Bloating is a very common problem that affects us all from time to time, however excess or chronic bloating is a sign that your digestive system is out of balance and could do with some attention.
Bloating occurs in your stomach and happens when your gastrointestinal tract is filled with excess gas. It is an uncomfortable feeling of tightness, pressure, or fullness. You may also experience a visibly swollen abdomen that looks bigger and can make your clothes feel tighter. This can make you feel very uncomfortable and not great at all. Bloating can often get worse as the day progresses. This used to be me after eating gluten about 12 years ago. I would look about 7 months pregnant by the end of the day. Bloating is more commonly a digestive issue but it can also be connected to stress and hormone fluctuations.
Bloating - what are the main causes?
Bloating happens when the gastrointestinal tract fills with excess gas causing your stomach to feel full and tight which can be uncomfortable and painful.
Here are some of the main causes of bloating:
Foods - bloating can be caused by the foods you are eating. Some foods are more gas-producing than others (e.g., FODMAP foods) also food intolerances such as lactose intolerance or gluten intolerance can play a part.
Gut dysbiosis (more bad bacteria than good) – an excess of gas in your digestive tract can be caused by certain unfavourable bacteria in your small intestine fermenting the foods that you have eaten, especially fermentable carbohydrates (FODMAP foods – more about this later)
Swallowing too much air - although this is temporary as these gases escape by belching before they reach the intestines.
Overeating - eating too much too fast
Gulping down foods without enough chewing
Poor digestion – such as low stomach acid or insufficient digestive enzyme production.
Constipation – backed up stools allow little room for normal amounts of gas to pass through, everything expands to contain the extra volume, leading to bloating.
Hormonal fluctuations – 75% of women experience bloating before and during their period.
Are FODMAP foods contributing to your digestive symptoms?
Food is not the enemy and is not the sole reason you may experience bloating. There will often be other factors that play a part such as an overgrowth of bacteria in the small intestines, constipation, and reduced secretion of digestion enzymes.
Some foods however can be more gas-producing than others. For example, many people will have noticed that foods like cabbage, onions, beans, and lentils cause a bit more gas than other foods.
Have you heard of FODMAP foods? FODMAP stands for Fermentable, Oligosaccharides, Disaccharides, Monosaccharides, and Polyols. These are short-chain fermentable carbohydrates (sugars) that are poorly absorbed by the small intestines and can cause an overproduction of gas in the intestines. If you experience frequent gas and bloating, it can be helpful to eliminate all FODMAP foods for a couple of weeks then slowly bring them back into your diet one at a time to pinpoint any foods that are causing a problem.
As they are poorly absorbed in the small intestines, FODMAPs move through the digestive tract to the large intestine (colon), where they can draw water into the colon and are rapidly fermented (digested) by commensal and dysbiosis bacteria. It is the fermentation of these foods that contributes to the build-up of gas.
While some people are able to consume FODMAPs without experiencing gastrointestinal symptoms, many people with digestive disorders (such as irritable bowel syndrome), ﬁnd that FODMAP foods trigger symptoms including abdominal pain, cramping, bloating, excess gas, constipation and/or diarrhoea.
FODMAP foods can be broken down to:
Oligosaccharides – wheat, onion, garlic, legumes, and beans
Disaccharides -sucrose (table sugar), lactose in milk, yogurt, ice cream
Monosaccharides – fructose, apples, pears, grapes, honey
Polyols or sugar alcohols - apricots, nectarines, plums, cauliflower, mushrooms, corn
It is often best to work with a qualified practitioner before implementing the low FODMAP Diet as there may be other root causes that need to be investigated.
A common cause of bloating is Lactose intolerance, which can often be confused with an allergy or intolerance to cow’s milk. It affects around 75% of the world’s population and can occur at any age.
Lactose is the milk sugar found in all forms of milk whether it is cow’s milk, goat’s milk, sheep’s milk, and even human breast milk. It can also be found in varying amounts in dairy products made from milk such as cheese and yogurt.
Lactose intolerance occurs when there is insufficient production of the enzyme lactase in the small intestine. As a result of this, if you drink milk or eat a lot of dairy products, the lactose (milk sugar) is not digested properly and can cause uncomfortable symptoms such as bloating, gas, diarrhoea, and abdominal cramps. This is because the undigested lactose lingers in the intestines and is fermented.
Some dairy products are higher in lactose than others. Many people with lactose intolerance can tolerate small amounts of low lactose dairy such as ghee, butter, hard cheese, kefir, and probiotic yoghurt providing they don’t have too much on the same day.
Taking a digestive enzyme containing the enzyme lactase can help relieve symptoms of lactose intolerance as it provides the tools for lactose to be properly digested. These are available in most health shops as a stand-alone lactase enzyme or in a broad-spectrum digestive enzyme formula.
Coeliac Disease or Non-Coeliac Gluten Intolerance
Bloating is a very common symptom of Coeliac disease, the auto-immune condition where gluten consumption triggers the immune system to attack the lining of the small intestines. Gluten is the protein found in grains such as wheat, rye, and barley. If you suspect you may have Coeliac Disease and still eat gluten daily, then it is worth getting tested by your GP to see if you have elevated antibodies which is a sign of an auto-immune response. If you have already been gluten free for a while this test is often inconclusive as you need to be eating gluten daily for at least 6 weeks for positive antibodies to show up.
