Why You’re Bloated With IBS: Identifying Your Type of IBS Bloating & How to Fix It

Jessie Wong 00:00:00 Welcome to the IBS Nutrition Podcast, your go to source for navigating the complex diagnosis of irritable bowel syndrome. Here, we dive deep into IBS and discover the power of diet and lifestyle to find freedom from your IBS symptoms. I’m your host, Jesse Wong, Fodmap dietitian and a gut expert. For years, I suffered from debilitating gut symptoms that kept me out of work, feeling constant discomfort in my body and anxious around food. Today, I’m in control of my IBS. Able to eat the food I love again, travel whenever I want and spend quality time with loved ones. It is my mission to help you do the same and transform the way you live with IBS. Let’s get started! Welcome to another episode of the IBS Nutrition podcast. Today we are diving into a topic that affects so many of us bloating. And today I am here with my amazing co-host Brooke, who is also our lead team IBS dietitian in our program. And all of our clients love Brooke so much. And I. Brooke, how are you?

Brooke Keenan 00:01:03 Hi.

Brooke Keenan 00:01:04 I’m good. How are you? Good.

Jessie Wong 00:01:07 Are you excited about this topic today?

Brooke Keenan 00:01:09 I am, I think everyone is excited to hear more about bloating.

Jessie Wong 00:01:13 But did you know there are different types of IBS bloating? We will explore what they are, why they happened, and most importantly, how you can manage them. Whether you are dealing with occasional discomfort or chronic bloating, we are here to provide insights and practical tips to help you find relief. Let’s get started on this journey to better understand and managing your IBS bloating. So we have three topics that we are going to share. One is different types of bloating. What they are, why it happens. Number two is how do you know how to know what type of bloating you have? And number three is going to be we’ll be sharing the three biggest reasons why you are bloated and what to do about it. And of course, last but not least, we’ll give you some tools and tips to improve your bloating. Let’s go dive right in.

Jessie Wong 00:02:07 Number one different types of bloating. So what are some of the different types of bloating we see very often in our clinic?

Brooke Keenan 00:02:15 We see bloating caused by IBS, Sibo, food intolerances such as FODMAPs and last but not least, abnormal visceral somatic reflex disorders.

Jessie Wong 00:02:30 That’s a mouthful. It is. Yeah. Can you explain I think I think most of these may be I mean, IBS and Cibo. We actually have an episode talking about IBS and Sibo and what are different types of bloating when you have Sibo would have that’s different than IBS. But that word abnormal, visceral somatic reflex, it’s actually more common than we think, and we actually see it quite often with IBS patients. Can you explain a little bit more what that is for us?

Brooke Keenan 00:03:00 Yes. So it means the diaphragm descends or contracts inappropriately and the abdominal wall muscles then relax allowing the abdomen to protrude. So because of this the abdominal cavity becomes smaller, making it more difficult to accommodate gas. And so this can lead to abdominal distension and may also affect how bloating and distention are perceived.

Jessie Wong 00:03:31 Okay. And this is something we actually see quite often in our clinic. And one of the ways that can really help with this is actually deep diaphragmatic breathing. So when we are doing the deep affirmative breathing, we are manually or we are moving our diaphragm in a way that can help it have better motions or moving it more appropriately, and that can really help retrain the diaphragm. And also it can really help with bloating. And one of our clients, I can’t remember her name, but I remember her talking about this when we told her to do more deep diaphragmatic breathing throughout the day, and she said one time she was really bloated after a meal, and she did two minutes or 1 to 2 minutes of deep diaphragmatic breathing, so it doesn’t need to be very long. And she said she measured her bloating because she was working with pelvic floor PT as well at the time. So the pelvic floor PT told her to measure her waist circumference and she said that her waist actually shrank by two inches before and after breathing.

