Bloating: Potential Causes and Treatments + a Book Giveaway!

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I thought I would talk about bloating today. Does that sound like a good plan?
Abdominal bloating is a common clinical problem, and I would say, it is one of the most bothersome symptom in individuals with IBS.
What contributes to bloating?  “Four factors are involved in the pathophysiology of bloating: a subjective sensation of abdominal bloating, objective abdominal distention, volume of intra-abdominal contents, and muscular activity of the abdominal wall.”  Reference
Bloating, like IBS, can occur by a combination of different mechanisms, depending on the individual; therefore, treatment for bloating is individualized. It is important to note that everyone experiences bloating from time to time. Slight bloating, without pain, after eating a large meal or one with a higher fat or fiber content is normal. Bloating, however, can be significant, associated with pain and may be helped with the following tips outlined in this post. As always, discuss your symptoms and treatment options with your healthcare provider first; do not self diagnose!
For this post, I interviewed two colleagues to gain their perspectives and experiences working with individuals with bloating,  Mark Pimentel, MD and Tamara Duker Freuman, MS, RD.
Tamara, wrote the book, The Bloated Belly Whisperer…and I will be doing a giveaway for this today, here on the blog! Details later in the post.
First up, I interview my dietitian colleague, Tamara Duker Freuman.
Kate: What is bloating?
Tamara: Bloating refers to either a visibly distended abdomen relative to a flatter “baseline” state, a feeling of internal pressure or discomfort just short of overt pain– or a combination of the two.  Bloating is a symptom, not a diagnosis.
Kate: I find bloating is a common and troubling symptom in individuals with IBS in my clinical practice, do you experience the same in your practice?
Tamara: Yes– absolutely.  Because one definition of bloating– the feeling of internal pressure/discomfort– is a subjective one, you will often see it in people with IBS who have visceral hypersensitivity— which, as you know, means having a heightened nerve response to a given amount of stimulus compared to people without IBS.  So let’s say that you have IBS and I don’t, and we both have the same amount of air pumped into our lower intestines.  I might not feel a thing until, say, 200 cc of air is pumped in, whereas you will feel really uncomfortable internal pressure after just 100cc of air is inserted.  The same can be said for a given amount of stool.  If I miss a day of pooping and an extra day’s worth of stool builds up in my colon as a result, I’m unlikely to even notice it.  Many of our IBS patients, however, are unbearably uncomfortable and bloated all day long if they don’t move their bowels well in the morning, because their visceral nerves are hypersensitive to the internal distention associated with that higher stool burden.
Another reason IBS patients often experience bloating may have to do with abnormal bowel motility patterns that allow even normal amounts of intestinal gas to “pool” in various locations throughout the intestines rather than being evenly distributed as moving along at a regular pace.  These larger pools of gas can create higher levels of intra-bowel tension along the way that people may experience as a ‘bloating’ sensation.  Interestingly, research suggests that people with IBS don’t necessarily have MORE gas than the average person– they’re just more attuned to the sensations associated with that internal gas pressure.
Kate: What are some conditions that prompt bloating?
Tamara: I find it helpful to break down possible causes between those primarily originating in the stomach and those originating in the intestines.  In the stomach, bloating is commonly caused by abnormally slow stomach emptying (called gastroparesis), acid indigestion, swallowing excess air (aerophagia) or a condition called Functional Dyspepsia, which is sort of like IBS of the upper stomach– visceral hypersensitivity in the stomach’s nerves related to stretching when food, liquid or gas fills it. With FD, there may also be a component of impaired ability of the stomach to stretch, meaning that people feel uncomfortably full very quickly, often after eating just a small amount.
Bloating that originates in the intestines is typically caused by gas or poop, so you’re looking at scenarios that either introduce excess gas in the bowel or those that prevent adequate defecation.  Constipation is the most common one I encounter.  Often it can be tricky to identify and treat, as many people who are able to move their bowels daily can still find themselves full of stool and bloated as a result. When defecation is incomplete– often a result of pelvic floor muscle dysfunction– this can happen.  Other conditions are dietary– poor digestion/absorption of certain carbohydrates that we all know as “FODMAPs” can create excess intestinal gas that some people experience as bloating.  One reason people can experience particularly bad bloating when consuming high FODMAP foods is when they have a condition called “Small Intestinal Bacterial Overgrowth,” or SIBO. Having too many of your mouth’s or colon’s normal flora living in the small intestines can provoke terrible bloating within 15-60 minutes of consuming certain types of carbohydrates.
There are others as well– but these are the most common.  And notice that “gluten intolerance” was not listed among them!  Contrary to popular belief, gluten intolerance is rarely the cause of bloating–though other high FODMAP components of gluten-containing foods can be.
