“Food First” Versus Supplements

Understand the “food first” approach, and how food is metabolized in the body to then directly impact our gut health.

Why navigating the wide world of supplements is important and being selective about your nutrition is key.

The benefits and risks of microbiome supplements vary, with some showing promise while others lack solid research. Understanding where evidence is limited is key.

Understanding digestion at a basic level is key to understanding our gut’s relationship to whole foods and supplements. The enzymes of the GI tract break down the food we eat into absorbable components. Proteins are broken down into amino acids. Carbohydrates are broken down into simple sugars and fats are broken down into fatty acids and glycerol. This breakdown is necessary because the gut lining will not allow larger forms of protein, carbohydrate and fat to be absorbed. Larger compounds will trigger our immune systems so they have to be broken down to amino acids, simple sugars and fatty acids.   

Although protein and fat are almost exclusively broken down, some carbohydrates are too complex for our enzyme systems to break down. These carbohydrates pass undigested through the small intestine and on into the colon where our colonic microbiome metabolizes and ferments the carbohydrates for their own energy. (Zhang, 2022). One of the main benefits of this fermentation is the production of short chain fatty acids (SCFAs), which regulate our immune systems and help us fight cancer. SCFAs also serve to modulate the gut epithelial barrier and mucosal immune system which are key to overall health. Food-sourced vitamins have a lower potential for toxicity and offer the added benefit of being naturally linked with other beneficial food substances that enhance their absorption and cellular utilization. 

The "Food First" approach emphasizes the importance of nutrition in managing chronic health conditions. Food First is not a diet but a sustainable lifestyle change focused on whole, unprocessed foods. This lifestyle change encourages mindful eating, prioritizing food quality over calorie counting, and following the 80/20 rule for flexibility. Nutritional changes take time, but even small steps can lead to lasting health benefits.

The approach is guided by four principles: eat breakfast with protein, maintain regular meals, drink water instead of sugary beverages, and eat mindfully with macronutrients. Personalized coaching is occasionally necessary, but integrating Food First into health care can improve well-being and reshape the future of medicine. There is however a lack of data on how this approach alters the microbiome, warranting further research to ensure its validity. This emphasizes the broader impact of diet on health, which we explore in the next section.

A nutritionally complete, whole food-based, fiber-rich diet supports a healthy gut microbiome and provides essential nutrients. Modern food processing can negatively impact the gut microbiome, leading to reduced diversity and increasing risks of obesity and intestinal inflammation, especially in Inflammatory Bowel Disease (IBD) or Colorectal Cancer (CRC) patients. Diets high in fiber and low in fat can positively affect the gut microbiome, with certain fibers counteracting the negative effects of a high-fat diet. Further research is needed to understand the molecular mechanisms behind diet-gut interactions and their role in gut health and disease prevention (Zhang, 2022).

With the rise in health trends on social media, we are increasingly exposed to products of uncertain origin that individuals claim to “boost gut health” or “provide microbiome support”. Common supplements using these claims are probiotics and prebiotics. 

Probiotics

Probiotics are live bacteria and yeasts that claim to support your health by adding to your body's existing beneficial microbes. Probiotics work through several mechanisms to support gut health and overall well-being. The specific bacteria chosen for probiotics can produce SCFAs, which help reduce pathogenic bacteria and modulate the immune response by influencing dendritic cells, macrophages, and T cells, and they help regulate inflammation (Latif et al., 2024). These actions contribute to probiotics' role in potentially preventing or treating conditions such as allergies, IBS, and inflammatory bowel disease. However, many products haven’t been studied, making it hard to choose evidence-backed options. Probiotics are measured in colony forming units (CFU), and higher CFU counts don’t always mean better effects. Labels often list total microorganism weight, which includes both live and dead cells, so look for CFU counts at the product’s expiration date (NIH, 2023). 

Probiotic regulation in the U.S. varies based on its intended use. Most are sold as dietary supplements, which don’t require FDA approval and can make structure or function claims but not disease-related claims without approval. There are no products that we commonly identify as probiotics that have been approved as a drug. If marketed as a drug for treating a condition, probiotics must undergo clinical trials and FDA approval to ensure safety and effectiveness (NIH 2025).

