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Evidence map

All 885 tips from all chapters, sorted by topic and confidence score. See what is well supported and what is still experimental.

Number of tips per topic and confidence score
Topic Established Well supported Promising Plausible Experimental
Gut barrier314132
Opportunistic pathogens11110171
Bacteriophages113
Microbial diversity1829412
Gut-brain axis11924
Digestive function392546
Small intestine colonisation3811
Immune system and inflammation252123
Total7411271758

Tap a number to see the tips below. Darker cells contain more tips.

44 tips

Gut-brain axis · Clear selection

Gut-brain axis

44 tips – expand

  • Trust score 4 of 5:Well supported Lifestyle

    Breathe slowly, a few minutes a day

    A meta-analysis of more than 200 studies found that slow breathing, around six breaths per minute, increases vagus-controlled heart rate variability, during the exercise, directly afterwards and after several weeks of practice. It is cheap and has almost no side effects. Whether it relieves gut symptoms has not been studied directly, but it makes sense as part of stress management.

    The vagus nerve: the data line between belly and head 1 sources

  • Trust score 3 of 5:Promising Lifestyle

    Take the urge to go seriously

    In the morning after breakfast and coffee the gastrocolic reflex is strongest: plan time for it and give in to the urge instead of suppressing it. A routine forms after a few weeks.

    A gut-friendly everyday life no source of its own, score based on judgement

  • Trust score 3 of 5:Promising Lifestyle

    Warmth on the belly

    A hot-water bottle, a heat pack or a warming patch relaxes the muscle and can ease the pain. Superficial warmth has mainly been studied for period pain, where it performed about as well as painkillers in individual studies.

    Abdominal pain and cramps: where the pain comes from 1 sources

  • Trust score 3 of 5:Promising Lifestyle

    Stay active

    Regular, moderate exercise improved IBS symptoms in a meta-analysis of 10 studies with 437 people. There is no single recommended programme; walking, cycling or swimming are enough.

    Abdominal pain and cramps: where the pain comes from 1 sources

  • Trust score 3 of 5:Promising Lifestyle

    Soften the stool when pain comes from constipation

    When hard stool stretches the gut, more fluid and soluble fibre such as psyllium husk help first. The constipation guideline recommends them; increase slowly and drink enough with them.

    Abdominal pain and cramps: where the pain comes from 1 sources

  • Trust score 3 of 5:Promising Lifestyle

    Turn stress down

    Stress increases how strongly pain is felt in the belly. Breathing and relaxation exercises, breaks and good sleep are no substitute for treatment, but they raise the pain threshold again. With persistent symptoms, gut-directed methods often help further.

    Abdominal pain and cramps: where the pain comes from 1 sources

  • Trust score 3 of 5:Promising Lifestyle

    Sleep first

    Regular times, a dark, cool room, nothing heavy late in the evening. Sleep disorders are common in IBS; whether treating them eases brain fog has not been studied specifically. If you wake at night because of abdominal pain or diarrhoea, tell your doctor, because night-time symptoms are a warning sign.

    Brain fog and fatigue: when your gut makes your head tired 1 sources

  • Trust score 3 of 5:Promising Lifestyle

    Exercise in small steps

    In inflammatory bowel disease, non-drug approaches such as exercise programmes and behavioural therapy eased fatigue somewhat in a meta-analysis. Build up slowly. If you are clearly worse for days after exertion, get this checked instead of pushing through.

    Brain fog and fatigue: when your gut makes your head tired 1 sources

  • Trust score 3 of 5:Promising Lifestyle

    Bring back one food at a time

    Start with something you used to tolerate, in a small amount, on a calm day. Increase the amount over a few days and note how it goes. A little gas or rumbling is normal and not proof of an intolerance.

