul, France.
present high levels of phytic acid [71,72].
The fact that sourdough fermentation improves the accessi- Acknowledgments
bility of minerals and that higher whole-grain consumption is
known to be associated with a reduced incidence of several We acknowledge Michael Ga €nzle (University of Alberta) and
chronic diseases [73] makes whole-grain sourdough-fermented Micka€el Boyer for comments that improved this manuscript. We
bread a nutrient-dense food with potential functional properties would also like to show our gratitude to the Knowledge Center
on health. at Lesaffre for their help in the initial bibliographic research.
This systematic review has a number of limitations. Because The authors’ responsibilities were as follows – LR, CL, MD-D:
of the exploratory nature of this review and the methodological conceived the study; RD, LR, CL, NB, MD-D: planned and
diversity of the included studies, it was considered inappropriate designed the study; RD, NB, MD-D: designed the search strat-
to perform a meta-analysis. As mentioned previously, the main egy; LR, RD, MD-D: performed the searches; RD, MD-D:
issue relates to the heterogeneity of studies, which widely differ screened the titles, abstracts, and full texts of retrieved pa-
in terms of products assessed and design and often lack infor- pers, with any disputes resolved in consultation with NB; RD,
mation related to products’ characterization. This heterogeneity MD-D: extracted data; RD: conducted the risk of bias assess-
appeared to be reflected in the results because it was not possible ment, which was verified by NB and MD-D; LR, RD, MD-D:
to establish a clear consensus regarding the effect of sourdough interpreted the data; RD, LB, MD-D: drafted the manuscript;
on the different health parameters assessed. Most of the studies LR, RD, CL, NB, MD-D: further contributed toward the writing
investigated the effects of sourdough bread acutely, thus giving and critical revision of the manuscript; and all authors: read and
no indication of whether the potential beneficial effects observed approved the final manuscript.
would be sustained over time. Still, this work provides a valuable
overview of the clinical studies related to the effect of sourdough
Appendix A. Supplementary data
bread on health and identifies a number of clinical parameters on
which sourdough products made under proper standardized
conditions could be beneficial, such as glycemic response or Supplementary data to this article can be found online at https
gastrointestinal immune response. ://doi.org/10.1016/j.advnut.2022.10.003.

27
L. Ribet et al. Advances in Nutrition 14 (2023) 22–29

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