BLOATING AND POOR DIGESTION

WHAT IS BLOATING AND POOR DIGESTION?

Poor digestion and bloating can affect both healthy and unhealthy people. According to a survey done by Fox News, nearly 74% of people suffer from gastrointestinal discomfort such as bloating or poor digestion (1). Generally, these symptoms are short-lived. In some cases, however, these symptoms are due to more serious underlying conditions such as celiac disease or irritable bowel syndrome and need to be addressed (2).

RISK FACTORS FOR BLOATING AND POOR DIGESTION

The following are factors that increase the risk of bloating and digestive issues:

• Anti-inflammatory drugs (3)
• Smoking (3)
• Obesity (having a BMI greater than 35)
• Alcohol use (4)
• Past abdominal surgery (4)
• Being female – (bloating is often a symptom of the menstrual cycle)
• Genetics

TYPES AND SYMPTOMS OF BLOATING AND POOR DIGESTION

Bloating

There’s nothing worse than being in public with a bloated stomach.  Bloating in the abdominal area is normally due to gas, or air, that is trapped within the gastrointestinal tract. This gas, or air, can originate naturally from the process of breaking down undigested food in the intestines, or when the air is swallowed while eating. Normally these gases are dispelled in the form of burping or flatulence. However, slow gas transport, or delayed emptying of the stomach, can result in a buildup of gases, and air, and will cause bloating (5). While this is the most common cause of bloating there are several other conditions that can result in abdominal bloating. Symptoms can include increased gas production, impaired gas transit, abdominal pain, and abnormalities in posture (6).

Indigestion

Indigestion, also called dyspepsia, is a common disease that frequently affects roughly 40% of people worldwide (7).  When a group of 30 people was asked to describe indigestion, the general description included “pain, wind, acidity, sickness, and upset bowels” (8). Indigestion is often closely related to bloating (4). These two conditions are commonly seen together.  Indigestion can be caused by a number of things but is most commonly due to diet.  Most of the time, a change in diet can help solve the problem.

Celiac Disease

Celiac disease is a permanent condition caused by a negative auto-immune reaction to gluten that damages the lining of the small intestine. When people with celiac disease eat food that contains gluten, such as wheat, rye, barley or some oat products, their immune system reacts by attacking and damaging the villi in their intestinal tract. The damaged villi can no longer absorb nutrients from food (9). This results in a variety of gastrointestinal issues such as:

• Abdominal pain, bloating, gas, or indigestion
• Constipation
• Poor Digestion
• Decreased appetite (may also be increased or unchanged)
• Diarrhea, either constant or off and on
• Lactose intolerance (common when the person is diagnosed, often goes away after treatment)
• Nausea and vomiting
• Stools that are foul smelling, oily, or stick to the toilet when flushed
• Unexplained weight loss (although people can be overweight or normal weight) (9)

Irritable Bowel Syndrome

Irritable bowel syndrome (IBS) is one of the most commonly encountered gastrointestinal (GI) problems in clinical practice with a 12%  prevalence in the general population (10). IBS is a heterogeneous disorder, meaning that it is genetically passed down from parents to child, instead of being caught or developed (11).  IBS is a functional bowel disorder characterized by recurring abdominal pain and inconsistent bowel movements (10). IBS significantly alters the life of an individual, so much that one study found that “patients with IBS account for increased resource utilization and decreased productivity compared with healthy persons” (10).

BLOATING AND POOR DIGESTION FACTS AND STATISTICS

• Research has shown that detection rates of depression and anxiety symptoms are high in patients with chronic digestive system diseases, especially in patients with digestive system tumors, liver cirrhosis, functional dyspepsia, and chronic viral hepatitis (12).
• Bloating is one of the most common gastrointestinal (GI) symptoms, which is a frequent complaint in the patients of all age (13).
• One in 10 people suffers from functional dyspepsia (indigestion) (3).
• The gut-brain axis is the close bond that exists between the digestive system and your brain. Emotions (including stress) and brain disorders affect how your body digests food (14).
• Aerobic exercise is the best type of exercise to keep your digestive tract in shape (14).

