Are Prebiotics Important for Gut Health?

Oct 28, 2022 · 139 comments
Greg (canada)
Would someone with knowledge explain the impact of mercury tooth fillings on gut bacteria? Thank you.
vishmael (madison, wi)
With thanks especially to late Utah Senator Orrin Hatch – "Orrin Hatch is leaving the Senate, but his deadliest law will live on." – LA Times 2018.01.05 – US and FDA have no control / oversight / monitoring of any of these supplement products, for safety. purity, efficacy or anything else. Buyer beware, or purchase with greater confidence from German manufacture.
Craig (Bham in the 4th corner)
For me, there are prebiotics and there are prebiotics. There are prebiotics that are formulated, processed, packaged and sold to make some money and caveat emptor. Then there are prebiotics that are grown and eaten as part of an every day meal. Those are the ones that my family use.
Artie Ash (Connecticut)
Big Food has been feeding the American population with unwholesome, over-processed, overly preserved, pesticide-laden, antibiotic-laded, artificially enhanced "food" for decades and the diseases of our digestive tracts are the result. Now we are offered pills to correct the situation? Eat a whole food plant-based diet (economical), organic if you can afford it. We don't need more medications. Our bodies are crying out for wholesome food.
Adam (Athens, Ohio)
No one ever discusses the effect of antibiotics on gut health. I have taken one antibiotic round in the past 30 years. It was reluctant, but felt necessary as a hangnail had become infected and seemed to be spreading. Don’t antibiotics kill bacteria everywhere including you gut? I have not been sick since as long as I can remember. I think avoiding antibiotics may be a factor. My resistance seems global as I don’t get the flu and have yet to get Covid despite wife having got it. I feel so lucky and often wonder what is contributing to this. We also eat food made from scratch almost exclusively save for the occasional dalliance.
jim (boston)
@Adam I've been hearing and reading about the effect of antibiotics on gut health for years. This really is not an obscure topic.
Luis (Puerto Rico)
@Adam completely agree, antibiotics are highly detrimental to our gut microbiome. I avoid taking them unless absolutely necessary, the last time was for a worrisome ear infection, about six years ago.
Mike (Monroe, NY)
When obtained from food sources, prebiotics and probiotics that thrive in your system will develop. Taken as a supplement it is not known which of the different strains they include will take hold in your system. On top of that, it is questionable whether or not adding tens of billions of cells from a supplement will make a difference in your system that naturally contains trillions of cells. In other words, the supplements may not provide any benefit while being expensive to buy. Concentrate on eating real food instead.
Karen (SFBA)
For best results, consume a diverse number of raw organic plants each day. Raw organic plants provide both the good bacteria (Probiotics) and the plant based fiber (Prebiotics) that the good bacteria consumes in your gut. But there is more -- choose which plants you consume carefully, because those plants also provide your mind and body vital nutrients that support a healthy mind and body. Favor vegetables over fruit. The core of a healthy diet includes leafy greens, nuts, seeds, root plants, and whole grains.
Proprius (Scranton, PA)
It don’t believe the author has read the paper linked to in the third to last paragraph. The paper is indeed on the benefits of fiber, but not as an alternative to prebiotics. In fact, the paper specifically addresses the benefits of prebiotics as a component of fiber in general, because prebiotic fiber (aka soluble fiber) is a type of fiber itself.
Marmot (Austin)
Brown rice is known to be heavily contaminated with arsenic. White rice is too, but not as much. Eat quinoa instead.
Alton (The Bronx)
@Marmot The Lundberg brand claims to monitor its rice for this. I've been eating its organic short-grain brown rice for about fifty years.
Uxf (Cal.)
@Marmot 3 billion people in Asia have managed to survive.
Mike (Monroe, NY)
@Marmot Soaking and rinsing brown rice 6-8 hours or overnight before cooking significantly reduces arsenic content.
Sequel (Boston)
Products that "promote the growth of helpful gut flora" are as susceptible to falsification as supplements that "promote memory health". Medicines that claim to reduce the risk of a serious ailment by a meaningless percentage are the same. The Pure Food and Drug Act of the early 20th Century has been turned on its head through industry capture of government.
Mac (Valhalla)
I have Celiac Disease. I'm also lactose intolerant. I haven't found a probiotic that is safe for me to take. It's very difficult to obtain accurate information on the sources of ingredients, or possible cross contamination. I have also noticed a fair amount of arrogance about being truthful about ingredients or cross contamination, among purveyors of 'healthy' supplements and food, in general. Gluten is not considered an allergen, so it is not subject to as stringent labeling as allergens. There is no mechanism to enforce violations when a product claims to be gluten free, but isn't. I am a locavore, and eat healthy foods, but if it's a prepared product, like crackers, if a national brand says it's certified GF, it's much more likely that it actually is. I know it's just anecdotal, but I've been glutened several times by small 'healthy' company products, and never once, from a major brand. Supplements are even worse.
Chelou (Terra firma)
So many judgmental comments and many from people who have never had gut health issues. I have always eaten what would be considered a healthy diet. At around 40 I developed a gluten allergy. I have had digestive reactions to stress my entire life, I still remember being unable to eat dinner as a toddler because my tummy hurt because of what was going on in our dysfunctional family. I have had IBS for about 15 years. Drs. have given me suppositories that did nothing. I would have urgent diarrhea to the point that I could not stray from the house far enough to walk the dog. It waxed and waned. I have taken probiotics with little effect, though no bad effects. I started a synbiotic about 4 months ago (The company is called Seed) and the effect has been astounding. It is not expensive either. I am cycling through low fodmap as well to identify any huge triggers, none so far. As has been pointed out, the $$$ is in drugs and so that's all we are ever offered. A gastro doc commented here in the comments that there is no proof blah blah so she has NEVER suggested pre/pro/synbiotics (can't remember which she mentioned) to a single patient, which is just crazy to me. But this is consistent with my experience with MDs - they know nothing about nutrition or non-RX solutions. And their arrogance knows no bounds. If nothing else helps, please try a synbiotic. You have nothing to lose but a few bucks.
