Gas Bloating Relief Overview
No discussion that relates to gas bloating relief can be had until the basics are understood. So before we start anything I’ll give you a very basic understanding of how the gut works. Very basic.
Just like every other organ system, the gut is an incredibly complex system that we still don’t understand fully. And few people understand even a small piece of what we do know.
And before you think that the average gastroenterologist much know quite a bit about the gut, you’ll realize quickly that few really understand the very organ their specialty circles around, otherwise the average GI practice would look far different than it does today.
As far as the importance of the gut goes—I always say that the body digests and does everything else. In other words, digestion and absorption of nutrients is THE most important thing our body does. Mess with this and all hell breaks loose.
Stages of Digestion
There are several stages to the digestive process. Problems with digestion play an integral role in stomach pain and bloating.
Contrary to common thinking, digestion does not begin in the stomach. It begins with your sense of smell and chewing. This aspect of eating is far more important than most realize.
And not just eating, but eating SLOW. Study after study has shown that those who eat faster and chew less have higher risk of diabetes and obesity. Merely slowing down and enjoying your food can improve your health. Don’t even need to exercise or eat less or even better (although you should…) to be healthier.
Your sense of smell, when triggered by food smells, kicks off the production of saliva. In saliva, the are several enzymes. The enzyme lingual lipase starts the fat breakdown process, and the enzyme alpha amylase starts on carbs.
Because of this, digestion of certain molecules begins even before food hits the stomach.
Gastric (Stomach) Phase
Once you swallow, digestion leaves the oral phase and picks up in the stomach.
So long as you’re chewing your food in a leisurely pace, the stomach is where most people’s digestive health starts to break down, leading with stomach pain and bloating. This is because it is affected greatly by stress, antibiotics and poor food choices.
Worst of all, however, is medicine’s wanton use of drugs that block acid. Acid is an critical point in the digestive process.
Stomach acid release, otherwise known as hydrochloric acid (aka HCl) is stimulated by saliva and the hormone gastrin. HCl has a long list of essential functions for good health. Some of these include:
- Most digestive enzymes are produced in an inactive form (otherwise the enzymes would digest the very glands they are made in). Stomach acid activates these enzymes so they can work.
- Creates an acid environment to break down certain proteins (the pH of the mixture in the stomach, called chyme, should be around 2-3, or very acidic).
- Kills off most of the live bacteria, viruses, parasites and fungus that is ingested. This becomes a VERY important factor.
- Needed to absorb certain vitamins like B12 and iron.
- Needed to turn on certain anti-cancer compounds in food (like broccoli).
- The pH of the stomach must be low enough to tell the pancreas to release bicarbonate. Stomach acid ensures this happens. Without it, the pH of the contents released from the stomach (chyme) stay acidic and can damage the entire length of the intestinal tract.
Other hormones released in the stomach include pepsin (breaks down protein) and gastric lipase (breaks down fat).
Pepsin works best at a pH of 2, which means that, if you are not releasing enough stomach acid from stress or prescription drugs to lower the pH of the stomach than pepsin won’t work to break down your food the way it should.
While not actually a stage of digestion, the rate at which your stomach empties is a really important step in the process of digestion and one that can get quite complicated.
To put it into simple terms, filling the stomach (as in drinking a lot of liquid or eating a big meal) will initially stimulate the stomach to empty a small amount into the small intestine. Probably the main reason this occurs is so the small intestine can “sample” what’s in the stomach and either slow down stomach emptying or speed it up.
More fats, amino acids and sugars will slow down stomach emptying so that the stomach can digest longer. Typically, most of what you eat will be out of the stomach about 2 hours later (so NOTHING you eat “goes right through you”).
This last phase of digestion is where the payoff is. This involves the absorption of all those food particles and nutrients that were (hopefully) broken down in the stomach.
Two very important things happen here beyond absorption.
First, the gallbladder releases bile to help absorb fats. If your gallbladder is gunked up or gone (both very typical in prediabetes / diabetes) you’re not going to be absorbing all the healthy fats you’ve been eating, the healthy fat-soluble nutrients like lycopene in tomatoes and the fat-soluble vitamins (A, D, E, K).
