Bloating is a common and uncomfortable symptom that many describe as feeling tight, full, and gassy in the abdomen. About 50% of those who experience bloating claim that it is accompanied by a distended abdomen (when the belly is visually swollen outward). It is most commonly associated with constipation. Although, there are other reasons, too.

Up to 90% of those with irritable bowel syndrome (IBS) suffer from bloating. However, even 10-25% of otherwise healthy people experience occasional bloating, with 10% of sufferers stating that they experience bloating regularly.

Boating can also be associated with hormonal changes. For example, 75% of women complain of bloating before and during their period.

Functional medicine can help you discover why bloating is occurring by getting to the root cause of the problem. Through various functional labs and treatments, bloating can be resolved.

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What Causes Bloat?

Bloating is not a diagnosis but a symptom. Before treating your bloating, you will want to understand the cause. Functional medicine shines in this scenario because it acknowledges the individuality behind diagnosing. Your cause for bloating might be different than someone else's cause for bloating. Here are some of the top causes of why bloating is occurring:

SIBO

Small Intestinal Bacterial Overgrowth (SIBO) is a condition where the bacterial population in the small intestine is abnormally increased. Specifically, in SIBO, there are types of bacteria present that are not typically found in this part of the GI tract.

SIBO is often the result of other GI diseases or even abdominal surgery. These circumstances ultimately slow the transit of food and waste through the intestines, attracting various bacteria.

Common Symptoms of SIBO

• Loss of appetite
• Abdominal pain
• Nausea
• Bloating
• An uncomfortable feeling after eating
• Feeling full quickly
• Diarrhea
• Unintentional weight loss
• Malnutrition

Dysbiosis

Dysbiosis is an imbalance in the gut microbiome. More specifically, it is the reduction of diversity, where fewer beneficial microbes and more pathogenic microbes are present in the gut. Our microbiome is so vital to human life that some consider it on par with our other organs. Antibiotics, high stress, and oxidative stress can cause this imbalance.

When dysbiosis is present, it can lead to microtears in the intestinal walls (Leaky Gut), allowing for larger particles to pass into the bloodstream inappropriately. This process leads to inflammation, swelling and bloat, and potential autoimmune conditions. Because the microbiome affects the whole body, those with dysbiosis may have symptoms outside of the digestive symptoms.

Common Symptoms of Dysbiosis

Gut Symptoms:

• Abdominal discomfort
• Bloating
• Belching
• Nausea
• Changes in bowel movements

Skin Symptoms:

• Atopic dermatitis (eczema)
• Psoriasis
• Acne

Brain Symptoms:

• Fatigue
• Mood changes
• Difficulty concentrating
• Depression
• Anxiety
• irritability

Exocrine Pancreatic Insufficiency (EPI)

The pancreas is a small organ responsible for producing many digestive enzymes. During EPI, the pancreas may not produce sufficient enzymes, leading to undigested food sitting in the small intestines. This undigested food can contribute to SIBO, and the bacteria in the small intestines can produce various gases, causing bloat.

Common Symptoms of EPI

• Bloating
• Diarrhea
• Foul-smelling, loose stools
• Greasy, fatty stools that float
• Flatulence
• Abdominal discomfort and cramping

• Unintentional weight loss

• Muscle wasting
• Nutrient deficiencies, including vitamins A, D, E, and K
• Mineral deficiencies, such as magnesium‍

Food Sensitivities

Food sensitivities are when certain foods negatively react in the body. While they share some similarities with food allergies, food sensitivities activate a different part of our immune system. So, instead of an immediate reaction (like in a food allergy), there will be a delayed reaction of up to 2-3 days, making diagnosing this condition quite tricky.

Food sensitivities lead to gut inflammation. The inflammation can then lead to various symptoms, including bloat.

Common Symptoms of Food Sensitivities

• Bloating, gas, and cramps
• Constipation
• Loose stools
• Skin conditions (eczema, acne, psoriasis, and dermatitis)
• Headaches
• Brain Fog
• Joint pain
• Anxiety or Depression (due to the gut-brain connection)
• Vitamin and mineral deficiencies

Premenstural Syndrome (PMS)

During a menstrual cycle, there are normal hormonal fluctuations. Some women with more imbalanced hormones than others experience PMS, which can lead to emotional and physical symptoms. The water retention and swelling in the uterus as it prepares to shed are both causes of bloating, a common physical symptom of PMS.

Common Symptoms of PMS

• Depression/anxiety
• Irritability, anger, crying easily
• Appetite changes or food cravings
• Sleep issues and fatigue
• Social withdrawal
• Difficulty concentrating or brain fog
• Changes in libido
• Breast tenderness
• Headache/migraine
• Acne
• Joint pain
• Bloating
• Constipation or diarrhea

Functional Medicine Labs to Test for Root Cause of Bloat

SIBO

The best way to test for SIBO is through the breath since the bacterial overgrowth will produce certain gases that can be detected in the breath. The trio-smart SIBO Breath Test examines hydrogen, methane, and hydrogen sulfide, the three primary fermented gases found in the gut microbiome. Measuring all three significantly reduces false positive/negative results.

