Bloating Causes, Testing, And Natural Treatments

Podcast Intro and Episode Setup 0:00

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This is Doctor Talks, real talk from real doctors on only issues that matter to you. Most. I'm joined here today with Doctor Williams, one of the doctors at Modern Med, and we're going to be talking about all things bloating. So we're going to be talking about bloating in the gastrointestinal tract. It is by far the most common complaint of our patients, people that come to see us for help. And so I want to kind of dig into what it is and we'll go from there. Welcome. And Doctor Williams, good to have you.

Thank you. It's great to be here. Like you said, bloating is so common. We see it daily in our practice. So it's definitely something that is worth diving into and talking about more. Yeah. How common is it? Like, how often do you think you see it in the practice?

What Bloating Is and How It Feels 1:24

Yeah, I mean, in practice I see it like I said daily, I would say most of our patients have bloating. But in general what we see is about the general population 30% report having bloating. Whereas if we get into the IBS population, up to 96% report having bloating. So it's extremely common. Yeah, I actually don't think I've met the 4% that don't have bloating and IBS yet, so they must be going to a different practice. Yeah I agree. Bloating sounds just intuitive that we all know what it is, but we actually really get caught up a lot of the time in practice and in differentiating like what kind of bloating is somebody actually talking about?

So let's talk about what is bloating. What's the bloating that we're talking about today. Yeah. So the boy that we're talking to is pretty much like this fullness in your abdomen feeling a lot of tightness, pressure. It's often due to buildup of gas. So you might have that sensation as well. Just overall distention. People will say like, you know, feeling like they have a balloon in their abdomen or like go six months pregnant. That's really the type of bloating that we're referring to here. So pretty much localized in the abdomen.

Okay. And what can I what can it be confused with that people will say, hey, I'm bloated and upon further questioning it's not the same thing. Yeah. So that's usually more like water retention or edema. And that can just happen when we have excess fluid accumulate in our tissues. And that's usually more widespread. So that's how we can differentiate the two. Like if you feel like you have like really swollen hands and fingers can't fit your rings on any more like a puffy face. Those are more overall like water retention.

And that's usually like hormonal fluctuations. Or it changes with your electrolytes and hydration balance. Yeah. So while it may feel like bloating or like before, some of these periods may feel like I'm bloated, but they're not necessarily having gas. It's more just like that water retention that they're feeling. Yeah. Yeah, exactly. And that was a really good segue into what you were saying, is that bloating usually goes hand in hand with gas or other symptoms like diarrhea, constipation overall like discomfort and pain in your abdomen, sometimes nausea.

Those are some ways you can differentiate the two as well. Yeah. So if you're having other abdominal symptoms from the GI tract like loose stools, then it's more likely to be from the GI tract. Some people when we talk about this, even when I explain,

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you know, are you talking about like actual gas in the intestines or are you talking about like, water weight? Are you talking about excess fat on the abdomen? Like having, like a little bit of belly fat in the lower abdomen? Some people still have a really hard time differentiating those things. Yeah, I have the same experience. And I think that sometimes people have multi-factorial things going on, so it could be a little bit of both. And one way that we tease that apart is with some of these, you know, questions that we ask of how are you feeling after meals?

Is bloating significantly worse after meals? Does it get worse as the day goes on? Like those are signs that there's more digestive things going on? Or is it better after a bowel movement? Those are some key pieces that can tell us between the two. Yeah. So tied to food intake, is it tied to bowel movements? Those are really helpful. And then what's like the keynote in terms of we talked about it a lot yesterday, but like waking up with no bloating. Can you go into that a little bit. Yeah. So so especially like when we think of like digestive related bloating, usually waking up with a flat tummy and then as the day goes on, kind of progressively getting more and more bloated after eating, and it's not really going down as that day goes on, like we would expect it to.

It just kind of progressively gets worse. And that's usually more of a sign of bacterial overgrowth in our small intestine, specifically where things just aren't functioning properly. The motility is usually disrupted, and we continue to get this bacterial overgrowth there. And what is normal for well, first of all, is bloating normal. Absolutely. So some extent of bloating is normal. So we always like to say, you know, if you eat like this much amount of food, like expect to have about that much of bloating after eating.

Because it takes a little bit to digest and absorb those nutrients and to move things along your digestive tract. So initially you will have some bloating after eating, but after a couple hours, we expect that to go down and decrease as it moves along through our intestines. So some bloating is normal. But it's really when it starts to get to be like really uncomfortable, really lasting the whole day no matter what you're eating. Those are some really big signs. If it's really affecting your activities as well as a big one.

Yeah. And I think that's really important because I think sometimes people come, especially in that functional medicine world where any little thing they're viewing is abnormal, like we should be humans that have zero symptoms throughout our days or our lives. And that's just not the reality. Yeah. Oh no. Especially around the holidays when we're all eating foods we don't typically eat or a lot more food. You know, you're going to feel some bloating afterwards and that's okay. Yeah. So yeah. Yeah.