If you can’t absorb these fat compounds, you’ve got big troubles (although this can be helped by taking a supplement designed to replace the missing bile). It’s one of those little tidbits they don’t tell you before you have your gallbladder yanked out.
Next, the pancreas senses the acid in the stomach contents and releases bicarbonate to neutralize the acid, bringing the pH of small intestine closer to neutral. This becomes a BIG problem with people on drugs that block stomach acid production. If the pH is too high (acid blocking drugs keep the pH of stomach stays above 5) the pancreas won’t release bicarbonate to neutralize the acid.
This leaves the mixture going through the rest of the digestive process being acidic instead of neutral. This is not what the intestinal tract was designed for.
There are other things that happen in the small intestine that contribute to stomach pain and bloating, but it’s beyond the scope of this article.
Which brings us to the large intestine.
The main functions of the large intestine are to house the intestinal bacterial flora (the intestinal microbiome), reabsorb water and absorb the vitamins produce by the bacteria (mainly K, B12, thiamin and riboflavin).
The appendix is also a part of the large intestine. While we used to think that the appendix no longer had a function (in today’s time—termed “vestigial”), we now understand that it functions as a reservoir of bacteria for repopulating the gut after a severe infection. Removing it will have permanent effect on the microbiome.
The Migrating Motor Complex in Stomach Pain and Bloating
While technically not a phase of digestion, it is critical that you understand this aspect of your digestive system and how it plays a role in small bowel bacterial overgrowth and gas bloating relief.
The MMC is a wave of electrical activity in the gut during the periods between meals. It is thought to serve a “housekeeping” role to sweep leftover undigested material through the digestive system. It does this through a complex series of contractions that also includes an increase in digestive enzymes released from the stomach, gallbladder and pancreas.
In addition to sweeping out food debris, another important job is to wash out loitering bacteria that should not be hanging around.
The periodic nature of the migrating motor complex is thought to be controlled from the central nervous system and may be implemented in part by the enteric hormone motilin. Like real housekeeping, the migrating motor complex is readily overridden by “more important” processes – for example, ingestion of food will abolish a migrating motor complex and restore a digestive pattern of motility.
The MMC is still somewhat of a mystery, but there is a hormone called motilin that plays a role in this sweeping action.
And while the specifics of motilin are not entirely understood, one thing has been determined—a higher pH (alkaline) in the small intestine triggers the release of motilin and increases motilin’s activity.
I’ve mentioned several times already just how incredibly BAD it is to be on drugs that block stomach acid production and how much they play a role in stomach pain and bloating.
There is no other way to describe it other than saying that these drugs wreak havoc on your digestive system. This is just another nail on the coffin of why acid blocking drugs are so incredibly BAD for your health.
Question to think about…
Do you think that the doctor who wrote you a prescription for acid blocking drugs know just how much stomach acid plays a role in stomach pain and bloating?
Problems Associated with Digestion
This section is not about tumors, bleeding ulcers or strangulated intestines.
Why? Because mainstream GI docs are pretty darn good at handling this stuff.
But once you’ve been scoped from the top down and bottom up (which, hopefully, where done in two separate procedures…) and nothing is found, this is where mainstream GI docs fail.
This begins to fall into the realm of “functional” bowel disorders. This is territory that the average GI doc is just not comfortable addressing.
Sure, any time a new medication comes out to treat constipation or diarrhea than the GI docs become the expert in this field (meaning that he or she now has a drug to not fix the problem but make the symptoms better).
But this isn’t fixing.
Digestion Problems (i.e. What Causes Stomach Bloating)
When discussing problems with the GI tract, I tend to break them up into “upper” and “lower” problems, although it’s never really that clear cut. Every aspect of the GI tract affects every other area. Period.
But this doesn’t fit well into a bullet point presentation like this article, so I’m going to conveniently ignore that fact for now.
This means that the best to start is in the stomach with “digestive” issues.
Digestive issues are really limited to reflux (heartburn) and gastritis. Ulcers fall into the “structural” problems with the GI tract and can be life threatening. This is one of the few scenarios where acid blocking drugs make sense.
