Many of us have experienced bloating at one time or another, the sensation when your stomach feels full and swollen. For some people, though, the discomfort caused by chronic bloating can interfere with everyday life.

Bloating is common affecting up to 30 per cent of the general population. Among people with irritable bowel syndrome (IBS), more than 90 per cent report bloating.

The good news: In many cases making simple diet changes can reduce, even resolve, uncomfortable bloating. The key, however, is determining what your bloat triggers are.

What is bloating?

Bloating is a recurrent sense of fullness, pressure or trapped gas in the upper abdomen (e.g., the stomach area). In some cases it’s accompanied by abdominal distention, a measurable increase in abdominal girth. Abdominal pain, gas and burping can also be present.

Symptoms may worsen over the course of the day or they can be triggered by eating a meal. Often bloating dissipates overnight.

The most common cause of bloating is air, or gas, trapped in the intestinal tract. What you eat – and how you eat – can lead to a build-up of intestinal gas.

Other reasons for bloating include inflammatory bowel disease, small intestinal bacterial overgrowth (SIBO), gluten intolerance (celiac disease) and non-celiac gluten-sensitivity. Chronic constipation, stress and certain medications (e.g., Aspirin, antacids, anti-diarrhea drugs) can also contribute to bloating.

Diet strategies to prevent bloating

While bloating may be caused by an underlying medical condition, it’s most often a result of what you eat and/or how you eat. Your first line of defense is addressing your diet.

Avoid overeating. Eating large meals, especially fatty meals that empty from your stomach slowly, can make you feel bloated. To eat smaller portions, serve meals on a luncheon-sized plate (seven to nine inches in diameter) instead of a dinner plate.

Check in with your hunger level halfway through your meal. You’ve had enough to eat when you feel satisfied but not full.

Slow your eating pace. Eating quickly can contribute to bloating by causing you to overeat. It takes roughly 20 minutes for appetite-related hormones to kick in and tell your brain you’ve had enough to eat.

Eating too fast also increases the amount of air you swallow, which can cause bloating. To eat slowly, put down your knife and fork after every bite and chew thoroughly.

Chewing gum, sucking on hard candies and drinking from a straw also increase the amount of air you swallow.

Increase fibre, water. If constipation is causing your bloating, increase your intake of foods rich in insoluble fibre, the type of fibre that retains water and adds bulk to stool, helping it pass more quickly through the colon.

Wheat bran, 100-per-cent bran cereal, whole wheat pasta and whole grain rye bread are excellent sources of insoluble fibre. Apples, berries, kiwifruit, pinto beans, green peas, sweet potato, avocado and prunes are also decent sources.

Fibre needs to absorb water to work effectively. Drink nine cups (women) and 12 cups (men) of water each day.

Try lactose-free. If you’re intolerant to lactose, the natural sugar in cow’s milk, consuming more lactose than your small intestine can digest can cause bloating, abdominal pain, distention, gas and loose stools.

If you suspect lactose may be the culprit, switch to lactose-free milk and lactose-free yogurt to see if your bloating symptoms improve. Hard cheeses (e.g., cheddar, Swiss, Parmesan) are low in lactose.

Consider a low-FODMAP diet. If you have IBS, bloating may be triggered by a group of poorly absorbed carbohydrates called FODMAPs. (FODMAP stands for fermentable, oligosaccharides, disaccharides, monosaccharides and polyols.) Lactose, by the way, is a FODMAP.

As FODMAPs move through the small intestine they draw in water. Once in the large intestine, gut bacteria ferment FODMAPs, which produces gas. Extra water and gas in the intestinal tract can cause IBS symptoms such as bloating, abdominal pain, flatulence and diarrhea.

Finding out which FODMAPs you’re sensitive to involves eliminating high-FODMAP foods for a short period of time and then, one at a time, adding FODMAPs back to your diet.

Consult a dietitian knowledgeable in low-FODMAP meal planning – and the strategic reintroduction and testing of FODMAPs – to ensure you follow a nutritionally balanced diet.

When to see a doctor

If dietary modifications don’t reduce your bloating, consult your doctor. It’s important to rule out any other conditions that could be causing your symptoms.

Leslie Beck, a Toronto-based private practice dietitian, is director of food and nutrition at Medcan. Follow her on Twitter @LeslieBeckRD

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The regulatory body for Ontario’s medical profession has barred two outspoken doctors from issuing any medical exemptions related to COVID-19 vaccinations.

The College of Physicians and Surgeons of Ontario announced the restrictions against Dr. Mark Trozzi, of Harrow, and Dr. Rochagne Kilian, of Owen Sound, on Monday morning.

Both Trozzi and Kilian have been outspoken about COVID-19 restrictions in the past while expressing skepticism about COVID-19 vaccines.

Kilian, in particular, has previously been a speaker at several rallies organized by the group “Grey- Bruce Freedom Fighters” and last month resigned from her position as an emergency room doctor in protest over the Grey Bruce Health Services handling of the pandemic.

Under the interim order announced today but issued last week, the physicians have been barred from providing medical exemptions in relation to COVID-19 vaccines, mandatory mask requirements for COVID-19 and testing for COVID-19.

Their practices will also be required to post information about restrictions in their offices.

The college said that it is issuing the interim orders under powers granted to it in 2018, which permits it to “suspend or impose terms, conditions or limitations on a member’s certificate of registration where the college believes that the conduct exposes or is likely to expose patients to harm or injury.

Neither doctor has been referred to the tribunal with allegations related to the restrictions at this point.

Asked about the orders at Queen’s Park on Monday, NDP Leader Andrea Horwath applauded the college for “proactively” addressing the issue while suggesting that there should be more of a system to protect the integrity of Ontario’s proof-of-vaccination requirement.

“If this has happened with these two physicians, where’s the system to make sure it’s not happening in many other instances so that how can we be assured of the reliability?” she asked. “We know that (Doug) Ford didn’t want to do this, we know that he got dragged to a certificate program kicking and screaming and a result it was late, and it’s inadequate and this is another one of the inadequacies.”

Chief Medical Officer of Health Dr. Kieran Moore has previously said that COVID-19 vaccines are safe and highly effective and that medical exemptions should only be granted at a rate of about five people per 100,000.

He has said that the only two legitimate medical exemptions are an allergy to one of the components of the vaccine or an increased risk of myocarditis.

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President Joe Biden’s administration on Monday asked the U.S. Supreme Court to block a Texas law that imposes a near-total ban on  abortion after a lower court reinstated the Republican-backed measure.

The administration made its request to the Supreme Court seeking to quickly reverse a decision by the New Orleans-based 5th U.S. Circuit Court of Appeals to lift a judge’s order blocking the law while litigation over the matter continues.

(Reporting by Andrew Chung in New York and Lawrence Hurley in Washington; Editing by Will Dunham)

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