Bloating

Definition

Bloating is a violation of the movement of gases and their accumulation in the bends of the intestine due to increased gas formation. Manifested at the physical level by a feeling of stretching, a feeling of fullness, discomfort in the epigastric region (central abdomen) and a visible increase in abdominal girth.

Gut health is affected by many factors that impair its ability to properly digest food and remove waste from the body in a timely manner.

Usually the problem of bloating is temporary. Consider the main reasons why the stomach swells.

The main causes of bloating

1. Violation of the gallbladder

The main function of the gallbladder is the accumulation, storage and dilution of carbonates (necessary to neutralize hydrochloric acid in the stomach) of concentrated bile coming from the liver. Bile, along with lipase (an enzyme that breaks down fats), helps the body digest and absorb fatty foods.

Violation of the gallbladder is a factor in the growth of pathogenic flora in the intestine: this is how bloating manifests itself.

2. Celiac disease (gluten intolerance)

An autoimmune disease characterized by an inflammatory response to gluten, which damages the tissues of the small intestine and increases intestinal permeability, which is one of the causes of bloating.

3. Food allergies and intolerances, FODMAP products

Foods that cause allergies or intolerances are not broken down and digested properly.

Products-record holders among potential allergens:

• dairy products (lactose intolerance);
• bakery products, pasta, cereals, etc. (gluten intolerance);
• corn;
• peanut;
• black pepper;
• shellfish;
• egg white.

An elimination diet prescribed by a nutritionist helps identify foods that cause food allergies and intolerances:

• first, potential allergens are excluded and the normal functioning of the gastrointestinal tract is restored;
• after 4-8 weeks of food elimination, once every 3-4 days, the excluded foods are introduced one at a time (from small portions to optimal). The reaction of the body to the product is monitored (according to the food diary) and food intolerances are clarified.

If there is the slightest allergic reaction, the product is excluded. If the body feels comfortable, the product can be returned to the diet.

FODMAP foods include types of carbohydrates that are not digested in the small intestine. "FODMAP" is an abbreviation for:

F - fermentable O - oligosaccharides D - disaccharides M - monosaccharides And - and P - polyols.

High FODMAP foods are capable of:

• stretch and expand the intestine;
• provoke excessive gas formation;
• cause intestinal disturbance and bloating.

Let's analyze these features in more detail.

4. Eating on the go and overeating

• If you eat on the go or watch TV at the same time, use different devices, communicate with people sitting next to you, you inevitably swallow air from the surrounding space - this process is called "aerophagy". The gastrointestinal tract is connected with the surrounding space, and the air that has entered the stomach will gradually pass into the underlying sections, so you need to eat in a calm environment. It is not for nothing that we have heard the phrase “when I eat, I am deaf and dumb” since childhood.
• When you are distracted by conversations, watching videos while eating, you can overeat due to the fact that your attention is scattered. Chew food carefully, listening to your feelings.

5. Violation of the protein digestion process (vegetable and animal)

The reasons:

• low acidity (hydrochloric acid denatures proteins, activates pepsinogen - a precursor of the pepsin enzyme, an inactive proenzyme produced by the main cells of the fundic glands of the stomach, hydrochloric acid creates a pH optimum for the action of pepsin - this causes normal protein digestion);
• lack of proteolytic (protein-splitting) enzymes of the pancreas.

In the intestines, an increased formation of gases begins - hydrogen sulfide and ammonia, a putrid, rotten smell appears.

6. Lack of ability to break down carbohydrates, glucose, fructose

The reasons:

• lack of enzymes (breaking down carbohydrates) or increased consumption of refined foods;
• insufficient production of the pancreatic amylase enzyme leads to insufficient breakdown of carbohydrates - the production of hydrogen and gases released, accompanied by a sour smell, increases;
• abuse of sugars, pastries, fruits with high GI (for example, canned apricots, raisins, dates, watermelon).

Norm of fructose: 10-25 g per day (2-3 pieces or 200-300 g of fruit).

7. Taking antibiotics and imbalance of intestinal microflora

There is a death or suppression of the functions of "good" bacteria. Immunity is reduced, this provokes SIBO and SIGR - syndromes of excessive bacterial and fungal growth. Pathogenic microorganisms multiply in the intestines, in the process of life they, like all living beings, produce "waste" in the form of carbon dioxide and hydrogen.

8. Stress

The brain and intestines are closely connected to each other through the vagus nerve. That is why stress can disrupt the normal functions of digestion.

