By Dr. Shawna Darou, ND
Bloating is one of the most frequent complaints that I hear, and the good news is that it is almost always treatable once we have determined the underlying cause. Frequent bloating can certainly be uncomfortable. It’s important to know that abdominal bloating is a sign of underlying dysfunction.
Here are some of the most common causes of bloating:
- Intestinal yeast overgrowth
- Food intolerances
- Gluten sensitivity or celiac disease
- Insulin resistance
- Irregular meal-times
- Deficiency of digestive enzymes or hydrochloric acid
- Other causes of dysbiosis
- Hormone imbalance or sensitivity
Some of these conditions can be tested for – food intolerance, gluten sensitivity, celiac, insulin resistance, SIBO and in other cases we treat based on the symptoms and history.
1. Intestinal yeast overgrowth:
Intestinal yeast overgrow is extremely common, and it is usually caused by frequent or long-term antibiotic use. The most common scenarios are – many rounds of antibiotics as a child for ear or tonsil infections, long-term antibiotic use for acne (tetracycline or minocin), or antibiotics for frequent urinary tract infections. Antibiotics alter your digestive flora, allowing yeast which are an opportunistic organism, to take over.
When there is too much yeast in the body, you will be bloated and gassy. This is because yeast ferment foods, causing gassiness. Some people will also experience very high sugar or carb cravings, tendency for binge eating, brain fog, fatigue, vaginal yeast infections, and possibly fungal skin infections.
The good news is that this is treatable by re-balancing your intestinal flora with a yeast cleanse: eating a no-sugar diet, taking supplements to kill yeast, and replenishing your intestinal flora with probiotics.
2. Food intolerance
Food intolerance is different from food allergy in that it is a delayed reaction to a food, rather than an immediate response of itching, swelling or anaphylaxis. Food intolerances cause immune stress and inflammation, and this can also irritate the intestinal tract causing bloating. The most common food intolerances are dairy, eggs, certain fruits (banana, citrus, pineapple especially), sometimes nuts (almonds and peanuts are most common), wheat, gluten, corn or others.
Food intolerances can be tested with a blood test to accurately identify them, which takes the guess-work out of eating. Food intolerance would be suspected in someone with a history of allergies, eczema, asthma or a family history of autoimmune disease, but can also be associated with many other skin conditions, digestive disturbances, and low energy. Typically bloating will improve within 4-6 weeks of eliminating any aggravating foods.
3. Gluten sensitivity or celiac disease
Gluten intolerance and celiac disease (a more serious form of gluten intolerance) are definitely on the rise, largely due to the significant changes in wheat over the past 50 years, and also our high consumption of grain products. Many people with a gluten sensitivity will complain of bloating, with or without gassiness, constipation or diarrhea.
There is testing available for gluten intolerance and celiac which does pick up most cases, although many people who test negative, still feel better off gluten. Another marker for gluten intolerance is someone who has low vitamin B12 levels without a vegan or vegetarian diet.
If you suspect that gluten may be a problem for you, a starting point is to do appropriate blood tests to check for celiac, and if you do think that symptoms are worse with bread products or pasta, to start a 5 week strict gluten-free trial. After 5 weeks strictly off gluten, it is important to re-introduce it back into your diet to clarify your reaction. There are so many great alternatives to gluten: rice, quinoa, millet, squash and sweet potato to name a few.
4. Insulin resistance
Insulin is the hormone that is released from the pancreas in response to glucose (sugar) in the blood. Insulin levels spike after eating a meal. When insulin is released in a non-insulin resistant (healthy) person, it triggers the body’s cells to utilize glucose and fats from the bloodstream. Insulin resistance occurs when the cells do not respond, or respond weakly to the insulin signal. This results in the body secreting even more insulin, and eventually creating toxic levels of glucose in the blood, known as high blood sugar.
Common symptoms of insulin resistance include: weight gain (often rapid in a period of 2-3 years); intense cravings for carbohydrates and sweets; increased appetite; and feeling tired and bloated after eating.
If you have experienced these signs, and especially if you have a family history of diabetes, you may have insulin resistance. There are blood tests that can confirm insulin resistance. The good news is that this condition is treatable and reversible with diet changes and exercise. The key is to lower your intake of sugar and carbohydrate foods, emphasizing more vegetables, proteins, fiber and healthy fats; and also to start exercising regularly.
5. SIBO (Small intestine bacteria overgrowth)
SIBO is becoming a very common condition to diagnose, and is a different type of bacteria imbalance where the overgrowth is in the small intestine rather than the large intestine. This is problematic because the small intestine is not meant to have large amounts of bacteria, and this creates fermentation reactions causing gas. Bloating with SIBO tends to be higher in the abdomen – pushing on the diaphragm and causing burping and maybe heartburn.
