Belly Fat Be Gone: Ways To End The Bloat

WHAT IS BLOATED BELLY?
Bloating refers to a feeling of pressure or discomfort—just short of pain—somewhere in the abdominal area, and/or visible distension of the abdomen that makes your waistline grow. It may affect the top of the abdomen right underneath the breastbone, the lower part of the abdomen underneath the belly button or the entire midsection more generally. Bloating is a symptom, not a medical condition in and of itself.

WHAT CAUSES A BLOATED BELLY?

Bloating usually results from an accumulation of substances passing through the digestive tract, or the abnormal handling of these substances by the nerves or muscles in charge of sensation and motility in your stomach or intestines. This means that the pressure sensation or distension you experience when bloated is typically triggered by one or more of these three things moving through the digestive system:

• Gas (either swallowed air or produced by the bacteria in your intestines)
• Food
• Stool

Bloating can be caused by many different medical conditions that range from completely benign to quite serious. Ten medical diagnoses associated with abdominal bloating are among the most common, however, and these are the ones taken up in detail in The Bloated Belly Whisperer.

HOW DO I FIGURE OUT WHAT IS CAUSING MY BLOATED BELLY?
The Bloated Belly Whisperer contains a quiz that can help narrow down the more likely causes of your bloating, and you can read about the top contenders to see which may sound familiar.

A visit to a gastroenterologist and/or a registered dietitian (RD) is also great place to start when seeking the cause of your bloated belly. Generally, they will try to examine the clues which would indicate whether your bloating originates in the stomach or intestines, though certainly it’s possible to have problems that produce bloating in both regions.

If your bloating is concentrated toward the top of your abdomen, or is accompanied by other “upper GI” symptoms like nausea, burping, loss of appetite, vomiting or heartburn—it’s more likely to have its roots in the stomach. If your bloating is concentrated underneath the belly button, or is accompanied by “lower GI” symptoms like diarrhea, constipation, cramping, excess intestinal gas (farting) or gas pain—it’s more likely to have its roots in the intestines.

Once your healthcare provider has a hypothesis about the cause of your bloating, s/he may order diagnostic tests to confirm it or just try treating you with the medicine, supplements and/or diet therapies for that condition to see if you respond.

HOW DO YOU KNOW IF YOUR BELLY IS BLOATED OR JUST PLAIN FAT?

Belly fat stays put morning, noon and night, and is visible whether you’ve eaten or not, whether you’ve pooped or not and whether you’ve got gas or not. Belly fat also becomes reduced when you lose weight. True “bloating” from a digestive cause will not improve with weight loss and typically waxes and wanes in conjunction with eating or pooping. It is typically better or worse at different times of day or in relation to certain eating behaviors.

 WHAT CAN I EAT IF I DINE OUT FREQUENTLY?

While the dietary specifics will vary by type of bloating, there are a few common attributes to restaurant cuisines that will render them more likely to agree with the majority of people who struggle with bloating. These include:

• menus/cuisines not too centered around garlic or sauces
• availability of lower-fat options
• large selection of appetizers or small plates to facilitate portion control

In practical terms, many people who struggle with bloating find that they do the best at the following types of restaurants:

Japanese/sushi restaurants: Sushi and miso soup meet the criteria above, and generally fit well with both the GI Gentle and Low FODMAP diets described in The Bloated Belly Whisperer. Japanese cuisine also has options for people with celiac disease following gluten-free diets.

• Steakhouse: While steaks themselves may aggravate certain types of bloating due to their high fat content or tough texture, typical steakhouse menus offer a variety of low-fat, minimally adorned seafood options, like grilled fish/shrimp, seared scallops and shrimp cocktail.
• They also offer baked potatoes and un-sauced vegetables that can cooked and seasoned to order with or without garlic, like sautéed spinach, asparagus and broccoli. People on GI Gentle, Low FODMAP and gluten-free diets can all find numerous suitable options on these a la carte menus.
• Diners: An omelet is usually a safe bet for people with many different types of bloating, and diners typically offer a whole host of them for breakfast, lunch or dinner. Omelets can be customized to include the ingredients you tolerate best as detailed in Chapters 11 on fiber and Chapters 12 and 13 that cover the main therapeutic diets for bloating.

I EAT HEALTHY, EXERCISE, AND JUST CAN’T SEEM TO LOSE THE BLOATED BELLY, WHAT ARE MY OTHER OPTIONS?

Seek professional help! A good gastroenterologist is a reasonable place to start, especially if your bloating is accompanied by other GI symptoms, like irregular bowel movements, abdominal pain, heartburn, nausea or excess gas. I’d ask friends or read online reviews to find someone with a reputation for taking the time to sit and talk with you as a new patient so they can gather detailed, and relevant information to help narrow down the likely cause of your problem.

