Big effect, small budget: low-cost measures for your gut

What demonstrably helps the gut often costs almost nothing: slow breathing, cooled potatoes, potato starch from the supermarket, legumes, psyllium, kiwis, a stool in front of the toilet. An overview of how well each is supported, what it costs and where you can skip expensive detours.

How solid is the research? Promising

Several of these measures are well supported and appear in guidelines, such as psyllium for IBS and constipation or exercise for IBS. Others, such as slow breathing, cooled starch or potato starch, are well understood and harmless, but their benefit for gut symptoms has only been shown in small studies or indirectly.

Healthy state

The gut basically needs little: food for its bacteria, movement, a rhythm of meals and breaks, and a nervous system that lets it work in peace. Almost all of this is available at the supermarket or for free. Fibre from legumes, oats, potatoes and vegetables is among the cheapest food there is, and it is precisely this that feeds the bacteria that make Short-chain fatty acids Acids such as acetate, propionate and butyrate that gut bacteria make from fibre. They nourish the gut wall and act throughout the body. More in the chapter “Butyrate and other short-chain fatty acids” such as Butyrate A short-chain fatty acid and the main energy source for the cells of the colon wall. It strengthens the barrier and dampens inflammation. More in the chapter “Butyrate and other short-chain fatty acids”.

A particularly cheap source is resistant starch. This is starch that the small intestine does not break down and that therefore reaches the colon, where bacteria such as Ruminococcus bromii break it down. It comes in several forms. Raw potato starch, sold in supermarkets as potato flour or starch for thickening, consists largely of it as long as it is not heated. When cooked potatoes, rice or pasta are cooled, part of the starch rearranges and also becomes hard to digest. In one study, the resistant starch content of rice more than doubled when it lay in the fridge for a day after cooking and was then reheated, and blood sugar rose less afterwards.

The nervous system can also be influenced without money. Slow breathing at about six breaths per minute strengthens the activity of the Vagus nerve The tenth cranial nerve and the most important nerve of the rest-and-digest system. It connects the brainstem and the abdominal organs; most of its fibres tell the brain what is happening in the gut. More in the chapter “The vagus nerve: the data line between belly and head” according to a large Meta-analysis An analysis that combines the results of several studies. It is only as good as the studies it includes. , measurable as heart rate variability. Belly breathing trains the diaphragm, which helps close the entrance to the stomach. And regular exercise gets the gut moving mechanically.

Potatoes, legumes, oats, breathing and exercise: what nourishes and calms the gut costs little.

Disrupted state: causes and effects

People with long-standing symptoms often spend a lot of money: on stool tests of the Microbiome, gut microbiota The community of all microbes in the gut, mainly bacteria, plus viruses, fungi and archaea. Most live in the colon. More in the chapter “Building microbial diversity”, supplement combinations, detox cures or special diet products. But expensive does not mean effective. With commercial microbiome tests, measurement quality varies by provider, and a single result hardly allows any treatment to be derived. Many supplement combinations against a “leaky gut” have barely been studied, and some products cause symptoms themselves.

Conversely, simple measures are often underestimated because they are unspectacular. Psyllium husk is in the American guideline for Irritable bowel syndrome Recurring abdominal pain linked to bowel movements, without tests finding another cause. Today it is understood as a disorder of gut–brain interaction. More in the chapter “The gut-brain axis” but costs only a few euros a month. Two kiwis a day worked at least as well as psyllium for constipation in an international study. More exercise eased IBS symptoms in a Randomised trial A study in which chance decides who gets the treatment and who does not, for comparison. This makes results particularly reliable. , and the effect lasted for years.

Cheap does not mean everything works for everyone. Resistant starch and fibre can cause bloating at first, and how much butyrate is produced depends on your own gut microbiota: in a study with 174 adults, potato starch clearly raised butyrate production on average, but barely in some people. In IBS with FODMAP Short for fermentable sugars and sugar alcohols that are poorly absorbed in the small intestine, such as fructans, lactose, fructose and sorbitol. More in the chapter “Doing low-FODMAP right” sensitivity, many tolerate legumes poorly. And none of these measures replaces having warning signs such as blood in the stool, weight loss or night-time symptoms checked.

