July 15, 2013

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?


Pepto Ad Image: Plan 59

44 comments:

  1. Excellent, sensible advice. In my case avoiding gluten most of the time has taken care of the bloating and heartburn. I'm glad it was easy, but it's not so simple for so many others.

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    1. I've seen some of your gluten free creations on your blog Leah, and it sure seems like your adapting well!

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    2. Gluten is a big culprit for so many people, Leah. My only dietitian caution for newbies: Be sure to get tested for celiac disease before cutting out gluten. If you're celiac, it's really important to know that because cheating isn't a good idea. That is, if you're just gluten sensitive, you might be able to get away with a bite of gluten now and then without any negative repercussions. But if you're celiac, that small bit can cause real problems. It's important to know how careful you have to be in that regard.

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  2. Now that my food allergies have mostly disappeared or are easily avoided (no more mushrooms! ever! sob!) I have very few digestive problems. I used to have a lot of gas pain. Nowadays, the only thing that gives me gas is swallowing snot, which is of course related to how bad my respiratory allergies are--all the body wants to get in on the act. Bless you, cromolyn sodium, for thirty years of reduced discomfort!

    Mary Anne in Kentucky

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    1. That's great that you've discovered the culprits Mary Anne.

      Cromolyn sodium? Haven't heard of it, but glad it's been such a great help.

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    2. It's a nasal spray that was prescription (brand name Nasalcrom) when I first started taking it in 1980, but has been OTC for many years. It blocks the histamine receptors in your nose so that inhalant allergens have far fewer places to latch on. I can breathe through my nose all year round; even if it is sometimes congested, it isn't stopped up. Now if only they would come up with something like that for inside tissue.

      Mary Anne in Kentucky

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    3. Thank you Mary Anne, I may check it out! My allergies are little better these days (who knows maybe the self-hypnosis helped!) but definitely not gone.

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    4. I'll have to check that out, too, Mary Anne. Thanks!

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  3. I had my gall bladder removed about 10 years ago and have had many digestive issues since! The worst part is it is not predictable and not triggered by certain foods (I've tracked and tracked). In the spring I started taking probiotics for the first time and they seem to help quite a bit. Maybe if I continue to take them consistently then one day I won't have any more issues!!!

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    1. Kim, I've had similar issues since my gall bladder was removed (four years ago TODAY, I just realized). It's the unpredictability that makes it hard to know what foods to avoid...I may try probiotics and see if that can level things out. Hope it continues to help you. :)

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    2. Sounds like I shouldn't take my gall bladder for granted, seems like they come in handy after all! Hope the probiotics help Shelley, and glad they work for you Kim.

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    3. So glad probiotics are helping you, Kim. Sometimes there is a simple answer to these problems although if you've been taking them since the spring and the issues aren't totally worked out, there may be some other things to explore. :(

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  4. This was a wonderful post, and Green Mountain sounds like such a healing place!

    My stomach is, alas, made of iron. Nothing bothers it in the least, so I have no natural disincentives against eating anything -- one of the main reasons my diet for most of my life consisted primarily of bread and milk products, accompanied by sugar and grease.

    I seem to also have no problems with the vaguely paleo diet I eat now. The only thing is that ever since I started eating healthy and working out I seem to only leave floaties in the toilet. It's apparently harmless, but I waste a lot of water on that second flush to get the stubborn ones.

    Um ... not to drop the tone or anything.

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    1. Gosh Trabb's boy, this is SUCH a highbrow blog that I'm just shocked you might mention toilet issues in a post about digestion and intestinal trouble!

      And mmm, bread and milk and sugar and grease... I would SO happily go back to all those in vast quantities should the experts ever change the rules on us.

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  5. I'm pretty much an ostrich when it comes to digestion: I can have anything and not feel a thing.

    Anaconda might be another fit analogy.

    HOWEVER, I feel so much lighter in my tummy when I limit my consumption of
    - dairy (especially milk with lactose)
    - grains
    - sweets

    Trial and error will lead you to the right answer for you!

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    1. Love the anaconda analogy HSH!

      Alas, my research methods suck and I try eliminating things in such a haphazard and inconsistent manner I can never quite figure out the bloating culprits, plus I'm not sure of my willingness to actually take too many things out of my diet.

      I THINK cow's milk and powerbars loaded with inulin, beans and certain veggies may be particularly problematic and probiotics seem to make matters worse. Goat's milk I do ok with.

      But I'm not in a have-to-run-to-the-bathroom situation no matter what I eat, it's just the basketball that suddenly appears in my midsection that I find annoying.

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    2. So true! I have some bloating and (sigh) gas issues, and it's very hard for me to figure out what's causing it. Any time I look at diets for special conditions they always seem to eliminate just about EVERYTHING I EAT. And actually doing any sort of elimination diet to figure things out really is a big commitment - there are hidden ingredients in so much that you really have to be careful!

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    3. A true elimination diet takes you down to the bare basics so there is no confusion about hidden ingredients. But as you say, it is a real commitment. But if you're suffering enough, it can be worth it!

      One caveat: If you have any disordered eating/eating disorder tendencies, an elimination diet can be very triggering. So definitely work with a professional who understands that if you think it may be the right way for you to go.

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  6. Very nice discussion of too common problem!

