Beat the Bloat: Causes and cures

Beat the Bloat: Causes and cures

Do you wake up with a fairly flat stomach most mornings, but find your clothes unbearably tight around your middle by the end of the day? If so, you’re not alone. In fact, studies show that 16 to 30 per cent of the general population experiences the uncomfortable symptoms of bloating.

Unfortunately, the struggle to zip up your jeans isn’t the only problem this complaint presents: Some people suffer from bloating so severe that it has a huge adverse impact on their day-to-day activities and quality of life.

More women than men suffer from a repeatedly ballooning belly, so for those of you who have said “I look six months’ pregnant” at the end of the day, this post will answer your two most important questions:

What causes bloating? And what’s the best way to treat it?


Constipation is a common cause of bloating, but people who suffer from constipation don’t necessarily experience symptoms of bloating and discomfort. According to The Gut Foundation, nearly one in five people over the age of 30 will have constipation at some stage of life.

Normal bowel function ranges from one or two stools a day to one stool every three to four days, but if your stools are hard or lumpy, and you have to strain to go, you’re constipated.

How to treat it

The first step is to ensure you’re getting enough fibre and fluids. Most adults should aim to consume at least 30g of fibre per day, along with adequate fluids. (The fibre absorbs the fluid to keep your stools soft and easy to pass.) You can increased your fibre intake by eating more wholegrain breads and cereals, beans, lentils, fruit and vegies.

Some people find that eating extra fibre worsens wind and bloating. If this is the case, you may have ‘slow-transit constipation’, a condition in which your bowel is a bit sluggish in moving things along. Laxatives can be an effective solution, but some laxatives are inappropriate for long-term use, so seek medical advice. Exercise is a great treatment for this type of constipation, as walking and jogging help keep you regular.

Irritable Bowel Syndrome (IBS)

IBS is probably the most common cause of bloating — up to 90% of people with IBS report bloating among their symptoms. IBS is a functional bowel disorder, meaning that no structural problems are visible in the bowel, but that it works in a somewhat abnormal way. IBS sufferers experience abdominal pain and discomfort, along with changes in bowel habits (constipation or diarrhoea, or both), and they can often suffer from excessive gas, bloating and abdominal distension.

IBS is classified as either IBS with constipation (IBS-C), IBS with diarrhoea (IBS-D) or IBS with fluctuating diarrhoea and constipation (IBS-M). Studies show that people who have IBS-C are more likely to experience bloating.

Interestingly, people with IBS don’t actually produce more gas, but for some reason, the nerves in their bowel are more sensitive to the gas they do produce.

How to treat it

Treatment for IBS varies, as it all depends on the individuals’s symptoms and type of IBS. The most effective approach is a combination of positive dietary changes, stress management and medication (which includes laxatives or drugs that stimulate movement through the bowel).

There’s some evidence to show that gut-bacteria problems can give rise to symptoms, and that some probiotic strains (found in yoghurts) and certain antibiotics can be beneficial. The herbal preparation Iberogast has also alleviated IBS symptoms, such as bloating, in a number of studies. Another plant-based solution is peppermint oil: Two studies show that it reduces abdominal distension and bloating in people with IBS. (You’ll find peppermint oil at chemists, in products such as Mintec capsules.)

If you suffer from an irritable bowel, it’s also a good idea to limit your consumption of fat, which can provoke problems with muscle contraction in the digestive tract. Poor absorption of certain carbohydrates can have an adverse effect, too. (See FODMAP sensitivity, below.)

Exercise is another valuable approach: In a 2006 Spanish study, subjects who rested after they’d eaten a meal experienced significant gas retention. But exercise subsequently reduced this retention by 50%, and subjects experienced fewer IBS symptoms, including bloating.

FODMAP sensitivity

FODMAP is an acronym for the scientific names of particular short-chain carbohydrates. FODMAPs include lactose (milk sugars), fructose (fruit sugars), fructans (components of wheat, rye, barley, onion, garlic and some fruits, vegetables and nuts), polyols (components of many artificial sweeteners and some fruits and vegetables) and galacto-oligosaccharides (components of legumes and some nuts and vegetables).

