21 When Your Gut Symptoms Shouldn’t Be Ignored

When Bloating, Bleeding & Indigestion Need a Closer Look

When is a digestive symptom just a digestive symptom — and when is it worth a closer look?

Bloating, changes in bowel habits, low iron, rectal bleeding and indigestion are incredibly common, and most of the time they have a benign explanation. But sometimes, the pattern of a symptom — how long it lasts, how often it happens, or whether it has changed — can be an important clue that further investigation is needed.

In this episode of the Team Gut Girls Podcast, Dr. Dominique Vanier, ND, Dr. Whitney Baxter, ND, and Dr. Christina Carew, ND unpack the digestive red flags they don’t want you to ignore.

They explore why colorectal cancer is increasingly being diagnosed in younger adults, how gastrointestinal bleeding can happen without visible blood, why heavy periods shouldn’t automatically be considered the only explanation for low iron, and how persistent bloating can sometimes warrant looking beyond the gut.

They also discuss ovarian and stomach cancer symptoms that can initially sound surprisingly ordinary — including bloating, feeling full quickly and persistent indigestion — and explain why new, persistent or changing symptoms matter more than how dramatic a symptom feels.

This isn’t about assuming the worst every time you’re bloated. It’s about knowing your normal, recognizing when something has changed, and having the information you need to advocate for yourself when it has.

What You’ll Learn

In this episode, you’ll learn:

• Why colorectal cancer is increasingly being diagnosed in adults under 50
• Why “you’re too young for that” shouldn’t automatically end a medical investigation
• The digestive red flags worth discussing with your healthcare provider
• Why rectal bleeding shouldn’t automatically be assumed to be hemorrhoids
• How gastrointestinal bleeding can be invisible — and show up instead as low iron or anemia
• Why heavy periods can contribute to low iron without necessarily explaining the whole picture
• What persistent bloating can tell you that occasional, meal-related bloating can’t
• The bloating, pelvic and urinary symptoms associated with ovarian cancer that warrant a conversation with your healthcare provider
• When persistent indigestion may need further investigation
• Why black or tarry stool, persistent vomiting, difficulty swallowing and unexplained weight loss deserve attention
• How your family history can change screening recommendations
• Why a previous normal colonoscopy, ultrasound or other investigation doesn’t necessarily explain a new symptom today
• How to track symptom patterns and communicate them clearly to your healthcare provider
• Practical language you can use to advocate for further investigation when something doesn’t feel like your normal

The Big Takeaway

Track the pattern, not just the symptom.

A symptom doesn’t have to feel severe to be worth mentioning. If something is new, happening frequently, changing from your usual pattern or persisting most days for more than two to three weeks, bring it to your healthcare provider’s attention.

And if you’ve mentioned it before and it’s still happening? You can bring it up again.

The goal isn’t to assume that common digestive symptoms mean something serious. It’s to make sure persistent or changing symptoms aren’t dismissed simply because you’re young, you’ve had the symptom before, or there’s an easy explanation available.

Because Better Gut Health Changes Everything.

Chapters

00:00 — Digestive Red Flags
Why common gut symptoms sometimes deserve a second look.

02:03 — Bloating Patterns Matter
The difference between occasional bloating and a new pattern that won’t go away.

03:30 — The Colorectal Cancer Age Shift
Why colorectal cancer is increasingly showing up in younger adults and how screening recommendations are changing.

06:06 — Hidden Bleeding & Low Iron
How occult GI bleeding can happen without visible blood — and why unexplained iron deficiency deserves investigation.

09:08 — When Heavy Periods Overshadow Other Causes
Heavy menstrual bleeding can explain low iron, but it shouldn’t automatically end the investigation.

12:59 — Colorectal Cancer Red Flag Checklist
Rectal bleeding, bowel changes, anemia, unexplained weight loss, persistent pain and family history.

19:02 — What the Colour of Blood Can Tell You
Bright red blood, black or tarry stool, and invisible bleeding — and why each deserves attention.

20:15 — Ovarian Cancer & Persistent Bloating
Why persistent bloating, pelvic or abdominal pain, early fullness and urinary changes can warrant a closer look.

22:34 — When Indigestion Needs a Workup
The signs that can move indigestion from “watch and treat” to “let’s investigate.”

24:49 — Practical Advocacy Takeaways
How symptom duration, family history and changes from your normal can help guide the conversation.

27:27 — What to Say to Your Healthcare Provider
Practical ways to describe symptoms, establish a timeline and ask about appropriate investigation.

