Get Rid of Bloating by Addressing the Root Cause
To get rid of bloating symptoms, you must identify the root cause. Depending on what is wrong, you’ll need to do “the basics” and then, typically, some other personalized steps. The gastroenterology literature compartmentalizes bloating into what they call “functional” (translation: they find no cause for it) and “non-functional” (translation: they can pinpoint a cause). Since Functional medicine prides itself on always finding and then addressing the root cause of symptoms, I’m not going to use this classification. What I’ll do, instead is go through some basic explanations, and then review the common causes and treatments for issues that cause bloating. You’ll learn not just how to reduce bloating but hopefully, how to get rid of bloating; either on your own, or with the help of a good functional medicine doctor.
- What is bloating?
- Can I “just” bloat?
- General happy gut hygiene
- Happy gut supplements
- Bloating due to Leaky Gut/Solution
- Bloating due to a Disordered Microbiome/Solution
- Bloating due to Insufficient stomach acid/Solution
- Bloating due to gut motility issues/Solution
- Bloating due to hypothyroidism/Solution
- Bloating due to SIBO/Solution
- Bloating due to SIFO/Solution
- Bloating due to carbohydrate intolerance/Solution
- Bloating due to food sensitivities/Solution
- Bloating due to Inflammatory Bowel Disease/Solution
- Bloating due to Celiac Disease/Solution
- Bloating due to Rapid weight loss or gain/Solution
- Bloating due to Irritable Bowel Disease
- Bloating due to Constipation/Solution
- Bloating due to Hormone Imbalance/Solution
- Bloating due to Chronic Stress/Solution
- Concluding comments
What is Bloating?
Bloating is caused by the physical sensation of having gas trapped in your belly. Put “more medically”-abdominal bloating is the subjective sensation of trapped gas, gassiness, or a feeling of pressure or being distended with or without obvious visible distension. It is decidedly not caused by fluid retention. You might have a bloated belly but have some fluid retention in other parts of your body (such as your feet and ankles) if you have a condition that’s causing both problems.
Patients also describe a sense of fullness or pressure, which can occur anywhere in the belly. We like to break it down into “above the belly button” (epigastric), belly button region, lower belly or diffuse so that we can analyze whether it’s an “upper belly” issue such as undiagnosed reflux, a small intestinal issue such as SIBO, or a lower bowel issue such as inflammatory bowel disease. All of these conditions will be covered in the “16 health issues” below.
Abdominal distension is the objective physical manifestation of an increase in abdominal girth. Male and female patients commonly describe how they look- “like I’m pregnant” when they have moderate to severe bloating with distension. Abdominal bloating and distension can occur independently, although they often occur together. Studies have reported that 50% of patients with “bothersome” bloating report abdominal distension. Remember when I said I wouldn’t talk about “functional bloating?” I’m going to break my rule this once: in so-called functional issues such as irritable bowel disorders patients are less likely to pair up bloating with visible distention than in decidedly non-functional disorders such as SIBO. Now that you know this, you can forgot I mentioned it.
Nearly all of us has experienced, at one time or another, a sensation of being bloated, gassy, or distended. For many people, these are merely annoying but transient sensations that occur after eating, resolve spontaneously, and do not lead to medical consultations. For others, however, abdominal bloating and distension are chronic, bothersome, and negatively affect their daily lives, whether they have a definitely treatable cause or a diagnosis of irritable bowel syndrome.
The occurrence of bloating with distension is significant, ranging from 15% to 30% in the general population, and is as high as 65%–90% in patients with irritable bowel syndrome (IBS). Women generally report higher rates of bloating than men, while patients with IBS with constipation predominance (rather than diarrhea predominance) have higher rates of bloating with distension. Seventy-five percent of patients with bloating (who do not have IBS) characterize their symptoms as moderate to severe, while 50% report that symptoms are so severe that they cause a reduction in daily activities.
