Image Credit: Wikipedia. This image has been modified.

What’s Your Enterotype?

The human gut has “a diverse collection of microorganisms making up some 1,000 species, with each individual presenting with their own unique collection of species.” But it wasn’t known whether this variation is on a continuum or if people cluster into specific classifiable types until a famous study analyzed the gut flora of people across multiple countries and continents. The researchers identified three so-called enterotypes. It’s pretty amazing that with so many hundreds of types of bacteria that people would settle into just one of three categories. The researchers figured that our guts are like ecosystems, similar to how there are a lot of different species of animals on the planet, but they aren’t randomly distributed. You don’t find dolphins in the desert, for example. Instead, in the desert, you find desert species, and, in the jungle, you find jungle species because each ecosystem has different selective pressures, like rainfall or temperature. This study suggested there are three types of colon ecosystems so you can split humanity into three types: people whose guts grow out a lot of Bacteroides-type bacteria, those whose guts are better homes for Prevotella, and others who foster the growth of Ruminococcus.

If you think it’s amazing that researchers were able to boil it down to fit everyone into one of just three groups, subsequent research on a much larger sample of people was able to fold Ruminococcus into Bacteroides, so now everyone seems to fit into one of just two groups. So, now we know, when it comes to gut flora, there are just two types of people in the world: those who grow out mostly Bacteroides and those who overwhelmingly are home to Prevotella species.

The question is why? It doesn’t seem to matter where you live, whether you are male or female, or how old or skinny you are. What matters is what you eat. Researchers looked at more than 100 different food components, and a theme started to arise. Different groupings of bacteria were associated with the presence of a particular food component in the diet. In my video What’s Your Gut Microbiome Enterotype?, you can see this illustrated in what’s called a heat map. Each column of the heat map is a different grouping of bacteria, and each row is a food component. Red is like hot, meaning a close correlation between the presence of a particular bacteria and lots of a particular nutrient in the diet. Blue is like cold, meaning you’re way off—a reverse correlation, meaning lots of a nutrient is correlated with very low levels of a bacteria in our gut. Bacteroides and Prevotella are kind of opposites. When it comes to things like animal fat, cholesterol, and animal protein, Bacteroides is red and Prevotella is blue, but when it comes to plant components like carbohydrates, Prevotella is red and Bacteroides is blue.

The study results clearly showed that the components found more in animal foods are associated with the Bacteroides enterotype, while those found almost exclusively in plant foods are associated with Prevotella. So, it is no surprise that another study found that African Americans fell into the Bacteroides enterotype, whereas most of the native Africans were Prevotella. This may matter because the Bacteroides species generally are associated with increased risk of colon cancer, our second leading cause of cancer death, yet a disease almost unheard of among native Africans. The differences in our gut flora may help explain why Americans appear to have more than 50 times the rate of colon cancer.

If whichever gut flora enterotype we are could play an important role in our risk of developing chronic diet-associated diseases, the next question is whether we can alter our gut microbome by altering our diet. The answer? Yes. Diet can rapidly and reproducibly alter the bacteria in our gut. Learn more in my video How to Change Your Enterotype.

More videos on the microbiome:

Who we have living in our gut may also play a role in autoimmune diseases. See Why Do Plant-Based Diets Help Rheumatoid Arthritis? and Gut Dysbiosis: Starving Our Microbial Self.

In health,
Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:


Michael Greger M.D., FACLM

Michael Greger, M.D. FACLM, is a physician, New York Times bestselling author, and internationally recognized professional speaker on a number of important public health issues. Dr. Greger has lectured at the Conference on World Affairs, the National Institutes of Health, and the International Bird Flu Summit, testified before Congress, appeared on The Dr. Oz Show and The Colbert Report, and was invited as an expert witness in defense of Oprah Winfrey at the infamous "meat defamation" trial.

51 responses to “What’s Your Enterotype?

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  1. Something that I’ve thought a bit about- Bacteroides break down meat and meat products. Pig is a meat that they break that down when people consumer bacon, pork, ham, etc. Humans and pigs are so similar that we can graft their skin onto ours and transplant their hearts to use inside people. Knowing all that, it’s completely reasonable to assume that Bacteroides eat our intestines or at the very least, constantly attack them.

