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What Causes Bloating and How to Prevent it

Written by Dr. Ruscio on December 5, 2023

Written by Dr. Ruscio on December 5, 2023 — Reviewed by Kellie Blake

A Four-Step Plan to Discovering (and Solving) Your Bloating

• Who Suffers From Bloating and Why?|
• Dysbiosis and Leaky Gut|
• Food Intolerances|
• Gut Motility Issues|
• Pelvic Floor Dysfunction|
• What’s the Best Probiotic Protocol for Bloating?|
• Bloating Can Be a Thing of the Past|

Bloating is an uncomfortable feeling of fullness in the stomach that most of us experience once in a while. Women tend to get it more than men [1, 2]

For some people, that tender, swollen feeling comes with a real and sometimes dramatic expansion of the abdomen. Others only feel the discomfort on the inside, without the need to loosen a button.

But whether you look like you’ve swallowed a basketball or only feel like it, bloating can really affect your well-being, especially when it becomes a daily occurrence. 

In this article, I’ll share the common underlying issues that my patients tend to have when they come to the clinic with bloating as a primary symptom. 

After a look at what causes bloating, I’ll walk you through the research-based steps you can take to help beat the bloat.

Who Suffers From Bloating and Why?

Up to 30% of Americans experience bloating, though it’s twice as common in women as it is in men [1, 2].

Occasional mild bloating, which may go along with belching and a gassy belly, is usually nothing to worry about. It may occur because you overindulged, drank too many carbonated beverages, or inadvertently swallowed too much sorbitol from chewing gum, for example.

However, if you’re troubled with persistent bloating, it’s much more likely because of a gastrointestinal disorder, such as Crohn’s disease, celiac disease or irritable bowel syndrome (IBS). In fact, about 90% of people with IBS experience bloating, especially if they have the type of IBS with constipation as a common symptom [2].

Many people assume bloating is just a build up of trapped wind, but gas, food, and fluid can all contribute to the feeling of distension (abdominal swelling) and stomach pain. People with IBS can also be unusually sensitive to normal volumes of intestinal gas and develop symptoms including cramps, burping, and bloating as a result [3, 4].

Regardless of the actual mechanics of bloating, the only really effective way to stop it is by addressing the underlying issues. 

In my clinical experience, bloating usually comes from one or a combination of the following four causes. I’m listing them in order of importance, with number 1 being the most likely cause and number 4 being the least likely.

1. Dysbiosis and leaky gut
2. Food intolerances
3. Motility (movement of contents through the GI tract) issues
4. Pelvic floor dysfunction

The best way to support a healthier gut and experience less digestive tract discomfort is to work through these four potential common causes of bloating in a stepwise fashion. 

Starting with improvements to your gut microbiota means you are targeting the most impactful change you can make first.

1 – Dysbiosis and Leaky Gut

Bloating that’s regular and severe, not just related to the occasional overindulgence, is often due to undesirable changes in your gut microbiota, known as dysbiosis.

Dysbiosis can result in bloating, flatulence, and abdominal pain because excess or unhealthy gut bacteria may produce a lot more gas than is normal. Dysbiotic bacteria ferment carbs and sugars in the gut, producing gas as a byproduct [5].

Dysbiosis also goes hand in hand with a leaky gut. Leaky gut, or intestinal permeability, occurs when the gut wall becomes more permeable and porous, allowing toxins and bacteria to leak from the digestive system into the body. Dysbiosis can contribute to a leaky gut by producing chronic inflammation, which can erode the tight connections between the cells lining your gut [6]. When food particles leak through, it can trigger your immune system to become intolerant to certain foods. Food intolerances, which I’ll cover in the next section, can cause you to bloat.

To stop that bloated feeling, it’s really worth putting the work into making your gut microbiome healthier and your gut wall stronger. Fortunately, with the help of a good probiotic supplement, it can be relatively easy to correct a dysbiotic and possibly leaky GI tract.

Beat Bloating With Probiotics

Probiotics are my first-choice natural therapeutic for resolving microbiota imbalances and a leaky gut. Both research and my clinical experience strongly support this treatment approach for many symptoms of gut imbalances, including bloating. 

The following evidence shows just how effective probiotics can be for correcting gut dysbiosis and leaky gut,  and improving gut health and bloating.

Probiotics can eliminate bacterial overgrowth [7]: In a 2017 meta-analysis summarizing 18 individual studies, probiotics were effective at eradicating small intestinal bacterial overgrowth (SIBO) in over 50% of cases.

SIBO is a type of dysbiosis in which there is an overgrowth of bacteria in the small intestine. In the meta-analysis, the SIBO removal rate achieved with probiotics alone was 53.2%, which was slightly better than the 51.1% eradication rate observed with the antibiotic Rifaximin.

While both treatments have value, I would certainly prefer to try probiotics for SIBO before turning to antibiotics. 