Steve (Pacifica CA)
Just curious - are pro/pre-biotics regulated the same way most supplements are? As in not at all, and you have no idea what the actual dosage per serving is? And the manufacturer is not obliged to guarantee that dosage in any way? Might have been useful
Craig (Bham in the 4th corner)
@Steve The manufacturers of supplements do not have to prove any of their claims. That's good for them as most studies show that they are ineffectual (and a waste of money).
JJ (Boston, MA)
Could the NYT refrain from citing small studies, or preliminary studies, or anything with "some evidence". The bar has to be higher, otherwise you can cherrypick anything you want.
Zamboanga (Seattle)
This is a staple of health journalism. “Studies suggest…..” It makes people distrust any and all studies. Eggs are good! Eggs are bad! I guess they have to write about something since that’s their job.
Nardo (USA)
@Zamboanga You don’t understand scientific discourse.
monitor (Watertown MA)
Without specifying which prebiotics are preferable, this isn't as helpful as it could be. Also, those who have the painful symptoms that can put a patient on a low-FODMAP diet in the first place are unlikely to benefit and may, in fact, be made worse by increasing fiber and certain fruits and vegetables. Would love to switch from the FODMAP regime (which involves a lot of experimenting to find out which things on the lists are applicable to yourself) and related Rx's, but leery of experimenting with miscellaneous OTC prebiotics.
cackalacky (NC)
absence of evidence is not evidence of absence (could be but research is expensive, requires potential profit for drug co but this is not a drug.)
TJ (Blue Zone)
@cackalacky Rapscallion’s head may explode. They can’t comprehend this fundamental concept.
FarTraveler (MD)
Applies to other things as well. Despite the barrage of ads you see on TV, there is no documented way to 'strengthen the immune system'. And as one professor of psychiatric pharmacology told me, "There's no evidence that Prevagen does anything at all!" Jellyfish or not.
WK (Chicago)
I eat a high fiber heart healthy diet (most of the time) and also take a probiotic. A GI doc recommended Align years ago when I was having some minor stomach cramping. I took it for two years and realized that I hadn't gotten sick -- no colds or other viruses -- that entire time. Don't know if it was the probiotic but my kids were in grade school then and bringing home everything, and somehow escaped. I started up again recently because I read that Covid may negatively affect the gut biome, so I figured I'd get out front of that just in case. The only downside is that Align is expensive.
Dreamer (Atlanta)
Dr. Colin T. Campbell has a lot to say about nutrition and the hijacking by industry with irresistible mouthfeel products. Automobile has undergone substantial changes and improvements, but my digestive system, is still primitive. In the hurry burry fast food world, my gut microbes are struggling to adapt. No more devouring two big macs and flush it down with a large pop. Everything between the two ends are important, not just mouthfeel alone.
Richard (Washington state)
It is all about kimchi and other fermented foods. A spoon full of kimchi is the medicine going down.
Bill (Colorado)
I have a few gut issues that have developed over time (years) and have found solutions for most of them. What I have learned from my experiences and reading a lot of info and talking to several doctors is: 1. Every body and its gut is different. A recipe of diet and meds that works for one person may not work at all for another one. You have to experiment and see what works best for you. 2. You learn the most from experiments that fail; ie: you try something, it does not work or makes things worse and you therefore avoid doing it in the future. On the flip side, if it improves things then you keep doing it. 3. It is very clear to me that some peoples' guts change as they age (and a lot of peoples' guts seem to stay the same!). You may not be able to digest all of that gluten that you enjoyed in your 50's when you get into your 60's. 4. I am beginning to think IBS is just a catchall diagnosis for some specific problem foods that need to be pinpointed. Tracking closely what you eat and drink and how you react to it is a good place to start. Reading about the FODMAP diet gave me a lot of useful clues as to what was really going on. One thing I learned is that sometimes the qty of a problem food is the issue, not just the food itself. Good luck! Bill
SAShepExPat (Canada)
Warning to some folks out there considering probiotics. I ended up in emergency after consuming some organic strawberry yogurt that I didn't realize had probiotics in it. My upper abdominal pain was so severe I could barely breathe and they thought I was having a gall bladder attack. Many unnecessary tests and stress of an impending emergency gallbladder surgery later only to be told that some people are intolerant to commercial probiotic additives and pills.
KBB (San Francisco)
Everyone's different, but taking prebiotics has been very beneficial for me. I'm an overall active healthy person, but I've had chronic constipation for 40 years, despite eating an extremely healthy organic whole foods diet, drinking lots of water, exercising, and all that. Taking magnesium and probiotics helped somewhat, but they didn't resolve it. A year ago I started taking the prebiotic inulin in a chewable gummy form, and MAN! I am finally regular!!! Amazing to me. The way I understand it, probiotics are little live creatures that live in the gut, but they need the right food to eat in order to survive and reproduce. If the store doesn't have green bananas that week and you run out of artichokes and asparagus, these "friendly bacteria" have nothing good to eat so they start to die off. Now, if I chew 2 inulin gummies a day (4 grams/fiber), I'm feeding them well, and I only take probiotics occasionally because my happy gut bacteria are thriving and reproducing like crazy. And I'm regular! I still eat fabulous healthy food because I love it. I hope this helps someone else become "unstuck". The Cleveland Clinic has info online about inulin, and the inulin low sugar fiber supplements are by Phillips.
Nemo (Mass)
Just eat your fruits and veggies already. Bananas, leeks, cabbage varieties are all full of probiotics. Aim for a wide variety and include fresh herbs. End of story. Nothing else is needed.