To simplify the concept of bloating think of your gut as a digestion and bacteria factory. For some reason, you have inadequate protein, sugar and/or carbohydrate digestion which then causes foods to ferment. This can be caused by any of the medical issues I discuss below. You also have an imbalance in your gut bacteria or microbiome. This just “goes with the territory.”
Non-functional etiologies for abdominal bloating and distension that will not be discussed in this article include pancreatic insufficiency, diabetes, gastroparesis, Scleroderma, Chronic idiopathic pseudo-obstruction, Acute gastroenteritis, Gastric malignancy, Bowel malignancy, Ovarian malignancy, and ascites; an accumulation of fluid in the abdomen.
It is unusual but possible for any gastrointestinal bloating to actually represent fluid collecting inside your belly. This is not bloating. It is a potential medical emergency, and what you think is bloating, we call “fluid distension.” It could mean an infection such as hepatitis or even cancer. It could mean bowel obstruction from scars caused by prior surgery or adhesions from ongoing inflammatory bowel disorder. If you have sudden gastrointestinal distention, please see a doctor ASAP! Now let’s talk about the bloating that you came to read about. First, bloating by itself: can it happen with no other symptoms?
Yes it can. If so, it is typically due to SIBO, SIFO or food sensitivities which I’ll address shortly. Other than these three things, it’s very unusual for bloating to occur without gas (upper or lower), diarrhea, or constipation. Lower intestinal gas is the primary “second” symptom associated with bloating. Constipation is second and is often helped with proper “happy gut” measures.
How to have a happy gut=how to reduce bloating
Chewing is obviously the first step towards the digestive process. The enzyme (amylase) is released immediately from your parotid glands, and makes digestion much easier on your stomach. Sicca syndrome (dry mouth), aging or having even a minor reflux disease (heartburn: with or without symptoms) can interfere with this initial process and cause bloating. So, your first digestive “job” is to chew your food thoroughly. We’ll get into whether or not you’ll need digestive enzymes.
In addition to chewing your food thoroughly, eat enough soluble and insoluble fiber (25-30 grams per day) to keep your colon “moving along regularly.”
Both soluble and insoluble fiber help bulk up your stools and can be used as a food source for good bacteria in your large intestine. Soluble fiber draws water into your gut, which softens your stools and supports regular bowel movements. Examples of healthy high soluble fiber foods include broccoli, sweet potatoes, avocados and figs, to name a few of my favorite foods. Two great examples of insoluble fiber include nuts and cauliflower.
Hydrate well which just means drink enough water so that your urine is clear. Too much of any fiber without enough fluid-added at once will cause constipation. Add fiber slowly and make sure you add more water or fluids to your diet at the same time. The combination of hydration and fiber keeps the GI tract moving along the way it’s supposed to do.
Exercise regularly. Exercise also helps with the GI tract’s peristalsis which is it’s rhythmic propulsion forward.
Eat a healthy diet. Fast food and processed food causes an array of gut issues- from leaky gut to dysbiosis.
Happy gut supplements
Any time the GI tract is “stressed” (causing any symptoms), I advise patients to chew food more carefully, cook meat and veggies more thoroughly, and take digestive enzymes to decrease the GI tract’s workload. A good digestive enzyme will contain HCL or betaine, and enzymes made by the pancreas and gall bladder. If you’re a gardener you know that you get better results with good fertilizer and good seeds. Your gut fertilizer is prebiotic fiber. Prebiotics and natural prebiotic fiber are a great addition to anyone’s diet. Some examples of good prebiotic fiber food: onions, asparagus, Jerusalem artichokes and un-ripe bananas. Unless you are making your own A2-milk kefir or yogurt, it’s a good idea to take a sporulating probiotic daily. Other products are required for specific symptoms or issues and will be discussed in conjunction with their specific issue.
