One thing about being in the field of nutrition is that you get pretty comfortable with some pretty uncomfortable topics, notably everything to do with digestion. The fact is, food comes in one end and out the other, and a lot happens in between. One of the most common issues with digestive health is bloating, which is why I asked registered dietitian and digestive health expert Tamara Freuman to enlighten us on the topic.
With nearly a decade of experience working in a leading New York City gastroenterology practice, Tamara is the perfect person for the job. She is the author of the just-released and aptly titled, The Bloated Belly Whisperer. The fact that she manages a healthy dose of humor while discussing some of our more unsavory bodily functions makes it not just an informative read, but an entertaining one, too.
How exactly do you define bloating and how common is it?
Bloating is a feeling of discomfort and fullness–not necessarily pain– in the abdomen, and/or a visibly distended waistline compared to your normal state of being that is NOT related to weight gain. Estimates I’ve seen suggest that bloating affects about 1 in 6 people, though some people may experience it more episodically while others have it chronically.
A lot of people just accept bloating as normal. How easy is it to identify the cause and to treat it?
Identifying the cause of bloating *can* be quite easy in most cases, though certainly there are more complicated cases that either require more invasive testing/interventions to pinpoint, or that can be elusive because they’re caused by more than just one thing.
If you have the luxury to be seen by a well trained GI dietitian or patient gastroenterologist who takes the time to obtain a detailed symptom history from you, it’s often quite straightforward to diagnose the cause of your problem with a short dietary trial or simple test or two.
How easy it is to treat varies widely and depends on the cause— in a simple case of slow transit constipation, some people are just a magnesium supplement away from full relief, whereas in the case of gastroparesis (slow stomach emptying), it can be very challenging to treat it fully even with a combination of medications and diet. Most people can get at least some degree of relief from an appropriate diet change, though.
Some of the healthiest foods we are told to eat can cause bloating. Can you talk about some of those foods?
Foods that contain fibers that are highly fermentable by gut bacteria are quite health promoting, as they support a robust and diverse gut microbiota. These are called high FODMAP foods, and include things like beans, brussels sprouts, pistachios, onions, garlic, apples and cauliflower. However, people who experience bloating related to too much gas or who are very constipated such that excess intestinal gas gets trapped and can be painful, eating lots of these objectively healthy foods may make them feel worse.
Another way that healthy foods can cause bloating relates to highly textured foods– “roughage” if you will. People with slow stomachs, acid indigestion related problems or hypersensitivity in the stomach can experience discomfort from eating very bulky, voluminous meals like giant salads, whole grain foods like popcorn or shredded wheat, nuts, etc. as they stretch the stomach walls and take more time and churning/acid to process before leaving the stomach compared to softer-textured alternatives. Some people experience this as bloating.
Are there ways to enjoy them without causing a lot of gas?
Certain foods rich in a FODMAP called galacto-oligosaccharides will be less gassy if you take an enzyme called alpha-galactosidase with them (Beano). Such foods include beans/lentils/chickpeas, kale, broccoli, brussels sprouts, beets, cashews, pistachios, butternut squash.
Onions and garlic can be sauteed in olive oil to infuse the oil with their flavor, but then strained from the oil. Using this oil for flavoring without consuming the actual onions/garlic offers flavor without the FODMAPs.
Other veggies and fruits high in FODMAPs don’t have workarounds, so I suggest people just watch portions of them; small amounts may not provoke significant symptoms, so portion control is the name of the game.
What would you suggest someone do if they are struggling with bloating?
Hopefully they’ll pick up my book, take the quiz, and read up on the 1-2 diagnoses that seem to map most closely to their symptoms. Having these hypotheses before making an appointment to see a well reputed gastroenterologist may help you make the most out of your visit and get to a diagnosis faster.
If you can, try out the recommended diet or supplement I suggest for a week or two prior to your visit, it can also help your doctor home in on the solution quicker; it says a LOT to your doctor if you can go in there and tell her you felt 75% on a low FODMAP diet or that you tried a low FODMAP diet for 2 weeks and felt no better at all. Regardless of your experience with the diet, it’s a huge clue to your MD as to the most likely origin/nature of your problem.
Also, try to stay off the internet; there is a lot of misleading info online and fabricated medical conditions being peddled by naturopaths and functional medicine practitioners. Your bloating is not caused by “leaky gut” or “candida” or “adrenal fatigue”. These are not a thing. Spending thousands of dollars on exorbitant supplement protocols peddled by people who traffic in these “diagnoses” won’t cure your bloating, it will just make you poorer and more confused than ever.