And we're always looking out for other symptoms too. Like we kind of mentioned. Like if bloating comes in combination with a lot of gas, if you're having like any nausea with it, if you're having changes with your stools like diarrhea or constipation, all those are pretty common. We associate associated, especially if there's something else going on. Okay, so looking at other things that are going on, I'm remembering now somebody I research this a while ago in terms of I have a fact about farting that I'm going to share.

Because some people ask, like, like I'm passing gas 5 or 10 times per day. And I tell them that's actually normal. So we actually know how many times it is that's normal to pass gas versus abnormal. The cutoff is 20 times per day is the cutoff for normal versus abnormal. So more than 20 we consider abnormal less than 20 we consider normal. And then we also want to take into consideration what you said in terms of like is there diarrhea is or constipation. Are there other things that are actually abnormal as well.

Yeah, absolutely. All right. So we talked about Sibo as a cause for bloating. But what are the other potential causes for bloating. Yeah. So some other causes that we commonly see is dysbiosis in our large intestine as well is a really big contributor. Also CFO small intestinal fungal overgrowth. That's a big one as well that can contribute to bloating. In general, I want to pause you and just let's talk about what do you mean by large intestinal dysbiosis, because those are some big words there.

Yeah. So we've been talking about small intestinal bacterial overgrowth. So obviously that's our smaller intestine. That kind of comes first. And then we have our large intestine which is the colon. So we can also have dysbiosis or overgrowth of bacteria in our large intestine as well. So that can cause a lot of bloating in and of itself. Awesome. Okay. And fungal overgrowth, just like bacteria, we can have an overgrowth of fungus that can cause symptoms. And yeah, what are some other ones. Parasites are some other ones that we sometimes look at.

Especially if there's other symptoms too going on like diarrhea.

Testing and Medical Workup 8:42

We're often looking at celiac disease. We're looking at pancreatic function as well, making sure there's no malabsorption conditions going on. And then another big one too is just looking at dietary factors like, is there a lactose intolerance going on? Are you purely having a reaction to have digesting gas producing foods like legumes and cruciferous vegetables? It could even be as simple as like just swallowing too much air when you're eating, eating too fast, drinking too many fluids while you're eating that alone can cause a lot of bloating as well.

So we're always looking to factors as well. Yeah, let's talk about that one. We actually don't talk about it a ton. But aphasia, is the medical term for what you said in terms of the, swallowing of air. And some people say, well, that definitely doesn't pertain to me. But can you talk about what that would look like a little bit more? And, and I think it's, it's way more common. It is really common because a lot of us are eating on the go. So essentially what it looks like is if we're just not like sitting down, being present with our food, if we're not chewing our food properly, we're just kind of like shoveling it in without even realizing it.

You're breathing in more air than you should and not giving your body enough chance to digest and move things along properly. So it's just, you know, eating too fast and not swallowing or not chewing as fast as much as you should. Yeah. So mindful eating, kind of tapping into the present moment. Er, aphasia is very commonly associated with anxiety too. So if somebody knows that they have anxiety then we definitely will talk about mindful eating. And and then there's a practice I don't know if you've done this with your patients, but if if you're drinking water, what I'll have people do is drink water and take a little sip of it.

But then blow out the excess air and then swallow. And to really slow that whole process down and exaggerate it and realize how much are you could actually be swallowing is very educational. But then doing the same thing with food of like chewing your food and before you swallow, kind of taking a break, blowing out the excess air and then swallowing. And I have people like slow this way down like exaggerated just so they can really tap into that. And it automatically puts them into the parasympathetic in a mindful state because they're doing something so slow.

And then it draws attention to, to the air as well. Yeah. That's a really important process to go through. I really like that because it is just something that we don't even think of. We just kind of eat and go about our day and we are just always on the go. So really being mindful can go a long way. Yeah, yeah. Huge. What are some other causes of bloating? Yeah. So, you know, those are some big ones that we talked about, with the Sibo, cf0, dysbiosis. That kind of ties into the IBS picture as well.

So about 70 to 80% of people with IBS are actually found to have Sibo as part of their root cause, at least. But that's definitely something that we want to be looking at. Another one that is often overlooked or we don't think of is if it's a female who is having a lot of bloating that comes on and doesn't really go along with those digestive patterns that we talked about. We want to always be looking at the potential for ovarian cancer and even hormonal disorders as well, like ovarian cysts or endometriosis, because those can contribute to a lot of bloating as well.

Yeah, and those are much more rare. But it is always on our radar in terms of abdominal bloating and ovarian cancer. And what kind of differentiates out ovarian bloating versus gastrointestinal bloating most of the time. Yeah. So I would say most of the time it's just more constant. It doesn't depend on what you were eating. It's just like you wake up and you feel bloated and it's just kind of that continuous feeling. So that is one of the big factors that we look at. Yeah, yeah. And I don't want this to be scary for anybody because I have had numerous like numerous patients that have had constant bloating.

