What to Do About Bloating
When it comes to digestive issues, the most common symptom people experience is bloating. In fact, bloating is a concern that is reported almost daily in any clinical practice and a symptom most people are familiar with. So many people think it’s normal to feel bloated most days. Some people put up with uncomfortable or even painful bloating for years as they think everyone feels that way. But bloating is not normal, it’s a sign that there is disharmony in your digestive tract that needs to be addressed.
What causes it?
Abdominal bloating can cause discomfort, pains, soreness, distention and stomach cramping. But what causes it in the first place? Bloating may just be the result of over-eating, however many other causes do exist. More sinister causes include Coeliac disease, Inflammatory Bowel Disease and even cancer but uncomfortable abdominal distention is mostly commonly attributed to two overarching concerns: digestive dysfunction and hormonal dysregulation.
- Causes related to digestive dysfunction:
- 1. Low stomach acid and digestive enzymes
Your stomach acid secretions are essential to good digestive function. Your stomach cells release hydrochloric acid and your pancreas, stomach, salivary glands and the brush border of your small intestine all release enzymes that aid in breaking down your food into nutrients you can absorb. If you don’t have enough stomach acid or enough digestive enzymes which can be a result of stress, medications, ageing, nutritional deficiencies such as zinc and certain surgical procedures including gastric bypass surgery, you will not be able to breakdown your food properly and it will be left to ferment by the bacteria in your gut. This can lead to symptoms of gassiness, bloating and stool changes. It is your stomach acid and digestive enzymes which kickstart the whole digestive process so if you do not have enough or they are not functioning properly, it can lead to a host of digestive issues.
- 2. Poor bile flow
On top of digestive enzymes and hydrochloric acid, your gallbladder also releases bile during your meal to aid in fat digestion. Bile is a natural fluid your body makes in the liver and stores in the gallbladder. It contains acids, proteins, salts and other products. When you eat, your gallbladder contracts and releases this bile into your stomach where the acids in the bile help break down fats so your body can absorb them efficiently. Bile is also used a natural laxative to promote regular bowel movements. When there are excessive fats present in the gastrointestinal tract due to sluggish bile flow, stomach emptying is slowed down, gas transit is altered, and peristaltic movement of the gut is disturbed. All these contribute to increased gas retention in the gut and bloating.
- 3. Food intolerances
Food allergies and sensitivities are one of the fastest growing chronic diseases in the Western world. They are becoming increasingly common, largely due to high sugar intake, overuse of antibiotics, food manufacturing and processing and excessive consumption of foods that the body is not designed to eat in large quantities (such as dairy and wheat). Gut symptoms due to food intolerance typically result due to components within a food (such as FODMAPs) not being digested or absorbed well. The most common food intolerances include wheat, gluten, soy, dairy and eggs. Intolerances can be difficult to identify as the reaction is often not immediate and can occur hours or even days after ingestion. It doesn’t only affect one body system either. It can affect the digestive tract and lead to symptoms such as bloating, constipation or diarrhoea, however it can also affect your skin, brain, muscles, joints and even your lungs. It can also lead to leaky gut where your gut lining becomes porous, allowing foreign particles such as pathogens, bacteria, viruses and more to enter into your bloodstream, creating inflammation and further exacerbating bloating.
- 4. High FODMAPs
FODMAPs are a group of short-chain carbohydrates (sugars) that are not completely digested or absorbed in our intestines. They move slowly, attracting water and increasing the amount of fluid exiting the small bowel. When they pass into the large intestine, FODMAPs are fermented by gut bacteria producing gas as a result. The extra fluid and gas cause abdominal distention. FODMAPs are found in a wide range of foods, such as fruits, vegetables, breads, cereals, nuts, legumes and confectionery and for many people with medically diagnosed IBS, following a low FODMAP diet has been shown to be effective.
- 5. Dysbiosis
Another cause of bloating is an imbalance of good and bad bacteria in the gut, known as dysbiosis. Beneficial bacteria play key roles not just in the functioning of the digestive system but in the functioning of many other body processes including hormonal regulation and immunity. A healthy gut microbiome will contain about 2kg of bacteria which should comprise approximately 75% of the beneficial strains and 25% of the harmful ones.1 When the balance is out of whack, and you have too many of the bad guys, this can lead to bloating and discomfort and much more.
- 6. Small intestinal bacterial overgrowth (SIBO)
In a healthy gut environment, the majority of the bacteria is found in the large intestine. SIBO is the term used when the bacteria in the large intestine proliferate into the small intestine. The excess bacteria then feed off the undigested food, causing the food to ferment higher up in the digestive tract, leading to symptoms such as bloating, gas and diarrhea. SIBO can be caused by low gastric acid, motility disorders, structural abnormalities and immune function deficiency.2
- 7. Poor eating habits
How you eat is just as important as what you eat when it comes to bloating. Eating when you’re in a hurry, when you’re stressed or when you’re distracted disrupts the whole digestive process so that food isn’t broken down into nutrients you can absorb. It can switch your body into “fight or flight” mode, where the secretion of digestive enzymes needed to break down your food is shunted away from the stomach and the whole digestive process is disrupted, leading to symptoms of bloating. Also, simply eating too much can lead to bloating and discomfort.