Other signs that may point to SIBO include:
- constipation or diarrhea
- poor nutrient absorption
- burping and gassiness
- acid reflux (especially if it is difficult to treat)
- rosacea and acne
There are accurate breath tests for SIBO to determine whether this is the cause of your bloating. Treatment involves a low carbohydate nutrition plan and anti-microbial treatment (herbs and occasionally antibiotics).
6. Irregular meal-times
Another common cause of bloating is simply eating at irregular times. When you go for long hours without eating, or have large amounts of food at bedtime, your digestion (and metabolism) will suffer. For example, skipping breakfast, and then eating a large lunch will almost always cause bloating – it is shocking your digestive system, and also will cause a big rise in blood sugar and insulin as described above. You will end up bloated and tired, searching for caffeine to stay productive in the afternoon.
Our bodies run best with regular and consistent meal times, and our digestive system also functions better with consistency. Aim for a breakfast within 1 hour of waking, a regularly timed mid-day lunch, and dinner before 7pm. Include mid-morning and mid-afternoon snacks if needed.
7. Deficiency of digestive enzymes or hydrochloric acid
Digestive enzymes are produced by the pancreas to help with the breakdown of food into forms that can be absorbed by your body. Enzymes break down proteins, carbohydrates, fats and lactose.
In some cases, the body may not be producing enough digestive enzymes, resulting in bloating, pain, indigestion and irregular bowel movements. A deficiency of digestive enzymes can be caused by: 1) food intolerance causing low-grade inflammation in the intestinal tract; 2) overgrowth of bacteria/yeast/parasites; 3) low stomach acid; 4) chronic stress; and 5) aging.
Lactose intolerance is also a form of enzyme deficiency, where there is insufficient lactase enzyme to breakdown lactose, resulting in poor digestion of dairy products. Lactose intolerance can be tested with a breath test, or with a 2 week dairy-free trial, followed by a challenge (meaning eating dairy products to watch what happens).
A temporary solution to this problem is to take digestive enzymes with your meals, and to avoid dairy if you have a lactose intolerance. It is however important to get to the root of the problem, and treat any imbalances in order to encourage the body to produce sufficient enzymes on its own.
Low hydrochloric acid, or “hypochlorhydria” is a condition where the stomach is not releasing enough acid to properly break down and digest proteins. This can be caused by chronic stress, age, H. pylori infection, certain medications, and low thyroid function. Without adequate stomach acid, you’re more vulnerable to SIBO, anemia (low iron or vitamin B12), gastrointestinal infections, and poor protein absorption.
A simple way to test for low stomach acid is a hydrochloric acid challenge, where you take an increasing dose of hydrochloric acid + pepsin capsules with a high-protein meal. In someone with good stomach acid production, the extra acid will make them feel uncomfortable with warmth and possibly heartburn. In someone with poor stomach acid, they won’t experience any symptoms until a higher dose is reached.
We can certainly treat low hydrochloric acid with appropriate supplements, but it is extremely important to also find out the cause.
8. Other causes of dysbiosis
It is very common to have an imbalance in the organisms in the intestinal tract, and in addition to yeast as discussed above, many people also carry extra pathogenic bacteria and even parasites in their digestive tracts. This is more likely if you have traveled recently (especially to Asia, Africa or South America), but even eating out in Toronto you can pick up some nasty bugs. With this type of digestive imbalance, there is also typically diarrhea, weight loss and fatigue, although a sudden onset of bloating still suggests dysbiosis of some type.
There is testing for bacterial overgrowth and parasites with a comprehensive digestive stool analysis to accurately pin-point what is growing. Treatment is then much simpler once the organism(s) have been identified.
9. Hormone imbalance or sensitivity
Many women experience significant premenstrual bloating for days or weeks before their periods. This bloating may be caused by the digestive shift that happens premenstrually, where women are more prone to constipation, or from sensitivity to the higher hormone levels that happen in the luteal phase of your menstrual cycle.
Relief from hormonal bloating comes from two sides:
(1) Addressing digestive function and resolving constipation. Drinking more water, adding soluble fiber (chia or flaxseeds), and possibly using magnesium to encourage regular bowel movements.
(2) Optimizing hormone balance: supporting estrogen detox pathways to reduce estrogen dominance (through nutrition and supplements); optimizing progesterone production, since low progesterone can cause significant PMS symptoms; and also reducing general inflammation in the body because inflammation aggravates menstrual cramps and swelling.
In conclusion, there are many causes of bloating that a Naturopathic doctor is looking for, and this is usually a very treatable condition. It is not normal to need to loosen your pants every night after dinner, or to be too bloated at the end of the day to go out and socialize. I hope this brief article has given you a starting point to improve your digestive health now.
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