Jessie Wong 00:04:34 And that is the power of deep diaphragmatic breathing when it comes to managing bloating. And it is a very helpful tool, and it’s one that we recommend all the time if you don’t know how to do it. Actually, at our free IBS Masterclass, we lead you through how to do it properly so that you know what to do in these situations. So if you want to register to our free ABS master class, you can go to IBS dietician.com/masterclass so you can register and join us for one of our sessions. You can. You also find the link in our show notes as well. All right. Now let’s talk about our topic number two how to know what type of bloating you have. This is always so tricky, right? Because sometimes I feel like initially when we start practicing, when we don’t have that many documenting tools, our patients will come in and they may not know what is going on. And we ask them. And I remember one of my clients, she asked, she’s actually a physical therapist herself, but not a pelvic floor therapist.

Jessie Wong 00:05:37 And she said, I didn’t know. There’s so many types of bloating, I know I am bloated. I didn’t know it was upper lower GI or when it starts where it starts. So whenever I was asking her all these questions, she would say, I don’t know, I don’t know, I don’t know. And it can be frustrating experience for the patients and for the practitioner as well, because there’s not a lot we can do to help you identify what may be causing it. If you don’t know the details about bloating. So what are some of the things that we would like to know about bloating when it happens to a person?

Brooke Keenan 00:06:11 Yeah. So number one is where is the bloating? Is it above your belly button, below your belly button, your whole abdomen. So that is really important to kind of determine is it lower GI bloating or is it more upper GI bloating. When does it start? Does it start first thing in the morning when you wake up and build through the day? Does it only happen after eating? Is it worse or better before or after a bowel movement? How long does it last? Is it right after a meal? And then when you digest, it kind of goes away? Do you have gas with that bloating? Is it painful bloating or do you just feel kind of full? And again, back to does it go away after you have a bowel movement?

Jessie Wong 00:06:55 Right.

Brooke Keenan 00:06:55 So lots of.

Jessie Wong 00:06:56 Details looking for. Yeah. Yeah lots of details. And let’s give an example when we ask whether it is above the belly button or below the belly button, what we really want to know is, is this related to upper GI symptoms. Is it happening in your stomach or in your stomach small intestine, or is this more so happening in your colon, your large intestine? Because these are all clues to tell us what may be going on in your gut and where the problem is, and then all the other little questions that are really important as well, because it gives us a clue, is is it a food intolerance or are you constipated? Or is it something else that is going on that we may need further testing with your physician? Okay. And we have a free symptom tracker for you to use so that you can start tracking your symptoms. and we really recommend it for anyone with, gut conditions to track your symptoms before you go into your physician, because you only have 15 minutes with your gastroenterologist.

Jessie Wong 00:07:55 If you are seeing a GI, and you need to be able to convey all of these information effectively to your physician within that 15 minutes so that they know what to do with you. They know what test you ordered, they know what treatments to recommend, and it can really help you get to the right diagnosis faster and also get the right treatment plan faster. So our free symptom tracker is actually on a PDF walk forward slash resources. You’ll find the link in our show notes as well. But it is a great tool and we really recommend anyone with gut symptoms to use it. Document your symptoms before you see your provider. And that’s something we always ask our clients to do. Please document a few days of your symptoms before our first session and also what you’re eating too. So we can kind of see if there’s any correlation between food symptoms and bowel habits. And when you bring in all the detailed notes about your symptoms, what your provider would ideally do is to help you identify what type of bloating you have, and then also help you dive deeper into what is causing the bloating.

Jessie Wong 00:08:59 Because at the end of the day, you really need to know what is causing your bloating to prevent it from happening again. Well, let’s move on to our third topic. What are the three biggest reasons why a person bloat and what to do about it? And this is something we see in our clinic and is also backed by research as well. So the biggest reason why somebody may bloat is actually constipation. And sometimes this is overlooked. And sometimes patients may be having a bowel movement every single day. But if that movement is not a full evacuation, then the residual stool in your colons will stay in there, they will get fermented and they will cause bloating and significant amount of gas and sometimes pain as well. So if you know that could be a recent, you know, then work on routine gut motility and have better evacuations every day to resolve it. And actually, one of the biggest things we see is constipation causing bloating. But like I said earlier, not everybody knows that they are constipated.