29:40 — Episode Recap
The digestive red flags and self-advocacy lessons we want you to remember.

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21 When Your Gut Symptoms Shouldn’t Be Ignored Transcript

Digestive Red Flags 

Dr. Dominique Vanier, ND: Welcome to another episode of the Team Gut Girls podcast. Today we’re discussing a topic that we’ve touched on, um, in many of our other episodes, and that is digestive red flags. So you may have seen this story going around, you know, a healthy-looking person in their 30s posting from a hospital bed captioned something like, “They told me it was just stress, uh, and hemorrhoids.”

And, you know, that kind of story is showing up more, not less these days. And today we’re talking about the gut symptoms that are easy to wave off, and the small handful of times waving them off is actually the wrong call.Dr. Whitney Baxter, ND: Yeah. So many people sit down in our clinic offices and say something like, “I know it’s nothing, but…” 

And generally, most of the time it isn’t anything, but there is a short list of signs and symptoms, and that’s our job is to, to listen for this, to assess you, um, to make sure it is nothing, and to make sure, um, we can help you in our office. [00:01:00] And we want you walking away knowing what these signs and symptoms are. 

Dr. Christina Carew, ND: So we’re gonna cover the three big ones: bleeding that keeps getting explained away, ovarian cancer symptoms that hide inside an ordinary bloating complaint, and stomach cancer symptoms that are assumed to be indigestion.  

Dr. Dominique Vanier, ND: Mm-hmm. Yeah, and we’re gonna spend, you know, some real time on a shift that’s caught a lot of clinicians off guard, and we’re talking a lot about this today, which is that colorectal cancer is showing up in people nowhere near the age that we used to associate with it. 

And, you know, I wanna be clear that this is definitely not a… It’s not supposed to be a fear-mongering episode whatsoever, but it’s, it’s, you know, information is powerful, and it’s about n- you know, knowing the difference.  

Dr. Christina Carew, ND: Yeah. Yeah, we were talking a couple weeks ago of just about I had an enormous amount of friends that had cancer diagnoses recently, and, and that, you know, they’re much younger than we would typically see people. 

And, and some of that spawned this conversation about, like, when we… let’s make sure that [00:02:00] our listeners know what they’re looking for.  

 

Bloating Patterns Matter 

Dr. Christina Carew, ND: So this week’s reel is, again, about bloating. Imagine, um, when you talk about bloating all your time, your phone gets filled with bloating reels. So bloating isn’t always just about your gut bacteria. 

It’s this magic probiotic blend that clears it all in three days, guaranteed, and everything is better.  

Dr. Dominique Vanier, ND: Mm-hmm.  

Dr. Christina Carew, ND: Does that work for you guys?  

Dr. Dominique Vanier, ND: Yeah, a little bit fishy, I would say. And, you know, for most people, most of the time w- we could probably say that that’s a fair description of ordinary bloating. So it comes after a meal. 

It… You wanna see this, like, transient kind of effect where it comes and goes. It responds to the usual things. Maybe we can even, like, pinpoint it back to like, oh, you know, I had wings and nachos and beer. Like, I’m bloated. It makes, it makes sense. Um, and the problem isn’t the advice, but it’s the words always and guaranteed, and we have to be cautious when we see words like that in marketing. 

Uh, so bloating [00:03:00] is one of the most common symptoms in medicine, like we’ve gone over in all of our ep- other episodes, but it is also occasionally one of the first ways that both ovarian cancer and colorectal cancer can show up.  

Dr. Whitney Baxter, ND: Yeah, exactly. So the useful question here isn’t will this probiotic help. 

It’s the pattern of bloating. So is it coming and going, or has it moved in here, and it’s there permanently when you wake up, when you go to bed? This pattern is important, not just the bloating itself.  

Colon Cancer Age Shift 

Dr. Whitney Baxter, ND: Okay, let’s go into our myth busting segment. Let’s start with colon cancer is an older person’s disease. 

I don’t need to think about it until I’m 50, and this is some of what our screening guidelines still say. Dominique, can you tell us more about this?  

Dr. Dominique Vanier, ND: Mm-hmm. Uh, I would say this used to be, like, a reasonably safe assumption, and it’s exactly the belief now that’s putting younger adults at a disadvantage. Um, so when we talk about, you know, uh, the way the guidelines have changed, [00:04:00] the most recent American Cancer Society data shows a colorectal cancer incidence is climbing. 

