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Chronic bloating and abdominal distention are common gut health complaints. In this article I’ll go over the various causes and solutions.
First, it’s important to address the obvious.
If you eat the standard American diet, which is high sugar, carbs, processed foods, and industrial oils, you can absolutely expect abdominal bloating, distention, and maldigestion. Pizza and beer, fries, processed fast food, soda — it’s normal for these foods to distress your gastrointestinal (GI) function.
However, some people eat a healthy diet with plenty of produce and exercise regularly yet still suffer from bloating and distention.
Using the gut north-to-south model to look for underlying causes of bloating and distention
When looking for issues related to gut health, you must work north to south. This means evaluating each step in the digestive process to look for breakdowns in function.
Is your diet causing your bloating
The first question with bloating is, is it your diet? Are your portion sizes too large, do you react to certain foods, or do you have a condition such as SIBO and need to go on a low FODMAPs diet?
Some people do not eat large portions but must eat very small portions because of dysautonomia, or dysregulation of the autonomic nervous system.
Does your bloating come from predominantly proteins, fats, starches, or produce? Each one of these reactions says something different about your GI tract, which I will cover below.
Chewing and bloating
The first but most-overlooked role in digestion is that of chewing. Many people eat while doing something else and may not be chewing their food thoroughly. This puts undue stress on the rest of the GI tract and can instigate problems.
Some people have difficulty chewing and swallowing due to poor saliva production and a dry mouth. This is a brain-based issue, such as from dysautonomia or brain degeneration. Vagus nerve exercises may help, but it’s also important to evaluate neurological function.
Start with chewing when you have gut health issues — chew each bite until you have liquified your food.
Stomach hydrochloric acid and bloating
If proteins such as meat cause bloating, your stomach may not be producing hydrochloric acid (HCl).
When food enters your stomach, it releases HCl to break down proteins.
In addition to breaking down protein, HCL triggers the small intestine to release pancreatic enzymes to further digest foods and the gallbladder to release bile to emulsify fats. These functions ensure good nutrient absorption, maintain GI health, prevent bacterial overgrowth, and promote a healthy gut microbiome.
Many people underproduce both HCl and pancreatic enzymes, particularly as they age but also in response to a lifetime of a poor diet.
Symptoms of low HCl include not only difficulty digesting protein but also acid reflux and bad breath.
You can address low HCl with HCl supplements with meals, or apple cider vinegar for a gentler approach.
If you take either HCl or apple cider vinegar and experience gastric burning, this is a sign of gastric irritation or stomach ulcers and the possibility of an H. pylori infection.
The H. pylori bacteria furrow into the stomach lining and prevent hydrochloric acid release.
To learn more about HCl, apple cider vinegar, and H. pylori, read this article.
Pancreatic enzymes and bloating
People with pancreatic enzyme issues experience bloating after eating starch or fiber. They may also experience nausea and mucus in their stool.
Pancreatic enzyme deficiencies are very common and often secondary to low HCl, as HCl triggers the release of pancreatic enzymes.
To learn more about pancreatic enzyme deficiency and supplementing with pancreatic enzymes, please read this article.
Gallbladder issues and bloating
The third most common cause of bloating that is also largely overlooked is sluggish gallbladder function. When most people think of gallbladder issues, they think of gallstones, but gallbladder sludge also impacts digestion and causes bloating.
People with poor gallbladder function experience bloating after eating fats, sometimes two to three hours after eating. They may also have nausea, indigestion, and belching. These are the people who burp up fish oils.
Pain under the right rib cage, tightness between the shoulder blades, floating stools, and pale stools are other indications.
When the gallbladder does not contract and release bile normally, the bile thickens and becomes sludge. This sludge eventually turns into gallstones that can obstruct the gallbladder. However, many people never go on to develop gallstones.
Factors that promote poor gallbladder function include metabolic syndrome, obesity, and a sedentary lifestyle. Women and certain ethnic groups are more prone to gallbladder issues.
Supplements that thin the bile and a low-fat diet can help kickstart your gallbladder function.
To learn more about gallbladder health, please watch this video (transcript included).
Small intestinal bacterial overgrowth (SIBO) and bloating
People with chronic bloating and distention may suffer from small intestinal bacterial overgrowth, or SIBO.
With SIBO, bacteria in the large intestine moves to the small intestine due to faulty valve function and poor contracture of the intestinal muscles. Bloating can cause the valve that separates the small and large intestine to open, allowing bacteria to move from the large intestine into the small intestine, where it doesn’t belong. This creates a vicious cycle of bloating triggered primarily by sugars and starches.
You can test for SIBO with a methane hydrogen breath test. It’s not 100 percent accurate as the bacteria release other gases besides methane and hydrogen, but it’s the most commonly used test.
The low FODMAP diet, which removes the sugars and starches that feed these bacteria, helps many people with SIBO. In fact, if you have chronic bloating and distention, you may want to go on a low FODMAP diet for a couple weeks and see if it helps you with your overall symptoms. If it does, then you may have SIBO.
Factors that can promote SIBO include chronic inflammation in the gut from issues such as poor diet, brain dysfunction, food intolerances, autoimmunity, and other factors that promote inflammation.
Brain function and bloating
Chronic gut inflammation degenerates the gastrointestinal nerve plexus, promoting SIBO and other gut dysfunctions.
Symptoms of brain degeneration also indicate the gut’s nervous system is likely degenerated as well.
Dysautonomia from a past brain injury, chronic neuroinflammation, or other mechanisms can impact the brain-gut axis. Poor GI muscular function can allow translocation of bacteria and inhibit release of HCl, enzymes, and bile.
Difficulty swallowing often points to a brain-gut axis issue.
Food sensitivities and bloating
Any kind of food sensitivity can cause bloating and distention. The most common food sensitivities in the west are to gluten and dairy. Egg, soy, and corn are also common. Food sensitivities can worsen with age as gut health and gut immunity worsen and you lose immune tolerance.
Undiagnosed celiac disease or other gut-based autoimmune diseases can cause chronic bloating and distention. If you already have one autoimmune disease, your likelihood of having intestinal autoimmunity is higher. The chronic inflammation from autoimmunity can destroy the gut nerve plexus, causing chronic GI complaints such as bloating.
Gut microbiome and bloating
An unhealthy gut microbiome that is overly dominant in bad bacteria can cause fermentation of food in the intestines, causing gas and bloating.
Eating a diet high in fiber and with a diverse array of vegetables and perhaps supplementing with short-chain fatty acids is the best way to support a healthy gut microbiome. Read this article to learn more.
By evaluating and addressing the digestive system from north to south, you are more likely to succeed at finding and addressing the underlying cause of your chronic bloating and distention.
This may seem overwhelming, especially if you have multiple symptoms and can’t access a functional medicine practitioner. In my gut health course, Gut Health: Solving the Puzzle — A top-to-bottom solution strategy, I address each of these steps in depth, teach you how to recognize symptoms of dysfunction at every stage, and show you how to make the necessary changes to recover gut function.