The answer might surprise you...
Welcome to the Gut Honest Truth blog where a Certified Functional Medicine Practitioner gives you digestible information to tackle your chronic health concerns.
That’s me, Katie Morra; and in this blog I am going to talk about the who, how, when, why's of bloating. We will dive into the most common contributors and how to relieve bloating and relieve symptoms.
Side note- If you want an even deeper dive into understanding and improving IBS - check out my "How to Get Rid of Your IBS" e-book.
And as always, working one-on-one for your specific needs is always our top recommendation, check out our appointment options to get started with one of our licensed health care professionals today.
We’ve all experienced it, we all slightly fear it, we all know that one person that constantly complains about it... but how deep of an understanding do we actually have around chronic abdominal bloating?
Abdominal distention, or bloating, is a common gastrointestinal complaint characterized by the digestive symptoms of trapped gas, abdominal pressure, and fullness. Generally speaking, it is the result of air that’s been confined somewhere in the gastrointestinal tract and is now causing pain or discomfort.
Before we dive deep into the topic of bloating, I want to make it known that a certain level of “bloat” after you eat is normal. You’ve just added food and liquid volume to your stomach, a degree of distention should be expected. The stomach naturally distends after eating to allow room for proper digestion.
A bloated belly only becomes a potential issue when it’s a consistent occurrence and/or it is accompanied by pain and discomfort. It is important to mention that the shame we often experience around bloating has absolutely no place here.
Your body is doing its best to protect you under your current circumstances, and the negative emotional connotation associated is simply not helpful. Please remember to extend grace and love to yourself as you continue along in your healing journey. I promise this will behoove you immensely.
I am sure that you have tried the basics like reducing carbonated drinks, eating slowly, probiotic supplements, watching fiber intake, reducing processed foods, drinking water, peppermint oil, ginger tea, stopped eating chewing gum, artificial sweeteners and sugar alcohols.
Some of you may have even tried gas relief capsules, low FODMAP diet and ruled out other issues like being lactose intolerant, Irritable Bowel Syndrome, Celiac Disease and Inflammatory Bowel Disease.
Perhaps you had a little success in reducing that bloating feeling but nothing that stuck. Please allow me to introduce you to the six main reasons individuals struggle with chronic bloating, that no one is talking about.
6 Main Contributors to Chronic Bloat:
Insufficient digestive output
SIBO/SIFO
Low thyroid function
Food sensitivities
Stress
Hormonal imbalances
Let’s dig a bit deeper into the GI tract, shall we?
Low Digestive Output
We often only think of stomach acid as a digestion necessity. However, there are three completely separate yet connected outputs of the body: stomach acid, pancreatic enzymes, and bile. Each has a specific job, and when in proper amounts aids in overall digestion. They rely on one another for both stimulation and completion of digestive output as a whole.
Digestive Enzymes
Digestive enzymes are produced by the pancreas and assist in the digestion of fats, proteins, and carbohydrates. Enzymes are often recommended, but should not be used long term unless prescribed in most cases. A temporary stint of support from these can help minimize the amount of undigested food particles, that may be a fuel source for pathogenic bacteria, yeasts, and parasites. They may help to reduce bloating in the digestive tract, reduce excess gas and abdominal pain.
Bile
Bile is made and released in the liver, but stored in the gallbladder. If the gallbladder is not optimally functioning, inflamed, or has been removed, digesting fats will be a difficult feat. Ox bile can be supplemental after meals to aid in the absorption and digestion of those fats. If your stools float often, it’s likely a sign of steatorrhea or fat malabsorption.
Stomach Acid
Stomach acid signals the release of pancreatic digestive enzymes and bile production. Your stomach acid is highly foundational in your ability to properly digest all food. It’s the great conductor of all digestion.
Meaning, any food we consume must be acted upon by adequate stomach acid in order to promote food breakdown. Most of us know that stomach acid is important for breaking down protein, but it also maintains further responsibilities.
These include:
Orchestrating your digestion
Breaking nutrients apart for increased availability
Stimulating the production of digestive enzymes
Stimulating the production of bile
Promoting nutrient absorption
Acting as your first line of defense against pathogens
Without adequate stomach acid, you can see how quickly your gut health can be negatively impacted. Stomach acid production relies on the availability of proper nutrients and a functioning parasympathetic nervous system. The vagus nerve, in conjunction with the hormone gastrin, has a role in stimulating parietal cells to create gastric acid.
All that to say, multiple things, ranging from nutrient deficiencies to stress can suppress stomach acid production.
If you have inadequate levels of stomach acid, you run the risk of passing food along to your small intestine in a less than ideal form, impairing digestion and nutrient absorption. The small intestine is akin to receiving food in a partially digested rather than a largely undigested sum. If this occurs, your body is subjected to physiological responses, such as bloating.
