Hilary’s Exlusive Interview with Dr. Rachel
Let’s face it. We’ve all experienced the all too familiar feeling of being bloated. The curious part is understanding exactly why and when it strikes. Ironically, it can be when someone decides to eat a healthier diet or go gluten-free that they find themselves bloated more often. Now why would a seemingly positive change come with such a discomforting side effect?
We wanted to get to the bottom of it, so we turned to the expert in digestive health and functional nutrition, Dr. Rachel Eppinga. With over a decade of experience as a Naturopathic Physician, we knew she could clear things up and help set people back on a path of feeling their best. Here are the wise insights she shared in response to our tough questions.
1. Dr. Rachel, when a gluten free patient comes to see you about bloating, what are the causes you investigate first?
I want to know if it is dietary specific or related to another condition that has yet to be identified. I take a detailed history around why they went gluten free, how long they have been gluten free and what they have noticed since doing so. I also want to know if they still eat dairy products and others on a list I consider to be aggravating to their digestive system.
I ask them to give me detailed examples of when and what they eat for all meals and snacks. Often individuals will simply find substitutions for breads and bread products they were eating and this can be a problem. I also need to know what “gluten free” grains and grain products are new to their diet.
I ask them to give me details about how their symptoms show up, the timing, situations and any other related symptoms they experience. I also ask about other changes like supplements, medications or life stressors.
I ask questions related to past history of food poisoning, opioid use from injury or surgeries, history of antibiotic use, other past gut infections and even stress management and lifestyle practices.
2. If celiac disease or gluten sensitivity is at play, why doesn’t a gluten free diet always eliminate bloating?
I always tell my patients that gluten free does not always equal “Healthy”. Especially these days with all the gluten free substitutions available on the market.
For some, going gluten free radically changes their health and eliminates all digestive issues. For others, the situation is more complicated and the elimination of gluten alone is not enough.
If someone has gluten intolerance, regardless of the cause, there has been injury to the digestive tract by the consumption of that food. Until this heals, the individual will find themselves sensitive to other foods or food groups and will continue to experience digestive upset. There is also a cross reaction (especially with dairy) that can happen where the body reacts the same to certain foods as it did to gluten and therefore, eating those food continues to cause problems.
In addition, the introduction of the many refined gluten free grains and starches that are in gluten free products are often upsetting to the micro-flora balance in the intestines, causing gas and bloating. The introduction of seed grains like quinoa, amaranth and millet can also cause bloating if these are new to their diet or the person’s digestive health has been compromised and the proper enzymes and digestive factors are not being produced to break these down properly. When introducing these new gluten free grains, start with small quantities only 1-2 times per week at first to allow your body to adjust. If you have been eating them in frequent or large quantities, try cutting back to see if you have an improvement in symptoms.
3. What is the best method for determining if there are additional allergies at play?
The gold standard for identifying food intolerances or sensitivities is elimination. This means 100% elimination for a minimum designated period of time. I’ll talk more about that toward the end of the post.
I often recommend food sensitivity testing as well, but I do not let the test alone guide my recommendations. Rather, I educate the patient on how to incorporate those results into the personalized plan we devise together that addresses their unique set of symptoms.
4. Is it sometimes just a matter of consuming too much corn or soy? Many processed gluten free foods contain those ingredients.
Yes. The overconsumption of these alternative products can often be a problem. Corn and Soy can cause digestive symptoms for many and these are foods included on the list I give for an elimination diet. Many gluten free foods contain refined starches like corn, potato and tapioca starch as well as soy, oat or rice flour. All of these can cause issues, especially symptoms of gas and bloating.
Unfortunately many gluten free products contain more processed and refined ingredients than their gluten containing counterparts. Processed foods in general are not optimal for our health.
I also find that many people over consume nuts and seeds when they go gluten free. These foods are meant to be condiments, not consumed in the larger quantities they often are.
5. What role does the microbiome play in all of this? Can you take probiotics and alleviate bloating?
A big one and I wish the answer could be that easy.
If someone is experiencing gas and bloating some aspect of it is due to an imbalance in their microbiome (dysbiosis). The microflora in our intestines are the sole producers of gas. So if you are bloated, the bugs in your gut are the culprits. For some, taking probiotics and supporting a mix of healthy bacteria alleviates their symptoms. For others, taking these supplements can actually make their symptoms worse. Believe it or not you can actually have too many good bugs in the wrong place!
A question I always ask my patients is whether taking probiotics helps them or not. Depending on their answer, I have more clues on further investigation that is necessary or what treatments might be needed.
6. Are there any causes for bloating that are not diet related that people should also be aware of?
Contrary to conventional thinking, from a Naturopathic perspective, diet plays a role in all digestive conditions (and in overall wellness!). However, diet therapy alone does not solve all digestive issues. Diet must be considered, however sometimes it is a matter of proper motility and location of the dysbiosis or imbalanced flora that is the problem. There can be abnormal levels of bacteria in the small intestine (SIBO) and if this is the case, additional treatment considerations are required.
I also take into consideration a person’s stress levels (stress impairs proper digestion), hormonal issues, posture (increased lumbar curvature can decrease capacity of the abdomen to hold gas) and other possible conditions like diabetes and inflammatory bowel. All of these can cause issues with bloating.
There are other warning signs that suggest the bloating may be due to something more serious so if any of the following are also present I recommend the person notify their physician immediately: weight loss greater than 10% of their body weight without major dietary or exercise changes, fluid build up in the abdomen, severe and sudden abdominal pain or vomiting, blood in the stool or abnormal vaginal bleeding or fever.
7. What about deficiencies in the diet? Could a deficiency in a specific vitamin or mineral lead to bloating and related digestive discomfort?
Trace mineral deficiencies can cause problems with motility and production of digestive enzymes and stomach acid, specifically potassium and zinc, which can lead to more bloating. Vitamin Ddeficiency is common in patients with certain digestive conditions. B vitamin deficiencies such as niacin, thiamine, active B6 and B-12 can also contribute to digestive discomfort due again to lack of digestive enzymes and healthy stomach acid.
8. What are some basic steps that gluten free individuals suffering from bloating should take to resolve the problem?
#1 step is to do an elimination diet. Take out all dairy, corn, soy, eggs, sugar, chocolate, alcohol, nightshades and peanuts.
I recommend 2 weeks at a minimum, but 30 days is a better trial. This can help them rule out other food intolerances. Within that, I recommend a 100% grain free week and suggest when they do have grains they choose whole grain rice or oats—organic and sprouted is best—rather than processed gluten free bread products. Limit nut consumption here as well.
I created Reintroduce Health to assist people in this exact process!
The following can be tried in combination or on their own:
● Take a digestive enzyme with HCL 15 minutes before every meal for a month. If this helps, continue for 90 days then try going without.
● Take digestive bitters 5-20 drops on the tongue 10 minutes before each meal.
General support to be added to the above:
● Take a Whole Food Multivitamin that has B vitamins and trace minerals. I like the over the counter MegaFoods brand.
● Take Vitamin D3, 2000 i.u. per day.
Given that everyone’s body is unique, I always recommend seeing a Naturopathic Physician who can address your whole health and create a personalized plan just for you!
Dr. Rachel is a Naturopathic Physician and Licensed Acupuncturist based in Portland, Oregon with over a decade of experience providing integrative health and wellness care through a unique functional medicine, mind-body approach. She has a special interest in Digestive Health and Functional Nutrition as well as Autoimmune and Endocrine disorders. She knows if you fix your gut and optimize your nutrition that your whole world can change! Learn more at http://racheleppinga.com and http://reintroducehealth.com/.