    Fear of food: when your list of safe foods keeps shrinking 1 sources

  • Trust score 3 of 5:Promising Lifestyle

    Know your own warning signs

    Your list of safe foods keeps getting shorter, you avoid eating with others, your thoughts keep circling around food, your weight drops, you feel dizzy or your period stops. Then it is time to get help, not to cut out something else.

    Fear of food: when your list of safe foods keeps shrinking 2 sources

  • Trust score 3 of 5:Promising Lifestyle

    Self-help based on CBT principles

    In ACTIB, a web programme with little support was more effective than usual care after one year; after two years the benefit for symptoms was no longer certain. Books and programmes based on CBT principles are a good start when therapy places are scarce.

    Gut-directed hypnotherapy and psychological therapy: treatment via the gut-brain axis 2 sources

  • Trust score 3 of 5:Promising Lifestyle

    A hypnotherapy app as a start

    A tested app with gut-directed hypnotherapy is cheaper and available straight away. In trials it worked better than comparison programmes, but probably somewhat less well than a therapist. Daily practice over several weeks is what counts.

    Gut-directed hypnotherapy and psychological therapy: treatment via the gut-brain axis 2 sources

  • Trust score 3 of 5:Promising Lifestyle

    Relaxation methods to practise

    Progressive muscle relaxation, breathing exercises and similar methods were among the therapies with benefit in IBS in the meta-analysis. They are a bridge while you wait for a therapy place, and they complement hypnosis and CBT.

    Gut-directed hypnotherapy and psychological therapy: treatment via the gut-brain axis 1 sources

  • Trust score 3 of 5:Promising Lifestyle

    In pregnancy: drink, move, fibre

    Against the common constipation, start with enough fluids, movement and fibre. Use remedies only after consulting your midwife or doctor.

    Hormones, the cycle and the gut 1 sources

  • Trust score 3 of 5:Promising Lifestyle

    More fluid and salt, but only after talking to your doctor

    In POTS, professional societies often recommend more fluid and more salt so that more blood stays in circulation. How much should be decided by your doctor: with high blood pressure, heart or kidney disease, extra salt can do harm. For the belly: large amounts at once can worsen nausea and fullness, small sips across the day are usually better tolerated.

    POTS and hypermobility: when circulation and connective tissue drag the gut along 2 sources

  • Trust score 3 of 5:Promising Lifestyle

    Exercise that starts lying down

    In small studies, a three-month endurance programme that began lying down (rowing machine, recumbent bike, swimming) and was increased slowly improved standing heart rate and quality of life. About half no longer met the POTS criteria afterwards. Training can briefly worsen symptoms at first, so start small and build up slowly.

    POTS and hypermobility: when circulation and connective tissue drag the gut along 2 sources

  • Trust score 3 of 5:Promising Lifestyle

    Breathe slowly before sleep

    Calm breathing with a longer out-breath raised heart rate variability in a meta-analysis, a measure of the parasympathetic system becoming more active. Whether this directly eases gut symptoms is less well studied. As an exercise in a stressful moment or before sleep it is risk-free, though.

    Stress, sleep and the gut 1 sources

  • Trust score 3 of 5:Promising Lifestyle

    Movement during the day

    Regular exercise reduces tension and helped in IBS in a randomised study. Very intense training late in the evening, on the other hand, can make falling asleep harder.

    Stress, sleep and the gut 1 sources

  • Trust score 3 of 5:Promising Lifestyle

    Exercise

    Regular moderate exercise eases symptoms in IBS in studies. Everyday movement counts too; what matters is regularity.

    The gut-brain axis 1 sources

  • Trust score 3 of 5:Promising Lifestyle

    Reduce avoidance step by step

    If you avoid food, travel or meetings out of fear of your belly, you keep the filter sensitive. In behavioural therapy for IBS you practise doing these things again in small steps. You can start on your own, with the easiest situation first.

    The gut-brain axis 1 sources

  • Trust score 2 of 5:Plausible Lifestyle

    Daily exercise

    A brisk walk or cycling stimulates gut activity. In one study, just a few weeks of endurance training measurably changed the gut microbiota. What counts is regularity; with a sensitive gut, moderate effort is often better tolerated than very hard sessions.