MEDICAL TREATMENT OF BLOATING AND POOR DIGESTION

Bloating and Indigestion

There is a wide range of treatments depending on the source of the problem.  Some treatments include exercise, antibiotics, tricyclic antidepressants, and laxatives (6).

Celiac Disease

A strict, lifelong gluten-free diet is the only way to manage celiac disease. The following foods contain gluten, and should be strictly avoided:

• Barley
• Bulgur
• Durum
• Farina
• Graham flour
• Malt
• Rye
• Semolina
• Spelt (a form of wheat)
• Triticale (15)

IBS

There are many different ways to treat irritable bowel syndrome. IBS can be treated with either medication, supplementation, therapy, or diet change. One common form of treatment is that of probiotics and prebiotics. Probiotics are supplements or foods that contain live microorganisms that help maintain and improve the good bacteria within the body, specifically the bacteria in the gastrointestinal tract. Prebiotics are foods, that are typically high in fiber, that act as food for the good bacteria, and thus encourage their growth.

Several studies using both prebiotics and placebos found that prebiotics significantly benefits patients with IBS. One study found that treatment with the prebiotic reduced the intensity of IBS symptoms and improved quality of life as compared with the placebo. The prebiotic significantly improved the composite symptom score, bloating and flatulence, and the subject’s global assessment. The researchers found a reduction in abdominal pain and flatulence with an improvement in the quality of life of patients receiving the active treatment (10).

Probiotics have been extensively studied in IBS patients with variable effects on gut symptoms. The most recent meta-analysis by Ford et al. demonstrated efficacy in IBS patients for improvement of global symptoms, abdominal pain, bloating, and flatulence (10).

NATURAL WAYS TO SUPPORT A HEALTHY DIGESTIVE SYSTEM

Practices to Help Support a Healthy Digestive System:

When thinking about how to best support a healthy digestive system, most people immediately think “improve the diet”. While this is true, there are also other lifestyle changes one can make in order to fully support their digestive systems.

• Get more sleep: Lack of sleep is linked with higher rates of obesity (16). With obesity come many other digestive diseases such as acid reflux, esophageal cancer, nonalcoholic fatty liver disease, gallstone, or pancreatic cancer (17).
• Exercise: Exercise increases blood flow which helps to ensure regular bowel movements. Activities such as yoga are also good for digestive health. The stretches and twists done during a yoga routine help massage the digestive system which releases trapped toxins and encourages the movement of food through the digestive tract (16).
• Managing Stress: Stress has been linked with stomach ulcers, as well as a variety of other digestive issues. Relaxing activities such as walking, hiking, biking, meditating, drawing, yoga, etc., can help reduce stress and thus reduce the risk of digestive diseases.

Natural Supplements to Support a Healthy Digestive System:

• Triphala (18)
• Caraway (19)
• Marshmallow root (20)
• Bifidobacterium (21)
• Lactobacillus (22,23)