- 8. Stress
When you are faced with a stressor, whether it be a tiger you’re running away from or perhaps something a little more believable like a work deadline, your body is switched into sympathetic dominance (the “fight or flight” mode). Excess cortisol, your stress hormone, is then released from your adrenal glands. Cortisol shunts blood flow away from the digestive tract, slowing down gut movement. This can affect digestive acid and enzyme secretions, altering the pH of the digestive tract and ultimately leading to bloating and discomfort. Cortisol can also affect your microbiome which we’ve already seen can lead to bloating.
- Causes related to hormonal dysregulation:
- 9. Progesterone
Hormonal fluctuations in women can also lead to bloating, abdominal tenderness and fluid retention especially before your period. In the week or two leading up to your period, progesterone is high relative to estrogen. Elevated progesterone triggers an array of changes that make you feel heavier and more bloated including water retention, a larger appetite, salt cravings and constipation. Once progesterone drops to lower levels after you get your period, you shed the excess fluid and your ravenous appetite disappears. Early in pregnancy, increasing progesterone can cause your digestive system to slow down and your smooth muscle to relax which can delay gastrointestinal transit time and result in constipation and bloating.
- 10. Estrogen
Having too much estrogen is also another cause of bloating. When estrogen levels are elevated, women tend to retain more water than usual. This helps to explain why a lot of women feel more bloated in the days leading up to their period. Having too little estrogen can also lead to abdominal discomfort as estrogen has an effect on bile production- when estrogen levels are low, bile production decreases. Bile acts as a lubricant for our small intestines and without proper lubrication, our food can accumulate within the small intestines and cause constipation and bloating. During menopause, bloating is common as estrogen levels erratically fluctuate before dropping.
Natural Remedies for Bloating:
- 1. Avoid trigger foods and undergo some gut healing
Determine what foods you react to via an Elimination Diet or undergoing testing and avoid them. The most common culprits include wheat, gluten, dairy, soy and eggs. Some foods which may promote inflammation and aggravate bloating include sugar, alcohol and refined grains and grain products. Replace those trigger foods with healthier options. For example, instead of gluten-containing grains, opt for ancient grains such as quinoa, millet and buckwheat. It’s best to avoid these foods for at least six weeks while taking gut-healing supplements such as glutamine, vitamin A, vitamin D and zinc. While individuals may have specific food intolerances, a low FODMAP diet has been confirmed to be effective in decreasing symptoms of IBS including bloating in at least 75% of patients.3
- 2. Eat kiwifruit
There is emerging evidence that kiwifruit is effective in the treatment of constipation and bloating as it promotes laxation and gastric motility.4 Studies have shown a significant reduction in bloating, abdominal pain and improving bowel movement frequency in patients with occasional constipation.5
- 3. Improve your eating habits
Try to eat sitting down in a relaxed environment, chewing your food until it is completely pureed. Also try to avoid consuming large amounts of liquid twenty minutes before and an hour after your meals, as this will dilute your digestive secretions and render them less effective. These strategies will assist in optimizing your digestive function, thereby maximizing nutrient absorption from each meal and reducing unwanted gastric symptoms. Also, drinking a squeeze of lemon juice in water before your meals helps to stimulate your gastric juices ready for nutrient breakdown and absorption.
- 4. Stay hydrated
Drinking plenty of water helps to keep food moving along in your gastrointestinal tract and prevents bloating. Dehydration and electrolyte imbalance can also stop the digestive process leading to bloating and constipation. Staying hydrated also helps to naturally flush our systems of excess water and sodium that we might retain.
- 5. Decrease stress
As we’ve already seen, decreasing stress is important to improve digestive function and prevent unwanted symptoms such as bloating. Journaling, getting out in nature, meditation and deep breathing are all ways to alleviate stress. Incorporating magnesium-rich foods into your diet such as almonds, cashews, pumpkin seeds, flaxseeds, lentils and chickpeas is also recommended as magnesium acts on many levels to improve the body’s response to stress. Magnesium can also help to fight fluid retention, expel gas and get the bowels moving.
- 6. Try some herbal medicines
There are numerous herbal medicines that are effective in relieving bloating and improving digestion.
Chamomile for example is a great carminative and digestive relaxant as it is soothing and helps with digestive issues that are worse for stress. It is especially helpful in dispelling gas, soothing the stomach and relaxing the muscles that move food through the gastrointestinal tract.6 Studies have shown Chamomile is quite effective in reducing symptoms associated with Irritable Bowel Syndrome.7 It is also easily available and not expensive and can be taken as a tablet or tincture or simply as a tea.