Some people can’t tolerate foods that contain FODMAPs. For reasons that experts don’t fully understand, these people have difficulty absorbing these naturally occurring sugars from the small intestine. As a result, they move into the large intestine, where gut bacteria ferment them, producing gas that causes wind, bloating and distension. In a hypersensitive intestine, this can also spark reflexes that either quicken the bowel (resulting in loose, urgent stools) or slow it (resulting in constipation).

How to treat it

If these sugars are disturbing your digestive system, you need to reduce your consumption of high-FODMAP foods. Doing so can make a real difference to your bloating, but you may have to follow a low-FODMAP diet trial for several weeks before you start to see results.

If you suspect you suffer from a sensitivity to FODMAPs, the best approach is to see an accredited practising dietitian who’s experienced with low-FODMAP diets. He or she can steer you through the trial and challenge process, which involves eliminating and then gradually reintroducing FODMAP foods.

Only some people have trouble with all of the FODMAPs – your system may be sensitive to just a couple. This is important to note because the strict low-FODMAP diet cuts out many healthy foods. These include high-fibre foods, which are essential to good bowel health. For that reason, it’s best to have a health professional help you identify your individual triggers and thresholds. You need to make sure you’re not following a diet that’s more restrictive than necessary for the long term.

Lactose intolerance

Lactose is the sugar in milk and milk products — it’s a disaccharide, one of the five types of FODMAPs. However, lactose intolerance can occur independently of other FODMAPs if you’re deficient in lactase, the enzyme that breaks down lactose to enable its absorption. When gut bacteria ferment unabsorbed lactose, bloating results, and is often accompanied by nausea, diarrhoea and abdominal cramps.

A stomach bug can trigger a temporary bout of lactose intolerance, and our lactase production can slow as we age. Lactose intolerance is also more common among certain ethnic groups, particularly in people of Asian, African and South American descent.

How to treat it

If lactose plays havoc with your digestion, you’ll have to reduce the amount of lactose in your diet – in other words, limit or avoid foods that contain this milk sugar. This can be a process of trial and error, as most lactose-intolerant individuals still produce some lactase, and the amount they produce dictates just how much lactose they can consume without experiencing discomfort. Milk and custard have the highest amounts of lactose, whereas yoghurt often contains much less, as the bacteria used in yoghurt-making ferment much of this milk sugar. Hard cheeses and butter contain negligible amounts of lactose; soft cheeses and cream have small amounts.

Lactose-free dairy products, such as milk, custard, yoghurt and cream are now available, while soy, rice, oat, pea and nut milks are naturally lactose free. (If you choose a plant milk, look for one that’s fortified with calcium.)

Once you reduce or remove lactose from your diet, those uncomfortable symptoms of bloating should quickly subside.

Eating legumes

Many people find that certain foods can cause some degree of bloating, and legumes are a well-known offender. Legumes, or pulses, include chickpeas and lentils as well as beans, such as soybeans, kidney beans, borlotti beans, cannellini beans and good old baked beans — the musical ‘fruit’ that makes you toot!

All of these contain the FODMAP galacto-oligosaccharides, which the small intestine finds difficult to absorb. When this FODMAP reaches the large intestine, gut bacteria ferment it, resulting in gas and bloating.

How to eat them

You could cut legumes out of your diet, but they’re really nutritious, low-GI foods that provide protein and fibre, plus many health benefits. Legumes are also a key source of protein for vegetarians. Luckily, you can reduce legumes’ gas-producing properties before you cook them. If you’re using dried legumes, prepare them the traditional way: Ssak, rinse and cook them in fresh water. If you prefer the canned variety, rinse and drain them thoroughly (unless they’re baked beans, of course).