Kate: Can you describe abdominophrenic dyssynergia (APD)?
Tamara: APD is an emerging diagnosis that describes a particular dysfunction of the nerves controlling involuntary abdominal muscle reflexes which results in a very exaggerated, almost ‘pregnant’ looking belly after eating or drinking even tiny amounts– including just water!  (If you’ve ever spent anytime on instagram following the hashtag #bloating and have come across the pre-meal and post-meal bloated belly selfies posted by otherwise small-framed, fit young women, you’ll have seen many examples of what it looks like.)
There are two things going awry in APD that cause the signature, very distended appearance. For starters, the diaphragm– a muscle that lays above the stomach and separates the abdominal cavity from the lung area– is SUPPOSED to relax and lift UP when you start eating and your belly starts filling with food, basically to make more room in the abdominal cavity for your growing stomach.  But in APD, the exact opposite happens: it contracts, pushing DOWN into the abdominal cavity, leaving less room within the abdominal cavity just as it is stretching and filling up.  At the same time, another nerve signal is misfiring.  The nerves that control the internal obliques start to relax and the abdominal wall muscles fail to maintain their tone.  This means that the muscles which typically stay contracted enough to hold your innards in are relaxing to a hugely exaggerated degree– behaving as if you’ve eaten a giant Thanksgiving dinner when in fact you’ve just had a few swallows of water.  The combination of these two factors–a stomach with less room to grow inside the abdominal cavity, plus the abdominal wall’s complete laxity in response to the internal push of a growing stomach– results in that very ‘pregnant’ appearance.
Notably, the bloat from APD typically recedes within a couple of hours– basically, once the stomach is empty again–assuming you don’t eat again. So people with this condition will bloat and flatten, bloat and flatten, bloat and flatten many times over the course of a day.  APD also doesn’t affect your appetite at all and it isn’t painful. 
[Note: biofeedback and physical therapy may help with this condition.]
Kate: What diet and/or supplements can be helpful for bloating?  Are there different remedies depending on the underlying cause of bloating?
Tamara: Diets and supplements need to be tailored to the cause of your bloating, and there is no one single diet that will help everyone who struggles with this symptom– nor is there a single supplement protocol, either.
I’d say that the two most common dietary patterns I use to help patients manage bloating are versions of a lower FODMAP diet, and what I call the “GI Gentle” diet, which is a soft-textured, lower fat diet meant to help food empty the stomach more quickly without producing too much distention in the GI tract.  These are the two main diets I discuss in my book, and often I will combine them.  I say ‘versions’ of the low FODMAP diet, because many people who suffer from bloating due to intestinal gas are not necessarily reacting to every single food that’s a FODMAP (unless they have SIBO, but that is treatable…).  So, some people may need to avoid foods high in fructose and polyols to manage their bloating, but they can handle foods that contain other FODMAPs– whereas other people can handle foods with galactooligosaccharides (GOS) as long as they take a proper enzyme supplement with them, but need to avoid foods high in fructans.  It’s so important to take the time to understand the nature of your problem, experiment with relevant, tailored dietary solutions, and then move forward with the most liberal diet you can comfortably tolerate.
I see too many people adopt these incredibly restrictive elimination diet protocols, achieve symptom relief, but then find themselves stuck eating almost nothing without having any insight as to which food(s) they eliminated were actually causing them trouble.
[Note: if you find your diet is very limited, seek guidance from a dietitian to help reintroduce foods and maximize your nutrition.]
As for supplements– again, I’m looking for products that address the underlying cause of the problem.  My constipated patients often respond very well to magnesium–which may sometimes can be layered with other supplements that work in complementary ways to address constipation, like senna tea. Digestive enzymes–like lactase or alpha galactosidase– may help with excess gas or symptoms caused by carbohydrate intolerances to lactose or GOS, respectively.  Enteric coated peppermint oil can help people with IBS who experience bloating due to visceral hypersensitivity to any/all things that (over)stimulate their GI tract– from large meals or gas to the stool they have yet to pass.  FDGard (peppermint oil and caraway seed oil) or Iberogast  can sometimes be helpful for people with Functional Dyspepsia.  Simethicone (Gas X or Phazyme) can help alleviate bloating from gas pressure, whereas chewable calcium carbonate (TUMS) is often helpful for people with bloating from mild acid indigestion.  These represent the vast majority of supplements or OTC remedies in my toolkit for bloating.  As you can see, there is not a probiotic on this list, which surprises many people.  But it’s true; I haven’t found any probiotics to be a silver bullet for bloating, and I’m increasingly concerned that superfluous probiotic use in the patients I see–with motility problems or on acid suppressing medications– may actually contribute to the risk of them developing SIBO.

