What causes Bloating
by Sue Kira, Naturopath & Clinical Nutritionist
I was walking along the beach one morning and there it was – an omen!
This dead bloated puffer fish – next to my alive foot – got me thinking about bloating and inspired me to write this article. At least his (or her) death was not in vain.
In this article I take an in-depth look at the many causes of bloating and what you can do about it. Generally we relate bloating to food, but you might be surprised by the various influences that produce bloating. There’s much to share.
Significant facts about bloating:
- There’s a lot of it around
- It’s uncomfortable
- It can be eliminated (perhaps cured is a better word)
Bloating is common in our society and it doesn’t discriminate between sexes, race or geographic locations. Indeed about 80% of my clients experience bloating. Admittedly they come to me with a health issue which is often related to a gut problem, so such a high percentage may not apply to the general population. Nevertheless, there’s lots around.
Bloating is uncomfortable. I know because I have experienced it on and off for many years. Apart from physical discomfort, there’s the other discomfort when you hear those ‘wonderful’ (written in sarcastica font) words:
“When is the baby due?”
“It’s not…I’m bloated.”
(Bet I’m not the only one to have heard a comment like this).
Bloating shows very clearly that the body is out of balance. It tells you quickly if you have eaten or drunk something that is wrong for your body, consumed too much, or there’s another reason.
It’s easy to observe your body so you can work backwards to find that reason. You can even hear your body in action, after all, burps and farts can be quite audible.
Note: Let’s clear the air here. I prefer to use the word ‘fart’ than ‘passing wind’. Fart has a more phonetic ring about it.
I used to get so bloated that I felt like I was 6 months pregnant. Sometimes it was so bad I felt my belly could explode and wished I could just stick a pin in it and fly around the room like a balloon releasing its air until it was all gone. Can you relate to that?
They say that normal people fart 14 times per day, but for those who get bloated and when the gas finally makes its way out, they might fart 14 times in an hour (or even 50+) often very painfully until it’s all out.
This intestinal gas can be composed of methane, hydrogen, sulphur CO2 or various combinations of these chemicals, which can explain the variety of smells (or lack thereof if you’re lucky) that emanate from your rear end.
Imagine if the gas that produced bloating was helium. We’d walk about seeing thousands of people floating around (and it would certainly be one way to be lighter on the scales).
But enough. Let’s focus on what we can do about this.
There are many reasons for bloating, some simple and some more complicated.
If in any doubt, see a practitioner. Gut support guidance can be obtained from an experienced naturopath or integrative/functional doctor.
Here are some of the reasons (which I expand on shortly):
1. Eating too much food. Reminds me of Christmas dinner or a party with lots of yummy foods and before long you’ve eaten far too much, feel bloated and horrible and want to have a nap until it all goes away.
2. Eating too fast. If you scoff your meal down in a hurry without masticating (chewing) sufficiently, then you don’t give your digestive secretions a chance to be released and there’s a good chance you also suck in extra air.
3. The wrong kind or combination of foods. Processed foods, junk foods, sugary foods or food combos that don’t agree with you like fruit with meat e.g. in a salad.
4. Food additives like sucralose and xylitol that are used to make foods taste sweet without excess sugar – but these additives can cause severe bloating and cramps for some. This happens to me and it’s horrible, so I completely avoid these substances.
5. Foods that don’t agree with your system. Many people can’t digest things like gluten, dairy products, grains, starches, fermentable foods, or lectin containing foods. These substances and foods can create an allergy reaction, intolerance, or they may trigger fermentation in your body. More on that soon.
6. Some people react to foods called FODMAPs – an abbreviation of Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols. Or more simply, certain foods that cause fermentation or gas in your belly. Common examples include onion, garlic, beans, legumes, cabbage, apples, and many others.
7. You may lack sufficient stomach acid or digestive enzymes to break down the foods you eat. Some lack just one type of enzyme, such as the enzyme to digest starch or the enzyme to digest protein, or maybe not enough bile from the Gall Bladder which helps us digest fats. Some health conditions can diminish bile availability and bile flow e.g. gall stones, hypothyroidism and fibromyalgia.
8. IBS (Irritable bowel syndrome). If you get constipated, have slow bowel transit time (time it takes for a meal to get from mouth to anus), or if you have IBS (Irritable bowel syndrome), then you may feel bloated purely because the gas isn’t getting out of the colon as easily as it should. Some people experience more pain from gas because the nerve endings in their bowels are very sensitive.
