Bloating - You don’t have to be suffering

Bloating (the feeling of being uncomfortably full) and distension of the gut (the actual increase in abdominal girth) are probably the most common gastrointestinal complaints and can be really debilitating, severely affecting the sufferer’s quality of life. Let’s see what are the most common factors and therapies for bloating. 

Before jumping into more complicated factors for an irritable bowel, it’s important to rule out the apparent.

If your diet is high in processed and packaged foods, refined carbohydrates, sugar and vegetable oils, trans fats, junk food, soft drinks, alcohol, and tons of coffee, you have all reasons to be bloated and have indigestion. Your body doesn’t recognise all the above (and more) foods, as opposed to whole foods, and can’t process them. And even if you say “salad and raw veggies bloat me, but fries don’t” this isn’t entirely true as, in the long term, you are harming your gut more. 

Still, there are people that do seemingly the best they can (healthy diet, organic foods, movement, good hydration) and yet experience bloating on a regular basis. So let’s have a look at all the other factors of bloating. 

What are the not-so-obvious causes of bloating?

When dealing with chronic gastrointestinal conditions, you must address them from top to bottom, starting with oral health. In other words, look at each individual step of digestion to identify any functional issue.

Is diet the problem?

I always start with the diet. Besides the obvious discussed above, there are more foods (otherwise healthy) that may be causing your bloating. Are you chewing properly? Do the foods you eat feed a healthy oral microbiome? Are you overeating? Are you intolerant to specific foods (food sensitivities) and perhaps your gut lining is damaged (leaky gut)? Are you reacting to specific groups of foods and do you need to eliminate and re-introduce them? Do you feel better on a low FODMAP or specific carbohydrate diet? And if so is it SIBO or IBS? Do you bloat right after eating or a couple of hours later?

Do you bloat after eating proteins, fats, carbohydrates, or fibre? Does it come predominantly from raw foods?

Oral health 

Is your oral microbiome healthy? (Yes we have probiotics in the mouth too that link to the gut!) Do you floss regularly? Tongue scrapping? Do you use a natural mouthwash?

Chewing (and table manners!)

A very important, but majorly underestimated factor for good digestion is chewing. Most people today eat while working, or on their phone, checking notifications, watching TV and so on and not chewing their food well enough. This puts stress on the whole gastrointestinal tract and can lead to chronic issues, such as bloating.

If you don’t produce enough saliva or have xerostomia, you aren't breaking down your food properly. Vagal nerve activation (there are plenty of easy and fun exercises you can do at home) can help, but it’s also important to check with a neurologist.

Start with chewing - chew each bite until it becomes really mushy. Good advice can be to leave your fork down in between bites. Or count until 20-30 for each bite. Your stomach doesn’t have teeth! In a while, this will come automatically.

What’s your position like when eating? Do you sit upright? Do you eat when in a hurry or stressed? Do you eat mindfully?

Stomach hydrochloric acid

If animal proteins, such as meat, aggravate bloating, you might be suffering from hypochlorhydria (lower stomach acid secretions). 

We need hydrochloric acid to be breaking down proteins but also to send signals to the small intestine to use pancreatic enzymes to keep digesting food, and the gallbladder to free bile to break down fats. If all is working fine, food is further broken down, nutrients are absorbed, gut health is maintained, pathogen overgrowth is prevented, and a healthy gut flora is ensured.

I very often see people who secrete low levels of both HCl and pancreatic enzymes for many reasons, including stress, poor chewing, poor diet, as well as ageing. 

Bad breath and heartburn are some other signs of poor hydrochloric acid secretion.

Low HCl secretion can be managed by chewing properly and incorporating apple cider vinegar, bitter herbs, and HCL supplements. If you have burning from either of the above, you might have a stomach ulcer and should immediately check with your doctor.

H.Pylori overgrowth in the stomach, which is very common, is another reason for bloating and stomach issues. H.Pylori prevents the release of stomach acid. 

Pancreatic enzymes

In addition to insulin, our pancreas secretes enzymes to digest food when in the small intestine. If you under-secrete pancreatic enzymes (again, very common) you will likely experience bloating, especially after eating carbohydrates or fibre (fruit, veg, legumes, bran, complex carbohydrates). Some other symptoms can be nausea and mucus in the stool.  

Low HCL often precedes under-secretion of pancreatic enzyme, as the two closely communicate. 

Chewing well and quality pancreatic enzymes are among the most successful solutions. 

Gallbladder issues

A largely overlooked factor for bloating and indigestion is a lazy gallbladder. We often evaluate the function of our gall bladder solely on the presence or not of gallstones and a healthy ultrasound. However, gallbladder insufficiency is very common and greatly affects our digestion, especially of fats.

If you have removed your gall bladder, you need to be taking digestive enzymes to be supporting bile acid secretion. 

