Adapted from episode 45 of The Perfect Stool podcast.
Most people experience bloating at some point in their lives, maybe even frequently, but when is it normal, and when is it a sign of a more serious root cause?
To start, let’s define bloating. Bloating is when gas builds up in the digestive tract and pushes the stomach outward, causing pain and tenderness. I’m well familiar with bloating as it was one of my primary symptoms of gastrointestinal distress from a young age. For me it usually happened after big meals out where I’d get what I now call a food baby, and I did look about 6 months pregnant. But it became more and more frequent for me as I got older, and not just after big meals, to the point where I was not just bloated after every meal but even often woke up bloated.
If you’re unsure if you’re bloated, most people describe it as feeling as if you’re full, like you’ve just had a huge meal, or have a tight feeling in your stomach and abdomen. You might also find that your stomach is swollen and painful to touch and you also may have gas and/or excessive burping. This can take all the fun out of eating, so here’s twelve common causes and their solutions.
#1: Your Eating and Drinking Habits
Sometimes bloating is caused by something simple and mostly harmless, like eating too much at once, eating too quickly, or even chewing gum. Simple tips like eating and drinking more slowly, chewing gum less frequently, eating smaller meals, and not drinking with a straw could all help if there is no underlying GI issue. Many people also swallow excess air while drinking, so double check your drinking technique, especially if you’re also dealing with frequent burping. Carbonated drinks can also cause bloating because of the extra gas you’re drinking.
#2: You’re Lactose Intolerant
Bloating is a common sign of lactose intolerance, which is incredibly common in adults. If you’ve done a genetic test like Ancestry or 23andme and have access to your raw data, you can find out whether you have the gene for lactase persistence (lactase being the enzyme that digests lactose) by running it through a free tool called Genetic Genie. If you don’t have the lactase persistence gene, lactose intolerance is likely a root cause for you. If you notice bloating after enjoying some cheese, yogurt or ice cream, you’re definitely not alone. Around 75% of the global population is estimated to have some degree of lactose intolerance! Thankfully, lactose and dairy-free foods are widely available, so you may not have to sacrifice the foods you love to avoid dairy. Or you can take a lactose digestant tablet/dairy enzyme pill* or two with meals containing dairy. But be aware that casein intolerance, which is an intolerance to the protein in dairy, is also a thing.
#3: You Might Have a Gluten Sensitivity
Gluten is another common trigger of bloating and other GI issues, both for people with celiac disease as well as people with non-celiac gluten sensitivity. Signs of celiac disease include bloating and gas, abdominal pain, anemia and diarrhea, among others. Some people with gluten sensitivity don’t have celiac disease, but experience similar symptoms. In their case, eliminating gluten can increase their digestive comfort and help avoid bloating and gas. If you do have a positive celiac test, it’s essential to strictly eliminate all sources of gluten to avoid further damage to the intestines, and dairy too for a while as the villi in your small intestine are healing. So I’d recommend getting tested for celiac and if it’s negative, going gluten free for a few weeks then reintroducing gluten to see if your symptoms go away and then return when your reintroduce gluten.
But ideally, if you suspect a food sensitivity or have never checked for this, I recommend a basic elimination diet where you eliminate the most common problematic foods at the same time, as often your gut needs time to heal if you have one or more food triggers. The foods I’d eliminate are gluten, dairy, soy, corn, highly processed foods with tons of ingredients, processed seed oils, added sugar in any form, artificial sweeteners except Stevia, monk fruit extract*, allulose* or erythritol*; caffeine and alcohol, or as many of those as you can handle for 3-4 weeks and then one by one reintroduce foods a couple times a day for 2 days then wait two more days to check for a reaction before reintroducing another food.
#4: You Eat High Fiber Foods Inconsistently
Even if you don’t have any food intolerances, high fiber foods such as legumes (such as beans, lentils and peanuts) or cruciferous vegetables like cabbage, cauliflower and broccoli can cause uncomfortable bloating and gas. By slowly introducing nutritious and high fiber foods like beans and lentils and then including them regularly in your diet, rather than eating a ton of beans in a very occasional bowl of chili, you’re less likely to experience bloating after eating them.
