Ask the Nutritionist: Bloating Blues and Other Digestive Dilemmas

Today's question involves bloat and other sorts of stomach and intestinal distress.

Why?  Well, for one, Crabby is one of those people who frequently bloats up like a Thanksgiving Day Parade float. She was eager to hear some expert advice: preferably the sort that doesn't require her to give up any favorite foods or seek out professional help or do anything differently than she's already doing.   A handy capsule, she was hoping, featuring some obscure combination of phytonutrients that would not only to solve the bloating problem, but also melt belly fat, increase energy, build better biceps, and whiten her teeth!

Alas, no such luck. Instead all she got was incredibly informative answer exploring all sorts of possibilities and solutions complete with great resources and a fresh perspective that one rarely hears when discussing tummy trouble.  Damn that Marsha Hudnall.

In addition, I've got a brief digression regarding my last mea culpa blog post, but I won't hold up the proceedings too long before we get to the good stuff.

Whew, that Last Post Was Sort of a Downer, Huh?

Guess I just needed to publicly "lower the bar" and remind myself, during a period when I can't spare as much time for blogging, that it's ok to limp along a bit and that the repercussions are not exactly world-ending.

I was totally blown away though, by how awesomely warm and supportive some of the comments were. Which come to think of it, shouldn't have been surprising, given how amazing and generous you guys are.  I even got teary a couple of times.  I really can't tell you guys how much that meant to me.  THANK YOU!!!

OK, and so finally, something that contains actual information on a health-related subject, written by someone who knows a lot more than I do.

Remember Marsha?

Marsha Hudnall

Marsha Hudnall, MS, RD, CD, is president and co-owner of Green Mountain at Fox Run, a healthy weight retreat in Vermont that is exclusively for women. Forty years ago, Green Mountain pioneered the non-diet, mindful/intuitive eating, healthy living approach which includes a team of registered dietitians, psychologists and exercise physiologists. Marsha is a frequent speaker to both lay and professional audiences and has written for a wide variety of popular and professional publications. She serves on the board of The Center for Mindful Eating and the Binge Eating Disorder Association. Her newest book "Eating Happy: A Woman's Guide to Overcoming Overeating" will be available summer 2013.

And here's the question I posed to Marsha:

A lot of people struggle with bloating and digestion issues, not only with controversial foods like dairy or wheat but also with "virtuous" foods like onions, beans, cruciferous vegetables etc.  What strategies would you recommend? 

Bloating and Digestive Difficulties

Digestive difficulties seem to be rampant these days. They certainly afflict a lot of the women who come to Green Mountain at Fox Run. And that may give us a good clue into why so many people struggle with bloating and the like. It has to do with stress.

Stress has a big impact on our digestion. It sends us into fight-or-flight mode, and can negatively affect digestive muscle contractions as well as hormones and other substances needed for efficient digestion. The end result, especially if we’re constantly under stress, is that the system just doesn’t work in an optimal way.

What kind of stress are we talking about? One of the most common sources I see -- and it's often not even recognized as stress -- is dieting. I'd wager that many Cranky Fitness readers have been on a few weight loss diets in their lifetime. And if they're like the women who come to Green Mountain, they've been on more than a few. Many women, and increasingly men, are chronic dieters -- they go on diets constantly -- and go off them constantly, too. Even many people who seemingly don't "need to diet," meaning they don't appear to struggle with weight, live with a diet mentality.

Dieting and the diet mentality translates to a lot of worry -- about their weight, about what to eat to lose weight, about whether those chips they just ate is going to make or keep them fat, about whether they should eat because they're hungry but don't want to because they want to lose weight. It also translates to on-again, off-again attempts at healthy eating that usually involve a lot of overeating, too.

Then there's the chaotic eating that comes out of these worries, and also is commonly seen among people who eat the Standard American Diet (SAD). By chaotic eating I mean skipping meals, overeating at others, eating a predominance of typical SAD foods, and eating unbalanced, e.g., not getting a good mix of protein foods, starchy foods and vegetables/fruits, which give your body the nutrients it needs to function well. The lining of our digestive tracts turns over every couple of days and we need good nutrition to grow healthy new cells that function properly as well as support a healthy gut environment to support digestion. You just don't get that with chaotic eating.