If your bloating is worse after eating fats, you most probably have poor gallbladder function. Indigestion might come directly after eating or two to three hours after, so keep an eye on it. Some other signs are nausea (and especially when eating fats), indigestion and burping. Another one is floating stool. You are also more likely to be belching and having a fishy taste after taking omega-3 oils!

Pain under the right rib cage and/or between the shoulder blades, stomach upset by greasy foods, greasy or shiny stools, and light or clay-coloured stools are other indications. Headache over the eye and a bitter taste in the mouth are less common but still indicate GB issues. 

When the GB does not contract and release bile as it should, the bile becomes thicker. Thick bile will eventually turn into gallstones that can block the gallbladder. So gallstones are only the end result! 

Some underlying factors of a sluggish gallbladder are high blood glucose and lipids, being overweight, and lack of movement. Women have a higher risk of poor gallbladder function.

Supplements that reduce the thickness of bile and a low/healthy-fat diet can help majorly improve your gallbladder function.

Small intestinal bacterial overgrowth (SIBO)

Small intestine bacterial overgrowth (SIBO) is very often at the root of bloating. Around two out of three people with IBS suffer from SIBO, too. Chronic stomach issues are also linked to SIBO, since a common causative factor is the overconsumption of antacids. 

SIBO means that bacteria that should be located in the large intestine migrate to the small intestine. A number of factors are to blame, including dysfunctional valves and constipation/slow motility due to the intestinal muscles. 

Bloating might precede SIBO, as bloating can cause the valve that is in between the small and large intestines to open, allowing bacteria to migrate from the large intestine to the small intestine, where they don’t belong! This happens more often if your diet is high in sugars and starches.

The best way to test for SIBO is with a lactulose breath test. It's not 100% accurate but is currently the best available option.

A diet low in FODMAPs, is one that removes otherwise healthy foods that contain sugars that feed the bacteria in the small intestine which can help in SIBO. However, a low FODMAP diet should only be followed for a specific amount of time and under the surveillance of your practitioner. Some high FODMAP foods are cauliflower, brussel sprouts, cherries, nectarines, and beans.

Not tolerating probiotics from food (such as fermented vegetables, sauerkraut, pickles, kefir, kombucha etc) and probiotic pills is another sign that you might have an overgrowth in the small intestine. If needed, your practitioner will give you a more suitable probiotic treatment.

The most common underlying causes of SIBO are a diet high in sugars, chronic use of antacids, food poisoning, IBS, food sensitivities, immune issues.

Gut-brain axis 

Chronic GI inflammation damages the enteric nervous system, leading to functional gastrointestinal issues. Brain degeneration means that the enteric nervous system is likely damaged too, as they are closely interlinked. 

Brain injury and chronic nervous inflammation can affect the brain-gut axis. This can further affect the gut muscular function and lead to the migration of bacteria, hypochlorhydria, and poor enzyme and bile secretion.

There are many neural retraining and hypnosis programs that can help with limbic system (brain) impairment and calm down the gut. Results can be beyond expectation. 

Food sensitivities and intolerances 

Food sensitivities (either immune or due to enzyme deficiency, such as lactase) commonly lead to bloating and distention. Two of the most common food sensitivities are gluten (and especially wheat) and dairy (especially cow's). Sensitivities to egg (white or yolk), yeast, wheat, oat, peanut, pork, soy, and corn are also common. Food sensitivities can aggravate with age as gut health and gut immunity get compromised and you lose immune tolerance.

Intestinal autoimmune diseases that haven't been diagnosed, such as IBD and coeliac, can cause chronic gut distention. People with autoimmune diseases, such as thyroid, are much more prone to developing gut autoimmunity too. Inflammation from autoimmunity damages the gut nerve plexus over the years, often leading to bloating, among other gut complaints.

Gut microbiome

We have ten times more gut bacteria than cells! An unhealthy gut microbiome is only bad news. Overgrowth of pathogenic bacteria leads to the fermentation of food (especially carbs) in the intestines, causing gas and bloating.

Chronic and functional constipation means a slower release of food through a bowel movement. Food stays for longer in the gut and is fermented and putrified. This is especially dangerous for animal proteins. Chronic constipation also leads to pathogenic bacteria overgrowth and so creates a vicious cycle of bloating. 

Eating a diet high in fibre (by steadily increasing to prevent bloating) and colours and supplementing with the appropriate pre-or probiotics or short-chain fatty acids is the best way to support a healthy gut microbiome. 

By working on the digestive system from top to bottom with the help of an experienced practitioner, you are more likely to succeed at finding and addressing the root causes of your chronic bloating and distention.

This might seem overwhelming, especially if you have been suffering for a long time and haven’t worked with a qualified nutritional therapist or functional medicine practitioner. In my Heal The Gut package, I support all these steps individually and thoroughly, educate you on how to identify unhealthy symptoms at every stage, and teach you how to make the appropriate changes to heal and have optimal gut health.

Wishing you health and happiness!