It’s climbing about 3% a, a year over the past decade, or just o- just a little bit over the last decade since 2013. Uh, and that’s specifically in adults age 20 to 49, while it’s actually falling in adults 65 and older. And so that trend is large enough that both the American Cancer Society and national screening guidelines have lowered the recommended starting age for average risk screening from 50 down to 45, and Ontario just, just did this as well. 

So Ontario also changed its screening program, which now starts at age 45, and that started July 1st, 2026.  

Dr. Christina Carew, ND: And so when we’re looking at this pa- patient population, it’s like one in five colo- colorectal cancer diagnosises are now someone under 55, um, which is about double the rate from about 30 years ago  

Dr. Whitney Baxter, ND: And do we know why this is happening?[00:05:00]  

Dr. Dominique Vanier, ND: Not really. I, I think there’s, there’s some, you know, there, there’s some things that are associated with this. You- So we look a little bit at diet, obesity, inactivity, early life antibiotic exposure, and shifts in the gut microbiome. Those are all being studied as possible contributors. But there’s no single confirmed cause yet, and it’s difficult to establish causation too, right? 

Um, there’s also, you know, there’s also more discussion around, uh, ultra-processed foods and then the increased risk of colorectal cancer. What we do know is that it isn’t just, you know, we’re finding more because we’re looking more. That’s not what’s happening here. Um, it’s showing up in people who had never been screened at all previously. 

Yeah.  

Dr. Christina Carew, ND: And even within that, like a lot of the screening was these like blood, blood in stool tests, and they’ve changed a lot of those in terms of like how do we get them, and even if we have, um, patients that have had blood in their stool that don’t make the criteria, it’s actually really [00:06:00] hard in some places to be able to get that screening to confirm. 

Dr. Dominique Vanier, ND: Yeah. Yeah, exactly.  

 

Hidden Bleeding And Low Iron 

Dr. Christina Carew, ND: So if we’re not seeing blood, then it can’t be a bleeding problem. That’s one of the myths.  

Dr. Dominique Vanier, ND: Mm-hmm. Yeah, bleeding doesn’t always, it doesn’t always announce itself. Um, and I have a case I’ll mention in just a moment. So it can be completely invisible and still show up as unexplained fatigue, uh, like low iron on a blood test. 

And like think about how many people have low iron, right? It’s like, “Oh, you’ve got low iron. Eat more iron foods.” Like, and we’ll talk a lot more about that in a moment. But when it’s, when it’s hidden, it- that’s called occult bleeding, and it’s one of the most under-recognized red flags there is. Um, and so I had a 40-year-old female patient, and we had been seeing each other for quite a while working on her upper digestive symptoms. 

So she had reflux, and that was really well managed. Periods never changed, and then suddenly her iron started creeping down and down, and it just, it didn’t really make sense. She wasn’t really [00:07:00] responding to oral iron supplementation or kind of was. And then we were finally like, “You know what? Why don’t we just get a colonoscopy?” 

‘Cause this is a, this, this would classify as an unexplained, um, low iron picture. And she had a three-centimeter polyp on colonoscopy, which for listeners, if like, you know, three centimeters, that’s a very large size polyp. And so it was thought from her GP and her GI specialist that she was actually having a microbleed. 

And we talk about microbleeding, that’s a hidden cause of bleeding where we’re not seeing like the fresh red blood, um, that being as the cause of her low iron. And you know, one can only assume that if she hadn’t had the colonoscopy, that polyp may have progressed to colorectal cancer, and again, only at age 40. 

Dr. Christina Carew, ND: Yeah. I’ve had a couple of those GI tests come back where the blood was, like, a lot in male patients in particular, and I was like, “Oh, I think that you definitely need to get this checked out.” And pretty much every time they had polyps, whether they were cancerous or not, you know, that’s generally [00:08:00] younger is better to catch those things. 

But-  

Dr. Dominique Vanier, ND: Mm-hmm …  

Dr. Christina Carew, ND: certainly we don’t always… And none of those people had ever complained that they saw, you know, blood on the toilet paper or blood in the toilet or anything like that.  

Dr. Whitney Baxter, ND: Yeah. Or, like, pain, right? Like, we, we get more worried about pain than blood, but yeah, it can be really subtle. Mm-hmm. And that’s a good question to ask yourself and your doctor if you have a period or if you don’t, you know, if your iron is dropping, don’t just take an iron supplement. 

Think about the gut. Could we be e- either not absorbing it, or could we be losing blood through the gut? And that’s where these tests are really helpful.  

Dr. Christina Carew, ND: Yeah.  