Most people can build up their tolerance of legumes, so start small and gradually incorporate growing amounts of them into meals on a regular basis. It’s also worth trying different types of legumes, as you may tolerate certain kinds better than others.

Coeliac disease

If you have coeliac disease, eating gluten triggers an immune reaction in your small intestine, damaging the intestinal wall and reducing its ability to absorb nutrients from food. This can cause symptoms such as bloating, along with diarrhoea, nausea and abdominal pain. This poor nutrient uptake also means that weight loss and deficiencies in certain vitamins and minerals, such as iron and vitamin D, are common, though some lucky people experience no symptoms whatsoever.

In children, unmanaged coeliac disease can affect normal growth and development, and they typically suffer from a very distended stomach and have thin arms and legs.

How to treat it

The standard treatment for coeliac disease is a strict gluten-free diet for life. Due to the restrictions of this diet, it’s important not to self-diagnose this condition. It’s also crucial not to cut gluten from your diet before being tested for coeliac disease, as the tests require you to be eating gluten at the time.

Gluten is the protein in grains such as wheat, rye and barley, so following a gluten-free diet means forgoing many breads, cereals and grain foods. You can replace these with gluten-free alternatives and gluten-free foods. Grains that are naturally free of gluten include rice, corn, quinoa, buckwheat, amaranth and sorghum, so you can also eat products made from these grains.

The gluten-free diet is strict, but the good news is that once you’re following the diet, your intestinal wall will recover and your bloating will resolve.

Bloating or distension?

Most people think of bloating and abdominal distension as the same thing, but they’re quite different. Bloating is the sensation of increased abdominal pressure, whereas distension is an increase in abdominal size. These conditions often occur together; however, many people experience bloating without any measurable distension.

In recent years, our understanding of bloating has improved, but there’s still a lot we don’t know. This condition involves many problematic factors, so its causes and treatment vary from one person to the next. These pages will help you identify the most common causes and their most effective treatments.

What is functional bloating?

Most of us have suffered from the occasional episode of bloating, especially after overeating or after eating extremely rich food. For some people, bloating is a symptom of a digestive disorder, such as chronic indigestion or even IBS. But for others, bloating occurs regularly, without other digestive problems, and can be particularly distressing. This is called functional bloating, which a doctor diagnoses when:

  • You’ve suffered from a recurrent sensation of bloating or visible distension for at least three days every month.
  • You’ve experienced symptoms for at least three months.
  • Your symptoms started at least six months ago.
  • You don’t meet any of the criteria for a diagnosis of IBS, indigestion or any other functional digestive disorder.

Is my bloating a sign of something more serious?

Bloating generally fluctuates in intensity, often improving overnight and worsening during the day, particularly after eating. Although it can be unpleasant and uncomfortable, its causes tend to be otherwise harmless. But if your bloating persists day and night, progressively worsens over time or is accompanied by symptoms such as weight loss, nausea, abdominal pain, changes in your bowel habits or blood in your stools, it’s important to tell your doctor — especially if all of these symptoms sound familiar. You need to rule out more serious causes of bloating, such as ascites (due to liver failure) and tumours, such as bowel cancer and ovarian cancer.

If you are struggling with bloating, or other digestive problems, Northside Nutrition and Dietetics has a dietitian with expertise in the dietary management of digestive conditions and food intolerance, including low FODMAP diets.  To book an appointment with Marie Ward, call our office on 9415 4845 or send an online appointment enquiry.

This article has been updated from an article originally published by Australian Healthy Food Guide. The original article appears here.

Avoid Winter Weight Gain

Avoid Winter Weight Gain

Do your clothes usually feel a bit tighter when Spring rolls around?  If so, you are not alone.  Research has shown that winter weight gain is common, although on average it’s no more than a kilogram or two.

But if you’re concerned about gaining weight over the colder months, here are some tips that can help:

Plan your winter menu

Eating well can seem more of a challenge in the colder weather.  For many people, fresh fruit and salads are less enticing and richer, heavier foods become more appealing.  The good news is that there are plenty of winter meals you can enjoy that are both healthy and satisfying.