Probiotics help heal a leaky gut [8]: Another meta-analysis, this time summarizing 26 randomized controlled trials, found that probiotics helped reduce leaks in the intestinal barrier, as measured by:

• Fewer bacterial lipopolysaccharide (LPS) fragments (which act as toxins) crossing from the gut to the bloodstream
• Lower blood levels of zonulin, a protein that is crucial for regulating the permeability of tight junctions between cells lining the gut wall; lower zonulin equals less leakiness.

This study also reported that probiotic supplements helped bring the microbiome back into balance while reducing levels of inflammatory markers. 

To support the action of probiotics in your gut, you should also aim to eat a generally healthy diet that cuts out highly processed foods. A Mediterranean or Paleo-style diet (plenty of lean protein, green vegetables, and healthy fats) works well for most people as a starting point.

2 – Food Intolerances

You may wonder why food intolerances come second in my list of bloating causes to address, since I usually go for a diet-first approach. 

My answer is that a deep-dive into figuring out your food intolerances won’t be very helpful against bloating until you’ve already done some good work on your microbiome, as I outlined above.

The reasoning here is that an unhealthy gut is a key factor in creating food sensitivities in the first place [9]. When dysbiosis increases the leakiness of your gut, partially  undigested food particles can pass from your intestines into your bloodstream, where they don’t belong. Those foreign particles can trigger your immune system to identify those particles — and the foods you eat that contain them — as invaders to be destroyed. Then, when you eat those foods again, your body mounts an attack and your symptoms tell you that you have a food intolerance. 

Dysbiosis alone can lead to food intolerances, too. For instance, an overgrowth of bacteria in the small intestine (SIBO) can lead to symptoms when consuming certain kinds of carbohydrates known as FODMAPs [10]. These FODMAPs (which I’ll explain more below) can feed pathogenic bacteria or bacterial overgrowths in some people. Other gut microbial imbalances or gut infections can also contribute to food intolerances [9].

The good news is that if you get on top of your dysbiosis and leaky gut with probiotics, your food intolerances may start to clear up [7, 8]. 

A third major cause of food intolerances is when the body struggles to produce a certain enzyme required to break down specific foods or food components. For example, the most common cause of lactose intolerance is a deficiency in the enzyme lactase, which is necessary for breaking down the milk sugar lactose [11].

Even if your food intolerance is related to an enzyme deficiency, probiotics may help. Case in point: a 2023 meta-analysis showed that people with lactose intolerance, which is typically caused by an enzyme deficiency, were more able to tolerate dairy products after they took probiotics [12]. 

This means you likely won’t need to tackle as many food intolerances if you wait to identify them after your gut healing process is already underway.

If you’re still bloating after a few months of probiotics and a healthy diet, you can figure out your food intolerances with an elimination diet.

Beat Bloating With an Elimination Diet

An elimination diet is the most effective way to identify food intolerances, including those that trigger bloating [13, 14].

The three typical phases of an elimination diet are:

• Elimination 
• Reintroduction
• Maintenance

In the elimination phase, you remove foods that are most likely to trigger bloating, and note whether your symptoms improve. 

In the reintroduction phase, you gradually start bringing the foods you eliminated back into your diet, noting any recurrence of digestive symptoms along the way. 

Once you’ve reached the maintenance phase, your goal is to have constructed a diet that is as varied and balanced as possible, without triggering your bloating and other symptoms. 

Which Elimination Diet Should You Follow?

For helping with bloating specifically, I usually recommend the low-FODMAP diet above others. In a 2022 meta-analysis,  the low-FODMAP diet ranked best for reducing abdominal bloating and distension in people with IBS [15].

On this diet, you remove foods that are high in Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and [15] Polyols. These FODMAPs are particular carbohydrates that your gut bacteria can break down through fermentation, a process that produces a lot of gas. Examples of high-FODMAP foods include fructose-rich fruit like apples and pears, along with brussels sprouts, beans, wheat, and onions, which all contain chains of fructose called fructans. 

The low-FODMAP diet can seem pretty restrictive at first. But over time, as you reintroduce foods, you will find out which carbohydrates you can tolerate better than others, and your diet will become more varied.

Monash University, in Melbourne, Australia, has done most of the pioneering work on the low-FODMAP diet. They offer a very useful app that will familiarize you with high-FODMAP foods and help you work out how much (or little) you can tolerate before having symptoms.

As I already mentioned, you will probably become less sensitive to various foods as your gut heals. So, take heart: just because you can’t tolerate one food now doesn’t mean you won’t be able to in the future.

3 – Gut Motility Issues

After gut dysbiosis and food intolerances, the next common cause of bloating to consider is impaired gut motility, or the movement of contents through your digestive tract. 

Impaired gut motility means the peristaltic motions (involuntary contractions and relaxations) of the gut muscles don’t always work properly. As a result, food moves through the system slower or faster than normal. Where bloating is concerned, it’s usually the abnormal slowing that causes the problem. As you might imagine, if you’re bloated due to poor gut motility, you’re likely to be constipated, too.