Dr. Dominique Vanier, ND: S- Yeah. So unexplained iron deficiency anemia always deserves the question, where is the iron actually going, before it gets treated as a simple supplement problem, just like we mentioned there. 

Dr. Christina Carew, ND: And that’s one of the things, um, I send a lot of patients for iron IVs because we’re sometimes finding them, like, not absorbing very well or the iron’s so low that it just take [00:09:00] forever for them to get improvement, and that’s one of the sort of screening things is, like, you know, where, where is the iron going? 

How do we explain this?  

 

Heavy Periods Overshadowing 

Dr. Christina Carew, ND: And so, um, myth number three, um, my iron is low, but I have heavy periods, so that must explain it all and I actually don’t need more investigation.  

Dr. Dominique Vanier, ND: Mm-hmm. Mm-hmm. Yeah, this is one of the most common ways that a real problem can slip through, I’d say precisely because the explanation happens to be true. 

Like, we know heavy menstrual bleeding is the single most common cause of iron deficiency anemia in premenopausal women, but also in perimenopausal women. Um, uh, so noticing it is important, but the mistake is that it’s, like, the automatic final answer, right? So saying, “Well, you have low iron because you have heavy periods,” and then end of story. 

And fam- family medicine guidance is clear that even when periods are heavy, a GI source of blood loss is still found in roughly six to 30, like a third, up to a third of cases. [00:10:00] Um, and so if iron levels don’t really rebound once the bleeding has been properly managed, let’s say the patient ends up, you know, putting in an IUD and we’re not, we’re not seeing iron change appropriately, or they’re doing oral supplementation and we’re not seeing the number move as we would expect, uh, you know, that’s the guidance to investigate further, not to shrug and really re- keep refilling the prescription. 

And I will say, like, a lot of my patients, at least more recently, they’re still getting the scope. Like, some pa- some doctors- Mm-hmm … um, now that there’s more attention and awareness to this is just like, “Yes, you have heavy periods, but we’re gonna do it. We’re gonna do a colonoscopy as well.”  

Dr. Whitney Baxter, ND: That’s good to know. 

Mm-hmm. So I do a lot of iron infusions in my practice, and we always start with a pre-iron infusion call to make sure someone is investigating why you have low iron. Someone is investigating the trend. And a lot of people ask me, “Okay, well, once I get this iron infusion, will my iron levels stay up?” And I say to every single person, like you said, even if they have heavy periods, you need to get this done in six weeks, see where it [00:11:00] landed, and then every three to six months. 

Make sure that it’s making sense with your symptoms, with your period. And hey, do you have indigestion? Probably ’cause you seem to. We should probably do some other screening to make sure- Right … it’s not leaving the gut. 

Dr. Dominique Vanier, ND: Yeah, and, and so this, you know, more broadly is, is it has a term, it’s called diagnostic overshadowing, and it’s a term that we’ve used in many other places in medicine, but it fits perfectly in this situation where once we have like a visible, familiar, familiar explanation for a symptom, every other possible cause can quietly get waived. 

Like as if, you know, we’re not gonna look, we’re not gonna look at where there could potentially be another leak in the bathtub kind of thing. So the period is definitely real, but it’s, it’s just not allowed to be the only question that anyone asks.  

Dr. Christina Carew, ND: Yeah A few things that would tell us a heavy period isn’t the whole story might be that, as Whitney alluded to, iron doesn’t rebound after adequate supplementation or IV or properly managed bleeding, so using, um, medications like [00:12:00] tranexamic acid or oral contraceptive or IUD, um, so they’re still low in iron after all of that. 

Uh, anemia that looks more severe than the blood loss, so some people will say, “Well, my, my period’s only heavy for one day,” or, you know, “It’s not that heavy. I’m still just using regular pad, tampon,” Nix, DivaCups. Um, any other red flags that we’ve covered today, so, um, before or even before today, so like changes in bowel habits, unexplained weight loss, family history. 

Um, and so being older is not actually the only criteria anymore, and so a GI investigation, um, should include, you know, why is the iron low and, and even things like H. pylori which we talked about in a couple episodes ago can be another reason why the iron might be low, um, but also something that needs a diagnostic workup. 

Dr. Dominique Vanier, ND: Mm-hmm. Yeah, absolutely.  

