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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 barrier3145
Opportunistic pathogens139510
Bacteriophages22
Microbial diversity2412135
Gut-brain axis3572
Digestive function1814109
Small intestine colonisation11273
Immune system and inflammation15147
Total520507243

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

27 tips

Immune system and inflammation · Clear selection

Immune system and inflammation

27 tips – expand

  • Trust score 4 of 5:Well supported Natural supplements

    Correct deficiencies in a targeted way

    Have iron, vitamin B12, folate and vitamin D checked regularly. With active inflammation or severe anaemia, the European guideline often recommends iron as an infusion, because tablets are then absorbed and tolerated less well. After surgery on the end of the small intestine, vitamin B12 injections are often needed long term.

    Crohn’s disease and ulcerative colitis: understanding inflammatory bowel disease 1 sources

  • Trust score 3 of 5:Promising Natural supplements

    Vitamin D: a small protection, shown from age 50

    In the large VITAL trial with almost 26,000 men aged 50 and over and women aged 55 and over, 22 percent fewer people developed a new autoimmune disease with vitamin D than with placebo. The result was just significant; omega-3 alone did not help clearly. Correcting a deficiency makes sense, high doses without a blood test do not.

    Autoimmune diseases and the gut: Hashimoto's, vitiligo, type 1 diabetes and more 1 sources

  • Trust score 3 of 5:Promising Natural supplements

    Selenium in Hashimoto's: lowers antibodies, benefit for wellbeing unclear

    A meta-analysis of 32 randomised trials found that selenium lowers TPO antibodies and, in people not taking hormone tablets, slightly lowers TSH as well. Whether people feel better was inconsistent, and whether lower antibodies change the course of the disease has not been shown. Too much selenium is harmful, so do not take high doses long term and discuss it with your doctor.

    Autoimmune diseases and the gut: Hashimoto's, vitiligo, type 1 diabetes and more 1 sources

  • Trust score 3 of 5:Promising Natural supplements

    In ulcerative colitis: E. coli Nissle for maintenance

    A particular Escherichia coli strain (Nissle 1917) prevented relapses for a year about as well as mesalazine, the standard drug, in a study with 327 people with ulcerative colitis. Some countries approve it as a medicine; ask in your country. In Crohn’s disease, probiotics have shown no benefit in studies.

    Crohn’s disease and ulcerative colitis: understanding inflammatory bowel disease 2 sources

  • Trust score 3 of 5:Promising Natural supplements

    Vitamin A only for a deficiency

    For a proven deficiency or in regions where deficiency is common, vitamin A is well supported. With a normal diet, an extra supplement brings nothing for the gut's defences according to current knowledge, but it can do harm. The upper limit for adults is 3000 micrograms of preformed vitamin A a day; in pregnancy only after consulting a doctor.

    IgA: the antibody that keeps the gut clean, and what vitamin A, D and omega-3 have to do with it 2 sources

  • Trust score 3 of 5:Promising Natural supplements

    For pain outside the belly

    Most studies are on nerve and joint pain. On average the benefit was moderate, and the trials were small and varied. Here too: set a goal and take stock after a few weeks.

    PEA (palmitoylethanolamide): the body's own inflammation brake in a capsule 2 sources

  • Trust score 2 of 5:Plausible Natural supplements

    Probiotics in pregnancy and breastfeeding

    The World Allergy Organization suggests probiotics for pregnant women, breastfeeding mothers and infants at high risk of allergy, mainly to prevent eczema. The recommendation is conditional and the evidence very uncertain; which strains are best is open. Probiotics do not cure an existing allergy.

    Allergies and intolerances: how the gut learns to tolerate food 1 sources

  • Trust score 2 of 5:Plausible Natural supplements

    In ulcerative colitis: curcumin as an add-on

    In a meta-analysis of six small studies, twice as many people reached remission with curcumin in addition to mesalazine. The studies are small, the products varied, and healing of the lining was not reliably shown. Only as an add-on and after discussion, not as a replacement.

    Crohn’s disease and ulcerative colitis: understanding inflammatory bowel disease 2 sources

  • Trust score 2 of 5:Plausible Natural supplements

    DAO capsules with histamine-rich meals

    Taken shortly before eating, they are meant to break down histamine in the gut. In a controlled trial with 100 migraine patients they shortened attacks by 1.4 hours, placebo by 0.9 hours. Smaller studies without a control group report fewer symptoms. Well tolerated.

    DAO: the enzyme that intercepts histamine from food 2 sources

  • Trust score 2 of 5:Plausible Natural supplements

    Do not take copper and the like on suspicion

    Because DAO needs copper, copper is often named as the solution. A deficiency is rare, too much copper does harm, and in the storage disease Wilson’s disease it is dangerous. High zinc doses can also displace copper. Have it measured first, then decide.

    DAO: the enzyme that intercepts histamine from food no source of its own, score based on judgement

  • Trust score 2 of 5:Plausible Natural supplements

    Omega-3 fatty acids

    Oily fish twice a week is the easiest way. Supplements only after consultation, especially if you take blood thinners. If you do not eat fish, algae oil is an alternative; whether capsules lower inflammation in the gut is not well established for gut diseases.

