Common culprits behind a swollen tummy, how to relieve it and when to seek help
If you’ve ever had to resort to an elasticated waist before your period, or been offered a seat on the bus because you were carrying a ‘food baby’, you’ll understand the discomfort being bloated can cause. “Bloating means different things to different people,” says Dr Sean Preston, consultant gastroenterologist at the London Digestive Centre at The Princess Grace Hospital (hcahealthcare.co.uk). “And even when you drill down to establish what’s going on, the underlying causes can be very different, from the very serious, to the trivial. Of course even for the latter the experience can impact on quality of life, so as a symptom bloating should never be ignored. If the episodes return consistently for more than two weeks, particularly in an older person, that’s when you should start discussing it with your doctor.” But what could be causing your bloating?
“Polyols, represented by the P at the end of the word ‘FODMAP’, are important to be aware of,” says Sean. “They’re found in sugarfree gums and can cause a lot of discomfort. People don’t often think of them as foods, so I specifically ask patients about their intake. Polyols are a class of carbohydrate, with sorbitol being a common example, and sugar-free gums are a pretty rich source.” In fact foods high in sorbitol or mannitol, another polyol, must by law carry a warning about their laxative effect. You could be encountering polyols in other sugar-reduced foods and drinks, and a sensitive gut may be irritated by levels that don’t require a health warning.
If, like most of us, you reach for the comfort carbs at key points of your cycle, you might feel culpable for painful bloating. Don’t – other factors are at play. “The bowel in general can be more sensitive at certain times of the menstrual cycle,” points out Sean. “So I always ask a patient if their bloating is more pronounced at certain times of their cycle. Typically, it’ll be around ovulation; progesterone and oestrogen are the main drivers here, so depending on levels of those, symptoms will be present.” The good news? Getting to know the symptoms of your cycle will ease your anxieties around bloating, lowering your sensitivity to the physical pain. “I will often recommend a magnesium-based supplement that helps to balance the female hormones,” adds nutritionist and naturopath Tanya Clarke (tanyac.co.uk). “Most people are deficient in magnesium, which is itself involved in so many crucial functions in the body.”
It’s easy to associate bloating with gas or fluid, but that uncomfy feeling of a distended abdomen could be down to waste products sitting in your large intestine, even in a healthy digestive system. “Our brain perceives things in very different ways and a lot of that is down to the interaction between our brain and our gut,” says Sean. “One person could have a colon full of faeces and not feel anything. The next person could have half their colon with a bit of poop in it and feel much more sensitive. We all perceive things very differently and express them differently. Our emotions play a huge part with our gut; if we’re anxious or stressed we may have a lower threshold and symptoms may feel difficult to us.” According to Tanya you should expect a meal to pass through your body in 24 hours, and you can test this by including plenty of sweetcorn or beetroot as markers in a meal and being vigilant for their reappearance!
IBS might be a frustratingly vague term for a very diverse set of issues, but one thing is clear: if your bowel is in a state of irritation, bloating is a likely outcome. According to Sean, IBS is central to bloating symptoms in the vast majority of cases, whilst conditions at the more serious end of the spectrum such as Crohn’s or coeliac disease will also cause bloating when triggered. To minimise suffering Tanya recommends a routine that optimises your digestive enzymes. “Don’t eat within three hours of going to bed, have an overnight fast of 12 hours, and make sure you allow four hours between meals – that’s the amount of time your pancreas needs to regenerate.” She also recommends a glass of room-temperature water with a squeeze of lemon half an hour before a meal, but that during a meal you refrain from drinking anything that will dilute your enzymes.
We know the cumulative effects of stress are toxic for our bodies, but did you know a single event can trigger a flare-up that can, if untreated, continue to disturb your equilibrium? “When I take case history I map from their birth looking for significant stress events that are triggers,” says Tanya. “With bloating I have the same protocol with acne flare-ups; why have the symptoms become so much worse? A timeline looking for clues should map things like hospital stays or courses of antibiotics, but also the events like the death of a parent, an issue at work or maybe a difficult stint with the children. Episodes like this in life that throw your homeostasis, your body’s natural equilibrium, out of whack.” Sean agrees. “Once you take out the known pathologies – cancers, IBS, coeliac disease – it can help to see a hypnotherapist or a psychologist.”
The past five years has seen an explosion in our understanding of the gut microbiome, and the rise of pre- and probiotics to foster healthy microbial populations in your gut. Dysbiosis, and specifically conditions such as small intestinal bacterial overgrowth (SIBO), occur when the gut’s natural equilibrium is disturbed, often by diet. “Bloating is a sign of toxicity, so my first move would be to bring down the toxic load in the body,” says Tanya. “I’d remove foods you may be intolerant to – classic ones are wheat and dairy. They’re known triggers and can cause all sorts of problems. Other intolerances related to bloating may include FODMAP foods – wheat, garlic, onions, apples, cabbage… I’d recommended a six-week trial removing them, and I’d also suggest cutting out processed foods and sugar.” For sufferers looking for instant answers Tanya recommends an organic acids test. “It’s a simple urine test that can shortcut some of the dietary modification,” she says.
Swelling and bloating around your abdomen is often caused by gas, but for those suffering liver damage, or ovarian or pancreatic cancers, fluid can be the culprit. Technically called ‘ascites’, the build-up of fluid in the abdomen is a serious cause for concern and may be accompanied by shortness of breath, tiredness and nausea. “When I’m addressing bloating I like to exclude any alarm symptoms,” says Sean, “so I always ask patients if they’ve lost weight, and I consider serious underlying pathologies. I check if there’s a family history of serious gastrointestinal or gynaecological diseases, and the severity of the bloating. If the pain’s keeping you up at night that’s a sign that something’s going seriously wrong.
“To ease the discomfort of bloating add two cups of Epsom salts to a warm bath (not too hot!) and soak for 20 to 40 minutes before lying down for 20 minutes to half an hour”– Tanya Clarke, naturopath and nutritionist
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