What’s causing this lady’s stomach to bloat after eating?

I came across this story today. It concerns a young lady who, it is claimed, can bloat up like a balloon shortly after she eats. Normal testing has not identified any particular problem.

I was interested in this story because it reminded me of a similar story given to me some years ago when I was lecturing in Toronto. One dinner, I sat next to the very nice Canadian administrator of the event on which I was teaching. I noticed she (let’s call her ‘Louise’) was eating only tiny portion of food. Often, individuals assume that someone eating micro-portions of food has something to do with weight control. But I’ve learned in practice to avoid making assumptions, and (gently) asked Louise why she was not eating much.

Louise told that the reason she ate small volumes of food because she would get bloated and uncomfortable after meals, and the more she ate, the worse it was. She had had ‘all the tests’, but none of these had helped her any. One of the investigations involved her eating a ‘radioactive sandwich’, which I assume was a test for the way food passed out of the stomach and through the small intestine. Louise said that she did feel it was a bit odd to be told that she had to wear protective gloves while she ate the sandwich, and that the room she ate it in was evacuated for the safety of others at the time!

In my experience, bloating after meals can be caused by a range of factors, but one of the most common is low or non-existent levels of acid in the stomach (termed ‘hypochlorhydria’ and ‘achlorhydria’ respectively). Stomach acid is a key component in the proper digestion of food. A lack of it can cause digestive strife – not just bloating, but symptoms such as indigestion, burping and reflux too.

If food does not digest efficiently, there’s a tendency for it to sit around in the stomach, and some individuals feel as though food has got stuck a bit. It’s not uncommon for individuals to have an evening meal and have the impression it remains undigested the following morning. Sometimes, these individuals will burp in the morning and taste the food they ate the night before. It turns out that Louise was one of these people.

One potential treatment for low stomach acid is for individuals to supplement with hydrochloric acid (the type of acid in the stomach) in capsule form before meals. As an aside, hydrochloric acid was a recognised conventional medical treatment for indigestion decades ago (sipped through a glass straw to protect tooth enamel). Then acid-suppressing medication came along and the concept of ‘excess acid’ which basically put a stop to doctors thinking that individuals might have inadequate stomach acid if they presented with indigestion-type symptoms (‘dyspepsia’).

I often have a few supplements in my ‘doctor’s bag’ when I travel, and had some stomach acid capsules with me on that particular trip. To make a long story a bit shorter, Louise took a couple of capsules of hydrochloric acid during the meal. The next day she volunteered that she had felt better, in terms of her abdominal and digestive symptoms, after the meal and again the following morning than she had for a long time.

This experience does not prove Louise’s problems were down to low stomach acid, but I strongly suspect it had a lot to do with it. Interestingly, the ‘radioactive sandwich’ test Louise had showed that food tended to stay in her stomach for extended periods of time. However, she could not recall anyone ever mentioning to her that low stomach acid might be the problem.

As for the lady whose story triggered this, I obviously have no idea whether her symptoms are caused by low stomach acid. Again, I wouldn’t be surprised if this is playing a part. I note that the piece includes a long list of potential causes of abdominal bloating, though low stomach acid is, again, not mentioned.

For more on low stomach acid secretion and some thoughts on its management, see here.

26 Responses to What’s causing this lady’s stomach to bloat after eating?

  1. janeray1940 4 August 2011 at 9:53 pm #

    I wonder if the woman in the article has been tested for fructose intolerance. I have this condition; while bloating was never that severe for me, before I was diagnosed there was a time when I would be unable to button my waistband after eating. Eliminating all fructose – and yes, that means all fruits, most legumes and grains, and many vegetables – solved the problem.

  2. John Briffa 4 August 2011 at 10:23 pm #

    janeray1940

    Good thinking – this could indeed be her issue and thanks for sharing.

  3. Steve Wright 4 August 2011 at 11:40 pm #

    Thanks for drawing attention to this Dr. Briffa!

    I too had many of the same symptoms of the ladies in question, horrible cramping and bloating, burping after eating and lots of gas. Through diet tweaks, Betaine HCL and digestive enzymes I have been able to get rid of my symptoms.

    Together with some other supplements I’ve gotten rid of my IBS problems. After talking with 1000′s of people through the blog I run, I’ve observed almost 80% of people with digestive complaints have a stomach acid issue and typically they all respond favorably to supplementing with digestive enzymes.

    I made a free video about both Betaine HCL and enzymes that you can check for free here: http://scdlifestyle.com/2011/07/two-tweaks-to-dominate-your-digestion/

  4. deirdra 5 August 2011 at 1:13 am #

    Is she eating any soy? One low carb tortilla constaining a smidge of soy flour causes extreme bloating and painful, staccato hiccups.