Dysbiosis

The GI-MAP is a comprehensive stool analysis that measures gastrointestinal microbiota DNA. It can evaluate various pathogens, including bacteria, yeast, viruses, and parasites. Looking deeper into the makeup of your microbiome will enable you to understand the overall balance. If sufficient diversity and beneficial microbes are present, then dysbiosis is unlikely. However, if pathogenic microbes are detected and have low variety, then dysbiosis is likely.

EIP

To diagnose pancreatic exocrine insufficiency, testing for Fecal Elastase-1 in the stool is necessary. Values under 200 are considered diagnostic for this condition.

Food Sensitivities

There are a vast amount of food sensitivity tests available. The FIT 132 test is unique because it measures food sensitivities and inflammation by testing for IgG1-4 and Complement Activation via C3d. This means that the only foods that will show up positive are ones that actually activate an immune response in your body. Testing this way typically reduces false positives, which significantly helps the compliance factor of an elimination diet (because fewer foods will need to be removed from the diet).

PMS

Because PMS is strongly related to hormonal imbalances, a thorough hormone test, like the DUTCH Cycle Mapping test, is warranted. This test evaluates the hormonal pattern throughout an entire menstrual cycle. This test uses dried urine, which is more valuable than a blood test that only detects levels at the moment of the blood draw.

Functional Medicine Treatment for Bloat

SIBO

A Low FODMAP diet is typically recommended to treat SIBO. The acronym stands for Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols, all short-chain carbohydrates that quickly ferment in the intestine. This is a 3-step elimination diet that typically lasts 12 weeks.

Along with the diet, herbal antimicrobials are typically recommended to kill off the microbes in the small intestine. The specific herbs have to do with the type of dominant gas. For example, Allicin is the herb of choice if Methane is dominant. In contrast, Berberine is the herb of choice if Hydrogen is dominant.

Dysbiosis

Treating dysbiosis includes nutritional changes and various supplements to help rebalance the microbiome. A nutrient-rich plant-based diet, such as the Mediterranean diet, is recommended to help feed the healthy gut microbes in the hopes of shifting the overall balance to a healthier one.

Probiotics and prebiotics (the food for the probiotics) are necessary for the healthy shift back to gut balance. These can either be eaten as foods (a probiotic example is fermented foods; prebiotic foods include banana, garlic, artichoke, and chicory root) or taken as supplements. Ginger is also beneficial for reducing the inflammation associated with dysbiosis.

EIP

Pancreatic exocrine insufficiency may have various root causes, which will take some time to treat. In the meantime, the treatment of choice is called PERT, which stands for Pancreatic Enzyme Replacement Therapy. There are many different types of digestive enzymes available as supplements. But when treating with PERT, you should look for enzymes containing lipase (to digest fats), protease (to digest proteins), and amylase (to digest carbohydrates) to cover the span of what is necessary for digestion.

Food Sensitivities

An easy way to remember how to treat food sensitivities is to think of the four Rs. Each R stands for a different part of the protocol: The first R is Remove, where you eliminate the foods that were positive on your food sensitivity test. The second R is Replace, where you replace these foods with more nutrient-dense and less inflammatory foods. The third R is Reinoculate, where you use probiotics and fermented foods to rebalance the microbiome. The fourth R is Repair, where you heal the gut lining using various helpful supplements such as L-Glutamine, Zinc, Curcumin, and Vitamin D, among others.

PMS

A healthy plant-based diet and herbs are the base for treating PMS. The specific herbs that are most commonly recommended are Vitex and Evening Primrose, although there are others, too. Reducing endocrine disruptors, which are chemicals that can alter our hormones, is also vital to addressing PMS. A healthy, gentle liver detox can help PMS symptoms significantly.

Summary

Bloating is an uncomfortable symptom that many experience. However, it is not an actual diagnosis, meaning that we need to dig much deeper to understand the cause of the bloating, and there are many possible causes.

There are gut-specific causes, such as dysbiosis, the imbalance of the gut microbiome, and SIBO. Pancreatic insufficiency is also a possible cause because it leads to undigested food in the intestines (which is a cause of dysbiosis and SIBO). Food sensitivities are also common and should be addressed on an individual basis. It is also important to remember that hormones can also play a role in bloating. The shifts experienced by those suffering from PMS also commonly lead to bloat.

Functional medicine can be used to uncover underlying causes of bloat so that you can understand where it is coming from and why. A functional medicine approach to treatment focuses on healing and reversing those underlying causes so you can get back to that flat non-gassy belly.