Jessie Wong 00:10:07 And one of our clients, I love her dearly. She came to us to work through the low-fodmap diets, as most people would when they are looking to work with a dietician, and what I learned about her was that she went to her doctor for constipation and bloating, and her doctor recommended a low Fodmap diet. So what she did was traveling the diet by herself. She actually bought cookbooks from other dietitians about how to do the low Fodmap diet, and she stayed on the low Fodmap diet for one whole year by herself. Her bloating and pain and symptoms went down when she’s on the low Fodmap diet, but any time she tries to reintroduce FODMAPs into her diet, her symptoms come right back. And here is her problem. So when she’s removing maps, we’re removing foods that are fermentable. So that helps with symptoms. But her biggest problem, her underlying root cause to her bloating is actually constipation, which was not resolved when she was on the low Fodmap diet. So whenever she’s eating foods that are higher in fall maps, her symptoms will come right back because it’s the the fault map.

Jessie Wong 00:11:16 Foods will stay in her colon. They will get fermented again because she’s still constipated and that will cause significant amount of bloating, gas and pain. But once we identified her problem, which is constipation, what we did was we worked on creating a routine for her that can really help her have better evacuations every day. And that included eating a good breakfast, having plenty of fluids, having a cup of coffee in the morning and she will have full evacuations every day. And we also worked on other lifestyle changes to help improve her gut motility, so that she can continue to have better evacuations every day. At that point, when she was having good evacuations for about 2 to 3 weeks after working together. That’s when we started reintroducing FODMAPs. So this climb was a little bit different because she came to us already on the low Fodmap diet. So what we did was, you know, really identifying what was going on, resolve the root cause. And then we reintroduce FODMAPs. So about after 2 to 3 weeks, that’s when we started reintroducing FODMAPs group by group, to see if there are any specific groups of FODMAPs that would cause her more symptoms.

Jessie Wong 00:12:27 So at the end, there was one group of maps that, even in smaller quantities, was causing her symptoms, and that was GEOs. And once we found out about that, she was able to eat all other groups of all maps except that one group. Now, that one group she is very sensitive to, but she can still eat them in very small quantities because at the end of the day, we don’t want you to cut out most of the maps if you don’t have to. And it really helps feed the gut microbes that can help break you down. So for girls, what we really encourage her to maybe eat it once a week and then increase the frequency so that she can tolerate it more and more, and she’s feeding the microbes that can help her break it down. So the key of the low Fodmap diet is to really identify your tolerance level to different groups of fat maps, so you don’t have to cut them out long term. And you can continue to feed your gut microbes to keep your gut healthy.

Jessie Wong 00:13:22 So constipation is the biggest reason why a person may be bloated. So that’s one reason. And then another scenario we see all the time. The second scenario we see all the time I guess would be Sibo, right? Sometimes when the bloating is very persistent, we know a person is not constipated anymore, but they still have, they still have bloating, they have gas, and sometimes a lot of the symptoms are more upper GI or in the middle of the abdominal area. Then we will look into, well, is it Sibo and actually one of my previous clients and this is a cautionary tale that I kind of want to share. This client, his name is Fayez and he was a wonderful young man. He wants to stay healthy. He exercise all the time. He really tries to take care of his body. But here is what he did wrong in taking care of his body. He really loves to go to natural or health food stores, and when he goes there he will buy a bunch of supplements.

Jessie Wong 00:14:22 He would buy protein powder. He bought all the stuff that was recommended to him from those stores and that included, things that were, probiotics and other stuff. He really loved those kind of stores, and he would buy whatever the salesperson would recommend. Now, these salespeople, I would caution everybody they are not actually health care providers. They do not have a nutrition background. Their training comes from the companies that make these supplements. Their training purely comes from the supplements companies, and their training is to help them promote or market these supplements to consumers. So when they are telling you something, oh wow, this has that benefit. This has that benefit. Take it with a grain of salt. Well, actually, one resource that I really love directing everybody who is curious about supplements to is the NIH supplements factsheets. They have all of the supplements out there that have been researched, and they actually break down the research to whether the research was high quality or it was low quality, and also say, well, how many people were in the research? Is it reliable or not? And you will find that once you look through a few of them, you will find that most of the supplements don’t really have evidence to support their use.