Bloating due to Leaky Gut
This extremely common condition is often caused by anti-inflammatory medications, antibiotics, stress (discussed later on in this article) or just “bad American food.” None of these things differentiate between “good” and “bad” bacteria when they are killing off organisms in your gut. Healing a leaky gut isn’t that hard. If you have one, you are likely not just uncomfortable, but you’re a set-up for autoimmune disease.
Getting you into remission from any autoimmune disease starts with fixing your leaky gut. Changing your diet to my A.I.P. diet plan is the first step in healing your gut and reducing your auto-antibody production. As you heal your gut over two months, your (probable) food sensitivities and, therefore, your bloating will diminish. If it doesn’t, it often means you have SIBO, which is not uncommon in those with leaky gut. We’ll discuss that in an upcoming section.
Solution: Use (under medical care) proper gut-healing peptides and (if needed), supplements for leaky gut such as l-glutamine and collagen powder. Vitamin D levels need to be normalized, and sporulating probiotics with their “fertilizer”-prebiotics, should be added when the symptoms start to subside. More about re-balancing your microbiome (the prebiotics and probiotics) coming up next.
Bloating due to a disordered microbiome
An imbalance in our microbiome is called dysbiosis. Dysbiosis an be caused by seemingly innocuous things from using too much mouthwash to stress to the use of hand sanitizers and consumption of OTC medications. When we carry around more pathogenic bacteria than we should, and also lack the proper diversity and number of protective bacteria we need, the microbiome is unbalanced, unhealthy, and will not serve our bodies well.
In the colon, there are trillions of healthy (and unhealthy) bacteria which compete for space. When the number of “bad bacteria” outweigh the “good bacteria”, the imbalance can lead to abdominal bloating and gas.
We obviously require a higher ratio of gut-friendly microbes to outnumber the harmful ones in order to stay symptom-free and optimally healthy. Unfortunately, due to multiples of bad habits, most people’s microbiomes are filled with billions of potentially dangerous bacteria, viruses, and other pathogens.
Solution: It’s all about the fertilizer and the seeds: the prebiotic fiber and the probiotics. First, a quick note about yogurt. The only healthy yogurt is made from A2 dairy, using live cultures. Even then, we all recommend that you avoid dairy-based yogurt until your gut heals. Therefore, at least initially, your probiotics should be from capsules so you’re in charge of the dosing.
If your gut microbiome is unbalanced with “bad bugs” in the majority, you need to use prebiotic fiber to feed a lot of good bacteria (and-if there is no mycotoxin illness- a little “good yeast”) to overtake the bad bacteria. You want to consume about 50 to 100 billion probiotic CFU’s per day. Some of the literature suggests that a mixture (in your main probiotic) of Bifidobacterium species and Lactobacillus species is necessary. Also, add in some friendly yeast called Saccharomyces boulardii. However, the latest research supports the use of sporulating probiotics for most conditions, especially for the treatment of Crohn’s disease and ulcerative colitis. No matter what we’re treating, there are strong suggestions that the sporulating probiotics will result in a more diverse (and therefore more healthy) microbiome. Here’s what to look for.
Find a probiotic that contains a few strains of the bacillus species, which are all delivered to the gut as spores which then encapsulate beneficial bacterial strains. Look for b. subtilis, b.coagulans and b.clausii, as they have been studied and documented as beneficial. If the amount of CFU’s found in one of these probiotics (rarely) gives you diarrhea, simply open and empty 1/2 of a capsule out before taking it.
Bloating Due To insufficient stomach acid
Although it seems totally counter-intuitive, reflux-or heartburn- is the result of insufficient stomach acid. It is indeed sometimes caused by the H. pylori bacterium, but a short course of antibiotics and proton-pump inhibitor medication (or the natural alternatives if you’re my patient) are indicated solely in these documented cases. The bloating for this one condition tends to be around or above the belly-button.
Here’s the problem with PPI medications like Nexxium or Prilosec. They were intended for short-term use but instead, are either prescribed or bought over-the-counter and used for years. When you do this, it alters your microbiome, suppresses your immune system and may even increase your risk of heart disease. As for your gut heath, it’s awful for that, too.