Here are a few ideas to get you started:

  • A bowl of warm porridge is a great way to get started on a cold morning. Use traditional rolled or steel-cut oats and add stewed apple and cinnamon for sweetness.
  • Don’t like porridge? Try baked beans or eggs with spinach and mushrooms on wholegrain toast instead.
  • Soup makes the perfect winter lunch – make a big pot on the weekend and freeze in individual portions. Include plenty of vegetables along with legumes for protein, fibre and low GI carbs.  For ideas check out our recommendations on Pinterest.
  • Casseroles and curries make a great winter meal and one you can make ahead of time so dinner is ready to heat and serve when you arrive home. Use lean meats and chicken, lots of vegetables and legumes for fibre and canned tomato, stock and fresh or dried herbs and spices for flavor.  Check out some of our favourites here.
  • For dessert try baked apples, apple or pear crumble with natural muesli topping or poached pears served with a dollop of Greek yoghurt.
  • A mug of herbal tea is a great way to warm up on a cold day – try a variety of different flavours to find the ones you like best.

Keep moving

The shorter days and colder temperatures can make it more tempting to curl up in front of the television or with a good book rather than head outside to exercise.  But moving is the fastest way to get warm and there are plenty of cold weather options:

  • Move your workout indoors. Join a local gym or dance class, buy or hire a treadmill or exercise bike, borrow an exercise DVD from your local library or consider one of the many online exercise programs now available.
  • Move your morning or evening walk to lunchtime and enjoy the winter sunshine.
  • Head to your local indoor heated pool to swim a few laps or join an aqua class.

Can’t seem to get motivated to move?  Check out our top tips for increasing motivation to exercise here.

Eat mindfully

Whether it’s due to spending more time inside, with food nearby, or feeling the winter blues, emotional eating can be more of a problem for some people at this time of year.  Mindful eating is about being aware of your appetite and reasons for eating, and can help to reduce overeating and non-hungry eating. It’s an important part of managing your weight at any time of the year.

If you recognise that emotional eating is an issue for you, particularly at this time of year, our 8 Steps to End Emotional Eating might help.

Stay well

Apart from being unpleasant, getting sick over winter can throw our healthy eating and exercise plans off track.  The good news is that there are steps you can take to reduce your risk of getting sick including eating well, staying active, getting enough sleep and practicing good hygiene. Check out our blog post Top Tips for Staying Well over Winter for tips on avoiding the dreaded winter colds and flu.

Reversing heart disease with lifestyle changes

Reversing heart disease with lifestyle changes

Heart disease is something we all need to take seriously.

According to the Heart Foundation, one Australian dies of heart disease every 30 minutes – that’s 52 deaths every day.

Nine out of 10 Australian adults have at least one risk factor for heart disease and one in four have three or more risk factors.  Many of these risk factors are lifestyle-related including high blood pressure, high cholesterol, overweight and obesity, physical inactivity, poor diet, alcohol and smoking.

The good news is that these are things we can change, and doing so can have big pay-offs.

When things go wrong…

The major cause of heart disease is a build-up of fatty material inside the artery walls, which is known as atherosclerosis. The fatty deposits gradually clog up the arteries, reducing blood flow to the heart.  A similar process can occur in the blood vessels to the brain, and is the major cause of stroke.

For your heart to continue beating, it needs a constant supply of oxygen from the lungs, which flows into the coronary arteries that feed the heart muscle. When there is narrowing or blockage of these arteries, blood flow and oxygen to the heart is reduced, causing angina or chest pain. If the flow stops completely, a heart attack results. If not treated quickly, this can result in permanent damage to the heart muscle.

The good news is that there are many things we can do to reduce the risk of developing atherosclerosis and even to reverse this narrowing of the arteries if it has already occurred.