    Makes you wonder, doesn’t it?

  2. Although I saw the video on this subject when it was first shown here back in Dec 2015, I still find this a fascinating subject. One question that has me curious is: What kind of diet/foods/food groups produce an abundance of the Ruminococcus gut bacteria? I realize that this group has since been been combined with the more current two groupings, but I’m still curious about which types of food would produce this kind of bacteria.

    I looked through the research paper where they used the Ruminococcus classification, but the food group connection wasn’t clear.

  3. Is it possible to produce your concise well-documented presentations as “Public Service Announcements” and run them on national media?
    Keep up the good work and thank you.
    J Casey Elgin, D. O. (Retired)

    1. I really like this idea. Or show Dr. Greger in a paid advertisement….

      I would not be adverse to my donations being used for this purpose. I would see it as a good way to make more of the public aware. I was unaware until my college age daughter left “The China Study” on our coffee table amongst a lot of other books and I HAPPENED to pick it up. Knowledge about proper eating should not happen accidentally and yet I think that is happening.

  4. Interesting study, and a contrast to the Dr Perlmutters of this world, who favour Bacteroides over Firmicutes bacteria on the basis that the former is associated with a leaner body than the latter.

    1. Yes, that’s how I heard it from the ketos, who are generally talking more about gut microbiome than vegans, in my experience.
      John S

  5. This article fits with my personal experience. I was hoping that there was an easy way to tell which was predominant in your gut but i doubt there is an easy way. They are both gram negative anaerobes and both can cause human disease. Prevotella might cause more lung infections, Bacteroides might cause more appendicitis. The idea that vegetarians get less colon cancer is suspect i think. See this.

    1. The study has serious limitations, including: 1. meating eating was moderate, 2. the vegetarians ate dairy and eggs, 3. the difference between the two groups in terms of fruit & vegetable intake was “not large”, 4. there was no discussion of fiber intake, presumably a major component of whole-food plant-based diets providing a protective benefit. In other words, the vegetarians seem to have been eating a “junk”-like vegetarian diet. Also, no statistics were cited for the vegans. I would think anyone on a WFPB diet can rest easy.

    2. Bill That last sentence of yours might be slightly misleading, I think. There are all sorts of appalling vegetarian and “vegan” diets. Dr Greger has been pointing this out for many years. Whole food plant based diets shouldn’t be lumped in with beer and chips type vegetarian diets.

      In any case, this is an old 2009 study which is, as the paper itself ackowledges, was contrary to results found by other studies on colon cancer. It also found that the incidence of all cancers combined was lower in vegatarians – but of course meat eaters will highlight the one type of cancer that appeared to go against this trend in an attempt to obscure the fact that meat eaters have higher rates of cancer.

      And only last year, Kedscape reported that

      “Eating whole grains daily and ramping up activity levels can reduce the risk for colorectal/colon cancer, according to a new report from the American Institute for Cancer Research (AICR) and the World Cancer Research Fund (WCRF).

      On the flipside, consuming red meat and processed meat increases the risk, as does drinking two or more alcoholic beverages per day.

      The evidence was considered to be “strong” for all of these factors, in either enhancing or decreasing risk.”

    1. The link you posted said,

      “A great heterogeneity was found in oligotype composition. Nevertheless, different oligotypes within the same genus showed distinctive correlation patterns with dietary components and metabolome. We found that some Prevotella oligotypes are significantly associated with the plant-based diet but some are associated with animal-based nutrients, and the same applies to Bacteroides. Therefore, an indiscriminate association of Bacteroidetes genera with specific dietary patterns may lead to an oversimplified vision that does not take into account sub-genus diversity and the different possible responses to dietary components.”

      And from a science perspective looking at the sub-genus diversity makes sense, but from a general understanding of the difference in WFPB and why it might reverse so many diseases through the gut microbiome, I find the simplicity of the pink and blue chart better.

      To me, it is like teaching children to read, first you learn the rules, then, you deal with the exceptions.

      It isn’t perfect, but the visual was all I needed to tell me enough.