Next up, Mark Pimentel, MD from Cedars-Sinai, MAST program, weighs in on bloating too.

Kate: How does SIBO contribute to the symptom of bloating?

Dr. Pimentel: The main source of gas in the intestinal tract is the gut microbiome. As such an expanded microbiome as is seen in SIBO would have a greater fermentation potential. More importantly, excessive bacteria in the small bowel mean that these bacteria receive fresh food that is easier and quicker to ferment than the left overs that would be found in the colon. More gas=more bloating.

Kate: Is hydrogen or methane + SIBO more likely to contribute to bloating—or do you see bloating in both?

Dr. Pimentel: This is complicated. We think methane is worse for bloating. Methane slows the gut down so any gas produced tends not to be expelled as easily. Therefore, patients with methane have more gas retention and therefore more bloating.

Kate: In your clinical practice, what are the main causes of bloating?

Dr. Pimentel: Absolutely the main cause of bloating is SIBO.

I like this overview article here that outlines a few additional tips to manage bloating: such as gentle exercise (walking), certain yoga poses (hello, child’s pose!), warm tub, abdominal massage, to name a few.

A big thanks to Tamara Duker Freuman and Mark Pimentel, MD for sharing their expertise and insights on bloating.

For a chance to win, Tamara’s book, leave a comment about what other gut health topics you would like me to cover in an upcoming blog post.

Winner will be selected May 8, 2019.

 

84 replies on “Bloating: Potential Causes and Treatments + a Book Giveaway!“

  • Ann

    I found the comment about probiotics very interesting! Prebiotics seem to be a completely different story, however, and of great help. Is that correct?

    • Cassie

      I have painful bloating every day. I’d like more information on possible help. The low FODMAP diet hasn’t helped. I’m very interested in reading the book.

    • S.

      I personally have noted a improvement in my digestive issues ,my personal Gastrointestinal PA suggested
      Dropping the probiotic tablets I was taking…to my suprise ..but…instead I have a delicious bowl of
      Lactose Free Yogurt ,plus some low fat mixed together with homemade granola and a small portion
      Of fruit.
      Yin Yoga which works the muscles, bones, fibers ,tissues also improves body discomforts ..try it you will like it.
      Thanks for sharing,

  • Maria Bricknell

    That was very interesting. I would appreciate more information on probiotic use as well as information on vitamins for those with recurrent SIBO issues. Thank you.

  • Sarah R

    Excellent article, very informative and reassuring as someone who deals with this daily. I’d love an article about anxiety and IBS. Also like the other commenters mentions I’d be curious if there’s vitamins I may be missing out on with IBS-d. Thanks!!

