Are you ever bloated? I hear it all the time from patients – “I eat a meal and a little later I look like I am 6 months pregnant!” Now I am not talking about feeling too full because you have just eaten your way through the Sunday Brunch Buffet. You’d expect to feel overly full when you eat the waffle and the eggs benedict and the omelet and the hash browns and the sausages (3 kinds) and still try to have room for the muffins and pie. No, I am talking about the “All I had was half of my protein power smoothie for breakfast and now none of my clothes fit me anymore” experience. Or maybe the “All I had was half a cup of Brussels sprouts and a slice of 7 grain toast at lunch and now I feel like I am going to burst.” Doctors hear this kind of thing all the time and generally ignore it as some sort of over-reaction. If you really pester them about it, they will prescribe you either some acid blocker drug or a mood lifter because obviously you are stressed.
Well I have watched my belly gain at least two inches in size at the waist and more like four inches at the navel after eating certain foods. This is not some fantasy but actual tape measure readings. What is going on? That is what I am going to discuss today.
There are at least three different types of bloating, and yes you can have all three at once. And there are two main constituents that create the bloating. Discovering the type of bloating leads us to the remedy for this uncomfortable situation.
Instant bloating: some folks find that the bloating feeling starts within minutes of eating or drinking the offending food. The bloating is felt right under the bottom of the sternum where the stomach hides. This type of bloating is basically caused by an allergy or sensitivity reaction to the food.
This is a good opportunity to discuss the difference between an allergy and food sensitivity. The truth is, the difference is about a medical turf battle. When the blood mechanism of allergies was first discovered, it spawned a whole new branch of medicine – the allergy specialist. The first research was done on a reaction called anaphylactic shock in which a person’s throat would swell up and they would die. Medicine loves life and death stuff because they love to save lives. Research discovered that this reaction was set off by certain proteins in sensitive people’s blood called Immunoglobulin E – IgE for short. Protocols for saving people’s lives were developed: adrenaline shots for the immediate reaction, skin reaction testing to find the offenders, and allergy shots to decrease the reaction in the future. Allergists proclaimed themselves the masters of this aspect of the body and defined the word allergy as meaning IgE reactions in the body.
Well science marched on and discovered that there were lots of other Immunoglobulins – IgA, IgM, IgG, IgD, besides the now famous IgE. The problem was the reaction protocols developed by the allergists for IgE didn’t work for these other Immunoglobulins. Rather than invest the time and energy in studying and developing methods to deal with these newly found immunoglobulins, the allergists found it more convenient to simply decide that only IgE reactions could be called allergies and these other reactions would simply be called sensitivities. They didn’t produce the immediate life threatening reactions that the docs wanted to protect us from anyway, so why expend the effort to learn new stuff when they could more easily say it wasn’t their problem. After all, they are allergists and allergies only happen with IgE. Of course us patients are stuck with a boatload of reactions making us miserable with no one willing to address them because they are not given the name allergy by the medical profession. The sad reality is that the medical profession as a whole is concerned with saving our lives, not our quality of life in the mean time. Quality of life is boring. Where is the heroism in that?
So back to instant bloating – a “sensitivity reaction” which us uninformed lay people might mistake for an allergy. Bloating, in these cases, is kind of like getting hives, but in the stomach and gut. There is instant inflammation and swelling as the tissues soak up water from the blood and pool it around the inflamed area. What can you do about it? The most basic step is to avoid the foods that create the reaction. That means keeping a food log so that you can figure out just what foods cause you to swell up. Fortunately strict avoidance of the food for three months will usually settle down the reaction, after which you can usually tolerate the food once every four to seven days without creating a problem. Sometimes the food has to be avoided forever, but usually not.
The next type of bloating starts about a half an hour after you eat. You are ok with the food initially, but once it starts to try to digest, problems arise. This type of problem involves a cluster of possible causes, all having to do with compromised digestion. I find four typical causes: valve regulation problems, poor hydrochloric acid production, insufficient enzyme production, and poor bile excretion.
If every type of food causes you problems, the most likely cause is the valves at the top and bottom of the stomach are not working properly – usually because of stress. Many of you have had me adjust you for a hiatal hernia/cardiac sphincter problem at the top of the stomach or for a pyloric sphincter problem at the bottom of the stomach. These will cause food to dump out of the stomach too soon causing digestion problems and bloating. The hiatal hernia problem also typically causes reflux pains. Besides adjusting the valves in the office, the real fix is all about handling your stress differently. We have several approaches for that, but the most potent one is seeing Ellen for Heartflow work.
If high protein foods really make you feel heavy or even nauseous, poor hydrochloric acid troubles are the most likely issue. Without enough acid in your stomach, your proteins can not digest properly, which inflames your gut lining causing bloating. The strong stomach acid is also necessary to trigger the release from the pancreas of the powerful acid neutralizing buffers. If the acid is only mildly strong the pancreas does not neutralize the acidity and this then burns the small intestine. This starts happening about half an hour after eating the protein. The cause is usually either an H pylori infection in the stomach or low zinc levels in your body. Zinc is needed to form hydrochloric acid. We can easily test for zinc levels in the office with a zinc taste test. One confounding issue is that just like calcium and magnesium, zinc can not be absorbed in our gut if we do not have enough acid in our stomach, so taking zinc supplements does not help. We have to use sublingual absorption of zinc with children’s zinc lozenges. In the short run, we use actual acid replacement supplements taken with your food to help resolve the digestion and bloating problem.
If your bloating is with carbohydrates and vegetables a half hour after eating, then the trouble is with your pancreas’ production of enzymes. We make sure your pancreas has the proper nutrition it needs to make enzymes, but often we have to supplement with the needed enzymes before each meal. There are four classes of enzymes that have to be considered: sugar enzymes, carbohydrate enzymes, protein enzymes, and fat enzymes. Deficiencies of each produce different symptoms in the body.
If your bloating is primarily whenever you eat fatty foods, then the most likely trouble is with your bile flow from the liver. You may even have gallbladder disease. The gallbladder stores and concentrates the bile from the liver and is supposed to squirt it out into the digestive tract just below the stomach whenever you eat fats. If it fails to do this, the fat irritates the gut lining, resulting in bloating and also sometimes diarrhea as well. We can use bile salts in a pill form to help with this. Sometimes herbs that promote bile flow are helpful. I use a liver cleanse at least once a year to keep this system running smoothly. But if the gallbladder is shot, then decreasing your fat consumption becomes necessary.
Now for the last type of bloating: bloating 3 to 4 hours after a meal. I have personal experience with this one. It is caused by a condition called SIBO, which stands for Small Intestine Bacterial Overload. It says that your bloating is being caused by tons of bad bacteria in your gut. With SIBO you can have 100 to 1000 times more bacteria in your gut than you should have. Resolving this condition is involved and will be the topic for an entire newsletter, but basically you have to starve out the bad bacteria and replace them with good guys.
So now you have a way to identify what the heck is going on with your bloating. You are not crazy, your bloating is a real thing and has many different possible causes. This information will help you figure out what your cause is and what to do about it.
Take care,
David