Prebiotics

Prebiotics are the fiber related foods that support the growth of beneficial microorganisms in your microbiome, enhancing the effects of probiotics and improving overall health. Unlike regular food, they are not digested in the stomach or small intestine but are fermented by gut microbes in the colon. This fermentation produces metabolites that provide energy for these microbes. By fostering a favorable gut environment, prebiotics can aid in disease prevention and support treatment by promoting a healthier microbiome (Palamutoglu et al., 2024). 

Be an informed consumer when choosing supplements, as they are not held to the same safety and efficacy standards as drugs. Research scientific evidence on their benefits and risks before use. "Natural" does not always mean safe—some herbs can be harmful, and labels like "standardized" do not guarantee quality. Supplements may also interact with medications or have unintended side effects. Always consult your healthcare provider to ensure safe and effective use (NIH, 2025).

• Avoid quick fixes – Gut health supplements take time to work. Be wary of products that promise instant relief or miracle results.
• Choose reputable brands – Look for trusted companies that provide full ingredient lists, third-party testing (like NSF or USP), and clear product labeling (Council for Responsible Nutrition, 2024).
• Check for quality ingredients – Probiotics and prebiotics should contain well-researched strains and list the number of live colony-forming units (CFUs) at the product’s expiration, not just at manufacture.
• Be cautious with online purchases – Many low-quality or contaminated gut health supplements are sold through unverified online sources. Buy from reputable retailers or directly from trusted brands (Council for Responsible Nutrition, 2024).

Personalized nutrition is an approach that tailors dietary advice, products and services to an individual’s unique characteristics, such as genetics, phenotype, health status, and lifestyle. It encompasses related concepts like precision nutrition and microbiomics, aiming to improve health by providing targeted interventions. Personalized nutrition powered by microbiome data can improve health by optimizing nutrient absorption and energy utilization. Since gut microbes play a crucial role in these processes, modulating the microbiota could be a key strategy for addressing malnutrition and disease (Vandeputte, 2020). While personalized nutrition shows promise in managing conditions like diabetes and optimizing overall well-being, large-scale validation is needed to determine its effectiveness and ensure accessibility for broader populations.

The U.S. personalized nutrition and supplements market, valued at $4.55 billion in 2023, is projected to grow at a compound annual growth rate of 16.28% through 2030, driven by increasing health awareness, technological advancements, and consumer demand for customized solutions. Key factors fueling growth include the rise of preventive healthcare, chronic disease management, and greater access to genetic testing. While the market faced a dip during COVID-19, it is rebounding due to growing interest in personalized health solutions, nutrigenomics, and microbiome research. The study of the microbiome offers new opportunities for understanding non-communicable diseases and developing personalized medical approaches for diagnosis and treatment (Laterza et al., 2022). The prevalence of diet-related diseases, such as obesity, diabetes, and cardiovascular conditions, has heightened consumer awareness of the link between diet and health, increasing the demand for tailored nutrition plans (Grand View Research, 2023).

Benefits

Supplements can be beneficial in specific situations where nutrient needs are higher or harder to meet through diet alone. Older adults may require more vitamin D, vitamin B12, and calcium due to decreased absorption with age. People following restricted diets, such as vegans, may need vitamin B12 supplements since it is found only in animal products (NIH 2021). Pregnant women need folic acid to prevent neural tube defects, and infants may require additional vitamin D. Individuals with chronic conditions like heart disease, diabetes, cancer, HIV/AIDS, or autoimmune diseases might also need more nutrients. Individuals who may lack beneficial organisms in their gut for regulatory purposes may benefit from supplementation to increase and/or diversify gut flora (Lozupone et al., 2021).

Risks

Dietary supplements contain active ingredients that can strongly affect the body, and taking them in high doses or alongside medications can lead to side effects or dangerous interactions. Some supplements, like vitamin K and antioxidants, can interfere with medications, while excessive intake of certain vitamins and minerals may cause harm (NIH 2021).

The growing connection between whole foods, supplements and personalized nutrition for gut health highlights the importance of a multi-faceted approach to wellness. While food-first strategies are key, supplements like probiotics and prebiotics play a supportive role. With the expanding supplement market, it’s important for consumers to choose evidence-backed products tailored to their needs.