#5: Poor Enzyme Function
Poor enzyme function can cause bloating with certain foods, even healthy ones like raw fruits and vegetables. If you have issues with these foods or see pieces of undigested food in your stool, a general digestive enzyme* may be helpful to take with meals.
#6: You Have Low Bile Flow
If fatty foods cause you bloating and discomfort and you have light colored stool, low bile flow due to poor gallbladder function may be at work. Bile is produced by the liver and stored in the gallbladder. The gallbladder is then responsible for secreting a bolus of bile to the stomach to aid in digestion. When it is not functioning properly and you eat high-fat foods, you may experience other symptoms such as nausea and gas. Other conditions can cause gallbladder dysfunction, including hypothyroidism and fibromyalgia. Other symptoms of gallbladder dysfunction include headaches, problems losing weight, pain in the feet or right shoulder, hormonal imbalances, yellowing skin, and constipation or diarrhea. Natural healing strategies can help improve gallbladder function, including starting your meals with a bitter food to stimulate bile flow like dandelion leaves, which are free in most of our yards, just be sure they’re pesticide free, other bitter greens, lemon zest or beets. Or you could take Swedish bitters before meals or consider a bitter aperitif before dinner like Campari, Aperol, amari, pastis or ouzo. If you’ve had your gallbladder removed or have been diagnosed with low bile flow, you may want to take Ox Bile supplement* with fatty meals. I’ve linked to good brands of these supplements or you can also look for them in my Fullscript dispensary to compare prices.
#7: You May Be in a Fight or Flight State of Stress While Eating
Bloating may start during a period of high stress, as eating in a sympathetic, or fight or flight state, rather than a parasympathetic, or rest and digest state, will leave food stagnating in your stomach. If you find yourself visibly stressed at meal time, stopping to take 4 or 5, 5-5-7 breaths, which is 5 seconds in, 5 seconds hold and 7 seconds exhale, can help trick your body into a parasympathetic state so that you can digest better. Then using meditation, exercise, yoga, therapy or coaching to manage your stress and working to eliminate the underlying cause is a longer-term solution.
#8: Too Many Sugar-Free Foods
Some sugar alcohols, common in many sugar-free or “diet-friendly” sweets such as light ice cream and sugar-free candy and gum, are also a major cause of bloating for many people. The bacteria living in the large intestine ferment sugar alcohols like xylitol, sorbitol and mannitol quickly and produce large amounts of excess gas. Although sugar-free gum and ice cream may sound appealing, you may be causing bloating and other digestion issues by choosing these foods. Erythritol*, Stevia, monk fruit extract*, and allulose* are safer choices for alternative sweeteners that shouldn’t cause you GI distress, except perhaps nausea for some people with erythritol.
If all these solutions have been tried and failed, you may have a gut infection from an overgrowth of dysbiotic bacteria, candida or other fungi. Officially, this may mean a diagnosis of SIBO or small intestine bacterial overgrowth, which is the root cause of most cases of IBS. Some GI doctors will test for SIBO with a hydrogen/methane and the newest addition, hydrogen sulfide breath test, which are taken after eating a low fiber diet for 24 hours, or after an overnight fast. I don’t use them with my clients as they’re not terribly reliable and don’t tell you anything about fungal overgrowths, which most GI docs don’t believe in, parasites, or other potential causes of bloating. Rather, I prefer the GI Map* or the Organic Acids Test, depending on my clients’ other symptoms, history of antibiotic and other medication use and past testing.
If your GI doc diagnoses you with SIBO, you may be prescribed rifaximin or Xifaxin, which is an antibiotic that only impacts your digestive tract, but I think it’s wiser to use herbal antimicrobials because they also reduce fungal overgrowths, and just taking antibiotics will often leave you overgrown in fungi like candida and cause more long-term issues.
