Bloating is a common and uncomfortable feeling that many describe as tightness, fullness, and gassiness in the abdomen. About 50% of those who experience bloating report that it is accompanied by a distended abdomen (when the belly appears swollen outward). It is most commonly associated with constipation, although there are other reasons, too.
Up to 90% of those with irritable bowel syndrome (IBS) experience bloating. However, even 10-25% of otherwise healthy people report occasional bloating, with 10% stating that they experience bloating regularly.
Bloating can also be associated with hormonal changes. For example, 75% of women report bloating before and during their period.
Functional medicine may help you explore why bloating is occurring by identifying potential contributing factors. Through various functional assessments, you may gain insights into managing bloating.
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What Causes Bloat?
Bloating is not a diagnosis but a symptom. Before addressing your bloating, it is important to understand the potential causes. Functional medicine can be helpful in this scenario because it considers individual differences. Your cause for bloating might be different from someone else's. Here are some of the top reasons why bloating may occur:
SIBO
Small Intestinal Bacterial Overgrowth (SIBO) is a condition where the bacterial population in the small intestine is abnormally increased. Specifically, in SIBO, there are types of bacteria present that are not typically found in this part of the GI tract.
SIBO is often associated with other GI conditions or even abdominal surgery. These circumstances may slow the transit of food and waste through the intestines, attracting various bacteria.
Common Symptoms of SIBO
- Loss of appetite
- Abdominal pain
- Nausea
- Bloating
- An uncomfortable feeling after eating
- Feeling full quickly
- Diarrhea
- Unintentional weight loss
- Malnutrition
Dysbiosis
Dysbiosis is an imbalance in the gut microbiome. More specifically, it is the reduction of diversity, where fewer beneficial microbes and more pathogenic microbes are present in the gut. Our microbiome is so vital to human life that some consider it on par with our other organs. Factors like antibiotics, high stress, and oxidative stress can contribute to this imbalance.
When dysbiosis is present, it may lead to changes in the intestinal walls, allowing for larger particles to pass into the bloodstream inappropriately. This process may contribute to inflammation, swelling, and bloat. Because the microbiome affects the whole body, those with dysbiosis may have symptoms outside of the digestive system.
Common Symptoms of Dysbiosis
Gut Symptoms:
- Abdominal discomfort
- Bloating
- Belching
- Nausea
- Changes in bowel movements
Skin Symptoms:
- Atopic dermatitis (eczema)
- Psoriasis
- Acne
Brain Symptoms:
- Fatigue
- Mood changes
- Difficulty concentrating
- Depression
- Anxiety
- Irritability
Exocrine Pancreatic Insufficiency (EPI)
The pancreas is a small organ responsible for producing many digestive enzymes. During EPI, the pancreas may not produce sufficient enzymes, leading to undigested food sitting in the small intestines. This undigested food can contribute to SIBO, and the bacteria in the small intestines can produce various gases, which may cause bloat.
Common Symptoms of EPI
- Bloating
- Diarrhea
- Foul-smelling, loose stools
- Greasy, fatty stools that float
- Flatulence
- Abdominal discomfort and cramping
- Unintentional weight loss
- Muscle wasting
- Nutrient deficiencies, including vitamins A, D, E, and K
- Mineral deficiencies, such as magnesium
Food Sensitivities
Food sensitivities occur when certain foods negatively react in the body. While they share some similarities with food allergies, food sensitivities activate a different part of our immune system. So, instead of an immediate reaction (like in a food allergy), there may be a delayed reaction of up to 2-3 days, making it challenging to identify.
Food sensitivities may lead to gut inflammation. This inflammation can then lead to various symptoms, including bloat.
Common Symptoms of Food Sensitivities
- Bloating, gas, and cramps
- Constipation
- Loose stools
- Skin conditions (eczema, acne, psoriasis, and dermatitis)
- Headaches
- Brain Fog
- Joint pain
- Anxiety or Depression (due to the gut-brain connection)
- Vitamin and mineral deficiencies
Premenstrual Syndrome (PMS)
During a menstrual cycle, there are normal hormonal fluctuations. Some women with more imbalanced hormones than others experience PMS, which can lead to emotional and physical symptoms. The water retention and swelling in the uterus as it prepares to shed are both potential contributors to bloating, a common physical symptom of PMS.
Common Symptoms of PMS
- Depression/anxiety
- Irritability, anger, crying easily
- Appetite changes or food cravings
- Sleep issues and fatigue
- Social withdrawal
- Difficulty concentrating or brain fog
- Changes in libido
- Breast tenderness
- Headache/migraine
- Acne
- Joint pain
- Bloating
- Constipation or diarrhea
Functional Medicine Labs to Explore Potential Causes of Bloat
SIBO
One way to explore SIBO is through breath testing, as the bacterial overgrowth may produce certain gases detectable in the breath. The trio-smart SIBO Breath Test examines hydrogen, methane, and hydrogen sulfide, the three primary fermented gases found in the gut microbiome. Measuring all three may help reduce false positive/negative results.
