These simple dietary steps can make the World of difference.
Bloating is one of the biggest digestive complaints presented to doctors, dietitians, and nutritional practitioners. When I say primary bloating, I am referring to bloating that is not a symptom of any other condition such as inflammatory bowel disease. Your first port of call is to work with your doctor to ensure that there are no other reasons for your discomfort. However, in most cases, I’d say it is more likely that the patient’s diet and lifestyle have become a little out of kilter. Bloating is something that I should imagine every one of us has experienced to one extent or another: the feeling that the abdomen is very tight and feels notably full. The abdomen can look as bad as it feels, too. I have seen clients that literally looked pregnant due to bloating, and that’s not the best look on a guy in their 30s! This discomfort is caused mostly by gas. Temporary bloating can occur after a weekend of indulgence, such as over Christmas. When this bloating is occurring regularly, and you have adequately ruled out anything more serious, then it’s a sure-fire warning sign that things are not right and your digestion needs a tune-up.
Potential causes of primary bloating:
In my experience, poor gut motility and/or constipation is one of the leading causes of primary bloating. Gut motility refers to the healthy movement of gut contents along their journey. This continual movement is caused by the rhythmic contraction of muscle in the gut wall. If this motility suffers, the natural movement of gut contents will slow down and things can become a little bunged up, so to speak. This is but one cause of constipation. Poor diet, stress and dehydration can all cause things to grind to a halt and leave us feeling out of sorts. When this happens, you start to feel pretty bad pretty quickly. You feel heavy, full, headachy, fatigued and moods can take a nose dive! The biggest discomfort, though, is bloating. As waste builds up in the lower intestine, the bacterial population of the gut will begin to work away on it causing fermentation of many of the substances within the gut contents, which will cause the release of gas. This gas can become trapped, as its usual exit route starts to get blocked off. This situation can build and begin to get very uncomfortable indeed.
As we have seen previously, the stomach is a very acidic environment. This strong acid is what is needed to break complex proteins down into simpler structures that pancreatic enzymes can then easily deal with. If, for whatever reason, stomach acid gets too low, then proteins do not get broken down to the extent they should. This means that, when food leaves the stomach and enters the small intestine, there will be proteins that will be less digested than they would normally be, so pancreatic enzymes may well not be able to finish the job adequately, too. What is the consequence of this? Well, it means that partially digested proteins can enter the large intestine, where bacteria will attempt fermentation processes, but cause putrefaction of the proteins. These proteins may also cause localised irritation, too. The end result is an aggressive fermentation-type reaction once more, which creates gas and discomfort.
As we found earlier, when food leaves the stomach and enters the small intestine, an array of enzymes set to work on it to break it down into the smallest possible denominations ready for absorption. Some circumstances can affect these enzymes. Their production may be down regulated, or their secretion may be affected. An example of this is inflammation in the small intestine (which may be chronic or acute). This can affect the ability of a tissue to secrete an enzyme, or inhibit their release. This again can cause incomplete digestion of certain food groups, causing a chaotic response to them by gut flora when they arrive at the large intestine, causing gas.
One factor that is certainly an issue for those of us living on the standard UK diet of refined carbohydrates, sugar and convenience foods is a gut flora that is in a very poor state indeed. The bacterial colony of the digestive tract, as previously outlined, regulate so many aspects of digestive health and are there to break down some of the foodstuffs that cannot be broken down by enzymes. They also regulate aspects of gut motility, not to mention take care of the gut tissue. When gut flora suffers, other opportunistic organisms can begin to flourish in the gut. These can cause all manner of problems, from quite ferocious fermentation reactions (meaning gas), through to immunological issues.
I’m not going to give this much attention at all. My view on this subject is often not a popular one, but my sole concern is to inform you sensibly and reliably, based on science, not to fall in with the masses. Food intolerances have become a fashionable bandwagon in the nutrition world. Now don’t get me wrong, I am not saying that they don’t exist, because they certainly do. The problem is they are nowhere near as common as some voices in the health world may have us believe. The world and his wife suddenly think they have one. A real, genuine, full-on intolerance you REALLY know about and, as for a full-on allergy, well, that comes with very serious symptoms indeed. My feeling is that often people are diagnosed with intolerances when their digestion is really taking the brunt of modern life. A short run of eating in a hurry, a bit of stress, some disturbed sleep, not enough water, and one vino too many will make you feel like World War 3 is going on in your digestive tract.