Note this is not how the PPI drug was intended to be used–ever! In the instances where people take over-the-counter PPI medications for their heartburn symptoms, the low stomach acid impedes the digestive process, making those individuals a total set-up for leaky gut!
Solution: To correctly treat run-of-the-mill heartburn, you need digestive enzymes containing pancreatic enzymes and bile acids. If that isn’t enough to quiet down your symptoms, add betaine (HCl) capsules; taken 15 minutes before meals. If your heartburn persists, you should be breath-tested for H. pylori. If you still have bloating (especially below your belly-button), you have lower gut issues. You might have developed leaky gut and/or food sensitivities, for instance. It’s time to seek Functional integrative care.
Bloating due to gut motility issues
In cases of leaky gut, with or without SIBO, as the gut lining becomes destroyed, some segments of the small and large intestine will propulse “out of sync” causing intestinal cramping and, often, constipation; sometimes, diarrhea as well. This can be easily addressed, but before we jump to the solution, let re-visit the concept of fiber a bit.
I’ve mentioned the need for fiber above but honestly, aren’t most people aware that they need to eat adequate amounts of dietary fiber for optimal gut health? To review: fiber is a non-digestible carbohydrate which you can find mainly in plant foods such as fruits, vegetables, legumes and whole grains. In addition, fiber helps maintain a healthy microbiome and supports healthy bowel movements (via motility and bulk) to decrease the risk of diverticulosis and colon cancer. The recommended amount of fiber is a minimum of 25 grams per day for women and 38 grams per day for men. This doesn’t even include the prebiotic fiber or “fertilizer” we’ve discussed previously. And yes, if you cannot manage to eat your prebiotic fiber it’s just fine to take powder-fiber supplement mixes which contain things such as inulin, citrus pectin, prune powder, and psyllium husk.
So, if you are experiencing cramping, constipation and some diarrhea while your leaky gut (let’s say) is healing, here’s what you need to do.
Solution: In this case, we usually recommend products to either bulk up the stool (e.g.: modified citrus pectin), and/or a fiber blend as noted above. We can also improve GI transit at the smooth muscle level with 5-HTP supplementation if constipation is the primary issue. While we wait for the 5-HTP to “kick in” we use non-stimulant and osmotic products to draw water into the colon and relieve constipation: trifala and magnesium hydroxide.
Bloating due to hypothyroidism
Since gut motility decreases when someone is hypothyroid, due to sluggish, slower or weaker smooth muscle gut contractions, constipation is a common symptom of Grave’s and Hashimoto’s disease. The resulting constipation, due to decreased gut motility is due to a decrease in FreeT3 which acts directly on the gut’s smooth muscle layer. This decrease in Free T3 can be due to T4 to T3 conversion issues but is often due to an unchecked increase in rT3 which is clogging up T3 receptors, rendering a patient “effectively” hypothyroid. This occurs quite often when someone has developed constipation which leads to leaky gut and then leads to SIBO-something we’ll discuss in the next section. It’s estimated that a minimum of 50% of those with Hashimoto’s thyroiditis have untreated SIBO. SIBO symptoms are often confused with those of other GI disorders and will be reviewed thoroughly in the next topic. Meanwhile….
Solution: Make sure you have all of the right thyroid hormones and auto-antibodies checked, including a reverse T3. Correct the hypothyroid state, and augment gut motility (methods above) as needed. Check for, and treat SIBO as discussed below.
Bloating due to SIBO
SIBO (small intestinal bacterial overgrowth) is an increased number and/or abnormal type of bacteria growing in the small intestine section called the jejunum, a part of the bowel that is supposed to be sterile. For years, a culture of the small bowel was the way we diagnosed SIBO based on the presence of ≥1 × 105 bacteria (colony-forming units (CFU)) per cubic centimeter of jejunal aspiration. However, this definition is now under a great deal of scrutiny, and current thinking is that “normal” rarely exceeds 1 × 103cfu/ml. Furthermore, the idea that someone needs to see a Gastroenterologist and have a procedure called an endoscopy is rapidly falling out of favor in Functional medicine.
