Bloating 101: What’s Normal, What’s Not, and What Might Help

Gas, discomfort, and the occasional mystery meal—here’s how to tell what’s going on in your gut, and what might actually help.

Danny Roth here, bloated as I sit here now, writing to you. Why is this happening? Did I eat too fast again? Is this some karmic punishment for not taking my Celiac seriously and sneaking those fries I was warned might be breaded? Is this somehow just… a physiological response to the stress of a looming deadline..? 

Bloating, which you likely know because you clicked on this, is a condition that causes a feeling of “tightness, pressure, or fullness in the gut” (as defined by the Cleveland Clinic). When people talk about bloating, they’re most commonly talking about the pain associated with gas, though constipation, hormones, and even stress can cause hard-to-distinguish feelings of belly discomfort. In researching to write this article, I’ve found that people love to Google things like “is __ bad,” which is probably why doctors roll their eyes at us when we tell them we’ve Googled our symptoms. 

But bloating, like many conditions with a variety of causes, can be as benign as “I ate ice cream again knowing full well what it would do to me,” and as severe as an underlying condition like Celiac disease or endometriosis. This means it’s worth digging into what’s causing your symptoms—and reaching out to your doctor—to know what’s “normal” and what isn’t, and what you’ll need to do to feel better.  

Identifying the cause

Some common causes of bloating are intuitive (if you’re constipated, you’re likely aware). Other causes are trickier to pin down. You may know you’re dealing with gas pain, but it may not always be apparent why. Gas occurs in the intestines as a natural byproduct of the digestion process (often referred to as “fermentation”), but a person suffering from bloating may be experiencing overfermentation—causing an excess of trapped gas—or in some cases, a heightened pain response to the gas. 

Trapped gas from maldigestion may be the easiest to wrap your head around (in part because it’s exactly what it feels like is happening in your gut). This may be an indication that your body is struggling to break down specific foods, either due to a mild intolerance or, less likely, a more chronic inflammatory or autoimmune condition. It can also indicate an overgrowth of bacteria in the gut known as SIBO (which, in my experience, was quickly diagnosed because of sudden pronounced bloating). But sometimes, the structural cause of an individual’s bloating is not always cut and dry. 

“There are a lot of foods that the human body does not fully digest and absorb,” explains Janelle Smith, a dietitian at UCLA Health. “There's a certain amount of fermentation and leftover food in our bellies all the time, normally. But some people's nervous system or gut sees that more as an irritant, which may cause them to experience worse symptoms.”

This phenomenon, called visceral hypersensitivity, is a disorder of gut-brain interaction and can account for why two people whose labs might look identical may experience different gut symptoms. Irritable bowel syndrome, functional dyspepsia, and even functional bloating—meaning bloating that does not have an obvious structural cause—all fall under this category. 

Another sneaky culprit: stress. It may come as no surprise that stress and anxiety can affect the sensitivity of the nervous system, but Janelle points out that it can physically impact the gut. “Stress actually can present in our abdominal cavity related to our nervous system,” she says. “Sometimes we see uncoordinated breathing patterns that lead to bloating as well.” 

In some cases, bloating can be exacerbated by some medications. There are some well-known offenders, like pain-relievers, which over time can irritate the stomach lining, and antibiotics, which can impact the overall gut biome.

“If you're taking any sort of antibiotic, I always recommend supplementing it with a higher probiotic, whether it's food-based or supplement-based,” says Emily Morgan, a New York-based registered dietitian. She also cautions that many diabetes and weight loss medications—like GLP-1s and Metformin—can be tough on the digestive system, and patients on these medications frequently report side effects like bloating, nausea, and acid reflux. 

Ironically, medications that may treat one of the underlying causes of bloating—like taking Prilosec to combat reflux in a patient with Celiac—can actually cause bloating themselves. If you’re concerned a medication may be affecting your gut, speak to your doctor and look into the potential side effects.

Lastly, reproductive health issues can also cause or worsen bloating. Discomfort from gas or fluid retention may align with hormonal changes or the menstrual cycle, but in some cases, conditions like ovarian cysts or endometriosis may be involved. Your doctor may want to rule these out before deciding on a treatment plan.

What you can do

If you’re dealing with persistent bloating, it’s recommended to go to the doctor to do some basic diagnostic testing is a good place to start. Many of the underlying chronic conditions mentioned above can be detected through labs. SIBO can be diagnosed with an at-home breath test. Some interventions that address the impact of stress on the digestive system—like diaphragmatic breathing and gut-directed hypnotherapy—may require a little more investigation to find the right practice and provider. 

If you think you may have an intolerance to something you’re eating, Janelle suggests forgoing a food sensitivity test, instead opting for a digestive enzyme or an elimination diet as a first-line treatment. A low FODMAP diet is a good blueprint to follow for reducing certain foods that, when fermented in the gut, can trigger irritation and bloating. These include lactose, fructan, and galacto-oligosaccharides (or GOS). In layman's terms: you may want to cut down on milk, ice cream, wheat, garlic, onion, beans, and nuts. The two major enzymes on the market are still the ones in your parent’s medicine cabinet, with extremely on-the-nose brand names: Beano for beans and Lactaid for lactose. When used as directed, they can offer real relief. 

“Taking the enzyme effectively can be tricky because it has to mix with the food in your belly,” says Janelle. “When digestive enzymes don't work, it's because people don't take them exactly at the right time with the food or they don't take a large enough dose.”

Before jumping into an elimination diet, Emily suggests interrogating some behavioural causes that may be contributing to GI symptoms like bloating. 

“Honestly, I think one of the biggest things is not food-related. It's actually how people are eating,” she says. “If they're eating really fast, or not chewing their food super thoroughly, that can make a huge impact on bloating. These are always things that, at least in my practice, we like to approach in the first few sessions because we find they can make a really fast improvement. Even if it's not fully better, it at least could help them see some result.” 

Like Janelle, she also suggests digestive enzymes for relief with certain food groups, as well as natural remedies like spearmint, lemon balm, and ginger. And if you haven’t already, she recommends cutting down on artificial sweeteners as well as fatty, processed foods, which may cause salt retention and create a sensation of pressure in the gut. 

Reader, let me be clear: I am still bloated as I sit here signing off. But empowered by my research and the wisdom imparted to me by the experts, I’m feeling motivated to make a few changes. I hope you are too. 

Words by Danny Roth