REFERENCES

1. Survey shows 74 percent of Americans living with GI discomfort. http://www.foxnews.com/health/2013/11/22/survey-shows-74-percent-americans-experience-gi-discomfort.html. Accessed August 2, 2018.
2. Gage J. Understanding the role of probiotics in supporting digestive comfort. Nursing Standard.2009 Sep 30-Oct 6;24(4):47-55. DOI:10.7748/ns2009.09.24.4.47.c7297
3. Talley NJ. Functional dyspepsia: New insights into pathogenesis and therapy. The Korean Journal of Internal Medicine. 2016 May;31(3):444-56. doi:10.3904/kjim.2016.091.
4. Jiang X., Locke GR, Choung RS, Zinsmeister AR, Schleck CD, Talley NJ. Prevalence and risk factors for abdominal bloating and visible distention: A population-based study. Neurogastroenterology. 2008,57(6), 756-763. doi:10.1136/gut.2007.142810
5. Abdominal bloating: Causes, Symptoms and Diagnosis. https://www.healthline.com/symptom/abdominal-bloating. Accessed on August 1, 2018.
6. Lacy BE, Gabbard SL, Crowell MD. Pathophysiology, Evaluation, and Treatment of Bloating. Gastroenterol Hepatol (N Y). 2011;7(11):729–739.
7. Jaber N, Oudah M, Kowatli A, et al. Dietary and Lifestyle Factors Associated with Dyspepsia among Pre-clinical Medical Students in Ajman, United Arab Emirates. Central Asian Journal of Global Health. 2016; 5(1):192. doi:10.5195/cajgh.2016.192
8. Kingham JG, Fairclough PD, Dawson AM. What is Indigestion?. Journal of the Royal Society of Medicine. 1983;76(3:183-186. doi:10.1177/014107688307600305
9. Celiac disease – sprue: MedlinePlus Medical Encyclopedia. https://medlineplus.gov/ency/article/000233.htm. Accessed August 2, 2018.
10. Lovell RM, Ford AC. Global prevalence of and risk factors for irritable bowel syndrome: a meta-analysis. Clin Gastroenterol Hepatol. 2012 Jul;10(7):712-721.e4. doi:10.1016/j.cgh.2012.02.029.
11. Menees S, Chey W. The gut microbiome and irritable bowel syndrome. F1000Research, 2018;7:1029. doi:10.12688/f1000research.14592.1
12. Zhang A, Wang Q, et al. Prevalence of depression and anxiety in patients with chronic digestive system diseases: A multicenter epidemiological study. World J Gastroenterol. 2016; 22(42): 9437–9444. doi:10.3748/wjg.v22.i42.9437
13. Seo AY, Kim N, Oh DH. Abdominal Bloating: Pathophysiology and Treatment. Journal of Neurogastroenterology and Motility. 2013;19(4):433-453. doi:10.5056/jnm.2013.19.4.433
14. Fun Facts About the Digestive System. https://www.healthline.com/health/fun-facts-about-the-digestive-system#3. Accessed August 2, 2018.
15. Celiac disease. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/celiac-disease/diagnosis-treatment/drc-20352225. Accessed August 2, 2018.
16. Your Digestive System: 5 Ways to Support Gut Health.https://www.hopkinsmedicine.org/health/healthy_aging/healthy_body/your-digestive-system-5-ways-to-support-gut-health. Accessed August 2, 2018.
17. Nam SY. Obesity-Related Digestive Diseases and Their Pathophysiology. Gut Liver. 2017;11(3): 323–334. doi:10.5009/gnl15557
18. What Are the Benefits of Triphala? https://www.healthline.com/nutrition/triphala#section1. Accessed August 1, 2018.
19. Caraway Herb – Side Effects, Uses and Benefits. https://www.herbal-supplement-resource.com/caraway-seeds.html. Accessed July 30, 2018.
20. Marshmallow. WebMD. https://www.webmd.com/vitamins/ai/ingredientmono-774/marshmallow. Accessed August 13, 2018.
21. Bifidobacteria: Uses, Side Effects, Interactions, Dosage, and Warning. https://www.webmd.com/vitamins/ai/ingredientmono-891/bifidobacteria. Accessed August 2, 2018.
22. Ringel-Kulka T, Palsson OS, Maier D, Carroll I, Galanko JA, Leyer G, Ringel Y. Probiotic Bacteria Lactobacillus acidophilus NCFM and Bifidobacterium lactis Bi-07 Versus Placebo for the Symptoms of Bloating in Patients With Functional Bowel Disorders. Journal of Clinical Gastroenterology. 2011;45(6):518-525. doi:10.1097/mcg.0b013e31820ca4d6
23. 9 Ways Lactobacillus Acidophilus Can Benefit Your Health. https://www.healthline.com/nutrition/lactobacillus-acidophilus#section4. Accessed August 1, 2018.