Yeah. And nothing was wrong with their ovaries. It was intestinal. So we, we sometimes say it's usually but there's so many exceptions to the case there. So you just want to talk to your doctor about it. Yeah, absolutely. I agree. All right. And let's talk about testing. So how do we start to workup somebody that comes to modern med for bloating. Yeah. So the big one that you talked about is probably the most, ordered test that we do is the Sibo breath test. But also looking at other things to tool to like stool testing, to look at some of your digestive enzymes, fecal fat, how you're absorbing your food, looking for parasites, looking at inflammatory markers like tucked in just to make sure that that irritable bowel disease picture isn't part of it.

We can evaluate for a CFO the fungal overgrowth through using like

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an for DK seven questionnaire, which is about seven questions. That really gives us a handle on how likely it is that fungal overgrowth is present. But we can also look at that through stool as well. So those are some main ones that we're looking at, especially if there's upper abdominal symptoms present like early satiety, fullness, burping, reflux. We always might be looking at each pylori as well, which is a bacteria in our digestive tract. That can cause a lot of those symptoms. And that would be typically through stool testing or breath tests for that as well.

So there's some really big ones that we're looking at. Yeah. And in terms of inflammatory markers, you mentioned Cal Protectant. Any other markers we're looking at with inflammation and why would we care about inflammation and bloating. Yeah. So so another one is lactoferrin is a common one that we test in stool as well. And then some general inflammatory markers that we look at in the blood is usually CRP, which stands for C-reactive protein. So, you know, we want to make sure that there isn't a too much inflammation in the digestive track.

Because that can be a really big sign of IBD, like Crohn's or ulcerative colitis. So we just want to make sure that we're not missing anything like that. Because I can contribute to a lot of, other symptoms down the line too, or any alarming like red flags, like weight loss blood in your stool, vomiting like those are usually more signs of that. And that would warrant a colonoscopy in that case. Yeah. Yeah, yeah. And I think we want to emphasize this too, because if you experience bloating and you've kind of tried the normal things in terms of a healthy diet, you really want to see, a doctor to get a full workup so that you are making sure that more serious things are ruled out, which most of the time are, but you're getting an expert opinion on making sure that it's not something deeper that's going on.

Yeah, absolutely I agree. All right. And let's talk about treatment. So we talked about Sibo already. But why don't you give us like your top 3 or 4 favorite things to tell patients that are actionable for people to help with bloating, especially around the holidays, we're all going to go eat a bunch of sugar and probably experience, bloating. But what are the best things that we can do? Even if we're not working one on one with a doctor to to help with just normal bloating that we experience? Yeah.

I mean, some of these we already touched on. So like you said, really avoiding snacking, aiming for three meals a day. So we need at least, like you said, about four hours in between meals to stimulate our migrating motor complex, which helps with our motility and digestion, which prevents any of that bacterial overgrowth and prevents bloating. So that can be huge. Making sure you're just chewing your food, eating slowly, avoiding fluids with meals, all those things can really go a long way. Avoiding carbonated beverages.

That's a big one as well. That can cause a lot of gas and indigestion. So those are some really big ones, even just movement, especially just walking after meals, can be really helpful to support our motility and decrease bloating. So especially after that Christmas dinner, go for a walk afterwards. That would be really helpful. So some of those can be really great. I know you mentioned Ginger earlier too. That can be helpful. Peppermint tea. Those are some nice ways just to soothe the GI track and decrease bloating.

Yeah, ginger. Such a festive, flavor too. So it's like a great kind of spicy, warm thing to have in the colder days. Yeah. Yeah, absolutely. Another thing too, that kind of ties into what we talked about in regards to IBS is how often we see stress as a contributor to bloating and just digestive symptoms in general. It's usually playing some sort of a role, I would say with, with all of our patients. So we want to just work on that gut brain connection through different stress management techniques can be really big.

I know we use a lot of CBT, cognitive behavioral therapy and hypnotherapy to also support that connection. So that's something that we're often recommending to just to make sure that we're addressing that component. Decreasing recurrence and really getting to the root cause. Yeah absolutely. And the holidays are such a great time to come together with family and relax. But they can also be really stressful times for a lot of people. Anything that you want to add to our bloating discussion before we jump off?

I think that we covered a lot of it. I can't think of anything else at the time. Awesome, awesome. So for those of you on Instagram, if you are interested in looking at Doctor

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Williams bio on our web page, it'll be in the bio, of Instagram on my page. And then she also offers a free 15 minute phone consult to chat with her about any digestive or general health symptoms that you're having and what it would be like to work with her one on one. To get to the bottom of things. Yes. Reach out to me if you have any questions at all. And I hope you guys all have a happy holiday season and awesome happy holidays. Bye! Thank you for tuning in to Doctor Talks. We hope today's episode has enlightened and inspired you on your path to optimal health.

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