Peppermint is another carminative herb which contains compounds that target the pathophysiology of IBS.8 It is antispasmodic and possesses antimicrobial, anti-inflammatory, antioxidant and immune-modulating activities, all of which may be relevant for the treatment of IBS.9 It’s also inexpensive and easily available and makes a great tea.
Ginger is a great herb for digestion. It stimulates the cells in the stomach to secrete acid to help break down food. It’s also antiemetic, anti-inflammatory and stimulates peristalsis, which moves food along and prevents bloating.
Gentian is known as a bitter which means it increases the secretion of saliva and stomach acid to help with the breakdown of food and increase appetite. It helps to regulate intestinal motility and thereby assists for normalising the frequency of bowel movements. It’s a very low dose herb which means not much is needed to be of therapeutic benefit.
Some other great herbs that assist with improving the digestive process and alleviating bloating include Meadowsweet, Dandelion, Lemon Balm and Licorice.
- 7. Take some digestive enzymes
Digestive enzyme supplementation can help out when your enzymes are low or to target a specific deficiency. Choosing the right enzyme supplement for you can be overwhelming as there are so many. Plant-based enzymes such as bromelain or papain help the digestive system to properly break down foods and reduce bloating. A combination supplement with a blend of multiple digestive enzymes is often the best way to address low enzyme production. It’s important to avoid brands with fillers or artificial agents.
- 8. Take some probiotics
Supplementing with probiotics or boosting probiotic foods in your diet can help reduce harmful bacteria that trigger digestive issues such as bloating. Probiotics act like policeman within the gut, restoring order and peace amongst the “citizens” of the microbiota. They keep the disease-promoting bacteria at minimal levels and promote the growth of beneficial bacteria. The more diversity they see in the community of microorganisms, the happier they’re going to be. Probiotic-rich foods include kombucha, kefir, sauerkraut, kimchi, miso, coconut yoghurt, tempeh and pickled vegetables. If considering taking probiotic supplements, the strains that assist immensely with bloating are Lactobacillus rhamnosus, Lactobacillus acidophilus, Lactobacillus plantarum and Bifidobacterium infantis.10
1. Ferranti, E. P., Dunbar, S. B., Dunlop, A. L., & Corwin, E. J. (2014). 20 things you didn't know about the human gut microbiome. The Journal of cardiovascular nursing, 29(6), 479–481. https://doi.org/10.1097/JCN.0000000000000166
2. Dukowicz, A. C., Lacy, B. E., & Levine, G. M. (2007). Small intestinal bacterial overgrowth: a comprehensive review. Gastroenterology & hepatology, 3(2), 112–122.
3. Halmos, E. P., Power, V. A., Shepherd, S. J., Gibson, P. R., & Muir, J. G. (2014). A diet low in FODMAPs reduces symptoms of irritable bowel syndrome. Gastroenterology, 146(1), 67–75.e5. https://doi.org/10.1053/j.gastro.2013.09.046
4. Drummond, L., & Gearry, R. B. (2013). Kiwifruit modulation of gastrointestinal motility. Advances in food and nutrition research, 68, 219–232. https://doi.org/10.1016/B978-0-12-394294-4.00012-2
5. Udani, J. K., & Bloom, D. W. (2013). Effects of Kivia powder on gut health in patients with occasional constipation: a randomized, double-blind, placebo-controlled study. Nutrition journal, 12, 78. https://doi.org/10.1186/1475-2891-12-78
6. Srivastava, J. K., Shankar, E., & Gupta, S. (2010). Chamomile: A herbal medicine of the past with bright future. Molecular medicine reports, 3(6), 895–901. https://doi.org/10.3892/mmr.2010.377
7. Agah, S., Taleb, A. M., Moeini, R. et al. (2015). Chamomile efficacy in patients of the irritable bowel syndrome. Der Pharma Chemica, 7(4):41-45. https://www.researchgate.net/publication/281859945_Chamomile_efficacy_in_patients_of_the_irritable_bowel_syndrome
8. Cash, B. D., Epstein, M. S., & Shah, S. M. (2016). A Novel Delivery System of Peppermint Oil Is an Effective Therapy for Irritable Bowel Syndrome Symptoms. Digestive diseases and sciences, 61(2), 560–571. https://doi.org/10.1007/s10620-015-3858-7
9. McKay DL, Blumberg JB. A review of the bioactivity and potential health benefits of peppermint tea (Mentha piperita L.) Phytother Res. 2006;20(8):619–633. doi: 10.1002/ptr.1936.
10. Foley, A., Burgell, R., Barrett, J. S., & Gibson, P. R. (2014). Management Strategies for Abdominal Bloating and Distension. Gastroenterology & hepatology, 10(9), 561–571.
Do you have Irritable Bowel Syndrome where you often feel bloated and suffer from constipation and/or diarrhea? Do your symptoms worsen if you eat a lot of garlic or onions? Have you tried a probiotic and it made you feel worse? Then you may benefit from doing a low FODMAP diet. FODMAP is an acronym for fermentable oligosaccharides, disaccharides, monosaccharides and polyols.View Details
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