Expensive tests and products promise a lot, but their benefit is often unproven. More money doesn’t mean more effect.

What often helps

Lifestyle

Diet, exercise, sleep, social contact and dealing with stress.

Slow breathing: free Five minutes a day at about six breaths per minute, that is four to five seconds in and the same out. This measurably strengthens the vagus nerve. Whether it directly eases gut symptoms has not been studied, but as part of stress management it makes sense and carries no risk. More in the chapter on the vagus nerve. Promising How we rate the evidence Established Recommended in medical guidelines or supported by several consistent meta-analyses of randomised human studies. Well supported Several randomised studies in humans with largely consistent results. Promising Single randomised or controlled studies in humans, not yet independently confirmed — or many consistent observational studies. Plausible Two cases: first observational or pilot studies with small samples — or a settled basis that is not in dispute, such as movement, sleep or meal pauses. But not tested in humans for symptoms. Experimental Barely studied in humans. Mainly lab and animal studies or theoretical reasoning; whether it helps is open. [1]
Belly breathing for reflux and belching: free In a small randomised trial, daily belly breathing training improved reflux symptoms and reduced acid reflux. When breathing in, the belly rises, not the chest. Instruction from a physiotherapist or speech therapist helps with learning. Plausible How we rate the evidence Established Recommended in medical guidelines or supported by several consistent meta-analyses of randomised human studies. Well supported Several randomised studies in humans with largely consistent results. Promising Single randomised or controlled studies in humans, not yet independently confirmed — or many consistent observational studies. Plausible Two cases: first observational or pilot studies with small samples — or a settled basis that is not in dispute, such as movement, sleep or meal pauses. But not tested in humans for symptoms. Experimental Barely studied in humans. Mainly lab and animal studies or theoretical reasoning; whether it helps is open. [2]
Let potatoes, rice and pasta cool: free Cooked starch that has been in the fridge for a few hours or overnight contains more resistant starch, even if it is reheated afterwards. Potato salad, leftovers or pre-cooked rice are therefore an easy source of fibre. Cool cooked rice quickly and keep it in the fridge, because germs can multiply in it at room temperature. Plausible How we rate the evidence Established Recommended in medical guidelines or supported by several consistent meta-analyses of randomised human studies. Well supported Several randomised studies in humans with largely consistent results. Promising Single randomised or controlled studies in humans, not yet independently confirmed — or many consistent observational studies. Plausible Two cases: first observational or pilot studies with small samples — or a settled basis that is not in dispute, such as movement, sleep or meal pauses. But not tested in humans for symptoms. Experimental Barely studied in humans. Mainly lab and animal studies or theoretical reasoning; whether it helps is open. [3][4]
Legumes and oats: the cheapest fibre Lentils, beans, chickpeas and oats cost little and provide plenty of fibre. People who reach 25 to 30 grams a day have the lowest risk of many chronic diseases in studies. With a sensitive gut, start with small amounts and increase slowly. Well supported How we rate the evidence Established Recommended in medical guidelines or supported by several consistent meta-analyses of randomised human studies. Well supported Several randomised studies in humans with largely consistent results. Promising Single randomised or controlled studies in humans, not yet independently confirmed — or many consistent observational studies. Plausible Two cases: first observational or pilot studies with small samples — or a settled basis that is not in dispute, such as movement, sleep or meal pauses. But not tested in humans for symptoms. Experimental Barely studied in humans. Mainly lab and animal studies or theoretical reasoning; whether it helps is open. [5]
Two kiwis a day for constipation Two green kiwis daily increased the number of complete bowel movements slightly more than psyllium in an international study and were better tolerated. More in the chapter on constipation. Well supported How we rate the evidence Established Recommended in medical guidelines or supported by several consistent meta-analyses of randomised human studies. Well supported Several randomised studies in humans with largely consistent results. Promising Single randomised or controlled studies in humans, not yet independently confirmed — or many consistent observational studies. Plausible Two cases: first observational or pilot studies with small samples — or a settled basis that is not in dispute, such as movement, sleep or meal pauses. But not tested in humans for symptoms. Experimental Barely studied in humans. Mainly lab and animal studies or theoretical reasoning; whether it helps is open. [6][7]
A walk after eating: free A brisk walk gets the gut moving. In IBS, more exercise improved symptoms in a randomised trial, and the effect lasted for years. It doesn’t have to be sport; regular walking is enough. Well supported How we rate the evidence Established Recommended in medical guidelines or supported by several consistent meta-analyses of randomised human studies. Well supported Several randomised studies in humans with largely consistent results. Promising Single randomised or controlled studies in humans, not yet independently confirmed — or many consistent observational studies. Plausible Two cases: first observational or pilot studies with small samples — or a settled basis that is not in dispute, such as movement, sleep or meal pauses. But not tested in humans for symptoms. Experimental Barely studied in humans. Mainly lab and animal studies or theoretical reasoning; whether it helps is open. [8][9]
A stool in front of the toilet With your feet on a stool, the angle to the rectum becomes straighter. In a study with healthy people, this shortened the time on the toilet and reduced straining. A pile of books or a child’s step works too. Plausible How we rate the evidence Established Recommended in medical guidelines or supported by several consistent meta-analyses of randomised human studies. Well supported Several randomised studies in humans with largely consistent results. Promising Single randomised or controlled studies in humans, not yet independently confirmed — or many consistent observational studies. Plausible Two cases: first observational or pilot studies with small samples — or a settled basis that is not in dispute, such as movement, sleep or meal pauses. But not tested in humans for symptoms. Experimental Barely studied in humans. Mainly lab and animal studies or theoretical reasoning; whether it helps is open. [10]
Ferment it yourself Sauerkraut made from white cabbage and salt costs almost nothing. In one study, fermented foods over ten weeks increased the diversity of the gut microbiota and lowered inflammation markers. How to do it safely is in the chapter on home ferments. Be careful with histamine intolerance. Promising How we rate the evidence Established Recommended in medical guidelines or supported by several consistent meta-analyses of randomised human studies. Well supported Several randomised studies in humans with largely consistent results. Promising Single randomised or controlled studies in humans, not yet independently confirmed — or many consistent observational studies. Plausible Two cases: first observational or pilot studies with small samples — or a settled basis that is not in dispute, such as movement, sleep or meal pauses. But not tested in humans for symptoms. Experimental Barely studied in humans. Mainly lab and animal studies or theoretical reasoning; whether it helps is open. [11]

