ZOE Science & Nutrition - Gas & Bloating: the causes & how to stop it

Episode Date: September 22, 2022

Most of us are familiar with the unpleasant feeling of being bloated. It can happen after eating specific foods or when you experience slower bowel movements. Sometimes, it can be a symptom of an underlying health condition.  To take a closer look at issues related to gas and bloating, we’ve invited a special guest this week: superstar gastroenterologist and Zoe’s US Medical Director Will Bulsiewicz. In today’s short episode of ZOE Science & Nutrition, Jonathan and Will ask: what are the main causes of gas bloating and how do we stop it? Follow ZOE on Instagram: https://www.instagram.com/zoe/   Download our FREE guide — Top 10 Tips to Live Healthier: https://zoe.com/freeguide Studies referenced in the episode: Burden of Gastrointestinal Symptoms in the United States: Results of a Nationally Representative Survey of Over 71,000 Americans + Am J Gastroenterol + here  Abdominal bloating is the most bothersome symptom in irritable bowel syndrome with constipation (IBS-C): a large population-based Internet survey in Japan + Biopsychosoc Med. + here  Sensation of bloating and visible abdominal distension in patients with irritable bowel syndrome + Am J Gastroenterol + here    This podcast was produced by Fascinate Productions.

Hello, and welcome to Zoe Shorts, the Bite Size podcast where we discuss one topic around science and nutrition. I'm Jonathan Wolfe, and this week we have a new expert joining me. Will Bulsiewicz is a board-certified gastroenterologist, author of multiple New York Times bestselling books on gut health, and Zoe's US medical director. And before this podcast, I actually looked up gastroenterologist to understand what it really meant. And the dictionary defines this as a medical practitioner qualified to diagnose and treat disorders of the stomach and intestines. And since today's subject is gas and bloating, it seems like Will, you are the perfect person for the job.

It's great to be here today. I'm super excited to talk about this topic. It's an important topic. Issues related to gas and bloating are incredibly common. One in six of us will experience bloating, but the symptoms that lead to bloating are far more complex than we often give them credit for. Thanks, Will. And I have children, so I know that this is often a subject of much entertainment for my kids, but it's also a very serious topic. So this week we're going to try and find out what it is that's also a very serious topic. So this week we're gonna try and find out what it is that's causing gas and bloating.

I think there's some pretty great research that explains why we experience bloating. And we may even have some ideas about how to combat it. Sounds good to me. So when it comes to gas and bloating, we did some research and it's actually one of the most common problems that people report. So about one in five people in the United States report experiencing

bloating. And it probably goes further than that. So I think anecdotally, a lot of people will get dressed in the morning and by the afternoon, their belt may feel a little tighter or their jeans are maybe uncomfortable around the waist. And that feeling of being bloated is incredibly common, even if we're not going to see a doctor about it. It is. Bloating is the feeling of an increased abdominal pressure, usually related to gas. And while for some people this bloating is actually visible,

like they almost can look like they're pregnant, others will feel the discomfort of bloating while displaying minimal or no distension of their stomach. And Will, I think a lot of people attribute bloating to days when they've had like a big lunch or perhaps this idea that their body is just producing excess amounts of gas because of something they ate. Is that what's going on? What's happening with your body is a bit more complicated. That's the thing that people need to understand.

If we want to get better at managing the bloating issue, we have to actually understand the nuance. That's what's going to allow us to get better at managing the bloating issue, we have to actually understand the nuance. That's what's going to allow us to get there. So you're saying there's quite a lot of different things that might be going on that explain why I might be suffering from it. Exactly. In fact, I would say there's four main causes of bloating that are worth discussing.