Reflux / Heartburn / GERD
Most of you know what this one is. That burning behind your sternum that feels like a lump that won’t go away. Gets worse when you lie down as acid splashes up onto the delicate tissues of the esophagus.
Most doctors will jump on acid blocking drugs to “fix” this type of stomach pain and bloating, but I think I’ve made it quite clear how I feel about this class of drugs and how much it totally destroys your health.
Reflux typically happens when acid from the stomach splashes back up on the esophagus, irritating these sensitive tissues. Long term exposure to this acid was, for decades, believed to contribute to the pre-cancerous condition known as Barrett’s esophagus.
It would then make sense that doctors should block acid production with drugs to stop the progression to esophageal cancer. And this is how doctors have scared patients into using drugs to block acid over the course of decades.
Or at least it would, if that was the only factor going on. As with anything else, the story is much more complex.
Barrett’s Esophagus and Esophageal Cancer – Inflammation and Prediabetes
If acid was the only factor affecting your risk of developing Barrett’s esophagus and cancer then blocking acid would totally fix the problem (there have been concerns that acid blocking drugs INCREASE the risk of Barrett’s esophagus—enough so that researchers felt the need to put this concern to rest with further research). But since this is not even close to true, you should understand some of the factors that DO increase the risk.
Anything other than acute inflammation after an injury or inflammation in response to an infection is a can be considered physiology’s arch enemy.
Because many types of cancer are related to levels of inflammation researchers looked to see if this same equation was present with esophageal cancer. They looked at several blood markers of inflammation (C-reactive protein-CRP, Interleukin-6-IL6, soluble tumor necrosis factor-sTNF receptors I and II and F2-isoprostanes).
Here’s what they found:
- Those with higher CRP levels had an 80% higher risk of esophageal adenocarcinoma.
- Even worse, those with higher CRP and an elevated waist–hip ratio had a 198% higher risk.
- Higher CRP and smoking upped risk 177%.
- Higher IL6 levels had a 200% higher risk of esophageal cancer.
- Elevated waist-to-hip ratios and smokers did not have a further risk above IL-6.
Understand that inflammation is NOT reduced using acid-blocking drugs. In many cases, the use of these drugs to block normal digestion would increase inflammation.
Another important thing to note is that having an elevated waist-to-hip ratio (meaning these people were very likely pre-diabetic) was more dangerous than cigarette smoking.
Barrett’s Esophagus and Esophageal Cancer – Bacterial Diversity / Microbiome
In the same study noted above, researchers looked at the bacterial diversity at the end of the esophagus just before it entered the stomach and found that lower microbial diversity (number of different types of bacterial) led to higher risks for both gastric and esophageal cancer.
There have been several other studies that have also found that the bacteria in the esophagus play a very important role in Barrett’s esophagus as well as esophageal cancer. This is a component of GERD that few docs discuss with patients.
As I’ve already covered, the use of drugs that block the production of stomach acid interfere with the normal balance of bacteria in the gut. And antibiotics absolutely DESTROY bacterial diversity. Diet, as expected, plays a major role in the types of bacteria that will grow and thrive anywhere along the entire length of the GI tract.
To show that acid-blocking drugs are more likely to create problems instead of solve them, one study looked at the use of proton-pump inhibitors (like Nexium) and the impact on the gut bacteria. Here’s what they found:
- There was a lower number of normal gut bacteria (commensals).
- There was a lower microbial diversity (the “mark of death” when it comes to a healthy gut).
- There were a higher number bacterial from the mouth (bacteria from the mouth are not getting killed off in the stomach).
The list I gave earlier on the important things that stomach acid does is really bad enough when it comes to destroying your health. But when you add in a disruption to the microbiome, the sky’s the limit to how much damage long-term use is to your health.
Overall, these things suggest that blocking acid is probably the least effective approach to protecting your esophagus and may actually bring harm in the long run.
Barrett’s Esophagus and Esophageal Cancer -Food Allergies
Food allergies are probably one of the biggest players in the heartburn / reflux and Barrett’s esophagus game.
