Bloating is a very common clinical complaint that we naturopathic doctors see in functional medicine practice all the time. Its manifestations are varied and having a skilled understanding of all the potential root causes is key to successful treatment. Most conventional doctors overlook the varied potential causes of this common symptom and treat symptomatically. Finding a skilled practitioner well versed in functional gastroenterology is essential for proper resolution of this uncomfortable symptom.

1. Eating while stressed

Eating while stressed causes your body to be in a sympathetic dominant, fight or flight mode. Adrenaline and cortisol surge through your body and all the blood begins to pool in your arms and legs and away from your stomach and intestines. Your body is trying to get you ready to run, to flee the perceived danger, not digest the food you just ate. Consequently your digestive enzymes aren’t going to be flowing properly and your food will go undigested leading to gas and bloating down the line(1).

Solution: Eating in a calm, relaxed state (parasympathetic state-”rest and digest” state). Chewing at least 15-20 times before swallowing. This will give your body time to produce the necessary enzymes and eliminate any downstream bloating effects. Meditation and mindfulness exercises (away from meals) can also help move you more into a parasympathetic state which will help the digestive enzymes flow when you are ready to eat.

2. Eating too much

Eating too much in any one sitting can lead to bloating due to a lack of sufficient digestive enzyme production to match the amount of food being consumed. If your eating more than your body is able to digest in any one sitting you will have left over food that the microbes in your gut will happily digest for you (and produce gas as a byproduct)(2).

Solution: Eating smaller, more frequent meals throughout the day.

3. Eating too fast

Along the same lines of eating while stressed eating too fast can give your body the impression it is in a sympathetic dominant state (fight or flight). In this state your body isn’t producing the necessary digestive enzymes leaving the bulk of the food to be digested by your gut microbes (leading to gas and bloating)(3).

Solution: Slow down! Think of eating as a time to relax and focus in the moment. Give yourself time to be aware of where you are and eat your food with intention.

4. IBS/ SIBO

SIBO stands for Small Intestinal Bacterial Overgrowth. A recent study showed that up to 75% of all cases of IBS (Irritable bowel syndrome) are due to SIBO(4). SIBO happens when gut microbes from your large intestine migrate up into your small intestine, where they do not belong, and start rapidly overgrowing. The reasons why this happens are varied (previous abdominal surgeries, chronic PPI use, previous abdominal infections, food poisonings, lack of digestive enzymes). Once in the small intestine these gut microbes start producing gas leading to bloating and abdominal distention. This is particularly true with with certain foods high in fermentable sugars(5).

Solution: Working with a knowledgeable healthcare practitioner who can test properly and utilize an array of tools: pharmaceuticals, herbs, diet(6), supplements, promotility agents, visceral manipulation therapies, mind body therapies.

5. Candida/ SIFO

Also occasionally referred to as SIFO (Small intestinal fungal overgrowth) this condition is marked by an overgrowth of intestinal yeast that can cause bloating symptoms (most commonly caused by Candida)(7). Candida is a commensal organism that normally lives in the gut but can overgrow and cause symptoms of gas and bloating. Foods high in carbohydrates and sugars feed these bugs and cause gas as a byproduct of their metabolism.

Solution: Working with a knowledgeable healthcare practitioner who can test properly and utilize an array of tools: antifungals, herbs, diet, probiotics (particularly saccharomyces), supplements, promotility agents.

6. Parasites

Protozoan parasites like Giardia and Blastocystis Hominis can be causes of bloating in the GI system. Usually picked up by drinking contaminated water or food these bugs typically cause more acute gas, bloating and diarrhea. Occasionally they can go chronic and lead to low levels of gas and bloating that persists long after the initial acute infection occurs(8).

Solution: Working with a knowledgeable healthcare practitioner who can test properly and utilize an array of tools: antimicrobials, binders, probiotics, herbs, diet, supplements.

7. H.pylori

A bacteria typically associated with ulcers and GI cancers H.pylori can also produce gas and bloating symptoms(9). There is some debate among practitioners on whether H. Pylori is actually a normal commensal bacteria that should not be treated, unless is causing symptoms, or whether it is always pathogenic and needs to be treated every time. Either way it is a bacteria that can cause gas and bloating in some people who have it.

Solution: Working with a knowledgeable healthcare practitioner who can test properly and utilize an array of tools: pharmaceuticals, probiotics, herbs, diet, supplements.

8. Celiac Disease

Celiac disease is an inability to digest gluten that leads to gut inflammation and damage. A common symptom of celiac disease is painful gas and bloating(10). There is a subset of the population who does not have celiac but is sensitive to gluten and have what is called Non-Celiac Gluten Sensitivity. These individuals can also react with gas and bloating when they eat gluten containing foods.

Solution: Gluten avoidance is essential for these individuals but also working with a knowledgeable healthcare practitioner who can test properly and utilize an array of tools: pharmaceuticals, herbs, diet, supplements.

9. Fatty Foods

In certain sensitive individuals a diet high in fat can lead to increased symptoms of gas and bloating(11). The reason behind this is less clear but may be a combination of factors stemming from poor acid and enzyme production in the stomach and small intestine.

Solution: Avoiding fatty foods in large amounts is usually the quickest fix. Taking digestive enzymes when you eat these foods can also be beneficial.

10. Menses

Fluctuations in the hormones estrogen and progesterone can lead to symptoms of bloating and abdominal distention. Usually cyclical and timed to menstruation the bloating can become more constant if hormone levels are more chronically dysregulated(12).

Solution: Working with a knowledgeable healthcare practitioner who can utilize an array of tools: herbs, diet, exercise, bioidentical hormones, lifestyle modifications and supplements.

11. Enzyme Deficiencies (ie Lactose intolerance, Fructose intolerance)

A lack of specific enzymes in the small intestine to break down sugars in foods can cause gas and bloating(13). If you’re body can’t break down these sugars (ex: Lactose in milk. Fructose in fruit) then these sugars become food for our gut flora who produce gas as a byproduct of their metabolism.

Solution: Avoiding these foods in large amounts is usually the quickest fix. Taking digestive enzymes when you eat these foods can also be beneficial.

12. Food Allergies/ Sensitivities

Sometimes specific food allergies or sensitivities can cause inflammation in the GI tract. These foods create an inflammatory environment that can cause certain microbes to proliferate and produce gas and bloating(14).

Solution: Working with a knowledgeable healthcare practitioner who can run specific blood work to test for food allergies and sensitivities. Avoiding these specific foods in large part will help diminish symptoms of gas and bloating.

References:

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8. "Extra-intestinal and long term consequences of Giardia ... - NCBI - NIH." 21 Dec. 2013, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3870550/. Accessed 4 Apr. 2019.

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10. "Frequency of Celiac Disease in Patients with Increased ... - NCBI - NIH." 26 Oct. 2015, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4954875/. Accessed 4 Apr. 2019.

11. "Dietary fat intake and functional dyspepsia - NCBI - NIH." 21 Apr. 2016, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4863403/. Accessed 4 Apr. 2019.

12. "Period bloating: Causes and remedies - Medical News Today." 1 Oct. 2017, https://www.medicalnewstoday.com/articles/319579.php. Accessed 4 Apr. 2019.

13. "Prevalence of lactose intolerance in patients with ... - NCBI - NIH." https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5697418/. Accessed 4 Apr. 2019.

14. "Food Allergy and Intolerance in IBS - NCBI - NIH." https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5358086/. Accessed 4 Apr. 2019.