Episode 74 – Strategies to Manage Bloating

Key Topics Covered

What is bloating? 

  • Bloating is defined as the abdomen feeling full and expanded. And the cause is typically a build-up of trapped gas or a disturbance of the digestive system. 
  • I think defining this is important because it helps us address the problem specifically
    • For example, bloating can sometimes get piled in with other complaints such as weight gain and water retention but it is separate to these things  

The Basics to Reduce Bloating

  • Starting with more common, but boring stuff, before moving on to more interesting approaches. 
  • Eat slower and chew more thoroughly. This is the most boring one, but it works well in a lot of cases. 
  • Minimise consumption of carbonated drinks + chewing gum. 
  • Rule out other medical conditions (IBD, Coeliac, etc + also check for a diagnosis of IBS if you haven’t already) 

Fibre 

  • While common advice to increase fibre intake can help in some cases, it also can cause issues at times too. 
  • Quickly increasing fibre intake typically contributes to bloating.
    • Your body adapts and can typically handle this better over time.  
    • But very high-fibre diets are still linked with bloating.  
  • Certain types of fibre are more likely to cause issues such as inulin (or chicory root).
    • This is a great prebiotic source of fibre, but it is a common trigger for bloating.  
    • Some products have it in large amounts e.g. it is the largest ingredient by weight in a fibre one bar (5g fibre per bar) and sometimes people have 2 in a day. 

Sugar Alcohols 

  • Sugar alcohols are added to a lot of low carb products to reduce the carb and sugar content 
  • Common ones include maltitol, erythritol, xylitol and sorbitol. 
  • These are notorious for causing bloating and other GI symptoms when consumed in large amounts. 
  • These cause symptoms in pretty much everybody if the dosage is high enough. I’ve seen research showing that it takes >25g of maltitol for most people to notice symptoms. But what if you 1) are more sensitive to it? 2) Have multiple foods that are potential triggers, causing a stacking effect? 
  • One of the first places I recommend looking at is whether you have a high intake of sugar alcohols 

FODAMPs 

  • FODMAPs are fermentable forms of carbohydrates or sugar alcohols.  
  • This fermentation process in the large intestine can lead to an increase in gas, which can contribute to bloating. 
  • Not all FODMAPs will typically be a trigger. Often it is just a few groups.  
  • Ideally you only think about FODMAPs if you have to. If you can manage the bloating without that, it’s easier. 
  • The goal standard is to go low-FODMAP and then reintroduce stuff systematically to identify triggers. 
  • Not a long term solution etc etc 
  • In the show notes we have a link to a comprehensive guide to the low FODMAP diet 

Caveat – for those on a plant based or vegan diet, sometimes bloating can become a problem simply due to an overall high FODMAP load and sometimes just actively reducing overall load a little can be what is needed to reduce excessive gas retention  

Food Volume 

  • There are a few things to think about with food volume. 
  • The obvious one is that a large amount of food can make you feel full. And this could feel similar to being bloated, even though it is a separate feeling. There could be an overlap 
  • More food could = more fibre 
  • More food could = more exposure to triggers e.g. FODMAPs or other intolerances 

Peppermint Oil 

  • Peppermint oil prior to meals has solid evidence that it can help bloating. 
  • On average, it improves IBS symptoms including bloating, by 44%, according to a 2019 systematic review 
  • The mechanism is that it relaxes the intestines, allowing trapped gas to pass through   
  • MINTEC is the one that we recommend – linked down below
     

Probiotics 

  • In some cases, probiotics can help. 
  • A systematic review from 2013 identified that on average, probiotics outperformed placebo in helping reduce bloating 
  • Not every study is consistent though. It very much depends on the dosage and the strain. 

Constipation 

  • Constipation can contribute to bloating due to trapping the gas in the intestines 
  • Addressing this aspect is crucial and cannot be stressed enough. 
  • Whilst the previous things we have spoken about can help, you will need to deal with the root cause of the bloating (constipation) for optimal symptom relief  
  • Episode 11 was on nutrition for constipation, so could be relevant 

Relevant Links/ Resources

Studies Mentioned:

Relevant Resources:

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