Robynne Chutkan M.D. - The Bloat Cure

Acid Blockers

W hen you think of stomach acid, you probably think of heartburn and ulcers, so getting rid of it may seem like a great idea. But you actually need stomach acid for healthy digestion, and blocking it can lead to serious bloat. Acid helps you break down food and absorb nutrients, and it stimulates your digestive enzymes. It also protects you from harmful bacteria that can enter your body through your mouth. Drugs such as proton pump inhibitors (PPIs) and other types of acid blockers change the pH of your stomach from acid to alkaline, turning it into a nice, friendly place for bacteria to settle and multiplyand produce lots of bloat-causing hydrogen and methane gas.

If youve been taking acid-suppressing drugs for more than a few months, it could be the reason youre bloated, especially if youre having lots of indigestion and gas after eating. It can be easy to confuse these symptoms with acid reflux, though, so you may end up increasing your dose of acid suppression or switching from one acid blocker to another, not realizing that theyre the cause rather than the cure.

Solution

• If youre on a PPI, I recommend that you try to go off the drug (check with your doctor first). Taper it slowly to avoid an acid surge, which can happen in the first few weeks after stopping it. Transitioning from daily use to every other day for a week, then every two days for a week, then every three days for a week, and so on, may help you quit more successfully.
• If theres an increase in your symptoms while youre tapering, supplement with shorter-acting antacids if possible, rather than restarting PPIs.
• Elevate the head of your bed by four to six inches with a couple of cinder blocks to make it higher than the foot of the bed, so that gravity can help prevent acid from refluxing up.
• Digestion becomes much less active once the sun sets, so give your stomach a curfew and dont eat after dark.
• Eat small, frequent meals. Your stomach is the size of your fistoverstuffing it will cause reflux in most people.
• Avoid fatty meals, which slow down stomach emptying and increase your chances of reflux.
• Consume caffeine, dairy, and alcohol with caution, since they can worsen reflux symptoms.

Aerophagia

I ts normal to swallow a little air when you eat or drink, especially if youre drinking carbonated beverages such as seltzer, beer, soda, or champagne. But as the day progresses, if you feel like the Michelin Woman and fantasize about deflating your stomach with a pin (not a good idea!), you may be swallowing large amounts of air on a regular basisa condition called aerophagia, which can lead to a massive buildup of gas in your gastrointestinal (GI) tract and major bloating.

Aerophagia is incredibly common but very underdiagnosed, and its frequently confused with conditions such as ulcers, gallstones, and bacterial overgrowth that can also cause abdominal discomfort and bloating. Most people with aerophagia complain of three main symptoms: bloating, burping, and a tense, distended stomach that feels like an overinflated tire. If you have chronic sinus problems, a deviated septum, or a history of allergies or asthma, you may be a mouth breather rather than nose breather, which predisposes you to aerophagia. Chewing gum, sucking on hard candy, smoking, eating too quickly, talking when youre eating, drinking lots of liquids with your meals, or holding your breath when youre anxious can all cause aerophagia. Eventually most of the air youve swallowed will get burped up or make its way through your GI tract and exit via the other end, but not without causing a lot of bloat in between.

Solution

If youre bloated and think you may have aerophagia, try these tips:

• Spit out the gum and hard candy.
• Eat slowly and mindfully.
• Dont talk on the phone while eating.
• Save drinking liquids for the beginning or end of the meal.
• Drink flat, not bubbly, water and beverages.
• Try some meditation if you feel anxious.
• Practice taking deep breaths that expand your lungs, not your stomach.
• If youre still feeling bloated, a speech pathologist may help you identify whether the problem is related to your speech, swallowing, or breathing patterns.