Many people complain of abdominal bloating after eating, and they may automatically link it to the accumulation of gases or to a specific type of food, so they decide to eliminate milk, bread, or legumes from their diet, but bloating does not always result from increased gases, and the food that causes symptoms for one person may not bother another person.
Bloating may be transient after a large meal or eating quickly, while in other cases it can be associated with constipation, irritable bowel syndrome, or intolerance to certain food components. How does the doctor determine the cause? Why is there not one diet that suits all those who suffer from this problem?
Bloating does not always mean excess gas
The term bloating usually refers to a subjective feeling of fullness or pressure within the abdomen, while abdominal distension means an observable increase in its circumference. The two symptoms may combine or one may appear without the other, and therefore the patient may feel severe bloating even though there is no significant increase in the amount of gases inside the intestines.
An expert review issued by the American Gastroenterology Association (AGA) explains that possible causes include disorders of the interaction between the gut and the brain, such as irritable bowel syndrome and functional indigestion, along with constipation, intolerance to certain carbohydrates, and disorders of the elimination of gases and intestinal contents.
Eating quickly, talking while eating, chewing gum, or drinking soft drinks may cause you to swallow large amounts of air, which may increase the feeling of bloating. However, limiting the cause to the accumulation of gases may delay the discovery of other factors, such as slow colon movement or increased sensitivity of the digestive system to expansion.
Constipation and irritable bowel syndrome
Slow bowel movement and accumulation of stool may lead to a feeling of fullness and difficulty in passing gas. Therefore, constipation is one of the causes that the doctor evaluates when bloating recurs, taking into account the nature of defecation, difficulty in passing gas, and the feeling of incompleteness.
As for people with irritable bowel syndrome, bloating may be associated with increased sensitivity of the intestine to expansion and disruption of its movement, and not necessarily with the production of an abnormal amount of gas. Symptoms may coincide with constipation or diarrhea, or alternating between them, in addition to abdominal pain associated with defecation or a change in bowel habits.
A review published in 2024 in the journal Nutrients indicates that the response of the digestive system to food in patients with irritable bowel syndrome is affected by several factors, most notably bowel movement, food composition, carbohydrate fermentation, and communication between the intestine and the brain, which explains the variation and difference of symptoms from one person to another.
Bloating is not just gas
Dr. Medhat Muhammad Ali, internal medicine consultant at the Royal Clinics in Qatar, says, “Abdominal bloating after eating is often a simple symptom if it appears mildly after a large meal or eating quickly and disappears after a short time. But it requires medical evaluation when it recurs or persists, or is accompanied by pain and changes in bowel movement.”
Medhat explained to Al Jazeera Net that determining the cause of bloating begins with taking a careful medical history, which addresses the timing of the symptoms and their relationship to food, the pattern of defecation, the presence of constipation or diarrhea, in addition to the medications used and any changes in appetite or weight.
He added that some foods, such as legumes, onions, garlic, some wheat products, sweeteners, and soft drinks, may exacerbate symptoms in some people. They may also be linked to milk products in people with lactose intolerance, but the association of symptoms with a specific food alone is not enough to diagnose an allergy or intolerance.
There is no one diet for everyone
Dr. Medhat emphasized that the difference in causes and responses explains the lack of one diet suitable for everyone, warning against excluding milk, wheat, legumes, or entire food groups based on guesswork, because this may lead to an unbalanced diet or a deficiency of some nutrients without treating the real cause.
The patient can record meals, symptoms, and bowel movements for a specific period, and then present them to the doctor or nutritionist, while restrictive diets, such as the low FODMAP diet, are applied when needed, temporarily and systematically, followed by reintroduction of foods to identify individual triggers.
He warned against relying on home prescriptions or using laxatives randomly without consulting, stressing the need to see a doctor when bloating continues or worsens, or appears accompanied by unexplained weight loss, blood in the stool, repeated vomiting, severe and persistent pain, a noticeable change in bowel habits, or chronic constipation.
He explained that these symptoms do not necessarily mean a serious disease, but they require medical evaluation and appropriate examinations, instead of resorting to diets or medications randomly.
Stimulating foods, but they are not prohibited for everyone
Some foods contain poorly absorbed, fermentable short-chain carbohydrates known as FODMAPs. These compounds may draw water into the intestines and be fermented by bacteria, which may increase bloating and pain in some IBS patients.
These compounds are found in varying proportions in onions, garlic, legumes, some fruits and wheat products, in addition to lactose in milk and some sugary sweeteners, but their presence in food does not mean that everyone should avoid it, because the symptoms are affected by the type of compound, the quantity consumed, and each person’s ability to tolerate it.
A review published in the journal Nutrients in 2024 showed that a low-FODMAP diet can improve general symptoms in some patients with irritable bowel syndrome, but its application goes through three stages: temporarily reducing foods high in these compounds, then gradually reintroducing them, and finally designing a personal regimen that excludes only the actual triggers.
A meta-analysis (combining and integrating the results of several studies) published in 2024 in the journal Food & Function also found that a low-FODMAP diet may improve symptoms of irritable bowel syndrome, including abdominal distension.
However, restrictive diets may affect the quality of the diet and the diversity of gut bacteria, which reinforces the need to implement them under specialized supervision, rather than as a permanent regime.
When does the doctor order tests?
Not every person suffering from bloating needs an endoscope, x-rays, or a long series of tests. The American Gastroenterological Association review recommends that tests be determined based on the medical history and clinical examination, with the possibility of conducting tests directed at celiac disease or malabsorption of some sugars in selected cases.
It is not recommended to perform routine imaging or endoscopy simply because of the presence of swelling, except when warning signs appear, a new and unusual change in symptoms occurs, or there are abnormal results in the clinical examination.
Therefore, the correct treatment of bloating does not depend on a long list of prohibited foods, but rather begins by identifying the pattern of symptoms and their relationship to food and defecation, then treating the potential cause and choosing the appropriate dietary modifications for each case.