"Why am I bloated after re-introducing gluten?"

 When wheat bloats you, is it because of the protein (gluten) or the carb (fructan)?

When wheat bloats you, is it because of the protein (gluten) or the carb (fructan)?

"Dear BBW,

I went gluten free seven years ago to help with inflammation in my body and also to alleviate bowel issues. Recently, I tried to introduce it back into my diet and I have obviously gone about it all wrong. My stomach has been hurting for 5 days now and I haven't consumed gluten for the past two! What is the best way to reintroduce gluten and why does my stomach hurt so bad?"


Dear MW,

With this level of detail, I can only offer hypotheses for you, but here goes:  Prior to giving up gluten 7 years ago when you were experiencing 'bowel issues',  had you been properly tested for Celiac disease?  If not, we cannot exclude the possibility that you might actually have it, which could explain the residual stomach pain even two days after abstaining from gluten-- and possibly some 'inflammatory' type symptoms from seven years prior, depending what those were.  If you were my patient, I'd be working with your doctor to have some genetic tests run (HLA types) to see if it's even genetically possible for you to have Celiac disease.  If you don't have either one of the two celiac genes, its highly improbable (less than one in one thousand chance) you could have the condition.  If you did have one of the genes, we'd be talking about whether you wanted to suffer through a 4-6 week gluten challenge to confirm the diagnosis, or just assume you're Celiac and part ways with gluten forever.  With only three days of wheat eating in the past seven years, it's unlikely that conventional blood tests (tTg-IgA) used to screen for Celiac disease will be reliable right now.

If your doctor did rule out Celiac disease years ago (or can do so with gene testing now), though, then it's more likely you're reacting to the fermentable carbohydrates in wheat (fructans) rather than the protein in wheat (gluten).  Recent studies show that this is the case for the vast majority of people without Celiac disease whose gastrointestinal symptoms improve on gluten free diets.  If you fall into this category, the gluten-containing foods that will likely agree with you the most are those low in fructans: sourdough bread made from wheat (white or whole wheat) and spelt bread (or spelt sourdough bread!).  Soy sauce and conventional oats, both of which likely contain some gluten, should also agree with you as they are low in fructans.

There are certainly other medical possibilities if these hypotheses don't pan out, but they're much rarer.  Good luck!



"How can I alleviate bloating from incomplete daily bowel movements?"


"Dear BBW,

I experience a bloated belly constantly due to incomplete daily bowel movements. I was diagnosed with a "redundant colon" four years ago. High fiber and drinking water don’t help much. I’ve been like this for 15+ years, but it got worse after two pregnancies and two C-sections. Thank you!


Dear ND,

"Redundant colon" is a tricked out way of saying that your colon is a little extra long, and that suggests it may take poop longer to make its way to the exit.  By the time the poop finally arrives, it may be a bit dried out and harder, meaning its less likely you'll have moist, plump, long "log-like" poops that are more likely to pass intact and completely.  The fact that things worsened after 2 C-sections suggests your problem may have been be worsened by weakened abdominal wall muscles; you need to be able to tense that abdominal wall tightly in order to create some force to propel your poop out during defecation.

Assuming your diet is indeed high in fiber already-- particularly high in "soluble" fiber that helps glue poos together cohesively (is it?)--I'd consider layering on two additional interventions to promote more complete defecation: magnesium and squatting. A dose of magnesium somewhere in the range of 400-800mg every evening should help speed the stool through your redundant colon before it can get too hard/dried out, while adding a bit of extra 'oomph' in terms of osmotic force to help propel the full stool onward and outward.  (Start low and work your way up by 200mg at a time.) Secondly, invest in a "squatty potty" or stepstool to place in front of the toilet when you go.  Drawing your knees up toward your chest when defecating helps get your pelvic floor muscles in the optimal pooping position and minimizes their reliance on a tight abdominal wall to conjure the force needed to finish off strong.

If soluble fiber, magnesium and squatting still doesn't do the trick, it may be worth having a gasto doc investigate your pelvic floor muscle function.  If its impaired, there are physical therapies that can be helpful.  


"Why do I sometimes wake up looking bloated?"


"Dear BBW,

I've always felt my digestion ran a bit on the slow side, but over the past year, I've noticed things getting worse.  I used to feel bloated and a bit short of breath often at night, but lately I'm even waking up feeling full, a bit nauseous and looking three months pregnant. The belly just grows as the day progresses, and my appetite shrinks along with it. What could be going on??"