The primary short-term diet change recommended for SIBO that is solely bacterial in nature is a low FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides and polyols) diet. This diet involves limiting high-FODMAP foods for a period of time and monitoring for a decrease in symptoms. Some examples of high-FODMAP foods include wheat, milk, onions, garlic, cauliflower, cabbage, artichokes, beans, apples, pears and watermelon but there’s a whole long list you can find by Googling it. Removing these foods will deplete the bacteria in your gut, so it’s important not to do this long term, but rather once your symptoms are gone for a couple weeks, to start reintroducing foods by groups and checking for a reaction to a given group. On a longer-term basis, you may need to limit quantities of these foods if you find yourself with recurrent SIBO. You’ll also need to determine the root cause of your SIBO, which if it isn’t from dysfunction of one of your digestive organs as I’ve already discussed, is likely related to issues with peristalsis, or intestinal motility in the small intestine, leading to stagnation of food, which causes bacteria to overgrow. That can be from vagus nerve dysfunction, which can stem from a stressful event or a brain injury or could be from low serotonin, which can arise from a poor diet, lack of exercise, a lack of exposure to natural light, chronic stress or insufficient protein intake or digestion.
Taking probiotics may also be helpful with bloating and SIBO, as they can help restore a healthy gut microbiome. However, it can take time for the microbiome to rebalance, so be patient when starting a probiotic and don’t expect immediate results. One with evidence to help with SIBO is Saccaromyces Boulardii*, which is a beneficial yeast. Another home remedy to try for consistent bloating is peppermint oil*, which has been shown to help IBS patients with bloating. You can take one gel cap 15 minutes before meals. It used to be helpful to me but does sometimes lead to a pepperminty stomach sensation and burps.
#10: Candida Overgrowth
Digestive system candida or fungal overgrowth, also known as SIFO, or small intestinal fungal overgrowth, is one of the most common conditions I find in my clients and is best diagnosed using the Organic Acids Test. Candida is a yeast that is present in all healthy people but can grow unchecked when the bacterial balance of the microbiome is off, usually due to antibiotic usage or a high sugar diet. Other symptoms of a candida overgrowth include sugar cravings, brain fog, rashes, a white tongue and vaginal yeast infections in women. Treatment for SIFO is trickier and can take longer than SIBO treatment, as it can take some time to restore the microbiome’s balance and bring the candida levels down, and usually requires removing added sugar and simple carbohydrates for a while, as well as other foods that stimulate candida growth.
#11: You May Have Low Stomach Acid
Low stomach acid levels can also be a cause of bloating. When you have insufficient stomach acid, it makes it hard to digest proteins, so proteins may not be completely broken down into amino acids. Stomach acid is also protective against pathogenic bacteria, so you are more susceptible to overgrowths of bacteria like E Coli, that thrive in a neutral pH environment, and are often at the root of SIBO.
We tend to have decreased stomach acid as we age and when we’re under stress. Taking a small dose of Betaine HCl*, which is just hydrochloric acid or stomach acid, with meals can help not just increase your acid and help with protein digestion and sterilizing your food, but will also help stimulate bile and enzyme flow, so this is a good thing to try if you’re middle aged or older, under stress, or are experiencing these symptoms. Another sign of potentially low stomach acid is GERD or acid reflux, as the pH of the stomach regulates the opening of the lower esophageal sphincter and an insufficiently acidic stomach environment can lead to a sphincter left open for acid to go up, which can cause heartburn, a warmth in your chest or a subtle cough.
#12: H. Pylori
A common bacterial infection that also causes low stomach acid is H. pylori or Helicobacter pylori. It’s a bacteria present in many people’s gut microbiomes that can cause gastric inflammation, GERD, insomnia, nausea, and for some virulent strains, ulcers and stomach cancer. I’ve seen it in many of my clients, even at levels that are not considered abnormal, and when I educate them on how to eliminate it in a safe way using mastic gum (and not triple antibiotic therapy as a GI doctor might prescribe) they always feel better.
Overall, bloating is an unpleasant and avoidable experience that I personally put up with for way too long. It’s not normal to have a food baby after eating unless you just ate an entire 16-inch pizza and it’s definitely not normal to wake up bloated. I can’t tell you how much better I feel and look now that I don’t regularly bloat after eating. So if you find that you have consistent, painful bloating and simple behavior- and diet-based interventions haven’t helped or feel too overwhelming to sort through, please set up a free, 30-minute breakthrough session or a one-hour consultation and we can talk about the best next steps for you to solve your bloating problem!
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