Uncovering the root cause of your bloating can be really frustrating - especially when you’re already eating well and are avoiding your ‘guilty pleasures’. Maybe you’ve even gone on a juice cleanse or elimination diet (and you even take a probiotic!), but your gut is still being problematic … what gives?
Studies show that IBS affects about 25% of the population - I believe that this number is much higher. Most of the clients who walk through my door have some digestive issue and there’s never one answer that can help them all (this is why I love practicing functional medicine nutrition - it’s truly the best form of individualized healthcare being practiced today).
Here are the most common issues that I see contributing to bloating and other digestive issues - Although I have separated them into two main groups: nutritional culprits and metabolic culprits, the story is always more complicated as the two are intertwined. Either way, I hope you enjoy and find it helpful in alleviating some of your digestive woes.
Hidden food sensitivities
Food sensitivities are caused by a delayed reaction to specific proteins in food. Unlike traditional allergies, these reactions can be delayed by a few hours to several days and can trigger symptoms like bloating, brain fog, indigestion, skin breakouts and joint pain among others.
There are tests available that measure different types of immune reactions - I’ve seen direct to consumer tests pop up on the market, but I am not sure how valid they are. I usually run a combination of IgE (food allergy) and IgG (delayed food sensitivity) testing. When lots of reactions show up on the IgG tests, it doesn’t necessarily mean that you’re sensitive to all those foods but rather is reflective of poor gut integrity. You normally don’t need to eliminate sensitive foods forever, but for a certain amount of time while you heal other gut imbalances. It’s best to work with a credentialed guide to help you effectively interpret and create an actionable plan based on these tests.
The gold standard for detecting a food allergy is to complete an elimination diet. I will usually start clients on a gluten, dairy and sugar free diet. But other reactive foods include eggs, corn, yeast, shellfish, tree nuts, peanuts, soy and fish. Do you eat one of these foods more than the others? If so, start by eliminating foods that you eat frequently first - commit to 4 weeks of elimination and see how your digestion changes after reintroducing it back.
Diet soda addicts, beware! Just because they don’t have calories, artificial sweeteners (especially sugar alcohols) will make you bloat because we cannot break them down. They pass undigested into the colon where bacteria ferment them which creates gas and bloating.
Avoid sweeteners like sorbitol, xylitol and mannitol. You can identify sugar alcohols on package labels because they end in ‘ol’. Common culprits are gum, hard candies and low calorie baked goods.
Fructose Intolerance / Malabsorption
Fructose is a sugar that is found in fruits and certain vegetables and more people are sensitive to it than realize. If you cannot absorb fructose, it will pass undigested into your colon where bacteria ferment it and cause you to bloat up. You may also not be a stranger to diarrhea, as fructose will pull water into the gut and cause loose stools.
Fructose is found in fruits like apple, pear, peach, watermelon, mango; sweeteners like honey, high fructose corn syrup and juice concentrate; as well in the form of fructans in wheat, onion and garlic.
If you are not digesting your food properly, you will have some sort of GI distress - whether it be bloating, reflux or indigestion and flatulence. The digestive tract is a complex organ with lot of moving parts. We rely on certain digestive factors like stomach acid, pancreatic enzymes and bile to digest the food we eat so that we can absorb the nutrients from our food!
If any of these parts is missing, it can throw off your entire digestion because each part relies on the previous step - like a game of dominos. For example, your ability to secrete enzymes depends on your ability to produce enough stomach acid.
The biggest risk factors for poor digestion include stress (yep! That brain - gut connection is real) and the use of antacids - whether they’re OTC like Zantac or Tums, or prescription like Prevacid, Prilosec or Nexium.
Pathogenic bacteria or yeast
Did you know that we have over 3 pounds of bacteria that live in the gut? The collection of these bacteria is known as the ‘microbiome’ and it plays such an essential role in our health and disease that many doctors and researchers now consider it its own organ.
Dysbiosis is the scientific term for imbalances in gut bacteria - and can be caused by a variety of issues like medications (especially antibiotics), stress / trauma, poor quality diet, poor digestion and even environmental pollution and exposures to pesticides. All of these variables can create the ‘right’ environment for the ‘wrong’ types of organisms to overgrow, which can cause bloating and digestive discomfort. It is best to work with a clinician to see if a stool test will help you uncover digestive imbalance to provide a roadmap to improve your digestion.
Small Intestinal Bacterial Overgrowth (SIBO)
Most of the bacteria in our gut is located in the large intestine. Certain conditions (really similar to the ones above re: pathogenic bacteria and yeast) can allow bacteria to overgrow in the small intestine and can cause severe bloating, reflux, abdominal pain, constipation, diarrhea and food intolerances.
It is estimated that 84 percent of people with IBS have SIBO, which resolves after the SIBO is gone. If you have SIBO, you may find yourself more reactive to certain fibers, especially those found in brussels sprouts, beets, sunchokes, asparagus, beans, dairy (lactose), fructose (see above) and artificial sweeteners (see above).
If you’re eating healthy and are still experiencing frequent and unexplained bloating, I highly recommend getting tested for SIBO to better understand what is going on. Treatment can be tricky and difficult and often takes a few rounds of treatment in order to get full relief. Treatment includes a combination of antibiotics (herbal or prescription), a low fermentable diet as well as treating the underlying cause such as poor digestion or motility. It’s best to work with a practitioner to facilitate your healing process.
Our gut regulates so much more than digestion - in fact, a lot of chronic and “age related diseases” are being linked to digestive imbalance which is why it’s so important to pause and listen to your body’s signs and symptoms because what is happening NOW can affect your health later in life.