Why Am I Bloated, And What Can I Do About It?

Bloating is defined as a sense of gassiness or a feeling of abdominal distention. It’s a common complaint in clinic and can be wildly uncomfortable.

When it comes to the gut, people get so accustomed to their symptoms that it becomes their ‘normal’, even if they have an inkling that something is not quite right. It can be embarrassing talking about bloating, gas and bowel motions, and so they put up with it. Interestingly, bowel motions can tell SO much about your health! So when it comes to bloating, bowel talk is a must.

What are ‘normal’ bowels like? To be honest, everyone is different. In a perfect world you are using your bowels daily, it feels easy and complete, and it sinks in the toilet bowl. If you were to look up a bristol stool chart, you're aiming for number 4. It's natural to pass gas, but it should not feel excessive or be extremely odorous. People’s level of ‘normal’ varies, so if you have noticed changes in your own bowel habits that’s a sign you should investigate further.

What is bloating?

In its most simple form, bloating is due to a buildup of excess gas in the stomach and intestines. But in reality, the pathophysiology of gas and bloating is complicated. Gut microflora, gas production, intestinal transit, intestinal propulsion of gas, and sensory function within the gastrointestinal tract all play a role.

So what are common contributors to bloating, and what can we do about it?

1. Constipation

The longer stool sits in your colon, the more time bacteria have to ferment what’s there, resulting in increased gas and bloating.

To reduce bloating due to constipation:

• Consume adequate fibre: 25g and 38g per day for men and women respectively. Don't touch the Metamucil! Fibre is found in all fruits, vegetables, legumes & wholegrains. Non-bloating fibre options include flaxseed, chia seeds, avocado, dark green leafy vegetables and blackberries.

• Hydrate: 33ml per kg of body weight per day is a good target, adding 500ml for every hour of exercise. For a 65kg person this is 2.1 litres per day, plus extra if you’re exercising.

• Exercise! Daily exercise helps food to move through the colon more quickly.

• Try 4g of PHGG (partially hydrolysed guar gum) daily: this is a low gas producing prebiotic which helps to regulate bowels.

2. Gas producing foods & liquids: 

A number of foods naturally result in gas production when they are metabolised by your system. If you eat too many of these foods and don't have enough enzymes to break them down, the gas may become uncomfortable. Foods such as sugar, carbonated drinks, the brassica family (broccoli, cabbage, cauliflower, bok choy, kale, and brussel sprouts), legumes, sauerkraut, onion and garlic, all result in higher gas production.

To reduce bloating due to gas producing foods:

• Take a digestive enzyme: 1 capsule at the start of your main meals

• Reduce the quantity of trigger food: start with small amounts of food such as sauerkraut & legumes, and build up as your system adjusts.

• Eat cooked brassica, onion & garlic: if you are sensitive to these foods, cooking may make them easier to digest than raw.

• Remove processed sugar & carbonated drinks

• Don't hold in gas: excuse yourself from the room and pass wind when you need to. Holding in wind makes bloating worse.

3. Stress

When the body is stressed, all energy goes into preparing you for action, turning attention away from digesting food. Have you heard of fight & flight, and rest & digest? Stress reduces the ability to break down food that you have just eaten, which can result in bloating.

Ways to reduce bloating due to stress:

• Don't eat when stressed: as this reduces the amount of gastric secretion necessary to process food effectively.

• Take digestive bitters: 5-20 drops in water prior to meals, to stimulate digestion.

• Chew well and eat slowly: allow plenty of time for your stomach to prepare for the food that’s coming.

• Find ways to manage stress if that's an issue for you: yin yoga, meditation, deep belly breathing and nature walks are all calming activities to help reduce stress levels.

• Try antispasmodics or carminitives after meals: peppermint tea, ginger tea, chamomile tea, fennel tea, and chewing caraway seeds all work to reduce bloating.

• Avoid wearing clothes that are too tight around your abdomen: tight clothing can exacerbate the sensation of bloating.

4. Food allergy or intolerance

Food allergy is an immune mediated reaction such as coeliac disease. If suspected, this should be investigated with your GP for a diagnosis.

Food intolerances can result from a number of causes. One cause is the lack of particular enzymes required to break down carbohydrates, fats or protein. Common intolerances include lactose, gluten, wheat, fructose, and egg. In this scenario, food is rarely the problem, it is the messenger. Work to understand why you are having the problem, correct it, and then trial the food again. When it comes to intolerances, trigger foods should not be eliminated forever.

Ways to reduce bloating due to food intolerances:

• Avoid trigger foods: pay close attention to what causes your bloating, and avoid suspect foods temporarily.

• Take glutamine: 5g twice daily, to strengthen the intestinal barrier.

• Take digestive enzymes: 1 capsule at the start of each main meal.

• Eat bitter greens: have a small salad of bitter greens prior to starting a meal, including rocket, bok choy, radicchio, endive and witlof. The bitter taste stimulates the production of digestive enzymes.

5. Dysbiosis or SIBO (Small intestinal bacterial overgrowth)

Dysbiosis simply means an imbalance of bacteria, fungus and other organisms of the gut. SIBO falls under the umbrella of dysbiosis, but specifically refers to an overgrowth of bacteria in your small intestine. Even minor disturbances in gut microflora can lead to significant changes in gut function, including gas production. In addition, these microbial changes may alter protein and carbohydrate metabolism in the gut, which can also result in bloating.

Ways to reduce bloating due to dysbiosis or SIBO:

• Consume polyphenol rich foods daily: such as blueberries, blackberries, red rice, black rice, cacao, flaxseed meal, black tahini, nuts with skin (hazel nuts, pecans, brazil nuts, almonds), purple carrots, and purple cabbage. Polyphenols are prebiotic-like foods which work to rebalance gut bacteria.

• Take a daily probiotic: Saccharomyces boulardii, Bifidobacterium lactis, Lactobacillus acidophilus, and Lactobacillus plantarum have all shown promise in correcting dysbiosis.

• Trial the FODMAP diet for 6 weeks only: before beginning food reintroduction. It's incredibly important not to stay on FODMAPs long term, and I would recommend completing this diet under the guidance of a practitioner.

• In some cases antimicrobials may be warranted. Antimicrobials work to reduce the numbers of undesired bacteria in the gut. Again, these should only be used under the guidance of a practitioner.

I do hope the above provides you some relief. The gut is a topic I find endlessly fascinating. If you would like to work on individual treatment for your digestive issues, please get in touch x

If you are experiencing bloating and would like individualised support, please get in touch by booking in a Discovery Call here

References
https://link.springer.com/article/10.1007/s12325-019-00924-7
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3264926/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3816178/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6199944/