What could be causing this bloating?

Article supplied by Giselle Cooke Natural Health Consultant

One of the commonest complaints I receive from my patients is unexplained bloating. When someone feels bloated they describe it as a discomfort in the abdominal region, usually accompanied by distension of the belly, which may be quite visible and causing distress due to its appearance and discomfort with movement. Pain or cramping may be associated with bloating, as well as constipation, nausea and feeling generally unwell.

Sometimes when bloating occurs we are aware that we have eaten or drunk something that has disagreed with our digestion, but also sometimes it is hard to exactly pin down the culprit. This is the case when there are multiple contributing factors, so it is hard to tease out one cause and one solution. One digestive problem may have led to another, such as overeating at meal times, leading to poorly processing food, which then ferments in the intestine and causes gases to be produced, mostly carbon dioxide, which distend the abdomen.

It is more mysterious when all the common causes of bloating have been eliminated, such as eating too many gas-forming cruciferous vegetables (cabbage, cauliflower, broccoli); onions and garlic, beans and legumes and nuts also cause flatulence. If you have tried the mint tea or the charcoal tablets and the bloating is not improving, it is then important to seek the assistance of your healthcare practitioner to make a correct diagnosis so that the problem can be effectively addressed.

It is my personal experience that the best practitioner to assist with managing digestive issues is a naturopath or a nurse or medical practitioner who has trained in nutritional and herbal medicine. Conventional GP’s do not generally spend enough time taking diet histories and doing investigations, such as stool analyses and food allergy tests, but rather treat each symptom with a patented medication, which will only bring short term relief and leads to having to manage the condition long term without solving it at the root cause.

It is also my experience that with minor digestive problems should not be referred to a gastroenterologist as a first step, since they also do not generally discuss diet management nor do digestive stool analyses, but arrange endoscopy routinely for most patients that are referred to them. In the case of a bloating problem this is often a fruitless exercise and causes unnecessary risk from a procedure which is designed to identify more serious diseases.

Some conditions to consider when identifying the cause of your bloating are:

Indigestion (Dyspepsia, Upset Stomach)
The commonest cause of bloating, indigestion usually results from eating excessive amounts of food at meals so that the digestive juices which contain acids, alkalis and enzymes are unable to cope with the quantity of food, so that it travels partially digested to the small intestine where it begins to ferment and cause distenstion. Also very common is a stressed digestion, where mental stress has shut down the production of digestive enzymes, stomach acid and bile, leading also to bloating and distension in the same way.
Symptoms of dyspepsia can also include upper abdominal pain, belching, nausea, vomiting, abdominal, early satiety, and flatulence.

Indigestion can be helped by taking herbal bitters to improve digestive capacity by increasing the output of digestive enzymes from the pancreas. Gall bladder tonic (cholagogue) herbs increase bile flow to help fat digestion and digestive enzymes (animal or vegan) can be taken to supplement what is not being naturally produced. There are also some lovely stomach tonic herbs for dyspepsia.

Paying attention to your dental hygiene is also critical for ensuring that your digestion works well. Having pain and inflammation in gums and teeth will affect chewing and mechanical processing of meals and over a period of time indigestion will result. Also jaw alignment problems will affect digestion in the same way and need to be correctly diagnosed and treated. Make sure you have an appointment with your dentist to discuss these matters in relation to your digestion. With the wholistic approach we take here at Lotus Dental we offer dental hygiene services and orthodontic assessments of your bite to ensure that your teeth and gums are healthy and working efficiently so that you get all your nutrients.

Irritable Bowel Syndrome (IBS)
Characterised by alternating constipation and diarrhoea, often with a sense of urgency to empty the bowels., involving strong, painful gut contractions. There may also be mucous in stools, but this is more typical of colitis or other types of inflammatory bowel disease. Typical triggers for IBS are food allergens and drinking coffee.