Jessie Wong 00:15:45 I mean, besides the ones that we know like multivitamins, vitamin D during the winter months, like those are solid. Those have solid evidence to back them up. But most of the supplements out there don’t really have a lot of evidence. And this is his problem. So he really likes to go to those stores to buy things. And what happens was and he started having more constipation, more bloating, and then it started switching from constipation to explosive diarrhea. And what happens was he gave himself small intestine bacteria overgrowth, Sibo. And he went to his physicians. He traveled to antibiotics. He was still very bloated and he still was alternating between constipation and diarrhea. So one of the things we did together was really to tell him when do not go back to those health food store, don’t buy stuff. And I think while we were working together, he still went back to those health food store one time. But he sent me a message and say, Jesse, you got to be very proud of me because I went to the store, but I didn’t get anything else besides a protein powder, that that’s all I wanted to get there.

Jessie Wong 00:16:52 The salesperson tried to talk me into buying a ton more stuff, but I just said no, my dietitian would not approve it. So he turned around and walked away. If you’re listening to this, be very cautious about it. You know we are hoping to save you money and save you time and save you from these fallacies that promise so much when in reality it might just all be placebo because we don’t know if it works or not. And in fact, I have an episode with Doctor Andrea Love where we talked about all the, the tests that you don’t need. And we see it a lot in our clinic, like food sensitivity tests or GI map, like they don’t have actual science backing to them. But you will hear people say, oh, I did this and I cut out those food, or I did this regimen and I felt so much better. Some of it might be placebo, we don’t know. And we just don’t have long term safety data to prove it. But anyways, go back to what happened to us.

Jessie Wong 00:17:49 He was wonderful, what we really did. Now he has the type of Sibo which is methanogens overgrowth that actually cause significant constipation. So and it’s really difficult to treat. And the reason why he got it I’m going to say that again is because he took probiotics and prebiotics supplements that was not suitable for him okay. And his Sibo was really persistent beyond antibiotics. And what we really did was creating a routine that worked for him to have better evacuations every day, because when it comes to sleep well, a lot of the times we see people have mobility issues and supporting that. Mobility is really important in recovering from people. And once we created that routine, he is bloating and symptoms got a lot better, but it was still a long road for him to recover. And we did, test all of the Fodmap groups because that’s what his doctor told him to do. His doctor said, go low-fodmap to manage your symptoms. Yes, low Fodmap diet really helps managing Sibo symptoms because you are reducing the fermentable carbohydrates.

Jessie Wong 00:18:57 But ultimately what we did was testing each group of the farm apps so that we know how much you can tolerate for those groups, and he can still safely eat a small amount of it and not trigger symptoms and not make your symptoms worse. So remember, be very careful what you put in your body and where you spend your money on. These are not things that works if they work. Your doctor will be recommending to you. We will be recommending to you. Trust us. We want you to have all the tools you will have available for you. and don’t forget to stick around because later we will give you five different, tips or strategies to help make your bloating better to help improve your bloating. Okay, so we talked about two of the biggest reasons why we see people bloated or have persistent bloating. And I’m going to talk about the third one as well. The third one is actually food intolerance. And of course, that’s what people come to us for as a dietitian is identify their individual food trigger.

Jessie Wong 00:19:56 And I want to share a client’s story. Her name is Karen. She is the sweetest young lady and she was very bloated, very backed up, and had a lot of pain. So and so that she went to the hospital many times because she was so afraid that something was really, really wrong with her. So she went to the hospital, she went to her gastroenterologist, also went to see another GI dietitian, and also went to a natural path. And people were telling her to cut out so many foods They told her to cut out dairy, gluten and also go low-fodmap as well. So when she came to us, she was basically crying and say, Jesse, all these people are telling me to cut out these, cut out that I don’t know what to eat. Okay, so what we did is we we did work through some of the elimination diets, mainly the low Fodmap diet, because that is what have the strongest evidence when it comes to helping the patients with IBS. Do we see patients with gluten intolerance? We do sometimes, but we don’t recommend the gluten free diet lightly because it is an extremely restrictive diet.

