Most Americans are uninformed about gut health and the microbiome

Washington DC, May 24, 2023 -- A new Ipsos poll, conducted on behalf of MDVIP, finds that most Americans are uninformed about the gut microbiome and its impact on general health and well-being. The survey finds that many Americans have learned to live with their digestive issues, and one in five feel they have tried many things to resolve their problems but now feel they are at a dead end. Half of Americans have tried mindful eating for reasons related to their gut, and two in five have tried over-the-counter products like laxatives or probiotics. Where there are differences among perceptions, knowledge-level, and experiences, they are most frequently seen between age groups, income brackets, and gender.

Detailed Findings

1. Seven in ten Americans rate their overall health and well-being as excellent or good (71%), while 68% of those aged 45-64 rate their overall health as excellent or good. Sixty-nine percent of Americans aged 45-64 rate their digestive health as good or excellent compared to 74% of those aged 65+ and 60% of those aged 18-44. One third of Americans aged 18-44 say their digestive or gut health is in fair condition, this compares to 22% of those aged 65 and older and one quarter (24%) of those aged 45-64.

• Those who work full time are more likely to say they have good or excellent overall health and well-being (79%), mental health (74%) and digestive and gut health (69%), than those who are not employed (55%, 48%, and 55% respectively). Those who are retired are also more likely to report better mental health (83%) and digestive health (75%) than those who are not employed.
• Men (72%) and women (70%) are equally likely to report they have excellent or good overall health and well-being, but men are more likely to say they have excellent or good mental health (75%) and digestive health (74%) than women (64% and 59% respectively). Taking a deeper look, men are nearly three times more likely to say their digestive health is excellent (21%) than women (8%).
• Among 11 common terms related to digestive and gut health, Americans are most familiar with the term “food allergy” (75%). Americans are at least familiar with the terms “leaky gut syndrome” (27%) and “small intestine bacterial overgrowth (SIBO)” (25%). Women are significantly more likely to say they are familiar with irritable bowel syndrome (IBS) (69%) than men (50%). Women are also more likely to say they are familiar with inflammatory bowel diseases, like Crohn’s, (63%) than men (48%).

2. Eighteen percent of Americans report that they have been diagnosed with hemorrhoids, and those aged 65+ are more likely to say this than their younger counterparts. One in six (15%) Americans report that they have been diagnosed with gastroesophageal reflux disease (GERD), including 19% of those aged 45-64.

• About one in ten Americans (12%) report they have been diagnosed with a food allergy, and 9% say they have been diagnosed with a food sensitivity. Eighteen percent of Americans say they have not been formally diagnosed with a food sensitivity, but they believe they have this condition. Younger Americans are more likely to say they have been diagnosed with a food allergy (16%) or sensitivity (14%) than older Americans aged 65+ (5% and 4% respectively). One in five Americans say they have either been formally diagnosed with IBS (9%) or they think they have the condition, but have not been diagnosed (10%).
• Women are more likely to report that they have been diagnosed with IBS (13%) than men (4%). Men and women are equally likely to report that they think they have digestive health conditions, like IBS, (10% each), inflammatory bowel diseases (6% men, 4% women), celiac disease (5% men, 4% women), but have not been diagnosed. Women (20%) and men (16%) are also equally likely to say they think they have a food intolerance or sensitivity but have not been formally diagnosed. Those who work full time (12%) are more likely to say they believe they have IBS but have not been diagnosed than those who are retired (3%).
• One third of Americans report they experience abdominal discomfort or pain at least a few times per month (34%). Forty percent of Americans report they experience bloating at least a few times a month, with 5% reporting they experience it daily. Women are more likely to report experiencing bloating a few times a week or more (26%) than men (11%). Women are also twice as likely to report experiencing abdominal pain and discomfort (19%) a few times per week or more than men (8%). Americans who have lower household incomes (under $50,000 annually) are also more likely to report having gas or gas pain (34%), diarrhea (15%), constipation (23%), heartburn (27%), and reflux (24%) than Americans who have a household income of over $100,000 (16%, 8%, 7%, 10%, and 10%, respectively).

3. When asked about various behaviors related to taking care of their own health, 82% of Americans say they mostly cook or prepare their meals at home, 82% report staying hydrated throughout the day, and three-quarters say they minimize alcohol consumption (72%). Three in five Americans report reading the labels on items before purchasing or consuming them (59%), and older Americans aged 65+ are more likely to say this (70%) than those aged 18-44 (52%). Two in five Americans also report reducing their intake of processed food (60%), or reducing their sugar, salt, and saturated fats (64%).