Colorectal Red Flag Checklist 

Dr. Dominique Vanier, ND: Yeah, [00:13:00] so let’s maybe talk about a few stats here as part of our educational and insight section, um, especially as it relates to the colorectal cancer age shift. And so we want listeners to be able to walk away with today that point one, incidents in adults age 20 to 49 is climbing about 3% every year since 2013 and, and it continues to fall in people, uh, 65 and older. 

Um, rectal cancer now makes up close to 1/3 of all colorectal cancer, which is up from about a quarter in the mid-2000s, so there’s been a large increase there, and much of that increase is actually happening, uh, where there are cancer, uh, cancers occurring in the rectum and the lower-left side of the colon. 

And then point three is about one in five of new colorectal cancer diagnoses are now in someone under 55, so close to double the rate, like we mentioned earlier, from the mid-1990s.  

Dr. Christina Carew, ND: Yeah. So it doesn’t mean that on your 45th birthday that you have to [00:14:00] immediately run in for your colonoscopy. However, if you’ve been having persistent GI symptoms and maybe you’re in 30s or 40s, um, you shouldn’t automatically get waved off by the practitioner that you’re seeing as you’re too young for that, and asking and advocating for yourself is really important. 

So the second area we wanna know is, like, well, what are the red flags for colorectal cancer at any age? So what are the things that I need to be watching for or, or looking at? And so these symptoms, um, may have often benign explanations, so you can also have a polyp that doesn’t have cancer that can be causing some of these issues, or other reasons why these might be happening. 

So this does not mean that you definitely have colorectal cancer. However, um, it is important to share any of these things with the practitioner ’cause that may help to advocate for [00:15:00] you getting a screening test much sooner. So any kind of, um, rectal, rectal bleeding, even though there are, you know, bleeding because of hemorrhoids, if you’re getting it more ongoing, if it’s more blood, if it seems to be more prominent, if it seems to be even with, um, you know, breaks where, um, there hasn’t been breaks between when there’s any healing, or i- if you’ve never even been diagnosed with hemorrhoids, um, that’s important. 

Anything in a change in bowel habits, so anything that more than two to three weeks of looser stool or narrow pencil-thin stools or any kind of urgency should definitely be checked out. Any type of anemia that’s found on, on routine blood work, um, especially if there is even obvious sources such as heavy periods or vegetarian diet, um, especially if your numbers aren’t going up or you’re taking iron, it’s not really changing [00:16:00] anything, um, there’s lots of reason to investigate that a bit more. 

Any kind of unintentional weight loss, so you’re losing weight despite not changing your diet or activity level. Any kind of abdominal cramping or pain that seems to, like, not just go away, or it lasts longer, or it’s more sharp or more, or difficult. And anyone that has a family history of colorectal cancer or polyps, especially in someone that’s a first-degree relative, so, um, sibling or parent that was diagnosed with that before age 50. 

Dr. Dominique Vanier, ND: Yeah, and I wanted to make another note about the iron piece, right? ‘Cause y- we wanna make sure that, you know, like as a clinician, we really know how to read iron properly on a lab test. So some patients that have underlying inflammation, such as where we can see that in their marker, their inflammatory marker C-reactive protein, that can falsely increase their ferritin, which is their iron stores. 

And so sometimes you get a lab back that says, “Oh, your ferritin’s actually normal,” like you don’t have iron [00:17:00] deficiency, when we can go more granular when we test. We can look at serum iron and, you know, saturation percent, et cetera. And so when we’re looking at iron, it’s really important for the doctor to look at the entire picture of somebody’s iron status to be able to ascertain whether somebody actually does have an iron issue going on. 

Dr. Whitney Baxter, ND: Yeah, that’s a good point. Not to mention normal ferritin is, like, 15 to 200.  

Dr. Dominique Vanier, ND: Yeah.  

Dr. Whitney Baxter, ND: It’s getting better, but You might be told everything’s normal, so ask for that blood test.  

Dr. Dominique Vanier, ND: Yeah, yeah.  

Dr. Whitney Baxter, ND: Um, so another thing we wanna talk about, and the whole reason for this episode, is just for teaching you how to advocate for yourself, what things to pay attention to, because younger patients are getting diagnosed more frequently, but also they’re getting diagnosed later, not earlier, so it’s not being caught- Mm 

which is really frustrating. Um, there’s research out of Stanford that found that younger patients take roughly 40% longer to get diagnosed, that’s a very long time, [00:18:00] um, than older patients, and by that time someone under 50 is diagnosed, close to three, three out of four have already have advanced stage cancer. 

