Bloating - All You Need to Know

Katie Wheaton Dip NT, mBANT CNHC

Stomach bloated or feeling gassy? Read on to find out more about this common digestive symptom and how to beat the bloat.

Why do I feel bloated all the time?

Bloating is an uncomfortable and tight feeling of fullness in the stomach or abdomen, which may also be accompanied by abdominal pain, gas and flatulence. These symptoms can be triggered by many factors, but a bloated stomach is a clear sign that your digestive health is not as good as it might be.  Many people put up with uncomfortable bloating on a regular basis, assuming it is just ‘part of life’. In this article however, we will look at both common causes and also some possible simple solutions.

Gas, bloating and possible causes.

Gas is produced as a normal part of the digestive process, and bloating is essentially a build-up of this gas.  But where does it come from?  Well, our microbiome (the name for the populations of bacteria living in our gut) is responsible for breaking down and digesting our food, and gas is a natural byproduct of this process. We actually excrete up to 1 and half pints of hydrogen, methane and carbon dioxide each day1

But if these gases are produced in greater than normal amounts, we may suffer symptoms, such as a full feeling in the stomach, or a bloated tummy. These can be signs that the digestive process is not functioning in an optimal manner. There can be a number of different causes, some of which may respond to simple diet and lifestyle changes, whereas others may need medical investigation/intervention.

Lifestyle related causes can include: an unhealthy diet (low fibre, high sugar, low nutrient value), stress, improper chewing or eating too fast and swallowing lots of air (known medically as ‘Aerophagia’).

‘Physiological’ causes include: an imbalance in friendly bacteria (dysbiosis), food intolerances, coeliac disease, low stomach acid, intestinal infection (e.g. parasite); intestinal infection (parasites), hormonal imbalances, IBS, constipationand small intestinal bacterial overgrowth (SIBO).

Let’s take a closer look at some of these physiological causes.

Woman holding her tummy

Dysbiosis

The gut, particularly the large intestine, is colonised by trillions of bacteria. These bacteria carry out many essential tasks such as helping us to break down food, extracting nutrients, and supporting our immune systems.  These beneficial and helpful bacteria are known as probiotics. They exist alongside other less friendly species, which can become opportunistic and pathogenic when allowed to over-grow.  

The microbiome is a delicate balance between beneficial and pathogenic bacteria. When this balance is maintained, and our internal ‘ecosystem’ is healthy, our microbiome keeps our digestive processes well regulated and running smoothly. 

When this internal ecosystem becomes imbalanced, due to any number of possible factors, including: an unhealthy diet, antibiotics, high sugar, and even chronic stress - numbers of the good probiotic bacteria in the gut diminish. This imbalance in gut flora is known as dysbiosis.  A reduction in certain species of probiotics may lead to a more sensitive gut, resulting in more gas and bloating for some people2. Equally, an overgrowth of certain types of pathogenic strains of bacteria in the gut microbiome, can also lead to persistent gas and a bloated belly.

Low stomach acid

Gas and bloating that is concentrated higher up in the abdomen could be a sign of low stomach acid. Stomach acid (or, hydrochloric acid) is vital for proper digestion of food, as it triggers the activation of an enzyme, called pepsin, that breaks down protein foods in the stomach. Sufficient levels of stomach acid are also needed to trigger the release of bile and pancreatic enzymes in to the upper small intestine. When stomach acid levels are reduced we can struggle to digest foods, which can cause upper abdominal bloating.

Levels of stomach acid decrease naturally with age. Additionally certain medications reduce its production, as does chronic stress and improper chewing. Most health food shops sell supplements of hydrochloric acid (Hcl), which can be extremely helpful for many people that experience bloating and discomfort after eating. Start with a low dose, and you can build up over time, if required.