    A gut-friendly everyday life 1 sources

  • Trust score 2 of 5:Plausible Lifestyle

    Regular sleep times

    The gut follows a daily rhythm. Regular sleep and meal times help it keep this rhythm. Do not eat dinner too late or too heavy, so that the cleansing wave can work at night.

    A gut-friendly everyday life 1 sources

  • Trust score 2 of 5:Plausible Lifestyle

    Human closeness

    People who spend a lot of time together share gut bacteria, even outside the family. Whether that makes you healthier is open, but it shows how social the microbiome is.

    A gut-friendly everyday life 1 sources

  • Trust score 2 of 5:Plausible Lifestyle

    Eat calmly

    Eat slowly, chew well and leave three to four hours between meals. Put the screen away and take two or three breaths before the first bite so that the cephalic phase can work.

    A gut-friendly everyday life 2 sources

  • Trust score 2 of 5:Plausible Lifestyle

    Small islands of relaxation

    Breathing exercises with a long exhale, walks, singing or conversation activate the brake of the autonomic nervous system. Two to three minutes before or between meals are enough to start; more in the chapter on the vagus nerve.

    A gut-friendly everyday life no source of its own, score based on judgement

  • Trust score 2 of 5:Plausible Lifestyle

    Eat calmly and at regular times

    Several smaller meals instead of a few large ones, chew slowly, do not eat right before bed. This is practical experience and not tested in large studies, but it often helps with fullness and cramps.

    Abdominal pain and cramps: where the pain comes from no source of its own, score based on judgement

  • Trust score 2 of 5:Plausible Lifestyle

    A diary instead of guesswork

    For two to four weeks, note brain fog, sleep, food, stress and gut symptoms. This shows whether the fog coincides with certain meals, bad nights or flares. It does not replace tests, but it makes the conversation with your doctor much more concrete.

    Brain fog and fatigue: when your gut makes your head tired no source of its own, score based on judgement

  • Trust score 2 of 5:Plausible Lifestyle

    Enough first, then variety

    Regular meals, even with the foods that feel safe right now. Once the amount is right again, add variety step by step. An empty stomach often does not make tummy trouble better.

    Fear of food: when your list of safe foods keeps shrinking no source of its own, score based on judgement

  • Trust score 2 of 5:Plausible Lifestyle

    Avoid forbidden-food lists from the internet

    Protocols with long lists of "forbidden" foods are usually untested. If you already avoid a lot, don't add another list; work out with professionals what is really necessary.

    Fear of food: when your list of safe foods keeps shrinking 2 sources

  • Trust score 2 of 5:Plausible Lifestyle

    Note your cycle in the diary

    Tick “Period” in the symptom diary. After two to three cycles you can see whether your symptoms follow a pattern. This also helps when talking to your doctor.

    Hormones, the cycle and the gut 1 sources

  • Trust score 2 of 5:Plausible Lifestyle

    Prevent around your period

    In the days before, watch out for gassy foods, alcohol and very fatty food; use warmth on the belly and gentle movement. This is experience, not tested in studies.

    Hormones, the cycle and the gut no source of its own, score based on judgement

  • Trust score 2 of 5:Plausible Lifestyle

    Note stool form with the Bristol scale

    Types 3 and 4 are considered ideal, types 1 to 2 constipation, types 6 to 7 diarrhoea. If you record stool form in the diary, you see whether it shifts in time with the cycle and can show your doctor concrete data.

    Hormones, the cycle and the gut no source of its own, score based on judgement

  • Trust score 2 of 5:Plausible Lifestyle

    Counteract in the second half of the cycle

    If you then tend to constipation and bloating: drink enough, move daily, increase fibre slowly and give the morning urge time. This is plausible but has not been studied specifically for the cycle.