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  7. Ugh. Stress bloat. No wonder. And yes, I am totally one of those constant bloaters...and no surprise, constant stress. Well, I do eat a lot of fiber and watermelon too. Watermelon of all things puffs me right up!

    Similar to the above poster I can also eat about anything and never actually feel ill. This is probably what gets me in trouble. I may not want to take the bloated tummy out in public, but that doesn't mean I actually feel ill. :)

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    1. Watermelon QD? I hadn't considered looking at that one! Have been enjoying quite a bit of it this summmer. Hmmm...

      And I'm with you... no other bothersome issues but the big belly! Which is sort of a disincentive to too much fussing around with my diet.

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  8. As long as i stick to clean eating, most of these problems are in the past, but i had a cast iron stomach for years and not much bothered me to begin with. Yes, i know how lucky that is.

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    1. That's great you found what works for you Messymimi!

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  9. I think I'm going to have to read this twice more before I can even comment properly! There is so much here. Especially for the likes of me. She's so right. That's all I can say for now. I must ponder.
    thanks!

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  10. Great info as always! I have had issues for years. I did find out early on that sugar alcohols & that sorbitol in sugarless chewing gum was not good for me.. well, I actually got the sorbitol thing down & stopped chewing gum & then I realized it was the sugar alcohols.. I can do in very small amounts at one time only....

    And of course all the yummy cruciferous vegetables attack me but I still eat them & in smaller amounts PLUS dairy is not nice to me wither.. I work my way around it all! ;)

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    1. Doesn't seem fair that something as good for us as cruciferous vegetables should be controversial to our systems! Oddly enough, I have NO problem with chocolate chip cookies.

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  11. Gluten, grains and dairy are not my friends...but I still pal around with them! What's up with that? P.S. My question is rhetorical!

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    1. TOTALLY get that Kimberley! Many of my favorites are suspect but I'm too stubborn to go without.

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    2. Alcohol is not my friend -- at least the day after. Or even a couple of hours after. But I still imbibe occasionally. It's hard to give up something there is no good substitute for! I find there are great substitutes for gluten foods but not for alcohol.

      For me, it comes down to getting clear that I don't like the negative effects, and keeping that top of mind when trying to decide whether I really want someting.

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  12. I have gained so much knowledge and insight since meeting MARSHA a few years ago.
    I stalk all she writes on the internet :-)

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    1. Yep, agree with ya Miz, Marsha is a real resource!

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    2. The experience is mutual, Carla! And for you, too, Crabby. I learn from both of your viewpoints/experiences. No [wo]man is an island.

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  13. My stomach problems definitely depend on how stressed I'm feeling. In someways this is good because if I reach that point I know it is time to take stock and relax.

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  14. Dear Marsha, Crabby and anyone else who might help!...

    A recent "spa day" (aka - colonoscopy) revealed that not only do I have a "redundant" colon (extra piping), but this extra bit of piping takes sufficiently extra twists, turns and crinkles so as to slow things down a bit.
    Hence, why my digestive issues revolve more around figuring out how to get max fiber without max bloat. I'm up for ideas from any credible source :) because everything I've tried so far is - pardon the expression - a crap shoot - as to whether it will work or - if so - for how long. (Sorry about the TMI factor here...............)
    Anon

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    1. I'd look for a good nutritionist who is trained in functional medicine. They would look at your issue holistically and there may be some things that could help beyond fiber. If you want to email me at marsha at fitwoman.com, I could see if I can recommend a nutritionist in your area.

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  15. PS - Marsha, you are right on about stress! Here's a clip from an ultrarunner's blog about a nutritional debacle he had at one of his races:

    "So what went wrong? In the first 30 miles of the race I relied mostly on my mix of gels, chews and gummy snacks that had worked fairly well in some of my shorter races. I unfortunately was very worked up about performing well at this race and placed a lot of stress on myself to perform well. I think this negatively affected my performance and my stomach. I was already dealing with anxiety, added a lot of simple sugar snacks and was hit with some early race queasiness." He goes on to talk a bit about the adverse affects of stress and anxiety. Pretty interesting!

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  16. You hit the nail on the head by identifying both stress and erratic eating habits as a cause for digestive problems. I would also suggest that commercial chemicals are equally offensive. These toxins build up to a point, over time, that exaggerates even mild digestive problems. Just saying, based on my experience.

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  17. Another great post! I have started following your blog a month ago, and have to admit that I am really enjoying it and learning a lot! Thanks for all your hard work.

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  18. I definitely think staying away from gluten and overeating has really helped me a lot. Losing about 15 pounds has also helped as well. I no longer have a sensitive lower back or heartburn that I've had forever. Good stuff!

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    1. I dare to venture that losing the weight is a result of staying away from overeating. And gluten could be one reason you were driven to overeat. I try to help people understand that weight can be an outcome of choices/behaviors just like tummy troubles. And focusing on the root cause instead of the outcome leads to much greater success in sustaining any changes. To me, this is a real problem with most weight loss programs -- they focus on the wrong thing.

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  19. mmm Gluten!

    Got gluten issues? Buy a rice cooker.

    I never figured out what was wrong, not even a gut feeling until I moved to university. We lived in a shambolic, filthy house with people passing in and out all around the clock. The rice cooker was never turned off, the rule being whoever finished it had to rinse it out and put new rice in.

    Terrifying stuff, but my stomach had never been happier!

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