Use of sourdough is of expanding interest for improvement of flavour, structure and stability of baked goods. Cereal fermentations also show significant potential in improvement and design of the nutritional quality and health effects of foods and ingredients. In addition to improving the sensory quality of whole grain, fibre-rich or gluten-free products, sourdough can also actively retard starch digestibility leading to low glycemic responses, modulate levels and bioaccessibility of bioactive compounds, and improve mineral bioavailability. Cereal fermentation may produce non-digestible polysaccharides, or modify accessibility of the grain fibre complex to gut microbiota. It has also been suggested that degradation of gluten may render bread better suitable for celiac persons. The changes in cereal matrix potentially leading to improved nutritional quality are numerous. They include acid production, suggested to retard starch digestibility, and to adjust pH to a range which favours the action of certain endogenous enzymes, thus changing the bioavailability pattern of minerals and phytochemicals. This is especially beneficial in products rich in bran to deliver minerals and potentially protective compounds in the blood circulation. The action of enzymes during fermentation also causes hydrolysis and solubilisation of grain macromolecules, such as proteins and cell wall polysaccharides. This changes product texture, which may affect nutrient and non-nutrient absorption. New bioactive compounds, such as prebiotic oligosaccharides or other metabolites, may also be formed in cereal fermentations.