More about ongoing processes:

• through the mucous membrane of the gastrointestinal tract, hormonal and chemical messages are transmitted to the central nervous system. The brain triggers signals to produce saliva (enzymes) to help with digestion, as well as control the hormones responsible for appetite. Stress and negative emotions can cause changes in this regard. The brain diverts attention from normal digestion in order to save energy and direct it to the place it thinks is needed;
• stress raises cortisol levels, followed by an increase in blood sugar levels, which provokes constipation and fluid retention, resulting in bloating;
• stress causes cravings for foods that provoke bloating, namely simple carbohydrates from sweet, starchy, carbonated drinks and other things;
• A link has been established between increased levels of stress and IBS, irritable bowel syndrome. This may be the cause of dynamic flatulence, that is, a slowdown in intestinal motility and the accumulation of gases and food in the lower gastrointestinal tract. You can read about it in our article on IBS.

9. Lack of sleep

• Lack of sleep has a huge impact on the functioning of all body systems. Lack of sleep causes the brain to release the “stress hormone” cortisol, which causes bloating.
• Scientists have proven that when a person does not get enough sleep, they consume more calories during the next day.

10. Constipation.

The provoking factor is insufficient fluid intake (less than 30–35 ml per 1 kg of body weight), low fiber intake (less than 30 g per day), stress, lack of adequate physical activity (less than 8000 steps and 30 minutes of any sport per day).

11. Lack of physical activity

We already know that sport and movement improve intestinal peristaltic activity. In addition, movement improves blood circulation in the digestive tract, which serves as a prevention of circulatory flatulence.

12. Bowel disease

• Diverticula

Diverticula look like pockets or sacs and create favorable conditions for the reproduction of "bad" bacteria. The reason for the formation of diverticulum is frequent and prolonged constipation, inflammation in the intestines. The chair should be decorated and daily! If you suffer from constipation, this is an occasion to understand nutrition issues, take feces for analysis and contact a nutritionist.

• Bowel obstruction

Abdominal distention may be accompanied by prolonged constipation with nausea and vomiting. In this case, you should immediately consult a doctor for medical assistance.

13. Hormonal changes

Bloating with concomitant symptoms such as constipation, fluid retention, and edema can be caused by PMS. Normally, this should not happen - any discomfort, cycle disorders, pain in the first days require consultation with an integrative gynecologist.

This condition may be a symptom of a disorder in estrogen metabolism. Most often, swelling is accompanied by stagnation of bile (it is she who removes the breakdown products of sex hormones).

14. Fluid retention

May be a manifestation of bacterial infections, diseases of the liver and kidneys.

15. Dehydration, electrolyte imbalance

Slows down the digestive process, promotes the development of constipation.

16. Incorrect processing and preparation of plant and animal sources of protein - legumes, cereals, nuts - also contributes to bloating, causing excessive gas production.

Legumes, cereals and nuts are recommended to be processed before cooking:

1. soak in cold water for at least 10 hours, after rinsing well. Change the water if possible. This procedure allows you to reduce the concentration of phytic acid, which causes bloating;
2. after the main processing step, you can germinate, ferment (for example, make probiotic sour cream from cashews), subject to gentle heat treatment (cooking, steaming, etc.).

Meat and fish must first be marinated - lemon, kiwi, oranges are suitable for this.

These types of processing can improve the quality of digestibility of the nutrients contained in these products.

Symptoms

Temporary bloating:

• passing increased gas formation due to the use of improperly cooked legumes, simple carbohydrates, large amounts of fructose;
• a feeling of fullness in the abdominal cavity and its visible increase, pain, discomfort are possible.

Constant bloating with the following symptoms, in which you should pay attention to the work of the body:

• fever;
• nausea, vomiting;
• allergic reactions (watery eyes, various skin rashes and other manifestations);
• constipation - coarse, hard stools once every two days or less;
• blood in urine, stool;
• unintended and sudden weight loss;
• pain in the lymph nodes and their swelling;
• rapid fatigue;
• "brain fog", problems with concentration;
• constant failure of the menstrual cycle.

How to get rid of bloating

1. Balanced diet and daily regimen, drinking regimen.

For the normal functioning of the gastrointestinal tract, it is vital for the body to receive a sufficient amount of fiber, water, macro- and micronutrients and other compounds.

Norm:

• proteins - 1 g / kg (vegetable and animal - 50:50).
• 1-2 times a week it is recommended to arrange fasting days, using only vegetable sources of protein;
• fats - 1 g / kg (vegetable and animal - 50:50);
• carbohydrates - 3-4 g / kg;
• fiber - 30 g (when bloated, it is not recommended to eat raw vegetables, it is necessary to subject them to heat treatment - cooking, stewing, baking);
• water - 30-35 ml / kg.