Gut Check (Washington DC)
If someone has IBS or other conditions that respond well to the low Fodmap approach (as a way to learn which foods are or aren’t well tolerated), your generally good advice can actually backfire.
monitor (Watertown MA)
@Nemo After your 70th birthday (if applicable), I challenge you to scarf up all the brussels sprouts, onions, cabbage, leeks, etc. you want and see what happens. I used to survive on bananas and avocadoes, and all the veggies on the shelves (along with whatever meats ...). I'm now punished promptly and painfully, esp. by bananas and avocadoes, and cruciferous veggies are a problem, even when cooked to mush. Most effective solution is not to live so long, but I'm opting to eat less indiscriminately and be glad I love parsley and white potatoes.
Karen (Denver)
Like many supplements, prebiotics appear to be an attempt to get the benefit of eating whole, unprocessed foods while avoiding actually *eating* whole, unprocessed foods. If you want to improve and encourage good gut health, eat unprocessed and minimally processed foods - fresh produce, single-ingredient foods such as butchered meats, rolled oats, frozen vegetables, etc. - as much as possible. To the extent your budget, health needs, and time allow, avoid relying on foods that are not visually recognizable as their original ingredients. There are a wide range of foods and supplements out there, designed for a wide range of consumers - foods for convenience, snackers, dieters, various health conditions, etc. - designed to encourage people to choose their product over others, and to eschew unprocessed and minimally processed foods in favor of touted benefits of their products. If you care about your health, learn to cook from scratch. That will provide far more benefits than any supplements, assuming you don't have a medical condition that necessitates such supplements.
Bart (Central Virginia)
Do probiotic pills manage to survive stomach acid and beneficially reach the colon? Scientific evidence, please.
Nemo (Mass)
The article is about prebiotics (fiber), not probiotics (bacteria).
Krasna (Cali)
Here’s what I believe: 1. We are each different. From each other, and day to day. So there are no single “right answers.” 2. One of the great ways to get plenty of pre- and probiotics is to eat high-quality fermented foods, modest amounts, 2-3 times a day. If your body needs them you will love them. 3. It’s okay to take a supplement if you want to. 4. Yes, a healthy diet with abundant, diverse fruits and veggies and protein, and grains and legumes if you tolerate them, is helpful for everyone. 5. Your body will do it’s best to nourish you from whatever you give it, but the better you feed it, the better you’ll feel.
K.J. (Orange)
Prebiotics are very expensive fiber supplements. Rather than use supplements which are highly processed and expensive eat a minimum of a piece of whole fruit and 1 c veg every day! The supplement industry thrives on pushing supplements. They are expensive, not well regulated and never a replacement for whole foods. Stay well. Eat well.
Barbara (Myrtle Beach)
Be smart. Eat a high fiber diet and skip supplements which are not guaranteed to do anything for you at all. It's easy to include more fiber in your diet by eating more grains, vegetables and legumes. They are all good for you in many ways besides containing fiber.
Cinzia Rascazzo (Puglia Italy)
The anti-gluten movement is the reason why people eat such little amount of fibers. We need fibers from fruit and vegetables but we also need the other type of fibers from whole grains (barley, farro, durum wheat) and legumes. This is why the "ancient" Mediterranean diet is so healthy: not because we eat plants and fruit.....but because we eat plenty of whole grains (and NO refined flour/no all purpose flour). I cannot believe that people are ok with taking supplements (which are among the worse polluters of the planet and in most cases are useless!) and they are not willing to make an effort to eat well. I teach courses on the ancient Mediterranean diet and people are always so impressed to see how well they feel after eating the way we eat in the few areas of Southern ITaly where we still follow this ancient way of eating and living.
Barbara (Myrtle Beach)
@Cinzia Rascazzo One can eat a high fiber diet while on a low or no gluten regime. Beans and other legumes, fresh fruits and vegetables and whole grains like oats and quinoa all contain plenty of fiber. So do nuts and seeds.
Joe In Co (Colorado)
Italy has one of the highest rates of celiac disease. There are also some really good gluten free pastas from Italy.
James (Reading, PA)
@Cinzia Rascazzo My digestive system can only tolerate brown rice pasta. Whole wheat and gluten are bad for me. I scoffed at the anti-gluten movement at first but I am embrace it now as it makes me feel so much better. My acid reflux is mostly gone.
SridharC (New York)
Antibiotics remain the greatest threat to your gut flora. Take them only if absolutely necessary. Most people who take them for especially upper respiratory tract infections probably don't need them. You can eat special diets and supplements but changing the gut flora is not that easy and mostly unproven.
TomWins (Spain)
@SridharC Three years ago (right as the world was shutting down) I had four eye infections within six months that sometimes even got into my sinus cavity. Every time the doctor gave me a round of antibiotics. It took me almost a year for my gut to recover from the damage. Each round of antibiotics made my energy level and digestive system worse. I finally had excess tissue on my eyelids removed as the folds in the eyelids were allowing infections to come back. Since then I'm been nurturing my gut health and finally feel like I've regained what was destroyed by antibiotics.
JohnL (UK)
@SridharC I took some (prescribed) anti-biotics recently due to an infection in my shoulder, and as I usually do when I take a course of anti-biotics I then went through a pack of Yakult afterwards, in the hope it helped my gut recover... Not sure if it's a pro- or pre- biotic tho...
Barbara (Myrtle Beach)
@JohnL It's easy to search and learn that Yakult is a probiotic, not a prebiotic.
Dreamer (Atlanta)
Following primitive diet rich in beans ( resistant starch ), peas, Asparagus ( sorry the stink in the urine ), and greens, helps control the small lipid molecules in the blood thanks to gut bacteria. The brain - gut connection improves and less delusions of all kind. thanks to the mission of Dr. Joel Fuhrman MD.
