Bloating is one of the most common symptoms that I see in my practice. Sometimes patients come in wanting help with their chronic bloating and other times it’s an additional piece to the puzzle that’s discovered during our initial consultation. Either way, it’s important to get to the root cause of bloating as it’s typically just one symptom of a much larger picture. Bloating is one of those symptoms that can happen for many reasons and if you’ve ever done some quick research, you might have been overwhelmed by the amount of causes. To help simplify this, the most common causes of chronic bloating can be separated into three groups: gastrointestinal, sex hormones and thyroid. When trying to determine the root cause of bloating, sometimes patients might fall into one, two or even all three of these overarching groups. I’ve broken these three groups down and listed the top 6 causes of chronic bloating.

• Suboptimal microbiome health

Our gastrointestinal microbiome is home to a whole bunch of little organisms, including bacteria and fungi. Some of these organisms are labelled as good and some bad, while others are neutral but can become bad given the right conditions. When it comes to the microbiome, balance is incredibly important! A healthy microbiome will always have some bad bacteria and some fungi, the most common being a yeast called Candida. However, there should be a healthy ratio of good to bad bacteria, as well as a healthy amount of Candida. The gastrointestinal system can run into issues if these numbers get out of balance. This can happen in three ways and all three are what we call a microbiome dysbiosis.

The first way occurs when there is too much bad bacteria, resulting in a poor ratio of good bacteria to bad bacteria. Bad bacteria have been linked to inflammation and obesity and can cause a wide range of symptoms, including bloating. The second microbiome dysbiosis is called small intestinal bacterial overgrowth (SIBO) and this occurs when there’s simply way too much bacteria. Even having too much good bacteria leads to SIBO and the most common symptoms experienced are gas and bloating. The third microbiome dysbiosis is called small intestinal fungal overgrowth (SIFO) and occurs when fungi species, most commonly Candida, have been given the right conditions to overgrow and thrive. This is commonly seen after antibiotic usage because antibiotics kill off bacteria in the gut, leaving a free surface for Candida to spread on. Once Candida has laid its fungal roots down, it’s hard to clear it without specifically targeting its removal. With all this being said, you might be wondering “how do I know if my microbiome is healthy or what dysbiosis I have?” The good news is that there’s stool testing that can be done to determine the composition of the microbiome (GI MAP). These results remove the guess work and allow for a very specific and targeted approach to remediation and repair.

• Poor digestion, absorption and motility

If somewhere along the chain of digestion is suboptimal or sluggish, patients can experience bloating. Think of digestion like an assembly line at a factory; every assembly point needs to run at peak efficiency for the line to move smoothly. If one of the assembly points is slow, then the line becomes backed up or bloated. Poor digestion can be caused by multiple factors including a low fibre diet, inadequate digestive enzyme production and/or hydrochloric acid production, dehydration, constipation, and Celiac Disease (autoimmune condition triggered by gluten consumption). If foods aren’t broken down properly and timely, then they can ferment in the intestines causing gas and bloating. There are several ways to assess if a patient has issues with their digestion. The best way is through a very thorough discussion but bloodwork or stool testing can also provide important insight.

• Food sensitivity or intolerance

Most patients know if they have a true food allergy because symptoms usually occur shortly after consumption. For example, individuals with a lactose allergy often find themselves seeking a bathroom within 20 minutes of consuming dairy products. However, for patients with a food sensitivity or intolerance, it might not be so clear cut or easy to deduce what the culprit is for their bloating. Regardless of the culprit, typically patients with food sensitivities or intolerances have some degree of damage to the gut lining. Patients can either develop leaky gut syndrome (increased intestinal permeability) from the foods their sensitive too or their gut was damaged from a different cause and they are now experiencing issues with foods. Leaky gut syndrome means that certain things, like bacteria, bacterial toxins and food proteins, can leak through the lining into the bloodstream. This causes an immune response that can lead to widespread inflammation. The resulting symptoms are highly variable between individuals but the most common symptoms are bloating, gas, food sensitivities and fatigue. When it comes to food sensitivities, the treatment is typically two-fold: repair the gastrointestinal lining and remove aggravating foods. The best way to determine what foods are causing problems is to do a proper elimination diet. Once the gut lining is repaired, some patients do find that they can start eating the foods that used to aggravate them.

• IBS and IBD (Ulcerative Colitis, Crohn’s Disease)

Bloating can be a common symptom of both Irritable Bowel Syndrome (IBS) and Irritable Bowel Disease (IBD). Both conditions typically have multiple contributing factors that can worsen the severity of symptoms. If you’ve been diagnosed or suspect you have IBS or IBD, it’s important to do a very thorough intake and the appropriate follow-up testing. One test that can provide vital information is gastrointestinal microbiome testing.

• Estrogen dominance

Hormonal changes and imbalances can cause or contribute to bloating. The most common hormonal issue is due to something called estrogen dominance. Estrogen dominance can happen from either too much estrogen or not enough progesterone. In either situation, the amount of estrogen is too high when compared to progesterone. Estrogen dominance can lead to a multitude of symptoms, including bloating, heavy menstrual bleeding, menstrual clotting and severe PMS symptoms (uterine cramping, abdominal pain, mood changes). High levels of estrogen have also been linked to uterine conditions including endometriosis and fibroids. It’s important to note that mild bloating before or during a menstrual cycle can be normal as estrogen levels rise then fall. If the bloating lasts beyond the menstrual cycle or is accompanied with other symptoms, estrogen dominance might be to blame.

• A sluggish thyroid gland

An underactive thyroid gland can lead to a condition called hypothyroidism. Hypothyroidism occurs when the thyroid gland doesn’t produce adequate thyroid hormones. Besides bloating, other common symptoms of hypothyroidism include fatigue, weight gain, constipation, having a sensitivity to cold and experiencing low mood. If an underactive thyroid is suspected, it’s important to do comprehensive bloodwork to determine thyroid hormone levels and determine if there’s an autoimmune connection. Additionally, certain nutrients are vital to the thyroid glands function and it’s important to assess that there isn’t a nutrient deficiency in the diet.

While these are the most common causes of bloating, they are not the only causes of bloating. It’s important to remember that bloating can also be caused by more immediately serious concerns, such as intestinal obstruction and cancer. If you’re experiencing bloating and are worried in any way, especially if you have severe pain, sweating, swollen lymph nodes, weight loss and/or a family history of cancer, you should not hesitate to book an appointment with your family doctor to receive the appropriate testing and imaging.

Dr. Hailey Traut, ND

References:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6039952/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3448089/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4954875/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2699000/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4177463/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3098121/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5358086/