photography by PHUONG NGUYEN
Where does one begin and end when it comes to gut health? Prebiotics, probiotics, supplements, powders, 10 million, 20 billion, 200 billion live cultures—ah! It’s all so confusing.
We ask two experts—Dr. Gil Weitzman, Clinical Assistant Professor of Medicine at Weill Cornell Medical College, and Jules Miller, founder of the popular supplements brand The Nue Co.—to break it down, once and for all.
Our gastrointestinal systems have naturally occurring bacteria, often referred to as our "gut flora" or "microbiome." “The bacteria that make up our microbiome help to regulate our internal systems,” says Miller. “Everything from helping to metabolize fats, proteins, and vitamins to providing defense against infection, and supporting a strong immune system. A healthy gut is one of the key foundations to optimal physical, mental, and emotional health.”
Unknowingly, a lot of us have been hurting our gut for a long, long time. “From processed and refined foods (which feed the unhealthy bacteria in our gut) to antibiotics (which are detrimental to our good bacteria), these things can all cause a negative imbalance in our gut microbiome,” says Miller. “We now have a wealth of research to support the importance of a balanced microbiome which means we are more empowered to make choices that will help to heal not only our gut but our health.”
On a basic level, what do probiotics do?
“Probiotics are live bacteria and yeast which tend to live symbiotically within our bodies, affecting many different organ systems, most notably, our digestive system,” says Dr. Weitzman. Miller adds, “Probiotics are good bacteria that are either the same as or very similar to the bacteria that are already in your body. Probiotics help to support the growth and balance of the good bacteria against the unhealthy strains of bacteria in your gut. The right ratio of good-to-bad bacteria is necessary for effective digestion, stimulating the gut’s immune system and maximizing your ability to extract nutrients from your diet.”
There are so many probiotic options, it can all be really overwhelming. Where should one start?
“Not all probiotics are alike and because it is not an FDA regulated medicine, it is unclear what you are really getting when you buy any probiotic,” says Dr. Weitzman. “I usually recommend a lower dose to start as it can worsen bloating initially when starting a probiotic. And then adjust the dose over the next few weeks if no side effects are experienced. That old saying, ‘Too much of a good thing’ can be true, and you should read the directions with any specific probiotic to determine how many pills you should take. Additionally, some probiotics may need to be refrigerated to maintain the live cultures while others can be stored at room temperature, so follow the instructions on the label.”
There are now probiotics for women's health, colon health, super health, etc. So many options!
“The name of the probiotic is largely marketing and many of the same bacteria are found among many different lines of probiotics,” says Dr. Weitzman. “We do not have head-to-head studies comparing one pill to the other, and it is very difficult to recommend one pill over the other. So I frequently recommend to try one brand, and then switch to another brand if no improvement is noted.”
Does price matter? There are $10 probiotics, then $150 probiotics.
“I would agree that you should avoid cheap pills,” says Dr. Weitzman. “Unfortunately, it is impossible to know with so many products on the market which are high quality or low quality. Supplements and vitamins are notorious for not containing the products that they purport to contain. So while probiotics have proven benefits, we must remember that these positive effects are counterbalanced by the fact that many so-called 'probiotic' products are unreliable in content and of unproven benefit or superiority over other products.”
Prebiotics are now all the rage. What are their benefits?
“Prebiotics are healthy digestive fibers that create a better environment for probiotic bacteria to thrive,” says Dr. Weitzman. “It is the fertilizer by which bacteria in our intestines survive on. It can be used as an adjunct to make probiotic supplements survive and thrive, potentiating its full effect. While many of the fruits and vegetables that we eat are prebiotics, it is difficult to ingest enough of these fibers to get the full effect of a prebiotic pill. Thus your doctor may recommend both a prebiotic and probiotic for particularly difficult to treat digestive complaints.”
Miller agrees prebiotics are beneficial: “Put simply, prebiotics feed the existing good bacteria in your gut and encourage it to thrive. A prebiotic acts like a fertilizer that promotes growth of the good bacteria already in your gut. They are available from plants such as chicory, asparagus, and yams. All of the products in our current collection include a prebiotic called inulin, derived from chicory. A functional, plant-based ingredient, inulin has been shown to effectively boost digestion and other processes.”
What are the benefits of starting a pre/probiotic routine?
“The gut has been touted as the second brain, and a happy, healthy gut is a great foundation for feeling good,” says Miller.
“Taking a prebiotic and probiotic daily is an easy step to incorporate into your day. Aside from easier digestion, a healthy gut has been shown to impact everything from mental health to weight, mood to skin, and beyond."
“A great starting point is ensuring that your diet incorporates a wide variety of fresh, whole foods—foods which are high in prebiotic fibre as well as probiotic rich foods such as kefir and kimchi. As well as consuming ‘good for your gut’ foods, decreasing consumption of processed and refined foods and sugars which feed the bad bacteria in your gut is key. Taking a pre and probiotic supplement daily will help to further promote the development of good bacteria in the gut.”
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