Why I stopped telling my patients to just try low-FODMAP

I want to take a step back from the framework for a moment and tell you something about where my thinking on all of this actually comes from — because I don't think it's enough to tell you what I believe without telling you why I believe it, and how I got here.

I'm a gastroenterologist based in Marin County, California. I trained at some of the leading academic medical institutions in the country, and toward the end of my gastroenterology fellowship I had the opportunity to train with Dr. Lin Chang at UCLA — one of the world's foremost experts in disorders of gut-brain interaction. That experience was formative. It gave me a deep clinical understanding of the gut-brain connection and what happens when the gut's nervous system becomes so sensitized that even normal digestion — ordinary gas, food moving through the intestine — is perceived as painful or deeply uncomfortable. It also showed me what truly multidisciplinary care looks like in practice, integrating dietary approaches, behavioral health strategies, and a serious understanding of the nervous system's role in digestive health.

I've also completed formal training in functional medicine through the Institute for Functional Medicine, with a focus on gastroenterology and hormonal health. This has always felt like a natural part of how I think about medicine rather than a separate lane. I came into this work genuinely interested in both conventional and functional frameworks, and what I've come to understand is that neither is sufficient on its own. Conventional medicine brings rigor, diagnostic precision, and evidence-based treatment; functional medicine brings a broader lens on root causes, lifestyle, and how body systems interconnect. What's distinctive about my approach is that I'm fully fluent in both, and the framework I've developed draws from each deliberately — taking what is clinically useful from each, guided by evidence where it exists and by careful clinical reasoning where it doesn't.

Outside of medicine, the most important part of my identity is being a mother. I have three young children with a fourth on the way. I also practice in a community full of women who are managing careers, families, and a relentless list of competing demands — and I understand that reality not just as their doctor, but as someone living it myself. The women I work with aren't looking for a protocol that takes over their lives. They're looking for something effective, sustainable, and designed around the reality of how they actually live. That shapes everything about how I approach this work.

Where I started — and where diet fits

I came into gastroenterology with a strong interest in nutrition and the role that diet plays in health and disease. That interest was part of what drew me to the field in the first place, and dietary intervention was often where I started with patients — removing dairy, trialing low-FODMAP for IBS and bloating, paying close attention to what they were eating and how their bodies were responding.

For some patients, it helped. Meaningfully. The low-FODMAP diet has a solid evidence base for a specific subset of patients, and dietary intervention remains a genuine part of my toolkit. I want to be clear about that — I haven't abandoned diet as a therapeutic tool, and the framework I've developed absolutely incorporates it alongside targeted microbiome support where the evidence supports it. What I've stopped doing is treating diet as the primary answer for everyone, because the clinical reality simply doesn't support that.

For a significant number of my patients, dietary intervention wasn't enough. Sometimes it helped partially. Sometimes temporarily. And sometimes — despite the patient following the protocol carefully, tracking everything, eliminating all the right things — it didn't help at all. They were still bloating. Still uncomfortable. Still frustrated.

But the pattern that troubled me most wasn't the patients for whom diet didn't work. It was the ones who had taken dietary restriction so far that they were barely eating anything — a handful of foods they'd deemed safe, a diet so narrow it had become its own source of stress and misery — and they were still symptomatic. Still bloating despite eating almost nothing. That told me something important: we had reached the logical extreme of the dietary approach and it still wasn't the answer. Restriction wasn't the solution. It was just a different kind of suffering — and an unsustainable one that no fulfilling life could be built around.

The patient I kept seeing

It wasn't one patient who changed my thinking. It was the same patient, over and over.

A woman, typically somewhere between her twenties and fifties, struggling with persistent bloating that had resisted everything she'd tried. She'd done the elimination diets. She'd spent significant amounts of money on tests and supplements that had been recommended with great confidence and delivered very little in return. She was exhausted — not just physically but emotionally, from years of trying and not getting there. And she'd often started to wonder, quietly, whether she was somehow the problem.

What struck me every time was how much was being missed. The gut-brain connection — the role of a sensitized gut nervous system, of chronic stress rewiring how the gut perceives and responds to normal sensations — was almost never part of the conversation she'd had with anyone before coming to see me. Yet for so many of these women, it was central to what was actually driving their symptoms. Not peripheral. Central.

I also started noticing patterns that no one had apparently thought to connect to her digestion. Her bloating was worse in the second half of her cycle. It had shifted dramatically during a pregnancy. It had changed again in perimenopause. These weren't random fluctuations — they were her hormones communicating directly with her gut, in a language that a food diary was never going to capture.

And then there were the patients who still weren't improving despite addressing all of the above. Women whose bloating had a mechanical, structural dimension — involving how the muscles of the abdomen and diaphragm were coordinating, or how the pelvic floor was functioning. As part of my practice I perform anorectal manometry — a test that directly measures how the muscles of the pelvic floor and lower digestive tract are functioning — and I kept finding significant dysfunction in women whose bloating workup had never included any assessment of this at all. It was being missed entirely, in patient after patient.

What I started doing differently

The frustration of seeing the same gaps repeatedly — in the standard approaches, in the tests being ordered, in the frameworks being applied — pushed me to go looking for something more complete. That meant additional training. It meant going deep into the research on disorders of gut-brain interaction. It meant pursuing formal training in functional medicine. It meant following the evidence on hormonal effects on gut function across the entire life cycle, from the monthly cycle through pregnancy, perimenopause, and menopause. It meant developing a genuine understanding of pelvic floor physiology that goes well beyond what most gastroenterology training covers.

I want to be honest about where that process currently stands: I am still refining it. I don't think any clinician working in this space should claim they have it perfectly solved — chronic bloating in women is genuinely complex, the research is still evolving, and what drives symptoms varies considerably from person to person. What I can say is that the approach I've developed is the most complete framework I've encountered for addressing the full picture, and the results I've seen in women for whom everything else had failed have been the most gratifying of my career.

That framework is what I call the Fine Belly Method. I'll explain it properly in a full dedicated article, because it deserves the space. But the short version is this: it's a structured, multi-system approach that incorporates diet and microbiome optimization where appropriate, while going well beyond them to address motility, the gut-brain axis, hormonal patterns, and the mechanical and pelvic floor picture. It's built around identifying which drivers are actually relevant for your specific pattern of symptoms — not applying a one-size protocol and hoping it lands — and it's designed to be sustainable for real life, not just a temporary elimination experiment.

I'm sharing all of this because I think you deserve to know who you're learning from and why I think the way I do. This approach isn't a collection of things I read about. It's the product of years of clinical practice, of sitting with patients who weren't getting better and refusing to accept that as the end of the conversation, and of following the evidence wherever it led — even when that meant going back to school on subjects my original training hadn't fully covered.

If any part of the story sounds like your story, I want you to know that there is a more complete way of looking at what's happening in your body. And that's exactly what the Fine Belly Method is built around.