So I’ve known people whom this has happened to, um, you read about it a lot, so it’s really frustrating. Um, and it’s not that the cancer behaves more aggressively or it’s hiding, it’s just it wasn’t screened for, and you’re … People often, age, you know, 30 to 40, there’s, like, a lot going on in this timeframe. 

Um, hormones are changing. We are losing. We have heavier periods and have low iron, but we’re always being told, “Oh, you’re too young for that,” or, “That’s normal.” You’re not getting taken to that next step, um, so the workup gets delayed. It’s not flagged as urgent. You’re kinda waiting for a f- callback. So it’s 

Yeah, just listening to this episode, and we always finish with how to talk to your prov- your healthcare provider so you know how to advocate for [00:19:00] yourself.  

Dr. Dominique Vanier, ND: Mm-hmm. Mm-hmm.  

 

Bleeding Colour Clues 

Dr. Dominique Vanier, ND: Yeah, and if somebody does see, um, blood in the toilet bowl, like, it, you know, depending on the color of it, it can give an idea as to where that bleed is happening. 

So, you know, GI bleed can be bright red, it can be black, or like we said, it can be invisible, and if it’s bright red or on the tissue or in the bowl, that tends to point to a source lower down in the digestive tract, so potentially the rectum or the anus. Hemorrhoids also fit this picture, although we absolutely don’t want to assume that bright red blood on the tissue paper is always due to hemorrhoids. 

Um, and like we’ve mentioned, new or changed bleeding still deserves a look rather than assumptions. When, when there’s black or tarry or unusually foul-smelling stool, that’s called, uh, melena, and it, and it tends to point to a source higher up in the GI tract, so that may be, like, a stomach bleed or, like, you know, a bleed right around the stomach area. 

Um, certainly also warrants prompt medical attention. And then thirdly is the hidden bleeding that we mentioned earlier in [00:20:00] that, in that case I discussed, where we have no visible blood at all but we can often see signs on somebody’s iron in their blood work, or possibly them feeling quite tired and, you know, some other nonspecific symptoms. 

 

Ovarian Cancer Bloating Signs 

Dr. Christina Carew, ND: Okay, so another one of our bloating red flags is, um, could bloating be caused by something called ovarian cancer? So ovarian cancer is often known as sort of a silent killer or whisper of symptoms because it doesn’t always, um, have very distinct complaints. So bloating, pelvic or abdominal pain, feeling full quickly, having to urinate more often, those are actually the most common symptoms, which describes probably most of the people on this, uh, podcast who have ever had bloating and are listening in. 

Yep. Um, and so on their own, each of those symptoms seems to be harmless. Like blo- bloating, pain, fullness, and needing to urinate more [00:21:00] often. Um, but it doesn’t always, um, mean that those are just things that should be dismissed.  

Dr. Dominique Vanier, ND: Mm-hmm. Mm-hmm. And it can be tricky to separate, like, what, you know, what is probably nothing from something that deserves a closer look, and, and this is where you’re, this is where this is the decision up to your doctor. 

Like, we don’t want … We’re not, definitely not advocating people to do, go down the Dr. Google route here. But the things that will be discussed are, like, how new are the symptoms, right? Are they transient? Um, are they new for that person? Do they show up frequently most days? Do they persist for more than two to three weeks? 

Uh, do they, do they come and go with a meal, stress? Is there, like, a link to the menstrual cycle? One widely cited piece of clinical guidance is pretty direct about this, in that, uh, if somebody has a new onset irritable bowel syndrome-type symptoms in a woman over 50, that should not be diagnosed as IBS until ovarian cancer has been considered and reasonably ruled out. 

Dr. Christina Carew, ND: Good. That was, this is interesting too, right? Like we see that the age of our patient or [00:22:00] their fertility issue seems to drive things like ultrasounds and screening tests because we’re really focused on that around fertility, but then as people age, that seems to be less important.  

Dr. Whitney Baxter, ND: Mm-hmm.  

Dr. Dominique Vanier, ND: Mm-hmm,  

Dr. Whitney Baxter, ND: mm-hmm. Yeah. 

Yeah, those ultrasounds can be really great, pelvic ultrasounds. Um, but also you made a good point. It’s not always about a scary new symptom that nobody’s felt before. It can be these ordinary sounding symptoms that simply won’t go. They have like a… They’re just hanging around for longer.  

Dr. Dominique Vanier, ND: Yep.  

When Indigestion Needs Workup 

Dr. Whitney Baxter, ND: So let’s move on to our educational point number six is stomach cancer, so when indigestion isn’t just indigestion. 