Emotional stress is always a component, if not the main component, of IBS and needs to be addressed always when managing the condition. Natural therapies are the choice par excellence for successful treatment of IBS, focusing on removing harmful micro-organisms from the gut, replacing prebiotics (nutrition for a health gut) and probiotics (the beneficial bacteria) for restroration of the health gut environment and using relaxant/digestive herbs to improve digestive capacity, renourishing the cells and rebalancing the system.

Small Intestinal Bacterial Overgrowth (SIBO)
This is a very common cause of bloating in my experience, due to chronic stress and the widespread use of antacids or proton pump inhibitor (PPI) drugs, which suppress the production of stomach acid. The hydrochloric acid our stomachs produce provides a bacterial barrier to sterilize our food and prevent over-colonisation of the intestinal tract with these bugs.

If acid levels are reduced, as occurs with ongoing stress, antacids and the menopause, SIBO occurs. The result is poor digestion of proteins in the stomach and fermentation of carbohydrates in the small intestine, which leads to excess gas, abdominal bloating and intestinal candidiasis (see below). Diarrhea may also occur with SIBO, leading to malabsorption then nutritional deficiencies, creating complications such as loss of skeletal muscle bulk and bone density.

If protein malabsorption continues over a longer period it will also lead to hormonal deficiencies, poor skin tone and wound healing and reduced cognitive function, since the brain depends critically upon optimal nutrient intake, especially protein.

Normalising the gut milieu with pre- and probiotics is the goal for treatment of SIBO, followed by an appropriate diet and nutritional supplementation regime to recover from the period of malabsorption.

Intestinal Candidiasis
A syndrome long denied by the medical profession and identified enthusiastically by naturopaths, is intestinal candidiasis (“candida”). After thirty years’ experience practising complementary medicine, I firmly believe this is a true clinical entity and should be treated seriously, since it is the cause of significant suffering in our community. Equally, effective treatment of intestinal candidiasis may be life changing for the patient.

The symptoms which may be associated with intestinal candidiasis are primarily bloating, abdominal distension,cramping and flatulence. Further complications which may result are fatigue, sugar cravings, perianal itching, sluggish liver metabolism, skin rashes such as tinea, and particularly vaginal thrush in women. Food sensitivities occur when “leaky gut” (increased intestinal permeability) results from low-grade injury to the gut wall by the toxins released from candida and other harmful micro-organisms as they over-colonise the gut. Larger than normal food particles then travel through these gaps in the intestinal lining and stimulate allergic responses in susceptible individuals, leading to food and food chemical allergies. It is also possible to be allergic to the candida itself, which further complicated the clinical picture.

I also associate “leaky gut” with “leaky brain”, meaning candidiasis sufferers also complain of feeling mentally vague, foggy and unfocussed. Naturopaths have an even more extended list of associated conditions, usually having a great deal of experience with treating this syndrome.

Overgrowth of yeasts, particularly Candida albicans, in the intestinal environment, is part of the syndrome of dysbiosis, meaning a digestive state with “the wrong mix of organisms”. Maldigestion in the upper digestive tract can create an environment in the lower gut conducive to the cultivation of yeasts and ferments and the consequent reduction in numbers of beneficial bacteriae. Regular and excessive intake of fermented drinks, such as wine, beer and especially champagne, creates an ideal growth medium for yeasts in the intestine (unfortunately!)

There are some excellent treatment regimes for intestinal candidiasis, using antifungal herbs, dietary correction and replacement of probiotics. The goal is to achieve longstanding recovery and to prevent relapses, which can occur quite easily and be quite distressing when they do. An experience natural health practitioner is your best ally for this program to be successful.

Dysbiosis is also a common complication of antibiotic therapy. Taking even one course of antibiotics may cause our enteric flora such devastation that, without appropriate treatment, it may take ten years to restore the ideal, delicate balance or “probiotics” (good bacteriae), of which there are usually around 1.5 kilograms in an adult intestine! Their role is to create a healthy stool for elimination by processing dietary fibre, as well as producing antibodies for the intestinal mucosa (lining) to assist in local immune defence. They also assist in female hormone regulation by aiding processing of oestrogens for excretion. Very hard-working micro-organisms!