  • Junie

    I would like more advice on diet.
    Having Ibs and being vegetarian and not being able to tolerate a lot of veggie alternatives . My diet is really bad.

    Would love to win the book

  • Cathy Karp

    Thanks for the great column, Kate! What is the recommended dosage of magnesium?
    Would love to win the book and learn more!
    –Cathy

    • Cathy Spinazola

      Great info and there are so many forms of magnesium. Any advice of which form is best?

  • Line Dallaire

    Great story! (May 1 st 2019)….
    I would love to hear from you on a next article of yours… topic: Which pro and pre biotic are best for IBS sufferers like myself…and what should I include (supplements) since I am in my menopause since 2 years…. I find my symptoms have worsen since then.

    Would love that book 🙂
    Thanks Kate.

  • Jackie

    Thanks for sharing! I suffer from bloating due to colonic inertia, ibs-c, Slow transit constipation. It’s so painful. I also find myself very restrictive with my diet. I would more information on constipation. Thanks!

  • Huda

    I also would like more info on SIBO. I have gastroparies and have frequent boughts with SIBO which causes terrible bloating.

  • Teri Luehrs

    Great information ! I just appreciate all the hard work going into these issues that normally do not get discussed or ignored. This is very helpful!

  • Gunnel Chadwick

    Great information, thanks! Since a keto type diet is so popular, I wonder if that is not helpful with IBS since the diet is high in fat? Also, how is IBS impacted by my not having a gallbladder??

  • Anne

    Thank you for sharing more great information. I was diagnosed with IBS 25+ years ago and my symptoms have changed with each 5-10 years of aging. Most recently my symptoms included significant bloating with lots of gas within 15-20 minutes of a meal along with frequent urgency for bowel movements that were seldom complete. Two months ago I adopted a low FODMAP diet which has resulted in a significant reduction in bloating, but I still experience lots of gas shortly after a meal as well as slow motility with digestion and incomplete emptying of my colon. My recent Hydrogen Breath Test proved negative for SIBO, so I’d like to explore supplement options. I also eliminated my Probiotic about 4 weeks ago and aside from the gas build-up and incomplete emptying of my colon, I have felt better. In addition to my consults with my GI physician and my Nutritionist, I routinely look to your column for support and recommendations as I continue my journey for eliminating symptoms of IBS and living a more “normal” life with more travel, social activities and less stress. Thank you! Thank you!

  • Carol Perecman

    This book sounds very interesting. Thanks so much for addressing bloating, which is so uncomfortable and not often addressed.

  • Alice

    Absolutely the most informative article/post about bloating and IBS. Will definitely be purchasing this book. Thank you for this great info!

  • Beth E.

    As one who suffers from bloating often, this is really helpful, and I’d love to read the book. I would like to read more about slow motility, particularly when following a high fiber diet.

  • Rachel F

    Thank you for this blog on bloating. I have SIBO and I am desperately trying to figure out ways to add more nutrition to my diet and eat properly for less digestion discomfort. I love recipes and any articles related on this subject. Would love to have a copy of the book!

  • Angie Scarlato

    Interesting read! Can you talk about what you should do if you suffer from severe gas and bloating, but have had every test imaginable done with the only diagnosis of IBS? I’ve tried low FODMAP, currently trying a SIBO diet with herbal antibiotics…

  • Kate Treasure

    Very good information. I have continual bloating that does get worse after a meal. I take Natural Calm as a magnesium supplement 2x a day. I try to avoid fructans, especially onions and garlic and I take Gas-X at meals. In spite of this I continue to have bloating. I have a very slow gut and constipation also very hard stools as a result. The information provided in your article gave me some other reasons for this issue. Thank you!

