Low FODMAP diet
A short restriction of fermentable carbohydrates followed by staged reintroduction; ACG, BSG, and NICE support a supervised trial, with the evidence graded very low quality.
Treatments
19 approaches, four categories
Each hub starts with what the major guidelines say, then collects the research, trials, news, and stories we have tagged to it. Nothing here is a recommendation.
Diet
What you eat is the first lever most clinicians reach for, and the one with the longest trial record.
Gluten-free diet
Removing wheat, barley, and rye gluten; BSG advises against it for IBS on very-low-quality evidence, and blinded challenge studies point to fructans rather than gluten as the usual trigger.
Supplements
Over-the-counter products with human trials behind them, and a few that have none yet.
Peppermint oil
An enteric-coated herbal antispasmodic; ACG conditionally suggests it and BSG grades it weak, with pooled trials positive but low in quality and a large 2020 trial missing its primary endpoints.
Soluble fiber (psyllium)
Psyllium (ispaghula) and other soluble fibres are first-line options in ACG, BSG, and NICE guidance, while insoluble bran is discouraged; pooled trials show a modest benefit with a number needed to treat around 7.
Probiotics
Live bacterial supplements with strain-specific and inconsistent trial results; ACG suggests against them for global symptoms, while BSG and NICE allow a time-limited trial without naming a strain.
Prebiotics (PHGG, GOS, inulin)
Fermentable fibres taken to feed gut bacteria; a 2019 meta-analysis found no overall symptom benefit, with bloating and flatulence depending on the type and dose, and no IBS guideline recommends them.
L-glutamine
An amino acid supplement with one randomised trial in post-infectious IBS-D with increased gut permeability, where it produced an unusually large response; no guideline addresses it and the trial is unreplicated.
Vitamin D
Low vitamin D is common in people with IBS, but supplementation trials disagree: a 90-patient Iranian trial was positive, a 135-participant UK trial was negative, and two 2022 meta-analyses reached opposite conclusions.
Curcumin (turmeric)
The active compound in turmeric; a 2018 meta-analysis of three small trials found a non-significant trend, one curcumin-plus-fennel trial was positive, and an 18-week trial of curcuma extract was negative.
Melatonin
A sleep hormone also active in the gut; three small placebo-controlled trials and a 2023 meta-analysis suggest 3 mg at bedtime may reduce abdominal pain independent of sleep; no guideline addresses it.
Berberine
A plant alkaloid sold as a supplement; one 8-week trial in 132 patients with IBS-D reported less diarrhoea, pain, and urgency, but there is no second trial, no guideline, and real drug-interaction and pregnancy cautions.
Digestive enzymes (alpha-galactosidase, lactase)
Enzymes for specific carbohydrates; a Monash crossover trial found alpha-galactosidase cut symptoms from high-GOS meals in GOS-sensitive patients, lactase helps only with lactose, and no guideline recommends them.
Iberogast (STW5 herbal blend)
A nine-herb liquid extract with one 4-week placebo-controlled IBS trial in 208 patients and a longer record in functional dyspepsia; no IBS guideline addresses it, and rare cases of liver injury have been reported.
No human IBS trials
BPC-157
A synthetic peptide studied almost only in rats, with no human IBS trials; not approved by any regulator, sold online as a research chemical, and flagged by the FDA as a compounding substance that may carry safety risks.
Mind and gut
Therapies that work on the brain-gut axis: hypnotherapy, CBT, and mindfulness.
Gut-directed hypnotherapy
A structured course of hypnosis focused on gut sensation; ACG conditionally suggests gut-directed psychotherapies, BSG grades it strong on low-quality evidence, and NICE lists it for refractory symptoms.
Cognitive behavioral therapy
IBS-specific CBT targets symptom-related thoughts and behaviours; ACG conditionally suggests gut-directed psychotherapies, BSG grades CBT strong on low-quality evidence, and NICE lists it for refractory symptoms.
Mindfulness and meditation
Eight-week mindfulness training has two randomised IBS trials showing reduced symptom severity, one fading by six months; guidelines endorse gut-directed psychological therapies but do not name mindfulness.
Lifestyle
Movement and sleep, where the evidence is thinner but the downside is low.
Exercise and physical activity
Regular physical activity is advised for everyone with IBS by BSG (strong, on weak evidence) and NICE; a Swedish trial and small yoga studies suggest symptom benefit, but trials are few and at high risk of bias.
Sleep
Poor sleep is common in IBS and, in diary and actigraphy studies, a disturbed night predicts worse abdominal pain the next day; one small pilot has tested treating sleep, and no IBS guideline addresses it.
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