Is Your Gut Trying to Tell You Something?
Insights from your digestive tract ...👂
ICYMI 👉
My patient K walked into my office last month with a look of frustration and exhaustion. Who could blame her? For months, she'd been dealing with bloating, irregular bowel movements, and abdominal discomfort that seemed to come and go without rhyme or reason. The blood and stool testing I had ordered came back normal. Her colonoscopy earlier in the summer was unremarkable. She'd tried cutting out gluten, added probiotics, and even attempted an elimination diet. Nothing was working, and she started to worry something was seriously wrong.
Sound familiar?
I don't think a day goes by in my practice where I don't see someone struggling with gastrointestinal issues. The complaints vary from bloating and gas to irregular stools and belly pain, but the underlying story is often remarkably similar. People feel like their bodies are betraying them, and they're desperately searching for answers in a world full of conflicting advice about gut health.
Here's what I wish everyone understood about digestive distress: your gut is often trying to tell you something about other elements of your health. And most of the time, the solution isn't as complicated as you think.
The Four Pillars of Gut Health
When I evaluate patients like K, I use a framework I call the Four “I”s. (I will describe this in detail in my forthcoming book.) This is a simple way to think about all the factors that influence how your health works. Let’s apply it to the digestive system today.
Informatics: Start with Hard Data
The first thing I want to know is what's actually going on inside your body. For anyone over 45, that includes colon cancer screening. Family history can change this timeline. (If colorectal cancer runs in your family, we start earlier.) I also look at lab work (blood and stool) to rule out infection, inflammatory conditions, and problems like celiac disease, thyroid disorders, or autoimmune processes.
But here's what I want you to know: when the tests come back normal, this doesn't mean your symptoms aren't real; it means we need to look deeper.
Inputs: Everything You Put Into Your Body
This is where the detective work gets interesting. I ask about everything: How much alcohol and caffeine do you drink? How much fiber, soluble and insoluble, are you getting per day? What are your eating patterns like? Are you rushing through meals or skipping them? Do you chew sugar-free gum? (That last one is notorious for causing gas and bloating, thanks to sugar alcohols.)
One of the most revealing tools I use is asking patients to keep a food journal for a week. Not to restrict or judge but to connect dots. People are often amazed to discover patterns between what they eat, when they eat it, and how their gut responds.
The inputs category also includes medications and supplements. NSAIDs like Advil can irritate the stomach lining. Even "natural" supplements can contain fillers that cause digestive upset. Magnesium, while helpful for sleep, can cause diarrhea in higher doses. Many prescription meds carry GI distress as a side effect (I’m talking to you, GLP1s!) These are just some of the “inputs” your gut may react negatively to.
Infrastructure: Your Body's Container
Believe it or not, your physical infrastructure—your musculoskeletal system and overall mobility—directly impacts gut function. If you're sitting at a desk all day, dealing with chronic pain that limits movement, or taking medications for joint issues, your digestive system feels it.
Movement is medicine for the gut. Often, chronic constipation improves dramatically with regular walking, adequate hydration, and giving your body time and space for physical activity. Your colon needs your whole body to function well.
Insight: The Mind-Gut Connection
This is where a dose of introspection and self-awareness can do a body good. It’s also where people grow skeptical. But after two decades of practice, I can tell you with certainty: emotions often manifest in the gut. Stress, anxiety, you name it—our digestive system and nervous system are intimately connected. This doesn’t mean that everyone with GI distress is mentally or emotionally unwell; it means we cannot ignore the mind-gut connection.
When K and I dug into what was happening in her life, she revealed she'd been dealing with a stressful situation at work while managing her teenager's college applications. Her body was keeping score, and her gut was where it showed up.
We call this Irritable Bowel Syndrome (IBS). Putting a name to her symptoms wasn’t the end of the story, but it anchored the rest of my recommendations to her.
IBS is Not a Throwaway Diagnosis
Patients often feel like IBS is a “throwaway” diagnosis—like we're giving up and slapping a label on something we can't figure out. But IBS is real. It's the spasm and irritability of your colon in response to triggers. The key is figuring out what those triggers are, and they're usually a combination of factors from all four categories.
For some people, it's FODMAPs—certain carbohydrates that the small intestine absorbs poorly, causing cramping and bloating. I don't recommend wholesale FODMAP restriction. Instead, I suggest using the FODMAP list as a detective tool to see if you can identify your personal triggers. This is where the food journal comes in.
For many people, IBS symptoms improve with adequate dietary fiber intake. I recommend aiming for 25-30 grams of fiber daily. Most Americans only get 12g daily—less than half the recommended amount! There are two types of fiber:
Soluble fiber dissolves in water, forms gel, helps lower glucose and cholesterol (oats, beans, apples)
Insoluble fiber adds bulk, helps food move through digestive system (whole grains, vegetables, nuts)
It’s important to increase your intake gradually (add 5 grams per week) and drink plenty of water to prevent digestive discomfort.
When Your Gut Needs Immediate Attention
Of course, not all non-obvious gut complaints are due to IBS. Some serious GI problems can be sneaky—from inflammatory bowel disease and parasitic infections to lactose intolerance and amyloidosis—so it’s important to thoroughly work up any persistent gastrointestinal distress. While most digestive complaints aren't emergencies, here are some symptoms that require prompt evaluation:
Blood in your stool (even if you think it's hemorrhoids)
Unintended weight loss
Severe abdominal pain
Persistent vomiting
Significant changes in bowel habits lasting more than a few weeks
Trust your instincts. You know your body better than anyone, and if something feels seriously wrong, advocate for yourself.
What did we do for K? We didn't overhaul her entire life overnight. We started small: She began walking after dinner instead of collapsing on the couch. She set a boundary with work emails after 8 PM. She cut back on coffee and started eating lunch with more fiber and away from her desk, chewing slowly instead of inhaling food between meetings. She stopped the four different supplements she'd been taking "just in case" and focused on whole foods instead.
Three weeks later, her bloating had decreased significantly. Her bowel movements became more regular. She felt more in control of her health (and her stress level).
Your Gut Health Toolkit
If you're struggling with digestive issues, start here:
Check in with your doctor. Consider what meds and supplements you are taking. Consider blood and stool testing plus/minus a colonoscopy if appropriate.
Keep a simple food and symptom journal. Note what you eat, when you eat it, your stress level, and how your gut feels. Look for patterns.
Audit your movement. Are you sitting all day? Can you add a 10-minute walk after meals?
Pay attention to your emotional health. Where are you on the anxiety continuum? What's your relationship with stress, work, and caregiving responsibilities?
Remember: common things are common. Most digestive complaints aren't rare diseases requiring exotic treatments. They're your body's way of telling you to pay attention to your whole health picture.
So, what's one small change you could make this week to support your gut health? I'd love to hear from you in the comments!
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Disclaimer: The views expressed here are entirely my own. They are not a substitute for advice from your personal physician.
Thanks for your good article. I’ve had success With a low FODMAP diet, but I need to be less restrictive and use it for a tool, not a religion.
So helpful. I definitely need to slow down while eating and do a better job of stress management. I’m grateful that you share your knowledge and expertise. Many thanks. I wish there were more Dr. McBrides!