Episode 7: How to Get Diagnosed With IBS

Do you think you have IBS and aren’t sure what to do next? Wonder if your IBS diagnosis was legit?

This episode breaks down how IBS is diagnosed and what you can do to get a proper diagnosis for what’s going on in your body.

You can check out the podcast on iTunes here, Spotify here, and on YouTube here! Below is a full transcript of the episode if you prefer to read through it or want notes.

Don’t forget to connect to others in The GUT Community, a Facebook group for those with IBS and digestive disorders to support one another and dive deeper into each episode together.

Welcome back to the podcast! I am excited about this episode because this is something that I get asked all the time, and I think it's a really important topic to cover. So today we are going to talk all about how to get diagnosed with IBS! The things that we're going to talk about today can also apply if you're thinking about getting diagnosed with any type of digestive disorder, whether that be a functional disorder, like IBS, functional diarrhea, functional constipation, and gastroparesis. or if you want to get diagnosed with a digestive condition, like inflammatory bowel disease, celiac disease, all of that will be covered as well as things like SIBO, H. pylori, infections, things like that. So if you have been interested in figuring out okay, what is going on in my body? What's the cause? What's the reason? How do I navigate this, and how to approach doctors and talk about these things in your appointment to get the best answers, then this episode is for you! This may also be for friends, so share the love.

Alright, so as we dive in, I want to start by saying that, you know, I'm a dietitian, I'm not your dietitian. So remember that all the information that I'm providing here, especially when we're looking at getting diagnosed is educational only. Whenever we are thinking about any conditions at all, so when it comes to health conditions, we do not self-diagnose. And I know that can be easy to do sometimes when we're googling things, or maybe our symptoms align so much with a condition, and we just know deep down that's what it is, we have to have a diagnosis by a doctor. Self-diagnoses, or being diagnosed by the wrong person that's not actually credible to diagnose, which would include a dietitian, we're not able to diagnose anything that can actually lead to harm, and you might be missing something that needs to be addressed very intentionally.

So I want to say that, and I want to be very clear that while you may have had negative experiences in the past when it comes to talking about the things that are going on or meeting with your doctor, it's very important to go through the right process to make sure that insurance can cover what you need to get covered, because that's important, and also you get the right care that you need. Because when we're thinking about the gut, especially, there's a lot that we really want to be aware of, not to put fear in you, but to just, you know, share that that it is serious, and we want to make sure that we're doing this correctly.

So with that being said, let's first think about okay, what symptoms would I be looking for, like, what are the signs that I may need to look for a diagnosis, right? How do I know that something is wrong or abnormal? And that is a great question. So whenever we're looking at digestion, something that we can do is really monitor bowel habits and bowel movements. And so my number one tip, and this is pre-determining if you want to get a diagnosis or post-determining that you want to get one. But if you're not able to figure this out on your own, you want to start keeping a journal or some sort of a log of this information.

So we start with monitoring what your bowel habits actually are. That can include how often you're going as well as the characteristics of your stool, your poop, in the toilet. So one resource that's very helpful and putting kind of a characteristic to what you're seeing and being able to label each bowel movement is the Bristol stool chart. So there are numbers that correlate to different types of stool and the form, ranging from pebley stool going to like a soft log and into a liquid and watery stool. Being able to look at the Bristol stool chart and put numbers to your bowel movements will allow you to determine are these actually”normal.”

So the four to five numbers three to five-ish, those are normal. Four is the gold standard, smooth like a snake, right? So that's what we want. If you're ranging lower than that, then you're probably leaning more towards constipation. If you're ranging higher than that, then you're leaning more towards diarrhea. And that's not exact, so again, we don't self-diagnose even based on the chart, but it will give you some insight into if your bowel habits truly are normal.

One thing that I see a lot, especially with functional gut disorders, is if this has been going on for a long time until there's the presence of pain or gas or another uncomfortable symptom, a lot of times diarrhea or constipation has become a new normal. And we don't realize that it's actually abnormal. And so we may not even know to bring it up to the doctor, we may not even know to address it, so it's really important to know where you stand.

So learn what your bowel movements are and notice, are they on the harder side and more heavily like constipation? Or are they on the looser side? Or more watery like diarrhea? And where do they fluctuate the most? Or do you range between the two significantly, because all of that would be abnormal. If you're getting solid fours every single day, then you are normal, and that is a good thing.

