(And Why No Doctor Explained It)
For almost a decade, I lived inside my own abdomen. Not metaphorically, I mean that my attention, my planning, my sense of what kind of day I was allowed to have, all of it lived downstream of what my gut was doing that morning. I was a physician. I knew the workup. And still, I spent years doubled over in call rooms and bathroom stalls, doing the thing I now watch my patients do every day: performing wellness while negotiating with my own body to just get me through the next twelve hours.
I want to tell you what actually changed.
The workup was thorough. The explanation wasn’t.
I did the scopes (endoscopy, colonoscopy). I did the elimination diets, the low-FODMAP protocol down to the gram, the stool studies, the SIBO breath tests, the referrals to GI colleagues I respected. Nothing was structurally wrong with me. Eventually, the chart said what so many women’s charts say: irritable bowel syndrome. And I want to be precise about something here, because it matters, that diagnosis wasn’t wrong. My bowel was, in fact, irritable. What I didn’t get was an answer to the only question I actually cared about: irritated by what?
IBS is a description of a pattern, not an explanation of its cause. It tells you what the gut is doing, hypersensitive, dysregulated, unpredictable, without telling you why. And in a fifteen-minute visit, with a waiting room full of patients and a system that reimburses procedures far better than it reimburses conversation, “why” is the question that gets left on the table. That’s not a doctor failing you. That’s a structure that was never built to ask it.
So the explanation I was given stress-sensitive gut, manage your diet, maybe try a probiotic, was true and also almost useless, in the way that “you’re tired because you’re not sleeping enough” is true and also useless to a new mother. I needed someone to ask what my nervous system had been carrying for the past ten years. Nobody did. So eventually, out of sheer exhaustion, I asked myself.
What I started noticing
The turn didn’t happen in a doctor’s office. It happened on an ordinary Tuesday when I caught myself, mid-flare, replaying a conversation from three days earlier, a boundary I hadn’t set, a request I’d said yes to when every part of me wanted to say no. My stomach had been in knots since. Not figuratively. Literally, physically, in knots.
I started keeping track, the way I’d been trained to track any clinical pattern, except this time the variable wasn’t food, it was feeling. I noticed that my worst flares didn’t line up with what I’d eaten. They lined up with what I hadn’t said. A tense phone call with a family member. A deadline I was terrified of missing. A version of myself I was performing for someone whose approval I’d been chasing since childhood. My gut, it turned out, had a much better memory for the things I minimized than my conscious mind did.
This is where the science actually does back me up, even though nobody had connected it for me in real time: the gut and the brain are not separate systems consulting each other from a distance. They are one continuous circuit, wired together by the vagus nerve, in constant bidirectional conversation. Your gut has its own dense web of neurons — sometimes called the second brain — and it is exquisitely responsive to your nervous system’s read on safety. When your body perceives threat, whether that threat is a tiger or a mother-in-law or the low hum of chronic self-abandonment, it doesn’t ask you to fact-check the threat level. It just responds. Digestion slows or speeds up. Blood flow redirects. The gut lining, which is basically one cell layer holding back your entire microbial world, becomes more permeable, more reactive, more raw.
I hadn’t been diagnosed with a broken gut. I’d been diagnosed with a nervous system that had been in a low-grade state of alarm for most of my adult life, and my gut was simply the part of me loud enough to finally get my attention.
What I actually did and what I want you to hear about it
I did not do one dramatic thing. I wish I could hand you a single practice and tell you it will do for you what it did for me, but that would be its own kind of dishonesty, and I promised you the real version. What I did was slow, unglamorous, and built over years not two weeks.
I started paying attention to sensation before it became pain, the tightening in my chest before a hard conversation, the way my jaw clenched right before I said “sure, that’s fine” to something that was not fine. I read and studied extensively about trauma as something the body stores, not just something the mind remembers, and understood what my gut had been metabolizing on my behalf: a childhood spent reading the emotional weather of the adults around me, a decade of being the reliable one, the fixer, the daughter and then the doctor who was not allowed to be the one who needed care. I practiced, badly, at first, saying no to things. I noticed that the flares got quieter roughly in proportion to how honest I got, both with other people and with myself.
None of this replaced good medicine. I want to be unambiguous about that, because I still practice medicine and I take that seriously. This was never instead of ruling things out. It was what became available to me after ruling things out — the layer underneath the diagnosis, the part of the chart nobody had space to write.
What I want you to take from this
If you are reading this with a folder of normal labs and a diagnosis that explains your symptoms without explaining your life, I am not telling you to stop trusting your doctors, and I am not telling you that your pain is “just stress,” a phrase I have come to genuinely dislike because of how easily it gets used to dismiss what deserves investigation. I am telling you that a body can be both medically clear and still be trying to tell you something. Those two things are not in conflict. Holding both is, in fact, the entire point.
Your gut may not be broken. It may be listening — to a life you’ve been white-knuckling through, to feelings you learned early were safer left unsaid, to a version of yourself that has been so busy being fine for everyone else that no one ever asked what you were actually carrying. Mine was. And when I finally started answering that question instead of only managing its symptoms, the pain that no elimination diet had ever touched began, slowly and then all at once, to loosen its grip.
That is the part no one explained to me. So I’m explaining it to you.
This reflects my personal experience and clinical perspective, and is intended for education, not as a substitute for individualized medical care. It applies once serious and structural medical conditions have been appropriately evaluated and ruled out by your own clinician. If you are experiencing new, severe, or worsening symptoms, please seek medical evaluation. Please consult your own healthcare provider before making changes to your care.