Small Intestinal Bacterial Overgrowth (SIBO)

A reduction in stomach acid (discussed above) can, in some cases, lead to an overgrowth of colonic bacteria living higher up in the digestive tract than is usual This condition is known as SIBO – which stands for Small Intestinal Bacterial Overgrowth. SIBO manifests when bacteria from the colon migrate upwards in to the small intestine, which interferes with digestion3. It results in the fermentation of carbohydrates in the small intestine, leading to an increase in hydrogen (and sometimes methane) gas production. This increase in gas causes upper abdominal bloating, and sometimes other symptoms such as nausea and pain in the upper abdomen (around the stomach).  Health professionals can read more about this condition in the Professionals site: Small Intestinal Bacterial Overgrowth

Hormonal imbalances

Imbalances in the female sex hormones oestrogen and progesterone, as well as high levels of cortisol (the stress hormone), may lead to abdominal bloating in some women. An increase in symptoms of bloating and gas around the time of menstruation and in early menopause, indicates that hormone changes certainly play a part in our gut health. However, more research is needed to fully understand the link4.

What is understood however, is that our microbiome is extremely sensitive to hormonal changes. The composition of both our gut microbiome, and vaginal microbiome alter dependent on both sex hormones, and even stress hormones. The impact of these changes becomes obvious when looking at the low incidence of thrush in menopausal women. The candida yeast that causes vaginal thrush, needs oestrogen to flourish, hence thrush is rare in post-menopausal women (unless they are taking HRT).

Women that suffer with abdominal bloating due to hormonal issues may consider taking a high quality, well researched probiotic to help balance their gut flora. Equally, women that suffer from intimate health infections due to changes in hormones, might do well to consider a specific probiotic to balance the vaginal flora.

If lower abdominal bloating occurs alongside irregular vaginal bleeding, then it is important to seek medical advice. Bleeding between periods (or bleeding post menopausally) with lower abdominal bloating, can be a symptom of common conditions such as: endometriosis, fibroids, or ovarian cysts, and should be investigated by a G.P. 

Once more serious medical conditions have been ruled out, women looking to ease symptoms related to hormonal fluctuations might consider incorporating ways to balance their hormones naturally. Optimal hormone balance can be supported by some simple diet and lifestyle changes. For example, consuming enough fibre supports the excretion of excess oestrogen and staying hydrated throughout the day can discourage excess water retention and support liver and kidney function.

For more advice about how to manage hormonal symptoms naturally, see Kathy's article about the best Supplements for Women

When should I be worried about bloating?

Bloating is very ubiquitous these days and so it is important to be familiar with environmental influences that may be contributing to your bloated stomach as well as being mindful of warning signs and symptoms to look out for.  Your bloating may be sporadic, cyclical or ongoing, and could be manageable with some simple diet and lifestyle changes. 

Warning signs to be aware of which may need further investigating by a doctor include symptoms such as abdominal pain, rapid weight loss, nausea, vomiting, fever, blood in your stool. Some common causes for such G.I symptoms include: constipation, stress, IBS, poor eating practices, and food intolerances (such as to lactose or gluten).  In some cases however, the symptoms may be due to a more serious underlying medical condition. Conditions including: gastroesophageal reflux disease (GERD), diverticulitis, gastroparesis, or inflammatory bowel disease (IBD) can all cause wide ranging gastric symptoms. For this reason, frequent or ongoing symptoms should always be investigated by a medical doctor.

How to prevent bloating?

The first step in managing bloating is to identify any dietary or lifestyle triggers and try to address the cause:

Rule out food intolerance

Elimination diets can be very useful in ascertaining which foods are exacerbating gas and bloating. By keeping a food diary and tuning in to when your symptoms appear worse, you can identify which foods you may be sensitive to. Common food intolerances include: wheat, other gluten grains and dairy.

Diet

Even healthy diets can cause bloating, so it is important to look closely at what you are eating. If you have recently changed your diet, for example to include more plant based foods, these alterations may cause some GI symptoms. Plant foods are generally high in fibre. This is excellent for creating a healthy, diverse microbiome but it can cause bloating and gas in some individuals initially.  Fruits, vegetables, pulses and legumes also all provide good amounts of prebiotics, which feed our gut bacteria and are essential to a thriving microbiome5. However, your gut bacteria may just need time to readjust to your new diet and adapt to this new way of eating.

Don’t be alarmed if you suffer with bloating after increasing the amount of plant-based foods in your daily diet! This symptom should be short-lived, however, if the bloating continues, it could be that your body is struggling with certain types of carbohydrates. Many people with IBS for example, do not tolerate ‘fermentable’ carbohydrates well. If this is the case, then these types of carbohydrates can be avoided, by following a specific diet, called the FODMAP diet6.

