All 885 tips from all chapters, sorted by topic and confidence score. See what is well supported and what is still experimental.
| Topic | Established | Well supported | Promising | Plausible | Experimental |
|---|---|---|---|---|---|
| Gut barrier | 3 | 4 | 13 | 2 | |
| Opportunistic pathogens | 6 | 28 | 12 | 4 | 1 |
| Bacteriophages | 1 | 3 | 2 | ||
| Microbial diversity | 6 | 10 | 21 | 11 | 2 |
| Gut-brain axis | 4 | 14 | 12 | 7 | 1 |
| Digestive function | 18 | 34 | 32 | 8 | |
| Small intestine colonisation | 8 | 11 | 9 | 1 | |
| Immune system and inflammation | 8 | 15 | 16 | 8 | 2 |
| Total | 45 | 113 | 118 | 52 | 9 |
Tap a number to see the tips below. Darker cells contain more tips.
Gut-brain axis · Clear selection
Trust score 5 of 5:Established Medical treatments
IBS is a positive diagnosis: if the pain is related to bowel movements, stool frequency or stool form, has lasted for months and there are no warning signs, no elaborate process of ruling out other conditions is needed. The Rome criteria (since 2026, Rome V) describe exactly this.
Abdominal pain and cramps: where the pain comes from 3 sources
Trust score 5 of 5:Established Medical treatments
Blood or black stool, unintended weight loss, fever, pain that wakes you at night, anaemia, newly appearing symptoms from about age 50 or pain outside the abdomen should be checked by a doctor. With sudden, most severe pain, a hard abdomen, fever and no bowel movement or wind, seek medical help at once. Warning signs are common in the general population and must be seen in context, not one by one.
Abdominal pain and cramps: where the pain comes from 2 sources
Trust score 5 of 5:Established Medical treatments
Unintended weight loss, blood in the stool, fever, night-time symptoms, anaemia or new symptoms from about age 50 are warning signs. They need a doctor, even if you already have an IBS diagnosis.
Fear of food: when your list of safe foods keeps shrinking 2 sources
Trust score 5 of 5:Established Medical treatments
Tricyclic antidepressants in low doses dampen the transmission of pain from the gut. They are used for this even without depression. They do not work immediately and have side effects such as dry mouth and constipation, so they should be medically supervised.
The gut-brain axis 1 sources
Trust score 4 of 5:Well supported Medical treatments
Gut-directed hypnotherapy and cognitive behavioural therapy relieve IBS symptoms. The guideline suggests them even when there is no mental illness.
A gut-friendly everyday life 1 sources
Trust score 4 of 5:Well supported Medical treatments
Gut-directed hypnosis, cognitive behavioural therapy and low-dose older antidepressants raise the pain threshold. In a network meta-analysis of 68 studies, tricyclic antidepressants and psychotherapeutic approaches in particular were effective. These drugs and methods belong under medical supervision.
Abdominal pain and cramps: where the pain comes from 3 sources
Trust score 4 of 5:Well supported Medical treatments
Useful with persistent fatigue: full blood count, ferritin (together with CRP, because inflammation raises ferritin), vitamin B12, the thyroid value TSH and a coeliac test (tissue transglutaminase antibodies with total IgA), while you are still eating gluten normally. With known gut inflammation, inflammation markers as well.
Brain fog and fatigue: when your gut makes your head tired 3 sources
Trust score 4 of 5:Well supported Medical treatments
Get these checked promptly: unintended weight loss, blood in the stool, fever, night-time symptoms, anaemia, new symptoms after 50, or confusion, unsteady gait, numbness or speech problems. Brain fog with such signs is not a case for self-experiments.
Brain fog and fatigue: when your gut makes your head tired 1 sources
Trust score 4 of 5:Well supported Medical treatments
Cognitive behavioural therapy and gut-directed hypnotherapy relieve IBS symptoms in randomised trials and also reduce fear of symptoms. They do not mean the symptoms are "imagined"; they act on the gut-brain axis.
Fear of food: when your list of safe foods keeps shrinking 2 sources
Trust score 4 of 5:Well supported Medical treatments
If IBS does not respond well enough to diet and first-line medicines, ask about gut-directed hypnotherapy: usually six to twelve sessions, individually, in a group or by video. Look for training specifically in gut-directed hypnotherapy. Whether costs are covered varies by country.