SIBO It is associated with anything that disrupts intestinal mucous, the microbiome and happens to be a quite common, undiagnosed cause of chronic constipation. It is a frequent result of chemotherapy, is (naturally) associated with leaky gut and with mycotoxin illness. As just mentioned above, it’s quite common in people who are hypothyroid.
The most common symptoms of SIBO are bloating and flatulence; particularly right after eating. Other symptoms include abdominal discomfort, constipation with interspersed bouts of diarrhea. It can be labelled as irritable bowel disease due to the alternating diarrhea and constipation. Multiple food intolerances are relatively common.
Solution: Diagnosis. First- get the right diagnosis! As mentioned above, the endoscopic procedure of bacterial sampling and quantification has fallen out of favor due to the variability of data regarding diagnostic parameters, patient discomfort, and inherent procedure risk. Breath tests are now routinely used as an alternative to direct aspiration because they are noninvasive and considerably less expensive. The most commonly used breath test is the hydrogen breath test.
The lactulose hydrogen breath test (LHBT) is the most widely used hydrogen breath test. After the oral administration of 10 grams of lactulose, we take breath samples at 15-minute intervals for 3 hours. There is a catch: there are a huge number of false negatives- up to 60%! Because breath tests are not very sensitive or specific, many Functional doctors will treat a patient if they exhibit symptoms and have underlying reasons for them.
Treatment includes antibiotics that are not absorbed by the gut (specifically Rifaximin) or with natural (herbal) substances. Herbal therapies are at least as effective as rifaximin for resolution of SIBO in head-to-head clinical trials. Herbals also appear to be as effective as triple antibiotic therapy for SIBO therapy for rifaximin non-responders. Some effective herbals (which should be given under medical supervision) include berberine, oregano oil, barberry, garlic, olive leaf extract, goldenseal, wormwood, Oregon grape, garlic, caprylic acid and pau d’arco.
As a last comment, in addition to the sporulating probiotics, often your bloating and gas will respond almost immediately to 10 billion units of L. plantarium daily.
Bloating due to yeast overgrowth-SIFO
Yeast overgrowth often occurs at the same time as SIBO. It occurs in the same scenarios as described for SIBO, and especially for those in moldy homes.
Solution: If you’re living in a toxic home, that needs to be cleaned up, or the SIFO just won’t get better. It is also very important that you exclude all sugars from your diet as this is what feeds the yeast. The medication nystatin is used by some doctors to kill intestinal yeast infections. Natural yeast-killers include oregano oil, olive leaf and caprylic acid.
Bloating due to Carbohydrate Intolerance
Lactose, fructose, and other carbohydrates intolerance means that you cannot digest certain carbohydrates due to a lack of one or more intestinal enzymes. Symptoms include diarrhea, bloating with abdominal distention, and flatulence. The most common carbohydrate intolerance is lactose intolerance. This occurs when the enzyme that is required to digest lactose (the sugar found in milk and various dairy products) is not readily produced in the body, leading to symptoms as minimal as mild cramping or as much as just described.
Solution: For lactose intolerance, the diagnosis is “clinical”-meaning-take away dairy products and the symptoms cease. For other hard-to-pin-down carbohydrate intolerances, a more accurate version of the hydrogen breath test is used. Treatment is simply-removal of the causative disaccharide from the diet. Or in the case of lactose intolerance, consumption of less-lactose-containing A2 dairy products in combination with the enzyme lactase, taken with the A2 dairy meals can be quite effective.
Bloating Due To Food Sensitivities
Food sensitivities are not the same thing as food allergies. If you have an IgE-mediated food allergy, you have an immediate and quite unpleasant reaction such as a rash or hives and/or throat tightening. We’re not discussing these issues, due to, for example: peanuts.