The first is swallowed air. Second, constipation. Third is a struggling microbiome, gut microbiome specifically. And then the last is our food choices. Well, why don't we start at the beginning with the swallowed air? So I can think of many ways that air can get into the body, but I think we should probably start with the most obvious way, which is through the mouth. Yeah. I think the most obvious way for air to get into your body is air that's being swallowed. So any air that enters your body through your mouth is

ultimately going to have to be expelled one way or the other. So you air that enters your body through your mouth is ultimately going to have to be expelled one way or the other. So you can belch it out up top, or it has to wiggle its way through your intestines to come out the other side as you pass gas from below. So that makes sense. And the air we breathe in has to go somewhere. We did some research on this, and there's actually a condition called aerophagia, which occurs when a person swallows too much air. It's actually quite common and can be displayed through things like frequent gulping. Many people won't even realize that they're doing this air swallowing and it's the cause of their discomfort if they suffer from regular bloating. Absolutely. These people suffer with intractable belching as well. They're the person who they can

literally belch their way through the ABCs, if you've ever seen a teenage kid do that. The air that comes out when you belch is actually air that entered at some point when you swallowed. So that is not air being produced by your gut microbes or something like that. This is the reason why it doesn't smell nearly as bad. But other common sources of swallowed air that people need to be aware of include carbonated drinks, sipping through straws, chewing gum, sucking on hard candies. And then also some people, they swallow air when they eat. So they're aggressive eaters. They eat fast, they drink fast, they do big gulps, and their air enters their body when they do that.

So the bottom line is that if the air gets in, it has to come out one way or the other, and it may work its way through the 20 to 25 feet, the six to eight meters of intestines before it comes out your bottom and the other end. That can be extremely uncomfortable. So if we're discussing entrances and exits, I think naturally we should talk about the other end and talk about the bowels. How do they relate to gas and bloating? Yeah, we definitely need to talk about this. So the bowels are actually extremely important to this type of manifestation of gas and bloating, and specifically in people that have slow bowel movements. Which otherwise is known as constipation. This can lead to intestinal gas retention, symptoms of bloating, abdominal discomfort.

In my experience as a gastroenterologist, the number one cause of gas and bloating that I've seen is actually constipation. And in people who are constipated, the most common symptom that they experience is gas and bloating. So these two are very sort of tied together, Will. Yeah, they're very much intertwined. And we actually have research, Jonathan, showing that people who are constipated, they produce more bowel gas. So I think it's worth noting that people with irritable bowel syndrome and chronic constipation, they may experience difficulties with regard to gas and bloating. And these challenges that exist, it can come from many different sources, which could include difficulty relaxing their bottom, difficulty having a good,

complete evacuation or bowel movement. No matter what it is, if you're suffering from constipation, there's a high likelihood that you're going to be suffering with gas and bloating at the same time. So in these cases, if you can remedy the constipation, you can hopefully offset some of the unpleasant side effects of bloating? Yeah, that's actually what I typically will strive to do as a gastroenterologist is from my perspective, I want to get them into a rhythm and get their bowels more regular. And if you can accomplish that, what I typically have seen is that the gas and bloating goes away. Got it. And so I guess fiber also can fit into this, right? So fiber can hold onto water, can soften stool, you know, a high fiber diet in general is correlated with quicker

transit times of food, generally helping people with more regular bowel movements. Yes, but there's a bit of a caveat. So, I mean, I am the world's biggest fan of fiber, but I also believe in keeping it real. And, you know, the am the world's biggest fan of fiber, but I also believe in keeping it real. And, you know, the thing you have to understand is that people who have mild constipation, they will generally improve when they increase their fiber intake. And oftentimes they can do little things like take a walk through their neighborhood or have a few glasses of water, all that gets them there. But the people who have more moderate or severe constipation, the people that are suffering with sort of a daily challenge when it comes to constipation, these people actually

may find that fiber makes their constipation worse. So my approach to this situation, it's not to say that fiber is bad. It's more so to say that I like to focus on getting their bowels moving first, and then I will ramp up the fiber second. So move the bowels first, and then the fiber helps to maintain the bowel rhythm once you've done that. Speaking of fiber and gut health, what about the role of our gut microbiome? So we've got these trillions of bacteria munching away on our food. Presumably that's going to generate a lot of gas. Yeah. So our gut microbiome plays an important role in processing and digesting our food. And this is particularly true with the high fiber foods. So when the gut microbiome is impaired or injured, it may struggle to process and digest.

