Nutrition

Bloating. This is a symptom that you probably have experienced at least once in your life and are familiar with. The discomfort when we experience bloating is real, and this can affect our ability to take part in social gatherings or even go to work. The question that comes up is, how do we beat the bloat? Remember that bloating is just a symptom, and is usually a small part of a bigger issue. So if we want to beat the bloat, we have to determine where the bloating is coming from.

Now what causes bloating?

1. Low stomach acid or inadequate digestive enzymes: Our bodies require stomach acid and digestive enzymes to digest our foods thoroughly, as well as absorb the vitamins and nutrients obtained from those foods. With inadequate stomach acid, we can’t break down our foods thoroughly, which can cause those foods to be fermented in the gut; exacerbating bloating, gas, and other abdominal symptoms. 
2. Dysbiosis: Our gut microbiome is the community of microorganisms that live in our digestive tract. This gut microbiome needs to be in balance for our bodies to function optimally. If we experience an overgrowth of particular microorganisms (ex. yeast) or lose some of our beneficial bacteria, this can cause dysbiosis to be present. If we do not have an optimal gut microbiome, this can cause inflammation in the digestive tract, affect the integrity of the intestinal lining, and contribute to abdominal symptoms such as bloating.
3. Food sensitivities: Food sensitivities can cause poorly digested foods to move through our digestive tract and trigger an immune mediated response. This response can increase inflammation in the digestive tract and contribute to bloating.
4. Small intestinal bacterial overgrowth (SIBO): SIBO is a digestive condition that involves the presence of bacteria in the small intestine, which can increase fermentation and cause gas, constipation, diarrhea, and bloating. 
5. Altered mind-gut connection: Our mind and gut talk to one another consistently, and therefore influence each others’ functions. When we feel stressed or anxious, it can cause stool retention, increase inflammation in the digestive tract, affect the integrity of the intestinal lining, negatively affect the microbiome composition; which are all contributing factors to bloating. 
6. Visceral hypersensitivity: This involves heightened sensitivity of the abdominal organs to stimuli such as distention and inflammation. When we experience visceral hypersensitivity, we perceive normal or mild stimuli to be intense or painful. This condition can be associated with IBS and functional dyspepsia as well. 
7. Endometriosis and hormonal imbalances: Endometriosis is a chronic inflammatory condition where endometrial tissue that lines the uterus starts growing on other parts of the body, such as the ovaries and abdomen. This condition can cause symptoms such as very painful menstrual cramps (especially those that are not fully alleviated with pain medication), pain during or after intercourse, pain with bowel movements, pain with urination, low back pain, and bloating. Bloating can also be associated with thyroid imbalances (ex. hypothyroidism and hyperthyroidism), high cortisol, and estrogen dominance. 
8. Poor eating habits: Overeating, eating too quickly, not eating mindfully, eating while working or driving, and not chewing your food thoroughly can affect our digestive process, affect stomach acid and digestive enzyme secretion, and increase fermentation; which can all cause bloating. 

Now what can you do about it?

1. Consume a nutrient dense diet, especially fiber-rich foods: Consuming a diet rich in plant fibers increases the diversity of our gut microbiome. Fiber is important because it feeds our gut microbiome. Some great fiber sources are oats, flax seeds, psyllium seeds, raspberries, broccoli, and apples. As a general recommendation, you want to try to consume 25-30 g of fiber/day. While adding in fiber, you also want to reduce your intake of processed foods, refined foods, sugars/sweeteners, and carbonated drinks because they can exacerbate bloating. 
2. Drink at least 2-3L water/day, with minimal water intake with meals: Optimizing your water intake is important to help ensure stools are moving in your digestive system, therefore preventing constipation. One recommendation I provide my patients is to start your day off with 1 tall glass of lemon water to set good intentions. 
3. Engage in regular physical activity: Movement helps support regular bowel movements, reduces the underlying inflammation in the gut, and helps support the growth of an optimal gut microbiome. Start off small by doing an exercise you love 1-2 days/week, and build from there!
4. Support your mental health: If you are experiencing chronic stress, anxiety, or depression, it is crucial to support your mood and the mind-gut connection. When you feel happy, your gut feels happy! As a starting point, consider mindfulness strategies such as yoga, deep diaphragmatic breathing, and self-care.
5. Eat mindfully: How we eat significantly impacts our mind-gut connection. Eating mindfully stimulates our parasympathetic nervous system, which supports our mood and digestive functioning. Don’t forget to chew your food thoroughly, take at least 20 minutes to eat each meal, eat with minimal distractions, sit down at the table while eating, and be present with the food in front of you.
6. Consider starting a good quality probiotic: Probiotics can be a great option to consider if you have a personal history of multiple antibiotic use or you are experiencing dysbiosis. While probiotics can be helpful for some individuals, it may not be the best treatment for others with bloating. Before consuming, always double check with your health care provider to ensure it's the best option for you.
7. Consider bitters if your digestion is sluggish: When you ingest bitters, the moment it touches your tongue it sends signals to your vagus nerve to stimulate digestion. It helps stimulate the release of stomach acid and digestive enzymes, provides anti-inflammatory benefits, supports liver function, and calms down the nervous system. Before consuming, always double check with your health care provider to ensure it's the best option for you.

As a gut-focused naturopathic doctor, when I am addressing bloating I initially complete a thorough assessment, order relevant laboratory blood work, and collaboratively work with my patient to create a personalized treatment plan specific to their root cause of bloating. Addressing bloating is not a one size fits all approach. So if you experience bloating let’s create a sustainable plan to beat your bloating for good!

Dr. Ishani Patel is a board certified Naturopathic Doctor who has a clinical focus in women’s health, hormones, digestive health, and autoimmunity. She is dedicated to helping her patients determine the root cause of their health concerns, help them find balance in their lives, prevent disease or a worsening of their health conditions, and help them live their optimal state of health.

You can connect with Dr. Patel through her website drishanipatelnd.com, by email at ishanipatelnd@gmail.com, or by reaching out to her on Instagram @drishanipatel.nd.