    Hormones, the cycle and the gut 1 sources

  • Trust score 2 of 5:Plausible Lifestyle

    Physiotherapy for joints and pelvic floor

    In hypermobility there are hints that exercises for strength and body awareness help; the evidence is small. If you have to strain hard with constipation, think of a pelvic floor evacuation disorder. It was common in EDS and responds well to biofeedback (see the pelvic floor chapter).

    POTS and hypermobility: when circulation and connective tissue drag the gut along 2 sources

  • Trust score 2 of 5:Plausible Lifestyle

    Smaller meals instead of ever stricter diets

    Several small meals are often tolerated better than a few large ones when fullness is a problem. Cutting out more and more foods risks nutrient deficiencies and an eating disorder. With weight loss, or if eating is ruled by fear, a dietitian is worthwhile, and before anyone considers feeding tubes.

    POTS and hypermobility: when circulation and connective tissue drag the gut along 2 sources

  • Trust score 2 of 5:Plausible Lifestyle

    Regular sleep and meal times

    Support the gut's internal clock. Ideally eat dinner two to three hours before sleep, and avoid late, heavy meals. Leave breaks between meals so the cleaning wave in the small intestine can run.

    Stress, sleep and the gut 1 sources

  • Trust score 2 of 5:Plausible Lifestyle

    Build in relief every day

    Breathing out slowly, going for walks, spending time with people who do you good. Regularity matters more than the method. Small breaks several times a day work better than one big break at the weekend.

    Stress, sleep and the gut no source of its own, score based on judgement

  • Trust score 2 of 5:Plausible Lifestyle

    Light in the morning, dim in the evening

    Daylight in the morning sets the central clock. Dim light in the evening and less screen time help you fall asleep. If you work shifts, keep mealtimes as constant as possible and eat only light food at night.

    Stress, sleep and the gut 1 sources

  • Trust score 2 of 5:Plausible Lifestyle

    Keep an eye on caffeine and alcohol

    Caffeine stays in the body for many hours and can disturb sleep and stimulate gut movement. Alcohol makes you sleepy but disrupts the second half of the night and irritates stomach and gut. Try caffeine only in the morning and no alcohol in the evening for two weeks and watch what changes.

    Stress, sleep and the gut no source of its own, score based on judgement

  • Trust score 2 of 5:Plausible Lifestyle

    Regular relaxation

    Breathing exercises and walks dampen the stress response. For yoga in IBS, a meta-analysis of 11 small studies has so far found no clear benefit. Find something you will really keep doing.

    The gut-brain axis 1 sources

  • Trust score 2 of 5:Plausible Lifestyle

    Diaphragmatic breathing instead of pulling the belly in

    Breathing deep into the belly and letting the abdominal wall relax on the in-breath can reduce tension and the feeling of being bloated. For people who tense the belly unconsciously, targeted training with feedback also helps. The evidence for this concerns mainly bloating.

    The gut-brain axis 1 sources

  • Trust score 2 of 5:Plausible Lifestyle

    Diary instead of constant checking

    A few weeks of writing down symptoms, stress and food shows patterns. After that, deliberately stop listening to your belly all day; constant monitoring amplifies signals.

    The gut-brain axis no source of its own, score based on judgement

  • Trust score 2 of 5:Plausible Lifestyle

    Belly breathing for reflux

    In a small study of 19 people with reflux, four weeks of belly breathing training improved acid measurements, quality of life and the need for acid blockers. The effect probably works via the diaphragm, which helps close the stomach entrance. Small, but harmless.

    The vagus nerve: the data line between belly and head 1 sources

  • Trust score 2 of 5:Plausible Lifestyle

    Eat in peace

    Digestion begins in the head, and the vagus is its start signal. Meals without screens or rush, thorough chewing and a break afterwards give the rest nerve room. This is based on physiology, not on a dedicated study of gut symptoms.

    The vagus nerve: the data line between belly and head 1 sources