Just to demonstrate how much food allergies play a role in esophageal problems, researchers in one study looked at the relationship to food allergies and eosinophilic esophagitis (EoE). When adults with EoE were put on an elimination diet, the results were nothing short of shocking:
- Common symptoms of EoE included problems swallowing (96%), food getting stuck (74%), and heartburn (94%). These patients were already on acid-blocking drugs.
- The number of eosinphils (white blood cells related to allergy) dropped 76% with the elimination diet
- Symptom scores decreased in 94% of those on the program (yes–you read that right–94%, as in “almost all”)
- After food reintroduction, eosinophil counts returned to pretreatment values.
- Foods most problematic were wheat (60%) and milk (50%), soy (10%), nuts (10%), and egg (5%)
- Skin-prick testing predicted only 13% of foods (in other words, just short of worthless)
What was even more surprising was that NONE of the patients in this study realized that they had food allergies / sensitivities prior to being put on an elimination diet. Which also means that their gastroenterologists likely never brought the subject up nor made recommendations on an elimination diet.
Overall, from all these examples, it is clear that ACID IS NOT THE REAL PROBLEM in reflux disease / heartburn.
Gallbladder / Pancreas Problems in Stomach Pain and Bloating
Next on the list (anatomically, at least) are problems with the gallbladder and pancreas that can cause stomach pain and bloating.
Since most of the problems that occur with the pancreas are more serious (tumors of the pancreas, pancreatitis, blockages) we won’t really cover this topic. The only thing I will say about the pancreas is that there is a very strong relationship between pancreatic cancer and prediabetes / diabetes. This topic is important enough to warrant its own article in the future.
Gallbladder problems are also strongly linked to prediabetes and can be a decades-early warning sign that you are on your way to diabetes (I don’t think I’ve ever had a patient that was told this by his or her surgeon).
The unfortunate thing is that removal of your gallbladder (the typical “solution” to fix your stomach pain and bloating) will speed up this process by impacting your ability to absorb fat soluble vitamins as well as healthy fats from your diet.
Gallbladder problems typically show up as midline or right sided abdominal pain after eating fatty meals. Fried foods seem to flare up pain the most.
It’s not uncommon for gallbladder problems to cause right shoulder blade pain.
As a chiropractor, I’m always on the lookout for these types of cases. I missed a case of this early in practice and quickly learned my lesson about what to look for to make sure this didn’t happen a second time.
Imaging of your gallbladder (ultrasound it one of the safest and easiest methods) may show stones or “sludge” and can give you an idea of how well your gallbladder is still functioning.
Just in case you’ve dodged the bullet of having your essential organs yanked (if you doctor told you that your gallbladder HAS to come out, this is not true—less than a third of patients with severe gallbladder flare ups will ever need surgery), I will cover some ideas to help your gallbladder later in the treatment section of this article.
Abdominal / Stomach Pain and Bloating
Abdominal / stomach pain and bloating is a biggie and experienced by an awful lot of otherwise healthy people.
If this is you, you’ve probably had countless specialty consultations and spent thousands of dollars on imaging and testing, only to have them all come back normal.
Sure. Maybe they find something—a few stones in your gallbladder, some fecal matter stuck in your large intestines—but nothing that really adds any value or gets you any closer to abdominal bloating relief.
Stomach pain and bloating doesn’t always have to be painful. Sometimes it just leaves you with an uncomfortable feeling in your gut that drains your ability to be positive and productive. And it can last for hours.
The stomach pain and bloating can hit an hour or so after you eat or can hit soon after a meal–way too soon for the food you just ate to make it through stomach digestion and cause direct problems in the small intestine.
So what does it mean?
Stomach bloating an hour or more after you eat is most likely related to poor digestion. As I pointed out at the beginning of this article, the stomach should digest a large portion of the foods that you take in. Proteins, carbs and fats.
If these don’t get digested properly in the stomach, these food products can get digested by bacteria in the small intestine. But these bacteria aren’t nearly as efficient as the stomach and so gas can be produced as a side effect of this inefficient digestion.
This gas builds up and collects in the upper quadrants of the abdomen—right under the rib cage. And it can really suck.
The pain can range from mild discomfort all the way up to enough pain to lead to an ER trip.