Jessie Wong 00:21:07 Most people who try to do gluten free by themselves, they are not really doing the gluten free diet because the real gluten free diet is extremely restrictive, very difficult to achieve. And, sometimes we do see that, but we don’t recommend it lightly unless it’s necessary. And we always challenge. But anyway, go back to Karen’s story. So she cut out so many foods and she really didn’t know what to do. And when she came to us, and what I realized was that she’s actually very, very backed up to a point that she was having really sharp pain on one side of her, her body on the left side and sometimes on the right side. So these were the sharp pains that we sent her to the hospital, and she didn’t know what was causing it. And when we know that she was very constipated, the first thing we did was use some over-the-counter laxative to help her clean out and then help her create a routine that really worked for her. So she stressed a lot. So what we really, what we did a lot was deep diaphragmatic breathing to help her bring down her stress level and really help her bring in her gut to have better communication so that she doesn’t have these pain episodes as often.

Jessie Wong 00:22:16 And deep diaphragmatic breathing was also one of the tools she use. Whenever the pain starts, she would start the deep breathing. She would say after a few breaths, the pain is so much better. Or sometimes they would be gone completely. So if you are listening, if you are someone who has bloating or pain, you know do. The deep breathing is our number one recommended tool. But what we really did to, of course, is to create a routine to help her have better evacuations every day. And at the end of working together, we reintroduce all the formats. I think at the end, she only had two groups of home apps that she didn’t tolerate at larger quantities, and that was lactose and onion. She could still eat them in smaller quantities. She just can’t eat too much of it in one setting. So after knowing what her food triggers were, she was able to expand her diet safely and not worried about the significant bloating from coming back again. So for those of you who are struggling with bloating right now, know that you can actually say bye to bloating.

Jessie Wong 00:23:15 It is possible, but you really need to know what your underlying causes. And don’t just cut out food because you think of food is, causing your bloating because in the long run it can cause more symptoms. And don’t pile on a ton of supplements because that can actually make your symptoms worse in the long run. Now, last but not least, let’s give you some tools to take away with this episode. What are some of the things that we recommend to our clients regularly that can help with their bloating?

Brooke Keenan 00:23:46 So the deep diaphragmatic breathing and you can do that pretty much as much as you want at least three times a day, sometimes before meals, after meals. All of that can be helpful for sure. Having regular bowel movements create a routine that works for you. Chew your food thoroughly. I think this one is very, very overlooked. We need to chew until applesauce. Consistency. Digestion starts in the mouth, so it’s really important to give our gut a healthy start with chewing really well. Another one is not to drink fluid with a straw.

Brooke Keenan 00:24:20 If bloating is an issue for you, go for a few days without drinking through a straw and see if that can help impact your bloating in a good way. also regular exercise, or even sometimes going for a walk after a meal can help stimulate digestion and help that bloat kind of move through. That’s that’s some good homework right there.

Jessie Wong 00:24:43 Exactly. Yes, yes. especially the one don’t drink fluids with a straw. I think most people don’t know that. But, a lot of the times when we’re drinking really fast through a straw, we are swallowing a lot of air, and that can cause us to feel like we are bloated more often. All right, that’s all for today’s episode on different types of IBS bloating. We hope you find the information helpful and empowering. Take care and we will see you next time on the IBS Nutrition podcast. Bye! Thank you for tuning into the IBS Nutrition podcast. We hope today’s episode has brought you closer to understanding and managing IBS. Remember, you are not alone on this journey and finding freedom is possible.

Jessie Wong 00:25:27 For more on IBS, make sure to follow us on your favorite podcast platforms and please leave us a five star review! We would really appreciate that you can access links mentioned in this episode in the show notes, to learn more about your type of IPS and how to identify your own food or lifestyle triggers, Register for a free IBS masterclass. Three steps to IBS relief for our proven, holistic, three steps approach to managing IBS once and for all, head to IBS dietician. Com forward slash masterclass to register. Until next time, take good care of your gut and here’s to your health and happiness.