Bloating is one of the most common complaints I hear in my office, and the good news is that it can almost always be treated once we determine the underlying cause. Frequent bloating can be uncomfortable, but for many women it affects their confidence and how they feel about their body.
Here are the most common things I look for when a patient complains of being bloated:
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- Intestinal proliferation of yeasts
- Food intolerances
- Gluten sensitivity or celiac disease
- Insulin resistance
- Bad food combinations
- Irregular meal times
- Deficiency in digestive enzymes (including lactose intolerance)
- Other causes of dysbiosis – small intestinal bacterial overgrowth or parasites
Some of these factors can be tested for – food intolerance, gluten sensitivity, celiac disease, insulin resistance, and in other cases we treat based on symptoms and history.
- Intestinal proliferation of yeasts
Intestinal yeast overgrowth is extremely common, and is usually caused by frequent or long-term antibiotic use. The most common scenarios are – lots of antibiotics as a child for ear or tonsil infections, use of long-term antibiotics for acne (tetracycline or minocin), or antibiotics for frequent infections of the urinary tract. Antibiotics modify your digestive flora, allowing yeast, which is an opportunistic organism, to take over.
When there is too much yeast in the body, you will be bloated. This is because yeast ferments food, causing flatulence. Some people will also experience strong cravings sugar or carbohydrates, tendencies to binge eating, brain fog, fatigue, vaginal infections, and possibly fungal skin infections.
The good news is that this can be treated by rebalancing your gut flora with a yeast cleanse: a sugar-free diet, taking supplements to kill yeast, and replenishing gut flora with probiotics.
- Food intolerances
Food intolerance is different from food allergy in that it is a delayed reaction to a food, rather than an immediate response such as itching, swelling or anaphylaxis. Food intolerances cause immune stress and inflammation, which can also irritate the intestinal tract causing bloating. The most common food intolerances are dairy products, eggs, certain fruits (banana, citrus fruits, pineapple in particular), sometimes oilseeds (almonds and peanuts are the most common), wheat, gluten, corn or others.
Food intolerances can be tested with a blood test to accurately identify them. 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 health problems, such as skin conditions, digestive disorders, and lack of energy. Bloating will improve within 4 to 6 weeks after eliminating all aggravating foods.
- Gluten sensitivity or celiac disease
Gluten intolerance and celiac disease (a more serious form of gluten intolerance) are clearly on the rise, mainly due to the big changes in wheat over the last 50 years, and also our high consumption of cereal products. Many people who have gluten sensitivity complain of bloating, with or without flatulence, constipation or diarrhea.
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There are gluten intolerance and celiac disease tests that don’t work in most cases, although many people test negative they feel better without gluten. Another marker of gluten intolerance is someone who has low vitamin B12 levels without being vegan or vegetarian.
If you suspect gluten may be a problem for you, a starting point is to do proper blood tests to confirm it, or to begin a 5-week strictly gluten-free trial. After 5 weeks strictly gluten-free, it is important to reintegrate it into your diet to clarify your reaction. There are so many good alternatives to gluten: rice, quinoa, millet, squash and sweet potato to name a few.
- Insulin resistance
Insulin is a hormone that is released by the pancreas in response to glucose (sugar) in the blood. Insulin levels peak after a meal. When insulin is released in a non-insulin resistant (healthy) person, it trains the body’s cells to use glucose and fats from the bloodstream. Insulin resistance occurs when cells do not respond, or react weakly, to the insulin signal. This results in even greater secretion of insulin in the body, and ultimately the creation of toxic levels of glucose in the blood, known as hyperglycemia.
Common symptoms of insulin resistance include: weight gain (often rapid within a period of 2-3 years); intense cravings for carbohydrates and sweets; increased appetite; and feeling tired and bloated after eating.
If you have had 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 can be treated and is reversible with dietary changes and exercise. The key is to reduce your consumption of sugar and foods rich in carbohydrates, with more emphasis on vegetables, proteins, fiber and healthy fats; and also to start exercising regularly.
Provisions
- Bad food combinations
Did you know that the types of foods you eat at the same time can affect how they are digested? Some people are much more sensitive than others. When foods are poorly combined, it slows down the digestive process, and can lead to bloating and indigestion.
The biggest rule of food combination is to eat your fruit alone, not by combining it with other foods, especially protein. For example, never eat melon or fruit salad directly after a fish dinner!
Other rules of food combination are not to combine proteins with carbohydrates. It becomes difficult and almost impossible with a vegetarian diet, but for those of you who eat meat, poultry or fish, try separating your starches and proteins and see how you feel. You may notice that you have much easier digestion. For example, eat a breakfast of fruit; have a mid-morning nut snack; eat a lunch of meat, poultry or fish with lots of vegetables; and then have a higher carbohydrate dinner like a sweet potato cooked with vegetables.
- Irregular meal times
Another common cause of bloating is simply eating at irregular times. When you go long hours without eating, or eat large amounts of food at bedtime, your digestion (and metabolism) will suffer. For example, skipping breakfast and then eating a large meal will almost always cause bloating –this is shocking to your digestive system, and it also causes a sharp increase in blood sugar and insulin as described above. You will find yourself bloated and tired, looking for caffeine to stay productive in the afternoon.
Our bodies function better with regular meal times, and our digestive systems also function better. Try to eat breakfast within an hour of waking up, lunch at midday, and dinner before 7 p.m. Include mid-morning and afternoon snacks if necessary.
- Deficiency in digestive enzymes (including lactose intolerance)
Digestive enzymes are produced by the pancreas to promote 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 cannot produce enough digestive enzymes, leading to bloating, pain, indigestion and irregular bowel movements. Digestive enzyme deficiency can be caused by: 1) food intolerances causing mild inflammation in the intestinal tract; 2) an overgrowth of bacteria/yeasts/parasites; 3) low stomach acid; 4) chronic stress; and 5) aging.
Lactose intolerance is also a form of enzyme deficiency, when there is not enough lactase to break down lactose, it leads to poor digestion of dairy products. Lactose intolerance can be tested with a breath test, or with a 2-week dairy-free trial, followed by reintroduction to watch what happens.
A temporary solution to this problem is to take digestive enzymes with your meals, and avoid dairy products if you have lactose intolerance. However, it is important to get to the root of the problem, and address imbalances to encourage the body to produce enough enzymes on its own.
- Other causes of dysbiosis – small intestinal bacterial overgrowth or parasites
It is very common to have an imbalance of organisms in the intestinal tract, and in addition to yeast as discussed above, many people also have pathogenic bacteria and even parasites in their digestive tract. It’s likely that if you’ve traveled recently (especially to Asia, Africa, or South America), but even eating out you can pick up parasites. With this type of digestive imbalance, there is also usually diarrhea, weight loss and fatigue.
There are precise bacterial overgrowth and parasite tests with a complete stool analysis (those from American laboratories are the best) to find precisely what is growing. Treatment is then much simpler once the microorganism(s) has been identified.
Overview
In conclusion, there are many causes of bloating that a naturopath looks for, and it is usually a problem that can be treated. It’s not normal to need to loosen your pants every night after dinner, or to be too heavy at the end of the day to go out and hang out with people. I hope this brief article has given you a starting point for improving your digestive health!