Natural supplements

Supplements do not replace a medical check-up. Discuss dosage and interactions with your doctor or pharmacist.

Potato starch from the supermarket Raw potato starch is one of the cheapest sources of resistant starch. In studies with a branded product made from raw potato starch, bifidobacteria increased, and in people aged 70 and over butyrate rose slightly. In healthy people it had no measurable effect on symptoms such as bloating or constipation. Important: don’t heat it, stir it cold into yoghurt, water or a smoothie. Start with a teaspoon and increase slowly, otherwise it causes bloating. Plausible How we rate the evidence Established Recommended in medical guidelines or supported by several consistent meta-analyses of randomised human studies. Well supported Several randomised studies in humans with largely consistent results. Promising Single randomised or controlled studies in humans, not yet independently confirmed — or many consistent observational studies. Plausible Two cases: first observational or pilot studies with small samples — or a settled basis that is not in dispute, such as movement, sleep or meal pauses. But not tested in humans for symptoms. Experimental Barely studied in humans. Mainly lab and animal studies or theoretical reasoning; whether it helps is open. [12][13][14]
Psyllium husk: a few euros a month Soluble fibre such as psyllium husk is recommended in the American guideline for IBS and helps with constipation and loose stools. Start with a teaspoon a day and drink enough with it. More in the chapter on slowly fermenting prebiotics. Established How we rate the evidence Established Recommended in medical guidelines or supported by several consistent meta-analyses of randomised human studies. Well supported Several randomised studies in humans with largely consistent results. Promising Single randomised or controlled studies in humans, not yet independently confirmed — or many consistent observational studies. Plausible Two cases: first observational or pilot studies with small samples — or a settled basis that is not in dispute, such as movement, sleep or meal pauses. But not tested in humans for symptoms. Experimental Barely studied in humans. Mainly lab and animal studies or theoretical reasoning; whether it helps is open. [15][7]
Peppermint oil for abdominal cramps Enteric-coated peppermint oil capsules eased abdominal pain in IBS in a meta-analysis. They are much cheaper than many specialty products. They can worsen heartburn. Promising How we rate the evidence Established Recommended in medical guidelines or supported by several consistent meta-analyses of randomised human studies. Well supported Several randomised studies in humans with largely consistent results. Promising Single randomised or controlled studies in humans, not yet independently confirmed — or many consistent observational studies. Plausible Two cases: first observational or pilot studies with small samples — or a settled basis that is not in dispute, such as movement, sleep or meal pauses. But not tested in humans for symptoms. Experimental Barely studied in humans. Mainly lab and animal studies or theoretical reasoning; whether it helps is open. [16]

