For more than a decade, Barbara Blane Toney has been dealing with the classic symptoms of irritable bowel syndrome: bloating, gas and abdominal distress.
Her doctors prescribed medication and over-the-counter supplements, treatments that only seemed to make things worse. Toney, an active, 64-year-old runner, still felt like she had an inflated balloon in her stomach.
"I've lived with this huge bubble in my stomach for so long that I don't know what normal feels like," Toney said. "I just can't get rid of it."
Bloat is a frequent complaint, especially among women. Though rarely life threatening, it's one of the earliest and most common signs that something is amiss in the gastrointestinal tract, a long and twisting road that stretches from the mouth to the anus.
Solving the mystery behind bloat, which is often accompanied by constipation or diarrhea, can help keep the 30-foot digestive superhighway flowing freely and dramatically improve quality of life, gastroenterologist Robynne Chutkan said.
"The GI tract is the body's digestive engine; everything else is the spokes," said Chutkan, a faculty member at Medstar Georgetown Hospital and the founder of the Digestive Center for Women. "If that's off, it affects everything."
Irritable bowel syndrome, a collection of symptoms, affects 3 to 20 percent of Americans, according to the National Institutes of Health. The symptoms, which affect twice as many women as men, most often occur in those younger than 45.
"Bloat is one of those things that people make fun of; you have gas, and your belly gets so much bigger after a meal," said gastroenterologist William Chey, a professor of medicine at the University of Michigan Health Systems and editor-in-chief of the American Journal of Gastroenterology. "But I can't tell you how many patents I've had come in and just break down. They can't figure out why it's happening. It's not as simple as what meets the eye."
Bloating is often triggered when people don't get enough water, exercise or soluble fiber, found in food such as chick peas, broccoli or cauliflower. Eating too much and too quickly also creates the uncomfortable feeling of fullness.
Chutkan encourages her patients to pay attention to the feedback from the digestive system, which includes regular stool inspections, especially if doctors are dismissive of their complaints.
If a bowel movement is pale, chalky and takes some effort to produce, "you need to fix that; you need to go eat some kale and lentils," Chutkan said. "It's so important to make the connection between what you're eating and what comes out the other end."
Toney has recently found relief by following the FODMAPs eating plan, which was suggested by her registered dietitian.
FODMAPs, which stands for fermentable oligosaccharides, disaccharides, monosaccharides and polyols, are short-chain carbohydrates that are poorly absorbed in the small intestine and rapidly fermented by bacteria in the gut, said Dr. Max Schmulson, a professor of medicine at National Autonomous University of Mexico (UNAM).
The diet temporarily restricts most dairy, corn syrup, wheat products, certain vegetables and fruit with a high glucose-to-fructose ratio, like apples and dried fruit. The foods are slowly added back in.
After a month on the plan, Toney said, she is off all medication and supplements and feels better than she has in a decade. "Getting rid of the bloating has made me feel like a normal person," she said. "I'm optimistic."
Bloating often occurs when there's too much gas in the intestine. But a host of other contributors also play a role. Here's a closer look:
Gender: Women are more vulnerable to digestive distress, in part because they tend to have longer colons that are tangled up in smaller bodies. This can lead to a lot of looping, crowding, constipation and bloating, said Chutkan, the author of "Gutbliss." "A woman's colon is hairpin turns and switchbacks; men have gentle curves. It's a whole different beast," she said.
Hormones: Women tend to experience more bloating when they first start menstruating and during menopause. Estrogen and progesterone withdrawal may contribute directly or indirectly, but the role of ovarian hormones isn't fully known, said Schmulson, an advisory board member for the International Foundation for Functional Gastrointestinal Disorders. Men have less bloat in part because they have more testosterone, which helps tighten the abdominal wall. "Men have a built-in Spanx situation," Chutkan said. The hormones in birth control pills also can disrupt the delicate balance of bacteria in the GI tract, leading to bloat.
Stress: Meals should be relaxed because stress "increases stomach acid production, causing heartburn and nausea; shunts blood away from the intestine, interfering with digestion and absorption of nutrients; decreases enzyme secretion; slows down stomach emptying; and speeds up colonic contractions," Chutkan wrote in "Gutbliss." This adds up to serious bloating.
Food intolerance: Foods that aren't absorbed by the small intestine end up in the colon, where they interact with bacteria, leading to fermentation, a key player in bloating, Chey said. "Because everyone's bacteria is unique, it's reasonable to think that different combinations of food interact with different types of bacteria that lead to more or less gas production," he said. Chutkan recommends eliminating six bloat-inducing foods: soy, alcohol, dairy, gluten, artificial sweeteners and sugar.
Air: Swallowing air when you eat or talk creates about half the gas in the digestive system. The rest is produced by the bacteria in the gut that helps digest food. "Drinking carbonated beverages, eating too quickly, chewing gum, sucking on hard candy, poorly fitted dentures and smoking all increase the amount of air you swallow," Chey said. Chutkan tells her patients to chew each bite of food at least 20 times. This reduces air and also allows more salivary enzymes to be released to help digestion.
Bacteria: Dysbiosis is a bacterial imbalance and overgrowth of the wrong kinds of bacteria in the gut. Antibiotics, steroids, including creams applied to the skin, and acid-suppressor drugs can all disrupt the delicate balance between so-called good and bad bacteria. Sugar, the preferred food for gas-producing bacteria and undesirable yeast species like Candida, can lead to dysbiosis, Chutkan said. Fermented foods or foods like artichokes, jicama, oats, garlic, leeks, onion and asparagus can help to promote the growth of live bacteria. Certain supplements may also help, but Chutkan cautions against relying on pills, which may not contain enough live bacteria.
Slow transit: If you eat corn on Thursday and don't see it until Saturday, you may not be getting enough water or fiber. Chutkan also recommends checking the medicine cabinet. Narcotic pain killers, antidepressants, vitamins that contain iron, calcium channel blockers and antacids containing aluminum can all slow things down.