The next thing that you want to look at is the frequency of bowel movements. So we consider normalcy to be three times a week-ish, right? So once every two to three days. In my practice, what I typically consider to be normal is once a day. So ideally, we want to make sure that we're going at least once a day, and then it can be up to two to three times a day that is considered normal. There's a lot of different reasons why this might not be the case for each person. So if you are a smaller person, it's eating less and your calorie needs are lower, you may go less, if you are a larger person eating larger amounts of food, then you may be going more, there's more to let go of. It can also depend on anatomy, it can depend on our hormones and the way that our bodies like to be in a routine, there's no perfect standard in terms of you know, once every two days, three times a day. But anything less than that or way more than that can be considered abnormal.

So if you're skipping more than two to three days without going or when you do go, it's very little, and then you're still skipping days, that would be considered abnormal. If you're going consistently more than three times a day, then that could be considered abnormal. So those are notes that you would want to take in your journal or your log to take to your doctor and talk to them about it.

So let's understand where you start and how that progresses and changes whenever you start getting into your plan. Some other characteristics to make note of would be the color of the stool. So if you're dealing with abnormal colors, sometimes there's nothing to be worried about. Sometimes we have a green stool because we've eaten a lot of green foods, you may have a pink or red stool simply because you ate more beets or red foods. Sometimes the coloring of the store might be due to something that you've eaten. Sometimes it can signify something that's wrong, like an infection. Red can sometimes signify blood, which can be signs of different things. So you really want to look at when there are different changes in the color of your store. Brown is the standard, that's what we want anything different than that, you want to make note of it. And then if you're keeping up with your food that will help your provider be able to know if that was due to something maybe that you ate, or if that was due to something else that they need to be looking more into. This can be a very valuable tool when it comes to getting your diagnosis and understanding the test results that you might be getting.

Another thing to look at would be undigested food. So there are some foods that don't break down fully and might come out more whole in your stool. kernels of corn are a great example of this, maybe the peel of a tomato, that can be normal. Whenever we're dealing with a lot of undigested food, and it seems like no matter what you're still dealing with lots of undigested food particles, that can be a sign that you're not breaking down and absorbing nutrients well, so we want to keep up with that and any other things that seem to be abnormal with your bowel habits.

Some other symptoms to look for that would be considered abnormal, painful and very distended bloat. So some bloating can be considered normal, it's good to know like when you feel like you're a lot heavier. so there's the feeling of bloat, which is that heaviness, there's also the visual of bloat where like your belly sticks out a little bit more, a lot of that is expected after a day of eating, after a meal, your belly is going to look different at the end of the day than it does at the beginning of the day. But that could also be a sign that something else is going on, and it could be a sign that there's some just behaviors or like foods in place that might be contributing, so it's helpful to keep up with when you are bloated.

One thing to note is that visible bloat as well as the pain that might be accompanied by it. So if you feel like you look pregnant, or your pants like completely don't fit, and that's happening day after day after day, then that is something that would be abnormal that you want to make sure that you write down. If you're dealing with distension that never goes away, sometimes that could be a sign of something very serious, and so you want to make note of that. Even if you feel like well, I don't know if I'm bloated or if I've gained weight, I know that that's something that gets tossed up, it's okay to write that note and keep up with that. That's something that you can evaluate with your doctor and look at the changes in your weight just to see if it's that or if it's something else going on. So it's just really important to keep up with that!

Pain is not normal. So every now and then, you know, we might deal with a little bit of pain. If you're constipated or you ate something that's kind of running through you, it's gonna be uncomfortable. If you're dealing with pain consistently, and that can be pre bowel movement, post bowel movement, it can be outside of bowel movements completely, make note of that. The place of pain and the quadrant of pain can sometimes help with where we're looking at, it doesn't matter as much. But it might be helpful to know kind of where it's located, what it feels like any descriptions that you can write down can be extremely helpful when you're getting your diagnosis.

And the last one is smells. Gas is very normal, gas is expected, it's a process that our gut bacteria are going through to produce byproducts that we need. Smelly gas, so really toxic smelling gas, foul smelling gas can be a sign that something else is going on. So you want to make note of when things just don't smell quite right, and make note of the different changes in smell, you likely know what they are so just write them down to talk about them because that will help. And then other symptoms that could be present that you'd want to make note of would be heartburn, reflux, any vomiting that's going on, nausea, dizziness, fullness, like quickly with a meal, lack of hunger, lack of fullness, all of those different cues that your body might be giving you as well as anything else you feel like your body is saying that would be helpful to look at. Those altered bowel habits, the symptoms that go with them like bloating and pain, gas, and then any other odds symptoms, those are the things that will help the most when we're looking at IBS.