Another thing that makes me insanely angry is some of the ludicrous methods by which people are diagnosed with having an intolerance. The worst of these is a strange contraption that is hooked up to a laptop. You hold a metal ‘sensor’ in one hand, and then another metal pen like gizmo is placed on the finger tips of the other hand. This machine then gives you a list of all manner of foods that you had a ‘response’ to. There is such a lack of solid science in this common practice that if it wasn’t such a serious matter of people being conned, it would be laughable.
The only way to figure out if you have an intolerance is to take two steps. The first is give yourself a digestive tune-up (see tips for general great digestion, page 000), then undertake an exclusion diet. This means avoiding the suspected foodstuff for at least six weeks. Then re-introduce it and see what happens. If your insides resemble nuclear fallout, then yes, that food is not for you. If not, it is safe to say the food wasn’t the problem and that it was more likely that your digestive heath was suffering and taking steps to improve it has eased your discomfort.
Nutritional action plan for bloating:
Ok, I know this may sound like a weak recommendation or a cop out but, believe me, this is one of the best first steps that you can take. It is all about gut transit! We all know we should eat more dietary fibre to help keep ourselves regular (I will discuss the reasons for this next). Well, this fibre is useless if we are dehydrated. This is because water is needed to make it swell up and do its job. Now, there are all sorts of weird and wonderful recommendations as to how much water we should drink. Some say eight to 10 glasses, some say three litres (wow). The truth is, we are all different, so our needs always vary. But you can use your body as a great barometer. Simply keep drinking until your urine runs clear. At this point, stop. Once the colour begins to return to the urine, drink a little more until the colour goes again. Following this guide will keep you hydrated.
Dietary fibre is one of the real keys to keeping everything moving in the digestive tract. The movement of gut contents through the digestive system is governed by a series of rhythmical contractions of the gut wall, called peristalsis, that essentially squeeze the gut wall and slide everything along. Many things affect peristalsis, such as enzymes and hormones, but one of the chief regulators is the gut actually being aware that it has sufficient content within it to give a contraction. This message is relayed by stretch receptors. These receptors measure the stretch of the gut wall, as its contents move through it. When these receptors are stimulated, the gut responds by giving a peristaltic contraction. I have mentioned the importance of water. Well, water and fibre come together here. Water causes dietary fibre to swell, as fibre can take up a lot of it. The more it swells, the greater the stimulation of the stretch receptors, the greater the stimulation of peristalsis. High-fibre foods aren’t necessarily dull-as-dishwater bran cereals of 90s fame. They are basically whole foods. Foods in their real state. Fruits, vegetables, low-glycaemic grains and pulses. The more of these you get in the better. It is worth mentioning here that there may be some individuals that are sensitive to a group of compounds found in some high-fibre foods, called FODMAP’s. These can cause aggressive gas and bloating in some susceptible people, but luckily are easy enough to avoid.
I stand by the statement that every lower digestive issue will benefit drastically by improving the bacterial colony in our digestive tract. They regulate and maintain so much, I can’t think of a single situation where this wouldn’t be relevant. In bloating, getting gut flora in good shape can work wonders, believe me! There are two ways of doing this and I advise both. The first is obviously to add more. I personally wouldn’t bother with those little yogurt drinks. Aside from being sugar bombs, the levels of the bacteria they actually contain most likely offer vary little clinical benefit. I recommend getting a good-quality supplement from your local health food store (see page 000). I recommend getting one that is a mixed culture (ie has more than one type of bug in it) and take it twice a day. One with a meal, and one on an empty stomach. The reason for this is that there is compelling evidence for both ways of taking it. So much so that I can’t actually make up my mind which would be the most suitable, so I recommend both to hedge my bets. The next step is to feed the bacterial colony that is already there and encourage their growth and flourishing. This is done by consuming foods that are prebiotic. This means they contain specific types of polysaccharide that, when the bacteria ferment them, causes the bacterial colony to reproduce and grow. It also causes them to synthesise compounds such as butyric acid that can help to repair the walls of the digestive tract.
The word carminative is old herbal terminology. In the most part, my approach is pharmacological and food based, but there are times when I revisit my herbal medicine heritage. Carminatives are basically herbs (or indeed foods, as many turn out to be) that soothe the gut, ease griping, reduce the production of gas and disperse gas. These ingredients all generally have a very high concentration of specific volatile oils, responsible for their distinctive aromas and flavours, that are responsible for these actions. So powerful are these ingredients that one of them, peppermint, is regularly recommended for chronic bloating and gas by GPs.