Gut instinct: How the microbiome became the wellness obsession du jour
There had been signs: the communal fridge at the yoga retreat, filled with bottles of probiotics. The advert for dog food that promised to improve your pup’s microbiome. The NYE dinner table conversation that turned to bloating remedies. Gut chat had entered the room. Is this simply where conversations go to die when you reach your thirties, or is something else going on?
In recent years we’ve obsessed over our sleep, our step counts, we’ve added varying blends of so-called health powders to our drinks and now we’re turning our attention to our stomachs. Call it gut instinct if you will, but talk of our once taboo bodily functions has emerged from the bowels of society to take centre stage. Since January 2019, Google search data show a 370% increase in people seeking gut health advice and on TikTok over 925k posts address hacks and tips to improve your innards. GutTok offers up advice from the spurious (drinking olive oil) to the more expert. At the start of the year, searches for ‘gut shot’ on the Ocado website increased by 734% and when we polled our readers*, 88% of you said you cared about your gut health, with 43% avoiding certain foods for this reason and 26% taking probiotics to improve it. The bottom line? Le shit, c’est chic.
And thank goodness, because our tummies are in a bit of a state. In a 2021 survey of over 73,000 adults, 40% reported gastrointestinal (GI) disorders, from bloating to constipation. In the UK alone, an estimated 13 million people suffer with irritable bowel syndrome (IBS) according to the NHS, with one in every 123 people diagnosed with a form of inflammatory bowel disease (IBD) such as Crohn’s or ulcerative colitis. Medical experts aren’t certain on why this is, but among the key factors that can contribute to gut malaise are genetics, poor diet, a lack of exercise and stress. Meanwhile, conversations around the health risks of ultra-processed foods have risen to the fore in recent years, with data suggesting that in the UK, they account for at least half of our diet.
Naturally, Big Wellness is ready to deliver us from evil, with numerous products hitting shelves that promise to de-bloat us and make us as regular as a metronome. It feels nigh on impossible to walk through a supermarket these days without being offered some sort of bowel benefit. Among the many adverts and press releases are products that promise to improve not only your digestion, but also your skin, mental health and even vaginal pH levels, via your intestines. And while there’s increasing evidence to suggest that the power of the gut-brain axis could be an untapped route to mental health support, the other two? Well, the jury’s out. Either way, our obsession with health has driven the global wellness economy to grow to $5.6tn (£4.42tn), as per data from 2022, with gut health making up a not insignificant part of it. The global gut health supplement market was expected to reach $12,305m (£9,759m) by the end of 2023 as consumers become increasingly aware of the gut’s impact on overall health. So, is it all about the money or is shotting, swallowing and macerating ‘good bacteria’ and ‘gut-friendly’ products really the silver bullet that will cure our insides once and for all?
The belly of the beast
Chris Probert, a gastroenterology professor at the University of Liverpool, puts our renewed interest in gut health in part down to a post-Covid health awareness. ‘If you’ve got diarrhoea and you’re working from home, no one notices. But put yourself back in the office and those symptoms become more of a burden. You’ve also had a chance to realise things are abnormal for you.’ He sees the heightened social awareness of gut health as a positive, as it’s working to shed previous taboos around common issues. ‘It’s become very acceptable to talk about life with gut problems. And people are destigmatising things like stoma bags. It’s been helpful,’ he says. But beyond these two factors, the rise in our colonic consciousness is largely down to the exponential pace of scientific advancements helping us better understand the gut and the role it plays in our wider health. ‘We’ve got many laboratory tools at our disposal enabling us to generate data much more readily,’ Professor Probert says. ‘I can do more experiments for the same amount of money now than I could in years gone by.’
It seems that the science is moving faster than the scientists. While access to new data is vital, the complexity of the gut means that simply having more information about the organ isn’t necessarily enough to do anything about it. ‘The trouble,’ explains Peter Whorwell, consultant gastroenterologist at the University of Manchester, ‘is that we don’t know what “normal” is, so when patients turn up with their stool analysis, I can’t help them’. Professor Whorwell is referring to the host of private companies offering to analyse your microbiome if you pop them a faecal sample in the post. ‘It’s legitimate, it tells you all the bacteria you’ve got in you, but we can’t say what it means – the public interest has overtaken the science. And that’s the problem. The data are meaningless.’
What the experts say
‘Gut Microbiome’, a word previously reserved for the science community, has now made its way into everyday conversations. It describes the ecosystem of trillions of bacteria, fungi and viruses that live happily in our large intestine. ‘The bacteria inside of you affect everything; your immune system and your mood. And interestingly, if you’re in a bad mood, your gut bacteria can change,’ says Professor Whorwell. In patients with IBS and IBD, that delicate ecosystem has become disturbed – and it’s this that wellness companies are promising to put right for us. But can they really? Essentially, explains Professor Whorwell, everyone’s microbiome is individual to them, so one set of results can only tell you what bacteria exist within you, not whether it’s good or bad.
