1: Why Your Gut Feels Bloated

Episode 1: Why Your Gut Feels Bloated

Dr. Christina Carew, ND, Dr. Dominique Vanier, ND and Dr. Whitney Baxter, ND discuss how common bloating is and how it can stem from many conditions, including non-digestive causes. They emphasize clarifying what patients mean by “bloating,” differentiating subjective bloating from visible abdominal distension, and gathering detailed descriptions (location, hardness, pain, gas, and impact on daily life).

Key assessment questions include timing (morning vs after meals vs later day), duration and onset, recent triggers (illness, travel, pregnancy, antibiotics, crash diets, medications), eating behaviors (speed, talking, gum, carbonated drinks), bowel habits and incomplete evacuation, and gas odor.

They review non-gut contributors such as menstrual cycle issues, endometriosis, PCOS, thyroid dysfunction, pelvic cysts/fibroids, vascular congestion, motility disorders (including GLP-1 medications, diabetes/gastroparesis), gallbladder/liver issues and ascites, and even diaphragm dysfunction. They caution against unguided elimination diets and note red flags warranting evaluation, including bleeding and possible GI, ovarian, or colorectal cancers, previewing future episodes on investigation and what’s normal.

• 00:00:00 Why Bloating Is Common
• 00:22:00 Defining Bloating vs Distension
• 00:03:57  Patient Questions Checklist
• 00:06:58 Constipation and Gas Clues
• 00:07:46 Hormones and Pelvic Causes
• 00:09:57 Other Organs and Medications
• 00:12:32 Food Triggers and Elimination Diets
• 00:16:11 Fiber Nuance and Travel Changes
• 00:18:04 Red Flags and When to Investigate
• 00:19:32 Series Preview and Wrap Up

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Episode 1: Transcript

Team Gut Girls Episode 1: Why Your Gut Feels Bloated Transcript

Welcome to Team Gut Girls, the podcast for anyone who’s ever unbuttoned their jeans at 10am, mapped out every public washroom in a 10 kilometer radius, or wondered why one bite of food can ruin an entire day. We talk about bloating, constipation, diarrhea, reflux, nausea, abdominal pain, histamine chaos, and all quiet gut symptoms you’re told to just live with. Join naturopathic doctors Dr. Whitney Baxter, Dr. Christina Carew, and Dr.

Dominique Vanier. Your gut is talking and we’re here to help you translate. You’re with Teen Gut Girls now. Let’s dig in. And before we dive in, just a quick note. This podcast is for educational and informational purposes only. It’s not meant for medical advice and doesn’t replace working with your own healthcare provider. We’re sharing general information, not diagnosing or treating anyone. Please always talk with your physician or licensed healthcare practitioner prior to making changes to your health medications or supplement.

Hey, guys, did you have any weird bloating cases this week in your clinic? I have odd bloating cases every week in my clinic. Me too. And that’s a maybe a good start, which is there’s bloating is so common and bloating is caused by so many different conditions. Sometimes not even digestive issues can cause abdominal bloating. Yes. Yeah. So I was thinking maybe we start today by just like talking about what is bloating, because certainly if someone’s tuning in today, it’s because they probably are experiencing this themselves.

And I don’t know about you, but I’ve definitely had people say something that they thought was bloating and it wasn’t that at all. And so usually in my practice. Well, maybe I’ll start and then we can go around and just like, how do we talk about it with our patients? So usually I start sort of like mouth all the way down to anus and start asking questions about each sort of area.

And when I get to bloating, usually I’ll ask people, like, if they have. If it feels like they’re distended, like so from, you know, that their belly button down or from their breast down, kind of like give them some orientation, like, what does that feel like for them? Does it feel hard? Does it feel like they have gas inside? Does it get better? Does it get worse? And start asking some questions that.

And for me, the idea of bloating is something that’s from the end of the stomach into the small intestine that’s causing some kind of air or some kind of accumulation. It may also be product accumulation, constipation, but it’s causing someone’s stomach to be distended and often painful. What about you, Dominique? How would you, how would you start asking someone about it? Well, and that’s. That, that is something that I will differentiate because I think the person’s general knowledge about bloating is actually more distension.