Gut-directed hypnotherapy and psychological therapy: treatment via the gut-brain axis 4 sources
Trust score 4 of 5:Well supported Medical treatments
CBT tailored to IBS, face to face, by telephone or online. In ACTIB, telephone CBT still improved symptoms after two years. In some countries there are apps that doctors can prescribe for this.
Gut-directed hypnotherapy and psychological therapy: treatment via the gut-brain axis 4 sources
Trust score 4 of 5:Well supported Medical treatments
If symptoms are new or atypical or warning signs such as blood in the stool, weight loss or night-time symptoms are present, see a doctor first. Psychotherapy is meant for IBS, not for unexplained symptoms.
Gut-directed hypnotherapy and psychological therapy: treatment via the gut-brain axis 1 sources
Trust score 4 of 5:Well supported Medical treatments
There are alternatives of similar strength: relaxation methods, other psychotherapies, or low-dose antidepressants for pain under medical supervision. The aim is to find something you can keep up.
Gut-directed hypnotherapy and psychological therapy: treatment via the gut-brain axis 1 sources
Trust score 4 of 5:Well supported Medical treatments
With ongoing strain, psychotherapy is not a weakness but an effective treatment, for the gut too. In IBS, a meta-analysis of 53 studies showed benefit for cognitive behavioural therapy, relaxation methods and hypnosis.
Stress, sleep and the gut 2 sources
Trust score 4 of 5:Well supported Medical treatments
Blood in the stool, unintended weight loss, symptoms that wake you at night, fever or iron deficiency need a medical check, even when life is busy.
Stress, sleep and the gut 1 sources
Trust score 4 of 5:Well supported Medical treatments
Gut-directed hypnosis and cognitive behavioural therapy often ease IBS symptoms lastingly. A meta-analysis of 53 studies found benefit. In some countries there are also apps that doctors can prescribe.
The gut-brain axis 2 sources
Trust score 4 of 5:Well supported Medical treatments
IBS is diagnosed from the symptoms, but other conditions such as coeliac disease or chronic bowel inflammation should be ruled out when there are suggestive signs. Warning signs such as blood in the stool, weight loss, symptoms that wake you from sleep or onset after age 50 need prompt checking.
The gut-brain axis 1 sources
Trust score 4 of 5:Well supported Medical treatments
Depending on the symptom pattern there are medicines for cramps, diarrhoea or constipation, and choosing them belongs in a doctor's hands. They complement work on the gut-brain axis but do not replace it.
The gut-brain axis 1 sources
Trust score 3 of 5:Promising Medical treatments
If you sleep badly for a long time, have causes such as sleep apnoea, restless legs or depression checked. Better sleep often eases gut symptoms too, and that is a route of treatment in its own right.
A gut-friendly everyday life 1 sources
Trust score 3 of 5:Promising Medical treatments
Drugs such as mebeverine or otilonium relax the gut muscle and are part of the basic treatment for IBS. The effect is limited, and approval and availability differ from country to country. They are usually prescribed; ask at a practice in your country.
Abdominal pain and cramps: where the pain comes from 2 sources
Trust score 3 of 5:Promising Medical treatments
With severe period pain, pain during bowel movements or sex, and symptoms that come and go with the cycle, think of endometriosis. Women with endometriosis are diagnosed with IBS about three times as often. A gynaecological assessment is worth having.
Abdominal pain and cramps: where the pain comes from 2 sources
Trust score 3 of 5:Promising Medical treatments
In Crohn's disease and ulcerative colitis, fatigue is much more common during a flare than in remission. Well-controlled treatment of the inflammation is therefore often also a treatment for tiredness. If tiredness persists in remission, look at iron, sleep and mood.
Brain fog and fatigue: when your gut makes your head tired 2 sources
Trust score 3 of 5:Promising Medical treatments
A dietitian experienced with gut symptoms helps keep diets short and targeted and then widen them again. Tell them if you have ever had an eating disorder or feel afraid of eating.
Fear of food: when your list of safe foods keeps shrinking 2 sources
Trust score 3 of 5:Promising Medical treatments
The first port of call is your GP or a gastroenterologist. Many countries have advice services and helplines for eating disorders, including anonymous ones. If you faint, have a racing heart, severe weakness or are losing weight very fast, seek medical help immediately.
Fear of food: when your list of safe foods keeps shrinking no source of its own, score based on judgement
Trust score 3 of 5:Promising Medical treatments
If abdominal pain and bowel symptoms clearly come and go with the period, or if severe period pain, pain on passing stool or pain during sex are added, ask a gynaecologist about endometriosis. Blood in the stool with the period also needs checking.