      1. I think the “fats” category is the one that interests me in the microbiome.

        I am wondering if there is a good fat, bad fat microbiome and I am asking that because fat is one of those high division topics and it is the blue versus pink that is causing me to ponder it.

        Fat is the slightly odd pattern.

  6. I have been reading about the gut microbiota / brain connection related to Alzheimer’s.

    I already know from the lack of comments that gut microbiota isn’t as romantic a topic, but I feel like it is one of the really important ones.

    I already shared it with a friend who has dementia.

    I am so happy that it breaks down to two types and that 4 days on, whichever diet you choose changes your enterotype. Simple Simon.

    I ponder FODMAP, which my friend is on, because they removed all the foods, which react to the bad guys versus switching enterotypes.

    Would they get an improvement after 4 days off their animal products diets?

    Right now, they are getting benefits from going off of grains and so many things and I don’t think they would even try this, but someday, if the bad guy gut bacteria cause cancer, they might.

    1. I know I said that it isn’t a romantic topic, but I do remember the researchers who studied kissing and making love as ways of sharing bacteria, so I know that researchers do probably see it as a romantic topic, but most of the women I know wouldn’t be very charmed by, “Do you want to swap gut bacteria with me?”

    2. Exercise also changes our gut microbiota

      “In particular, they noted widespread increases in certain microbes that can help to produce substances called short-chain fatty acids. These fatty acids are believed to aid in reducing inflammation in the gut and the rest of the body. They also work to fight insulin resistance, a precursor to diabetes, and otherwise bolster our metabolisms.

      Most of the volunteers had larger concentrations of these short-chain fatty acids in their intestines after exercise, along with the microbes that produce them.”

      1. That is really cool.

        Odd that something like exercise would change the gut microbiome, but it changes what is being fed, so that makes sense.

        If they didn’t have the answer how it works, I would think they swallowed flies while walking.

        I say it, because my brother always would say that he thought fruit flies came inside the fruit itself, because they would show up so fast.

        And I remember one time when they showed up so fast that I wanted to take a video camera to see if he was right.

  7. There were some cool things on this topic in the Food Revolution Summit talks from today.

    William Li, MD was talking about purple potatoes helping our gut bacteria and that it kills Colon Cancer stem cells on the Food Revolution Summit today.

    He also was talking about people being treated for immune therapies for cancer where they can make cancer go away by activating the immune system in an exceptional manner and he said that – if you have one particular gut bacteria, akkermansia, you would respond to immune therapy, but if you didn’t have that one bacteria, immune therapies won’t help you and that gut bacteria can’t come from taking probiotics. You have to eat or drink cranberries or pomegranate to get that bacteria.

    He did other foods for cancer, which are on Dr. Greger’s list.

    Tree nuts, beets, mushrooms, onions, garlic, leeks, cabbage, broccoli etc.

    He talked about the need to chew the foods enough to enhance the enzyme benefits and to allow the microbiome in the mouth to work.

    1. Deb,

      I have been listening to the Food Revolution Summit talks, but haven’t heard the one yet by William Li. I’ll catch it on the Replays. I found your comment on eating cranberries to get the gut bacteria that fight cancer interesting because NutritionFacts has a video on cranberries fighting cancer (see link below). But the study in the video describes the phytonutrients in the cranberry itself destroying cancer cells rather than affecting gut bacteria. Maybe it provides a “double whammy” :-)

      1. Hal,

        Hope you enjoy it.

        Yes the cranberries or pomegranate being the difference between your body fighting the Cancer with its immune system versus it not working blew me away!

        That is a game changer!

        I have one stubborn old man who I am going to try to get that information to carefully. He blasted me a year ago when I talked about a food helping Cancer study, but he is near the end of his life so he might try it.

  8. One thing, which I had never heard of before was eating zucchini flowers.

    He mentioned it protecting against EMF’s and a whole bunch of things.

    That topic came up recently.

    (I had brought it up as I pondered it with soy, because of foods with magnesium affecting calcium channel… and Calcium channel blockers affected EMF’s, so I was searching for foods, so I was happy that he gave me another one to add to my list.)

    1. Anthony William talked about “the unforgivng four” and he explained things like that viruses feed on heavy metals and spit them out as neurotoxins in our bodies.

