‘Gut health’ and the microbiome in the popular press: a content analysis

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The term microbiome (derived from the Greek for ‘small life’) encompasses the microbial community that lives in and on our bodies, as well as the genes these microorganisms express and their metabolic activity. Over the past decade, technological advances in genetic sequencing have greatly accelerated our understanding of the human microbiome in health and disease. Fuelled by extensive research, important discoveries about the microbiome have steadily increased resulting in a growth in coverage by the popular media. Researchers have been examining the roles that diverse microorganisms play in shaping our environments and impacting our health. This includes exploration of how the microbiome may influence, for example, risk of obesity, cancer mental health outcomes, and cardiometabolic and chronic disorders. Other research has been investigating the microbiome’s role in childhood asthma as well as the how the use of antibiotics alters gut microbiota. Currently, however, there are only a few microbiome-related interventions in use, and critiques have been made around the hyping of gut microbiome’s potential impact in various contexts. In particular, while research has indicated benefits for the use of probiotics in the context of paediatric antibiotic-associated diarrhoea, critiques have also been raised about the exaggerated benefits attributed to probiotics. Concerns have also been raised around the popularisation and commercialisation of microbiome-related research, particularly with regard to its portrayal in the popular press and on social media. Searches on Google, for example, yield an extensive assortment of microbiome-related discourse detailing products, therapies and research developments, including gut makeovers, gut health diets, cleanses, microbiome reboots, probiotic products, skin regimens, cures for disease, and treatments such as colonic hydrotherapy or colonic reflorastation. It was also observed during the COVID-19 pandemic that ideas of gut health circulated often when immune-boosting was discussed. In the case of faecal transplants, for example, while clinical research is progressing and showing signs of promise, there has already been a case of a Canadian naturopath using the procedure to treat children with autism. Research has shown that in the context of microbiota–gut–brain axis, articles in popular press simplify research and potential health impacts by highlighting ‘dietary change (including probiotics) as a ‘natural’ means of changing the microbiome, and thus host health status.’4 Further media research has indicated that microbiome coverage tends to focus on observational studies with less coverage given to clinical trials and systematic reviews.32 Indeed, as noted by Reid et al 30 ‘on a consistent basis scientists, media and industry misrepresent probiotics or make generalised statements that illustrate a misunderstanding of their utility and limitations.’ This project analysed portrayals of the microbiome in popular English-language news sources for American and Canadian audiences. We mapped out how often, and for which health topics and conditions, microbiome ideas were portrayed as beneficial. We then determined how often, and which actions were presented in order to obtain stated benefits. Lastly, we examined how often ideas of the microbiome were presented critically—that is, whether microbiome benefits or actions were presented as unproven, uncertain, ineffective or exaggerated.

To examine how the microbiome was portrayed in the popular press, we performed directed content analysis on articles published in newspaper sources popular among English-speaking American and Canadian audiences. We used the FACTIVA Database to search for and download all articles published on a popular source list between 1 January 2018 and 11 October 2019 (the day of data collection), which contained at least one of the following search terms: ‘microbiome’, ‘microbiota’, ‘gut health’, ‘healthy gut’, ‘unhealthy gut’, ‘gut bacteria’, ‘probiotic’ or ‘probiotics.’ The search terms were chosen to capture microbiome-related media content created for general audiences without excluding the presence of more specific, research-focused content. The terms were finalised after various reviews of sample searches were performed. The time frame was selected as it was observed through FACTIVA searches and analysis on Google trends that the topics of ‘microbiome’ and ‘gut health’ had been steadily and increasingly receiving media attention from 2010 onwards with no apparent deviations. See online supplemental material 1 for search summary and list of sources including article counts. After the removal of duplicates by FACTIVA, our initial dataset totalled 1395 articles, which were downloaded into and made accessible for analysis through the creation of customised platform. We then developed a coding frame using the inductive and deductive methods established by our team from previous studies, which involved creating an initial coding frame, applying it to a large sample of the data, and modifying it as necessary to accurately capture the reality of the content. The coding frame had three primary objectives: (1) to determine if claims of health benefits were made in relation to the microbiome (including ideas captured with associated rhetoric, ‘gut health’, ‘gut bacteria’, ‘probiotics’, ‘microbiota’, etc), and if so, which health topics these benefits were described in relation to (ie, allergies, cancer, skin health, general health (‘wellness’), etc); (2) to determine if the article described actions that could be taken to reap the claimed benefits, and if so, what these actions were (ie, eat certain foods, take probiotics, perform faecal transplants, etc); and (3) to determine if any benefits or research related to the microbiome might be portrayed as unproven, uncertain, ineffective or exaggerated. Through the sample analysis, specific categories to classify health benefits and related actions were developed, and three further coding categories were established: (1) whether the article’s principal focus was on scientific research, either pertaining to a particular project or summarising a body of work; (2) whether the article discussed babies or children in relation to the microbiome; and (3) whether an article portrayed taking probiotics as beneficial without describing or connecting that probiotic intake to health benefits associated with the microbiome. See online supplemental material 1 for complete coding frame. During coding, articles that were coded as irrelevant were removed, and the finalised total data set resulted in (N=830) articles. Articles were deemed irrelevant if they were duplicates, incomplete (eg, a ‘gut health’ headline embedded in an unrelated article), television show transcripts, or focused exclusively on animal biology or business developments. All articles were coded by two coders who met periodically to discuss any irregularities and reach consensus on disagreements. This process, as outlined and enacted in other research projects, entailed coders being instructed to flag any articles which posed coding ambiguities, and on each meeting collaboratively coding these uncertainties through discussion and consensus. Once all articles had been coded, each coder performed an audit on a sample of articles coded by the other coder to ensure no significant issues were present. This research was done without patient or public involvement. Patients or members of the public were not invited to comment on the study design and were not consulted to interpret the results. Patients or members of the public were not invited to contribute to the writing or editing of this document for readability or accuracy. Funders had no input on the decision to publish nor the content.