Susan Anderson (New York)
I started taking gummy probiotics about two months ago when I had to take a regimen of antibiotics due to an infection that stemmed from chronic kidney stones. I had no problem tolerating the antibiotic… Also my urologist has suggested that it might help (other these drinking a lot of fluid and avoiding oxalate rich foods ) , that added nutritional calcium intake ( from food ) plus regular BM’s would be very helpful to eliminate the oxalate in my body. With the probiotic I am regular every day.  Keeping my fingers crossed that my “elimination “ will help me make less stones.
John Virgone (Pennsylvania)
Scam or not? Snake oil at best. Healthy food and a daily six pack and the gut will be just fine.
Barbara (Myrtle Beach)
@John Virgone The gut might be fine, but a six pack is enough to become alcoholic, which will harm every organ in the body eventually.
@Barbara Drinking any amount of alcohol daily isn’t advisable.
Dr. J (WH)
Probiotics “can be found in fiber-rich foods like green bananas, asparagus, artichokes, garlic, onion, barley and wheat bran.” In other words, plant foods. Probiotics are fiber and resistant starch found in plant foods. And they are found in all plant foods, but at higher concentrations from fruit to veggies to beans to whole grains. So, cut back or cut out the processed food, and animal products (meat, dairy, and eggs), which don’t contain fiber and resistant starch, and eat more veggies and fruits, beans and whole grains. Plant foods also contain hundreds to thousands of phytonutrients — which are missing in animal products and vanishingly low or absent in processed foods — as well as vitamins and minerals.
Susan Anderson (New York)
Probiotics are not meant to replace foods or healthy eating habits- They work along with your body and the good food that you eat and fiber to help you digest better… As I said in my previous comment my doctor suggested them to help me tolerate an antibiotic… Which It did exactly that -because usually I don’t tolerate antibiotics well at all -even if I take them with food.
Sarah (OR)
This is an article about prEbiotics. Is everyone talking about the same supplement? Susan's comments suggest she is referring to prObiotics.
Maurie Beck (Encino, CA)
Don’t go looking for reliable conclusions with any studies cited in this article, or anywhere else for that matter. There have been no large experimental studies with adequate double blinded treatment/controls.
@Maurie Beck No "large experimental studies" are done on anything that doesn't have the potential to generate a profit. Do your own research on natural/homeopathic alternatives or wait for an expensive drug to be "proven". That's the choice.
Jeff (New York)
@Maurie Beck The studies cited in this article are close to irrelevant. One stuck out to me: 44 subjects? Seriously? The article felt like a school exercise: prove your point with no fewer than 12 external sources cited
fred (Columbus)
" following a fiber-rich diet with plenty of fruits and vegetables will likely be better for you". Wow, didn't see that one coming.
BabbleFish (Salem Oregon)
How about trying to eat a healthy and varied mix of the best quality foodstuffs you can source? Oh, you want to eat the cheapest possible foodstuffs sourced from the frozen isles or restaurants with the least expensive big plates of food. You think popping a pill with many side effects is the better idea? Well, you will not only cost me dearly for health care, you are likely to enjoy a sicker and shorter life.
Craig W. (PDX)
Pharmacologist here. The data for prebiotics is indeed scant and don’t forget that a healthy meal is the best prebiotic AND the best multivitamin. Don’t skimp on food quality and to supplement your way out of it.
JW (Long Island)
I love and agree with the registered dietician’s comment. Eat foods high in soluble fiber. Eat whole, unprocessed foods! As much of them in your daily diet as you can. Gut health is very real. Recent research related to damaging effects to lack of sleep begins in your gut. When you go without sleep for too long, you’re going to build up very abnormally high levels of reactive oxygen species (ROS) in your gut. This is analogous to the process of rusting! I learned about this from a podcast which you can find online or you can read here:
Bill (SF, CA)
@JW Thank you. Great podcast. BTW, which genus does reactive oxygen species belong to?
Pradeep (Boston)
I followed this thread and it appears to repeat the famous old French saying : "Plus ca change, plus c'est la meme chose"...from beautiful "bleached" white industrial bread back to local farmer's produce. Are we stupid or do we allow the "marketing lobby" to convince us, over and over again at that, that they have found something new?
TroutMaskReplica (WIsconsin)
@Pradeep Answer: we're stupid. And the marketing lobby knows it. People want a shortcut to everything and are all too happy when a self-described "expert" tells them that s/he has discovered a great "secret" that no one else knows.
Jim (NH)
Culturelle 3-in-1 seems to work for me...eliminating the usual "gut issues"...
Deirdre (New Jersey)
Eat an apple or two a day Done
Judith (Reality)
No, one pill doesn't solve everything, but popping a pill and eating less processed food do help. I suffered with debilitating IBS (think pain so bad that you feel as though you might vomit) for years. I started taking a natural source probiotic that contains 14 strains of bacteria about 12 years ago. One a day. I have not had the problem since. I am also calmer and less anxious. That was an unexpected side-effect. I also love alliums (leeks are a seriously underappreciated vegetable), legumes, and asparagus and artichokes - the latter two with lashings of hollandaise sauce, preferably. Also, I found that cooked veg suit me better than raw, and kefir is nectar of the gods. It's really fun to make, as well.
Sequel (Boston)
"A fool and his money are soon parted." Aesop
Vivo (Nueva York)
“We each have hundreds of species of bacteria blossoming in our intestines,-“ Thabkbyou for this i needed a good chuckle. Namaste!
Marjorie Summons (Greenpoint)
Real food is better than a pill. Who knew?
