Why Do I Feel Bloated All The Time? Simple Practical Solutions
Introduction
Bloating is a relatively common symptom most people would have suffered from at some point in time.
I have not only experienced this symptom but also see it daily both as a GP and functional medicine doctor.
So what is bloating anyway?
The word bloating simply means swelling or distension, and is usually referred to the stomach.
Although bloating could be caused by fluid or gas, distension from gas tends to be the commoner of the two.
It is also worth mentioning that bloating does not usually occur in isolation, but mostly in conjunction with other common digestive symptoms like gas, stomach pain, diarrhoea, constipation, indigestion, and more.
In my experience, patients who present with bloating hardly get to the bottom of this symptom despite seeing their own GP.
This is because the underlying root causes of bloating are hardly ever addressed, and the tablets at a GP’s disposal don’t always do the trick.
Let’s discuss some of the many reasons you might be suffering from bloating:
Food Intolerances
Food intolerances result from the inability to properly digest a particular food type.
In most cases, this inability to properly digest the food type in question is due to a lack of an enzyme.
Here are the commonest food intolerances:
Lactose Intolerance
Normally in the human body, milk sugar or lactose is broken down by the enzyme lactase.
Lactase is present in the small intestine and breaks down lactose into smaller sugar units, namely glucose and galactose, which are absorbed into the bloodstream.
Lactose intolerance occurs due to the lack of the enzyme lactose, and as such lactose remains undigested where it is transported into the large intestine.
In the large intestine, lactose gets fermented by your gut bacteria, thereby forming gas and bloating.
Gluten Intolerance
The topic of gluten, in general, is a complicated one.
At one end of the spectrum, we have the well-recognised case of coeliac disease, an autoimmune reaction to ingestion of gluten.
There is another entity to be distinguished from coeliac disease called non-coeliac wheat sensitivity (NCGS), also known as non-coeliac wheat sensitivity (NCWS). In this condition, the body’s non-specific immune system (innate immunity) reacts to components of wheat other than gluten.
Common symptoms include bloating, among others.
Some patients with NSGS eventually develop coeliac disease, but those who don’t suffer for years on end as their tests keep showing up normal all the time.
Histamine Intolerance
Histamine intolerance is caused by the excessive accumulation of histamine in the body, or the inability of the body to break it down.
We naturally produce the enzyme diamine oxidase (DAO) that breaks down histamine present in the foods we eat.
A DAO deficiency potentially leads to an accumulation of histamine that causes bloating amongst other symptoms.
Reasons for a DAO deficiency include the following:
Excess consumption of histamine-rich foods like alcohol, processed meats, fermented foods, shellfish, and more.
Small intestinal bacterial overgrowth (SIBO)
Medications that have DAO-blocking activity like some antibiotics, antidepressants and antipsychotic drugs.
Stress
The term stress was coined by Hungarian-Canadian endocrinologist Hans Selye as far back as 1936.
He defined it as the non-specific response of the body to any demand for change. Since then, lots of work in the area of stress has been done, and a lot more is still unknown.
However, the basic premise remains that the body’s physiology changes irrespective of the type of stress it is subjected to.
In other words, your body doesn’t differentiate between the type of stress it encounters from nutrition, physical or emotional trauma.
Now, your gut is supplied by the enteric nervous system and the vagus nerve, part of the parasympathetic nervous system.
In a highly stressed state, your body reverts into a state of sympathetic dominance.
In states of stress, the effects of the parasympathetic system are reduced, favouring the effects of the sympathetic nervous system.
So in essence, your digestive functions take a back seat as your body prioritises a fight or flight situation.
More specifically, here is what happens:
Diversion of Blood From The Gut
Blood is diverted away from the gut to the muscle organs ready for the fight-or-flight response.
Low Stomach Acid
Apart from its function in protein digestion, stomach acid also acts as a disinfectant by killing off any unwanted pathogens in the stomach.
Stress causes your stomach to produce less acid, leading to the growth of harmful bacteria potentially causing bloating.
Sluggish Liver and Gall Bladder
Normally, the liver produces bile which is stored in the gall bladder and recycled back through the small intestine.
This process helps with the digestion of fats and healthy maintenance of the gut microbiome.
In times of stress, levels of cortisol, also known as the stress hormone increase.
Cortisol in turn leads to a reduction in bile formation, consequently leading to less of it being recycled.
