The truth about Bloating
food baby or functional gut issues?
Bloating.. ugh… After 20 years practising as a dietitian, I think this might be the most common gut complaint I’ve encountered.
Although everyone experiences bloating differently, it generally means a swollen, uncomfortable stomach, associated with a painful ‘over-full’ sensation. Strangely, there are some people who get the discomfort without the physical distension, and others who experience the ‘food baby’ without any pain or gut upset.
But before we delve deeper, I want to talk a bit about what’s normal and what’s not.
Normal = having a stomach that protrudes (a bit or a lot), and might necessitate undoing your top button after a big meal or toward the end of the day. This is just physiology. It might depend on your body shape, your posture and how much you ate. I’m going to get a bit shouty here and say there are TOO MANY PICTURES on social media of thin women with slightly protruding stomachs, complaining about their ‘boating issues’.
Abnormal = troublesome attacks associated with marked (and often rapid) increase in stomach size, pain and / or feelings of excessive fullness. Problematic bloating is often associated with altered bowel habit, fatigue, anxiety and poor body image. So it’s not just about the need for elasticised granny-pants – this type of bloating can be miserable and interfere with day-to-day life.
What causes bloating?
Okay, let’s get down to it. Predictably, bloating doesn’t have just one cause, or one simple solution.
The most obvious potential cause of bloating is a physical build-up of food, fluid and gas, pressing on the gut walls and ‘inflating’ our intestines. This might be from:
Physical triggers
Large meals (particularly if eaten quickly)
Swallowing air (which happens when we eat and drinking too fast, chew gum, drink fizzy drinks and talk while eating)
Tight pants put more pressure on our abdomen, so - duh - they’re going to make you feel more bloated
A lot of people find that sometimes even just a big glass of water, if drunk quickly, can sometimes bring on a bloat
gas producing foods (Big wind energy)
Eating a diet rich in windy, high FODMAP foods like legumes, onion/garlic, apples, juices, dried fruit, bread and pasta can increase bloating
Going to town on low carb ‘diet food’ like bars, shakes and gums containing FODMAP sugars (eg. sorbitol, mannitol and xylitol) can do it too
Similarly, certain types of dietary fibre like wheat bran, barley and inulin are highly fermentable = hello bloat baby
If gas is the reason for your bloating, once it gets pushed along to the other end and you have a good, old fashioned toot (or 10), things will soon be back to normal. This kind of bloating is often well managed with dietary and lifestyle measures, under the care of a good dietitian.
Image source: Unsplash, Charles Deluvio
Other Food triggers
Processed, sugary and fatty foods are often blamed for bloating, and there are a number of reasons why they may be problematic.
·Rich, high fat foods take a lot of work to digest, and can slow our gut transit time, exacerbating distension and discomfort.
Sugary foods such as soft drinks, baked goods, chocolate and lollies can be problematic in large doses. This may be in part due to an overload of fructose, which, if not well absorbed, will then be rapidly fermented in the large bowel, resulting in gas and distension.
Processed, highly flavoured foods like this usually come in a package with natural and added flavours, colours and preservatives. In some food sensitive individuals, these dietary compounds can seem to affect the tone of smooth muscle and sensitivity of the gut nervous system.
Bloating due to functional issues
I’m talking here about Irritable Bowel Syndrome (IBS), Functional Constipation and Functional Bloating. These often involve oversensitivity of the gut, and disruption of the brain-gut axis, causing altered motility (stop-start / too fast / too slow). Functional gut issues can also cause abnormal tone of key muscles like the diaphragm and the smooth muscle that lines our gut.
In a well behaved gut, our diaphragm is supple and accommodating. When needed, it can ‘tent up’ to make more room inside our abdominal cavity. Similarly, our abdominal muscle wall will usually ‘tighten up’ in response to greater pressure – keeping us relatively sucked in.
Image credit: simplifiedsciencepublishing.com
So you can imagine what happens when these normal responses and reflexes malfunction: A rigid diaphragm, and a relaxed abdominal wall, means there’s really only one way for the pressure to go. And that’s OUT.
Some added extra bloating triggers for those with functional gut disorders can include:
Hormonal fluctuations (which influence the smooth muscles in our gut system)
Stress (through its strong effect on the brain-gut axis)
Constipation (causing more bulk and pressure)
Weak OR overly rigid pelvic floor muscles
Altered gut flora
Another potential cause of excessive bloating is when your gut bacteria are out of whack. It might mean an imbalance, too many of some types, or even that gut bacteria have migrated up into the small intestine (where they have a little ferment party every time we eat).
NB. Don’t believe everything you read online about SIBO. It’s not as common OR as easy to diagnose as some will have you believe. If you’re bloating immediately after eating or drinking sugary or starchy foods, it’s time to see your gastroenterologist, and discuss testing and treatment in further detail.
9 things you can do to reduce bloating
Firstly (of course) I’m going to tell you that it’s vital not to self-diagnose. Discuss any symptoms with your doctor, who can arrange testing and referrals as needed, and rule out conditions like undiagnosed coeliac disease, or rare but sinister causes of bloating like ovarian cancer.
Try slowly down and eating more mindfully, chewing each mouthful at least 30 times. This tells your gut that food is on the way, and gets it primed for digestion and absorption. It also means you’re a lot less likely to over-eat, putting too much pressure on those poor, over-stimulated enteric stretch receptors.
Smaller, more frequent meals (breakfast, snack, lunch, snack, dinner, snack) is a whole lot better idea than hours on end of fasting, followed by big meals. Intermittent fasting might be very hot right now, but it is no friend of the bloat-prone.
Go easy on fatty foods and highly processed sugary foods – don’t ban them, but eat them slowly and mindfully, and watch the portion size.
If constipation is an issue, focus on treating and managing this, with diet, fibre supplements and adequate hydration.
Seek the help of an experienced dietitian, who can offer individualised dietary assessment, support, guidance and practical suggestions that suit your lifestyle and food preferences.
Avoid restrictive clothing like skinny jeans, Spanx or tight yoga pants.
Work on stress management – anything that helps you manage stress and anxiety, should help your gut function and feel better. Particularly helpful can be deep, diaphragmatic breathing (try doing this for a few minutes before meals). Seek professional help, if you need it, via a psychologist or counsellor.
Find a specialist physiotherapist, who can teach you diaphramatic breathing breathing exercises, assess your pelvic floor and abdominal muscle strength and functioning, and prescribe treatments to help.
And there you have it. Just as you guessed, bloating is about a lot more than food intolerance.
If you need more individualised help and support with your diet, drop me a line.