Did you know that the humble and much maligned appendix has been shown in recent research to be a reservoir of probiotics? “Long denigrated as vestigial or useless, the appendix now appears to have a reason to be – as a “safe house” for the beneficial bacteria living in the human gut” (Science Daily, Oct. 8, 2007). After a bout of diarrhoea which can eradicate the intestinal flora, the appendix assists in repopulating the gut with probiotics. It therefore makes sense not to remove the appendix unnecessarily, as has been surgical vogue in the past.

The best way to assess your intestinal flora and digestive function to assist in creating your recovery from bloating program is to have a Comprehensive Digestive Stool Analysis performed through Healthscope Laboratories. You can access these services through your natural healthpractitioner at Lotus Health.

Coeliac Disease
Signs and symptoms of celiac disease along with bloating include flatulence, diarrhea, foul smelling gas, and increased amounts of undigested food visible in the stool, greasiness (fat). These are signs of malabsorbption due to the damage caused by dietary gluten to the intestinal lining in individuals who have an inherited intolerance to this protein. Genetic testing on blood can confirm whether or not you have celiac disease and perhaps an endoscopy may be required to confirm the diagnosis.

With our Celtic heritage in Australia, where it is thought the gene originated, we are seeing a significant number of individuals being diagnosed as celiac. It may also result from intestinal wall damage from an enteric infection, but this type of gluten-sensitive enteropathy has the potential to fully reverse with correct treatment.
It is very important to have a clear diagnosis of either genetically-linked coeliac disease, gluten-sensitive enteropathy, wheat allergy or intolerance to faciltate best treatment results. Your nutritionally trained medical practitioner is your best ally in this case. Similar

Lactose Intolerance
Similar to gluten intolerance, lactose intolerance is a condition where the individual may have a genetic deficiency of lactase, the enzyme required to process lactose, the sugar in animal milks. Lactase deficiency is commonly seen in Asian populations, perhaps since it is uncommon to consume dairy products in many of these cultures.

It is also possible that lactose intolerance may result from an episode of enteric infection, such as food poisoning, rendering the gut unable to process lactose for at least one week after the infection. Consuming milk after a bout of infectious diarrhoea may prolong the lactose intolerance so that it becomes a chronic condition.

Symptoms of lactose intolerance include abdominal bloating and distention, diarrhea, flatulence, abdominal pain and less commonly nausea. Symptoms completely resolve with the removal of animal milk products from the diet of the affected individual, or by supplementing lactase to the meals at which dairy is eaten. Butter is usually easily tolerated in lactose intolerant individuals since it is mainly animal fat and not so much sugar.

Premenstrual Syndrome (PMS)
Many women who experience the cyclic distress of PMS complain of abdominal bloating during the days or weeks that they experience oestrogen dominance in their cycle. Mood swings, fatigue, irritability, headache, fluid retention, weight gain and sore breasts are all symptoms which can occur when excessive amounts of oestrogen circulate in the second phase of a woman’s menstrual cycle, leading to salt and water retention. This type of bloating is relieved by assisting the liver, with herbs and nutrients, to process these excess oestrogens and eliminate them via the kidneys, along with the salt and water.

Intestinal Parasites
Bloating is also a symptoms associated with infestation by intestinal parasites. A classic presentation for someone who has intestinal parasites is lower abdominal bloating, cramping and urgency to empty the bowels, usually early in the morning, often disturbing sleep. Evacuating the colon usually brings temporary relief until the organisms cultivate again and the cycle resumes. Parasites also lead to malabsorption, particularly of iron, leading to anaemia and fatigue.