Anyone around since the early days of Yakult and Activia will remember the rise of the ‘good bacteria’ conversation – and since then, throwing a load of live culture into your system has become de rigueur for the health conscious. In recent years, this has developed into probiotics – bacteria that ‘confers a health benefit upon the host’, explains Professor Whorwell. But do we all need to be downing a gut shot before breakfast, and if so, where should we begin when it comes to selecting one in such a saturated market? On this, the experts are divided. For a probiotic to reach your gut intact, explains Professor Probert, it has various hurdles to overcome, including high levels of acidity in your stomach. If they do make it to the large intestine, they’re joining a ‘huge community of bacteria living in you and you’re taking this little gloop of something and hoping to change the entire structure of that community. Really, most of the time, it’s a drop in the ocean’. Despite my own protestations that my daily probiotic has improved my own IBD, he says, ‘While there are a few patients who swear by them and there is a small percentage that are genuine responders, there’s a chance it’s a placebo.’ He stands firm, ‘There’s no good evidence for any particular probiotic being uniformly helpful.’
Professor Whorwell is somewhat more optimistic about their validity, saying that, while ‘it’s still a case of trial and error, there’s some evidence that suggests probiotics are good for your immune system’. And certainly, research has shown a promising response to probiotics in IBS and IBD patients and that probiotics have the potential to promote a healthy immune system (as much as 70% of our immune system is found in our gut). Professor Whorwell recommends patients take a probiotic during and after antibiotic use (which he says is akin to ‘pouring bleach on your microbiome’). He has worked with several brands and won’t endorse a particular one, but anyone interested selects one, takes it for four to six weeks and if you haven’t noticed any changes, try another one. Even if they don’t work, you may be out of pocket but, ‘The good thing is they don’t do any harm. They’re safe as houses,’ he says.
For those wanting to try a probiotic, the experts align that it should offer a blend of several strains of bacteria that are ideally live upon consumption. Also, look for one that has had a control study conducted on its tolerability and the survivability of the bacteria.
Variety is the spice
So what does ‘good’ gut health look like? ‘What we call “normal” is going to the loo somewhere between every other day to twice a day. If it’s beyond that or if you’re suffering with bloating after meals or getting regular mucus or blood in the stool or diarrhoea for more than six weeks, you must see a GP,’ says Professor Probert. Don’t go off and get your own tests. If we can, we should stop people going down an expensive rabbit hole. He also points to the charity Guts UK which has advice on symptoms. And despite what advertising would have us think, it seems that beyond expensive products, colonic irrigations or detoxes (both strongly advised against), the key to improving our general microbiome, outside of genuine medical concerns, lies not in a single shot, but in our wider diets. The good news is that, unlike with other health fads, improving your gut health is quite attainable and, thankfully, affordable.
‘The microbiome is like a tropical rainforest,’ explains Professor Probert. ‘You’ve got life of different kinds, a diversity of plants, animals and insects, all this richness. What we find in diseased states is this diversity being suppressed.’
Jennifer Medhurst, a nutritionist and gut health specialist, puts it in layman’s terms. ‘It’s not enough to just eat vegetables, we need a range of plants for the body to function optimally. People can be very restrictive in terms of what they choose to eat and just keep eating the same thing over and over again. But this is a mistake.’
Medhurst recommends introducing fermented foods such as sauerkraut, kimchi and kefir into your diet. While the research around the efficacy of fermented foods on supporting the microbiome remains limited, a study from 2023 found that people who ate six helpings a day saw the benefits. And Medhurst points to blue zones – the areas of the world where people live the longest and in which fermented foods, beans and legumes are a large part of the diet. ‘If there was a drug that could cure numerous health conditions, the pharmaceutical industry would be all over it, and yet we have food but it’s a very small part of the conversation,’ she says.
Gabrielle Morse, a gut health specialist and registered dietitian at The Gut Health Clinic, agrees, adding that eating live yoghurts, more plants and having general dietary diversity can ‘quickly see improvements in things like bowel movements, gut symptoms and energy levels’. Though she notes that fermented foods might not agree with everyone, so suggests introducing new things gradually and in small amounts. Morse also cautions against some of the gut shots on the market, including cider vinegar, which ‘is not recommended as it can worsen upper gastro symptoms such as reflux’ and emphasises that ‘you can’t detox the gut, and there’s no need to’.
While it’s no bad thing that we’re now more open to discussing symptoms that we might previously have considered too awkward to talk about, we may be at risk of falling for marketing that promises something with little scientific backing. And though taking a probiotic is unlikely to do us harm, for those without gut issues, it may not be the best use of their money when a cheaper range of veg from our local Tesco is likely to have a greater impact.
*Cosmopolitan UK survey of 515 readers
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