Author: Heather K. Mackie, MS, RD, LD Week of September 9, 2013Nothing is worse than that bloated feeling!  Not only does it make you appear bigger than you are, but it is also uncomfortable.  Bloating may be caused by excess gas (in the stomach or the intestines), irregularity, or water retention, among other reasons.  Overeating is also another common reason for bloating.  However, not all individuals that experience bloating consumed an oversized meal and struggle with bloating daily.  Hopefully this will help you to find the culprit of your bloating and help you learn how to get rid of bloating and help you feel more comfortable.

Common Bloating Causes

Decrease the Sodium, Increase the Potassium. The more salt (or sodium) one consumes, the more fluid your body is likely to retain causing you to feel more bloated.  One solution is to decrease the sodium in your daily eating plan.  The American Heart Association suggests only 1,500 mg of sodium per day, however the average American consumes more than 3,000 mg per day.  Rather than eating something salty and crunchy, opt for some fresh veggies.  Another big culprit of our sodium intake is processed foods as they have too much sodium to start with and many individuals add even more salt to these convenience foods. Another solution is to increase the potassium-rich foods in your daily eating plan as potassium helps to counteract sodium’s water retention capabilities.  Potassium helps all cells, tissues, and organs to operate properly.  It helps to relieve bloating by balancing and circulating body fluids.  It will also help to keep your blood pressure lower and reduce your risk of other chronic diseases.  Bananas, avocados, nuts (almonds and peanuts), asparagus, melon, tomatoes, citrus fruits, green leafy vegetables, milk, potatoes, and white mushrooms are all good sources of potassium. Lactose Intolerant? Calcium is a very important mineral for bone health and muscle function.  One of the best sources of calcium includes dairy foods, which contain lactose.  Some individuals are lactose intolerant, meaning they do not have the capability to break down lactose.  Some bariatric patients tend to develop lactose intolerance following their surgery and should opt for alternative ways to get in their dairy foods, such as almond milk, soy milk or low-lactose containing dairy foods (aged cheeses and yogurts). Please keep in mind it is best to confirm any allergies or intolerances with your doctor.  Many people self-diagnose and then unnecessarily eliminate healthy foods from their eating plan. Find your Fluid Balance. Water also helps to restore the sodium balance in the body and helps to normalize the digestive tract.  Some professionals will say drink 8 glasses of water per day or 64 oz.  Other professionals say half of your body weight.  Another method to determine adequate hydration status is to look at your urine (yes this is gross, but it helps).  If your urine is pale in color and mostly odorless you are well hydrated.  If it is straw colored or darker, you need to drink more fluid.  However, one caveat is some people will have a neon yellow colored urine.  This is due to taking supplements containing riboflavin (Vitamin B2) and not needing as much riboflavin that day as what is in the product.  Extra riboflavin is excreted in the urine and turns it a bright, neon yellow color. Mighty Magnesium. Magnesium is a mineral that can help ease constipation and relax the muscles in the intestinal walls.  Check your multivitamin to ensure that it contains magnesium.  Also, try to include magnesium-rich foods in your daily eating plan.  These foods include almonds, spinach, soy milk, black beans, edamame, whole grains, salmon, halibut, and chicken, among others.  The Recommended Dietary Allowance for adults is 310 mg-420 mg per day depending upon male or female and age.  However, specific recommendations have not been set yet for bariatric patients, but some patients may require additional magnesium if they had a malabsorptive procedure.  We need more research to help determine the exact recommendation for all bariatric patients. Sweeteners. Sweeteners are found in many reduced-calorie foods, beverages, and supplements.  Some sweeteners, especially sugar alcohols are not tolerated well by some people.  This is not related to bariatric surgery though.  Some people do not break down sugar alcohols well and this may result in bloating, gas, and other gastrointestinal symptoms.  A couple examples of sugar alcohols include sorbitol, xylitol, mannitol, maltitol, and erythritol.  Sorbitol and xylitol tend to be more tolerable and not as gas-producing as some of the other sugar alcohols. Carbonated Beverages. Carbonated drinks, like soda cause air bubbles to form and expand in your abdomen.  These bubbles cause bloating and can easily be avoided by avoiding carbonated beverages. Eating Too Fast. Eating slowly and chewing your food well (something all bariatric patients should do anyways), will help to reduce bloating.  When you eat too quickly or do not chew your food well, it can cause air swallowing that leads to bloating.  Eating slowly also helps to prevent overeating (another common cause of bloating). Too Much Chewing Gum.Chewing gum can also lead to swallowing air, which can cause bloating.  Also, many sugar-free gums contain sugar alcohols, which may cause bloating in some individuals.

