Part 2: Gastroenterologists Are Specialists Trained to Treat
Serious Digestive Diseases, Not Prevent Them

A male gastroenterologist

This article describes one of six things I've learned about gastroenterologists through my personal experiences and through research. I'd suggest you set your expectations accordingly, but your experiences might vary from mine.

For the complete series of articles, see Six Things You Should Know About Gastroenterologists.

Gastroenterologists Are Trained to Treat Disease

The human digestive system

Gastroenterologists specialize in the digestive system. They learn how to diagnose digestive diseases and treat symptoms using over-the-counter drugs (OTC), prescription medications, and surgery. They save lives. However, they typically don't try to prevent disease, much less find and fix root causes of existing disease.

So imagine the potential frustration of patients who don't yet have a diagnosable gastrointestinal (GI) disease—except, perhaps, for irritable bowel syndrome (IBS)—but are experiencing chronic digestive symptoms.

(In my opinion, IBS is the bucket you are dropped into when your doctor can't explain your symptoms.)

Might something worse, like an autoimmune disease, be lurking around life's corner—unless the root causes are promptly addressed?

“There is an ancient Chinese proverb that goes something like this: The wise physician prevents disease, the mediocre physician treats impending disease, and the inferior physician treats disease. By those standards, I and my medical colleagues across America are mediocre to inferior.

One hundred years ago, Thomas Edison, one of America’s most prolific inventors, said, 'The doctor of the future will give no medicine but will interest his [or her] patients in the care of the human frame, in diet and the cause and prevention of disease.'

Sadly, we are still waiting for that physician to arrive.”

— Terry Wahls, MD, clinical professor of medicine at the University of Iowa, a staff physician at the Iowa City Veterans Affairs Hospital, and the author of The Wahls Protocol: How I Beat Progressive MS Using Paleo Principles and Functional Medicine

Autoimmune Disease Doesn't Develop Overnight

Autoimmunity word cloud

Many people don't realize this, but it can take years for early symptoms of autoimmunity to devolve into a diagnosable disease such as celiac disease or Crohn's disease. A person isn't free of autoimmune disease one day and then suddenly struck down by it the next.

According to Aristo Vojdani, PhD, autoimmunity progresses over three stages. (1)

  1. Stage 1, or silent autoimmunity, occurs when elevated antibodies against body tissues or organs are present with no obvious symptoms or loss of function. Silent autoimmunity is a predictor of future autoimmune disorders.

  2. Stage 2, or autoimmune reactivity, occurs when these elevated antibodies cause symptoms and loss of function, but the damage is not yet severe. Vojdani states: “This process may continue over a period of three, five, or ten years before tissue damage is detectable.”

  3. Stage 3, or autoimmune disease, occurs when the immune system activity against body tissues or organs causes significant damage and pathology that is detectable by conventional testing methods, such as an MRI. Vojdani states: “Once detectable damage occurs to various tissues such as brain, joints, thyroid, or pancreas, it is very difficult to reverse.”

For example, one study of celiac disease patients found that it took an average of 9.7 years from the appearance of the first symptoms to diagnosis (though from the first doctor visit, it took an average of 5.8 years for a proper diagnosis to be made). (2)

Prior to these first symptoms, patients experienced silent autoimmunity for some period of time. So the development of their autoimmune disease from the very beginning took even longer than reported in this study.

If Left Unaddressed, Digestive Symptoms Can Worsen Over Time and the Opportunity to Prevent Disease Can Be Lost Forever

Often, digestive symptoms start out as vague and perhaps annoying, but not alarming. For example, constipation can initially be intermittent. Maybe you mention the symptom to your doctor, maybe you don't. And if you do, chances are you'll be told to eat more fiber or take an OTC stool softener.

However, in some people, constipation can eventually become a constant problem where no bowel movements occur naturally without the aid of a laxative. Many people come to accept this symptom as normal, in part because it can evolve gradually. They don't hear the alarm sounding.

A lot of people, including many doctors, think constipation is no big deal. However, according to Terry Wahls, MD—who overcame secondary progressive multiple sclerosis using paleo principles and functional medicine—constipation is “absolutely the most common” symptom of autoimmune disease. (3)

So we should listen to symptoms such as chronic constipation, which could be our body's way of sounding an alarm. We should view them as opportunities to find the root cause or causes, fix them, and ultimately prevent worse things from happening.

Most Gastroenterologists Can't Help You Prevent Autoimmune Disease

Unless you are working with an integrative gastroenterologist, most gastroenterologists can't help you change this trajectory—even though the development of an autoimmune disease is not inevitable, despite one's genetics.

The sad fact is that the training of most gastroenterologists doesn't give them the skills and knowledge required to change this trajectory—even though they are experts in diagnosing and treating autoimmune diseases of the digestive system such as celiac disease, Crohn's disease, and ulcerative colitis.

To change this trajectory, you need to seek the help of a healthcare practitioner with training in functional medicine.

That said, don't abandon the care that a gastroenterologist can offer you. A gastroenterologist can be a valuable member of your healthcare team.


1. Vojdani A. Celiac Disease and Its Association with Other Autoimmune Disorders Beyond the Gut. Townsend Letter. Jun 2013.

2. Norström F, Lindholm L, Sandström O, Nordyke K, Ivarsson A. Delay to celiac disease diagnosis and its implications for health-related quality of life. BMC Gastroenterol. 2011 Nov 7;11:118.

3. Wright, S. How to Fix Autoimmune Problems Like Multiple Sclerosis With Dr. Terry Wahls (Podcast 75). SCDLifestyle blog. Feb 10, 2014. home page > Articles
6 Things You Should Know About Gastroenterologists > Gastroenterologists Are Trained to Treat Digestive Diseases