Ross Salinger (Carlsbad California)
How would anyone know what diet hunter gatherers followed? We don't have their stomach contents to analyze. It seems more likely that they killed things and ate meat to me. Have you ever seen what corn looked like before it became cultivated? You think that apples were 3" in diameter. You think that bibb lettuce was plentiful. This is the usual bunch of placebo false positive food fad nonsense to entrap people with more money than sense.
cranio (santa fe, nm)
@Ross Salinger Archaeologists are a pretty clever bunch... In this study they analyzed pottery fragments of hunter-gatherer groups living in the Baltic to understand their culinary habits:
Katherine Holden (Ojai, California)
@cranio yes but the San people in Botswana were very different from Mediterranean people--no ceramics--woven baskets- very unlikely dairy involved, but certainly bird eggs, including Ostrich (eggs and meat.) The more hunters and gatherers moved, the less heavy items they took with them. I doubt they got close enough to water buffalo to milk!
Ernesto (Walnut Creek, CA)
@Ross Salinger We know what hunter gathers eat because anthropologist have live with them and record the diet which is basically 50% animal and 50% plant. Yes they eat tubers (have you ever tried poi from the taro plant), fruiting plants and grasses , which we would find to be boring in flavor but it is better than hunger. Although they do occasionally get their sweet tooth going by raiding bee hives.
Mountain Walker (East End Of The Milky Way)
Most supplements tend to cause stomach issues, once you find the fiber you like and eat some every day your digestive system will be healthy and you will be regular.
Rebecca (CDM, CA)
I have been taking probiotics for 22 years. They changed my life in my early thirties, when I suffered from IBS. There is one called Sacchromyces boullardi that I don’t hear much about, but I took it for many years and it seemed to help. Some information/studies on this probiotic would be helpful as well.
Earl (Sacramento)
“Very few things are solved just by popping a pill,” Dr. Swanson said. As someone who has GI issues, I take pre and probiotics. I am not looking for a solution (and am mildly insulted by the comment of the gentleman.) I am looking for incremental benefits from both diet mods and "pills."
Laurie (Ontario)
Some anecdotal evidence 84 yo father has leukaemia, type 2 diabetes, and bladder cancer (off and on) for about 10 years, and he is fanatical about prebiotics so much so, that every day he has kefir in his bran flakes and slices a red onion with a Tablespoon of apple cider vinegar into his salad at dinner. He feels great, so much so, that he's convinced that his health charts have been mixed up with some other poor sap who is walking around with all these problems.
Daniel B (Chicago)
Scientifically speaking, anecdotal evidence is an oxymoron. Happy for grandpa but no need to disseminate magical thinking.
Jennie (WA)
@Daniel B Sounds like he's eating well, which is good for his health. No magical thinking needed.
BlueIsle in a RedSea (NC)
Healthy, unprocessed food is the best medicine. Nutrition education is dangerously lacking in the USA. We want pills as magic bullets and prefer to take no responsibility in our choices of what to put in our mouths just like Big Ag takes no responsibility in all the processed foods with their researched methods of addiction to salt, fat, and sugar. The results? Look around! Bellies hanging over belts, red faces if faced with activity, pre-diabetes/diabetes, heart and circulation problems, and the mountain of gastric disturbances experienced by over-stuffed Americans. And when any of this is mentioned, people recoil in the face of reality, indignant that someone would suggest how to save the quality and if not literally, their lives!
David H (Northern Va.)
@BlueIsle in a RedSea Correct. Also worth mentioning is the fact that homo sapiens do not need three full meals a day. I started intermittent fasting a year ago; one meal a day, more or less anything unprocessed that I want to eat. Restrictions: no sugar, no processed foods (including no vegetable oils -- these are poison). I don't mean to boast, but the results -- combined with walking about 5 miles a day -- have been dramatic: down 40 lbs, and blood work that is normal for the first time in my adult live. I'm almost 63.
I (East Of Philly)
@David H I have had low blood sugar ALL my life I’m 63 and if I don’t eat at least 3 small meals a day I’m in serious trouble
BlueIsle in a RedSea (NC)
@I There are ex options to everything. Bodies are not vehicles in that the human body enters diagnostics with many more variables - including reactions. Common sense.
David H (Northern Va.)
There is absolutely no need to take pills or supplements to get prebiotics. Oatmeal, apples, onions, garlic, leeks are all great sources.
Archer Crosley (McAllen, TX)
An apple a day keeps the doctor away. That's what I tell my patients.
Katherine Holden (Ojai, California)
@Archer Crosley --Funny how that motto arose...until late 19th century apples were grown to make hard cider which basically everyone drank. As the prohibition movement grew in strength, what to do with all the apples harvested? Literally, an advertising genius came up with the saying "an apple a day keeps the doctor away." Boy did it work! And we have believed it to be medical advice ever since. It DOES give good medical advice, but stringing those words together was a marketing tool.
Tabula Rasa (Monterey Bay)
Osmotic laxatives, Costco high fiber capsules and lots of chilled water. They work in concert to the tune of “all your troubles down the drain.
As someone with on again / off again gastric issues in my early years ... I'm 60. Use antibiotics with some thought ... obviously we need to be thankful for what they can do -- but, don't take -- just because. Growing up they were given like candy and I never made any direct connection with any gut abnormality. I was on reflux meds on and off for much of my 20's and 30's . My family lived internationally growing up ... I joined the PC after grad school abroad and my work takes me far and wide ... I eat everything and my doctors blamed the travel when I was back home. It was not until I was in my later 30's that I made the direct connection between antibiotics and proper gut. When away I was free of these drugs. My systems works better after an extended trip through Asia and especially Africa. After the epiphany I have not needed any reflux drugs in 20 years ... also in all my travels I have only needed to take Cipro once for travel illness -- Namibia airport. It's as if my body needs microbes from some places .. I can tell. Use Antibiotics wisely.
Indenyc (New York)
@GT And lets not forget: in conventionally raised life-stock, cows are given antibiotics to fatten them up. AND although the industry claims that there is NO residue left in the MILK they sell and we drink, try making Yogurt - as I have - with such milk. I does not work, it won't ferment. DO it with organic milk, it works just fine.