I can’t tell you how many times over the years I’ve had patients who have gone through all kinds of testing to only be told by the GI doc that they couldn’t find anything. Then the simple addition of digestive support supplements provides abdominal bloating relief in a matter of days.
If digestive enzymes don’t quickly work or if your stomach pain and bloating hits immediately after you eat, there’s a very good chance that you’ve got Small Intestinal Bacterial Overgrowth, or SIBO.
Ultimately SIBO is the most important thing I’m going to cover in this article that will impact the vast majority of readers, but since it’s so important and cuts across every other condition in the gut, I’m going to use it to lead off Part 2 of this article.
Constipation / Diarrhea / Irritable Bowel Syndrome and Inflammatory Bowel Disease
Constipation and diarrhea are two rather unpleasant GI conditions that hits all of us at some time or another.
But I’m not here to talk about the two days you spent living on the toilet from diarrhea after a bad batch of Taco Bell (I call that health karma…) or the day or two of constipation from dehydration or more bad dietary choices.
No. The more important situations come into play when you have a bowel movement every 2 weeks or 2 hours. Considering that most experts feel that you should have a bowel movement at least twice per day and that this is the path that your body uses to eliminate toxins and waste products, having a bowel movement as often as you change your sheets that’s a pretty big deal.
Irritable bowel syndrome (IBS) is a catch-all term for unexplained diarrhea, constipation or both (termed “mixed”). Thus, the answer to IBS lies in improving the health of your gut, regardless of what diagnosis someone has given you.
Chronic constipation and good health absolutely, positively do not belong in the same sentence (except for this one, and only for illustrative purposes).
For this reason alone, it’s critical that you get your bowels moving ASAP.
The long term and best answer is to figure out what is causing the problem in the first place. This list is pretty well contained:
- Dairy is a well-accepted cause of constipation (check out my “evils of dairy” eBook by clicking here in case you’re still under the impression that milk is good for you).
- Food allergies are a big contributor to constipation. It’s beyond the scope of this article to go into food allergies, just suffice it to say that if you’ve got chronic constipation this needs to be on your list.
- Two-thirds of the dry weight of your stool is dead bacteria. This means that anything that supports the growth of bacteria in your gut will help increase the bulk of your stool. Probiotics can help, but fiber is the key here. And principally soluble fiber. Stayed tuned until part 2 of this article for all you ever wanted to know about fiber.
But since getting your gut moving is off crucial importance to your health, quick fixes for constipation are important.
And, despite all the years you may have tried stool softeners and laxatives and maybe even a new-fangled drug or two for constipation without any lasting fixes, the answer to chronic constipation is actually pretty darn easy.
It’s called osmotic diarrhea.
You see, when you take in more of something than your body can absorb, the remainder will stay in the GI tract. Your gut won’t like this and will try to dilute the concentration down with water (called osmotic pressure). Depending upon how much water flows into your GI tract, you can range from loose stools all the way to explosive diarrhea confining you to within 12 feet of a commode.
For someone who has a bowel movement once a full moon, a little side effect like loose stools can sound like a pretty good thing.
The best tool to use in this manner is magnesium. It’s cheap, safe AND it’s a commonly deficient nutrient. This means that trying to overdose on magnesium is working towards getting your body fully loaded on a mineral that plays a strong role in good health.
It’s all about dosage and form of magnesium.
In our office, we generally recommend Biotics Mg-Zyme because I know at what dosage patients will respond. For this product, I recommend 400 mg before bed. It may take a few days for your body to absorb all the magnesium it needs, so be patient.
And remember that magnesium can’t NOT work. It’s just a matter of how much you take and how much your body needs. If you’re stressed—your body will burn through more magnesium and you may have to up the dosage for a few days as your body sucks up more magnesium to deal with the stress.
Trying to fix constipation in ANY other way with things like stool softeners, laxatives or drugs like Linzess is a BAD idea. Bad.. Two periods.
These other approaches to chronic constipation will change the way your gut works, creating long term problems on top of whatever was going on in the first place. Using magnesium just uses the simple process of movement of water across a semi-permeable membrane—it doesn’t change the way your gut functions.