All of these changes above potentially lead to conditions like small intestinal bacterial overgrowth (SIBO) that can cause bloating amongst other symptoms.
Low Digestive Enzyme Production
Stress significantly impacts digestive function, especially enzyme production.
Infection
Gut infections can be acute or chronic.
In the former, the symptoms are short-lived and are usually due to having eaten contaminated food at home, restaurant, or after a trip abroad.
While most cases are self-limiting, other cases go on for months or even years.
When this happens, this is a clue there is some underlying dysbiosis-In other words, an imbalance between your gut’s good bacteria and bad bacteria.
Although a standard stool test requested by your GP might sometimes pick up infections like salmonella, Escherichia coli (E. coli), Salmonella, or Campylobacter, it isn’t the most comprehensive of tests.
To really get a detailed picture of your microbiome, you will need to resort to more advanced tests based on polymerase chain reaction (PCR) technology.
These tests map out your entire microbiome and show proportions of each type of bacteria present as well as parasites and other parameters.
Let’s look at some common infections you might have that cause bloating:
Candida
Although Candida albicans is the most common fungal infection seen, it remains a controversial topic when it comes to the gut!
Candida albicans is a fungus that naturally colonises the gut.
However, when the balance of the microbiome is altered, it can proliferate, leading to what is termed dysbiosis.
Dysbiosis can lead to bloating amongst multiple other symptoms.
Helicobacter Pylori (H. Pylori)
The story of H. Pylori is an interesting one. For years, the mainstream medical establishment believed ulcers were caused by lifestyle and stress—a rare case of mainstream medicine asserting the role of lifestyle in pathology.
However, two Australian researchers, Barry Marshall and Robin Warren went against the establishment.
They proposed the idea that gastritis (inflammation of the stomach) and ulcers were caused by a species of bacteria called Helicobacter Pylori (H Pylori) that lived in the stomach.
To prove the point, Barry Marshall gave himself an ulcer by drinking a culture of H. Pylori! He then biopsied his stomach to show the bacteria. Twenty-one years later, both Barry Marshall and Robin Warren were awarded the Nobel Prize in physiology.
As already mentioned above, H. pylori causes gastritis and ulcers, as well as bloating.
How Can You Fix Bloating?
We have discussed the causes of bloating above, but is there anything we can do to fix it?
In a way, this is a summary, as we have already briefly touched on some of the solutions.
However, here is a slightly more detailed review.
Elimination Diet
As previously mentioned, the simplest thing you can do to resolve a bloated stomach is going on an elimination diet.
This entails cutting out all gluten, dairy, sugar and, also histamine-rich foods.
The thought of no gluten, dairy or sugar sometimes alarms people, but all you have to do is choose whole foods.
Stress Reduction
We have already discussed the effects of stress on the body and more specifically the gut.
To curb the effects of stress, I recommend the ancient technique of meditation, exercise and, good quality sleep.
Meditation always seems an abstract concept to many, but it needn’t be so.
Simply put, meditation is a mental technique that aims to increase concentration, focus, and awareness.
Listening to every note or drumbeat of ones favourite song, counting one’s breath or heartbeat are simple ways of meditating.
Digestive Bitters
Digestive bitters have been used in ancient cultures for over 2000 years in ancient Egypt.
In essence, digestive bitters are herbs that stimulate digestion.
They work on the bitter receptors in the tongue, stomach, gallbladder and pancreas to secrete stomach acid, bile, and pancreatice enzymes.
The result is reduced bloating and overall improved digestion.
Digestive Enzymes
Digestive enzymes are proteins secreted by the body that help break down food into smaller absorbable forms.
Digestive enzymes can be bought as supplements, and usually contain a broad range of enzymes that break down carbohydrates, proteins and fats.
It is worth mentioning that there is a different category of enzymes called systemic enzymes which have a different role.
Comprehensive Stool Testing
If none of the above methods helps reduce your bloating, it might be time to have a more detailed look at your gut.
As we also mentioned above, a standard stool test requested by your GP has it’s limitations.
I prefer comprehensive stool tests based on polymerase chain reaction (PCR) technology.
These tests provide a detailed picture of your microbiome, revealing information like the proportions of each type of bacteria present as well as parasites, markers of inflammation, gut permeability, and much more.
Depending on your stool test results, you can then set out on a personalised treatment plan.
If you have any questions please comment below or send me an email.
To your gut health!
TAGGED:
bloating / low stomach acid / stress / gallbladder / infections / food intolerances
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