Common Solutions to Treat the Bloat

Get Moving. For many individuals, exercise and physical activity stimulate the bowels, which may help those suffering from constipation.  Walking will also help to release gas, especially for those patients that are immediate post-op.  When they do laparoscopic surgery, they fill your stomach with carbon dioxide to expand it and give the surgeon more room to work, however afterwards this extra gas can cause back and shoulder pain and walking is the best way to rid of the carbon dioxide. Moderate intensity physical activity, such as running, aerobics, cycling, etc. activate the sweat glands to release fluids the body could be retaining.  Taking a 15-20 minute brisk walk after dinner is enough to help with digestion.  Exercise can also help to relieve stress and help to prevent stress eating.  Talk to your surgeon and/or dietitian to determine when and what type of exercise you should incorporate into your daily routine. Peppermint Tea. Peppermint tea may help to alleviate gas by relaxing the digestive tract and boosting normal peristalsis (wave-like muscle contractions that move food through the digestive system).  Talk to your surgeon or dietitian before taking any sort of tea as some of these may have extra ingredients that may or may not be safe for you following your bariatric surgeon. Find the Fiber. Eating fiber-rich foods can help to push digested food through your system.  Fiber moves food through the gastrointestinal tract quickly for better digestion.  Women need about 25 grams of fiber per day, while men need about 38 grams of fiber per day.  This number will lessen as one ages due to the decrease in food consumption.  These numbers were calculated based on a formula from the Institute of Medicine that suggests about 14 grams of fiber for every 1,000 calories.  Therefore, bariatric patients should not need as much as their non-surgical counterparts depending upon their caloric intake.  It is important to work up to this recommendation as adding too much fiber, too quickly can also have negative effects.  The average American consumes about 10-12 grams of fiber per day, so see where you are now and slowly work to what is recommended by your surgeon and/or dietitian. To increase your fiber intake, include foods such as oatmeal, bran flakes, raspberries, lentils, and other fruits, vegetables, legumes, and whole grains in your daily eating plan.  Your surgeon and/or dietitian may suggest a fiber supplement like psyllium or other soluble fibers to help regulate digestion and prevent constipation. While beans and some vegetables can be gas producing, it does not mean you should avoid them in your healthy eating plan.  If you are not used to eating beans or cruciferous veggies (broccoli, Brussels sprouts, and cauliflower), then start out slow to allow your body time to adapt to the compounds that initially cause gas. Friendly Probiotics. Probiotics are good bacteria similar to those that naturally occurring in the body and aid with digestive health.  Probiotics regulate the amount of healthy bacteria in your system and assist with normalizing bowel movements.  There are several ways to incorporate probiotics in your daily eating plan between supplements, probiotic-enriched food sources like yogurt, miso, soy drinks, and juices.  Look for “live and active cultures” listed on the package. See a Professional.Talk to your family doctor and/or bariatric surgeon if bloating is interfering with daily activities.  There are many diseases and conditions that could be attributed to bloating, including endometriosis, peptic ulcer, liver, kidney, gallbladder, celiac, thyroid, and pelvic inflammatory diseases.  It can also be linked to certain cancers (stomach, colon, and ovarian).  Bloating is associated with irritable bowel syndrome, among other gastrointestinal conditions.  If you are consistently bloated and/or experiencing intense pain, be sure to make an appointment with your doctor. Experts agree that you should not fast, skip meals, or use laxatives or water pills to get rid of the bloat or lose weight.  Also, doing sit-ups or crunches all day long will not get rid of excess belly weight (you cannot spot reduce).  However, you can strengthen abdominal muscles with exercises like Pilates and an exercise ball workout.  Stronger muscles will help your belly to feel flatter.

Overall, there are many things that can cause bloating and many changes one can make to reduce and/or prevent that bloated feeling.  Talk to your surgeon and/or dietitian to develop a plan for you.