9. Other causes for bloating can include hormonal imbalances, allergies, stress, not enough good bacteria in the right places, certain vitamin and mineral deficiencies, digestive issues
10. And there’s more, including SIBO (Small Intestine Bacterial Overgrowth), LIBO (Large Intestine Bacterial Overgrowth), or you may have parasites, which can be in the stomach, small intestine, large intestine or pretty much anywhere in the body. On a more serious level there are inflammatory bowel diseases (IBD) such as Crohn’s disease and Ulcerative Colitis – both of which give rise to bloating as one of their many symptoms.
Digestive issues can create vitamin and mineral imbalances, and also inadequate amino acids (digested from protein) to balance our hormones and neurotransmitters. There’s often a vicious circle of influence.
There are many other causes of bloating, however the above are the most common.
Next, we look at these causes of bloating in more detail to help understand what might be creating the problem and what can be done about it. The information also provides the opportunity to work through a process of elimination to get to the root cause.
The timing of bloating after eating can give clues to where in your intestines you may have the imbalance. Generally, the quicker that the bloat occurs after eating, then the problem is higher in the digestive tract.
But not always. Sometimes the whole digestive system can be so backed up that the trigger of eating starts off the chain reaction lower in the intestines. You can have wind up higher (burping), wind down lower (flatulence) or wind out (bloating tummy) or any combination of the above.
Good digestion is critical to gut health and to help prevent bloating.
First steps to good digestion:
(I don’t mean smell of bowel gas). Did you know that digestion actually starts from the smell of food which triggers salivation? If you have low zinc levels, you may not smell your food properly and therefore miss that crucial first step in digestion. Digestion is a chain reaction process; miss one step and the rest is disrupted.
The next step is triggered in the mouth by the action of chewing. Yes, we’ve heard it before, chew your food ‘x’ number of times before you swallow. I think the going rate is about 32 chews per mouthful, but that’s often quite unreasonable and a bit obsessive if you ask me.
Many years ago I had fun by observing people at restaurants chewing and discovered that those who put their knife and fork (or spoon) down, or simply rested them on the table in their hands, automatically chewed food longer for what appeared to be the right amount of times, according to what they were eating.
On the other hand, there were those intent on loading up their cutlery, ready for the next intake as soon as possible. Consequently they didn’t chew their food enough, so bigger lumps were going down their throats, making digestion much more difficult.
Obviously, softer foods need less chewing than say meat where you chew for longer.
It’s better still to be present when eating. What does that mean? Simply being relaxed and focused on your food, how you eat, your posture, taste, aware of how well chewed your food is before swallowing.
It means not being distracted by the television, computer, phone, the newspaper, or other things we really don’t need to engage in while eating.
Sound simple? It can be both simple and difficult. Difficult because it’s a new habit to form, but once you’ve been doing it for a while you find your new habit becomes more habitual.
If you find yourself halfway through a meal that you practically inhaled because you ate it so fast, it’s not too late to slow down and finish the meal while relaxed and present.
The cutlery trick I mentioned above is easy to do and can be a gateway to being more present when you eat to help you avoid bloating from poor digestion.
You may eat what appears to be a healthy combination of foods but become bloated soon after eating. This could be from something as simple as the wrong combination of foods in the one meal. For many, it’s not an issue; for others it can be disastrous.
There are a few simple rules when choosing meal ingredients for good food combining.
Number one: always eat fruit on its own, and not with any meal. Putting fruit on your muesli, or mango slices with your salad could spell trouble.
Number two: don’t combine starches and starchy vegetables with animal proteins. Potato, sweet potato, corn, bread, or pastry with meat don’t work well. Out goes that Shepherd’s pie, ham on toast, eggs on toast, fish and chips.
Yet this flies in the face of all that many of us have known, particularly when brought up on steak and chips, stews with toast, and hamburgers. And for many…that could well be the source of your bloating and discomfort.
For example, one that affected me was Massaman Curry. I love the taste, but it combines either lamb or beef with starchy potatoes and starchy rice. Instead, I drop the rice and potatoes and replace with starch free vegies such as zucchinis, carrots and beans.