So we’ve talked in earlier episodes about heartburn, indigestion, exactly what it looks like is common, benign, and manageable. So these are pretty clear symptoms, whereas, uh, stomach or gastric cancer is much more rare. It tends to be, [00:23:00] tends to hide behind the same it’s just indigestion label for a long time because early symptoms are pretty unremarkable. 

They’re pretty benign. So the features that shift indigestion from watch and treat to this needs to be investigated a little bit more is things like bloating, vomiting blood, um, or black tarry stool we talked about a moment ago. Vomiting blood can also just look like, um, streaks of blood in the, in the spit up. 

Dr. Dominique Vanier, ND: Yep.  

Dr. Whitney Baxter, ND: Um, coffee grounds in your, in your spit up or your vomit. So just take a peek. Unintentional weight loss, it’s a pretty well-known symptom of cancer, so more than about 5% of body weight over a few months should be looked into if you’re having other symptoms as well. Anytime there’s difficulty swallowing, so swallowing food, like it’s sticking on the way down, swallowing liquids, so a lot of doctors will ask about this. 

Persistent [00:24:00] vomiting, so if you, if you’re feeling nauseous on a regular basis and you’re having to go throw up, that’s, that’s something to be investigated. If it’s not tied to an obvious cause, like a stomach bug, a supplement, um, new medication change, just something to look into. And again, unexplained iron deficiency anemia, same as the hidden bleeding pattern we described earlier for colorectal cancer. 

If there’s some blood loss happening through the gastrointestinal full tract of the tube. And then new indigestion that doesn’t improve after a proper trial, trial of standard treatment, like acid suppressing medication, those proton pump inhibitors, especially in somebody over 50 or with a family history of known H. 

pylori infection.  

Dr. Dominique Vanier, ND: Yeah. Yep, all helpful information.  

 

Practical Advocacy Takeaways 

Dr. Dominique Vanier, ND: Yeah, so let’s talk about some practical takeaways that our listeners can, uh, have for this episode. And keep in mind these are not prescriptions, it’s just education. W- the most important thing, and [00:25:00] we probably talk about this in every episode, we wanna track the pattern not just the symptom, and that’s really useful for, uh, both the, both the person who’s tracking it but also the practitioner. 

So a simple useful habit is if a GI or pelvic symptom is new and it’s been present most days for more than two to three weeks, that’s probably worth saying, you know, out loud at somebody’s next appointment, moving the appointment forward if they don’t have an appointment. Um, even if it feels minor, just let your practitioner do their work. 

Duration and persistence are doing more work here than how dramatic or not dramatic the symptom may feel. Remember, there’s no such thing as TMI in our offices. We all, we talk all about poop all day long. It’s no big deal.  

Dr. Whitney Baxter, ND: Exactly. That’s their job. We wanna know. So this is a big one. Know your family history. 

And sometimes we don’t think to ask why grandma passed away or what cancer they had, um, and you have [00:26:00] to share this with your doctor too, ’cause we’re listing it and we’re keeping it on the radar. So things like colorectal, ovarian, gastric cancers, they all have a hereditary component. So it’s worth knowing who had it. 

So whether it was in your immediate family, if a first degree relative was diagnosed with any of these and what age, this is something to mention. Even if you feel like you’re young and healthy, this is a single piece of information that can change when the screening starts  

Dr. Christina Carew, ND: And just because you’ve had an investigation in the past doesn’t mean that you couldn’t have something have changed when you’re getting a new symptom. 

So a normal ultrasound or a normal colonoscopy or a negative test in the past doesn’t necessarily mean, um, that everything is okay. And so, uh, if you’re getting a new symptom, you need a new workup, and you need it to be on its own timeline.  

Dr. Dominique Vanier, ND: Yeah. That’s one of the questions I’ll ask my patients, which is if they’ve had a scope, let’s say, two years ago but they have new symptoms that are [00:27:00] persistent, it’s c- like, you know, we’re kind of starting now from zero and working forward. 

Um, and something else that’s important is that bleeding is never nothing until it’s explained. Uh, and so it doesn’t have to be the worst-case scenario. Like, truly, it could be… Like, hemorrhoids are quite common. Um, and the vast majority of the time, bleeding is not something that is sinister. Uh, but bleeding of any kind definitely deserves a reason and not just an assumption. 

 

What To Say To Your Doctor 

Dr. Dominique Vanier, ND: And so transitioning from that, it w- uh, another helpful area for our listeners would be how to talk to your practitioner. So here are some phrases that you can bring straight to your next visit. You could mention, um, you know, “My bowel habits have changed for the last few weeks, and it isn’t going back to normal. 

