A distended abdomen, a condition commonly described as bloating or bloatedness, is something most women suffer from and an increasing amount of men are starting to admit to. Having to compromise your wardrobe to accommodate those ‘I can’t bear anything restricting my midriff’ days, makes for many a frustrating clothes shopping experience. Many women have been asked: “When is your due date?”, when they are not even considering pregnancy. What causes this embarrassing and often painful physical condition?
A bloated stomach can occur for many different reasons. The most obvious instance is when we eat too much and our stomachs naturally distend to accommodate the excessive amount of food. But too often we are unable to identify the triggers of recurring bloating. The following triggers are commonly associated with abdominal bloating:
- Irritable Bowel Syndrome (IBS)
- Food Intolerances and Allergies
- Candida or yeast overgrowth
- Hormonal Imbalances
- Lack of digestive enzymes
- Intestinal permeability, commonly referred to as Leaky gut
- Parasites and dysbiotic bacteria
- Insufficient good gut bacteria such as Lactobacillus and Bifidobacterium
- Stress, related to abnormal or elevated cortisol secretion
I see many patients who suffer from IBS and their major complaints are constipation, diarrhoea and bloating. A recent patient commented that her goal is to be able to look feminine again. I was perplexed until she explained that she just wants to be able to wear girlie clothes rather than androgynous, sack-like outfits.
Isolating the cause
The most frustrating part about being bloated is that many people spend their lives experimenting with different treatments without successfully eliminating the symptoms. Identifying the root cause of bloating may require a comprehensive investigation into past medical history, dietary habits and lifestyle choices.
A general practitioner is well equipped to determine if there is cause for concern about structural damage to the abdominal cavity and arrange a referral to a specialist gastro-enterologist. Once structural damage has been ruled out, the next step is to investigate the status of the gastro-intestinal tract through a comprehensive stool analysis. This non-invasive test can assess the status of the good gut bacteria, such as Lactobacillus and Bifidobacterium, and identify any dysbiosis with regards to unwanted bacteria, parasites and possible yeast overgrowth, commonly referred to as Candida.
The next step includes a comprehensive dietary analysis. A diet rich in refined carbohydrates, sugar and excess salt may exacerbate bloating. Sugar is believed to feed Candida and certain unwanted bad bacteria and parasites. Sugar is also detrimental to organs involved in blood sugar control, such as the liver and pancreas. Today’s frenetic pace of life makes it all too convenient to choose refined carbohydrate type foods that give us perceived instant energy. Most meals are consumed on-the-run while we give in to demands on our time. Consequently, we tend to have limited opportunity to sit around a table eating a meal prepared the old fashioned way.
The increased consumption of ready meals, due to time restraints and inability to cook, has seen a significant increase in sodium intake. Excessive, regular sodium intake is often associated with hypertension (high blood pressure) and oedema (swelling). It is shown that high, dietary sodium intake can lead to osteoporosis because sodium increases the loss of calcium via the urine. Common dietary sources of sodium include processed food to which salt has been added during preparation like pickles, cheeses, soups, crisps, pretzels and most ready meals with an extended shelf life. Some restaurants may add extra salt to food, thereby encouraging fluid consumption, which is more lucrative for the proprietor. Consumption of excess salt combined with insufficient hydration may present in noticeable abdominal bloating.
Eating fast or rushing meals obviously impacts on the second phase of digestion, the mechanical breakdown of food by means of chewing. The first phase (the cephalic phase) occurs when sight and smell stimulate the digestive organs to prepare for the work which is about to follow. Mastication is necessary to break food into smaller, more easily digestible parts upon which the stomach acid can act. To maximise absorption of nutrients from any given food, our physiology requires every mouthful to be as small as possible in order for the vast array of digestive enzymes to be most effective. Due to the space constraint in the stomach it is not practical for food to stay in such a constricted environment for an indefinite period of time. Gastric emptying occurs at regular intervals and larger food particles that have not been digested properly can potentially become toxic in the colon. These large food particles of undigested food can ferment in the big bowel and cause abdominal bloating.
The current financial crisis demands increased productivity which often necessitates longer hours spent working towards an expected deadline and unrealistic targeted goals. The longer working day inadvertently diminishes time for exercise and relaxation which has a significant impact on our ability to handle stress. The physiological effects of sympathetic nervous system stimulation, or commonly referred to as the flight-or-fight response, include pupil dilation, increased heart rate and contraction, elevated cortisol levels and the inhibition of peristalsis in the gut, which effectively means your digestive system is on strike. Nutritional demands, when stressed, are more than when we are in a state of calm, Nirvana-like bliss. Combine the increased secretion of cortisol, which elevates your blood sugar, with eating a refined carbohydrate meal and a cup of coffee while your digestive system is on vacation, and the unwanted symptom of bloating may be apparent.
Recently the increase in food sensitivities or intolerances have been noted. These non-allergenic food hypersensitivities are believed to be caused by an enzyme deficiency, chemical sensitivity or may even be associated with an immune response related to food specific antibodies called IgG antibodies. These IgG antibodies recognise and bind to specific food proteins to form immune complexes in the body, which leads to an abnormal physiological response and may cause a myriad of symptoms including bloating. Patients who suffer from ulcerative colitis and Crohn’s disease have been able to alleviate symptoms associated with food sensitivities by eliminating certain trigger foods . It may therefore be greatly beneficial to assess food intolerances by means of testing or dietary food rotation as a means of establishing whether consumption of certain trigger foods are indeed the cause of bloating.
There are a multitude of conditions that share one common recurring symptom, bloating. For many sufferers this may also be associated with abdominal pain and discomfort. Many women and an increasing number of men appear to be affected by this recurring affliction, desperately seeking relief. Without proper diagnosis it is all too easy to apply costly, ineffective remedies which may, at best, offer short term relief. With the increasing availability of non-invasive testing methods, it is now possible to accurately pinpoint the root of the problem and address it with the most effective treatment. This type of health investment may yield priceless long term returns and directly impact on your quality of life.
1. He FJ, He FJ, MacGregor GA. Reducing population salt intake worldwide: from evidence to implementation. Progress in Cardiovascular Diseases (0033-0620). Vol. 52, Iss. 5; p.363-82. 2010
2. Triggs et al. Dietary factors in chronic inflammation: Food tolerances and intolerances of a New Zealand Caucasian Crohn’s disease population. ScienceDirect Journals. 2010
Golan, R. Optimal Wellness. Ballantine Books. New York. ISBN 0-345-35874-0
This article was published in Positive Health On-Line Magazine in 2010