Even the name sounds like something that is going to be difficult to talk about, let alone how much it can disrupt a normal life.
I remember a patient years ago that had IBS-D so bad it would take her about twice as long to drive to work because she would have to pull over several times during her commute to work to go to the bathroom (which she had mapped out).
Sometimes chronic diarrhea can really be as simple as making sure you’re not taking in too much of something your body can’t absorb fully (like magnesium in the previous section). While this sounds like too simple of a solution to something you may have been dealing with for years, you’d be surprised how often this is the case.
If your chronic diarrhea happened to start suspiciously close to having your gallbladder yanked out by some overzealous surgeon (less than 1/3 of people with acute attacks actually need to have the gallbladder removed), or if you get diarrhea from fatty meals ever since your surgery, osmotic diarrhea is likely the culprit.
The nice thing about this type of diarrhea is that there is a very simple fix.
Post-cholecystectomy (gallbladder removal) diarrhea is an osmotic diarrhea that comes from fats being poorly absorbed because of the lack of bile when needed. Take a gallbladder supplement that contains bile (ox bile is the most common—like Biotics Beta plus) and Viola! Diarrhea disappears.
Chronic diarrhea, like chronic constipation, means that something is very wrong with the way your gut is functioning. The best approach is to figure out what is wrong and fix this. Short term answers (like magnesium for chronic constipation) is an important part of the process, but is just that—short-term.
Since chronic diarrhea can be more complicated to resolve than chronic constipation, I’ll cover this in more detail in the second part of this article.
In this meantime, probably the strongest tool to manage chronic diarrhea quickly is high dose probiotic supplementation on the range of 100+ billion per dose. Our office recommends VSL-3 and finds that, in almost all cases, it can calm down the gut until other changes can help to stabilize the gut and help achieve normal bowel movements. It’s not the cheapest option, but it’s one of the best.
Inflammatory Bowel Disease
While irritable bowel syndrome (IBS) is considered a benign condition (unless, of course, it’s happening to YOUR gut), inflammatory bowel disease (IBD—Crohn’s Disease and Ulcerative Colitis) is not benign.
Serious problems like scar tissue, large amounts of blood in the stool and even fistula formation with other organs (where the gut ends up connecting to other organs like the bladder…) can occur. In more severe cases, portions of the small or large intestine may need to be removed (called a “resection”), potentially leading to a life with a colostomy bag.
In other words, it’s not something to mess with.
My thoughts on IBD have changed over the years. In the earlier, more simplistic days, I really focused on things like the permeability of the gut (“leaky gut” is linked to flare ups of IBD) and candida.
Over time, research began to accumulate on how much bacteria played a role. Initially it was the presence of certain bacteria (Mycobacterium paratuberculosis) and then it was feeding the bacteria of the gut with soluble fiber to produce butyrate to heal the lining of the gut.
Later, it was antibiotic use in infants and toddlers that destroyed the delicate balance between the immune cells lining the gut and the developing bacterial populations of the gut, leading to massive spikes in the risk of inflammatory bowel disease.
All of these factors play a role, but not individually. It is how they all work together to affect the lining of the GI tract, the bacteria in the gut (microbiome) and the immune system. THIS is the key to understanding inflammatory bowel disease and how to manage and even eliminate it.
And it has nothing to do with actually treating the inflammatory bowel disease directly.
Not to tease you with the topic of IBD and not provide answers, but the topic blends really nicely with the much larger discussion on small intestinal bacterial overgrowth, which will be covered in part 2 of this article. Stay tuned–it’ll be a good one.
Marylou Ewen says
Dear Dr. BOGASH,
Very good article as always. I have added 2 prunes to my diet with
excellent results: easier, more regular bowel movements & not,
according to labs, anemic anymore. This has, of course, befuddled
Still having considerable piriformis issues. Xrays reveal severe hip
arthritis and lower lumbar issues. This since May 11th!! But very much
improved with the exercises given me by a PT.
Hope you & yours are well.
James Bogash says
Thanks for the feedback! Anything that helps the gut to keep moving is a good thing!
Kathy Gobel says
Great information here!