The foods which cause most food sensitivities are (in this approximate order) gluten, dairy, eggs, corn, soy, shellfish, peanuts, citrus, lectins (namely beans) and nightshade vegetables (tomatoes, eggplant, white potatoes and peppers.) Food sensitivities most often develop in conjunction with other issues such as leaky gut, SIBO, chronic constipation, mold exposure and so on. If you are indeed sensitive, eating any of these foods can contribute to inflammation and even autoimmune responses such as skin rashes, migraine headaches, weakened immunity and even worsen or trigger the onset of autoimmune diseases.
Let’s discuss a few important specifics. Sometimes GI symptoms are caused by mild gluten sensitivity. This probably has to do with the fact that almost all U.S. wheat is GMO and is added to many products as a thickener. Estimates show that a minimum of 30% of the U.S. population has some variant of gluten sensitivity. Try removing it from your diet-if it’s the problem, your symptoms will resolve.
A last word about beans. We joke about flatulence being caused by beans. This is simply a matter of your digestive enzymes being overwhelmed or a true sensitivity to the lectins in the beans. An example of a high-lectin bean is the kidney bean, with lentils being fairly low in lectins.
Note there are sophisticated tests (Doctor’s Data labs, etc.) that can detect specific food sensitivities if you have eliminated the “frequent offenders,” fixed your gut, and other issues to be discussed below. However, most people find that removing the above foods and then slowly reintroducing them will pinpoint the foods you need to avoid. This doesn’t account for FODMAPS foods (to be discussed).
Solution: The vast majority of people find that their food sensitivities start reversing in concert with the reversal of their GI symptoms. You can try doing an Elimination and re-intro diet if you still have food intolerances. If you’d like more specific data, the lab “Doctor’s Data” does the most accurate food sensitivity blood testing. I have not found that Cyrex labs (who seem to be popular with the public- perhaps due to social media advertising) to be all that predictive.
Bloating due to Inflammatory Bowel Disease
If you have an inflammatory bowel disorder, you started out with a leaky gut, didn’t have treatment and it then produced more symptoms and finally evolved into Crohn’s disease or Ulcerative colitis. Leaky gut can indeed be asymptomatic, and you might shrug off some post-meal bloating as due to something you ate. Inflammatory bowel disease symptoms such as explosive diarrhea or rectal bleeding can come, seemingly, out of nowhere. To get the plethora of symptoms under control, and your disease in remission is not only possible, but something that we Functional doctors who “treat a lot of guts”- do all the time. When I discuss solutions, for this topic, getting into remission is not something you can do “on your own.”
Solution: You’ll need to start out with a strict AIP diet and make sure there are no environmental factors (e.g. mold) contributing to your problem. Next, you need your leaky gut healed, and if you’ve had bloating and constipation, SIBO and SIFO will need to be evaluated and addressed. We now use peptides and LDN to treat IBD, so find a good Functional doctor who can do this for you. You’ll need good prebiotic fiber with sporulating probiotics. It might even be a good idea to suppress TNF-alpha and IL-6 with supplements. Some patient also benefit from a low-FODMAP diet: please refer to the IBS section below for more details on this.
Bloating due to Celiac disease
If you feel that gluten is causing severe symptoms such as cramping, bloating and explosive diarrhea, you might have Celiac disease, which is not the same as gluten intolerance. Individuals with Celiac disease are considered to have an autoimmune disease, with detectable antibodies on lab testing.
Solution: Blood testing for Celiac disease and then elimination of all gluten from the diet. The website Celiac-dot-com is quite helpful.
Bloating due to Weight loss or gain
Rapid weight loss or (much more commonly) weight gain are associated with abdominal bloating. How common is this? In one study, recent “COVID weight gain” occurred coincidentally with new onset bloating in 25% of the study participants. Why? A possible mechanism may involve an abnormal feedback mechanism from the abdominal adipose tissue which helps modulate the brain–gut axis.