Jsutton (San Francisco)
I have acid reflux. I find that Kefir is extremely helpful It's full millions of probiotics. I somehow suspect that taking probiotics as they occur in foods is better than taking a pill, but I really don't know if that is true. I hadn't heard of prebiotics until I saw this article!
David H (Northern Va.)
@Jsutton "I somehow suspect that taking probiotics as they occur in foods is better than taking a pill, but I really don't know if that is true. " It is true for one simple reason: because the FDA does not regulate supplements, you really don't know with any precision what is in the pill that you purchase.
bee (MA)
@Jsutton Kefir has been a lifesaver for me. Had been suffering for years with chronic diarrhea. Probiotics in pill form did nothing for me. Once I saw that kefir was 99% lactose free I tried it and now never go a day without at least a juice glass of it. Doctors had no solution other than useless pills that made feel like I was doped up. Can't recommend it enough.
SMB (Boston)
As far as I know, most of the data on diet, inflammation, and microbiota are based on comparisons between samples who consume a lot of high fiber greens and those who don’t. There are a smaller number that compare diets with more or fewer fermented foods. But it’s a bridge too far, scientifically, to jump from that to powders and capsules. Too many hidden or unmeasured variables. Think of the problem like ice cream: Full of sugar, but as any diabetic knows, safe to eat in moderate amounts. How can that be? The delivery system. Fats in the ice cream slow down absorption enough that the sugar won’t cause an insulin spike. For all we know, the slower breakdown of fibrous greens in their natural state may figure in their impact on gut flora and fauna. Or unidentified molecules destroyed in the process of refining it all into fine powder may be as important as the those we know about. Nature is not parsimonious. It’s messy. And the mess is out of focus.
Lymn (Portland)
@SMB Do more looking around. People do experiments & publish. Everything from macular degeneration & gut microflora to IBD to Immunotherapy works/doesn't work depending on gut flora Look around
SMB (Boston)
@Lymn I’m pretty familiar with the scientific literature. I think you misunderstand my comment, though. It’s decently established that gut microbiota influence a wide range of systems, from immune to neural, probably through release of molecules that mediate inflammation. I said that. The studies of what diet influences gut microbiota are chiefly those that look at dietary fiber or fibrous vegetables. For example, they may compare actual bacterial species in gut samples from West Africa and the U.S. Or they may compare higher and lower fiber diets within a single population. I said that too. Then there are studies that try to correlate specific genuses and species of bacteria to release of specific molecules. I add that here. Finally, there are clinical studies that report amelioration of symptoms from specific infections, such as C. difficile, or from chronic inflammatory disease, by fecal transplants. I add that here. But there are no reliable studies I know of that compare “prebiotic” capsules, for instance, with a high vegetable diet. Or “probiotic” capsules or drinks with naturally fermented foods such as kimchi or yogurt. I may have missed them, but the doctors quoted in the article also said giving capsules was more trial and error, “couldn’t hurt.” This is not surprising; such a study would be complicated. Lot of variables, many hidden, or unmeasured; would require a very large sample to control. I said that, too. So don’t really understand your point.
David H (Northern Va.)
@SMB "But there are no reliable studies I know of that compare “prebiotic” capsules, for instance, with a high vegetable diet. Or “probiotic” capsules or drinks with naturally fermented foods such as kimchi or yogurt." Why is that? Who would want to fund such esoteric research, other than the corporations that make supplements? Could it be that there are no such studies because pill manufacturers know that natural sources are always more reliable than pills -- the contents of which are unknown because of the absence of FDA oversight?
Zengzi (San Diego)
People throughout the world have experimented for centuries with herbs and the like, but it takes an Industry....intentionally capitalized with capital...not so much to advance knowledge but to make money. Maybe a lot more experimentation by ordinary people might be just as efficacious.
David Williams (San Diego county)
@Zengzi " Maybe a lot more experimentation by ordinary people might be just as efficacious." Nope. I prefer the scientific method.
Maria Coler (Jersey City, NJ)
Citizen science is a thing. It has helped change the world in many ways— think the farmer in W. Virginia who exposed the dangers of PFAS to the world by dissecting his cows. Or the mothers at Love Canal who refused to be dissuaded by the state of the science st the time. The science eventually caught up with their established correlations to prove causation . Anecdotal evidence confirmed by the scientific method (if funding were made available) would be valuable in this instance .
D (Upstate bordertown NY)
@David Williams And the "scientific method" can be manipulated to support pretty much anything. Read this recent NY Times article: , and read David Michaels' book, "The Triumph of Doubt: Dark Money and the Science of Deception".
Lawrence Ordine (Bayside ny)
Did this really explain the functional difference between pro and pre biotics? Cause I don’t get it. And haven’t the heath conscious among us already switched to whole wheat bread & pasta, brown rice, and whole grain cereals with nuts and berries? Aren’t we limiting Carbohydrates and eating sufficient quality proteins with moderate but heathy fats? Does anyone really need gut pills if they eat a healthy diet in moderation and exercise? This seems like a diet of first world consumer advertising.
Paul Smith (Austin, Texas)
@Lawrence Ordine Probiotics contain beneficial bacteria. Prebiotics provide fiber to feed those bacteria. But we don't get pills. We can get beneficial bacteria from yogurt, kefir, kimchi, and homemade refrigerator pickles. We can feed the beneficial bacteria with all the fiber-rich foods mentioned in this article.
Lymn (Portland)
@Lawrence Ordine Here is an example: Google immunotherapy & gut microbiome. If you eat well you could be fine. If you've had antibiotics you might not be fine & your immunotherapy won't work
Lisa L. (Phoenix, AZ)
@Lawrence Ordine Another RD here: This is from a recent webinar I heard regarding this subject-- PrE biotics- the E means energy or substrate (food) for the microorganisms PrO biotics- the O means live microorganisms that benefit the host, these are very specific Easy to buy, cheap sources of prebiotics are peas, beans, soy beans, lentils, onions, leeks, garlic, whole grains, artichokes. Garlic & onion powder do provide some prebiotic.