Of course, people have significant stress in their lives from other sources, too, like work, families, other health issues that involve taking a lot of medications, and more. Stress from these sources can impact the digestive tract also. The medications may do so, too.

In that vein, one of the hot health topics of today is probiotics. It seems new studies come out constantly talking about the role gut bacteria play in the health of our bodies. They play an important role in the health of our guts, too. And stress negatively affects the good bacteria in our guts; one big source of stress for these bacteria is the overuse of antibiotics.

So stress is where I start when looking at digestive problems. Although there are many stress-reducing strategies, we work with our participants to help them stop dieting and worrying about weight, as well as begin to make healthy eating a consistent reality in their lives. Doing that along with strategies such as regular and pleasurable physical activity, meditation and/or yoga can lead to significant improvement in digestive troubles.

You mentioned dairy and wheat as problems for many. They're representative of common foods that many people are sensitive to. Food sensitivities are different from food intolerances, such as lactose intolerance, which is basically lack of an enzyme needed to digest the carbohydrate in milk. They're also different from food allergies, like to peanuts.

For some reason that no one is quite clear about, food sensitivities appear to be increasing among people in this country. I have my own opinion (as always ;)): I and others more knowledgeable than me think physiological and psychological stress from worry, poor nutrition, overuse of medications, etc., negatively affects the lining of the gut, causing it to become more permeable and allow food particles to get through that aren't supposed to get inside the body. The body then mounts a defensive attack that results in chronic inflammation and can lead to digestive troubles as well as all kinds of chronic disease. This phenomenon is called a leaky gut, or more technically, increased intestinal permeability. Just a short time ago, it was considered a little on the edge in terms of its validity but today increasingly is recognized by the medical community as a true problem.

Frequently, a person isn't just sensitive to one food either. It can be several foods -- for example, people who are gluten sensitive are often sensitive to the protein in dairy foods also. There's also increasing recognition of sensitivities to certain types of carbohydrates – FODMAPS, which stands for Fermentable, Oligosaccharides, Disaccharides, Monosaccharides, and Polyols. These are a family of carbohydrates that are more easily fermented in the gut and can cause gas, bloating and other undesirable symptoms.

The treatment is to remove these foods from the diet to let the gut heal. That may involve special treatment, too, such as high-dose probiotics and other supplements. But it's wise to work with a professional who is trained in this area; as I said in my last Ask the Nutritionist post, supplementation can cause harm if it's not done correctly. It's not clear whether the gut can heal sufficiently to let a person again eat foods he or she was previously sensitive to. My guess is that's a very individual thing.

It's worthwhile to note here that individual food sensitivities may be just that -- individual -- and not particularly related to anything except that an individual doesn't react well when they eat a certain food. Like getting gas when eating cruciferous vegetables. If the problem isn't overly troublesome, it may be easier to live with it, e.g., just not eat the offending food, than try to figure out what is causing the reaction.

If it's pretty troublesome, though, that's the time to work with a professional. One of the first things a professional will probably do is explore the health of the gut of a person who is having troubles. One of the best ways to do this is via stool tests that look at bacterial balance in the gut as well as levels of digestive enzymes and more. Food sensitivity tests may also be called for.

Obviously, this is a complicated subject that I can't do real justice to in a blog post. If anyone wants to read more about this, here are a couple of great books: The Inside Tract: Your Good Gut Guide to Great Digestive Health by Kathie Swift, RD, and Gerard Mullin, MD. Also, registered dietitian Kate Scarlata’s book The Complete Idiot's Guide to Eating Well with IBS. They probably have more information than the average person is interested in. But if you're struggling with digestive difficulties, they could be good reads that keep you up late into the night.

But be sure to sleep late the next day -- lack of sleep is also a source of stress!

Do any of you have digestive issues, and if so, what's helped?

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