A few signs of low stomach acid:
Gas/bloating immediately after eating
Undigested food in stool
Heartburn/reflux
Nausea after taking supplements
Nutrient deficiencies
Multiple food sensitivities
Weak peeling fingernails
Itching around rectum
Learn more from my blog post on the topic.
So, what can you do about it?
Testing your stomach acid may be the easiest place to start! The baking soda test is an at home method you can trial to evaluate your stomach acid production.
The baking soda test:
Mix ¼ tsp of fresh baking soda into 8oz of water first thing in the morning, prior to breakfast.
Drink it and assess how long it takes for you to start burping.
If you start burping under 5 minutes, your acid production is likely adequate.
If it takes longer than 5 minutes, you have some work to do and proper treatment will likely be an important part of your healing.
You may benefit from things like digestive enzymes, bile acids, or HCl retraining. I’ve outlined further testing in this ebook!
SIBO/SIFO
Do you experience most of your bloating 1-2 hours after eating? This may be a sign of small intestinal bacterial or fungal overgrowth (SIBO or SIFO, respectively).
A clinical sign of a bacterial or yeast overgrowth in the intestines is bloating and gas production, especially that worsens throughout the day. The small intestine should be fairly low in bacterial count, while the large intestine should have trillions of bacteria.
As of the publication of this article, research shows that much of the small intestine is meant to be a sterile or a low bacteria environment, and for good reason.
The small intestine is a muscular tube, made of three sections, with the primary purpose of digesting your food to optimize nutrient absorption. The small intestine produces hormones that stimulate the release of bile and pancreatic fluids (other digestive necessities) to further aid in the digestive process.
More importantly, the small intestine is where the contractual movement of food, bacteria, and debris through your digestive tract occurs. This organ’s main job is to absorb nutrients, and move the food along to be eliminated by the bowels.
When there is an obstruction, whether it be a structural abnormality or due to a bacterial overgrowth, the ability to digest and absorb food is minimized. SIBO and SIFO are both examples of such impairments- they are simply overgrowths of bacteria and fungi in places they’re not meant to be.
When there is an impaired movement of food through your small intestine, overgrown bacteria feed off your undigested food (specifically carbohydrates), cueing fermentation and produce gas as a byproduct. This is how SIBO is contributing to the digestive issues you may be feeling such as feeling bloated, excessive gas, pain, and inflammation.
How did you get SIBO in the first place?
Low digestive output
Adhesions
Slowed motility
Medications
Food borne illness
Chronic stress
SIBO is complicated, as there are different types and treatment approaches. However, to rule it out and get to your root cause for bloating, it’s worthwhile to get tested for SIBO and find a practitioner to help you create a protocol for healing. I’ve written a guide on how to do just that here!
Low Thyroid Function
Your thyroid is considered the “master” of your metabolism. I like to think of it as the team captain. It controls how well you digest and absorb food, utilize energy, and store fat.
Decreased thyroid function, or hypothyroidism, can result in a wide range of symptoms such as fatigue, weak or brittle nails, various skin conditions, poor hair health, joint pain, slowed metabolism, constipation, and gas. It slows everything down. You read that right.
Since hypothyroidism slows the movement of food through your stomach and intestines, it creates an opportunity to potentiate bloating. Unfortunately, thyroid issues get overlooked easily and often.
If you’ve had your thyroid labs run, and the only marker ordered was a TSH (thyroid stimulating hormone)...maybe a T4 (thyroxine) level… you don’t have the full picture. This happens frequently and is one of the top reasons people come to me for clinical help. Only looking at an individuals’ TSH and T4 is like looking at a piece of ice floating in the ocean but not seeing there’s a WHOLE iceberg below it that might cause some real damage.
The truth is you need the following values: TSH, T4, T3, reverse T3, as well as thyroid antibodies.
Optimal ranges can differ in the functional versus conventional medicine worlds. In my practice, when I look at thyroid markers, I am looking to see how the whole team is working together, not just how the captain is performing (TSH). As you may be able to infer, there are a lot of players to look at which leaves a lot of room for sub par performance.
What can you do about it?
First and foremost, get all those lab markers tested! Advocate for yourself and really dig deeper into how your thyroid is functioning. Your thyroid relies on adequate nutrients and proper rest as well, so auditing your current intake and sleep quality is an excellent way to best support your overall thyroid health.
If you need more thyroid support, check out my ebook How to Put the Fire Out On Your Thyroid.
Food Sensitivities
Food sensitivities occur as a physiological reaction to a particular food that can result in a plethora of symptoms from headaches, skin reactions, joint pain, fatigue, diarrhea, constipation, gas, sinus congestion and you guessed it, bloating.