A qualified dietitian, especially one who specializes in GI issues, is also a good option, especially if you’ve noticed a strong relationship between food choices and bloating symptoms. Dietitians are food and nutrition experts. When they meet with you, they ask very different types of questions than a doctor would, and are far more likely to inquire how different foods affect your symptoms and in what time frames.

A dietitian—particularly one who is experienced with gastrointestinal disorders—should have the type of specialized knowledge to help interpret the meaning of different adverse food reactions, and use this information as a clue toward the cause of your bloating. Dietitians are also likely to spend more time with you than would a typical doctor.

Dietitians cannot diagnose medical conditions. But they can “prescribe” diet changes based on a known or suspected medical diagnosis to observe how your symptoms respond to the change. Your response to a diet change—or even lack of response—will often provide helpful data to a medical doctor tasked with diagnosing and treating you.

Most people with one of the ten types of bloating discussed in The Bloated Belly Whisperer will notice a significant improvement in their symptoms within days of initiating the correct therapeutic diet for their condition, whether or not they’ve been given a formal diagnosis.

 WILL PROBIOTICS CURE MY BLOATED BELLY?

Probiotics get a lot of press with regard to digestive health, but it’s unlikely that they’ll cure a bloated belly.

Most causes of bloating that originate in the intestines aren’t likely to respond to probiotic supplements, and Chapter 14  reviews the scientific research behind a variety of popular probiotic brands and bacterial strains to summarize which products have demonstrated benefit for improving which digestive symptoms.

One issue for which a probiotic may have some utility is constipation-related bloating; a select few species/strains of probiotics have demonstrated promise in increasing frequency of bowel movements—and this can help relieve bloating as a result. These are discussed in Chapter 14. In reality though, if a probiotic is going to help address constipation, it’s far more likely to help as one component of a multi-pronged strategy that involves other interventions as well. Probiotics are rarely a single “silver bullet” for constipation.

If your bloating originates in the stomach, probiotic supplements will probably be useless. Probiotic pills are coated to survive the stomach’s acid environment, so the bacteria contained within them will not be released until the pill arrives into the intestines. Also, exceedingly few species bacteria can survive and function in the low (acidic) stomach pH–and certainly none of these are included among those marketed as commercial probiotics.

DOES STRESS PLAY A PART IN A BLOATED BELLY?

For some people it can. Many hormones related to the stress response act on receptors in the gut, and these affect both motility and the pain response. This means some people may have a heightened sense of discomfort from even normal amounts of gas and stool in their gut when they are exceptionally stressed, while others may find themselves prone to too-fast or too-slow motility patterns, either one of which can aggravate feelings of discomfort and bloating.

WHAT DOES IT MEAN IF YOU HAVE A BLOATED BELLY THAT FEELS FIRM/HARD?

A: It often suggests the possibility of a high stool burden—constipation—or what I refer to as the “Backed up bloat.” This may or may not be accompanied by lots of gas.

However, there are other less common but more serious conditions that a hard, distended belly can suggest. Certain cancers, like colon cancer and ovarian cancer, can present with a bloated belly, as can advanced liver disease. These produce bloating as the result of a tumor or excess fluid in the gut or abdominal cavity—not gas, food or stool.

If you have a family history of colon cancer, ovarian cancer or are a known carrier of the BRCA gene, it is prudent to consult your doctor if you begin to develop a bloated belly, particularly if your belly’s distension never goes down under any circumstances, like being fasted or having a complete bowel movement.

Other signs that something potentially serious may be happening that needs to be investigated include:

• Unintentional weight loss of more than a few pounds
• Blood in your stool
• Recurrent vomiting
• Jaundice (yellowing skin or yellowing of the whites of your eyes)
• Nutritional deficiencies, such as anemia
• Fever

DOES CONSTIPATION CAUSE YOUR STOMACH TO BLOAT?

Yes, it can; see above. Sometimes people don’t realize they’re constipated because they move their bowels somewhat every day. But if you’re taking in more fiber than you’re pooping out, you can have a back-up of stool that produces a distended, bloated belly.

Freuman answers your “Text Tom” questions on the next page. 

Is my bloated stomach due to little exercise over 40 or meds (aygestin) to reduce my periods?
Unfortunately, without meeting you, talking with you and learning about your diet history and your symptoms, I have no way to give you an informed answer to that question. When I meet with a patient to give them a personalized assessment, we sit together for a full hour and I ask dozens and dozens of questions and gather loads of info about your medications, diet, symptoms, weight, everything. Just knowing your age, exercise patterns and one medication doesn’t give me enough data to go on.

What’s the difference between the stomach and the gut?
Gut refers to your intestines, where nutrients are absorbed and waste is handled. Stomach refers to your stomach—the ‘blender’ that liquifies your food with acid and squeezing so that its liquid enough to pass into the intestines (gut ) on its digestive journey.