  5. Zizzle 5 August 2011 at 9:18 pm #

    I looked 4 months pregnant after my first bite of food each day. I was lactose intolerant but dropping lactose didn’t help with the constant bloat. I was diagnosed with lymphocitic colitis and later realized I was gluten and dairy intolerant.The GF/DF diet worked quickly. Within days I had a flat stomach and no bloating, EVER. Now I know when I’ve accidentally eaten gluten or dairy because my abdomen swells like a balloon within minutes of eating it.

  6. Lori 5 August 2011 at 9:31 pm #

    It could just be too many carbs–they can cause gas in your digestive system, whereas protein doesn’t cause much, and fat doesn’t cause any. Whole wheat products and apples really used to do a number on me (I don’t eat them anymore).

  7. NoGlutenEver 6 August 2011 at 12:05 am #

    gastroparesis symptoms can be caused by gluten intolerance

  8. patricia 6 August 2011 at 12:22 am #

    I believe I have the opposite problem – too much acid. I had a duodenal ulcer when I was 21, and now Im 77, and have to take lots of medication including aspirin. The aspirin has to be dissolved & swallowed mid-meal or I suffer! Im also puzzled by the fact that my tongue is always coated, though I think my digeation is OK. Any suggestions? thankyou

  9. Neil Fiertel 6 August 2011 at 4:44 am #

    An improper flora environment in the gut surely can be the obvious reason for much bloating. Daily eating of live bacteria yoghurts can certainly improve many people’s issues with this. It has no lactose either so it is a good way to obtain high protein and calcium in the diet also.

  10. Sam 6 August 2011 at 4:02 pm #

    Dr Briffa,

    What is your view that prehistoric man was frugivorous? ( fruits and greens all uncooked)

    It does make sense, considering the great apes all have a much similar diet, and our bodys are designed to meat the criteria as a fruigvore.

    Just wondering…

  11. Sally Seal 7 August 2011 at 11:34 am #

    This article was a revelation to me. I have never heard of too little stomach acid. The moment I read it I realized that I had all the symptoms which have been getting worse and my food intolerance as well. It was getting to the point where I dreaded going to other’s houses for meals as I always had problems after. My solution was to take indigestion tablets which, of course, I now realize made it worse.
    Tried the cider vinegar test suggested and it eased so now am taking it before meals and will be getting some Betaine HCL as well.
    Thank you so much I feel that I can solve this problem now and in a just a couple of days feel so much better.

  12. Melanie Flower 8 August 2011 at 4:08 pm #

    I frequently see clients who suffer with bloating in my clinic, it’s very common. And I too sometimes use a supplement of stomach acid to help this if it looks like low stomach acid is the problem; it usually works very well.

  13. Reijo Laatikainen 9 August 2011 at 5:46 pm #

    Once again, I also suggest: FODMAP diet, ie. restriction of poorly absorped carbohydrates if lady had IBS. But hydrochloric acid and vinegar may indeed also help.

  14. Lee Lomoljo 10 August 2011 at 3:33 am #

    Dear Dr. Briffa

    It’s a great pleasure to read your blog. I find your post very interesting. Experiencing a constant bloated stomach, especially after eating can be attributed to a number of reasons but in many cases, the problem is due to the type of food we eat.

    As a reader, I consider your writing to be a great example of a quality and globally competitive output. It would be a great thrill and honor if you could share your genuine ideas and knowledge to our community, Physician Nexus. With this you can gain 1000 physician readers from over 62 countries on Nexus.

    We would love for you to visit our community. It’s free, takes seconds, and is designed for physicians only – completely free of industry bias and commercial interests.

    Best,

    Lee Marie Lomoljo
    On behalf of the Physician Nexus Team
    http://www.PhysicianNexus.com

  15. Steve Wright 11 August 2011 at 7:56 pm #

    Reijo,

    FODMAP is a good diet to see a reduction in symptoms, but other being a food restricted diet it does little actually help the underlying problems.

    I think its best use is in conjunction with other diets like the specific carbohydrate diet and proper supplementation. A plan such as that while keeping an eye on high FODMAP foods would be the best solution in my eyes.

    Take care!

  16. ValerieH 1 September 2011 at 6:49 am #

    Wise Traditions Journal from Summer 2010 has an article about acid reflux which also mentions that people might not have enough stomach acid or the ph might be off. http://www.westonaprice.org/digestive-disorders/acid-reflux-a-red-flag
    One thing that is mentioned is that salt is NaCl. The chlorine from salt is where the hydrochloric acid gets that element. Low salt diets could contribute to a low acid environment in the stomach.
    All of this stuff is so interesting!

  17. GinaW 7 January 2012 at 6:53 pm #

    Excellent blog Dr. Briffa. Thank you. For me, going on the Paleo, or grain-free lifestyle, ended my persistent bloating issue. It had many other beneficial results as well. I would bloat after almost every meal. And, no, eating yogurt did not help.

