Feeling like a Pufferfish: The Dreaded Stomach Bloat

"These jeans fit last week, and now I have to lay on the bed and do acrobatics just to button them up." We've all been. But the sad truth is, abdominal bloating does not only occur after your Thanksgiving meal or your weekend getaway with the girls. 1 in 10 Americans is bloated on a daily basis. Yes, that could mean 24/7 feeling like a pufferfish. What is bloating? What causes bloating, and why is it so uncomfortable? And what can you do to stop it? I'm here to help answer these common questions.

Let's start with what is abdominal bloating and why it is so uncomfortable?

By definition, abdominal bloating is the sensation of distention, tightness, and fullness in the abdomen. Bloating is usually due to excess gas or water retention located somewhere along the digestive tract.  It often is accompanied by excess belching and flatulence, pain, discomfort, and physical distention of the belly (i.e., why your clothes may feel tight). This distention is why bloating can be so uncomfortable.

What causes bloating?

Unfortunately, the answer to this is not that simple and can take a little investigative work to figure out. Some of the typical culprits are listed below.

Diet and how you eat, or as I like to call it food hygiene, are of the top causes of abdominal bloating.

• Overeating and eating too fast. It can take up to 20 minutes for satiety signals to reach the brain. That is an additional 20 minutes of over-consumption of food, especially if you are eating fast.
• Inability to break down fats. This is particularly true for individuals who have liver problems, gallbladder problems (including gallstones), or has had their gallbladder removed. However, don't count this out if you have not been diagnosed with any of these conditions.
• Eating gas-producing foods such as beans and lentils, whole grains, or high fiber products. I know fiber always gets a good reputation, however, if you are eating a lot of fiber-rich foods and not consuming adequate amounts of water this can lead to excess gas, abdominal distention, and even constipation.
• Eating gas-producing vegetables. Uncooked vegetables, especially cruciferous vegetables (broccoli, cauliflower, cabbage, Brussels sprouts, kale, collard greens) are very gas producing. Uncooked greens, like spinach and kale, and onions and garlic can also cause excess gas and bloating. 
• SUGAR. Artificial sweeteners, including sorbitol, and fructose a natural sugar added to many store bought products are challenging to digest and can create gas.
• High salt diet. Salt causes water retention.
• Dairy. Many people have difficulty digesting lactose and milk sugars and do not know it. People believe that since they were fine as children, there is no way dairy is the reason for bloat, but this is far from the truth. Dairy intolerance is on the rise and a common cause for abdominal distention, excess gas.
• Gluten. I know it's sad, but Grandma's Italian Sunday dinner (meat sauce with pasta) can be the reason for your bloat. Gluten intolerance is classified as celiac disease, in which gluten causes severe damage to the intestinal lining. This can cause bloating, pain, and a vast array of other symptoms. Other individuals may have nonceliac gluten sensitivity; this does not cause severe damage to the intestinal lining but can cause bloating, excess gas, abdominal pain, and distention.
• Drinking carbonated drinks and gulping too much air (this occurs while chewing gum or drinking).

There are also non-dietary causes of bloating.

• Gastrointestinal conditions: constipation, irritable bowel syndrome (IBS), inflammatory bowel disease (Crohn's disease, or ulcerative colitis).
• Liver and gallbladder issues.
• Imbalances of gut bacteria. Certain gut bacteria are responsible for breaking down different foods; without these essential bacteria, foods are not broken down correctly and bloating emerges. In additional, overgrowth of unwanted or "bad bacteria," sometimes referred to as SIBO (small intestinal bacterial overgrowth) can lead to excess bloating.
• Menstrual cycle and PMS.
• Medications, including birth control. Many birth controls can cause water retention. It is essential to work with your doctor to find the right birth control for you. If one brand is causing unwanted symptoms, try another.
• Hormonal imbalances. Hormonal imbalances can also lead to water retention. 

What can be done?

First and foremost, it's critical to determine what is causing the bloating. Sometimes it can be simple to figure out, for example, every time you eat kale you bloat, but other times it's not that easy and requires a little investigative work and the help of a physician.

You can start by changing your diet.
* Rule off thumb- eat till you are 80% full. 

* Identify foods in your diet that are causing abdominal bloating and eliminate them. This can be any variation of the foods mentioned above or potentially another offenders. This elimination does not have to be a permanent avoidance if the foods are causing bloating due to imbalances in gut bacteria, or excessive reactivity caused by inflammation. 

* Limit whole grains and high fiber foods. If you are wanting to increase fiber, do so slowly and make sure you are consuming an adequate amount of water. 

* Avoid processed foods, excess sugar, excess salt, and carbonated beverages. 

* If gluten is suspected, eliminate gluten. 

Other measures:
* Determine if you have any food allergies or food sensitivities. This can be done via blood test ordered at our office by one of the physicians.

* Determine if you have an underlying condition, intestinal bacterial imbalances, or hormonal imbalances. In our office, the physicians will go in-depth about your medical history and symptoms, perform a thorough physical exam, and may order blood tests to determine what is causing your abdominal bloating and treat accordingly.

* If it is found that you are having trouble breaking down certain foods, supplementation with enzymes may help. 

* Stay active. Exercising regularly helps the digestive system work at its best. 

* Try drinking ginger tea, peppermint tea, or chamomile tea to help reduce symptoms 


Important Disclaimer: The information provided on this site is intended for your general knowledge only; it is NOT meant to substitute professional medical advice or treatment for specific medical conditions. You should NOT use this information to diagnose or treat a health problem/disease without consulting with a qualified healthcare provider.

Author

Dr. Pamela Santapaola Dr. Pamela Santapaola (AKA Dr. Pam) is a licensed naturopathic physician in the state of Connecticut and co-owner of Healing Duo Integrative Family Medical Practice. Dr. Pam has a passion for educating, whether it be through her writings or in her office in a one-to-one setting. She is an advocate of making small lifestyle changes that can make a big impact in the future. Her goal is to enlighten individuals about holistic medicine and empower them to make the changes necessary to live a healthier life. As her saying goes, "It’s time for you to start feeling like your best self.”