Gluten-Free & Gassy
The top 7 reasons you’re still feeling sick.
Over the almost two decades I’ve been in clinical practice, my patient population has been changing. Ten years ago, I was diagnosing people with celiac disease and gluten intolerance and introducing them to the gluten-free diet. With the explosion of publicity about celiac disease and the gluten-free diet, most of the patients I currently see are already gluten-free. Now I’m working to identify other conditions that co-exist with gluten intolerance and that don’t respond to the gluten-free diet alone.
Gas and bloating are two of the top reasons that people come to see me. Many with these symptoms have already been diagnosed with irritable bowel syndrome (IBS), which is only a description of their symptoms, not a cause.
Here are the seven most common reasons for residual bloating and gas. Keep in mind that you can have more than one of these simultaneously.
1. Getting “Glutened”
The first culprit I always consider is trace gluten contamination. Often people aren’t as gluten-free as they think they are. Doing a thorough inventory of the surprising but common sources of gluten contamination is key. Some of the most frequent offenders are silverware drawers full of gluten crumbs; sponges that spread gluten; shared toasters, pasta colanders, wooden utensils and cutting boards; cross-contaminated condiments, spreads and nut butters; pet food containing gluten; cosmetics and medications.
2. Food Allergies, Sensitivities & Intolerances
Besides gluten, the most common foods that cause bloating are dairy, eggs and soy. A sign that food allergies or intolerances may be the root of your GI distress is when systemic symptoms like headaches, rashes, joint pain and insomnia accompany the bloating and gassiness. A wide variety of testing methods can help distinguish which foods may be causing your symptoms. Work with a healthcare practitioner who has experience and knowledge in this area.
3. Fructose & Lactose Intolerance
Some enzyme deficiencies prevent the digestion of dietary sugars. When these foods are poorly digested, they can cause frequent bloating and gas. Treatment involves avoiding the offending sugar—either lactose (found in dairy products) or fructose (found in certain fruits and vegetables, such as apples, peaches, pears, asparagus, dried fruit and honey). For lactose intolerance, you can take a supplemental lactase enzyme to help you digest dairy products. There is no such enzyme for fructose intolerance, so you will need to avoid high-fructose foods. Both conditions are diagnosed with breath tests and elimination diets.
4. Small Intestinal Bacterial Over-growth (SIBO)
We hear about good bacteria in the gut but, in fact, the good bacteria belong in the colon. When bacteria proliferate in the small intestine instead of the colon, it’s considered an infection. SIBO can cause significant gas and abdominal distension and can be diagnosed by biopsy or breath test. Some people with mild SIBO will respond to probiotics. Severe cases are treated with the antibiotic Rifaximin.
When we eat, our stomach usually empties within 90 to 120 minutes. Gastroparesis is a condition where the stomach slows down and takes hours to empty, causing an uncomfortable fullness that’s often described as bloating. It can cause vomiting and acid reflux or gastroesophageal reflux disease (GERD) since gastric emptying is impaired. High-fat and high-fiber foods—including raw vegetables and salads—can be particularly hard to digest. Gastroparesis is diagnosed with a gastric emptying test that uses a meal of scrambled eggs mixed with a weak radioactive substance. The test sometimes uses oatmeal; be aware that oatmeal may not be gluten-free. Gastroparesis can be treated successfully with a digestive enzyme but medications and a change to a low-residue diet may also be needed.
6. Pancreatic Insufficiency
The pancreas is known for its role in insulin production, but it also plays a vital role in digestion. It secretes enzymes that help digest fat and carbohydrates. Pancreatic insufficiency can cause problems with undigested food moving too quickly through the digestive tract, resulting in uncomfortable gas and bloating. A stool test for elastase and fecal fat levels can help diagnose the condition. The treatment is to decrease your fat intake and to take a digestive enzyme to help digest the fat you’re still eating.
I diagnose a lot of bacterial, fungal and parasitic intestinal infections using stool tests. These infections may cause diarrhea, abdominal pain and bloating. Treatment involves eliminating the infection and restoring proper balance of good bacteria.
Even after your digestive problems have been identified and treated, you may not feel fully recovered until your nutritional status is restored. If your gluten-free diet is loaded with processed, refined foods, you may not be getting sufficient nutrients. To add to the problem, most of these conditions can cause nutrient malabsorption.
It is important to work with a savvy healthcare practitioner to learn how to eat nutritiously and to take the appropriate high-quality supplements to reverse your nutritional deficiencies. Once your intestinal issues are treated and you’ve adopted a healthy diet, you’ll notice significant improvement in your digestion and your quality of life.
Written by Christine Doherty, originally published in Gluten Free & More.