So when they say bloating, they’re. They most, they most often actually mean that they’re distended, which is like an increase in girth. So what’s often described as, oh, you know, my stomach is flatter at the beginning of the day, but then by the end of the day it looks like I’m pregnant. And so I will often go into like. Well, bloating is actually a subjective sensation. So you feel like you have a balloon in your stomach.

Distension is where like you’re actually seeing that increase in girth. Like you have to wear your stretchy pants. They often occur together, but they do mean two different things. And so that’s, that’s typically where I am starting. Right. Which is like getting clarity on actually what the definition is or what that sensation is that they’re actually feeling. Yeah, I do the same ask them as. Yeah, we’re going through like top, the bottom.

Okay, so you mentioned bloating. What does that feel like to you? Please describe it. And I’m just, usually I’m typing verbatim and then I’m pulling things out of their description because yeah, like you said, it’s not always that experience expansion. But it feels like they’re puffy or they’re swollen or then they start saying, I’m really uncomfortable. And then I start trying to get a idea of when it starts during the day.

Is it there right when you wake up? Is it expanding throughout the day? Do you start feeling it throughout the day? Do you have to get home and rip off your pants and turn, change it to sweatpants? Like it starts to become like this. Like it’s so ingrained in their day to day and it’s like such an experience that you just don’t stop thinking about if you’re uncomfortable and it’s.

If it’s expanding and painful, uncomfortable. It’s really a good clue to get someone’s description of their bloating. I think sometimes also it depends on where someone is from, like how they describe it. And so lots of times people will say, well, I have all this inflammation, right? That’s like another one that often people will say, or I have way of gas or I have stomach pain. And so I think it’s really important, both as a practitioner but also as a patient, to be as descriptive as possible when you’re talking to someone about how you’re feeling because it gives them more idea of what’s going on.

So maybe we’ll just start with a list of questions that we would ask patients. We’ve talked about some of them already, but just so that if you’re listening to this podcast for the first time and, and you’re experiencing what you believe is bloating. Has anyone asked you any of these questions? And if they haven’t, maybe like start just even thinking about them yourself as is, is some of this relevant to help me to help that practitioner or practitioner and seeing in terms of helping me to get to an end resolution.

So I would say certainly time of day is when we talked about when are you experiencing this sensation? Once we clarify what the sensation is, do you have it as soon as you wake up in the morning? Which might completely tell us something different than something that happens as I’m eating or something that happens after I’m finished eating or something that happens later in the day? Yep. One of the questions I was going to say, one of the questions I asked too is like, it’s important to me to know how long this has been happening for.

Is this like an acute, is this an acute thing? Is it, is it happening with some in somebody that has had long standing digestive issues since they were a kid, for example? Or am I seeing a person who’s in their 50s and 60s who has never had digestive issues before and all of a sudden is having bloating. And how I treat those two people in terms of like workup and testing is going to be different.

And then that bloating isn’t always caused by foods or the gut. There’s all these other components that we have to think about with bloating and we’ll get into this. So a good place to start is, is this happening while you’re eating? Walk me through what eating looks like for you. Are you running around after toddlers? Are you trying to eat during your workday? Are you drinking a lot of like bubbly waters or are you chewing lots of gum throughout the day?

Are you eating while talking? Which I do all the time, but it could be from like eating behaviors and then what we’re eating, the components, the fiber content and then all the way down to like, we get into function of our, of our gut Too, I’d say to build on Dominique’s piece, too. Like, what happened before this started? Like, did you have a pregnancy? Did you have a food poisoning?

Did you have a traveler’s diarrhea? Were you really sick? Did you go through. Are you using medications that might be contributing to the situation? You know, have you done. Have you done some kind of a crash diet? Like, is there anything that sort of started the whole situation from, you know, to take a big budget into that? It’s really sick. They also sometimes can give us some considerations of things that are going on.