  • Susan

    Hi Kate,

    I was diagnosed with IBS and SIBO several years ago when my symptoms increased significantly. I had two hydrogen/methane breath tests, both returning positive for IBS and SIBO, along with several other standard tests. I tried multiple remedies with regard to dietary changes as well as 3 rounds of xifaxan which gave little relief to my symptoms of bloating, abdominal pain and irregular bowel habits. I followed the lowfodmap diet with some moderate success; however, I was never very successful with the reintroducing phase. One day I was speaking with a Naturopath at a local Pharmaca who discussed the benefits of celery juice. I did some research, spoke with my gastroenterologist and started drinking 16 ounces of organic celery juice which I made every morning before eating and/or drinking anything, waiting about 30 minutes before consuming any food. Fairly quickly I noticed improvement in my symptoms. I have continued this daily practice for the past two years and without question many symptoms have been minimized and/or alleviated. The best news is that my episodes are fewer, do not last nearly as long and are not as intense as they once were. I still try to eat small meals several times a day and often successfully eat foods that are not on the low fodmap diet. The research validates the benefits of celery juice and while my GI knew nothing about these he was comfortable with adding the morning juice to my diet. It has made such a significant difference.

    Thank you for letting me share my story.

  • Sharon Kang

    I recently discussed FODMAPS with my Cell Biology teacher. It seems strange to both of us that even a monomer like monosaccharides cannot be digested. (Boy, can I vouch for the fact the my body cannot digest them!) He wondered if it has something to do with a Na+ imbalance within the intestines and more specifically a problem with Na+ transport pumps/system. Has any research been done on this?

    • katescarlata

      I am not sure if research has been done on that specifically. There are many factors that impact monosaccharide malabsorption– from FODMAP perspective– excess fructose is commonly malabsorbed–occurs in 1 in 3 people. Not all become symptomatic–so the role of visceral hypersensitivity in IBS seems to be key. Monosaccharides can come in contact with microbes before digestion –contributing to intolerance too. So role of gut microbiota is another factor to consider. Inflammation in the small bowel or fast transit time–are other factors that impact digestion—or potential malabsorption of monosaccharides.

  • Katie Grzyb

    I would love more advice on how to truly understand the ‘diet’ you should be on. I have SIBO and fecal loading. I feel better on the FODMAP diet, but haven’t truly reintroduced everything back in after discovering a few of my heaviest hitters (garlic and onion). It’s hard to balance life and reintroducing – what has been successful for people?

  • Sharon Kang

    I discussed FODMAPS with my Cell Biology instructor. We both find it strange that even a monomer (monosaccharides) cannot be digested. (I can vouch for its indigestibility and subsequent bloating.) He wondered if it has to do with a Na+ imbalance in the intestinal tract due to a transport problem; specifically the Na+ pumps. Has any research been done on this?

  • Sara

    I would like to know more about magnesium supplement expecially for those who suffer of ibs. Is it ok for their gut? Thank’s

  • Debbie Gertner

    Hi Kate! I’d like more information on how other conditions effect the management of IBS or GI symptoms. Like the added impact of slow gastric emptying, celiac, and dysfunction deification, pelvic floor issues effect a persons food choices and physical as well as mental lifestyle. I’d love the opportunity to wind this book! Thank you!

  • Mary Kate

    Interesting read. I suffer from mild symptoms discussed here and have other medical conditions that contribute to them, but I also cook for several families where one or more member(s) very restricted diets. I generally stick with low FODMAP ingredients, and try to get creative, but it would be great to learn more and find more ideas to try for these folks. It’s often a nice change for me to prepare meals that are different than the rut they have gotten into, but I feel like I’m in a rut sometimes too. I would love to learn how to better serve my clients!

  • Dima Sbenaty

    Thank you so much for this valuable information!

    It is really hard for me to explain to even the closest people to me what exactly I experience and why. My dad thinks that I have become so picky with what foods I eat or don’t eat and the timing of my meals to where I have actually CAUSED the sensitivities and imbalances and feed into them more. He usually likes to have dinner around 8 or 9pm, and he gets upset with me if he invites me for dinner and I tell him that it is way too late for me to eat a large meal, or that I can’t eat this or that.

