Gut health has become one of today’s biggest wellness buzzwords. With so many products on the market, from supplements to sodas, it is hard not to be inundated with advice about how to improve the gut microbiome. Physicians often prescribe antibiotics for illness, but antibiotics disrupt the bacteria in the gut.
According to Michael Passarella, M.D., gastroenterologist at UAB St. Vincent’s, the good news is that the gut is far more resilient
“While it’s difficult to truly ‘protect’ the microbiome while taking antibiotics, certain probiotics, especially Lactobacillus, Bifidobacterium and Saccharomyces boulardii, have shown to reduce the risk of antibiotic-associated diarrhea,” Passarella said. “They are safe to use, but the long-term benefits are uncertain.”
He says the real focus should be on what is done before and after antibiotics. “It’s more about your overall lifestyle and diet,” he noted. “There’s no one-size-fits-all approach; but eating a healthy, diverse and fiber-rich diet can help your gut bounce back more quickly.”
Food for a Healthy Gut
Fiber is one of the key nutrients that supports a healthy gut microbiome. “Fiber basically acts as a prebiotic,” Passarella said. “If probiotics are the good bacteria, prebiotics are the food they need to thrive.”
He recommends eating plenty of fruits, vegetables and other fiber-rich foods. Gut health is not as simple as adding vegetables to one’s plate. Some foods can cause discomfort for people who are sensitive
“Dairy is a big one. Lactose can be tough for a lot of people,” Passarella said. “Artificial sweeteners are another. People underestimate how much impact they can have on the gut, even in small doses.” He says sugar alcohols, such as xylitol and sorbitol, commonly found in “sugar-free” drinks, can trigger bloating and digestive issues
Even some foods that seem healthy, like cauliflower, broccoli and avocados, can be harder to digest for certain people. “It’s a balancing act,” Passarella said. “You don’t want to steer away from healthy foods, but it’s important to listen to your body and make adjustments if something consistently bothers you.”
The Truth About Probiotics
Passarella is quick to clarify that, while probiotics can help some people, they are not a magic solution. “We practice evidence-based medicine, and there just isn’t a ton of strong evidence for the long-term benefits of probiotics across the board,” he said. “Most probiotic supplements do not colonize the gut long term; they tend to pass through. So, benefits, when they occur, are usually present only while taking them.”
Still, he has seen enough patients benefit to keep an open mind. “I’ve been doing this for nearly two decades, and I’ve seen people start probiotics and feel better, and seen others where probiotics were not helpful. But if it helps, I’m not going to tell you to stop.”
When choosing a probiotic, he recommends skipping the expensive, trendy brands. “Some of the commonly found over-the-counter options are just as effective as more expensive versions. A high CFU count isn’t necessarily better. The specific strain matters more than the number of bacteria.”
He adds that probiotics seem most beneficial in specific situations, such as for people dealing with irritable bowel syndrome or antibiotic-associated diarrhea
To get probiotics from food instead of supplements, fermented foods are a good option. “Yogurt with live cultures, kimchi, sauerkraut, miso, kombucha — those are all great natural
He noted that incorporating these into a balanced diet, rather than relying on them as a cure-all, is key: “It really comes down to overall healthy eating, avoiding things that irritate your gut and staying active. Exercise is a big part of gut health, too.”
The Gut Will Heal
For anyone worried about damaging their gut microbiome after antibiotics, Passarella offers some reassurance. “The gut is a very resilient organ,” he said. “The vast majority of the time, it’s going to restore itself. It may take some time; but for most individuals, the microbiome returns close to baseline within two to eight weeks after antibiotics, although some subtle changes may persist longer.”
One of the best and most important ways to protect the gut, he says, is simply to avoid unnecessary antibiotic use. “It’s really easy to go to urgent care or your doctor for a cold and walk out with a prescription,” Passarella said. “But most of those illnesses are viral, and antibiotics won’t help. Up to 30-50 percent of outpatient antibiotics in the United States are unnecessary.”
He encourages patients to ask their providers questions before starting antibiotics. “It’s not wrong to ask, ‘Do I really need this?’ or ‘Can I wait a few days to see if I improve?’” he said
In the end, Passarella’s advice comes down to balance and patience. “Your gut is tougher than you think,” he said. “Focus on a healthy lifestyle, adequate fiber intake is important and give your body time to recover.”
