Few things are as frustrating to many of my patients as the mysterious abdominal bloat that comes and goes. Bloating is one of those symptoms that is hard to quantify. For some people it is feeling of a too full belly, for others it is abdominal distention that comes on suddenly, and for others it is all about the excess gas. We are not talking about just a big belly from too much belly fat. This is the more bizarre situation that can appear in a matter of minutes to hours and go away just as easily. Clinically I have read about extreme cases in which a patient’s abdomen could swell and increase their waist size by up to twenty-two inches in a couple hours. What the heck is going on?
That is the real problem – there is not one answer; not one cause to bloat. There are lots of possible causes, and you can have more than one at a time! Lets start with the short list:
Carbohydrate digestion disorders:
Food allergies and sensitivities
Protein digestion disorders
Gallbladder / Liver disease
Dyspepsia / acid reflux
Constipation
Leaky Gut
IBS
SIBO
Dyssynergia
Gastroparesis
Hormonal imbalances
Fear/fight or flight stress
Candidia / gut yeast infection
Celiac disease or gluten intolerance
Intestinal stasis from sitting too much
Brain function loss decreasing Vagus Nerve tone
This is the common causes list and leaves out scary things like cancer, serious infections, surgical complications / alterations, pregnancy, etc…
The list can be overwhelming, which is why most doctors simply ignore your complaints of bloating once they rule out cancer and infections. The instant you say the swelling comes and goes, they stop listening because neither cancer nor infection does that. Nothing else on the list will kill you this week so you are good.
So how can you figure out what is causing your bloating? You put on your Sherlock Holmes hat and start investigating – trial and error testing – elimination diets and lifestyle changes – and a few clinical tests. Lets go through the list again and this time I will give you a few clues to follow up on:
Carbohydrate digestion disorders – go on a FODMAP diet for 3 weeks and see if you feel better – avoid dairy, sugars, grains, legumes, and certain vegetables
Food allergies and sensitivities – start a rotation diet or elimination diet to find sensitivities – lab tests are available, but expensive
Protein digestion disorders – take HCl and proteolytic enzymes with each meal and see how you do
Gallbladder / Liver disease – lab tests, try taking bile salts with any fatty foods or go on a low fat diet and see if you get better
Dyspepsia / acid reflux – usually caused by either low hydrochloric stomach acid production or stress – check for low zinc levels and H. pylori infection – treat with appropriate protocol – possible hiatal hernia cause
Constipation – if bloating disappears after a bowel movement, then this is probably a factor – gradually increase your dietary fiber, take magnesium, and drink lots of extra water
Leaky Gut – blood lab work followed by a special diet and nutrition – L-glutamine helpful – must avoid gluten and dairy – A and D helpful
IBS – try IBS diet and proper specific probiotics – meditation helpful
SIBO – try SIBO diet or fasting. Breath tests for bacteria and right antibiotic – check out article for a good diagnostic differentiation between SIBO and the next two conditions – may be caused by PPI acid reflux meds
Dyssynergia – sudden swelling right under ribs after consuming anything, even water – caused by diaphragm spasm triggered by eating
Gastroparesis – stomach empties very slowly so food backs up all day – possibly a pyloric sphincter spasm
Hormonal imbalances – DUTCH test and go from there – very complex – hormone replacement is usually not the answer
Fear/fight or flight stress – does the bloating go away while on vacation or away from stress?
Candidia / gut yeast infection – history of antibiotic use several times? Tongue have a white coat on it? Treat with Saccharomyces boulardi
Celiac disease or gluten intolerance – lab blood workup cyrexlabs.com – if positive, avoid all grains and dairy – usually takes 6 months to a year to feel better
Intestinal stasis from sitting too much – proper bowel movement needs exercise/body movement
Brain function loss decreasing Vagus Nerve tone – age / dementia / stroke / memory issues all signal decreased frontal cortical brain functioning which is vital for proper vagus nerve functioning – the nerve that controls all your digestion processes. – Treat with brain nutrients, exercise, and brain stimulation – vagal stimulator a possibility.
By reading all this you may have a fair idea of what is causing your bloating issues if you are so afflicted. If you need more direction, please feel free to ask me at your next visit. I can arrange most of the lab work if you need to have that done, however anything done through my office will not be covered by any insurance. Most of the tests like this usually aren’t. Bloating falls into that gray area between disease and health that the medical establishments don’t deal with. They exist to save your life. Non-life threatening, bothersome conditions don’t generally interest them… but they interest you. That leaves you to do the work to find the answers. I am happy to help, but the hard work is all on you.