So after we have the symptoms that okay, I think that something's going on, I'm aware that I have symptoms going on that would maybe lead me towards a diagnosis, that is when you want to keep a journal, if you do do not already, we have a gut journal for this, it's a 90 day journal that guides you through some mental health stuff, as well as keeping up with all those characteristics of your sleep, signs of hormone changes, your symptoms, your food, your exercise, your medications, or supplements, all of those different things. You can also do this through an app or just through you know, a notebook or whatever journal resource that you enjoy. The key is just making sure that you're keeping up with things that are going on, so your food, your symptoms, that can be the first step.

Ideally, you want to keep up with things like your sleep and your stress levels and you want to keep up with as much as you possibly can to really get a picture of what's going on day to day and what could be linked. When we're looking at a journal and the diagnosing process, so this is discovery, right? We just want to know, we want to gain awareness. This isn't about like definitely making changes, right. so if you see that there are correlations make note of that, and if you make a change based on those correlations, definitely make a note that that happened, it's very important to take that raw data in to the provider or the doctor to get your correct diagnosis.

So what they can do is they can analyze what's going on and they might see some correlations that could be signs of something like SIBO or IBD, or you know, celiac disease and that will help guide them on what which tests to do first, and what interventions to try or what referrals to make. So whenever we're looking at keeping a journal on the front end, it's really about gathering the data, building some awareness, you're gonna learn a lot about yourself, and then your doctor will also be able to learn a lot. So you want to make sure you take that in and don't make assumptions about what it means, just provide that data for them so that they can look at it and then be able to see that full picture and that allows you to not have to sit there and try to recall everything that has been going on. So I highly recommend keeping a journal!

Okay, the next step after you've been keeping up with some data, you want to meet with a gastroenterologist if you can, so this conversation might start with your primary care provider. Sometimes a primary care provider will do some of the initial tests, they might even diagnose something like IBS, but it's very important to also consult with a gastroenterologist that is well versed in digestive disorders. The reason for this is that many symptoms between different digestive disorders or digestive conditions can overlap with one another. The diagnosis of IBS is based on symptom criteria. So you meet a set of criteria and then you would have IBS.

The problem there is that you might meet that criteria and it might be something more than IBS, or it could be IBS plus something else. And so meeting with the gastroenterologist is the gold standard, depending on your insurance, you might not be able to go directly to the gastro, so you can start with your primary care. And if they do some of that initial testing, awesome, ask for the referral, then on to the gastroenterologist or ask when that step would come in the process. Just make sure you're communicating that desire to move up. We'll talk a little bit towards the end about finding a good provider as well as preparing for that visit because I know there are many in our community that may have had poor experiences in the past, and there's a way to find the right provider for you. So we'll talk more about that at the end of the episode, which means stay tuned, all the way to the end!

Okay, so whenever you want to go meet with your gastroenterologist or your primary care, some of the testing that's going to happen is going to depend on what they think is going on, as well as their approach in terms of cost. Testing can be very expensive, and so some people will get very extensive testing right away, some will not, this is gonna look different for every person, but I want to go through some of the tests that you might expect and why they are doing them.

So the point of testing is to rule out other conditions or find what condition is going on, so some of the tests might seem unnecessary in your mind, but what they might be doing is ruling out other conditions so they can confidently say, this is IBS, or, you know, this is functional diarrhea or functional constipation. And what that means is that, okay, there's not something with more serious health outcomes or negative effects that we really need to treat immediately. And that would be like an inflammatory condition like IBD that can contribute to damage or increase risk of colon cancer, those sorts of things, so this is what they're typically looking for.

So usually this is going to start with bloodwork. What they might be looking for are nutrient deficiencies and things like that. They can also look for markers of celiac disease, and inflammatory markers that might signify IBD, which would include Crohn's and colitis. When we're looking at bloodwork for celiac disease, it's important that you're eating gluten at the time of the test. So many providers may not ask if you're eating gluten, and if you've been avoiding it, because of you know, the thought that it might be contributing to symptoms, you can get a false negative for that first celiac screen. So if you're not eating gluten, make sure you talk to your provider about that, and either start eating gluten prior to the testing around 10 days before, or you would want to talk to them about other testing options to truly rule out celiac disease and not get a false negative.