Luckily, slow gut motility is another issue that probiotics can help remedy. Indeed, one meta-analysis found a Lactobacillus and Bifidobacterium blend sped up gut transit time (how long it takes the food you eat to come out as poop) by nearly 14 hours [16]. That’s a big deal to a constipated person!

Probiotics aside, you can also improve gut motility and reduce your bloating with a few good lifestyle habits.

Beat Bloating With Hydration, Stress Management, and Movement

Drinking plenty of fluid is an important factor in improving gut motility because water bulks out the fiber that passes through your small intestine and ends up in your colon. The bulky fiber then puts pressure on the colon walls to stimulate the peristaltic contractions that keep food waste moving downward. 

Being dehydrated, on the other hand, can reduce motility in the gut, slowing things down until you become constipated and bloated.

The National Academy ofMedicine suggests a daily fluid intake (from food and drink) of around 13 cups for men and 9 cups for women, with 1 cup equaling 8 ounces. This will vary depending on the air temperature and your body size and activity levels [17]. 

A good way to find out whether you’re drinking enough is to check the color of your urine — pale straw color is best.

Stress can also negatively affect motility, so practicing relaxation techniques, such as meditation and mindfulness, may benefit your digestion and bloating. 

A specific way to reduce digestive stress is to eat mindfully. Simply chewing your food thoroughly and taking more time to finish a meal can help regulate your stress response and encourage better digestive function [18].

Finally, don’t underestimate the power of adding some physical activity into your life to keep your gut functioning well. One meta-analysis showed that 4–6 weeks of doing regular light aerobic exercises, such as walking or Qigong, can noticeably improve constipation [19].

In fact, walking can be as beneficial as medication for stimulating gut motility and easing bloating. In one study of patients with bloating, half the subjects went for a post-meal stroll, while the other half were treated with prokinetic medication. The results revealed that after one month, bloating had improved more in those who walked than in those who took prokinetics [20]. 

4 – Pelvic Floor Dysfunction

If addressing gut dysbiosis, food intolerances, and gut motility still hasn’t resolved your bloating completely, then the final thing to consider is your pelvic floor.

The pelvic floor is the musculature that runs front to back across the bottom of the pelvis to hold up the bowel and bladder, plus the uterus in women. Sometimes bloating and constipation can occur because the muscles of the pelvic floor don’t coordinate very well. 

To be more specific, during the course of a normal bowel movement, the abdominal muscles need to contract to push waste toward the anus, and the anal sphincter has to relax to let the waste out. But when pelvic floor muscles are weak or otherwise not in sync, bowel movements can go awry and lead to constipation and bloating [21].

Beat Bloating With Pelvic Floor Therapy

Exercise that strengthens your pelvic floor and abdominal muscles can help generally with healthy gut function and prevent bloating and constipation.

A physical therapist who specializes in the pelvic floor can also offer you biofeedback therapy. This therapy can help uncoordinated muscles of the pelvic floor to act in sync again so that normal bowel movements can occur.

Biofeedback can have impressive results for the right candidates, such as patients with severe bloating who haven’t responded to IBS dietary guidelines. In one study of these patients, pelvic floor biofeedback produced at least a 50% improvement in bloating [22].

The Best Probiotic Protocol for Bloating

You’ll see that probiotics have come up many times in this article as a solution to bloating symptoms.

Though not every study has found probiotics are helpful for bloating, I would definitely recommend you try them for a period of at least two to three months. As you take them, pay close attention to signs that things are improving, and look for the greatest improvements at month two or three. 

But which probiotics are best to beat the bloat, and in what dosage?

The general answer is that any high-quality probiotic is better than no probiotics, and a blend is probably better than just one strain.

A protocol we’ve used to good effect for bloating in the clinic involves one or a combination of these three types of probiotics:

If you choose to start with just one of these, I’d suggest you go with the Lactobacillus and Bifidobacterium blend. However, you may find bigger benefits by adding in one or both of the others. Figuring out the combo that works best for you may take some trial and error, but let your body show you the way. 

If you’d like to cover all your bases from the get-go, you can opt for all three in one product. 

Bloating Can Be a Thing of the Past

Bloating can be miserable, but with this four-step approach to tackling it, you should start to see relief pretty soon. Hopefully, just taking the first step of tackling dysbiosis will make a difference as your improved microbiome reveals many positive downstream effects.

If you’ve given all four steps a solid try and are still bloated on a regular basis, your situation may be more complex than most. You might try delving in to work on your gut health more fully with the thorough guidance and 8-step plan in my book, Healthy Gut Healthy You. Or, you can reach out for a virtual or in-person session with a Ruscio Institute practitioner by clicking here.

The Ruscio Institute has also developed a range of high-quality formulations to help our patients and audience. If you’re interested in learning more about these products, please click here. Note that there are many other options available, and we encourage you to research which products may be right for you.