    Yesterday I experienced the most awful bloating and pain, to the point I had to stay home from work. My husband is ‘tired’ of me not fixing my problem. Little does he know that I have been trying to figure out what works for me for many years. After seeing dozens of specialists that tell me I am not gluten intolerant and to just keep a food diary and play it by ear, I got my masters in microbiology and immunology so that I can figure out what is actually going on and I am still on that quest. Low FODMAP and this blog REALLY HELPED ME A LOT! I think we all are trying to understand more about what and why the body responds the way it does, and many factors contribute to that. I just wish I had a better way of explaining it to the ones around me. I think I am perceived as a princess by most: has to sleep 8 hours, must eat specific things at specific times, MUST go to yoga, must take frequent walks.

    I am curious about how people best explain their symptoms and issues in a social setting.

    • katescarlata

      Thanks Dima, for sharing your experience. Like so much in life-we often have no clue how impactful something may be until we go through it ourselves. Sometimes even those that love us the most–simply don’t understand. I am glad you are on mission to learn more! And I am also glad my blog has supported you on your journey.

  • Holly Moyer

    Interesting! I would like to learn more about SIBO. It seems to have symptoms relating to IBS and would be good to learn more. Thanks for all the info!

  • Dana

    I would love to read more about bloating, what determines “normal” vs hypersensitive, and more about the different digestive enzymes and supplements mentioned! Also I’ve heard the relation between gut and brain, and would be interested in the role of depression in gut health (or anti depressant medication?). Is it a “chicken or egg” situation?
    Can’t wait to check out the new book!

  • Mary

    Thank you for the article. I would like to learn more about pelvic floor muscle dysfunction.

  • Jan

    Thanks for the great information! I learned a lot and would like to continue learning more about hypersensitivity.

  • Lolli Gonzalez

    Hi Kate! I would like to see you cover how to effectively combine a low carbohydrate diet (essential for pre-diabetics and diabetics) with a low FODMAP diet.
    Thanks !

    • Junie

      Me too, I can not find any combined diets.
      IBS , cholesterol and I am vegetarian.

      Working out how to combine diets would be a great help.

  • Melanie B.

    Thanks for great info. I have IBS (mostly -C) and reflux. Occasional bouts of gastritis… Stress goes right to the GI tract!! Even with treatment, the reflux is irritating. The Low FODMAP diet has helped quite a bit, probably with both. I am going to back up Holly’s and Mary’s suggestions just above. I am wondering what exercises, if any, can help the pelvic floor issue. (Kegels, maybe?)

  • Mary Ibarrola

    I am thrilled to find the low FODMAP diet, it has helped enormously. I am, however, still on acid suppression which I think contributes to the bloating problem and the imbalance in the intestines. Psyllium husk fiber has been very helpful for the chronic constipation.

  • Jackie

    Hi Kate,
    Love all of the topics you cover but would be interested in something on benefits of digestive enzyme?
    I borrowed this book from the library and would love to win a copy as I did t get a chance to finish it..

  • Dana

    I’d love to learn more about digestive enzymes! Also the gut brain connection as it relates to bloating. Would antidepressants or other “brain/mental” interventions help?!

  • Julie Kim

    Thanks Kate for all your amazing articles. I would also like to learn more about how pelvic floor dysfunction can affect bloating. I’ve been treated by a pelvic floor physio for hip pain after my daughter was born via forcep delivery. For a year I was diagnosed with bursitis until finally I was referred to a pelvic Physio who cured my hip pain. Maybe my pelvic floor dysfunction is causing some of the bloating I experience.

  • Natalie

    Thank you for this very interesting blog. I am interested to know more about acid reducing medications in relation to SIBO, C-diff, probiotics, as these problems are on the rise and are concerning. I feel the medical community needs to be informed and take more precautionary measures as well as treating the cause of IBS rather than the symptoms. Thank you for making me feel that I am not alone and that there are answers out there!!