Medical treatments

Information, not a treatment recommendation. Decide together with a doctor. Approval and availability differ from country to country.

Gut hypnosis by app or audio Gut-directed hypnosis is among the best-supported treatments for IBS. An app or audio programmes are much cheaper than sessions and helped many people in studies, though somewhat less than therapy with a therapist. Some health insurers cover the costs; ask in your country. Well supported How we rate the evidence Established Recommended in medical guidelines or supported by several consistent meta-analyses of randomised human studies. Well supported Several randomised studies in humans with largely consistent results. Promising Single randomised or controlled studies in humans, not yet independently confirmed — or many consistent observational studies. Plausible Two cases: first observational or pilot studies with small samples — or a settled basis that is not in dispute, such as movement, sleep or meal pauses. But not tested in humans for symptoms. Experimental Barely studied in humans. Mainly lab and animal studies or theoretical reasoning; whether it helps is open. [17][18]
Save money on expensive microbiome tests With commercial stool tests of the gut microbiota, measurement quality varies by provider, and guidelines do not recommend them. Targeted tests, often paid for by health insurance, such as calprotectin, a blood count or a coeliac test make more sense when symptoms call for them. Well supported How we rate the evidence Established Recommended in medical guidelines or supported by several consistent meta-analyses of randomised human studies. Well supported Several randomised studies in humans with largely consistent results. Promising Single randomised or controlled studies in humans, not yet independently confirmed — or many consistent observational studies. Plausible Two cases: first observational or pilot studies with small samples — or a settled basis that is not in dispute, such as movement, sleep or meal pauses. But not tested in humans for symptoms. Experimental Barely studied in humans. Mainly lab and animal studies or theoretical reasoning; whether it helps is open. [19]
A diary instead of guesswork A symptom diary and structured test phases cost nothing and often show more than an expensive test, for example whether lactose, coffee or a supplement causes symptoms. Both are available on this site. The diary also helps at the doctor’s. Plausible How we rate the evidence Established Recommended in medical guidelines or supported by several consistent meta-analyses of randomised human studies. Well supported Several randomised studies in humans with largely consistent results. Promising Single randomised or controlled studies in humans, not yet independently confirmed — or many consistent observational studies. Plausible Two cases: first observational or pilot studies with small samples — or a settled basis that is not in dispute, such as movement, sleep or meal pauses. But not tested in humans for symptoms. Experimental Barely studied in humans. Mainly lab and animal studies or theoretical reasoning; whether it helps is open.

In the mood for something completely different? Another one, at random

How we rate the evidence

Trust score 5 of 5:Established: Recommended in medical guidelines or supported by several consistent meta-analyses of randomised human studies.
Trust score 4 of 5:Well supported: Several randomised studies in humans with largely consistent results.
Trust score 3 of 5:Promising: Single randomised or controlled studies in humans, not yet independently confirmed — or many consistent observational studies.
Trust score 2 of 5:Plausible: Two cases: first observational or pilot studies with small samples — or a settled basis that is not in dispute, such as movement, sleep or meal pauses. But not tested in humans for symptoms.
Trust score 1 of 5:Experimental: Barely studied in humans. Mainly lab and animal studies or theoretical reasoning; whether it helps is open.

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