If they do find signs of celiac or inflammatory conditions, that will not be the end-all diagnosis, that is a preliminary sign, they will typically go into a colonoscopy or some sort of scope to be able to take a biopsy in order to test the tissue and look for damage in true signs of the condition to get your diagnosis. So the bloodwork might lead you to another test right away, it may lead you to okay, we ruled out celiac and IBD, and then you might do some more testing or try and approach for something like IBS to see if it's successful. What might be done at the beginning as well would be a stool test. So a stool test, what we're looking for are signs of bacterial infection or something like that. So we might find, like C.diff could be diagnosed that way, if you had C.diff you’d probably know, there are some other conditions that might not be as intense that they might identify through a stool test, they can also look for some signs of different things that could be going on, so that could be done fairly quickly.

Something else that might be done is a colonic transit test, this is testing the speed of the gut. And so they could test the speed of the food going into the stomach, the stomach emptying, the intestines just to see how the transit or the movement of the gut is going. Sometimes I see this done, sometimes I do not.

Another option would be an endoscopy, so that is a scope down the esophagus, and that is usually going to look for the activity of the stomach. Sometimes they can get all the way down to the small intestine to see how things are going from the stomach to the small intestine. Typically, this is going to be done to look for signs of acid reflux or something going on with like stomach and esophagus. This is going to usually be done if you're dealing with something like heartburn or something like that.

There's also a capsule endoscopy where you can swallow a capsule that will actually take video and things as it goes through and collects data, that's another option that might happen versus a traditional endoscopy. An ultrasound is sometimes used to look for stool or look for abnormalities. And this is typically not always diagnostic, but can be used to look at some things that are going on in your stomach, just like if you're pregnant. That's a lot of times used to identify if you're full of stool like we like to call it, which is just severely constipated. You can have diarrhea and be full of stool, and so it's important to see if that's there or if there are any other blockages or something like that going on that they need to go in and address.

A colonoscopy is a very common test, and so that's going to look at your large intestine, and then some of the base of your small intestine. Typically what they're looking for there are any abnormality, signs of inflammation, any damage done to the gut, they're going to try to look for any signs of anything that could help give them answers. So that is commonly done and commonly coming back negative, which can be frustrating if you're dealing with IBS. Honestly, it's a good sign because that means hopefully no colon cancer or inflammation present, it doesn't mean that nothing is actually wrong.

Some other tests that are done that might be less common would be gastric emptying scintigraphy test, which is a GES test, lactulose glucose breath test, which can be used to monitor or measure SIBO and diagnose small intestinal bacterial overgrowth. You might get a lactose intolerance test, which is like a breath test, you can do testing for sucrase intolerance or sucrose intolerance, and that's a breath test. So different breath tests can be used for either carbohydrate intolerance or SIBO. And then another test would be an anal rectal manometry test, which is going to test the strength of your pelvic floor and the function of your pelvic floor muscles, and so this might be done, it's where a balloon is pulled up, and they measure the put up through the anus, and they measure the air and like how your muscles are actually working around that balloon in the pressure that is there. And so that will be done to measure if you have a pelvic floor dysfunction, and then that referral would go to a pelvic floor physical therapist.

So there are going to be some other tests that might be available out there, there's also going to be a lot of times where these tests are not going to be done. Remember, these can be very expensive. insurance doesn't always cover them all fully, and so depends on if your doctor is going to take a more conservative approach, or just go full-on into all the testing, this just varies from provider to provider. What you can always ask is, what's the purpose of the test? What are we looking for, or if you're expecting to do a certain test, but you're not getting it yet, you can ask why and just get clarity on what's going on and why you're choosing to go the route that you are, your doctor may have clear reason, or they may be confident in the testing that they've already done, to be able to move forward with the plan that they have.

If they want to do any additional testing, just ask for the validation of those tests and the purpose again. There are a lot of tests out there that might be used by some providers, especially in the functional medicine and alternative space that aren't necessarily validated, and so this is something that's important to just do your research and make sure that there's some research backing it up or your provider has a reason for it. That could be like a food intolerance test, that might be a different type of stool test, a microbiome mapping test, things like that, they're not validated yet, the science isn't quite there, that doesn't mean that they're completely false, it’s just important to know what you're getting into, what the purpose is, and what where you guys are going together.