Judy (Albuquerque, New Mexico)
I find the last sentence very interesting. "Very few things are solved just by popping a pill." But that seems to be exactly what most doctors seem to advocate. 63% pf people over the age of 60 are deemed to need statins and a similar percentage are deemed to need blood pressure medications. Instead of emphasizing that for most people (except a few who have genetic susceptibility or specific conditions), lowered cholesterol, blood pressure and the prevention of type 2 diabetes can be achieved through a combination of diet and exercise, the majority of people over 60 who go for a routine checkup are offered pills. The average person over the age of 60 takes several medications which can lead to diziness, balance problems and dementia. If things are rarely solved by popping a pill, why does the average senior citizen take multiple medications? Presumably, because doctors' prescribing decisions are dicatated by pharmaceutical company profits.
Brie (Ohio)
@Judy ...Because the phrase, popping a pill rarely solves anything is hooey. Provider here with extensive health issues, least of which is RA, which I've had since childhood. Modern medicine keeps me alive. Antibiotics as well with bacterial infections as my body typically can't clear them without because of the RA. I have patients who do actually either do everything right or do nothing more harmful than the next person and yet cannot control their htn or dm without treatment. Diet can't do everything when the genetics are stacked against. It's incredibly ignorant and ableist to believe otherwise, and yet, here we are. Ask 100 physicians, and typically, even knowing this, maybe 60 will continue this nonsensical statement. Good diet and exercise are important but only a component. Modern medicine, public health, and hygiene have extended life tremendously in just the past 100 years. That the US does not see the same benefit as Europe stems from terrible public policies that predispose even the upper middle class to unhealthy exposures not seen to the same extent in Europe. Data from several studies show mixed results with pre and probiotic use in patients with recurrent bowel infections and IBS. Reading one small article in NYT that is precursory at best does not reflect what is seen, nor conferring with 1-2 gastroenterologists. Regardless, asking physicians' advice is like asking rabbis a question, ask 5 people and get 8 opinions.
JT (Coupeville, WA)
@Judy I agree that healthy choices is always the best frontline strategy. Unfortunately, high blood pressure, type 2 diabetes, and cholesterol levels are all mostly dependant on behaviors and choices which are very difficult to change for most folks. Also, our hope for a magic pill that takes care of everything is deeply ingrained in our culture. Oh human nature......
L H (Fl)
@Judy Everything you wrote is a conspiratory with the medical and pharmaceutical communities portrayed as villains. Consider that many of these very individuals suffer with GI issues as well, while searching for a solution to their personal madalies. To use your words... the average clinician or pharmacist may also take pills to manage chronic health conditions as to enjoy a better life. Generally people over 60 are offered medications only after being advised to implement diet and lifestyle changes first.
LarryAt27N (north-central Florida)
I'm waiting for gourmet prebiotics, preferably from France. I'm fussy about what I use to feed my gut bacteria. Very, very fussy.
Lymn (Portland)
@LarryAt27N Perfect. Research in France & Switzerland use navy beans to increase the desired bacteria in the gut microbiome
Old Cali Boy (CA)
Our bodies age just like cars. They still work but need more maintenance. Elderly take B12 because our bodies can't manufacture enough and eating more food is not practical. Sometimes taking supplements is more efficient. Raising my B12 lab level from 545 to 1100 with supplements significantly improved my well being. For pre and pro biotics, I suggest trying it and see if the help.
Ellen (NYC)
Our bodies do not make B12 or any other vitamin at any age.
Jennie (WA)
@Ellen He probably means absorb. I have to take B vitamins due to the metformin I take for diabetes.
Gchas (Santa Monica)
Our hunter gatherer ancestors consumed a massive amount of fiber - and our bodies haven’t changed much. Prebiotic fiber supplements have greatly helped my own inflammation issues - highly recommend.
Iman Onymous (Here, Right Outside Your Galaxy)
@Gchas How could anyone know with certainty that "our hunter gatherer ancestors consumed a massive amount of fiber" ? Time machine ? This seems like an easily tossed-out statement which would be very difficult to verify with solid evidence. I don't believe the number of study cases (many thousands) needed to prove this with certainty exists.
Brandy Danu (Madison, WI)
@Iman Onymous They had to eat something - what do you think was available? Green plants, roots, nuts & berries... - occasionally people might score some protein. Plant sources were dependable and more readily available. According to archaeological studies, women may have done most of the - gathering - but apparently also joined in the hunting.
Paul Smith (Austin, Texas)
@Iman Onymous How could they have avoided eating massive amounts of fiber? There were no processed foods and white flour. Here's an article which discusses analysis of prehistoric poop fossils:
Diogenespdx (Portland OR)
Gut Issues, yet another sign (as is diabetes) of society poisoning itself . Eventually we’ll learn, like we know now to limit lead pipe use and lead paint chip intake, but it would be better to learn before rather than after. One thing to keep in mind (and we know this about ag crops, but I guess it’s too difficult to extend to ourselves), monocultures are not such a good idea, even of a bacterial collection . Profitable though they may be for their pushers, they carry hidden risks for the users. You think Covid was bad !
Janet Gunn (Chicago)
This article says "A flourishing microbiome has been associated with various health benefits, including reduced risks of certain conditions like diabetes and obesity." The Harvard study is referring to Type 2 diabetes. There is a difference in these two diseases.
Jennie (WA)
@Janet Gunn Diabetes refers to both types and type two is much more common.
CAT Productions (Atlanta)
I like Align.