My stomach is bloated every morning…is there a reason why?
There’s always a reason why. Take the free quiz on my website (www.thebloatedbellywhisperer.com) to see if it helps you narrow it down. Some people wake bloated because they’re constipated and full of poop. Some who use a CPAP machine for sleep apnea may swallow lots of air when they sleep. Some people may have slow stomach emptying and still be full from eating a lot the night before. My quiz should help you narrow down the more likely possibilities.

Do different types of sugar/sweeteners affect the body differently and cause bloating? For example honey, raw sugar, agave, brown sugar?
They definitely can, but not for everyone. The main difference between the sweeteners you list is that honey and agave are high in fructose compared to sugar and brown sugar. A certain percentage of people have something called fructose intolerance (which is like lactose intolerance, but for fructose) in which they don’t absorb fructose very well. In these cases, about 4-8 hours after consuming fructose, they may find themselves gassy, bloated and/or subject to loose stools or diarrhea. There is a breath test available that can diagnose fructose intolerance.

How can I cure bloating if I have had gastric bypass surgery? 
Make sure you’re not overeating for starters. Avoid sugar-free products sweetened with sugar alcohols like sorbitol, xylitol, maltitol (anything that ends with “ol”) or that use an added fiber called inulin (chicory root). If you find that many foods still give you bloating/gas, ask your doctor whether you might have something called SIBO (Small Intestinal Bacterial Overgrowth), which is a common side effect of gastric bypass surgery, as bacteria can overgrow in the blind loop of bypassed bowel. This is treatable with antibiotics.

Does taking iron help swelling?  I hear watermelon has iron, is that true?
Iron does not help “swelling”, by which I think you mean fluid retention? Potassium is what helps reduce fluid retention, and it can be found in coconut water, bananas, avocados, oranges/citrus, potatoes/sweet potatoes, tomatoes, dried apricots, lowfat dairy products (milk, yogurt) and a variety of other foods.

If you actually need more iron in your diet due to anemia, then watermelon has no iron. Iron-rich foods include red meat, some fish (shrimp, sardines…), beans/lentils, instant/fortified oatmeal and other cereals (Cheerios etc), tuna, prunes, dark chocolate (hooray!) and blackstrap molasses. Taking some Vitamin C or eating Vitamin C rich foods WITH iron-rich foods can help improve absorption. Among these are red peppers, broccoli, tomatoes, strawberries, kiwi and citrus fruits.

I have breast cancer and with the chemo and the medication that I’ve been taking my stomach blew up. Did it come from the medications?
I can’t say for sure, but certainly if the belly “blew” up coinciding with the medications, it seems like a reasonable guess. From this question I can’t tell if you’re referring to belly fat gain or a digestive bloating, though… I imagine your doctors have seen many people use this medication and can give you some better insight as to how it affects weight and/or digestive function.

 Do you recommend summer savory to cut the gas in food?
No–I have never recommended summer savory for this purpose. The only herb I know of that *may* have a mild anti-gas effect is fennel seed, but this is more of a folkloric derived benefit than an evidence-based one.

I have hypothyroidism is there something I can do to encourage weight loss?
First, to make sure your medications are calibrated properly to maintain balanced hormone thyroid hormone levels. Second, I typically recommend people try to front-load their calories to the first part of the day (pre- 4pm) with a substantial breakfast and make lunch the main meal of the day—balanced with lots of veggies, some protein and a small portion of a carb.

If dinner is to be late, a small 4pm snack is a good idea so that you don’t arrive starving to the dinner table. Making dinner a smaller, LOW CARB meal (just protein and veg) and no more eating after dinner helps align the day’s intake with your metabolism’s normal daily rhythms and encourage weight loss. I call this the “circadian synced diet.”

Are there any probiotics without lactobacillus? Do onion and garlic powders cause bloating?
There are many probiotics without Lactobacillus. One national brand is called Florastor. Onion and garlic powders can cause bloating from excess gas to susceptible people—as onions/garlic contain a type of carbohydrate called a “fructan” which is poorly digested by people but well digested by the bacteria living in our guts.

Tamara Duker Freuman is the author of The Bloated Belly Whisperer: See Results Within a Week and Tame Digestive Distress Once and For All Freuman, a Registered Dietitian (RD) and New York State Certified Dietitian-Nutritionist (CDN) who holds a Master of Science degree in Clinical Nutrition from New York University, is a nationally-known expert in digestive health and medical nutrition therapy for gastrointestinal diseases.  

Freuman graduated summa cum laude from Duke University, has a Master’s of Science degree in Clinical Nutrition from New York University, with her clinical training completed at Mount Sinai Medical Center.  She also holds Master’s of Science degree from Georgetown University’s School of Foreign Service.

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