Susan had written \u201cBLOATED!\u201d in the section marked \u201cWhat\u2019s the main problem?\u201d She told me she\u2019d been suffering for years, her stomach feeling like some gremlin was inflating a balloon every time she ate. When the bloating was especially severe, Susan said she looked like she was in her fifth month of pregnancy. She was even embarrassed to accept dinner invitations. \u201cYou can actually see my stomach expanding. I have to wear elastic waistbands\u2026it\u2019s horrible!\u201d<\/p>\n\n\n\n
Susan had visited a couple of gastroenterologists, who quickly asserted the problem was irritable bowel syndrome (IBS), though she had neither of the two IBS mainstays, diarrhea and\/or constipation. Her colonoscopy was completely normal. She\u2019d been prescribed all the standard stuff for IBS: bulking agents (e.g., Metamucil), antidepressants (e.g., Prozac), and antispasmodics (e.g., Bentyl). Since she wasn\u2019t particularly constipated, she was never prescribed the two newer meds for constipation-related IBS (LINZESS and AMITIZA).<\/p>\n\n\n\n
One gastroenterologist gave her an honest shrug of his shoulders, telling her \u201cWe just don\u2019t know.\u201d On the plus side, despite the misery of her symptoms, \u201cbloated\u201d has never, in the history of medicine, appeared on anyone\u2019s death certificate. On the downside, being bloated can truly impair your quality of life, ruining day-to-day enjoyment of meals and activities. It\u2019s especially frustrating when you hear over and over again the mantra of modern medicine, \u201cWe can\u2019t find anything wrong with you\u2026all your tests are normal.\u201d<\/p>\n\n\n\n
Subjective symptoms are those you report to your doctor as physical sensations. A physical examination, including an abdominal exam, may show you\u2019re perfectly healthy. When you\u2019re with your doctor, you might say something like, \u201cI just feel so full and gassy every time I eat. I want to belch but nothing happens.\u201d What you really feel like doing is isolating yourself and passing gas until you empty out like a deflating balloon. But no such luck.<\/p>\n\n\n\n
When bloating becomes severe, it\u2019s accompanied by very visible distension, or expansion, of your abdomen. Seen at the right moment, your doctor will nod in agreement.<\/p>\n\n\n\n
As Susan learned early on, bloating is on the list of the numerous symptoms associated with irritable bowel syndrome (IBS), a condition that in one way or another affects about 25% of the population. Symptoms of IBS are just what you\u2019d expect: constipation or diarrhea (or a blend of the two), GERD (gastroesophageal reflux disease, or heartburn), indigestion, nausea, pain, and cramping. However, some IBS sufferers experience bloating with or without belly distension and no other IBS symptoms.<\/p>\n\n\n\n
Not surprisingly, a lot of research has gone into IBS and bloating. In most cases, the answer is still elusive. The reason for the mystery is that there are so many possibilities, which explains why a treatment that works miracles for one patient will do absolutely nothing for the next. Patient A, for example, might eliminate gluten from her diet and find she\u2019s cured. Patient B eliminates gluten and now she grievously misses her croissants but remains as bloated as ever. A third patient eliminates gluten and feels maybe 50% better, but when she adds acupuncture to the mix she\u2019s almost cured.<\/p>\n\n\n\n
Let\u2019s see where you can start. First, nutritional approaches and useful diagnostic tests:<\/p>\n\n\n\n
1–Food sensitivity elimination diet<\/u>. If a particular food is an issue, you\u2019ll usually get a clear answer. For two weeks, completely eliminate all dairy, egg, corn (and corn products), gluten grains, citrus, and soy (and soy products). If you\u2019re feeling better, add one food group back every three days until feeling crummy again indicates you\u2019ve located the culprit. If you feel exactly the same after the elimination\/reintroduction period, then food sensitivity is not an issue. Move to steps 2, 3, and 4.<\/p>\n\n\n\n