Probiotics

There is now evidence to support the use of well-researched probiotics in modifying your microbiome and reducing dysbiosis.6 Choose a product that has research behind the strains used that are relevant to your specific health condition or symptoms. For example, certain strains of probiotic (including: Lactobacillus acidophilus Rosell-52) have been researched to support digestion of foods that can cause a bloated stomach, such as lactose, and foods high in starch. If you have identified certain foods as a trigger for your bloating, then it could be helpful to try a probiotic that has been researched to help with the breakdown of these common ‘trigger’ foods. Alternatively, if your bloating is linked to constipation, you would do well to look at probiotic strains, such as Bifidobacterium Lactis BB-12, which have research to prove that they can help with this condition.

Stress management

Eating food whilst under stress, or in ‘fight or flight’ mode, compromises our digestion and ultimately leads to symptoms such as a bloated belly and gas3.  In order to support and regulate our digestive function, it is important that we address any chronic ‘stressors’ in our life. Whilst we are designed to be able to cope with short periods of acute stress, long term, chronic, stress is known to reduce digestive function, whilst also having a negative impact on immunity. When we are stressed blood flow is reduced to the intestines, and energy is diverted away from the gut, to our large skeletal muscles. If possible, we should avoid eating heavy meals when we are feeling stressed, as we do not digest them well, leading to bloating.

Practicing ‘mindful eating’ can help to reduce stress, and boost digestion.

Mindful eating

Mindful eating is an act of self-care that supports better digestion, and therefore reduces symptoms such as bloating and gas. Eating ‘mindfully’ allows time for the proper digestion of meals. There are many attributes to this practice, which include:

  1. Not eating ‘on the go’ -Taking time to stop and appreciate what you are eating puts your body into a relaxed parasympathetic state. When our nervous system is relaxed we are better able to digest foods.
  2. Chewing well - Digestion starts in the mouth, and chewing activates digestive enzymes that kick start optimal digestion of food.
  3. Cultivating a mindful kitchen – Making better food choices, and eating foods that are nutritionally balanced enables us to support our gut health, and overall health.

Cut out sugar and processed carbohydrates

 A diet high in refined carbohydrates, processed grains, and sugar contributes to dysbiosis in the gut, which can lead to increased gas production.  Even natural fruit sugars can contribute here, so try to only eat fruits that are naturally lower in fructose. These include: berries, citrus, apples and pears. Lower sugar fruits, such as these, are better tolerated than high sugar fruits such as mango, pineapple, orange, melon and dried fruits.  Cooked fruits are also lower in fructose, making them a healthier alternative too.

For more information take a look at natural remedies for bloating or if you are a healthcare practitioner you can find more information on specific probiotic strains and the clinical research behind them over on the probiotics database.

References

  1. Lacy, B, E; et al. (2011) ’Pathophysiology, Evaluation, and Treatment of Bloating, Hope, Hype, or Hot Air?’ Gastroenterology & Hepatology, 7(11): pp. 729-739
  2. Lacy, B, E; et al. (2011) ’Pathophysiology, Evaluation, and Treatment of Bloating, Hope, Hype, or Hot Air?’ Gastroenterology & Hepatology, 7(11): pp. 729-739
  3. Ghoshal et al. (2017). Small Intestinal Bacterial Overgrowth and Irritable Bowel Syndrome: A Bridge between Functional Organic Dichotomy. Gut and Liver, 11(2): pp. 196-208.
  4. Heitkemper, M, M et al, (2009) ’Do Fluctuations in Ovarian Hormones Affect Gastrointestinal Symptoms in Women With Irritable Bowel Syndrome?’ Gender Medicine, 6:(2) pp. 152-167
  5. Tomova, A, et al. (2019) ‘The Effects of Vegetarian and Vegan Diets on Gut Microbiota,’ Frontiers in Nutrition, 6: p. 47.
  6. Nanayakkara, W, S; (2016) ’Efficacy of the low FODMAP diet for treating irritable bowel syndrome: the evidence to date,’ Clin Exp Gastroenterology, 9: pp. 131-142.