Since I've carved out an apparently under-served niche in blogging about bloating, emails have been pouring in from readers all over the world. While the specifics vary, the essence is the same: "No matter what I do, I'm always bloated or gassy. Doctors have tested me for everything and haven't been able to help. What could it be?"
• Be a good historian. Patients often report having been "tested for everything," but when I start asking about the specifics, this is rarely actually the case. Often, my patients don't know which tests they've had done or what the results showed. As a result, a lot of time is wasted chasing down old leads that have been ruled out or repeating tests done elsewhere.
If you're seeking help from a new doctor or dietitian, you'll get the most out of your visit by bringing along printed copies of test results conducted previously. Bringing blood work tells your provider whether celiac disease, thyroid dysfunction or certain parasites have been ruled out or whether there are vitamin or mineral deficiencies that might offer clues as to what's transpiring inside.
Results from endoscopies, colonscopies or CT scans are also helpful. Mention if you've had breath tests for carbohydrate intolerances or bacterial overgrowth. (And if some of these test names are unfamiliar, then you most certainly have not been checked for everything!)
• Remember: not all bloating has a dietary trigger. Just because abdominal distension occurs immediately after eating or drinking, it doesn't mean the bloating is a reaction to the food itself. Sometimes, the very act of eating or drinking – and the mechanical distension of the stomach it produces – triggers bloating. This can be the case in extreme constipation, gastroparesis (delayed stomach emptying) or variants of irritable bowel syndrome (IBS) that affect the esophagus and upper stomach.
Sometimes, what you refer to as "bloating" isn't the result of gas at all but rather of weak abdominal wall muscles that can't support the weight of a recently fed belly. For women who have previously been pregnant, this is not an uncommon phenomenon.
• If bloating is indeed diet-related, chronic bloating is most likely caused by foods you eat chronically. Many people are creatures of habit, at least during the workweek, and rotate between a small handful of breakfast, lunch and dinner options. If you're one of them, use this to your advantage and start to play around with eliminating certain of your usual options for a week at a time to see how symptoms are affected.
I'd prioritize highly-processed or functional foods (cereals, bars, shakes); anything with added sugar or sweeteners; and foods containing bean family ingredients – including soy. If dairy is a staple, try swapping in lactose-free versions for a week to see if that makes a difference. Resist the temptation to eliminate multiple foods at a time; otherwise, you'll be hard-pressed to identify the smoking gun if your symptoms spontaneously improve.
[Read: IBS? Could be the FODMAPs.]
• Pay attention to timing. I cannot emphasize enough the importance of a written food and symptom journal that captures times of both food eaten and symptoms experienced. The timing of symptoms is essential to zeroing in on the cause of your bloating. And unless you understand the physiology of digestion, you are likely to mistakenly attribute digestive symptoms to the wrong dietary triggers.
True dietary intolerances – like to lactose, fructose or soy – aren't likely to cause bloating symptoms for two to six hours after you've eaten the food, assuming your digestive transit time is normal. This is how long it takes for a solid meal to arrive in the colon and be available for fermentation by gut bacteria. Therefore, gas, bloating and diarrhea within an hour after eating dairy is not generally an indication of lactose intolerance.
One exception to this rule would be in the case of a liquid-only snack – like a high-fructose sports drink – that may arrive in the colon sooner. Another exception would be in the case of Small Intestinal Bacterial Overgrowth (SIBO) – a condition where bacteria take up abnormal residence in the small intestine and therefore are able to ferment your carbs relatively soon after they exit the stomach.
But as a rule, if you become flatulent within an hour of finishing a meal, the trigger is more likely to be a food you ate at your previous meal (or even two meals ago) that was just pushed into the colon as the result of a post-meal digestive system reflex.
[Read: When Good Foods Make You Feel Bad.]
If you're just distended and uncomfortable (but not flatulent) in that one-hour time frame, the physical properties of the meal you just ate are worth considering: Was it a large total volume of food? Was it a bulky, fibrous meal – like a giant raw salad? Was it a very high-fat meal? Depending on what else you have going on digestively – acid reflux, irritable bowel syndrome, chronic constipation or gastroparesis – any of these factors could result in significant discomfort soon after eating.
• Every Sherlock Holmes needs a Watson. You, your doctor and your dietitian are partners in getting to the bottom of your digestive woes. So if you don't feel your concerns are being taken seriously – or if you've hit a diagnostic dead end – then consider seeking out a clinician who brings a fresh perspective and open mind to the problem. No matter how long you've been suffering, don't give up: There is someone out there who can help you figure out why!
Hungry for more? Write to firstname.lastname@example.org with your questions, concerns, and feedback.
Tamara Duker Freuman, MS, RD, CDN, is a registered dietitian whose NYC-based clinical practice specializes in digestive disorders, Celiac Disease, and food intolerances. Her personal blog, www.tamaraduker.com, focuses on healthy eating and gluten-free living.