  • Kelly Peterson

    I also am interested in how to use digestive enzymes and when they would be most useful to prescribe. I have many patients who suffer from various GI issues and the pharmaceuticals seems to compound their problems even more. Thanks!

  • PAULA Jacunski

    I would like to see you cover APD in more depth. This is the first I’v heard of it. I had a scan for abdominal pain a few years ago, and the report said my diaphragm was pushing on my intestines, and my doc had no clue what that was about and didn’t seem concerned. I’ll order this book today, so take my name out of the pool.

  • Meghan Cabral

    I would love any additional information on how to cure and reduce sibo. I’ve tried 2 rounds of medication and that did not work.

  • Carolyn Simmons

    Slow motility is my concern. I take a prescription medicine to empty my bowels. I would like to learn if a certain diet would help.

  • Nan

    Wonderful information. I would like to know more about how exercise can help. I find yoga helpful for digestion but would love more information on how it all works.

  • Karen Scott

    Thanks Kate for your important work and support regarding gut health! And thanks to all those who responded- though I don’t wish anyone discomfort, it’s somehow comforting to know I’m not alone. I would like to better understand possible causes of pain in the stomach, liver region almost immediately after eating & possible remedies. (Perhaps too specific but it’s annoying)
    Take care everyone.

  • Jo

    I would love more information on treating chronic severe constipation with sibo and having a rectocele. Hydrogen sulfide sibo and gene mutations would be great too! Thanks for the post and information.

  • Nicole M

    This was a GREAT interview! As an RD who works with digestive issues I found this information to be really clear and insightful. I’d love to read her book 🙂

  • Leah

    I find all your information very helpful. I am an example of someone who has done the Low FodMap diet and couldn’t get past the elimination phase. After 6 years I am trying to be more of a flexatarian but still suffer. Have been diagnosed with IBS, SIBO, diverticulitis and have twice had exploratory surgery- had resection of small intestine and next gall bladder removed. I am a kidney transplant patient on heavy meds which also contribute. So I would like to hear about some of everything and also how to cope in social situations.
    Thank you for all your help always.

  • Annie

    Love this forum for sharing information related to IBS, SIBO, and other digestive issues… Thank you! I’ve suffered with IBS for 25+ years and my symptoms and coping strategies have changed about every 5 years as I’ve aged. I have only been introduced to the FODMAP diet within the last 2 months and it has brought me so much relief with regards to bloating and overall “sick” feeling after eating. I still struggle with slow motility, elimination and gas, so I’m always looking for information on how to resolve or cope with these symptoms as they still limit my ability to easily travel and commit to social events. I recently had and abdominal CT scan the breath test for SIBO but all came back negative. I find everyone’s stories extremely helpful, and I would be interested in learning more about APD and supplements. The book looks very interesting. Thank you!

  • Gae

    Kate, thanks for this article (and your blog and website). The low FODMAP diet has helped with my IBS symptoms but I still have bloating. I will be tested for SIBO next. I would also love to learn more about probiotics and digestive enzymes.

  • Sara

    Thank you so much. I would like to know more about magnesium supplement, expecially for those euro ibs-C.

  • Erin

    I have Crohn’s disease and chronic SIBO due to a surgery that removed the ileocecal valve. Low fod map is so so restrictive and hard to follow, and honestly didn’t really help me much. I’d love more on SIBO.

  • Gae

    Kate, thanks for this article and for your website and blog. I learn so much from you. I have been on the low FODMAP diet for a few months but am still having bloating. So, I would like to see more about SIBO. I’d also like to learn more about probiotics and digestive enzymes.

  • michele

    I echo many of the above posts. I would love to learn more about SIBO and also how to combine diets for IBS-C, cholesterol, vegetarian, and low carb. I know it is a lot to ask, but it would be much appreciated. Thanks!