Anything that's done in terms of like muscle testing, to identify food intolerances, where you're not actually looking at the body, but you're testing like your body's reaction, those have been proven to be false and inaccurate, so it's very important to avoid those. It's also important to avoid anything that is very unnecessary or seemingly invasive. So anything where we're cutting you open or doing a scope unnecessarily or you know, any type of procedure or anything like that, really be careful about why providers are doing it, what they're actually doing to make sure that it is not going to do harm for you.

Alright, so you've gotten your testing done, if the tests come back negative, so if they come back and your doctor is able to rule out other conditions, and you meet the criteria called the Rome IV diagnostic criteria for IBS, then you would get the diagnosis of IBS. That criteria is laid out to be the presence of symptoms over three months, and it would be a change in bowel habits, so either constipation or diarrhea or the fluctuation between both and the presence of pain. Typically, if you don't have the presence of pain, but you meet the other diagnostic criteria, then you might be diagnosed with functional diarrhea or functional constipation.

Sometimes, providers will go ahead and give you referrals or give you resources to take with that diagnosis, some providers may not give you much information at all. So what to do after the diagnosis is typically where things start to get a little bit frustrating for clients. And that might be where you're at currently, or where you've been, that could be bringing up a little bit of trauma. So after you get your diagnosis as the patient, the first thing that you want to do is ask your doctor, what are my options? So we don't want to go straight to Google, you might get some misinformation. I mean, this is why picking the right doctor is important, which we are going to get to in just a moment, but you want to ask, you know, what are my options? And what are the things that I can do?

So the doctor, the role of the doctor could be prescribing medication, they might prescribe or recommend a certain supplement, they may recommend a certain intervention or approach, they may give you some tips. Typically, medical management is going to include maybe supplements or medication for the symptoms you have. A referral to a dietitian or Registered Dietitian in the US, that's who we consider a credible, trained, credentialed health care professional for nutrition. And so a registered dietitian will help you with diet and maybe some lifestyle behaviors to help with your symptoms according to the test that you've had in the diagnosis that you have. So that's where you're going to get into more of the nutrition management, as well as maybe some lifestyle pieces that go along with that.

Pelvic floor physical therapy should be recommended I believe for anyone with IBS. Typically, there'll be a recommendation right away for pelvic floor dysfunction. The pelvic floor physical therapist can help with things like posture, proper pooping technique, connecting to the right muscles for proper evacuation, making sure that the pelvic floor muscles are working properly for release and closing. If you're dealing with things like leakage, or severe constipation, or straining, tearing, hemorrhoids, fissures, anything like that, a pelvic floor physical therapist can help with restoring the health of the pelvic floor muscles, helping with healing, working on manual work to repair the muscles, all that good stuff. So pelvic floor physical therapist is extremely important there.

And then a therapist or a psychologist, especially a gut psychologists can also have an important role. The reason why is that IBS is a functional gut brain disorder, the gut and the brain are connected, and with IBS, this connection is a little bit off. We've talked about this in previous episodes, but that means that there's an increased risk for mental health conditions like anxiety, depression, higher levels of stress, lower quality of life, and we also know that things that are going on in the brain, like your stress, anxiety, depression can impact the gut. And so the role of a therapist or a psychologist is going to be in stress management, as well as maybe some targeted approaches for that gut brain connection or dealing with the things that are going on in the brain, to then improve the symptoms of the gut more effectively.

If you get a referral to a psychologist or therapist, that does not mean that it is in your head. Your symptoms are very real, there's a real reason for them, the role of the mental health professional is going to be on the brain side of that gut brain connection to make sure that you are getting the best care possible. So we need to de-stigmatize that, especially if there's medication around that too, a doctor might prescribe that or your psychologist could prescribe that as well. There's a reason for it, so just ask for clarity if it doesn't make sense, or if you feel offended by that recommendation, ask for clarity so that you can better understand the reason why.

So the psychologists could also work in something like gut directed hypnotherapy, cognitive behavioral therapy, or different approaches that then target that gut brain connection, and that connection to the muscles and the organs so that you can have better symptom control. In an ideal world, providers would lay out all of these referrals so that you have a full team on your side, helping you work through the symptoms that you have in the condition that you have. And this would be true of IBS, SIBO, functional constipation or diarrhea, IBD, celiac, all of those different conditions.

