Start with the pattern—not a label
When a patient tells me, “My gut is always acting up,” I do not assume there is one universal cause. Bloating, reflux, constipation, diarrhea, cramping, and early fullness can overlap across many conditions. My first job is to understand when symptoms began, what changes them, and what has already been ruled out.
The digestive system includes the gastrointestinal tract, liver, pancreas, and gallbladder. A useful evaluation may consider several of those systems rather than focusing on a single food or supplement.
Concerns I commonly evaluate
- Persistent bloating, gas, or abdominal discomfort
- Constipation, diarrhea, or alternating bowel habits
- Reflux, indigestion, nausea, or feeling full too quickly
- Suspected irritable bowel syndrome (IBS) or food intolerance
- Questions about SIBO, celiac disease, inflammatory bowel disease, or pancreatic function
- Digestive symptoms that affect energy, sleep, work, or confidence around food
How I organize the evaluation
1. Your timeline and symptom pattern
I review your medical history, medications and supplements, travel, infections, surgeries, family history, diet, stress, sleep, and bowel pattern. These details often determine which questions deserve priority.
2. Appropriate testing
Testing should answer a clinical question. Depending on the situation, that may include routine blood work, celiac testing, breath testing, stool testing for a specific indication, or referral for imaging or endoscopy. I do not order every available panel simply because it exists.
3. A practical care plan
The plan may include meal structure, fiber or fluid adjustments, movement, sleep and stress support, and targeted nutrition changes. Supplements are considered only when they have a clear purpose and are reviewed for medication interactions.
When symptoms need prompt medical attention
Seek urgent or timely medical care for black or bloody stool, vomiting blood, severe or persistent abdominal pain, trouble swallowing, repeated vomiting, jaundice, fever with worsening symptoms, dehydration, unexplained weight loss, or a major change in bowel habits. These signs should not be managed with a wellness protocol alone.
My goal for you
I want you to leave with fewer assumptions and a clearer map: what we know, what we still need to investigate, and which next step is most likely to be useful.