  • Dee

    Hi Kate,
    Another great topic … thank you! I would like to know more about which specific lactase enzyme brands to take for lactose intolerant folks that you would recommend that are all natural with no fillers.
    Thank you!
    Dee

  • Wendy White

    Hi Kate
    I was so excited to read your explanations on the gut. I have tested positive for SIBO but do date have found NO HELP.
    In addition, I have Multiple Sclerosis and am paralyzed from the waist down. My husband and I are eating Dr Terry Wahl’s paleo protocol. He is doing great but me, no so. I remain bloated ++ and it is difficult to distinguish the gas pressure from needing a bowel movement.
    It would be good to additionally speak to those of us with neurological diseases who are unable to walk, do yoga or get into a warm tub. I am extremely interested in remedies you suggest that will help me. Thank you.

    • katescarlata

      Thanks Wendy for providing your perspective- and I need to come up with other ideas for those with neurological limitations. I wonder if adding a prokinectic drug such as prucalopride would be helpful for you?

  • Jenni Robinson

    This book sounds great! Thank you for the information shared here today as well. I would be interested in how to find a GI doctor who is willing to not blow you off as “it’s just IBS” or stress. When I get in their office I realize they’re inundated with patients with probably far worse life threatening problems than mine! Also, any researched correlations with IBS and vaginal issues?

  • michelle marrone

    This was a very informative interview. I would like to know more about and visceral hypersensitivity & Functional Dyspepsia. I was able to put my IBS in remission once from following your 1st book. I felt normal and healthy and my clothes fit all the time. I am having a hard time getting back to that comfortable place :(. Thank you for keeping this community updated with new information all the time.

    xoxoxoxo
    Michelle

  • Kaitlynn R

    Hi, thank you for the article, this was very helpful. I learned a few new things! A couple suggestions for future topics
    1. IBS and Pregnancy: risk factors of IBS-d vs. IBS-c or if you have a combination, what questions or things should I be asking my doctor while pregnant
    2. More information on gut brain communication
    3. More in depth article on how to talk to your GI doctor, maybe interview a doctor with their perspective as well as your perspective as someone advocating for their patient while working with the doctor.
    4. What resources do you recommend for RD’s who want to learn more about the GI tract as well as keep up and be “in the know” with new research for IBS / SIBO / journals, books, etc (other than the one you have created) Which is great and I have completed!

  • Sandy Wilcox

    Constipation! I have learned many of the high fiber foods recommended for constipaton are high in FODMAPS. I try to watch those closely and determine what works for me. Does the omneprazole, and hiatal hernia contribute to my slow elimination? My GI also wrote me an RX for Amitiza. It is very costly and I never filled it at $700 a fill. My insurance plan won’t cover it until I meet all the deductibles and then my family total out of pocket. I have done a bit of reading on it with pros and cons I’m not convinced it is for me. Can you share any research you have done on Amitiza?

  • Cailyn Schroeder

    Any thing more on irregular bowel movements such as incomplete evacuation or alternating patterns of diarrhea/constipation

  • Kaitlynn R

    Hi, thank you for the article, this was very helpful. I learned a few new things! A couple suggestions for future topics
    1. IBS and Pregnancy: risk factors of IBS-d vs. IBS-c or if you have a combination, what questions or things should I be asking my doctor while pregnant
    2. More information on gut brain communication
    3. More in depth article on how to talk to your GI doctor.
    4. What resources do you recommend for RD’s who want to learn more about the GI tract as well as keep up and be “in the know” with new research for IBS / SIBO / journals, books, etc (other than the one you have created) Which is great and I have completed!

    Kaitlynn

  • Carrie

    This is a great article, thank you! I’d like more information and perspective on recommended probiotics, prokinetic drugs (like Iberogast or Motilpro) and natural supplements (ginger or oregano) — especially for IBS + SIBO patients.

  • Maria

    Hi Kate, I’m looking forward to more articles. I’m especially interested in learning about the latest research on IBS. Is there any particular ethnic group that is more prone to having issues with high fod map foods? Being Italian pasta, bread , cheese, beans were staples in our diet growing up. Having been to Spain I found them to be very proactive on gluten free foods in particular and not sacrificing quality of the menu and taste.

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