2–Reduce your FODMAPs<\/u>. A lot of recent research has shown that reducing foods containing FODMAPs can help IBS and bloating. The letters stand for fermentable oligosaccharides, disaccharides, monosaccharides, and polyols<\/strong>, which are gas-producing, short-chain carbohydrates. The FODMAP diet, though not difficult, is best undertaken with professional supervision. I\u2019d recommend an appointment with one of our nutritionists. Unlike many programs, the low-FODMAP eating plan is not<\/em> a lifetime diet. Many high-FODMAP foods can be reintroduced once your symptoms are under control.<\/p>\n\n\n\n 3–Comprehensive Stool Digestive Analysis with test for parasites and candida<\/u>. You\u2019ll get a kit to take home, where you\u2019ll collect some poop and FedEx it to the lab for a detailed testing of your digestive processes, bacterial balances, and the presence (or absence) of parasites. Most insurers cover the lion\u2019s share of this test, though there\u2019s usually some out-of-pocket expense. When test results are positive, they\u2019re usually caused by:<\/p>\n\n\n\n 4–Breath Test for Bacterial Overgrowth in your Small Intestine (SIBO)<\/u>. <\/strong>This kit contains a harmless sugary liquid to drink and a very clever system to collect samples of your breath. You\u2019ll FedEx your breath to the lab for analysis (anyone else chuckling at that sentence?). Again, insurers cover much of the cost. A positive test result will show an excessive amount of hydrogen and methane in your breath. Check this link for a typical positive test result. Treatment for significant bacterial overgrowth can include natural products containing <\/a>essential oils and herbs<\/a> or a prescription antibiotic called Xifaxan.<\/p>\n\n\n\n If those approaches to your bloating yield absolutely nothing of use, try any of these well recognized treatments. At least one of them should give you some relief, and if you do get relief, add a second to see if you\u2019ll do even better.<\/p>\n\n\n\n The solution to Susan\u2019s bloating turned out to be fairly straightforward. Her SIBO Breath Test was very<\/em> positive for significant bacterial overgrowth, and even before the results were back from the lab she was improving with a low-FODMAP eating plan. We went right to the prescription intestinal antibiotic and she\u2019s now pretty much symptom-free.<\/p>\n\n\n\n However (and she\u2019s prepared psychologically for this), bloating symptoms can return in a few months as gas-producing bacteria regenerate. It\u2019s not uncommon to need a course of antibiotics each year or two, but we\u2019ll make every effort to keep her symptoms at bay with periodic use of the natural antibiotics.<\/p>\n\n\n\n Be well, Susan had written \u201cBLOATED!\u201d in the section marked \u201cWhat\u2019s the main problem?\u201d She told me she\u2019d been suffering for years, her stomach feeling like some gremlin was inflating a balloon every time she ate. When the bloating was especially severe, Susan said she looked like she was in her fifth month of pregnancy. She was […]<\/p>\n","protected":false},"author":2087,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[2,531,29,2335,256,3,2315,2314],"tags":[142,1803,736,161,1017,1370,137,183,30,1154,1804,1805,1156,1229,1341,344,725,162,1031,1342,1806,822],"class_list":["post-7320","post","type-post","status-publish","format-standard","hentry","category-blog","category-case-studies","category-digestion","category-homeopathy","category-i","category-knowledge-base","category-most-comments","category-most-view","tag-acupuncture","tag-bloated","tag-bloated-feeling","tag-bloating","tag-candida-yeast-infections","tag-chinese-medicine","tag-digestion","tag-digestive-enzymes","tag-digestive-health","tag-elimination-diet","tag-fodmaps","tag-food-sensitivity","tag-food-sensitivity-diet","tag-homeopathy","tag-ibs","tag-irritable-bowel","tag-irritable-bowel-syndrome","tag-nutrition","tag-probiotic","tag-probiotics","tag-sibo","tag-yeast"],"yoast_head":"\r\nNext steps<\/strong><\/h3>\n\n\n\n
David Edelberg, MD<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"