Yeah. Which is like, you really identifying, like, was there a massive shift in somebody’s microbiome that kind of like turned the light. The light switch on. Right. Which from an evidence standpoint, we have a lot of research that supports. Right. Like somebody being sick or some sort of gastroenteritis event then leading to a change in somebody’s gut health. Some of the other questions I’ll ask are, do you feel like a complete sense of evacuation when you have a bowel movement?

Right. Which is on the topic of constipation, because some people don’t actually know they’re constipated. And we have an entire episode on that one. But if we’re not having complete evacuation and revivals, where it feels like, you know, I could. I could spend five more minutes in the bathroom, but I have to chase my toddler. Right. Or whatever. Get to work. We’re more likely to have bloating and gas happen throughout the day after that.

I also ask about their gas. Like, when does that happen? Is it really smelly? People always seem like they’re gonna pass out when I ask them, like, about the smell. But I think that’s really helpful. Right. It tells us, you know, something fermenting in there. Or is it sort of just the air passing through that we swallowed because we were eating so quickly? Yes. There are some. Some clues in there.

What about. Let’s talk about some of the things that might not be gut related that could also cause senses of bloating that people should consider. So I would say certainly one of them could be things around menstrual cycle and certainly just different people having different types of menstruation. So endometriosis or pcos, which creates different senses of inflammation and different movement within the intestinal tract. For sure. What else would you guys add in?

Kind of along the lines, with hormones, we can think like the whole endocrine system. So our thyroid hormone, if you have thyroid, like, typically hypothyroid where things are slowed down. Gonna slow down the, like, motility or movement of your digestive tract, possibly leading to that constipation. So more likely to bloat. And then. Yeah, you mentioned endo. And then pelvic ultrasounds can be really indicative to look for, like, cysts or fibroid growth.

And that’s typically bloating. That’s not really changing throughout the. Maybe it’s been getting worse over a period of time. It’s usually not acute or quick in nature. So we’re definitely asking around pelvic health. Yeah, yeah, exactly. Like, to back to the question of what are some of the questions that we ask patients is like, have you had a. Have you had an abdominal pelvic ultrasound? And have you had a transvaginal ultrasound?

Right. So we’re looking both externally and internally to visualize some of those other structures to see is there something going on that feels like abdominal bloating, but it’s not at all. Yeah, And I think it was. One of the things I talked to you guys about a couple weeks ago is like, I have a patient that had pelvic venous congestion, so basically a flattening of some of the arteries and veins that move the blood through the body.

And so she’s getting a lot of increased pressure in the abdomen, which she thought was bloating, and we thought was bloated because she had had Crohn’s disease. So we were like, oh, yeah, of course you’ve got problems. You’ve had Crohn’s disease. And it wasn’t that at all. It was actually that her. Her body was accumulating all this fluid just in that area. And so that’s just like another piece of the puzzle is like, oh, it’s maybe not always on the inside as much as we think that it is.

What about other organs that we see that can add to. Add to bloating sensation in the intestines? So I was thinking about motility issues. Could be one. So if the stomach is empty, delays with people who were using the tirzepatides, and we’re seeing a lot less emptying in the system, and that’s certainly causing some senses of, like, fullness and bloating. Medication induced. Yeah, like, when we talk about, you know, diabetes, possibly poorly controlled diabetes, and that affecting the motility, we can see, you know, gastroparesis is the.

Is the medical term. And that can. And that can overlap with some other conditions, too. And so. And so the patient may not even maybe realize that, like, Their sugars are not well controlled, but they’re presenting with abdominal concerns. Certain gallbladders that have been removed. Yeah, that really changes the cadence of both the breakdown of some of our food and our movement of food. Yeah. Which is pretty common.

And then the liver too. If there’s anything going on in the liver, it can just cause. It’s called ascites, but flu, fluid accumulation. So that’s where like with all of these things. But we’ll be doing an abdominal exam, most likely running some blood work and then assessing you and like, where does it hurt? Show me where you feel the bloating. What does this look like to kind of get a better picture?