Can we look into this rather than assume it’s just stress?” And certainly, if it’s stress, that’s also something you wanna talk about. Um, you can mention that, you know, if, if you’ve noticed rectal bleeding, that this is something that you have seen, and the color, uh, doesn’t line up with hemorrhoids, or maybe somebody doesn’t [00:28:00] know that they have hemorrhoids, so getting that investigated further And sometimes, you know, on the bloating topic is a lot of my patients anyway will know their pattern of bloating, but th- that that pattern can deviate, such as, like, feeling like a pelvic heaviness that maybe wasn’t there before. 

So talking about how somebody’s possible patterns or symptoms that they really felt confident about now feel a little bit different than they did before, and again, assigning a timeline there. So how long has that happened? If there hasn’t been a gynecological workup, such as doing a transvaginal ultrasound or a pelvic ultrasound, is that maybe that’s, you know, something that the person’s doctor can requisition. 

Um, you know, discussing whether indigestion has or has not responded to a trial of proton pump inhibitors. Is it n- necessary to get, uh, a referral to an endoscopy? And then, like we talked about before, um, referencing the family history. That’s always really important. What kinds of cancers, colorectal, ovarian, stomach cancer? 

When [00:29:00] should screening start? And also being aware that at age 45, like we’ve talked about, that’s when the, uh, the FIT stool tests are now being given to patients, right? So the… People don’t always go to a colonoscopy right away. There’s the stool test that actually can be the, the, the preliminary test that’s done. 

So not, like we mentioned before, not all of these phrases are meant to make you sound alarmed. Uh, it’s just about establishing that pattern, putting it on record, and making sure that, uh, that symptoms don’t kind of get quietly assumed and then tucked away and never looked at again.  

Dr. Christina Carew, ND: Just because you brought it up once doesn’t mean you can’t bring it up again. 

Dr. Dominique Vanier, ND: Exactly, yeah.  

Episode Recap And Closing 

Dr. Dominique Vanier, ND: Okay, let’s do a quick, uh, ep- recap of this episode. So Whitney, take it  

Dr. Whitney Baxter, ND: away. I’ll get started. Uh, we mentioned colorectal cancer incident is climbing in people under 50, and screening now starts at 45, not 50  

Dr. Christina Carew, ND: If someone is telling you the symptoms you have, whether [00:30:00] they, um… Sorry, the test doesn’t, isn’t which symptoms you have, it’s whether something new, frequent, or sticking around past two or three weeks is something that you’re having. 

So bleeding, bloating, uh, irritation, diarrhea, weight loss, um, anything that’s new or ongoing should be discussed.  

Dr. Dominique Vanier, ND: Mm-hmm. Rectal bleeding, unexplained anemia, unintentional weight loss, or there may not be weight loss, right? We don’t always have to have this whole constellation of symptoms, but any of the above are never things to just quietly live with. 

Dr. Christina Carew, ND: A heavy period, which really is, um, sometimes self-assessed as being heavy, um, because some people don’t even realize it’s heavy ’cause that’s how it’s always been, um, can explain low iron, but it’s not only one of the things that should, um, be considered. And the other thing is that depending on the gender of your doctor, heavy [00:31:00] is gonna be different for them and their own experience. 

Like, what, what do they know about heaviness? And so really explaining what that means, how many pads, tampons, DivaCups, do you bleed through your clothes? Do you have to wear a diaper at night? That’s, those things are really important because they’re not the same for everyone.  

Dr. Whitney Baxter, ND: That’s a really good point. 

Yeah. Yeah. Quant- quantifying it. Yeah,  

Dr. Dominique Vanier, ND: exactly.  

Dr. Whitney Baxter, ND: Collection.  

Dr. Christina Carew, ND: Yeah.  

Dr. Whitney Baxter, ND: Um, a big one, too, younger patients get diagnosed later, not because the disease is different, but because too young for that keeps delaying the workup.  

Dr. Dominique Vanier, ND: Yeah. Yeah. So the next time a symptom sticks around longer than it should, whether it’s bloating, bleeding, indigestion, persistent indigestion, persistent bloating, you know, we, we don’t want to assume it’s just IBS, or we may have an underlying diagnosis of IBS but now our symptoms are different, and we don’t want to assume it’s just stress. 

It might be all worth a second look, and that’s definitely worth [00:32:00] investigating. Because remember, better gut health changes everything.