The 830 articles were published in a total of 41 sources of which 143 (17.2%) came from 18 Canadian sources, 244 (29.4%) came from 18 American sources, and 443 (53.4%) came from the 5 sources based in the UK. Of the 830 articles, 439 (52.9%) were published in 2018, and 391 (47.1%) were published in 2019 (before 11 October). In describing the findings, we will use the term ‘microbiome’ as an all-encompassing term for all associated rhetoric. It was considerably more common for articles to discuss the microbiome in a non-research-specific context (n=650, 78.3%) than to focus on specific research (n=180, 21.7%) (figure 1). In total, 779 articles (93.8%) discussed health benefits in relation to the microbiome. The vast majority (n=732, 88.2%) did so including (detailed) descriptions of gut health, the microbiome, gut bacteria, etc, while some articles (n=47, 5.7%) did so simply portraying probiotics as beneficial without mentioning ‘gut health’ or the ‘microbiome.’ Articles of this nature, for example, described probiotic-based health regimes of athletes, bars and restaurants offering probiotic health drinks, spas providing probiotic shots and raw water products containing beneficial probiotics. Microbiome benefits, critiques, research focus and baby/child focus in press articles popular among Canadian and American audiences (N=830). Microbiome benefits, critiques, research focus and baby/child focus in press articles popular among Canadian and American audiences (N=830).

Actions one could take to reap the health benefits associated with the microbiome appeared in n=653, 78.7% of all articles, and 89.2% of all articles that discussed microbiome benefits (figure 1). Some articles discussed the microbiome in the context of babies or children (n=100, 12%), with approximately half of these 100 articles (n=46) focused on specific research developments. Articles discussing the microbiome in the context of babies or children made up a quarter (25.6%) of all research-focused articles. A total of 156 articles (18.8%) provided critiques, suggesting that either generally or in specific contexts, the health benefits and/or current research of the microbiome might be unproven, uncertain, ineffective or exaggerated (figure 1).

In total, there were more than 135 different health topics for which the microbiome was portrayed as beneficial (see online supplemental material 1 for complete list). The health topics most commonly associated with the microbiome are presented in figure 2 and table 1. Some topics appearing in fewer than 4.0% of articles included anxiety (n=24, 3.3%), Alzheimer’s disease (n=15, 2.0%), Parkinson’s disease (n=14, 1.9%), autism (n=12, 1.6%), dementia (n=8, 1.1%) and menopause (n=8, 1.1%). The majority of the articles discussed the microbiome in relation to one health topic (n=455, 62.2%), while 86 (11.8%) connected the microbiome with four or more health topics in the same article. Some singular articles, for example, discussed the microbiome in relation to a wide range of health topics such as allergies, diabetes, obesity, Parkinson’s disease, asthma, autism, Alzheimer’s disease, etc.