It’s one thing to have the occasional bloated belly or a bad reaction to a questionable meal. It’s quite another when your gut feels like it’s permanently in protest. If you’re someone who’s struggled with chronic digestive issues—bloating, gas, constipation, diarrhea, abdominal pain, nausea, or reflux—and feel like you’ve tried everything without relief, you’re not alone. And you’re certainly not crazy.
Digestive disorders are more common than most people realize. According to the National Institutes of Health, about 60 to 70 million Americans are affected by digestive diseases. But not all of them are easily diagnosed—or treated. If you feel like you’ve exhausted your options, it’s time to reframe your approach. Here’s a deeper look at how to troubleshoot persistent digestive symptoms when nothing seems to be working.
Step One: Don’t Settle for “Normal” If You Feel Miserable
Many people with digestive issues are told that their lab tests are “normal,” their endoscopy is clear, or “it’s just IBS (irritable bowel syndrome).” These comments can feel dismissive and discouraging. But just because a test doesn’t show inflammation or structural damage doesn’t mean something isn’t off functionally.
Disorders of Gut-Brain Interaction (DGBIs), such as IBS, often don’t show up on scopes or standard bloodwork. These conditions were previously known as “Functional Gastrointestinal Disorders” because they involve disruptions in how the gut works, rather than visible structural damage or inflammation. The updated term, DGBI, better reflects what’s really happening: a miscommunication between the brain and the digestive system that affects motility, sensitivity, and gut function. Your symptoms are real, even if standard tests come back normal, and you deserve to feel better and to keep asking questions.
Step Two: Keep a Symptom and Food Diary
Before overhauling your diet or asking for more invasive testing, get organized. Keeping a detailed food and symptom log over the course of two to four weeks can help reveal patterns you might not have noticed. Track:
- Meals and snacks
- Ingredients and preparation methods
- Timing of symptoms
- Stool consistency (yes, it’s worth noting)
- Stress levels and sleep
- Medications and supplements
Sometimes what seems like a “random” issue turns out to be linked to overlooked culprits, such as sugar alcohols, carbonated beverages, or certain fiber types.
Step 2A: Handy Dandy Bristol Stool Chart
By the way, check out the Bristol Stool Chart above to help you.
Step Three: Get Evaluated by a Gastroenterologist—Again
Even if you’ve already seen a GI specialist, it might be time for a second opinion or updated testing. New research is constantly emerging, and what wasn’t available or considered a few years ago might now offer insights. Ask your doctor about:
- Stool tests for infections, inflammation, and microbiome balance
- SIBO breath testing to evaluate bacterial overgrowth in the small intestine
- Celiac disease screening if not already done
- Colonoscopy or endoscopy if warranted
- pH monitoring for suspected acid reflux
- Transit time or motility studies if constipation or slow digestion is an issue
If your provider isn’t receptive or seems dismissive, consider finding one who specializes in functional GI disorders or motility.
Step Four: Consider the Low FODMAP Diet—With Support
One of the most evidence-backed strategies for managing functional gut disorders is the low FODMAP diet, developed by researchers at Monash University. It focuses on reducing fermentable carbohydrates that can cause symptoms in sensitive individuals. But it has three Phases, and the initial two are not meant to be done indefinitely. The last phase, Personalization/Integration, is long-term, but it is not static. It evolves with your ever-changing tolerances. In addition, the diet is far more effective when guided by a Registered Dietitian trained in the protocol.
Many people see significant improvement in bloating, pain, and irregular bowel habits when they approach the diet strategically and correctly.
Step Five: Explore Gut-Brain Therapies
If food changes alone aren’t helping, consider that your gut is deeply connected to your brain, and vice versa. This doesn’t mean your symptoms are “all in your head,” but rather that stress, anxiety, and trauma can significantly impact gut function.
Several gut-directed therapies show promise:
- Gut-directed hypnotherapy, like the Nerva program, has been shown in studies to be as effective as the low FODMAP diet for many people with IBS. It works by calming the gut-brain axis.
- Cognitive Behavioral Therapy (CBT) tailored for GI disorders can help break the cycle of symptom anticipation and anxiety.
- Biofeedback and mindfulness-based stress reduction (MBSR) techniques can support nervous system regulation, which is essential for digestion.
Step Six: Rule Out—or In—Autoimmune or Inflammatory Conditions
While conditions like Crohn’s disease, ulcerative colitis, or autoimmune gastritis often present with obvious symptoms, they can also simmer for years before diagnosis. If you have red flag symptoms such as unexplained weight loss, rectal bleeding, anemia, or fever, don’t ignore them.
Even in the absence of these, persistent inflammation or immune activity might be part of your story. Ask your doctor about:
- C-reactive protein (CRP) and ESR tests
- Fecal calprotectin
- Comprehensive autoimmune panels
- ANA or specific antibody tests (especially if you have joint pain, fatigue, or other systemic symptoms)
Step Seven: Reassess Your Supplement and Medication List
Over-the-counter supplements and medications can sometimes cause digestive issues, ironically, even the ones marketed for gut health. Magnesium, vitamin C, and certain herbs can cause loose stools; iron and calcium can be constipating. Probiotics can backfire in some people, especially those with SIBO.