  For every cup of coffee drunk - plus 1 more glass of pure water (because coffee has a diuretic effect);

• fructose - 10-25 g per day.

The norm for people with metabolic disorders is no more than 15 g per day. For bloating, it is recommended to do a home fructose tolerance test: eat 1 bunch of grapes and see if you have bloating and flatulence. If so, you have malabsorption (impaired absorption of fructose). Opt for berries and low-fructose unsweetened fruits with FODMAP to the rescue.

A nutritionist can create an individual balanced diet.

2. FODMAP program

Step 1. Login to the program:

1. evaluation of habitual eating habits and symptoms;
2. Build a trial low FODMAP menu for 2-6 weeks. Keep a food diary and record your observations and condition in it;
3. after 2-6 weeks of nutrition, evaluate the results.

Other conditions, such as celiac disease, must be ruled out before changing diets. A preliminary consultation with an integrative nutritionist is recommended.

Example of prohibited foods (high FODMAP content):

• fruits - apple, apricot, cherry, blackberry, boysenberry, mango, nectarines, peach, pear, persimmon, plum, watermelon;
• vegetables - asparagus, artichoke, garlic, onion, peas, cauliflower, mushrooms;
• cereals and nuts - legumes, wheat, rye, barley, cashews, pistachios;
• dairy products - condensed and concentrated milk, homemade cheese, ricotta, custards, ice cream, milk, yogurt;
• the other is carbonated drinks, pastries.

Example of allowed foods (acceptable FODMAP content):

• vegetables - tomatoes, carrots, spinach, chili, fresh ginger, cucumber, eggplant, green beans, olives, zucchini;
• any greens;
• fruits and berries - grapefruit, tangerine, orange, lemon, lime, banana, grapes, rhubarb, blueberries, raspberries, strawberries. The consumption rate is 10–25 g per day. The norm for people with metabolic disorders is no more than 15 g per day. The fructose contained in fruits has a certain limit of absorption by the intestines. Anything that is not digested provokes increased gas formation and bloating. Exceeding the norm of fructose consumption disrupts metabolic processes and causes a number of other adverse processes in the body;
• cereals - rice, oats, quinoa, buckwheat, polenta, spelt;
• dairy products - ghee, yogurt and milk (lactose-free), hard cheeses, vegetable milk (rice, almond);
• vegetable protein sources - tofu, tempeh, nuts - hazelnuts, macadamia, peanuts, pine nuts;
• animal protein sources - eggs, chicken, veal, fresh beef, lamb, pork.

Step 2. Strategy for improvement:

• food provocation (determining the level of "tolerance" for each FODMAP subgroup, including the body's response to a serving and the frequency of eating a variety of foods with FODMAP);
• identification of individual food triggers.

An individual modified low FODMAP diet is prescribed.

3. Add foods to your diet that help with bloating

• Probiotics. The intake of probiotic products or supplements saturates the intestinal microflora with "good" bacteria, inhibits the reproduction of "bad" bacteria and their harmful effects on the body. An example of probiotic foods: kimchi, sauerkraut, yogurt (homemade, farm), kefir, homemade kvass, kombucha.
• Herbs (teas, decoctions, infusions), spices. They act as diuretics, prevent edema, help the body remove excess fluid, improve digestion and relax muscles in the gastrointestinal tract, which prevents constipation. Example: ginger (fresh root), rosemary, oregano, parsley, bearberry, fennel, dandelion, chamomile, milk thistle, nettle, aloe vera, green herbal teas.

4. Adequate physical activity and outdoor walks

This contributes to the normalization and improvement of the processes of digestion, blood supply, elimination of constipation, supports detoxification functions - circulation and movement of lymphatic fluid throughout the body.

5. Dealing with stress, sleep patterns

• it is necessary to create a favorable emotional background (hobbies, reading books, relaxation, meditation, walking, communication, etc.);
• normalize sleep patterns - sleep for 7-8 hours, if possible, fall asleep at the same time, until 23:00.

6. Consult a specialist, a doctor

If it was not possible to prevent bloating on your own and none of the listed remedies alleviate the symptoms, it is recommended to consult a doctor to take tests, determine the source of the problem and eliminate it.

There is no single test to determine the cause of bloating. For primary diagnosis, you can pass a coprogram, feces for dysbacteriosis, a breath test with lactulose, and other tests. An integrative nutritionist will determine a list of tests that will provide all the necessary indicators to identify the cause of persistent bloating, and will make a plan, following which you will know how to treat this condition.