      I nodded off by the time I got to him so I can’t give a whole list of things.

      Purple potatoes are antiviral is one thing I remember.

      He talked about blueberries, which I still haven’t figured out how to get my brain to like them, but it might be that I never stimulated my vagal nerve about them. I did turmeric and I am using up bottles of it. I did pomegranates and I eat pomegranate seeds almost every day. I gave my device to my cousin before I got to blueberries.

      1. Deb,

        I found your comment “I nodded off by the time I got to him … ” so humorous :-) Yes, some of those speakers have such a monotone voice, they would put an insomniac to sleep!

        Regarding your not liking blueberries … when I want to eat a food I don’t particularly like, I mix it with things I do like and blend it into a smoothie. Works great for me.

      2. You don’t throw a few in your oatmeal?!? I suggest this: chop up a pear and add it to your oatmeal with a few blueberries. Add sprinkles of powdered ginger–enough to taste the ginger. My bet is that you won’t notice the blueberries and they’ll go down real easy.

        1. Thanks Lisa.

          I will figure something out eventually.

          It is a mind-set problem.

          I know that, because I genuinely like the turmeric and pomegranate seeds now. Somehow, my brain linked onto something when I was young and emotions of something knocked some healthy foods into the “I don’t like” category. I have to work on moving them out of that category.

          I will confess that I have bought cartons of blueberries a few times in the past 6 months and ate 1 blueberry each time and they weren’t horrible, but weren’t something I wanted to eat.

          I also think the turning blue when you eat them maybe had something to do with it.

          It is all so subconscious that I am not sure what happened, but I regularly have yellow fingers from turmeric nowadays, so a little blue just will add some artistic elements to my life.

  9. I had the coolest thing happen tonight.

    I visited my cousin and showed him all the kidney failure and phosphorus videos and Dr Gregers grandmother story YouTube channel version and he loved it.

    He said that other than telling him to eat chicken and jelly beans and stay away from so many foods, they haven’t given the concept of using good to help any of it.

    His doctor told him that meat idnt acidic, and thst was covered in the video along with the aluminum in cheese.

    He is going to eat vegetable sources and I found the double boiling technique, which will leach 40-something percent of the potassium and phosphorous out of things to help more.

    He needs to solve cheese.

    He said that he can’t have cashews. Is that true?

    I need to find a sliced vegan cheese without too much phosphorous or potassium.

  10. Which is e-coli Nissile (apparently good for healthy immune response) as my Dr prescribed this as apparently I had none detectable (& Lactobacillus) after tests. But same Dr wanted me to go paleo! Should I stop taking it if it’s wrong.enterotype? I guess it’s bacteroides? But also its located further down the tube?

  11. That is really interesting. I think it worth pointing out that (from the study abstract):

    “β-diversity analysis revealed that exercise-induced alterations of the gut microbiota were dependent on obesity status. Exercise increased fecal concentrations of short-chain fatty acids in lean, but not obese, participants.”

    And we know what kind of diet promotes leanness.

    Also, as Dr. Mirkin discusses in the article

    two new studies showed that among longtime cyclists “muscle size and strength, amount of body fat, levels of hormones such as testosterone, and blood cholesterol levels were close to those of much younger people. Their maximal ability to take in and use oxygen was more like that of people in their twenties than in non-exercisers of their own age group. Incredibly, the cyclists’ immunity did not show the deterioration that is expected with aging. These studies focused on cyclists, but similar results would probably be found with other types of sustained exercise.”“With aging, the thymus gland in the front of your upper chest shrinks and progressively loses some of its ability to make T-cells that help to protect you from developing cancers and infections. The most surprising news from this study is that the thymus glands of the older cyclists produced as many T-cells as those of the young people.”

    1. That is cool!

      I haven’t been cycling in a few years.

      I emotionally feel like I need a tricycle with a basket, as I get older.

      My 7 year old pal doesn’t want to take off her training wheels and she will be quite confused if I push her to take off her training wheels and then I get a tricycle for myself.

      Honestly, I did look at them, but it took four of the handiest – engineer, machining, repairmen half a day to put together my friends tricycle and I mean these are people who built their own houses and repair their own cars and assemble everything themselves with 40 to 50 years of assembly experience, but when things are manufactured so that nothing lines up properly, you have to figure things out.