Unlike a food allergy, food sensitivities can happen hours or even days (up to 72 hours) after you eat something. Due to the lengthy response time of 3 days and that mounting a response is often dose-dependent for each person, it can often make it difficult to identify the “problem”.
People often jump to cutting gluten and dairy out of their diet, but those two foods aren’t always the automatic triggers for everybody. Cutting foods out of your diet without properly identifying if and how much of that food is causing the response may not be in your best interest.
Firstly, it restricts food which can lead to increased stress (see next section). Secondly, it can minimize exposure to different fiber chains and dietary diversity necessary for your gut health.
Additionally, the goal of any dietary adjustment should be reintroducing as many foods as possible. Meaning once those foods are identified and minimized, there must be work to heal the gut with the intention of re-introducing those foods back into your dietary rotation.
The gold standard for testing food sensitivities is to do a proper elimination and reintroduction program.
Remember that bloating and intestinal gas are simply your body’s innate way of sending you signals that something is off- not necessarily “wrong”- but that there are ways to get to the root of the issue and deal with them head on.
Stress
It wouldn’t be a GHT blog if we didn’t highlight some of the implications of stress and its effect on the body. Stress may exacerbate decreased stomach acid production, which we’ve already identified as a main cause of bloating. More importantly, stress plays a role in poor digestion in the immediate moment.
I want you to take a minute to think about how often you feel overwhelmed or stressed. Your body responds by ceasing digestion so it can tend to other necessary functions. The body’s initial response to stress is to rush blood and energy away from your digestive tract and toward your extremities in preparation for defending you from the perceived threat. That threat used to be more like a lion chasing you, but in our present world, it looks a bit different. Your body can not differentiate a lion attack from your boss yelling at you regularly. Every time you experience that stress response (say, your boss just reprimanded you in front of the whole department), and you’re trying to sit down and have lunch, your energy and blood flow flee to your extremities like you’re going to prepare to run from a lion.
A key thing to understand here is the concept of perceived stress. Often we associate stress with fighting with a spouse or loved one, meeting deadlines at work, or having to make serious life decisions.
However, that’s not the only form of stress. It’s important to understand that feelings of unpredictability or a lack of control, and thoughts around how much stress you’re under at any given time, have just as much impact on you from a physiological response standpoint.
Stress is impossible to escape, but it is imperative to do what you can to minimize, reduce, and manage your stress better.
Practical considerations for stress management:
Seeking a therapist
Developing systems that make daily activities more seamless
Creating a routine that allows for intentional habits that bring you joy (baths, reading, coloring, etc.)
Exploring breath work techniques such as box breathing
Spending time with loved ones without your phone
Hormonal Imbalances
When considering bloating and the associated hormonal fluctuations, progesterone is the culprit more often than not. During your luteal phase of the menstrual cycle (days 14-28, day 1 being the day you bleed), there’s a hormonal shift in estrogen and progesterone that result in water retention (bloating).
Although hormonal discrepancies deserve to be further investigated (as they are often the result of gut issues, low stomach acid, nutrient deficiencies, and stress), most women experience some semblance of belly bloating within their menstrual cycle.
Optimizing your hormones is the most advantageous way to minimize the amount of bloating you experience with these hormonal fluctuations, but movement, specific foods/herbs, abdominal massages, and rest can be equally beneficial.
Testing your hormones with a DUTCH is our most recommended way to identify estrogen and progesterone levels (amongst other markers), to better understand the ratio of the two and how they may be impacting your physiology. If you are interested in running this test please reach out to us using our contact form to get started.
Bonus: Tips to Decrease Bloat
Ensure your fiber intake is adequate- 25-35 g/day is the recommendation, but assess where you are and increase slowly, as large quantities can greatly disturb your digestion if done too quickly
Ginger- one of the best food with anti-inflammatory properties. Ginger can be added to your diet in a number of ways, tea, stir fry, and soup are the most common ways to incorporate them.
Peppermint- Proven to positively impact digestion and reduce bloating. Although you can cook with peppermint leaves, it’s usually much simpler to get a peppermint tea and sip on it throughout the day.
Opt for cooked veggies over raw veggies. It’s true that we need adequate fiber intake for many reasons, but too much fiber can be aggravating for the gut. In most cases, raw veggies further complicate the digestive process as the fiber of the raw skin is difficult to digest and can be a source of belly bloat.
Low sodium foods- processed and packaged foods have extra sodium, which can cause water retention and increase bloating. Eat your water- foods like watermelon and cucumber have high water content which can offset water retention from high sodium foods.
If you’ve been plagued with constant bloating and excess gas, the chances that you’re dealing with one of the above categories is fairly high, but that doesn’t mean you can’t change it. Proper testing and targeted healing will do wonders for you and your digestive system.
Remember that some bloating is normal, but a constant state of discomfort is not. You deserve answers. You deserve to feel your absolute best. GHT is here to support you.