The First Question I Ask Isn’t “What Are Your Symptoms?” It’s “What changed?”
Whether someone comes to see me with bloating, reflux, constipation, diarrhoea or food intolerances, I almost always start in the same place.
“Did anything happen or change around the time this started?”
It’s a simple question, but over the years I’ve found it often tells me more than a list of symptoms ever could.
If you’ve been struggling with digestive symptoms for months or even years, you’ve probably spent a lot of time trying to work out what’s causing them. That’s completely understandable. But over the years I’ve found that the answer often isn’t hidden in today’s symptoms. It’s hidden in what changed before they appeared.
One of the reasons I still love working in digestive health after all these years is that it never becomes predictable.
Two people can walk into my clinic with exactly the same symptom and leave with completely different treatment plans. Not because one of them described their symptoms better than the other, but because the story behind those symptoms is different. Understanding that story is often far more valuable than simply naming the symptom.
>data-fusion-font=”true”>That’s why our first consultation often feels a little different. Rather than jumping straight into the symptoms you’re experiencing today, I’m trying to understand how you arrived there.
When did it start? What was happening around that time? Was there a bout of gastroenteritis, a course of antibiotics, a new medication, a particularly stressful period, pregnancy, perimenopause or gallbladder surgery?
Sometimes people know immediately. Other times we’ll be twenty minutes into the consultation before they suddenly stop and say, “Actually… that’s exactly when everything changed.” I always pay attention when that happens, not because it gives us the answer, but because it often gives us our first real clue.
While nutrition remains important, emerging research suggests that transit time may play a surprisingly powerful role in shaping the gut ecosystem.
If you’ve developed reflux, you want the reflux to stop.
If you’re bloated after every meal, you want to know what food could be causing it.
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If your bowel habits have changed, you want them to go back to normal.
There’s nothing wrong with wanting relief. In fact, usually helping someone feel better quickly is absolutely my first priority. But if we want to make sure that the issue never returns, we really do need to work out why it started in the first place.
Sometimes I can tell people are wondering why I’m asking about their stress levels, past medical history or previous infections when all they really want to talk about is their uncomfortable gut. But that’s often where the consultation becomes most interesting, because those details can completely change how I think about what’s driving their symptoms.
Bloating Isn’t Always About the Food
Take bloating, for example.
People often arrive convinced they’ve identified the problem because they’ve worked out that onions, legumes or apples make them feel worse, and sticking to a low FODMAP diet helps. That observation is genuinely useful, but it doesn’t explain why those foods suddenly became a problem after years of eating them without any issues.
=”true”>My thinking usually goes somewhere else. I’m wondering whether food is moving through the digestive tract differently than it used to, whether the gut microbiome has changed, or whether this all began after antibiotics, gastroenteritis or a particularly stressful period. I’m also interested in whether any other symptoms appeared at the same time, because they often point towards a common underlying cause.
The foods might be triggering symptoms today, but they may not be the reason those symptoms developed in the first place.
Why Reflux and Bowel Changes Need a Bigger Picture
Reflux makes me think in much the same way.
It’s common to assume reflux means too much stomach acid because that’s the explanation many of us have heard for years. Sometimes that’s true, but sometimes reflux develops after changes in stomach emptying, gut motility, pregnancy, certain medications or other changes in digestive function.
Whenever I see that pattern, I find myself asking the same question: why now? Why did someone who never experienced reflux before suddenly develop it in their forties or fifties?
Bowel changes make me think in a similar way. Constipation isn’t always about needing more fibre, and diarrhoea isn’t always something you’ve eaten. Sometimes they’re connected to changes in gut motility, inflammation, medications, hormones or the gut microbiome. The symptom tells me where the problem is showing itself, but not necessarily where it began.
Why Food Intolerances Often Develop Later in Life
One of the hardest conversations I have in clinic is with people who tell me they’ve started collecting “safe foods”.
“It always makes me a little sad when someone starts talking about their ‘safe foods’. Food is meant to nourish us. My goal is always the same: to help you understand why those foods became a problem so that, wherever possible, we can start adding them back into your diet rather than taking more away.”
-Kate Troup, Naturopath
“I’ve lost eggs.”
“I can’t eat vegetables anymore.”
“I’ve only got a handful of foods left.”
I completely understand why people get there. If eating leaves you feeling unwell, avoiding those foods feels like the sensible thing to do. But I’ve also seen people whose world has gradually narrowed until they’re living on four or five foods. That’s no way to live, and it’s certainly no way to build a healthy, resilient gut.
This is where I think we’ve started asking the wrong question. Rather than asking, “What else can’t you eat?”, I’d much rather ask, “Why has your digestive system become less tolerant?” They’re very different questions, and they lead us down very different paths. One tends to end with a longer list of foods to avoid. The other looks for the reason those foods became a problem in the first place.
If you’ve reacted to a food since childhood, that’s one conversation, but if you’ve eaten it happily for thirty years and suddenly can’t tolerate it, that’s a completely different conversation.
That difference matters because it changes the questions we ask and where we start looking for answers.
Looking Beyond Individual Symptoms
Over the years I’ve found that digestion makes much more sense when you stop thinking about individual symptoms in isolation and start thinking about the digestive system as a whole.
Food has to be broken down effectively, mixed with digestive enzymes and bile, moved through the gut at the right pace and processed by a healthy microbiome. If one part of that sequence changes, it’s not surprising that symptoms can appear in several different places at once.
That’s why someone may experience bloating, reflux, bowel changes and food intolerances together rather than as completely separate problems. Once we understand those connections, we have a much better chance of restoring digestive function and, wherever possible, rebuilding tolerance rather than continually narrowing someone’s world.
The Same Question Applies Beyond Gut Health
Although this article has focused on digestive symptoms, it’s actually the same way I think about fatigue, hormones and mood. Whether someone has lost the ability to tolerate certain foods, they’re struggling with their energy, or they simply don’t feel like themselves anymore, I’m asking the same question:
What changed?
Because once we understand that, we can start restoring function instead of simply managing what’s been lost.
Ask a Different Question
If there’s one thing I’d like you to take away from this article, it’s this.
The next time you’re tempted to ask, “What food caused this?”, try asking a different question.
What changed around the time this all began?
You might not know the answer immediately, and that’s okay. Sometimes it takes a conversation, careful questioning and a bit of detective work to piece the story together.
But in my experience, that’s often where the path back to eating more foods, having more energy and feeling like yourself again begins.
Further Reading
If this way of thinking about gut health resonates with you, these articles explore some of the underlying reasons digestive symptoms can develop.
