1. You’re Swallowing Air (Aerophagia)
It’s normal to swallow a little air when you eat or drink, especially if you’re drinking carbonated beverages like seltzer, beer, soda, or champagne. But as the day progresses, if you feel like the Michelin woman and fantasize about deflating your stomach with a pin (not a good idea!), you may be swallowing large amounts of air on a regular basis—a condition called aerophagia, which can lead to a massive buildup of gas in your GI tract and major bloating.
Aerophagia is incredibly common but very underdiagnosed, and it’s frequently confused with conditions such as ulcers and gallstones that can also cause abdominal discomfort and bloating. Most people with aerophagia complain of three main symptoms: bloating, burping, and a tense, distended stomach that feels like an overinflated tire. If you have chronic sinus problems, a deviated septum, or a history of allergies or asthma, you may be a mouth-breather rather than a nose-breather, which predisposes you to aerophagia. Chewing gum, sucking on hard candy, smoking, eating too quickly, talking when you’re eating, drinking lots of liquids with your meals, or holding your breath when you’re anxious can all cause aerophagia. Eventually most of the air you’ve swallowed will get burped up or make its way through your GI tract and exit via the other end, but not without causing a lot of bloat in between.
2. You’re Creating Hormone Imbalance (Birth Control Pills)
Birth control pills (BCP) contain various forms of estrogen that can be very bloating. If you’re on a high-estrogen BCP, deflating your midsection may be extremely challenging due to fluid and salt retention as well as weight gain. The pill can also cause insulin resistance, a condition that interferes with your ability to lose weight, especially if you eat a lot of carbohydrates. If you already have a tendency toward insulin resistance or are prediabetic, you may be more likely to become bloated and gain weight from BCP.
3. You’re A Really Good Veggie Eater (Cruciferous Vegetables)
All gas and bloating is not created equal. Beans and cruciferous vegetables such as cabbage, cauliflower, kale, and broccoli contain potent cancer-fighting compounds and lots of healthy fiber, but they also contain a starch called raffinose that your body can’t fully break down and digest. Bacteria in your colon ferment raffinose and produce methane, which you may experience as bloating accompanied by smelly gas. This is what I consider good gas, though, because it’s accompanied by the health benefits that eating those foods confers.
4. You Have A Lazy Stomach (Gastroparesis)
Virtually everyone with gastroparesis—delayed emptying of the stomach—complains of bloating. We don’t know the specific cause of gastroparesis in most people, but there are lots of different reasons it can develop. The vagus nerve, which controls stomach emptying, can be damaged or affected by illness, causing the muscles to not work properly. Insulin, intestinal surgery, pain medication, antidepressants, and neurological conditions such as Parkinson’s disease and multiple sclerosis are also causes, and gastroparesis can occur after a viral illness.
If you have gastroparesis you’re probably experiencing bloating, abdominal pain, and feeling very full after eating, especially with fatty meals. Fat takes longer to digest than other kinds of food, so when receptors in the stomach sense a high fat content, they send a signal to the nerves that control stomach emptying to slow down even more, making your gastroparesis worse.
5. Your Bacteria Are Out Of Whack (Small Intestinal Bacterial Overgrowth/SIBO)
Your small intestine is hardly sterile, but it has a lot less bacteria than your colon, the main living quarters for gut bacteria. Small intestinal bacterial overgrowth (SIBO) refers to bacterial imbalance (dysbiosis) that occurs when large amounts of not-so-good bacteria take up residence in your small intestine, causing gas, bloating, and abdominal discomfort. Antibiotic use is a major cause of SIBO, but impaired bowel motility, which can slow down passage of your intestinal contents, and acid suppression, which creates a hospitable environment for bacteria to overgrow, are also risk factors.
We can test for SIBO by giving you a poorly absorbed sugar to eat that gets fermented by gut bacteria in your intestines. High levels of undesirable bacteria produce greater-than-expected levels of methane and hydrogen gases, which are expelled through your lungs and measured in the breath (via a lactulose or hydrogen breath test). Although breath tests can be useful, they’re not always reliable, and a clinical diagnosis of SIBO based on history, physical exam, and signs and symptoms can be just as helpful.
For solutions to these and 101 other things that can bloat you, read The Bloat Cure: 101 Solutions for Real and Lasting Relief.