This doesn't always happen. So it is important to know what your treatment options are, and then how to go about finding those people. We have a free five day IBS training that goes into a lot of this information and really talks about what to do after your diagnosis. So after you have your treatment options, then you're going to find the providers that you connect well with and then come up with your plan. The plan for IBS is look gonna look different for every single person, so this is where it's going to get personalized depending on what works for you and the providers that you connect with. When finding the right provider, there are some tips that can help as well as some things that you can do to prepare for an appointment to help you have more success in that limited amount of time when you're meeting with your provider.

The first thing is finding the right professional on the front end. So it's really important to vet the places that you are going to go, this might be limited depending on your area and the providers available, as well as your insurance and the coverage that they provide in your network. So know that this might not be possible, but know what is possible, and then within the different options that you have, it can be helpful to call ahead of time, before scheduling the appointment and just asking things like do you guys have experience with IBS? What kind of testing do you typically do? Do you provide resources and referrals if I want to take different approaches? If you have certain values that you want to make sure that they align with like, are you health at every size? Are you able to do a weight-neutral approach? Are you able to help me if I have a different gender?

Whatever it might be, being able to ask those values ahead of time and just kindly asking, and then noting how they respond. And if they either can't line up with that, say great, okay, I'll find someone else, or if there is some tension or it already just feels off, trust that gut feeling and move to the next person to find the one that works. Vetting on the front end, maybe looking at reviews, and things like that will help you avoid some of that frustration in that appointment. This can be hard to do if you've gotten referred and you're feeling a little lost in it, but it can be very powerful if you have that ability to slow down and just get it out right.

After you've done that, whenever you are preparing for your appointment, whether it be your first appointment or a follow up appointment, writing out the things that you want to cover and say is extremely helpful. This is so important when you're going into that first appointment with a provider and you want to go over your history, especially if there's emotion tied to that history, or maybe you've had some negative or poor experiences in the past with different providers and testing. So my recommendation is to try to write it out as plainly as possible of symptoms began here, these are my exact symptoms, don't leave out details, just say it plainly, this is the testing that's done. This is what I've tried, this is what has happened. This is the severity, like write it out plainly. And then whenever your doctor's asking, you can either hand that to them, if you don't feel comfortable talking through it, or you can literally read your piece of paper, hand them your log that you've been keeping, and that will help you be able to communicate what you want to communicate without the nerves or you know, the feelings of overwhelm or the emotion kicking in and causing that kind of brain fog that does not let you you know, share what you want to share. So I highly recommend that, especially if you're going to be in shorter appointments, because you'll feel less rushed and feel like you're going to get more out of that conversation.

If the provider talks over you or disregards what you said, say it's okay to say, hey, I would prefer to be able to get through this first, and then we can talk more about it or hey, I feel like you're not really listening to me, do you mind kind of clarifying what you're referring to? Or would you mind, you know, repeating that back to me, just make sure that they're truly listening. A lot of providers get busy and so there's a lot of stress involved, and sometimes they may not be using their best judgment, you might be catching them on a bad moment on a bad day, so it's okay to stick up for yourself and just be very firm and what you need, and by writing that down, you're going to get a lot of success from that.

The last thing is to ask clarifying questions. So if the provider is giving you a recommendation, or is about to do a test or maybe leaves you with the diagnosis, ask for clarity on what they want you to do. They're prescribing something, ask for clarity on okay, what are the side effects? Are there other options available? What am I looking for here? And if they can't do it in their time with you, then say, okay, great, is there someone like a nurse or someone else that I can talk to about these things? Or can I call or how do I get more information about this? Really ask for it. Sometimes they may not know that you have questions if you don't ask them. And so it's very important to really ask those clarifying questions, and if you don't feel comfortable moving forward with something yet, instead of going forward with the discomfort or just like completely running away from it, asking the clarifying questions and getting more information may help you build up your confidence as well as get other resources if that's what you feel better about.

And then the final thing is ask for referrals. So like I mentioned, not all providers will refer and so if you know that you want referrals, or if you've been reading about okay, well, I know nutrition can play a role or I know that the gut brain connection is at play here, you know, I've done some research there, ask for the referrals for those different pieces so that you can get connected to the providers that will work for you.

I hope this was helpful and just understanding how to get diagnosed, there is a lot of information and there are nuances to this. So I would love to continue this conversation in our Facebook community! Search “The GUT Community” on Facebook and ask to join and then we would love to talk more about today's episode or other questions that you may have with other members of our incredible community. Let me know what you think about the episode through your review, and I will see you on the next episode!