What is bloating and what causes it?

For some people, bloating is experienced as slight discomfort during the day. For others, it can be all consuming – painful, gassy, distended, uncomfortable. It is definitely one of the most common symptoms that are presented during a consultation.  Generally, the reason for bloating is too much intestinal gas and can be caused by a number of things. Some of the associated conditions include irritable bowel syndrome (IBS), inflammatory bowel disease (IBD) and other functional bowel disorders. Some of the other contributing factors include food sensitivities, high FODMAPs foods, small intestinal bacterial overgrowth (SIBO) and low stomach acid.

Food sensitivities

Sensitivities to foods like wheat, corn and dairy can cause bloating. Sometimes adding in a digestive enzyme can help. However, for many people it is necessary to follow an elimination diet and then to slowly add back in potentially problematic foods and see if they initiate a negative response.

FODMAPS

FODMAPs are a group of sugars that are not completely digested or absorbed in our intestines. When FODMAPs reach the small intestine, they move slowly, attracting water. When they pass into the large intestine, FODMAPs are fermented by gut bacteria, producing gas as a result. The extra gas and water cause the intestinal wall to stretch and expand. Because people with IBS have a highly sensitive gut, ‘stretching’ the intestinal wall causes exaggerated sensations of pain and discomfort.

For these people, it is necessary to follow a Low FODMAPs diet for a period of time and then to slowly try and reintroduce high FODMAPs foods one group at a time.

SIBO

Small Intestinal Bacterial Overgrowth, or SIBO, occurs when the bacteria in your small intestine become unbalanced and overgrow.  This can increase fermentation of sugar in the carbohydrates you eat, and bloating often occurs from this excess gas production.  As a result, people with SIBO often can’t tolerate carbohydrates, including starches, sweets, and sugars. To address SIBO, it is necessary to implement an elimination diet which is usually a combination of low FODMAPs and low carbohydrate.

Low stomach acid

Bloating, within a short time of eating a meal, may be associated with low stomach acid.  The most common sign of low stomach acid is a feeling of bloating or stomach expansion after eating a protein-rich meal or even a meal rich in vegetables. If you experience this on a regular basis, you might benefit from supplementation.

There is often a degree of trial and error when it comes to dietary interventions to address bloating. Sometimes, taking a detailed medical and lifestyle history can help your healthcare practitioner make a decision on what the best type of intervention will be for you.