Blastocystis hominis, Giardia lamblia, Dientamoeba fragilis and cryptosporidium are commonly found in the faeces of Australians, contrary to popular medical belief. One gastroenterologist indignantly told my patient “We are not a Third World country!” when she asked if her abdominal discomfort and diarrhoea could be due to having parasites. That may be true of our economy, however our intestinal parasites are global, mostly due, I find, to Aussies being such dedicated travelers into the Third World, as well as being owners of millions of pets!
If you suspect you may have a parasite or other dysbiosis, the Comprehensive Digestive Stool Analysis performed through Healthscope Laboratories and interpreted by your natural health practitioner at Lotus Health. There are herbal therapies available for treating parasites, which are very effective.

CREATING A HEALTHY DIGESTIVE ENVIRONMENT

Eating food should always be a relaxing and pleasurable experience to effectively nourish to your body. Eating on the run, swallowing food in chunks or whole and consuming unhealthy, devitalised, processed food leads to maldigestion and undernutrition. It’s also a waste of time and money!

Food should be eaten consciously, without any distractions such as watching TV or doing emails, when you are in a calm state of mind. Sending the blood to the brain, as occurs with a business lunch, makes sure the gut does not receive the circulation to help process the food just eaten. Each bite needs to be chewed thoroughly, as Jennie Burke from Australian Biologics Testing Services will tell you, when they perform Live Blood Analysis. She can tell that you have not chewed your food by the appearance of protein indigestion when she examines blood after her client has eaten a meal!

The digestion process actually begins when food becomes mixed with saliva. A common mistak is to drink water with meals - which Jennie also emphasizes to her clients. This dilutes and inhibits our digestive juices from acting fully upon the food. It is best to avoid drinking anything until 30 minutes after a meal. Avoid carbonated beverages completely, as they weaken the digestive secretions.

Keeping food choices and cooking processes simple will simplify digestion and avoid bloating. Using beneficial digestive herbs, such as dill, fennel, and mint will reduce flatulence and warming spices such as cinnamon, black pepper and ginger improve the blood flow to the gut during meals to make digestion more efficient.

Fresh fruits and vegetables provide us with plant enzymes that aid in digestion and help us assimilate nutrients better. Raw fruits and vegetables are best, particularly when freshly juiced and consumed immediately.

Avoid over-consumption of food, which outstrips digestive capacity and leads to fermentation in the lower bowel. Chewing your food slowly will also fill you up faster and you will want less to eat, also aiding in weight loss. .

Poor elimination from a sluggish and contaminated colon will also lead to maldigestion, so one of the first steps to correcting digestion and other health issues is to treat constipation. Loss of appetite, bloating and abdominal distension are often the signs of constipation, even though a daily bowel action may reassure you that you are not constipated. There are excellent foods and herbs to assist elimination, such as aloe vera juice and slippery elm powder. Colon cleansing at a colon hydrotherapy clinic is the best treatment for chronic and more serious constipation states.

Generally most of us have low levels of hydrochloric acid in our stomachs, which leads to food only being partially digested, resulting in most indigestion symptoms: gas, bloating, belching, diarrhea or constipation. Taking betaine hydrochoride may assist this problem, along with a herbal tonic for calming the mind to improve stomach acid production naturally .

A good quality digestive enzyme taken 20 – 30 minutes prior to eating is very beneficial for s stressed digestion, but should not be taken long term to prevent suppression of endogenous production of our own digestive enzymes. Try to limit its usage to two months maximum.

A lovely herbal tea called “Digest”is available from Express Dispensary (02) 9977 3782. It can be dispensed without a naturopathic prescription and is guaranteed to improve any type of bloating, due to the antispasmodic, tonic and calminative herbs it contains – and it tastes delicious!

If you feel you would like to visit Lotus Health for a consultation regarding your digestion, or any other health condition, please contact Rebecca Fondacaro to make an appointment with me on (02)9953 7881

ALLIED SERVICES

Australian Biologics Testing Services
www.australianbiologics.com.au
Phone for appointments (02) 9283 0807

Healthscope Functional Pathology
www.functionalpathology.com.au
Phone : 1300 55 44 80

Express Dispensary
www.expressdispensary.com.au
Phone (02) 9977 3782

Copyright Giselle Cooke