D.K. K (Florida)
Strong doses of antibiotics I was given for h-pylori destroyed my gut bacteria and put be on an IBS tailspin, constipation, gut pain …. And my immune system was off too. I started taking good probiotics (many strains and 50billion or more) every day and it restored my digestion and regularity. And I don’t have allergies anymore. None of the 6 different medications prescribed for IBS were worked, in fact they had bad side effects. Why do we need studies to tell us if probiotics and prebiotics will be helpful? Each of us can try different probiotics in the market and see if they work. We know and feel our gut better than the doctors. In general, including fermented foods in our diets is good. By the way, the doctor who prescribed the heavy dose of antibiotics knew that it may cause IBS, but I was not told.
Brie (Ohio)
@D.K. K Untreated H pylori causes esophageal cancer. Which would have preferred---IBS or cancer? There are no medications without potential side effects. Treatment for one cancer may raise risk for another cancer. Funny but my patients were always thankful when I treated H py successfully. Perhaps you have also not read but HPI can cause IBS itself, and there are links with low serotonin levels. Modern medicine is no less part science, part art, part mystery than any other field of science.
Brie (Ohio)
@D.K. K Untreated H pylori causes gastric cancer. Which would have preferred---IBS or cancer? There are no medications without potential side effects. Treatment for one cancer may raise risk for another cancer. Funny but my patients were always thankful when I treated H py successfully. Perhaps you have also not read but HPI can cause IBS itself, and there are links with low serotonin levels. Modern medicine is no less part science, part art, part mystery than any other field of science.
Brie (Ohio)
@D.K. K Untreated H pylori causes gastric cancer. Which would have preferred---IBS or cancer? There are no medications without potential side effects---just as treatment for one cancer may raise risk for another cancer. Funny but my patients were always thankful when I treated H py successfully. Perhaps you have also not read but HPI can cause IBS itself, and there are links with low serotonin levels. Modern medicine is no less part science, part art, part mystery than any other field of science.
Fred (Los Angeles)
the only biotics that actually do anything are antibiotics.
Silvery Moon (Upstate NY)
My health care providers have recommended taking a pro (not pre) biotic pill when they prescribe certain antibiotics. They basically say it can’t hurt, might help. I couldn’t tell if the pill made my digestive issues better or worse. I kinda think worse. I’d like to see an article that looks into the antibiotic angle.
CAK (Keene, NH)
@Silvery Moon As a Registered Dietitian, it is frustrating when docs "recommend" taking a probiotic when they prescribe antibiotics - kind of willy nilly - sort of a feel-good for themselves. First of all, the antibiotics are meant to KILL bacteria (probiotics are bacteria too!, from specific (gram positive, gram negative, etc., etc.) to broad-spectrum, so they are likely killing any probiotics you are taking UNLESS you separate them by enough time, at least four hours. But the truth is - borne out in all of the research - that very few probiotic supplements available to the consumer are anymore helpful than a spoonful of quality yogurt or a forkful of real fermented sauerkraut or kimchi (no evidence to support kambucha). There are specific probiotics that are beneficial for specific conditions, but they are not available "over the counter". They are medical quality, very expensive, and available only with a doctor's prescription and come from specific laboratories where they are produced. That said, it may be helpful to take a course of garden variety probiotic supplements following a course of antibiotics as "invited guests" to come in to help your natural good bacteria rebuild the house that illness and it's treatment have destroyed. You could of course get those bacteria supports from yogurt or ferments . . . but then you have to remember to feed the workers with plenty of prebiotic fiber!
Kara (Austin)
Thanks so much for sharing your wisdom and expertise! I wish this article author had included you in these interviews and quotes.
Jill (NJ)
@Silvery Moon My experience. If I take antibiotics alone, I get a yeast infection. If I take probiotics when I am prescribed antibiotics, I do not get a yeast infection. A pharmacist recommended probiotics about 20 years ago when he was filling a prescription for an aggressive antibiotic. I take them. They work.
cll (80904)
I have recently been watching the ZOE project podcasts on you tube with Dr Tim Spector and other experts. They talk research based data and educate in simple terms. Dr Spector is UK epidemiologist who has written books on diet.
CAK (Keene, NH)
Registered Dietitian here. Plant food that we consume has two kinds of fiber: soluble and insoluble. Think of it like a dish washing sponge. The soft, absorbant side is the soluble while the "scrubby side" is the insoluble. The scrubby, insoluble fiber does not get digested, it gets pushed through the intestines as stool. Meanwhile, the soluble fiber is fermented in our large intestines by all the good bacteria, and it is the fuel that keeps the good bacteria doing their mighty jobs fighting inflammation, supporting our immune systems, mysteriously helping to control our blood pressure and our blood glucose and our cholesterol. The prebiotics in those supplements come from the soluble fiber in plants. Delicious plants! Barley, oats and oat bran, artichokes and Jerusalem artichokes, onions and leeks and shallots, garlic, oranges, asparagus, Brussels sprouts, not-too-ripe bananas, berries, apples and pears, beans and peas and lentils, all are high in soluble fiber. Also high in vitamins and minerals and DELICIOUSNESS for the tongue and a feast of colors for the eye! So why take a supplement when you can get so very much more from eating food?
@CAK Agreed, since you need to purchase food anyways, it makes a lot more sense to get all these nutrients straight from the source rather than wasting money on supplements. That said, if a person has a deficiency for a specific vitamin or a disease that could benefit from a short course of probiotics that could be beneficial. I just feel like the average healthy person is wasting their money. Maybe people want to cheat by eating only meat and processed carbs and then take pills for the rest.
South Of Albany (Not Indianapolis)
it’s fascinating none the less that the sheer number of people with gut problems seems to indicate changes in our environment that have triggered auto-immune problems beyond what we’ve previously just thought of as allergies.
@South Of Albany As part of our "environment" one should include the typical grocery store environment, which contains mostly pre-processed foods.
See also