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Gas, bloating, diarrhea, constipation: If you’re experiencing gastrointestinal discomfort, you’re not alone.
A 2020 study polled over 73,000 people in 33 countries and found nearly 40% of adults — mostly women — have some kind of functional gastrointestinal disorder.
Looking at just the US, Canada, and Great Britain, the report found more than 1 in 4 adults have a GI issue.
And if you’re one of these folks chances are you’ve tried over-the-counter medication or some form of an elimination diet.
But if your chronic digestion problems continue to persist, it’s important to rule out any underlying medical conditions like Crohn’s disease, ulcerative colitis, and more.
That’s where finding the right specialist is crucial.
Most people have already trial-and-errored with their diet by the time they’re looking for a doctor, says Ashkan Farhadi, MD, a gastroenterologist specializing in IBS at MemorialCare Orange Coast Medical Center.
If you can’t find a pattern among what you’re eating, and the basics of eating more fiber, drinking water, exercising, and starting a prebiotic and probiotic routine haven’t helped, it’s time to see a specialist.
Knowing what kind of doctor to turn to for treatment can be confusing — not to mention expensive and exhausting with insurance coverage and paperwork.
We’ve made it simple — below outlines exactly what kind of expert you should see for help with any kind of chronic gut issue.
Best option for: Initial treatment and tests; obtaining a specialist referral; leveraging an established medical history with your PCP
When to see them: If you’ve been going to the same primary care physician (PCP) for years, they’re the ideal first stop as they’re familiar with your medical record and general lifestyle. If your insurance requires a referral for a specialist, this will also be your initial go-to.
What to expect: Your PCP will review your medical and medication history, and ask about patterns in your gut symptoms, mental state, diet, and exercise.
So, it can be extremely helpful for them if you have a food journal that’s tracked how you feel after each meal.
A PCP may run lab tests to rule out basic underlying issues (e.g., thyroid issues, bacterial infection). If your symptoms are fairly straightforward, they can also recommend certain trial therapies to attempt to treat you so you don’t need to see a specialist.
How to find one: Search providers via your insurance. If you don’t have insurance, the cheapest option for a PCP is often telemedicine services.
Best option for: People with health insurance; severe symptoms; a family history of GI issues
When to see them: A gastroenterologist is one of the three types of specialists you can see.
You’ll want to see a specialist if the initial line of treatment from your PCP doesn’t fix your symptoms.
Gastroenterologists focus on function and diseases of the esophagus, stomach, intestines, and other digestive organs. If you are having bloody stools, severe abdominal pain, or have multiple days consecutively without bowel movements, a GI doc is the person you should turn to, says gut health specialist Heather Finley, RD, who works in private practice with a doctorate in clinical nutrition. These are red flags for an underlying condition; the main purpose of seeing a gastroenterologist is to rule a more serious issue out.
What to expect: The gastroenterologist will evaluate your symptoms to determine next steps. If they think you have an underlying condition, they may run stool and blood tests. They may also schedule you for an upper endoscopy or colonoscopy if they suspect you have something like ulcerative colitis or an infection. If you do, you’ll continue to see a gastroenterologist for individualized treatment.
But if your issues are from diet, gut bacteria, or lifestyle, your treatment then focuses on ongoing education (i.e., stress management, exercise, probiotics, adapting your diet to stressful periods of your life), which can come from the GI doc or from another specialist.
How to find one: Search providers via your insurance.
Best option for: People without insurance; with Celiac disease; who can’t get an appointment with a gastroenterologist soon
When to see them: If a gastroenterologist deems your issues nutritional, they may send you to a nutritionist for ongoing education, particularly if you have Celiac disease. But you can also start here, “especially if you are having uncomfortable bloat, constipation, gas, or diarrhea and don’t want to wait months to get into the gastroenterologist, or are wanting to use a more holistic approach,” says Finley.
If you come to an RD with those red flag symptoms, they’ll likely send you to a gastroenterologist.
What to expect: An RD is going to look at your medical history, symptoms, and lifestyle, as well. If you haven’t already had a stool analysis or blood work, they may send you to a physician who can run some lab tests. These tests will look for infections, bacterial overgrowth, digestive insufficiencies, and thyroid, vitamin D, and iron levels, which should pinpoint the problem.
If the issue is non-medical, a nutritionist’s treatment focuses on changing your diet, taking supplements if needed, and shifting your lifestyle to manage stress and get more sleep. This process is quite similar to how a gastroenterologist handles treatment, but with more of a holistic emphasis.
After digestive symptoms have calmed, the focus becomes adding foods back in to find a new norm among a calmer gut. All in all, Finley says she typically sees clients for a minimum of three months, but ideally six to reinforce sustainable changes.
How to find one: Look for a registered dietician (RD/RDN) or licensed dietician (LD/LDN) first, and then one who specializes in gut health specifically. You can search “gut health RD” in Google or, surprisingly, Instagram.
Best option for: People who favor Eastern medicine; who have more general feelings of sluggishness, exhaustion, and improper absorption; who haven’t seen relief with the help of other specialists
When to see them: Similar to a nutritionist, if you aren’t having red flag symptoms, you can start by seeing an eastern medicine specialist (they’ll also send you to a GI doc if they spot these alarming symptoms).
Traditional Chinese Medicine (TCM) incorporates techniques that have been used as treatment in eastern or Asian culture for centuries, including herbal medicine, acupuncture, cupping, and more.
If you can’t find any patterns between your diet and GI issues, or are also grappling with total-body issues like fatigue and strange inflammation, TCM can be helpful as it looks at the body as a whole, explains Jenelle Kim, doctor of Chinese medicine, master herbalist, founder and chief formulator of JBK Wellness Labs.
While TCM has a long proven history behind it, practitioners are often also more expensive; they’re usually not covered by insurance and prescribe herbs and supplements that aren’t filled by a pharmacy and, therefore, can be more costly.
What to expect: Your TCM practitioner will analyze how all the systems in your body are working via a traditional pulse and tongue diagnosis, and then go over your chief complaints, history, lifestyle, eating habits, general mental state, and any labs you’ve had run. They may prescribe or perform acupuncture, as well as herbs, supplements, or probiotics to help balance your gut bacteria.
Kim says people often feel an improvement after one to three treatments, but it takes six weeks or more of weekly acupuncture and herbal adjustments for sustainable changes.
How to find one: Practitioners should be state or nationally board-certified (NCCAOM) and specializing in gut health. Use the NCCAOM database to find someone near you, or try Wellset, a telehealth platform connecting you with acupuncturists, Ayurveda specialists, functional medicine practitioners, and more. Look for the blue checkmark which confirms the practitioner is certified and passed a background and reference check.
Gastrointestinal symptoms like bloating, gas, and nausea are more common than you may think. But you don’t have to tolerate it.
Work with your PCP or a specialist to help you determine what lifestyle changes or medications you may take to find relief.