These food combinations don’t affect everyone, but many people can’t digest starch very well, which is exacerbated when mixed with an animal protein.
There are other food combining principles, but these are the two main offenders. For more about good food combining see the Food Combining Diet
If you find you are bloated from eating too much, or too fast, or the wrong combo of foods, here are some simple home remedies to help your tummy settle quickly.
- Camomile tea
- Peppermint tea
- Ginger tea
- Fennel seed tea (or chew on a few seeds)
- Caraway seeds (chew on them)
- Lemon juice and mint leaves steeped in hot water
- Lay down for 15 minutes or so and focus on breathing gently/meditating to allow some of the gas to pass
Now we look at some of the more serious causes of bloating and what you can do.
FODMAPs is an abbreviation for Fermentable Oligo-saccharides, Disaccharides, Monosaccharaides and Polyols.
These are fermentable sugars that include lactose, glucose, fructose, fructans, galacto-oligosaccharides, maltitol, mannitol, isomalt and xylitol.
FODMAPs are a common cause of bloating, especially in reaction to consuming these fermentable foods.
Where are FODMAPs found?
Fructose: a monosaccharide fruit sugar found in various levels in most fruits and vegetables
Lactose: a disaccharide sugar found in dairy products like milk
Fructans: classified as an oligosaccharide, found in many vegetables and grains
Galactans: also an oligosaccharide but found mostly in legumes.
Polyols: sugar alcohols like xylitol, sorbitol, maltitol and mannitol. You find them mainly in artificial sweeteners, chewing gum, sugar free lollies and mints. These additives can cause bloating because they’re FODMAPs.
Other: FODMAP ingredients such as inulin (from chicory root), natural flavours, high fructose corn syrup, agave, and honey are added to many foods.
To read more about FODMAPs and a Low FODMAP diet, go to Low Fodmaps Diet
If you find that removing the high and medium FODMAP foods don’t help, or you react to too many of the foods re-introduced into your diet, then further exploration needs to be done.
You may have SIBO (Small Intestine Bacteria Overgrowth) or LIBO (large intestine bacterial overgrowth), a parasitic infection or overgrowth of candida species (yeast/fungi).
An introduction to SIBO
The gut is possibly the most important organ to keep a healthy balance in our body. If the gut isn’t healthy then the rest of the body will be compromised.
By digesting our food, our gut provides the fuel we need. But more than that, it is also the main site for the genetic material of trillions of bacteria, viruses, yeasts, and protozoa (aka parasites) all collectively called our microbiome, which are not of human origin.
Microbiome helps us to maintain balance with many other systems in the body. For example, serotonin, one of our happy hormone neurotransmitters is predominantly found in the gut and needs the support of our microbiome to work effectively.
We actually have lots more microbiome genetic material in and on our body than human genetic material. Some reports say 10 times the amount, others say 200 times. Whatever the number, it’s a huge amount of microbiome.
We also have a GALT (Gut Associated Lymphoid Tissue) where the lymphatic system wrapped around the gut helps to clear out toxins we have consumed. This is part of the reason why it is said that 80% of our immune system is in the gut. Apart from GALT, our immune system is also about having the right balance of bacteria.
Did you know that bacteria help us to digest certain foods and absorb certain vitamins? Vitamin B12 is one of those crucial vitamins that need specific bacteria to help absorption. Without these bacteria, all the meat and eggs (which contain B12) in the world won’t give you enough B12. (You also need what’s called an ’intrinsic factor’ which is a glycoprotein, but that’s another story).
You’ve probably heard about our friendly bacteria, but what many don’t know is that when one species of bacteria is wiped out (from antibiotics, sugar etc) it may not be able to be replaced simply by taking a probiotic, and that strain of bacteria could be a crucial step in a process our body needs.
Taking a probiotic has certain strains but may not include the one we lost. Hence what we eat, how we care for ourselves, and our lifestyle has a huge influence on our microbiome balance.
Consuming a large variety of different foods seasonally adds to the biodiversity of our microbiome. Even going out for recreation to beaches, national parks, travelling etc has an impact on the biodiversity of our microbiome because we pick up bugs everywhere.
This relates to why it’s considered that we are now ‘too clean’ for our own good. Obviously, hygiene is important. We know there are ‘clean bugs’ and ‘dirty bugs’. For example, clean bugs come from plants, sand, dirt, trees, rocks – things we touch in the environment. Dirty bugs come from the toilet, decayed rubbish and so on.