An important point to remember is that many people are not actually Coeliac but gluten can still be causing inflammation and damage to the body as well. This is called Non-Coeliac Gluten Sensitivity. If Coeliac Disease has been ruled out by your GP but you still feel like you are having problems with gluten, food intolerance testing through a practitioner like myself can be a good way to identify intolerances. Please contact me if you would like further information on testing options.
Otherwise, a good way to test yourself is by eliminating gluten 100% for 4 weeks and then having a piece of wheat bread every day for 4 days to see how your body responds. If you have any noticeable symptoms that is a sign that you need to eliminate gluten for at least 6 months, possibly longer. The only issue with doing this is that if you decide at a later date to have screening for Coeliac Disease, it may show up negative as you have been avoiding all gluten. So, I would recommend having tests for Celiac Disease with your GP first, and if it is negative but you still feel gluten is a problem, then do the elimination test. A small percentage of the population are actually Coeliac, a larger percentage appear to have Non-Coeliac Gluten Sensitivity.
Whether you have Coeliac Disease or Non-Coeliac Gluten Sensitivity, gluten is still damaging your body so avoiding gluten 100% is the key.
Small Intestinal Bacterial Overgrowth (SIBO)
Have you heard of Small intestinal Bacterial Growth, otherwise known as SIBO? I hadn’t until I studied nutrition about 10 years ago however it is very common and I am seeing it more and more in my clinic. Essentially SIBO is an overgrowth of gram-negative (opportunistic) bacteria in the small intestines, more than what would normally be found there as the majority of bacteria is found in the large intestines.
When there is an overgrowth of bacteria in the small intestines, this contributes to bloating and other digestive symptoms as the bacteria hanging about in the small intestines have a good feed on the food, you are eating, especially those fermentable carbohydrate foods (FODMAP foods). The bacteria ferment the food which leads to excess gas, bloating and abdominal pain. The bacteria also feed on undigested protein and steals nutrients like Iron and B12 from us, as well as bile so we end up with an inability to digest fats properly and absorb nutrients leading to nutritional deficiencies.
The development of SIBO is connected to the disruption of the body’s own protective mechanisms against bacterial overgrowth. Some of these include:
Low stomach acid - it is thought that much of the bacteria in the small intestines actually comes from the mouth and not just the large intestines. I learned recently at a Microbiome Labs webinar that the mouth houses 22% of the body’s population of microbes and the gut houses 29%. Stomach acid is the gastric barrier that protects detrimental bacteria in the mouth and from the food we eat from getting into the small intestine. When stomach acid is low or absent, the gastric barrier protection is weak and the bacteria survive the stomach pH and are free to travel through the digestive tract.
Poor bile production - bile acts as an antimicrobial agent in the small intestines. If you are not producing adequate bile (due to SIBO and other factors), not only will you have issues with digesting and absorbing fats, the antimicrobial protection is absent and the bacteria are free to colonise.
Motility issues - with constipation food remains in the gastrointestinal tract for a long time which can lead to the fermentation of foods by the gut microbes. The opportunistic bacteria also make a substance called LPS (lipopolysaccharide) which slows down peristalsis and impairs the Migrating Motor Complex, which is a natural sweep that cleans out residual food and bacteria from the small intestines when the gastrointestinal system is empty (more on this shortly)
Compromised integrity of the mucosal lining of the small intestines (leaky gut) and inflammation
Use of Proton Pump Inhibitors (PPIs) such as Omeprazole - these medications are used to suppress stomach acid production so the gastric barrier protection is not there and the bacterial
is free to travel to the small intestine.
What is the treatment for SIBO?
This is very individual and will depend on a client’s symptoms. However, there are many natural anti-microbial that can be really helpful at reducing SIBO such as berberine, high allicin garlic extract, neem, and oregano depending on the type of SIBO you have. It is important to take a holistic look at the whole body, especially the digestive system and liver function. Improving stomach acid and bile production is one of the first steps and can be helped with digestive enzymes as well as natural remedies such as apple cider vinegar in water or warm water and lemon before meals.
Please get in touch if you want to find out more, including how to get tested for SIBO. One of the tools practitioners like myself can access is a SIBO breath test to determine whether a person has SIBO and whether the gas produced in the bowel is either hydrogen or methane dominant which will determine the best course of treatment.
Migrating Motor Complex (MMC)
In our gastrointestinal tract, during periods of fasting a natural sweep called the Migrating Motor Complex (MMC) occurs every 90 – 120 minutes to sweep residual debris through the GI Tract. Abnormalities in the MMC have been linked to the development of SIBO as bacteria may not be effectively swept into the large intestine leading to bacteria hanging around in the small intestine.
We can support the natural function of our MMC by:
Fasting for 12 hours overnight (e.g., eating last meal at 7 pm and not having breakfast until 7 am)
Not snacking and having at least 4 – 5 hours in between eating (e.g., eating just breakfast, lunch, and dinner)
Having these breaks in eating allows the MMC to sweep and clean out the small intestine. A good sign that your MMC is working is a rumbling tummy. How often do you hear your tummy rumble? If you don’t feel your tummy rumble very often it is a sign that you are eating too frequently and a bigger gap in between meals would be worth trying.
Hopefully, these suggestions have given you a few ideas to try if you are experiencing uncomfortable symptoms of bloating. Please reach out if I can be of further assistance. I am available for consultations in clinic for Tauranga clients, or via Zoom for the rest of New Zealand.