Solution: You probably know that I’m going to recommend that you slowly achieve your ideal weight and try to “stay there.” If you have cravings or binges, a little tweaking of your brain chemicals is done with intra-nasal peptides or integratives which are precursors to “happy brain chemicals.”
Bloating due to Irritable Bowel Syndrome
IBS (Irritable bowel syndrome) affects 7–15% of the U.S. population. Many people with a diagnosis of Irritable bowel syndrome have a treatable disorder. For instance, diarrheal-type IBS is often a problem called bile-acid malabsorption (BAM). Leaky gut, as you’ve read, causes bloating, constipation and diarrhea; often similar to IBS. You might have a chronic parasite infection if you are a world traveler or live near and recreate in a fresh-water lake.
Constipation-dominant IBS is quite often undiagnosed SIBO. In fact, some studies show that up to 80% of those diagnosed with IBS have SIBO!
Solution: If you do indeed have IBS, the #1 currently effective treatment is a low-FODMAP diet. Eliminating high-FODMAPS from your diet will help with symptoms; specifically bloating. The FODMAPS acronym stands for Fermentable Oligo, Di- and Monosaccharides and Polyols sensitivity. Foods containing glucose, fructose, polyols, and lactose can all cause symptoms for everyone with IBS and some people with IBD.
The mechanism of action of low-FODMAP diets is probably a reduction in small intestinal absorption of osmotically active polyols, resulting in diminished intestinal water content and beneficial effects on colonic fermentation and subsequent gas production. Other treatments include stool bulking agents such as modified citrus pectin, good prebiotics and probiotics, and if needed; anti-spasmodic medications. A few clinical trials show some benefit from biofeedback and even meditation.
Bloating due to Constipation and Outflow Obstruction
Functional (meaning perceived with nothing in particular being diagnosed) abdominal bloating and distension may be related to constipation and to functional outflow obstruction. Now, this being said, I’ll bet you that most cases of “functional” constipation are just cases of diagnoses not being made. At any rate, retained stool in the rectum can cause impaired gas evacuation and slowing of intestinal transit.
Yes, there have been positive clinical trials with drugs for constipation-type IBS, but since I don’t like the drugs one bit, I’m not going to name them. What I always go back to is “what is the root cause” of the slow transit. Let’s talk more about serotonin than we did in the gut motility section. Serotonin is the happy brain chemical that you probably think is made in the brain. However, in both men and women, about 90% is made in the GI tract!
When your GI tract is not making enough serotonin, not only are you anxious and a little depressed, you have less GI motility and therefore constipation. You can have low GI motility due to a lack of serotonin, be constipated and not feel depressed or anxious as a FYI. Slowly adding some 5-HTP to your evening supplements will increase your gut motility, as mentioned previously. And you can also add trifala and magnesium hydroxide if needed, too. Please don’t get into the habit of taking stimulant laxatives, as this can cause permanent neurological damage to the propulsion in your gut.
Bloating Due to Hormone Imbalance
Bloating is a common sign of low progesterone. During the luteal phase of your menstrual cycle (after ovulation), both water and sodium retention increase with low levels of progesterone and high levels of estrogen. This occurs because the estrogen lowers the “osmotic threshold” for which water being reabsorbed in the body. When estrogen levels are high, this threshold is lowered and therefore less water is excreted through urine. This then causes the body to retain water and creates the sensation of bloating. Since this type of bloating, unlike “GI bloating” is indeed due to fluid retention, it’s different but often perceived as the same thing.
Low progesterone symptoms include the sensation of lower abdominal bloating. The bloating symptoms are usually accompanied by other low-progesterone (cyclical) symptoms such as irritability, sleep disruption and a little brain fog. If you have low progesterone due to perimenopause or early menopausal symptoms, your symptoms are less cyclic and you might, then blame your GI tract. Be on the lookout for this mistake.