And, in fact, probiotics are NOT meant to be taken during the Elimination or Challenge Phases of the low FODMAP Diet. They can alter your digestion of FODMAPs, which is what you are trying to assess at the time. Even well-meaning doctors, who are typically not well-versed in the diet, will recommend them. Read more here.
Also, evaluate prescriptions. Common culprits include:
- NSAIDs, which can irritate the stomach lining
- Metformin, known to cause GI distress
- SSRIs, which affect gut motility
- Antibiotics, which alter the microbiome
Talk to your doctor or pharmacist about any suspected issues, and never stop a prescription cold turkey.
Step Eight: Don’t Underestimate the Role of Sleep and Movement
When digestion is off, we often zero in on food—but sleep and movement are two of the most overlooked tools for gut health.
Sleep helps regulate your gut’s circadian rhythms. Poor sleep can disrupt digestion, increase cortisol, and throw off motility and the microbiome. Aim for 7–9 hours per night. If you still feel tired or have insomnia, talk to your doctor about a possible sleep study. To improve sleep quality: keep a consistent sleep schedule, avoid screens before bed, limit late-day caffeine and alcohol, and create a quiet, cool, dark sleep environment.
Movement stimulates digestion and relieves tension. You don’t need high-intensity workouts—gentle, consistent activity is more important. Try walking after meals, or yoga.
Certain yoga poses can stimulate digestion, relieve constipation, and soothe the nervous system. Poses like Supine Twist (Supta Matsyendrasana), Wind-Relieving Pose (Pawanmuktasana), Cat-Cow (Marjaryasana-Bitilasana), and Child’s Pose (Balasana) are particularly helpful. (We have a Yoga Series for you).
Tai Chi and swimming are helpful as well. If you have mobility challenges, chair yoga or stretching in bed can still help calm the gut-brain axis.
Listen to your body: if intense workouts aggravate symptoms, scale back. Combining good sleep with daily movement can help restore balance to your digestive system—and your life.
Step Nine: Look Into Less Common Diagnoses
If you’ve ruled out the usual suspects and are still suffering, it’s worth investigating lesser-known conditions such as:
- Ehlers-Danlos Syndrome (EDS) or hypermobility spectrum disorders, which can affect gut motility
- Mast Cell Activation Syndrome (MCAS), associated with food and chemical sensitivities
- Endometriosis, which can masquerade as GI pain
- Exocrine Pancreatic Insufficiency (EPI), where the pancreas doesn’t produce enough enzymes
- Bile acid malabsorption, often mistaken for IBS-D
- Long COVID: Ongoing digestive issues such as nausea, diarrhea, bloating, or abdominal pain have been reported in individuals experiencing long COVID (also known as post-acute sequelae of SARS-CoV-2 infection, or PASC). Research suggests that lingering inflammation, autonomic dysfunction, microbiome disruption, and altered gut-brain signaling may play a role. If your GI symptoms began or worsened after a COVID infection, discuss this with your provider as new protocols are emerging to address these effects.
You may need to seek out a specialist or functional medicine practitioner who has experience recognizing complex overlaps.
Who Helps the Most with Chronic Digestive Issues?
A growing body of evidence suggests that patients with digestive disorders get the best outcomes when they’re supported by a multidisciplinary team, particularly when that team includes both medical and nutritional expertise.
Gastroenterologists + Registered Dietitians = Best Outcomes
According to a 2024 study, involving a registered dietitian in the care of patients with IBS significantly improved symptom severity and quality of life compared to standard care alone. The low FODMAP diet, which is considered the gold standard dietary approach for managing IBS, is most effective when administered by a dietitian trained in FODMAP protocols, especially since it involves a complex elimination and reintroduction phase.
The American Gastroenterological Association (AGA) also officially recommends that patients with chronic GI conditions, including IBS and IBD (inflammatory bowel disease), work with Registered Dietitians as part of their care team. The AGA emphasizes that dietitians play a critical role in identifying trigger foods, correcting nutrient deficiencies, and improving long-term outcomes.
A 2021 report from the AGA Nutrition Summit concluded that co-managed care by GI specialists and RDs reduced hospitalizations, improved symptom management, and minimized unnecessary testing and supplements.
Beware of “Nutritionists”: Titles Aren’t Always Regulated
In the United States, the term “nutritionist” is not legally regulated. That means anyone can call themselves a nutritionist, even if they have no formal education or clinical training. By contrast, Registered Dietitians (RDs or RDNs) are licensed professionals who must complete:
- A bachelor’s degree in nutrition or dietetics (now moving toward a master’s-level requirement)
- A supervised internship (usually 1200+ hours)
- A national credentialing exam
- Continuing education to maintain licensure
This distinction is crucial when you’re dealing with digestive conditions, which often involve complex dietary needs, medication interactions, and risks of malnutrition if not managed properly.