Yeah, yeah. The gallbladder is interesting. Like, I’ve actually had a few cases where it presented like ibs, but it was actually a gallbladder pathology where they’ve ended up having to get their gallbladder removed at a later. At a later time. So, like that abdominal ultrasound, you know, it can really give somebody or a practitioner and a patient, like, a lot of information when actually their case is presenting a little bit differently.

But I’ve also had patients where it’s like a functional gallbladder issue. So biliary dyskinesia. And again, like, we’ve kind of got more IBS like symptoms like bloating, you know, reactions to food. So the gallbladder and the liver, they. They both play big roles and in how our digestion functions. I have a woman who has a diaphragm issue, actually. So her diaphragm actually doesn’t move very easily. And so it gets stuck in a position which also creates a lot of the bloating and heartburn.

So she gets a lot of heartburn sensation as well. And so once that started to move more freely than all the other gastro type symptoms. So just people thinking that, you know, it’s not. Not always super clear. Bloating isn’t necessarily just one reason. Maybe we talk a little bit more about food because certainly food is a big one that people hone in on. It feels like something that they can control and feels like something that maybe is directly related as people are trying to document, like, when am I bloating?

What is it that I eat? And I would say commonly, one of the things I’ll see when people come in and they’re having any kind of that issue in particular bloating as well, is that they’ll have removed a whole bunch of foods from their diet in. In an effort to think it is one or More foods that may be causing the bloating. Do you see that all the time?

Yeah, yeah. There definitely has been some investigative work. Usually when, like, that someone has done before, they come into my office, and sometimes it’s misguided and sometimes not. But I think one of the main patterns that I see more for functional digestive conditions is, like, somebody can react to one food one day, and the next day they’ll have the same food, same kind of eating environment, and there’s no issues.

And so there’s this lack of predictability, which is. Can be really confusing and frustrating for people. Yeah, absolutely. Also, just going down, like, the path of elimination is overwhelming. It’s restrictive. We’re risking those nutrient deficiencies. We’re risking disordered eating behaviors. Even if you don’t even notice that that’s what’s going on. There’s been a lot of research into elimination diets because there is a ton of research around, like, the low fodmap diet for irritable bowel syndrome and like, folks with visceral hypersensitivity or, like, increased sensitivity to pain, like normal digestion function.

But these. These diets have a place where it’s like, more of a trial, but it really needs to be guided. So you need to be working with a dietitian or a naturopathic doctor or some practitioner that’s like, working you through it systematically so you can really pinp what exactly is triggering you or. Or if that’s the issue at all. And say another piece too is. And. And we have an episode coming up on this.

Celiac and non gluten sensitivity is that often people will say, well, I was tested. I was tested for celiac, but maybe they’re being tested during this period where they’ve eliminated all of these foods. Or the practitioner who’s looked at. I have a child that came in a couple weeks ago, and her. She was on a medication to lower her immune system. So she’s already having sort of a suppressed immune system.

And the gluten sensitivity test came back. In the test that she had done, the high was 15, and she was 14. And the practitioner that saw her told her, well, then she didn’t. And so I was like, to the family, I was like, oh, most of my patients that you have this test, it’s either zero or there’s something on the test. And so the fact that it was so close, like, it’s not school where, like, 50 is the past and 49 is not that.

It probably that in combination with the medication, like, that gluten was probably not the best thing person at that point in time. Right. It doesn’t mean forever. It just means, like, currently, you know, maybe they are or not celiac, but they’re definitely sensitive to gluten in some way because their task was so high. And so I think sometimes people come in and they’ve done a test, but they’ve done a test after they’ve already eliminated the thing that is potentially the problem probably.

I think that also with like, sugar, people take out sugar and then they’re like, oh, I ate something and then I got all this bloating again. Right? Yeah. Oh, yeah. That’s a common. Actually we can probably do a whole episode on why that happened. I think the conversation just about. About food and about fiber is important too, because the types of like, fiber is quite, I guess we’ll say, like a nuanced subject, which is like insoluble versus solub versus viscosity.

