Why I became an integrative gastroenterologist
Dr Laura Flor-Prades, integrative gastroenterologist, in consultation
Where I started
Most of my early training was conventional. I qualified as a gastroenterologist in Spain and the United Kingdom, including a fellowship at Imperial College Healthcare NHS Trust. I performed endoscopies, managed inflammatory bowel disease, prescribed proton pump inhibitors, ran the standard work-ups for chronic abdominal symptoms.
Conventional gastroenterology does a great deal extremely well. For organic disease — Crohn's, ulcerative colitis, coeliac disease, malignancies — the diagnostic and therapeutic pathways are precise, evidence-based, and often life-saving. I remain firmly grounded in this discipline and continue to follow BSG and NICE guidelines in everyday clinical practice.
But over the years I noticed a pattern that conventional gastroenterology, on its own, did not always resolve.
The patients who taught me the most
A patient would come in with persistent bloating, altered bowel habits, food-related symptoms or recurrent SIBO diagnoses. The investigations would come back unremarkable. A diagnosis of IBS would be made — sometimes accurately, sometimes without a full differential having been completed. Empirical treatment would follow — antispasmodics, dietary fibre, perhaps an attempt at a low-FODMAP diet without proper supervision. Some patients improved. Many did not. They returned, frustrated, often having spent months or years cycling through restrictive diets, supplements and repeated test cycles, no closer to understanding what was actually happening inside them.
Why I trained further
I extended my training beyond conventional gastroenterology into the areas where my patients most needed answers: clinical applications of nutrition in digestive disease, the Monash low-FODMAP protocol, functional medicine through the Institute for Functional Medicine, mindfulness-based cognitive therapy at Oxford, and mindfulness-based eating awareness training in California. None of this replaced my gastroenterology — it extended it.
What I call integrative gastroenterology is, in practice, evidence-based gastroenterology with a wider toolkit. It is not alternative medicine. It is not a rejection of conventional care. It is the recognition that some clinical questions need more than a prescription pad to answer well.
How I work now
In my consultations, I begin where any gastroenterologist begins — with a thorough history, a proper differential diagnosis, a review of investigations. From there, depending on the case, the work may extend into nutritional strategy, gut-brain interventions, targeted functional testing, or coordination with a GP for further conventional work-up. Each step is decided based on what the case clinically requires, not on a fixed protocol.
The aim is the same in every consultation: to provide clarity about what is happening, an accurate differential diagnosis, and a clear plan of action.
Is this right for you?
If you have been carrying chronic digestive symptoms without resolution — if you have been diagnosed with IBS or recurrent SIBO without a complete differential having been carried out, or if you have cycled through restrictive diets and supplements without understanding why — you may need a wider conversation than standard care has offered you.
That is what I try to provide.