    Eating against silent inflammation no source of its own, score based on judgement

  • Trust score 2 of 5:Plausible Natural supplements

    DAO capsules

    In a controlled study with 100 migraine patients, DAO capsules shortened attacks slightly more than placebo; smaller studies without a comparison group report fewer symptoms. Many people affected report that the capsules clearly help with individual histamine-rich meals. A benefit is therefore possible, but small in studies. More in the chapter on DAO.

    Histamine intolerance: much searched, little proven 1 sources

  • Trust score 2 of 5:Plausible Natural supplements

    Omega-3: interesting, but not proven for IgA

    In small studies, omega-3 fatty acids change the composition of the gut flora, for example more butyrate producers. Whether this affects IgA production has not been studied. Oily fish once or twice a week is a sensible approach; a capsule specifically for IgA is not.

    IgA: the antibody that keeps the gut clean, and what vitamin A, D and omega-3 have to do with it 1 sources

  • Trust score 2 of 5:Plausible Natural supplements

    Vitamin D

    In meta-analyses, vitamin D somewhat improved IBS symptoms, but the studies were small and very different. Useful mainly if a deficiency has been confirmed.

    Immune system and inflammation 1 sources

  • Trust score 2 of 5:Plausible Natural supplements

    Omega-3 fatty acids

    They help regulate inflammation. For gut symptoms the effects are inconsistent.

    Immune system and inflammation no source of its own, score based on judgement

  • Trust score 2 of 5:Plausible Natural supplements

    For IBS abdominal pain: a cautious trial

    Two small studies with PEA plus polydatin suggest less abdominal pain, more clearly in children than in adults. The combination was tested, not PEA alone, and independent confirmation is missing. If you try it, talk to your doctor, especially for children.

    PEA (palmitoylethanolamide): the body's own inflammation brake in a capsule 3 sources

  • Trust score 2 of 5:Plausible Natural supplements

    Mind the amount and duration of products

    Many products contain clearly more than the 350 mg a day that a Danish authority considered shown safe for healthy adults. That does not mean more is harmful, but it is simply little studied, especially over months. Better avoid it in pregnancy and breastfeeding. Whether micronised is better has not been tested in humans.

    PEA (palmitoylethanolamide): the body's own inflammation brake in a capsule 2 sources

  • Trust score 2 of 5:Plausible Natural supplements

    Probiotics for eczema: little benefit

    According to the Cochrane review, the probiotics tested so far probably make little difference to existing eczema. Money and hope are better spent on good skin care and treatment.

    Skin and gut: what there is to the gut-skin axis 1 sources

  • Trust score 2 of 5:Plausible Natural supplements

    Probiotics for acne: small studies

    Three double-blind trials with a total of 231 people suggest slightly fewer inflamed spots, with great uncertainty. Usually well tolerated as an add-on, but no replacement for dermatological treatment.

    Skin and gut: what there is to the gut-skin axis 1 sources

  • Trust score 1 of 5:Experimental Natural supplements

    Probiotics: no evidence yet against autoimmune disease

    Research is looking for bacteria that calm the immune system. So far there is no capsule that has been shown to prevent or improve an autoimmune disease. If you take probiotics for other reasons you can do so, but do not expect an effect on the autoimmune disease.

    Autoimmune diseases and the gut: Hashimoto's, vitiligo, type 1 diabetes and more 2 sources

  • Trust score 1 of 5:Experimental Natural supplements

    DAO from legume sprouts

    Sprouts of peas, lentils and chickpeas contain plant DAO; germination raises activity up to 250-fold. Only studied in the lab so far. Yeasts and mould can grow during sprouting, so pay attention to hygiene.

    DAO: the enzyme that intercepts histamine from food 2 sources

  • Trust score 1 of 5:Experimental Natural supplements

    There is no capsule of "dog dust bacteria"

    Lactobacillus johnsonii protected mice against allergic reactions of the airways. No product reproduces the effect of a dog in the home in humans, and nothing like it has been tested. If a product claims this, it is marketing, not a finding.

    Dogs and cats: what pets do to your gut, immune system and nerves 1 sources

  • Trust score 1 of 5:Experimental Natural supplements

    No substitute from the supplement shelf

    There is no over-the-counter product that works like LDN. “No prescription” offers online are risky because content and dose are not controlled.

    Low-dose naltrexone (LDN): hope, studies and limits no source of its own, score based on judgement

  • Trust score 1 of 5:Experimental Natural supplements

    Quercetin, vitamin C and co.

    These substances are often sold as “mast cell stabilisers”. There are lab experiments for this, but no good studies in people with gut symptoms. If you try them, treat it as a trial with a fixed end.

    Mast cells: alarm cells in the gut, histamine and the disputed MCAS no source of its own, score based on judgement

  • Trust score 1 of 5:Experimental Natural supplements

    For mast cell and histamine complaints: lab evidence only

    That PEA calms mast cells has been shown in cells and animals, but not studied in people with mast cell activation or histamine intolerance. A trial here is an experiment, not a proven path.

    PEA (palmitoylethanolamide): the body's own inflammation brake in a capsule 1 sources