The five best supplements for gut health

From stress and anxiety to eczema and obesity, our gut health can have a huge impact. Here are the top supplements to support it

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The state of our guts is so revealing about our health. Stress, illness, anxiety can all manifest in our stomachs. “It affects how susceptible we are to a range of things such as inflammatory diseases, autoimmune disorders and even allergies,” says Emily English, a nutritionist.
We all know about the crucial role our diet plays in keeping our guts healthy, but the confusing part is whether we can – and should – take a shortcut with supplements. How to navigate the many different types is far from straightforward, let alone get our heads around what terms like prebiotic or probiotic even mean in the world of gut health.
Here we demystify the different kinds of gut health supplements and which are the best to take, if at all.
Prebiotics are found in foods naturally and it’s what the bacteria inside your gut feasts on. They’re found in most fibre-rich vegetables. While probiotics – found in fermented foods such as kimchi and kefir – are the bacteria themselves.
“While probiotics are the live bacteria in your gut, prebiotics are the foods that naturally feed and populate your gut bacteria,” explains Lucy Kerrison, a consultant gastrointestinal dietitian. Both can be found naturally in foods and are also in supplements.
Kerrison encourages her patients to focus on eating more prebiotics over probiotics as it’s the easiest way any of us can improve our diet.
“When you’re taking a probiotic supplement, you’re taking the live bacteria, and so that benefit will just last while you’re taking the supplement itself – maybe for a little bit after – but not long term,” she says. “For the general, healthy population, probiotics are often not needed and slightly over-marketed.”
Prebiotics, on the other hand, are the foods that naturally feed and populate your gut bacteria. While every gut specialist agrees they would ideally be obtained via the foods we eat, there has been a flood of interest in supplements as people seek convenient ways to try to ensure their gut health is in the best condition.
Kerrison says it can be helpful for certain people to supplement their diets, at particular times, with prebiotics:
“If you’re someone who really struggles with a high-fibre diet, or perhaps have to eat out a lot for work or travel, you can’t always make the best choices and this might help, but there is limited long-term research available as yet.”
For: Improving general bowel health in certain circumstances (eg while you’re on holiday and less able to follow your usual fibrous diet). It can help with constipation, but for many IBS sufferers they can increase gas and cramps.
The most common commercially available prebiotic compounds are called fructo-oligosaccharides (FOS). These are plant sugars that are not digested until they reach the colon, where they feed good bacteria in the colon which helps them grow and can improve bowel health.
They can be taken in a sweet powder form and added to drinks, yogurt, or sprinkled on cereal.
For: Conditions such as eczema, colic, hay fever, food allergies, constipation and obesity (the scientific evidence to support most of these uses is so far limited). If you have IBS be cautious as gas and cramps can be increased.
Galacto-oligosaccharides (GOS) are prebiotics made up of plant sugars. These are long chains of lactose sugars which stimulate the growth of beneficial gut bacteria.
GOS are naturally found in dairy products, beans, and certain root vegetables. As a supplement, it’s available in a syrup, powder or tablet.
For: Blood sugar control and appetite management. Once again IBS sufferers can find increased symptoms such as gas and cramps.
Inulin is a fructan polysaccharide, which means it’s a mixture of fructose polymers with glucose molecules at each end. It’s not digested or absorbed in the stomach. It stays in the bowel and helps certain beneficial bacteria to grow.
Inulin is a starchy substance, and the kind that is used in supplements most commonly comes from soaking chicory roots in hot water. Supplements are available in both capsule and powder.
For: Anyone suffering from constipation or IBS-related diarrhoea.
Dr Megan Rossi, a gut health scientist, recommends this water-loving fibre in her own clinic sometimes as it has two uses. “It’s helpful for both thickening up loose poo and softening hard poo, making it a supplement that you might want to consider if you are suffering from either constipation or IBS-related diarrhoea,” she explains.
It may also help improve other troublesome gut symptoms, such as “incomplete evacuation” (where you feel like you haven’t completely emptied your bowels after a bowel movement).
She suggests starting with half a tablespoon (3g) daily, and if that’s well tolerated, increase to 1 tablespoon/ day after one week, and gradually up to a maximum of 3tbsp/day (alongside an extra 150ml of fluid per tablespoon). Dr Rossi warns that it forms a thick gel when mixed with cold fluids or food, so it’s best combined with warm porridge or soup. The husk is easier to mix than the powder.
For: Anyone who has taken a recent course of antibiotics and to normalise stool consistency.
This is less fermentable and therefore more easily tolerated by some people, says Kerrison.
She recommends this in specific circumstances, such as during antibiotic treatment for SIBO (a condition where there is an abnormal amount of bacteria in the small intestine). “They can be taken during and after antibiotics and I would perhaps encourage this,” she suggests.
It’s wise to follow the instructions on the product, and for many people timing (whether morning or evening) is less important than remembering to increase fluid at the same time as increasing your prebiotics – as they are fibres.
“Timing is especially more important for those with gastro symptoms, so for example, if someone is constipated I’d recommend the fibre is added in the morning, as you have a large natural intestinal contraction at this time and a full day of fluids to benefit from, so I tend to find adding fibres in the morning is more effective.”
While there is limited evidence available, Kerrison believes that in theory, it might be beneficial to pick a daily prebiotic, and then alternate it every four weeks, to make sure you are getting a wide range in the gut.
If you’re taking any prebiotic supplements for the first time it’s recommended to start gradually and increase the amount slowly to give your digestive system time to adjust. While all are unlikely to cause any harm, some can exacerbate bloating if too much is introduced too quickly.
“Many prebiotics – including FOS, GOS and inulin – are highly fermentable and difficult to digest for a sensitive gut,” warns Kerrison.
She also says that there are some prebiotics that people might want to take in a high dose – and in the long term but should do so under advice –“because they are selectively fermented by certain bacteria within the gut, and we do not want an overgrowth of any type of bacteria within the gut, even the good strains.”
For children, anyone pregnant, breastfeeding, or suffering from autoimmune diseases it would be wise to check with your GP or dietitian before supplementing.
English says: “Choose a high-quality supplement you know that you can incorporate into your routine and will fit in with your lifestyle.
“When it comes to choosing your supplement, ensure they are scientifically backed. When taking your supplement, consistency is really important – it can take a while for your gut microbiome to get used to the new bacteria.”
Kerrison adds: “Whilst we all strive to obtain prebiotics purely from diet, this is not practical for everyone and there are certain circumstances where prebiotic supplements are indicated and beneficial. This could be during travel, whilst taking certain antibiotics and for some clinical conditions for example – it is not a one-size-fits-all approach.”
Dr Rossi maintains that prebiotics “are really best to get from the diet” instead of relying on supplements.
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