The point is, get out and enjoy the environment, don’t molly coddle the kids, let them get dirty.
Another interesting factor is that some of our ‘good bacteria’ can become ‘bad bacteria’ if overgrown and out of balance – even acidophilus species (a common probiotic species).
By all means, use antibiotics where needed to preserve life plus a probiotic during and after treatment. But not all the ‘good guys’ will be replaced which can result in an imbalance, potentially leading to all sorts of complications, such as depression, anxiety, blood sugar balance (diabetes), weight gain, and more.
Once the gut is re-balanced by removing the bad guys or reducing overgrowth, then a variety of foods, self-care and exposure to nature can all contribute to consolidating the good guys lost from previous bad habits and various illnesses.
Bloating is a sign that all is not well in the digestive system. If you have considered and implemented previous suggestions about bloating and not much has changed, then the next step is to look at the possibility of SIBO (the small intestine bacterial overgrowth).
You can also get LIBO, which an imbalance in the large intestine. Other contributing factors could be parasitic infections or candida yeast overgrowth. Really, the name isn’t that important, but the correct balance of gut microbiome is!
An imbalanced microbiome can produce toxic gases including methane, hydrogen, sulphur or a combination of these. We experience them as flatulence, farts, gas, wind, bloating, cramps and disturbances in bowel movements.
There are many potential causes for SIBO, LIBO, Parasites and Candida overgrowth which need to be dealt with appropriately. Diet or prescription in isolation normally cannot heal this imbalance; it’s the combination of both that’s needed to treat this problem.
Seek the advice of a ’gut experienced’ practitioner to guide you with the appropriate SIBO diet along with herbs/antibiotics/vitamins/minerals etc needed to support your body to clear the imbalance.
An allergic reaction is usually quite severe and will often give rise to more symptoms than just bloating, but sometimes bloating may be the only symptom until the reaction gets stronger.
In this case, you usually notice that every time you eat a certain food you react, and the reaction gets worse each time, indicating an allergy. If you stay tuned with your body’s signals, allergies can be easier to pick up.
But sometimes, even severe allergies can be missed. This is common with Celiac disease, where symptoms aren’t noticed (or ignored) until a lot of damage has been done. Fortunately, we do have very good tests for Celiac. Gluten intolerance is a little harder to pick up.
With food reactions such as allergies and intolerances, there is a ‘top ten’ list of most commonly reactive foods. You can try an elimination diet, where you eliminate the ‘top ten’ and then see if your bloating and other symptoms subside. If so, you can then work towards bringing back each food individually until you find the culprit(s). For more details, see the Allergies & Intolerances Diet
Another type of food reaction can be generated by substances called ‘Lectins’. Lectins are certain types of proteins that can be found in foods such as legumes, grains, some nuts and seeds, dairy products, and some vegetables, especially the nightshade family such as tomatoes, potatoes, eggplant, chilli etc.
Lectins can be very difficult to digest, creating flatulence and bloating and many other symptoms. Lectins in foods are considered the reason why many react to foods like peanuts, shellfish, egg whites, gluten, dairy etc.
Most foods contain some lectins, but some are worse than others. For the full list and more information on symptoms, testing and what foods to eat to avoid lectins, see the Low Lectins Diet
As mentioned previously, poor digestion that leads to a bloated belly can be caused by a lack of stomach acid – hydrochloric acid – the same acid used in batteries and in swimming pools to balance acid/alkaline levels.
We need acid produced by our stomach to further break down food beyond the chewing process. Then beyond the stomach we have digestive enzymes secreted by the pancreas, and bile produced by the liver and stored in the gall bladder, ready to be released when we eat fats and oils.
To find out if you lack any of these, you can use symptoms as a guide, but many symptoms overlap and can be tricky to fully evaluate. Fortunately, you can get your digestive system pathways checked with a CDSA (comprehensive digestive stool analysis) which notifies if any of these digestive processes are not working properly.
You need a referral from a practitioner for CDSA tests, particularly to evaluate the results as they can be tricky. These tests can also cover parasites, signs of SIBO, friendly bacteria levels and any cancer markers, depending on what level of testing you do. A comprehensive digestive stool analysis is very useful to help you understand your digestive health.