Dysbiosis
The GI-MAP is a comprehensive stool analysis that measures gastrointestinal microbiota DNA. It can evaluate various pathogens, including bacteria, yeast, viruses, and parasites. Looking deeper into the makeup of your microbiome may help you understand the overall balance. If sufficient diversity and beneficial microbes are present, then dysbiosis is less likely. However, if pathogenic microbes are detected and there is low variety, then dysbiosis may be more likely.
EIP
To explore pancreatic exocrine insufficiency, testing for Fecal Elastase-1 in the stool can be helpful. Values under 200 are considered indicative of this condition.
Food Sensitivities
There are many food sensitivity tests available. The FIT 132 test is unique because it measures food sensitivities and inflammation by testing for IgG1-4 and Complement Activation via C3d. This means that the only foods that will show up positive are ones that actually activate an immune response in your body. Testing this way may help reduce false positives, which can significantly aid the compliance factor of an elimination diet (because fewer foods will need to be removed from the diet).
PMS
Because PMS is strongly related to hormonal imbalances, a thorough hormone test, like the DUTCH Cycle Mapping test, may be useful. This test evaluates the hormonal pattern throughout an entire menstrual cycle. This test uses dried urine, which can provide more comprehensive information than a blood test that only detects levels at the moment of the blood draw.
Functional Medicine Approaches to Support Digestive Comfort
SIBO
A Low FODMAP diet is often suggested to help manage SIBO. The acronym stands for Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols, all short-chain carbohydrates that quickly ferment in the intestine. This is a 3-step elimination diet that typically lasts 12 weeks.
Along with the diet, herbal antimicrobials may be considered to help manage the microbes in the small intestine. The specific herbs depend on the type of dominant gas. For example, Allicin is often used if Methane is dominant, while Berberine is used if Hydrogen is dominant.
Dysbiosis
Addressing dysbiosis may include nutritional changes and various supplements to help support the microbiome. A nutrient-rich plant-based diet, such as the Mediterranean diet, is often suggested to help nourish healthy gut microbes in the hopes of shifting the overall balance to a healthier one.
Probiotics and prebiotics (the food for the probiotics) may be helpful for supporting gut balance. These can either be consumed as foods (a probiotic example is fermented foods; prebiotic foods include banana, garlic, artichoke, and chicory root) or taken as supplements. Ginger is also considered beneficial for supporting digestive health.
EIP
Pancreatic exocrine insufficiency may have various contributing factors, which may take some time to address. In the meantime, Pancreatic Enzyme Replacement Therapy (PERT) may be considered. There are many different types of digestive enzymes available as supplements. When considering PERT, look for enzymes containing lipase (to help digest fats), protease (to help digest proteins), and amylase (to help digest carbohydrates) to cover the span of what is necessary for digestion.
Food Sensitivities
An easy way to remember how to address food sensitivities is to think of the four Rs. Each R stands for a different part of the protocol: The first R is Remove, where you eliminate the foods that were positive on your food sensitivity test. The second R is Replace, where you replace these foods with more nutrient-dense and less inflammatory foods. The third R is Reinoculate, where you use probiotics and fermented foods to support the microbiome. The fourth R is Repair, where you support the gut lining using various helpful supplements such as L-Glutamine, Zinc, Curcumin, and Vitamin D, among others.
PMS
A healthy plant-based diet and herbs are often suggested for supporting PMS management. The specific herbs that are most commonly considered are Vitex and Evening Primrose, although there are others, too. Reducing endocrine disruptors, which are chemicals that can alter our hormones, is also important. A healthy, gentle liver detox may help support PMS symptoms.
Summary
Bloating is an uncomfortable feeling that many experience. However, it is not an actual diagnosis, meaning that we need to explore further to understand the potential causes of the bloating, and there are many possible contributors.
There are gut-specific contributors, such as dysbiosis, the imbalance of the gut microbiome, and SIBO. Pancreatic insufficiency is also a possible contributor because it may lead to undigested food in the intestines (which can contribute to dysbiosis and SIBO). Food sensitivities are also common and should be explored on an individual basis. It is also important to remember that hormones can play a role in bloating. The shifts experienced by those with PMS may also lead to bloat.
Functional medicine can be used to explore underlying contributors to bloat so that you can understand where it is coming from and why. A functional medicine approach to support focuses on addressing those underlying contributors to help you achieve digestive comfort.
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