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)
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
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.