-LT, New Jersey

Dear LT,

Sounds like you might indeed be pregnant... with what I call a "food baby."  You mentioned feeling full, nauseous and having lost your appetite, which makes me wonder if perhaps your stomach emptying might have slowed down.  Sometimes a sudden change in stomach emptying can happen following an acute infection-- a bad stomach bug or flu, a case of food poisoning or a parasitic infection. It may be worth taking to your doctor about investigating your gastric emptying. 

In the meantime, try this out for the next few weeks: steer clear of rough, tough textured foods like raw veggies, nuts and popcorn and eat soft, lower fat meals and snacks like eggs, sushi, well-cooked veggies, smoothies, soups, turkey sandwiches, veggieburgers, baked fish, ripe/skinless fruits and yogurts.  Try to eat 4 small meals or large snacks per day that are spaced out by 4 hours, and limit your drinking to between meals.  Make dinner your lightest meal of the day, not your largest. 


"I'm constipated and bloated, but eating fiber for my constipation makes me more bloated!"


"Dear BBW,

I'm pretty constipated.  I only go to the bathroom (#2) once every 2 or 3 days, and even then it feels like there's more I need to get out but doesn't come out.  My doctor told me to eat more fiber and to take Metamucil, but I feel like salads and fiber supplements constipate me even more!  I know I need to eat more fiber to go to the bathroom so I won't be so bloated all the time, but more fiber makes me feel even MORE bloated all the time. Help!"

-CF, New York

Dear CF,

There are many ways to tackle constipation, and fiber is only one of them.  What's more, there are many different types of fiber, and some may be more bloating than others--particularly when you're 'FOS' (that's short for 'full-of-stool.') You didn't mention whether you take anything in the laxative department. When my patients present with similar problems, we usually take a three-pronged approach:

  1. Coffee every morning right after waking to help stimulate the urge to go
  2. Gradually increasing fiber from "soluble" sources that aren't going to cause too much gas: oatmeal, chia/ground flaxseeds, quinoa, sweet potatoes, avocadoes, oranges/clementines, papaya, cantaloupe, zucchini, winter squash, peeled eggplant and carrots. I'd lay off the fiber supplements and lots of roughage, like kale and salads and popcorn for now. And steer clear of any 'high fiber' bars or fiber-fortified foods.
  3. If your kidneys are healthy, you can also try taking some magnesium supplements in the evening. Doses of 400mg to 800mg usually do the trick, and they're not dependency forming.

Of course, there are PLENTY more tricks up my sleeve if this trifecta doesn't get the job done. But you'll have to buy my book next February to learn the rest of them! ;)




"Why do I feel MORE bloated after starting a probiotic supplement?"


"Dear BBW,

I have IBS, and I decided to try taking a probiotic supplement after reading lots of things online and my having my doctor recommend it. Am I the only person who actually feels more bloated and extra gassy since starting a probiotic??  Why could this be?"

-MK, San Diego, CA

Dear MK,

You're definitely not the only person to have this experience.  Without knowing the nature of your bloating and which brand of probiotic you've been taking, I can't offer a very informed opinion about why this particular pill gave you these particular symptoms, but I can comment in general.

Probiotics are bacteria pills. Different bacteria feed on different dietary compounds in the gut, and they produce gas as a byproduct. If your probiotic pill happened to introduce a species/strain of bacteria that particularly loves to dine on a staple of your usual diet-- a certain type of fiber, starch or sugar-- it may be rewarding you with all sorts of gas.

Another common reason for probiotics increasing gassiness and bloating is related to the product's inactive ingredient fillers. Some brands of probiotics contain pure lactose, and other brands contain ingredients called "prebiotics," like inulin or fructo-oligosaccharides (FOS), designed to feed the gut's "probiotic" bacteria.  Objectively, these prebiotics are probably health-promoting. But subjectively, they can cause lots of gas and bloating for susceptible people-- especially people with IBS!

Sometimes, people acclimate to the probiotic after a week or two.  Sometimes people switch brands and find one that doesn't cause side effects. Some people just stop taking probiotics entirely.  Personally, I've not found probiotics to be any sort of "silver bullet" for bloating among my patients with IBS, though some people get lucky and find a particular brand that happens to make a difference for them. There's a fair amount of expensive trial and error involved with that.