  18. Kristen 19 February 2012 at 5:22 am #

    Hello, I have had similar problems as well as this lady. I had constant bloating right after i ate any type of food. Doctors had no idea what it was from. I did many tests and all came back negative. However I had run into this nurse and vitamin rep from the company Usana. She heard all of my symptoms (severe stomach bloating which was for 3 months, stomach pain and low appetite). She guessed that i had an inflammation in my stomach and intestines and this was from eating too much processed food causing me to not be able to digest foods properly ie the stomach bloating. This is very common with people. She suggested i put a lemon wedge in my water half hour before i ate any meals as well as eating 3 probiotic yogurts a day for a couple weeks. The lemon in your water before eating gets your digestive juices flowing so you can digest your meal.

    She also recommended Usana Probiotic (take for one month) , digestive enzymes (take for one month) and Essentials (take for 6 months). I have got all these vitamins and supplements and my stomach bloating has stopped!!!! I highly recommend these vitamins and Usana is the best vitamins and supplement company in the world. Check them out if you are experiencing the same issues as the lady in this article. http://www.usana.com.

  19. Judi 13 June 2013 at 7:46 pm #

    I have had a bloating problem for literally YEARS (at least 24). It seems no matter what I eat or drink, even a glass of water, can make my stomach swell up so much that people have actually stood up for me to sit down on public transport believeing I’m heavily pregnant. I’m a vegetarian, have been for the last 7 years,and follow a healthy diet eating lots of fruit, salads, vegetables, brown rice, yoghurts..etc. It has got worse during the last month and is extremely painful as well as my stomach being rock hard. I dread being asked out for dinner as whatever I wear ends up looking awful. At the moment I’m getting blood tests, urine and stool samples done and have my second appointment with an internal medicine specialist next week. I will mention to her the comments about low levels of acid ion the stomach as I’d never heard that before. Any other help would be greatly appreciated as this is NOT normal.

  20. rusty 2 July 2013 at 1:20 am #

    just thought I’d chime in with my own experience.

    Vitamin D deficiency can cause intestinal bloating.

    Amongst other things, such deficiency causes up-regulation of IL-17, which is a pro-imflamatory cytokine, as well as reducing intestinal tight-junction integrity.

    These two effects together mean that inflammatory foods are presented via increased paracellular intestinal permeability to an immune system that responds with excessive immflamation. The net result can be a rapid and quite substantial “bloating”.

  21. Judi 3 July 2013 at 4:35 pm #

    I too have had the same problem for over 20 years & it has got a lot worse recently. I’ve had a ton of tests done & it now turns out I have a lot of adhesions from previous surgery. 22 years ago I was opened up as i had an ovarian cyst & they had to remove the cyst, ovary & falopian tube. These adhesions are basically scar tissue which sticks together gathering pockets of air whenever you eat or drink anything at all. Unfortunately, surgery to remove them results in more adhesions. It has caused so much upset over the years & I can really sympathise with anyone else going through this. I’ve had people stand up for me on public transport thinking im pregnant.

  22. Phil 12 July 2013 at 6:44 pm #

    My bloating got uncontrollable shortly after I received a flu shot has this happened to anyone else?

  23. Morgan 29 August 2013 at 4:20 pm #

    Over the course of a year and a half I slowly lost 60lbs. For the last year, I haven’t been able to lose any other weight. However the momemnt I stopped losing weight, I began to develop digestion issue. It started with difficulty in elimination and bloating. I have been able to deal with it though. This past Thanksgiving I got a severe pain attack. I figured it had something to do with kidney stones. Went to the doctors, long story short, I ended up getting my gallbladder removed in January 2013. Ever since then the digestion issues have gotten worse especially since May. I have been tested for almost everything. Lately, the moment I eat my stomach swells. After breakfast it is slightly bloated and by the time I finish dinner, I look 5-6 months pregnant. I have been tested for celiac and it was negative. I was put on antibiotic for bacterial overgrowth for 3 weeks and didn’t feel any better. My GI doctor was at a loss of words. I maintain a gluten free diet even though my test was negative because back in June I did a 3 week test to see how I would feel gluten free. I noticed a slight difference. So my GI doctors only conclusion was severe IBS with a gluten allergy. He told me to maintain a gluten free diet and follow a FODMOPS diet. I have been following both religiously since July. I feel worse. I have no clue what to do. I do know I can’t keep going on like this. I try not to stress about it. However when you literally feel miserable 24/7 and there is no relief, it is hard not to stress. I don’t even want to eat anymore. I am a very health oriented person. I have a had a very clean diet for the last 2 years and I exercise almost daily. Does anyone have any recommendations?

  24. Betsy 19 October 2013 at 2:50 am #

    Phil, did your bloating go away? how long did you have it? my bloating began right after flu shot which was also the same time i had surgery so i thought it was surgery caused but i was told it was not. reading it happened after you got the flu shot made me remember the same thing happened to me.

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