        1. When I did Sparkpeople, a lot of people did the couch to 5k plan.

          I tried running when I was younger, briefly, but never enjoyed it. Felt hard on my knees.

          I used to WALK 13 miles a day and genuinely loved it. I couldn’t afford all the walking shoes though to keep it up in the long term and after my injuries a few years back, I never got back to distance walking. I did do an hour a day on a treadmill at Planet Fitness, but my dog got jealous and he gained weight while he waited, so I switched back to walking paths, but I am not up to proper speed or distance yet.

          I did just get new sneakers this week. (I wore cheap boots from Walmart all winter until then and started having my feet get mad at me.)

          Back to running, I watched videos of people running on the antigravity treadmills and I genuinely would ponder that. It is a steeper price than walking shoes in the long term. $25 per session.

          But it looks fun.

          And they had those races where they cover you in all the colors and that looked tempting. Probably not good for your lungs, but I applaud them for making running look fun.

          I work with a very elderly man who had to give up running a few decades ago and the way it looks he is working until 90, so running probably has the same thing as cycling.

      1. I don’t ride a bike – like to keep my feet on the ground ever since flying over the handle bars when around 11 yo and getting a concussion (60 years ago, yikes!). But as Dr. Mirkin surmised likely an other aerobic exercise of comparable effort would work, and I do quite a lot of that, from walking/hiking/jogging/stair climbing to high-intensity interval training (Norwegian 4 x 4) on an elliptical machine, stationary bike or treadmill (where you can control the grade to raise heart rate). Plus I lift weights several times per week. Guess I am now an exercise fanatic, trying to make up for past sins.

        1. That is a good list!

          Laughing at the concept of trying to make up for past sins.

          That will probably be me in my next decade.

          This decade is more trying to manage presenting sins, which I am doing better at.

          Looking forward to having everything become past sins.

          Seems like they have to be past by at least a few years to genuinely call them “past” and I am not there yet.

  12. I had a very big treadmill in a very small house and moved it out to bring a hospital bed in and I wonder what type of treadmill Dr. Greger has.

    I also had a couch potato type cycle and liked that very much, but gave it to my friend whose son needed it and she went homeless so I am not getting it back.

    Walking trails are free.

  13. I’ve been taking probiotic supplements since I was diagnosed with C Diff after taking an antibiotic a few years ago. Should I stop taking the probiotic supplements? If not, is there anything I should look for in a probiotic to help me remain in the right enterotype?

  14. Van, have you watched the prebiotic and probiotic videos on the site?

    I think the main thing is eat a wide variety of fruits and vegetables and make sure they are organic, because Round Up changes the bacteria of the foods.

    Interestingly, tonight on PBS, they had pills of bacteria from healthy donors. The person had to take a lot of pills, but it worked.

    If I couldn’t afford organic food and probiotics, I would be inviting WFPB people over and I already have a dog to help pass the bacteria around.

    1. Start going to every WFPB event you can find and make sure to shake as many hands as possible, and open the doors yourself to make sure you touch the handles.

  15. After the beneficial bacteria donor Nova episode, they had the search for new and safer batteries and there was one they could cut into pieces with scissors and not only didn’t it explode, it still kept the lights on.

    The person used a solid electrolyte and, it made it so safe that he could go back to the solid lithium bar and have the much higher energy density with no danger of blowing up.

    That show was the first time that battery was ever revealed to the public.

    Hooray. They didn’t quite spell out the math of what it means for the electric car industry, but having batteries with much higher energy densities, which don’t blow up on impact and keep running even if they are shredded is such a cool reality now.

    Life just changed as we know it, because by tomorrow, every other thing which can be used as a solid electrolyte will be tried out and batteries will never be the same soon.

    I say that, because I watched a video of a diligent man who replaced his smoke detector batteries twice a year and recycled them and burnt his house down with the 9V batteries. That is gonna be a thing of the past.

  16. That wasn’t really a Nutrition type of thing, except it is gonna change the carbon footprint.

    My pondering, nutritionally, because of my cousin….