Hormones, the cycle and the gut 2 sources
Trust score 3 of 5:Promising Medical treatments
With new constipation or new diarrhoea together with tiredness, feeling cold or a racing heart, a thyroid blood test makes sense.
Hormones, the cycle and the gut 1 sources
Trust score 3 of 5:Promising Medical treatments
As far as we know, the same approaches help as in other people with functional symptoms: testing for Helicobacter, acid blockers for a few weeks, constipation treatments, low-dose neuromodulators and gut-directed psychotherapy. There are hardly any studies specific to hEDS or POTS, but specialists recommend following these guidelines.
POTS and hypermobility: when circulation and connective tissue drag the gut along 3 sources
Trust score 3 of 5:Promising Medical treatments
Diagnosis relies on a standing or tilt-table test with heart rate and blood pressure measurements. Specialists recommend also ruling out conditions that mimic POTS, such as anaemia, an overactive thyroid, dehydration or medications.
POTS and hypermobility: when circulation and connective tissue drag the gut along 2 sources
Trust score 3 of 5:Promising Medical treatments
Many people take several drugs at once. Opioids slow the stomach and gut considerably and worsen nausea and constipation; some drugs for pain, nausea or circulation also affect the belly. Reviewing the list together is worth it.
POTS and hypermobility: when circulation and connective tissue drag the gut along 1 sources
Trust score 3 of 5:Promising Medical treatments
If you have slept badly for more than a few weeks, have causes checked: sleep apnoea (breathing pauses at night, which also promote reflux), restless legs, depression or anxiety, thyroid, medicines. For persistent insomnia, a specific form of behavioural therapy is the usual first choice, often available online.
Stress, sleep and the gut no source of its own, score based on judgement
Trust score 2 of 5:Plausible Medical treatments
A specially developed therapy over about 20 to 30 sessions: feared foods are practised again in small steps. In a study of 94 people, those afraid of the consequences of eating reached remission almost three times as often as others. Studies with a control group are still missing.
Fear of food: when your list of safe foods keeps shrinking 2 sources
Trust score 2 of 5:Plausible Medical treatments
Painkillers such as ibuprofen relieve period pain but can damage the stomach and gut. Take them with food, at the lowest dose and only for a short time. Not with a history of stomach ulcers, kidney disease, blood thinners or during pregnancy; in those cases, check with a doctor first.
Hormones, the cycle and the gut 1 sources
Trust score 2 of 5:Plausible Medical treatments
If constipation, bloating or sleep problems are new during the menopause, raise them with a gynaecologist or family doctor. Whether hormone treatment affects the gut is little studied; the decision depends on other symptoms and your history.
Hormones, the cycle and the gut 1 sources
Trust score 2 of 5:Plausible Medical treatments
If nausea and vomiting dominate, measuring gastric emptying can make sense (see the gastroparesis chapter). Breath tests for small intestinal bacterial overgrowth, on the other hand, were never positive in hEDS in one clinic; they rarely help with typical functional symptoms.
POTS and hypermobility: when circulation and connective tissue drag the gut along 2 sources
Trust score 2 of 5:Plausible Medical treatments
A branch of the vagus reaches the skin of the outer ear. In a study of 40 people with constipation-predominant IBS, four weeks of ear stimulation improved constipation and abdominal pain more than sham stimulation. In adolescents with abdominal pain, a device that stimulates nerves at the ear also worked better than sham. Both are single studies; devices from the internet have not been tested by them.
The vagus nerve: the data line between belly and head 2 sources
Trust score 2 of 5:Plausible Medical treatments
It is used for epilepsy and depression, and there are first small studies in Crohn's disease and rheumatoid arthritis. For gut diseases it is not yet a standard treatment. If you are interested, ask a specialist centre about studies.
The vagus nerve: the data line between belly and head 2 sources
Trust score 2 of 5:Plausible Medical treatments
Watches and apps show heart rate variability as a “vagus score”. It varies with age, sleep, exercise, alcohol and measuring conditions. In IBS it hardly differs from healthy people on average. As a personal trend it can be interesting, but it is not a diagnosis.
The vagus nerve: the data line between belly and head 1 sources
Trust score 1 of 5:Experimental Medical treatments
These paid programmes lack independent, controlled studies with few dropouts, and for gut symptoms there are none at all. If you are looking for the "calm the nervous system" approach, you will find it tested in gut-directed hypnotherapy and CBT.
Gut-directed hypnotherapy and psychological therapy: treatment via the gut-brain axis 2 sources