Sauerkraut and SIBO: Fermented Cabbage, Histamine & Lactic Acid

In short: no study has tested sauerkraut in people with SIBO. In a small 2018 trial in people with IBS, 75 g of sauerkraut a day for 6 weeks improved symptoms, and pasteurized sauerkraut worked about as well as raw¹. The possible downsides for people with SIBO are the fermentable cabbage fibers, histamine and other amines that build up during fermentation, and D-lactate. A cautious approach is to avoid it during treatment and reintroduce it slowly afterwards.

This guide covers what is in sauerkraut, what the research shows, and how to decide whether to eat it with SIBO. For fermented dairy, see our kefir guide.

What is in sauerkraut?

Sauerkraut is shredded cabbage fermented with 2% to 3% salt. The fermentation happens naturally, driven mainly by lactic acid bacteria such as Leuconostoc, Lactobacillus (including L. plantarum and L. brevis) and Pediococcus. The lactic acid they make lowers the pH and preserves the cabbage². Raw sauerkraut contains these live bacteria; pasteurization kills them.

The bacteria in sauerkraut vary a lot between batches and brands. A 2025 analysis of commercial sauerkraut found a wide range of bacteria and quality measures between samples⁶.

What the research shows

In the IBS trial, sauerkraut bacteria (L. plantarum and L. brevis) were found in stool more often in the raw sauerkraut group. Because pasteurized sauerkraut helped too, the authors suggest that the benefit came more from the cabbage fibers than from the live bacteria. The study was small and had no group without sauerkraut¹. A 2019 review concluded that there is not yet enough evidence to judge the effect of fermented foods on gut health and disease².

None of these studies tested people with SIBO. Probiotic supplements, which have been studied in SIBO, can help clear it but have not been shown to prevent it⁷; see our probiotics guide.

Possible downsides with SIBO

Fermentable fibers

Cabbage contains carbohydrates that gut bacteria ferment. SIBO diets reduce fermentable carbohydrates because bacteria turn them into the gases that cause symptoms⁸. How well a person tolerates sauerkraut varies; check a FODMAPFODMAPs Fermentable oligo-, di- and monosaccharides and polyols: short-chain carbohydrates that are poorly absorbed and quickly fermented by gut microbes. guide for serving sizes and see our low-FODMAP guide.

Histamine and other amines

Lactic acid bacteria in fermented vegetables can produce histamine⁵. Fermentation also produces other “biogenic amines”. In the 2025 analysis, putrescine and cadaverine were the main amines in sauerkraut, and four sauerkraut samples exceeded an estimated upper limit for total amines⁶.

People with histamine intolerance, a condition in which histamine from food is broken down poorly in the gut, may react with headaches or gut or skin symptoms. Fermented cabbage is among the foods excluded on low-histamine diets. The condition is still poorly defined, and more research is needed on how to diagnose and manage it⁵.

D-lactate

Leuconostoc, the main bacterium in sauerkraut, makes D-lactate, a form of lactic acid that can cause metabolic stress when too much is taken in⁴. In a 2018 study, 30 people with brain fog, gas and bloating, all of whom took probiotics, had SIBO and D-lactic acidosis more often than people without brain fog. Brain fog resolved in 77% after they stopped probiotics and took antibiotics⁹. That study was about probiotic supplements, not sauerkraut, but it is one reason some practitioners are cautious about large amounts of lactic acid bacteria in people with SIBO.

Should you eat sauerkraut with SIBO?

There is no evidence-based answer yet. A reasonable approach:

• During treatment, consider avoiding sauerkraut, along with other fermentable foods, to keep symptoms down. SIBO practitioners use diets during treatment mainly to reduce symptoms, not to clear the overgrowth⁸.
• After treatment, reintroduce it slowly, starting with a teaspoon or two and increasing over days if you tolerate it. The IBS trial used 75 g a day¹.
• If you react to histamine-rich foods such as aged cheese, wine and cured meats, sauerkraut may cause similar symptoms⁵.
• Raw vs. pasteurized: raw sauerkraut contains live bacteria; pasteurized does not. In the IBS trial both helped similarly¹, so if live bacteria are a concern, pasteurized sauerkraut is an option.

See our guides to the SIBO diet and eating after SIBO treatment.

Common questions

Is sauerkraut a probiotic?

Raw sauerkraut contains live lactic acid bacteria, but the types and amounts vary between batches and have not been standardized like a probiotic supplement²⁶.

Can sauerkraut cause SIBO?

There is no evidence that it does. Most SIBO is caused by problems such as slow gut movement or low stomach acid; see our causes guide.

Why do I feel worse after eating sauerkraut?

Possible reasons include fermentation of cabbage fibers by bacteria in the small intestine, or a reaction to histamine or other amines⁵⁸. Try a smaller portion, or wait until after treatment.