In some states, only RDs can legally provide medical nutrition therapy. In others, anyone can give dietary advice, regardless of training. Always ask about credentials and clinical experience, especially when you’re trusting someone with your health.
And please, steer clear of wellness coaches or nutrition coaches; stick with RDs.
Naturopaths: A Mixed Bag
What about naturopathic doctors (NDs)? In the U.S., the naturopathic field is also inconsistently regulated, with wide variation in training and scope of practice by state. Some states license naturopathic doctors who have completed a four-year doctoral degree at an accredited institution and passed national board exams. In these cases, NDs can be helpful members of a care team, especially when they coordinate care with MDs and RDs.
However, many people who use the title “naturopath” have completed only short certificate programs with no clinical oversight. These unregulated practitioners may suggest expensive tests (such as IgG food sensitivity panels, which are not evidence-based), restrictive diets, or unproven supplements, sometimes causing more harm than good. If they are selling supplements themselves, run away.
A 2016 review in The Journal of Alternative and Complementary Medicine found that while some patients report subjective improvement with naturopathic care, the quality of evidence is low, and risks increase when naturopaths operate outside an integrated medical framework.
Bottom Line: Choose a Team With Credentials and Communication
If your digestive issues aren’t improving, you need more than Google searches and guesswork. Look for:
- A gastroenterologist who is open to dietary and lifestyle approaches, not just medication
- A registered dietitian (RD or RDN) with expertise in GI disorders (ideally trained in the low FODMAP diet if appropriate)
- Providers who communicate with one another and with you; your care should feel collaborative, not disjointed
- Professionals who are transparent about their credentials and training
If you’re exploring integrative or functional medicine options, ask how they work alongside traditional care. And avoid practitioners who discourage standard testing or diagnostics, or who promote pseudoscientific therapies without peer-reviewed support.
Other Specialists Who May Be Key Team Members
Depending on your symptoms, don’t overlook these professionals, who can play a major role in uncovering and managing digestive issues:
- Pelvic Floor Physical Therapists: Especially helpful if you have chronic constipation, incomplete evacuation, or feel pressure in the rectal or abdominal area. Pelvic floor dysfunction is a hidden culprit in many “IBS” cases.
- Psychologists or Therapists Specializing in Gut-Brain Health: Licensed therapists trained in Cognitive Behavioral Therapy for IBS (CBT-IBS) or gut-directed hypnotherapy (such as the North Carolina Protocol or the Nerva app) can dramatically reduce symptoms by calming the nervous system’s communication with the gut.
- Endocrinologists: If thyroid disease, diabetes, or adrenal imbalances are suspected, an endocrinologist may be key—since hormonal imbalances can affect gut motility and overall digestion.
- Allergists/Immunologists: To rule out IgE-mediated food allergies, mast cell disorders, or Eosinophilic Esophagitis (EoE) if symptoms include throat tightness, hives, or respiratory reactions.
- Primary Care Physicians: While they may not specialize in GI health, a good primary care provider can act as a coordinator—making referrals, monitoring labs, and helping track long-term progress.
Who Not To Consult
We have to address who NOT to ask for help. Do not ask your friend with IBS. Do not ask a Facebook Group. Or a Subreddit. Do not listen to the person you just met who is telling you about their best friend’s sister. And steer clear of TikTok and Instagram, which are riddled with “health coaches”. Some of our Monash-trained Registered Dietitians are on Instagram, so please learn how to discern. Repeat studies have shown that 50 percent of health information on TikTok is misleading and often dangerous.
Step Ten: Build a Multidisciplinary Team
Digestive health is not just about one organ. It involves your entire system—nervous, endocrine, immune—and often requires a team approach. This might include:
- A gastroenterologist or motility specialist
- A dietitian experienced in food sensitivities and GI disorders
- A pelvic floor physical therapist (especially if constipation or pain is an issue)
- A mental health provider trained in gut-brain work
- An integrative or functional medicine doctor if traditional care has stalled
Final Thoughts
If your digestion feels like a puzzle you can’t solve, take heart: relief is possible, even if it’s not immediate. The key is to stay curious, persistent, and open to trying both conventional and emerging approaches.
Be cautious with unregulated practitioners who offer unproven tests or promise quick fixes. Always ask about credentials and look for collaborative, science-backed care. The best outcomes come when medical, nutritional, and lifestyle support are integrated, so you’re no longer managing symptoms alone.
You are your best advocate, and with the right tools and support, you can reclaim your quality of life.
For more practical tips on managing gut issues, including how to vet nutrition professionals, and what hidden triggers might be making symptoms worse, explore articles at FODMAP Everyday. You’ll find resources written by Monash-trained experts that take the guesswork out of gut health.