There are certain foods that can help improve stomach acid levels and stimulate bile flow, but further tests should be done first to determine the cause of the deficiency. For example, what can appear to be an imbalance in stomach acid could be due to a parasitic infection in the stomach called Helicobacter Pylori, which is the number one cause of stomach ulcers.
Stress, hormonal imbalances, other health conditions and even medications can trigger bloating, so do seek the help of an experienced health practitioner who can request or perform the necessary tests. Then they can guide you with the most suitable diet to help rebalance your body to eliminate bloating and support you to regain vitality.
IBS – Irritable Bowel Syndrome
A syndrome means there is a cluster of symptoms, including but not limited to bloating. It seems there are no tests available to determine IBS, so the conclusion of a diagnosis for IBS is made by exclusion.
For example, someone may have symptoms of bloating, alternating bowel habits such as constipation and diarrhoea, or a combination of both, often accompanied by severe cramping and sometimes vomiting and nausea. Yet all tests show no elevation of inflammation markers and the bowel appears clear and healthy on a colonoscopy or endoscopy.
It is believed that 84% of IBS cases are caused by SIBO. The remainder appears to be a combination of factors including, but not limited to, emotions, food intolerances and/or poor migrating motor complex (MMC).
MMC is a wave like action that sends the waste material in our colon down to the anus for evacuation. MMC only happens when we have had no food for at least 4hrs, and then activates this movement once every 90 minutes but is switched off the moment we eat something.
So if you snack all day, or eat meals with less than a 4hr gap, then the MMC cannot work efficiently and may only work on the overnight fast, which is why most people have a bowel movement first thing in the morning.
A poor functioning MMC will create a back log of faeces (stool/poo) which will not only cause all of the symptoms mentioned for IBS but also increase the risk for SIBO, which as mentioned earlier is common in those with IBS.
IBD – Inflammatory Bowel Disease
The word disease gives you the clue that this condition is much more serious than any of the conditions mention previously. Interestingly, IBD can have the same symptoms of IBS, SIBO and the other causes of bloating. The defining difference is the severity and the fact there are pathological markers to test for.
Inflammation markers such as faecal lactoferrin and/or faecal calprotectin are picked up, as well as ulcerations in the colon commonly seen in a colonoscopy and/or endoscopy. Symptoms include severe bowel pain, cramping and bloating, often accompanied by rectal bleeding and severe fatigue.
There are two types of IBD. Ulcerative Colitis (UC) and Crohn’s Disease (CD). Both commonly have ulcerations and inflammation in the bowel.
With Ulcerative Colitis, the lesions are commonly found anywhere from the illio caecal valve (ICV) to the anus, or in other words, the lower end of the colon or large intestine. But they can be along the entire length of the colon from mouth to anus and found in the mucosa or mucus layer of the colon (more surface level inflammation).
Whereas with Crohn’s Disease the lesions are found more in the small intestine but can also be found in the entire length of the colon from mouth to anus. Crohn’s Disease is a much deeper level of inflammation called ‘Intramural Inflammation’. Intramural means found within the walls i.e. not surface level but much deeper.
These conditions commonly have SIBO but more often as an after effect of the disturbance IBD causes to the gut microbiota rather than the cause of the disease. Having said that, several of my clients contracted ulcerative colitis after a severe infection in the gut from travels to Bali, India and similar places.
Some even contracted ulcerative colitis at home from Giardia, Blastocystis and Helicobacter Pylori parasitic infections as well as severe candidiasis (fungal) infections. But these infections were considered the trigger to an already compromised immune system that activates the auto-immune condition in the gut.
Both IBD’s (and Celiac) are Auto-Immune Diseases that need medical attention. But alongside medical treatment, augmented therapy with diet and natural therapies can be implemented for SIBO, auto-immune conditions, and gut repair, along with support for any other underlying conditions.
Never treat these illnesses alone. Always seek professional guidance and therapy for any health condition. Diets to support these conditions can include the Auto-Immune Diet, SIBO Diet, Irritable Bowel Syndrome (IBS) Diet or the diet your practitioner recommends that will best support you.
Whatever the cause of your bloating, never give up. Keep looking until you and your practitioner/s find out what causes your bloating and any other symptoms, so ultimately that balloon in your tummy fizzles away…for good.
Aaahhh…that feels better
Yours in good health,
Sue Kira N.D