When this happens, this is when you can experience side effects like gas and bloating. So Will, we've discussed a lot about our bodies, but what about the things we eat? How do external factors like the food we choose lead to gas and bloating? This is definitely a part of the equation. You know, there are certain foods that are more common in terms of producing gas and bloating, so we need to be aware of those. And from your experience, Will, what would you think are the two biggest areas of concern if somebody is experiencing chronic gas and bloating and listening to this? I have advice that I routinely would give to

people who come in with gas and bloating, like literally on the first visit, and that would be to eliminate non-fermented dairy and artificial sweeteners. Fascinating, because we just did an episode about artificial sweeteners, and we're probably going to do some more in the future. So can we start with those? People have traditionally thought of artificial sweeteners as being benign. I mean, I have certainly been guilty of this myself. 10 years ago, I was dropping a couple packets of Splenda into every single coffee. That's a lot of sweetener. Yeah, yeah. And I've moved on. I drink my coffee black now. I've gotten used to it. But the thing is, they're not absorbed by the intestinal system. They don't contain calories. And for these reasons,

people think of them as just being completely benign. But actually, it's a lot more complicated than that. They still come into contact with our gut microbes. And because they're coming into contact with our gut microbes, they can be fermented, or they can have different effects on our digestive system that ultimately cause gas and bloating. And also people should be aware they can cause diarrhea. So that makes sense on sweeteners. What about dairy? Why would you look to eliminate that? Well, I think first of all, Jonathan, let me sort of make a distinction. There's dairy products that are fermented and then there's dairy products that are not fermented. And fermented dairy

products are things like hard cheeses or kefir or yogurt. And the fermentation process is unique because actually the microbes, the bacteria that are living as a part of the ferment, they consume the lactose. And Will, what is lactose? Lactose is a sugar. So it's the rare example where an animal product, in this case dairy, actually contains a carbohydrate. So lactose is a sugar that is specifically found in cow's milk. Around 70% of the world is actually intolerant of lactose. So what that means is that, I mean, there's a certain amount that can tolerate. It's not an allergy, but when they exceed what their body is capable of consuming, then

the digestive symptoms kick in. They get gas and bloating. And once again, similar to the artificial sweeteners, they may actually get diarrhea. So for these people, if they were to lower their intake of these lactose-containing dairy foods, they would find their digestive symptoms would improve very quickly. Brilliant. So there we have it. It turns out, like so much on this podcast, that gas and bloating is a lot more complex than just having tight trousers, and that there's a lot of reasons why you might experience it. So when we sum this all up well, if somebody is

experiencing gas and bloating, what steps do you think they should take to remedy the situation? Help us to pull it all together. I think for the person who's at home, what I really want to encourage you to do is to think about these four specific things, because it could be a combination of them. So do a personal intake. If you're suffering with gas and bloating, do you sip through straws, chew gum, drink carbonated drinks, eat fast? Do you have constipation? Do you eat foods that are known to cause a lot of gas and bloating? And the last thing is, is there any sort of history of irritable bowel syndrome or damage to the microbiome? And this will help you to sort of get closer to what's going on. And then once you understand that, then you can create plans that are more targeted in terms of your approach.

And Will, I find I do experience some bloating and gas sometimes, particularly when I'm ramping up some new food that Zoe thinks is great for me, but has lots of fiber in it. Do I just need to avoid that food? No. So the answer is not to avoid. We don't want to avoid. What we want is we want to include that food, but we also want to understand that our body may take time to adapt to it. So if you haven't been eating that food in the past, then you're just not ready to consume large quantities of it, but you absolutely could be in the future. So you just start low and you go slow. And over time, by increasing the amount and giving your body a chance to adapt to what you're doing, you're going to find that you're able to tolerate it.

So there you have it. I think some fantastic advice, including don't exclude, start small and build up because diversity, I think, is what you and so many other experts are talking about. We can't promise to remove gas or bloating at Zoe, but if you'd like to understand more about your own gut bacteria and how to improve your overall health, you can certainly try Zoe's personalized nutrition program and get 10% off by going to joinzoe.com slash podcast. I'm Jonathan Wolfe. And I'm Will Balsawitz. Join us next week for

another Zoe podcast.