There are a lot of factors that go into whether somebody is sensitive to fiber or not. There’s a lot of information online saying just take out fiber and eat more of a meat diet to get rid of your digestive symptoms. And, you know, not to go down that rabbit hole. But like, that’s. That’s not exactly the best advice. But. But fiber in itself, it’s, you know, when are we having it?

Are we spreading it out through the day? Are we fiber loading or fiber dumping and then not having it later in the day? Are we having too much that maybe our system is sensitive to at one point in time? So. So on the, you know, the topic of food is like just basically looking even at fiber and what kinds of fiber somebody’s having can be helpful for their bloating.

Or did you get back from a trip and you didn’t eat much fiber while you were away, and then you get home back to your regular diet, and then boom, your microbiome’s having a party and you’re really bloated and uncomfortable. That could be so. Bloating is so funny because that can be totally normal, but freaky and uncomfortable. So we’re trying to uncover that piece too. And certainly there’s other conditions kind of on the idea of like coming back from vacation that may be contributing to temporary bloating or medications that we started or introduced because of having heartburn when I was on vacation or having, you know, an inflammation or I got hives when I was on.

On vacation, that certainly can contribute to the impact of the digestive system, you know, stomach Acid, H. Pylori. All kinds of different things that maybe people either got treated or got diagnosed with maybe just experiencing with aging. And I guess there’s one category we haven’t talked about at all, which would be red flags around bloating or things that maybe cause us to consider that there might be something that is more pathogenic that’s going on.

It could be, you know, indications of bleeding or stomach cancers or ovarian cancers. And so certainly one of the reasons why, if you are having bloating, that it’s really important to talk to someone about it is that some of those things could be going on and we would not want you to just, you know, only your head or something that you’re eating and you’re not getting evaluated for those things.

Oh, yeah, go ahead. Oh, I was. I was going to say, like, that the red flags that you spoke to important and like something that is always in the back of my mind is, is, you know, early onset colorectal cancer statistics. Right. Which have changed so significantly in the last decade. So bloating is not something that, you know, we want to kind of just brush off, like, well, this is just your digestion reacting.

Right. We really want to make sure that we’re taking a very thorough investigative approach to feeling really confident about what the cause is. And then we have external things that could be going on, so exposures, environmental exposures, reactions to the body, and maybe even an unknown pregnancy. But we really wanted pregnancy, but feels like pregnancy. Yeah, yeah. And what we really wanted to let people know is that the next, I believe we have 20 episodes at least, that we have planned out.

We’re going to talk about all these various reasons around bloating and how do you investigate them and how do you ask your practitioners about them and what might be key signs and similar. Probably your experience as a listener is going to be like. Our experience in medical school is whenever you learn about something you think you haven’t, because it sounds like everything, like a horoscope, everything sounds like it’s the moment in time.

And as much as it is good to bring in information and go through assessments on your own, like all practitioners see other practitioners, we are not trying to diagnose and treat ourselves, and we don’t want you to do that either. But we do want you to feel more informed and have more information, and we’ll even talk about what is normal bloating. So we have lots of episodes coming up.

We’re really excited. Anything else you guys want to add in bloating is a good example of the Dunning Kruger effect, which is like what you just mentioned there. So you feel like, you know, a lot of bloating coming out. And I think this is for pretty much all practitioners that may. May be like, exposed to bloating when they first kind of start in practice. But then. Then you realize that bloating is multifaceted and you feel like you don’t know a lot.

And then I feel like all of us, you know, have been practiced for, what, close to 10 years or more, and we know a lot more about bloating now. Yeah. And the guidelines are better than they were before. And, like, we’re just learning so much more about the microbiome and the gut and disorders of gut brain interaction, which we’ll dive into. So it’s more exciting for us. We love the gut.

Well, thanks for tuning in. We’re excited to share with you everything that we have learned and know. We teach each other every day. And also, if you have questions or you’re reading about things that you do want us to cover, by all means. There’s a spot on our website where you can send in your questions and we’ll include those in future discussions.