• Americans who live in higher income households are more likely than their middle and lower income counterparts to report always or often doing behaviors to promote health. For instance, Americans in higher income households are more likely to say they are reducing their intake of processed foods (71%) than middle income Americans (59%) and lower income Americans (45%). They are also more likely to say they are reducing added sugar, salt, and saturated fat (77%), compared to 57% of middle income and 52% of lower income Americans. Higher income Americans are also more likely to report eating a healthy, well-balanced diet (77%), getting enough exercise (56%), maintaining a healthy weight (71%) and managing/reducing stress (74%) than lower income Americans (58%, 44%, 59%, and 55% respectively).
• Women are also more likely to say they partake in certain health-promoting behaviors than men, such as preparing meals at home (86% of women, 78% of men), reading the label before buying/consuming foods (65% of women, 53% of men), minimizing their intake of alcohol (79% of women, 67% of men), and getting an annual physical exam (72% of women compared to 62% of men).
• For reasons related to their gut, half of Americans report they have engaged in mindful eating (50%) or have taken over-the-counter digestive products like laxatives or fiber supplements (46%). Forty-one percent report having taken over-the-counter probiotics. One in three Americans (32%) reports they have done or are currently fasting (not as religious practice). One in five Americans report they have tried or are currently on a dairy-free diet (21%), which is especially true of those aged 18-44 (26%) compared to 15% of those aged 65+. One in five Americans also reports having done or currently doing a vegetarian/vegan/plant-based diet (19%). Again, younger Americans aged 18-44 are more likely to say this (27%) than Americans aged 65+ (13%). Americans are least likely to say they have tried or are currently doing a Low-FODMAP diet (8%). Fourteen percent of Americans say they have tried or are currently doing a gluten-free diet. Men are more likely to report having tried or currently doing a low-FODMAP diet (13% of men compared to 4% of women). When it comes to other practices, women are more likely to say they have tried or currently do mindful eating (55%) than men (44%). Women are also more likely to report having taken or currently taking over-the-counter digestive products (55%) and over-the-counter probiotics (49%) than men (36% and 32% respectively).
• Looking at health conditions, Americans are most likely to report being concerned about cancer (61%), followed by heart disease (56%), arthritis (56%), and their mental health/emotional well-being (55%). Younger Americans are more likely to be concerned with their mental health/emotional well-being (61%) than Americans aged 65+ (42%). Just under half report they are concerned with their digestive or gut health (48%), with insignificant differences between aged groups.

4. Regarding their gut health and their primary care physician, about half of Americans say they have talked to their doctor about what they are eating (51%), and 38% say they have talked to their doctor about their digestive health. The same number of Americans would like to talk to a registered dietitian to help improve their diet (38%). Young Americans aged 18-44 are more likely to say this (45%) than those aged 65+ (28%). Half of Americans say they would rather talk to a specialist about their digestive health (50%). Two in five Americans say they talk more about their digestive issues with their family/friends than their doctor (41%), while a similar proportion rely on the internet for research and advice on their digestive health (40%). Women (45%) are more likely than men (34%) to say they rely on the internet for research and advice on their digestive issues. A quarter of Americans (26%) report they experience digestive issues but have not discussed them with their doctor, and 24% report they are embarrassed talking with their doctor about gas or bowel movements. Americans with lower incomes (36%) are more likely to say they are embarrassed talking to their doctor about gas and bowel movements than the general population and those who live in higher income households (16%).

• Twenty-eight percent of Americans say they had a condition that was not properly diagnosed or addressed by a doctor, and this is especially true of Americans aged 18-44 (35%) compared to those aged 65+ (18%). Along the same lines, one-in-three Americans (31%) say certain concerns they brought up during an appointment were not taken seriously by their doctor. Thirty-two percent of Americans say they felt too embarrassed to bring up certain health concerns with their doctor.
• Those with lower incomes (under $50,000) are more likely to report dissatisfactory experiences with their doctors than Americans who are middle or higher income. A majority of lower income Americans say they have had to wait longer than they’d like to get a doctor’s appointment (52%) compared to two in five middle (41%) and upper income (39%) Americans. They are also nearly twice as likely to report feeling rushed during an appointment (41%) compared to just a quarter of those making more than $100,000 per year. Lower income Americans are also more likely to say that issues they brought up with their doctor were not taken seriously (42%) than middle income (31%) and higher income (24%) Americans. Lower (37%) and middle (33%) Americans are also more likely to say they had a condition that wasn’t properly diagnosed, compared to just 18% of Americans earning $100,000 or more.
• Women are also more likely than men to report bringing up issues and not been taken seriously (38% of women, 24% of men), to have felt rushed (38% of women, 24% of men), to have a condition that was not properly diagnosed (34% of women, 21% of men), and to wait longer than they would like for appointments (51% of women, 35% of men).
• Sixteen percent of Americans report they have seen a nutritionist or dietitian in the last 10 years, and this is especially true of Americans aged 18-44 (22%) compared to those aged 45-64 (9%) or those over the aged of 65 (11%). A quarter of Americans (24%) report that they have seen a gastroenterologist in the last 10 years. There are no significant differences between the age groups. One quarter of Americans report they have had a depression, and/or stress/anxiety screening performed or checked by their doctor in the last year (23%). Women (30%) are twice as likely as men (15%) to report having had a stress/anxiety/depression screening in the last year, as are those with middle incomes (29%) compared to higher incomes (18%). Higher income (47%) and middle income (45%) Americans are more likely to say they have had their blood sugar checked by a doctor in the last year than those who are lower income (33%).

