A wide variability of pulse-derived fermented foods has been available for centuries. The microorganisms involved in legume fermentation hydrolyze and metabolize pulses constituents resulting in the production of valuable products. Pulses fermentation causes desirable changes including the improvement of nutritional value and sensorial properties and increased nutrient and phytochemical bioavailability, and favors the formation of new bioactive compounds. This chapter provides a comprehensive review of nutritional and phytochemical composition of pulses and their health-related benefits, nutritional changes occurring during fermentation, and finally, emerging evidence of the potential beneficial effects of pulse-derived fermented products on chronic disease prevention.