Target your risk factors

While there are a number of risk factors we can’t change such as genetics, age and gender, the Heart Foundation lists a number of ‘modifiable’ risk factors we can take steps to address:

  • Smoking – both active smoking and being exposed to second-hand smoke.
  • High blood cholesterol
  • High blood pressure
  • Diabetes
  • Physical inactivity
  • Being overweight
  • Depression, social isolation and a lack of social support

Undoing the damage

While medications to control cholesterol and blood pressure, and surgery (including cardiac stents and bypass surgery) are the mainstays of treatment and life savers for many, research by US cardiologist Dr Dean Ornish has shown that a program of diet, exercise and stress management can reverse the damage.

In 1983, Ornish and colleagues published the results of the first randomised controlled trial showing improved heart function after 30 days of a lifestyle program targeting dietary changes and stress management.  Participants also had a 91% reduction in frequency of angina episodes compared to a control group.

Following this, in the 1990s, they conducted the Lifestyle Heart Trial, which looked at impact of comprehensive lifestyle changes (a low fat vegetarian diet, moderate exercise, smoking cessation and stress management training) over a longer time period in participants with existing heart disease.  The group taking part in the lifestyle program experienced a 4.5% relative improvement in the narrowing of their coronary arteries after one year and 7.9% relative improvement after five years.  In contrast, the control group, who were given usual care (they were asked to follow the lifestyle recommendations of their  doctor and take medication), had a 5.4% relative worsening at one year and 27.7% relative worsening after five years..

The lifestyle change group experienced more regression of their atherosclerosis without the use of cholesterol-lowering medications than the control participants who were taking medication.  Even more important was the fact that more than twice as many cardiac events (such as heart attacks and the need for cardiac surgery) occurred in the control versus the lifestyle intervention group.

The ‘Undo It’ program

Undo It with Ornish’ is the new name given to Dr. Ornish’s Program for Reversing Heart Disease. It’s described as the first program scientifically proven to reverse heart disease by optimising four important areas of your life, and is now covered by Medicare in the US. The comprehensive program involves 18 sessions of 4 hours each, and unlike most quick-fix diet programs, 88% of participants remain committed to the program after a year.

While the Ornish program isn’t available here in Australia, we have a similar program, called ‘Complete Health Improvement Program’ (CHIP). This program focuses on the same four key lifestyle areas as the Ornish program: revising dietary choices; increasing daily exercise; improving support from friends and family; and decreasing stress.

Results of the CHIP program have found that it reduces the need for medication in people with diabetes, reduces stroke risk, lowers blood pressure and cholesterol, reduces weight and improves depression — all factors which are known to reduce heart disease risk.

The CHIP programs are conducted by trained and licensed CHIP facilitators. According to facilitator Dr Darren Morton, who helped to develop the program, “CHIP is not simply a diet and exercise plan, it’s about moving towards an optimal lifestyle — one that promotes health and discourages disease”.

How to reverse heart disease

The Ornish program and CHIP focus on four key lifestyle areas:

  1. What you eat. Eat a plant-based diet of vegetables, fruits, wholegrains, legumes, nuts and seeds. If you are not quite ready to go vego, then just cutting down on animal foods and incorporating some plant-based meals is a good start.
  2. How much you move. Do regular, moderate intensity exercise. The ‘Undo It’ program recommends a minimum of 30 minutes per day or one hour every second day of aerobic exercise per week. More intense exercise will give additional benefits, as will strength training two–three times a week.
  3. How you manage stress. Better stress management is key. The programs encourage you to learn relaxation and stress management techniques.
  4. How much love and support you have. Love and support help to make you healthier and happier. Having people around you who care about you is a key component of good health.

The bottom line

Keeping your heart healthy is about more than just cutting out a few foods and taking medication. Making lasting changes in these four areas will benefit your heart and — literally — give you a new lease of life.

This blog post is an edited version of the article The Diet that Mends Broken Hearts, written by Dr Kate Marsh and originally published by Healthy Food Guide in March 2016.  Read the full article here.


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