SIBO

You might occasionally experience bloating after a hearty meal or consuming gas-inducing foods like beans, cauliflower, or too many raw vegetables in one sitting. Bloating is almost guaranteed if you overeat, don't chew your food thoroughly, or drink carbonated drinks with your meal. These could be normal if bloating resolves on its own and subsides within a few hours or maybe a day.

However, suppose you're constantly feeling bloated even during fasting periods or after every single meal or your bloating is accompanied by other symptoms like nausea or changed bowel movements interfering with your daily activities. In that case, it's not normal and needs to be investigated.

Triggers for bloating

While diet and eating habits are often blamed for bloating and gas, these factors might not be the only primary culprits in chronic bloating cases. For instance, overeating, consuming fatty foods, or drinking fizzy beverages are known triggers for bloating. However, these factors generally cause temporary discomfort.

Continual bloating symptoms often indicate underlying health issues. Stress, anxiety, and lack of physical activity are frequently blamed, but these usually exacerbate the existing problem rather than cause it directly.

Three reasons behind constant bloating: a deeper dive

Several functional reasons could contribute to chronic bloating. Here are some of the main ones:

Insufficient digestive juices

Several glands in the digestive system secrete digestive juices to aid in digestion. These juices contain enzymes that help break down food into smaller parts and different nutrients. The organs that release digestive juices include the salivary glands, stomach, liver/gallbladder, pancreas, and small intestine. (1) These digestive juices also serve as your body's natural defense barrier against infections.

Here is a short overview of some of the digestive juices, their functions, and possible issues:

Salivary glands

Digestion starts in the mouth. When you take a bite of food, enzymes in your saliva, called amylase, start breaking down carbohydrates. Poor oral health, including gum disease, cavities, and missing teeth, can disrupt this critical step, leading to less effective digestion and potential gut issues.

Stomach

Glands in the stomach lining make stomach acid and enzymes that break down food. Muscles of the stomach mix the food with these digestive juices. The stomach secretes proteases to function as the initial site of protein digestion. The stomach has a very acidic environment, with a pH ranging from 1.5 to 3.5. (2)
The higher the number goes, the more alkaline it becomes, which we don't want because an adequate level of acid is required for:

• Protein digestion
• Activating pepsin (enzyme)
• Proper sphincter function (so the valve stays closed and food doesn't reflux back)
• Stimulating other digestive juices to be released further down your digestive tract
• Mineral absorption
• Killing unwanted bacteria and parasites in the food (preventing SIBO or food poisoning)
• Activating intrinsic factor that is needed for vitamin B12 absorption (3)

Stomach acid production can be negatively impacted by chronic stress (4), Helicobacter pylori infection (5), chronic inflammation, autoimmune disorders (6), and aging (acid levels decrease as we get older). (7) Proton pump inhibitors (PPIs) and antacids are commonly prescribed or purchased medications that lead to low stomach acid production. (8)

Low stomach acid, also known as hypochlorhydria, can cause a wide range of digestive symptoms (9):

• Heartburn, nausea, acid reflux symptoms, GERD
• Trouble digesting meat
• Gas and bloating after eating, early fullness
• Food allergies and intolerances
• Nutritional deficiencies (iron, vitamin B12, Magnesium)
• Hair loss, thinning hair, or brittle fingernails
• Undigested food particles in the stool
• Constipation or diarrhea
• Skin problems, such as acne or eczema
• Overgrowth of bacteria and yeast (Candida albicans)

Liver

The liver makes a digestive juice called bile that helps digest fats and some vitamins. Bile ducts carry bile from the liver to the gallbladder for storage between meals or to the small intestine for use when food is present.
But bile has other roles besides food digestion. It serves to maintain the intestinal environment clean with its antimicrobial properties. Bile keeps the bacteria in check and prevents them from colonizing the small intestine.
Bile also plays a vital role in removing toxins from the body. Toxins from liver detoxification processes are secreted into bile and eliminated through feces (bowel function). (10)

Stagnant or sluggish bile flow, also known as cholestasis, can be caused by various factors. Some of the causes of stagnant or sluggish bile flow can be drugs, sex hormones, bile duct obstruction (like gallstones), low-fat diet, etc. (11)

Here are some signs of poor bile flow:

• Greasy, foul-smelling, and light-colored stools
• Nausea
• Bloating
• Diarrhea or constipation
• Vitamin deficiencies (fat-soluble)
• Fatigue
• Migraines
• Skin problems such as acne or eczema
• Jaundice
• Mood swings
• Liver inflammation

Pancreas

The pancreas makes digestive juice with enzymes that break down carbohydrates, fats, and proteins. The pancreas delivers the digestive juice to the small intestine for proper digestion. The main types of pancreatic enzymes include:

• Lipase: breaks down fats into fatty acids
• Protease: breaks down proteins into amino acids
• Amylase: breaks down carbohydrates (starch) into sugars

Food may not be broken down properly without enough pancreatic enzymes, leading to pancreatic insufficiency or exocrine pancreatic insufficiency (EPI), producing digestive issues such as gas and bloating, feelings of fullness, abdominal pain and cramps, and diarrhea. Sometimes, insufficient pancreatic enzymes can lead to malabsorption and malnutrition. (12)

Small intestine

The small intestine makes digestive juice, which mixes with bile and pancreatic juice to complete the breakdown of proteins, carbohydrates, and fats. Bacteria in the small intestine produce some of the enzymes needed to digest carbohydrates.

If the small intestine cannot absorb the nutrients and fluids, we may talk about malabsorption syndrome. This issue may involve symptoms such as chronic diarrhea (undigested food passes through the digestive system too fast), weight loss (not being able to absorb the nutrients needed for the body), abdominal pain and bloating; pale, bulky, and smelly stools; fatigue, etc. (13)