5. About half of Americans are unsure of whether the attention being brought to gut health is real or a fad (47%). Seven in ten Americans agree that there is no right diet for everyone managing digestive issues, and women (77%) are more likely to say this than men (62%). Younger Americans aged 18-44 are less likely to agree (62%) than those aged 65+ (82%). Three in five Americans (61%) also say that certain foods seem to give them problems (gas, bloating, abdominal pain, diarrhea, constipation, etc.), but those aged 18-44 (67%) are more likely to say this than those aged 65+ (53%). Two in five Americans agree that the standard American diet is healthy as long as people eat sweets in moderation (41%). Americans of all age groups are likely to say this at the same rate. However, Americans without a college degree (46%) are more likely to agree than those with a degree (32%).

6. Half of Americans say they have learned to live with their digestive issues (49%), and a similar number (47%) say that gas and bloating are a normal part of life and something they worry about. Americans aged 65+ are less likely to agree with this (35%), compared to those aged 18-44 (53%). Nearly three in ten (28%) say that digestive issues impact the quality of their life, with one-third of Americans 18-44 (34%) saying this. Those with lower incomes (38%) are more likely to report that their digestive health has negatively impacted their quality of life compared to those with middle (25%) and higher incomes (22%). One in five Americans (20%) say nothing they have tried to resolve their digestive issues has worked, and they are at a dead end, including 30% of those 18-44, while 14% of 45-64-year-olds say this and just 7% of those aged 65+.

7. For the quiz section of the survey, 85% of Americans received a failing grade, 10% received a grade of a “D”, 4% received a “C”, 1% received a “B”, and no one who took the quiz received an “A” grade. There are no differences by age group. Those who earn less than $50,000 per year are more likely to have failed (90%) than those who earn more than $100,000 per year (81%). Although neither group performed well on the quiz, those with a college degree were less likely to receive a score of “F” (78%) compared to 89% without a degree. Most Americans who did not answer correctly conceded that they did not know the correct answer to the question.