Since progesterone helps gut motility via serotonin increases, low levels will generally cause some constipation. Men can also suffer from low progesterone symptoms, in addition to low testosterone issues, by the way.
Can chronic low progesterone lead to SIBO? Or leaky gut? Interesting questions which haven’t been studied but I would say a definitive “yes.”
Solution: Treatment is simple. Bioidentical hormone replacement with progesterone will clear up the bloating and constipation. Sometimes a little 5HTP is needed as well. A temporary measure is to use pregnenolone (non-prescription) which partially breaks down to progesterone. Progesterone creams sold over-the-counter are absolutely ineffective.
Bloating Due to Chronic Stress
If you “feel stressed” a good part of your workday, chances are good that you have a high fasting cortisol level. High cortisol levels can easily cause the breakdown of your GI lining. It slows down both GI motility and the entire process of digestion. As a result, some people experience “heartburn” while others have no symptoms whatsoever. Blood flow subsequently decreases to all of the digestive organs. This then adds insult to injury and results in a higher concentration of toxic metabolites which then whittle away at your gut lining. You can see that if the cortisol alone doesn’t give you leaky gut, the entire shutdown sure will. And if this isn’t enough, there’s actually more to this story. Simply being stressed out can lead to leaky gut, then to constipation, then to SIBO and food sensitivities.
Solution: Stress-management techniques are a must but it’s hard to find the time to do them if you’re already over-worked and over-stressed, right? If you can’t find the time for yoga, meditation or deep breathing exercises, try intermittent parasympathetic activation via your vocal cords. Do this by gargling salt water or even singing. You can get your cortisol down with adrenal adaptogens, as well. Do this not just for your gut, but for your brain, and arteries and more!
If you have a little bloating once in a while, you can probably clean up your diet and your microbiome and maybe even identify an offending food or two, and voila, you’ll be fine. If you have been “abusing your gut” with processed foods, toxins, pharmaceuticals or stress, you’ll need functional medical help to get it all repaired and get rid of not just your bloating, but your other GI symptoms. GI symptoms are painful and bothersome. Don’t put up with them, now that you have some answers.
Altered Colonic Bacterial Fermentation as a Potential Pathophysiological Factor in Irritable Bowel Syndrome
Bloating and Abdominal Distension: Old Misconceptions and Current Knowledge.
Small Intestinal Bacterial Overgrowth and Irritable Bowel Syndrome: A Bridge between Functional Organic Dichotomy
How to Test and Treat Small Intestinal Bacterial Overgrowth: an Evidence-Based Approach.
Low-FODMAP Diet Improves Irritable Bowel Syndrome Symptoms: A Meta-Analysis
Is a low FODMAP diet beneficial for patients with inflammatory bowel disease? A meta-analysis and systematic review.
Persistent symptoms in patients with Crohn’s disease in remission: An exploratory study on the role of diet.
doi: 10.1007/s10620-011-1834-4. Epub 2011 Jul 29.
Abdominal bloating and distension: what is the role of the microbiota
Low-FODMAP Diet Improves Irritable Bowel Syndrome Symptoms: A Meta-Analysis
doi: 10.1038/ajg.2017.129. Epub 2017 May 16.
Bloating and Abdominal Distension: Old Misconceptions and Current Knowledge
Bloating and Abdominal Distension: Clinical Approach and Management
doi: 10.1016/j.cgh.2020.03.056. Epub 2020 Apr 1.
Management of Chronic Abdominal Distension and Bloating
Probiotics and Prebiotics: Present Status and Future Perspectives on Metabolic Disorders
Small Intestinal Bacterial Overgrowth: Nutritional Implications, Diagnosis, and Management.
The resilience of the intestinal microbiota influences health and disease.
Probiotics for Preventing and Treating Small Intestinal Bacterial Overgrowth: A Meta-Analysis and Systematic Review of Current Evidence.
Antimicrobial Activity of Basil, Oregano, and Thyme Essential Oils.