QUESTION: “Hello there. Thanks so much for all your input. I love listening to the podcast. So helpful and informational. I'd like to ask a question… I've been having horrible bloating problems the past couple years. I went to doctors for advice, I've been to a nutritionist, took some antibiotics, I did an ultrasound, an endoscopy, I've taken gluten and lactose and eggs allergy tests and all returned negative. But I still suffer from this extreme bloating problem everyday day (as big as if I were 5 months pregnant), along with gas pains, stomach acidity once in a while, etc. I've talked with some friends who've also had somewhat the same issues at different times. I've also heard from others that it's a very common, normal thing. But why? I've never heard of it before I had the problem.
And what would be normal about it, for it to cause so much pain and discomfort? Is it that people are starting to speak up about it more? Is it due to diets or the quality of foods we have today? I've always eaten very healthy and have not really been on any strict diets, I don't eat junk food, I exercise regularly, basically do everything I can to stay healthy. Though I did have an eating disorder for a number of years. Doctors have told me that that has nothing to do with it. I don't know anymore, but I'm quite frustrated as I feel I've tried everything and with no success. Thanks for any help or advice you would have on this topic. Super appreciate it.”
DR. NEAL: Thank you so much for your question and kind words. I’m so glad you enjoy the show. Thank you for having the courage to ask an uncomfortable question like this.
I’ll start with my usual disclaimer: any recommendations I provide should always be discussed with your doctor. Because I am not a medical doctor, I can’t and won’t diagnose you, because that is outside my scope of practice and would therefore be unethical of me.
What I CAN do is provide some guidance.
The Problem with GI Diagnoses
I’m sorry that you’ve had to experience this discomfort for so long. It sounds like you’ve already had a number of tests to try and figure out what’s going on… everything from food allergy testing, infections, and ultrasound and even an endoscopy. Unfortunately, it sounds like those tests have come back with very few answers. I can understand your frustration.
Gastrointestinal issues are notoriously tricky to diagnose. This is because the underlying causes can range from bacterial or viral infections, to a food allergy, to stress, and even our exercise habits.
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Going back to the endoscopy, if you haven’t had one performed already, something that I would recommend discussing with your doctors is a lower endoscopy procedure, basically, a colonoscopy.
The word “endoscopy” is a general term that basically refers to a doctor inserting a camera into the GI tract. Doctors can perform an upper endoscopy, where they look at what’s referred to as the “upper” portion of the GI tract – the esophagus, stomach and small intestine. They can also perform a lower endoscopy, also known as a colonoscopy, that looks at the large intestine and rectum, specifically.
If you hadn’t had a lower endoscopy, or colonoscopy, performed yet I would discuss this with your doctor to see if they would recommend one. This is because it may provide a better overall picture of the health of your GI tract.
It’s recommended that everyone have a colonoscopy performed at least once around their 50th birthday. But, for those that have underlying gastrointestinal conditions or are experiencing gastrointestinal discomfort like you, having one performed earlier in life may be recommended.
Many people are afraid of going through this procedure – the preparation for it is the worst. Because of my own chronic disease history, I can say that I’ve gone through about a baker’s dozen colonoscopies.
My first colonoscopy was when I was 19. So, I’m pretty used to it and can honestly say, it’s not that bad… the mental stress we put ourselves through before the procedure is usually worse than the actual prep or the actual procedure. If I can put up with it, anyone can.
Could it be IBS?
Anyhoo, beyond getting a colonoscopy, if your doctor hasn’t ruled out Irritable Bowel Syndrome, I would suggest discussing that with them. Irritable Bowel Syndrome (also known as IBS), likes to work in mysterious ways. It tends to come and go without warning. Some days are great, other days can be very uncomfortable.
The symptoms of IBS include gas, bloating, bouts of diarrhea or bouts of constipation or both. Foods can trigger IBS symptoms. So, can stress.
You've mentioned you’ve been tested for food allergies. But have you carefully looked at which foods may be triggering your gas and bloating symptoms? One of the best ways to monitor this is through a detailed food journal. You write down everything you eat and drink for at least 2 weeks and make a note anytime you experience the symptoms you described.
If it doesn’t seem to be food related, you can also try keeping a stress journal. Stress is a known trigger for a lot of conditions – in fact, we talked about that earlier this week. But stress and IBS symptoms tend to go hand-in-hand. The gut-brain connection is quite strong.
Reducing Bloating with The Low-FODMAP Diet
I’m going to go back to foods, though. If you haven’t tried something called the Low-FODMAP diet, I would discuss that with your doctor, too.
The Low-FODMAP diet is an eating plan created by researchers at Monash University in Melbourne, Australia. They found that certain natural compounds found in common foods can aggravate gastrointestinal discomfort in people sensitive to those compounds.
The word, “FODMAP” is actually an acronym for fermentable oligosaccharides, disaccharides, monosaccharides, and polyols. These are fancy names for specific carbohydrates.
Basically, the diet encourages less consumption of foods that contain these specific carbohydrates. What ends up happening is the body naturally ferments these carbohydrates.
As part of the fermentation process, waste gases are produced. But in those that are sensitive, these waste gases can cause a great deal of discomfort. By limiting the consumption of these foods, less waste gases are produced. In fact, studies have shown that when a Low-FODMAP diet is followed, the odds of experiencing less stomach pain and bloating are 75% or higher!
I mention all of this because if you decide to keep a food journal and monitor your symptoms, you may want to consider monitoring how you respond to a Low-FODMAP diet.
What Foods Should I Avoid to Reduce Bloating?
So, which foods should you avoid while following a Low-FODMAP diet? It would be difficult to list every single one here, but Monash University’s website has some fantastic resources.
In the meantime, I will list some common foods to avoid according to this eating plan:
- Wheat, barley and rye
- Garlic and onion
- Certain fruits, like those with a large pit (which are also known as “stone fruits). These include mangoes, peaches, nectarines, plums, and cherries. Apples and watermelon should also be avoided.
- Certain vegetables like asparagus, Brussels sprouts, cauliflower, mushrooms and snow peas
- Beans and lentils
- Some sweeteners, like agave and HFCS
Now, I should mention that avoiding some of these foods is not a permanent thing. You want to try limiting these foods for 3-8 weeks. Then, slowly reintroduce them back into your diet.
Because many of these high FODMAP foods are important to consume as part of a nutritious and balanced diet, long-term avoidance of some of these foods can increase disease risk.
So, again, discussing this eating plan with your doctor would be a good idea. Many people have found quite a bit of relief by avoiding some of these foods.
I hope you feel better soon!