• Forty-seven percent of Americans know that there is more bacteria living in the gut than there are cells in the entire body, while 8% said this was false and 45% did not know. Half of men (50%) and 44% of women answered this correctly. Forty percent of Americans know that most of the immune system (70-80%) is located in the gut, while over half (52%) said they did not know and 9% said this was false. Thirty-one percent of Americans incorrectly believe that the bacteria living in the gut get their food from the bloodstream, while 54% don’t know and 14% answered correctly. Men (37%) were more likely to give an inaccurate answer than women (27%), while women were more likely to respond that they do not know (61%) than men (46%). Almost half of Americans (48%) know that humans are unable to process certain vitamins without the help of the gut microbiome. Half of men (53%) and 44% of women answered this correctly, while women were more likely to say they do not know (51%) than men (40%). Seventy-eight percent answered correctly that humans have both good and bad bacteria constantly in the body, and women were more likely to get this correct (83%) than men (74%). Those with higher incomes (81%) also answered this correctly at a higher rate than those with an income under $50,000 (72%).
• Sixty-nine percent of Americans answered incorrectly that the average adult should have a bowel movement every day, while just 13% answered correctly that this is false. Men (68%) and women (70%) were equally likely to get this question wrong. Forty-seven percent answered correctly that constipation is defined as three or fewer bowel movements a week. Fifty-three percent of Americans answered correctly that poor sleep can be a sign of an unhealthy gut, with about half of men (50%) and 57% of women answering correctly. Younger Americans under age 45 were more likely to get this correct (60%) than Americans aged 45 and older (48%).
• One-third of Americans (35%) are aware that skin irritations like eczema and psoriasis can be a sign of poor gut health, while 13% answered incorrectly and 51% did not know. Men (32%) and women (38%) were equally likely to answer this correctly. Those working full time (39%) were also more likely to answer correctly than those who are retired (26%). About half of Americans are aware that an unhealthy gut can cause brain fog (49%) while 43% don’t know. Women (56%) were more likely to answer this question correctly than men (41%). About half of Americans are aware that people with digestive disorders, like IBS and Crohn’s, are at higher risk for depression and anxiety (51%). There were no statistical differences between men (47%) and women (55%) responding to this question.
• Just one in three Americans are aware that antibiotics kill both the good and bad bacteria in your gut (30%), while the same number answered incorrectly that antibiotics only kill bad bacteria (29%). Americans with higher incomes (19%) were less likely to answer incorrectly than those with middle incomes (36%) and lower incomes (39%). Most Americans are aware that a lack of physical activity can lead to constipation and bloating (66%) while 6% answered incorrectly and 27% did not know. Women were significantly more likely to answer this question correctly (75%) than men (56%), while men (34%) were more likely than women (22%) to say they did not know.
• The survey also explored knowledge of pre and probiotic foods. This section received the highest proportion of “don’t know” responses. Seventy-three percent said they did not know if a Jerusalem artichoke is a prebiotic or probiotic food, but 15% did answer correctly that it is a prebiotic. Men (15%) and women (15%) were equally likely to respond correctly about Jerusalem artichokes. Sixty-eight percent of Americans said they were unsure of whether miso is a prebiotic or probiotic, but 15% answered correctly that it is a probiotic food. Men (19%) were more likely than women (11%) to answer correctly concerning miso. Just 22% of Americans know that sauerkraut is a probiotic, while 58% did not know. Americans are most informed about kombucha, where 30% correctly answered that it is a probiotic. Men (30%) and women (31%) were equally likely to answer that kombucha is a probiotic food, while those earning more than $100,000 per year (36%) were more likely to get this question correct than lower income (25%) Americans.
• Americans are also most likely to be aware that stress (68% answered correctly) and sleep (67% answered correctly) impact the balance of good and bad bacteria in the gut. There were no major demographic differences among those answering correctly about stress’ impact on the microbiome. However, women (74%) were more likely to answer correctly that sleep impacts the balance of bacteria in the gut than men (59%). Americans were less informed about how the following impact the gut microbiome: spending time in nature (43% answered correctly), living in a city compared to a rural area (38% answered correctly), how infants are fed (36% answered correctly), use of hand sanitizer (32% answered correctly), and living with a dog (29% answered correctly). Younger Americans aged 18-44 were more likely to answer correctly concerning hand sanitizer’s impact on the gut microbiome (40%) than Americans aged 45-64 and those over aged 65 (26% each). Younger Americans ages 18-44 (44%) were also more likely to correctly say that how infants are fed impacts the balance of the gut microbiome than those aged 45 and older (29%).

About the Study

These are some of the findings of an Ipsos poll conducted between March 28-29, 2023 on behalf of MDVIP. For this survey, a sample of 1,005 adults aged 18+ from the continental U.S., Alaska, and Hawaii was interviewed online in English. The sample also includes 451 respondents aged 18-44, 311 respondents aged 45-64, and 243 respondents aged 65+.

The sample was randomly drawn from Ipsos’ online panel, partner online panel sources, and “river” sampling and does not rely on a population frame in the traditional sense. Ipsos uses fixed sample targets, unique to each study, in drawing a sample. After a sample has been obtained from the Ipsos panel, Ipsos calibrates respondent characteristics to be representative of the U.S. Population using standard procedures such as raking-ratio adjustments. The source of these population targets is U.S. Census 2022 American Community Survey data. The sample drawn for this study reflects fixed sample targets on demographics. Post hoc weights were made to the population characteristics on gender, age, race/ethnicity, region, education and political party affiliation.

Statistical margins of error are not applicable to online non-probability polls. All sample surveys and polls may be subject to other sources of error, including but not limited to coverage error and measurement error. Where figures do not sum to 100, this is due to the effects of rounding. The precision of Ipsos online polls is measured using a credibility interval. In this case, the poll has a credibility interval of plus or minus 3.8 percentage points for all respondents. Ipsos calculates a design effect (DEFF) for each study based on the variation of the weights, following the formula of Kish (1965). This study had a credibility interval adjusted for design effect of the following (n=1,005, DEFF=1.5, adjusted Confidence Interval=+/-5.3 percentage points).

The poll also has a credibility interval of plus or minus 5.7 percentage points for respondents aged 18-44, plus or minus 6.8 percentage points for respondents aged 45-64, and plus or minus 7.7 percentage points for respondents aged 65+.

For more information on this news release, please contact:

Chris Jackson
Senior Vice President, US
Public Affairs
+1 202 420-2025
[email protected]

Annaleise Lohr
Director, US
Public Affairs
[email protected]

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