    I went back to Dr. Barnard and getting rid of fatty Pancreas and, then, I jumped to fatty liver and they improved that by getting rid of refined carbs and associate it with fructose and linked it with kidney disease.

    I obviously don’t understand why they are having my cousin eat white bread, chicken and jelly beans in the first place.

    So, refined flour causes fatty liver and fructose kills you faster.

    How do I figure out if they are trying to help him or kill him faster? Is this why they die before dialysis?

    I am telling him that I don’t think it is mandatory to eat those things. They are just the only things the kidney doctors can think of to feed you.

    It is moments like this that I genuinely regret not understanding science or medicine well enough to really help.

    I just feel like if he can get rid of the phosphates and saturated fats from the chicken and get rid of the refined carbs from the white bread and the fructose from the jelly beans and still try to limit the things they are telling him to limit… maybe having him eat more like chick peas and vegetables or something.

  17. I went to Dr. McDougall’s and he has most of the same themes as they do.

    It has to be the fear of low calories is more dangerous to them than heart attacks and strokes and cancer?

    Is that why they suddenly have to eat things, which will increase their risk of the rest of it?

    I read somewhere else what Dr. Greger put about many people live for years on dialysis, but they tend to die of heart attacks and strokes and things like that.

    Is starvation one of the things?

    Is that the biggest risk?

    For me, to add to the fatty kidney and fatty liver and fatty arteries and have him eating things, which have already caused him to be in so much pain that he can barely walk doesn’t make sense.

    They are creating the type of pain that Dr. Greger’s grandmother had by having him eat this way and they are doing it on purpose.

    I am not trying to be argumentative about topics that I don’t understand.

    I just really don’t understand and my cousin has been lied to even about meat and he isn’t being told about the phosphates in chicken and I am wondering why I am the one telling him to double boil things.

    I don’t understand doctors.

    They don’t put their cards on the table most of the time.

  18. Also, I am pondering that it was lowering refined carbs, which lowered fatty liver.

    Do we know for sure it was the animal products AND the refined carbs, which got rid of the pancreas fat and not just the refined carbs?

    I don’t want to have the scientific understanding wrong, when my Keto friends.

    And, NO, I am not tempted to go back to animal products. I am just pondering that it was the refined carbs, which is what they successfully lowered fatty liver by reducing it.

    I hate that the Keto crowd acts like avoiding refined carbs is their diet when it is most diets.

  19. I have eaten fresh garlic for 30 years,( I’m 72 years old) and I have very good health. Would like your opinion on fresh garlics effect on the body, thank you, Frans

  20. Frans,

    Found a rather good set of responses for you from Biology answers:

    Lactic acid bacteria were found to be more resistant to GP (garlic powder) compared to the clostridial members of the gut microbiota. While for most bacteria the antimicrobial effect was transient, the lactobacilli showed a degree of resistance to garlic, indicating that its consumption may favour the growth of these beneficial bacterial species in the gut. Once the strains of other bacteria (eg: Bacteroides ovatus, Bifidobacterium longum DSMZ 20090 and Clostridium nexile A2-232) became resistant, they retained their resistant phenotype upon sub-culturing. Garlic intake has the potential to temporarily modulate the gut microbiota (reference).

    Overall garlic can prove to be beneficial, because it seems to have more of an effect on detrimental bacteria like Helicobacter pylori (H. pylori), even when its strains were resistant to antibiotics. Overall garlic was found to be more detrimental to pathological bacteria when compared to normal gut flora (reference). Garlic’s diallyl disulfide has also been found to effectively cause cell death in Candida albicans which is a fungus in our gut which if not kept in check can cause health problems (reference).

    Inulin and fructooligosaccharides present in garlic can also serve as nutrients for the probiotics colonizing your body (reference).

    For another take consider the article: Diet and Gut Microbial Function in Metabolic and Cardiovascular Disease Risk where they saw lowering of TMAO, a chemical associated with cardiovascular disease (animal food being the primary cause) and garlic in the gut being beneficial.

    And if your not convinced to keep eating more garlic, see Dr. G’s work at: Garlic .

    Dr. Alan Kadish Health Support volunteer for Dr. Greger

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