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Symptoms requiring routine medical review: Bloating that persists beyond 46 weeks despite dietary modifications and adequate dose titration Symptoms that significantly impact quality of life or ability to maintain adequate nutrition New or worsening heartburn or regurgitation, which may indicate gastro-oesophageal reflux disease (GORD) Changes in bowel habit such as persistent diarrhoea or constipation Concerns about medication adherence due to gastrointestinal side effects Your healthcare professional may recommend investigations to exclude other causes of bloating, particularly if symptoms are atypical or severe

Exercise even when you do not feel like it

it is about "priming" your system

5.8 Evidence Strength Overview This table reflects current knowledge not speculation

Problems with cognition and motivation may get in the way of adherence