Q: My son-in-law suffers from bloating and abdominal pain. He’s had every test and imaging, but they’ve all come back negative. He even went to a nutritionist and was put on the FODMAP diet with no relief. I’m not sure where to guide him next; do you have any suggestions?
A: A low FODMAP diet eliminates many fermentable carbohydrates, helping to reduce symptoms at least in the short term or for the duration of the diet. For many, it doesn’t bring a full resolution of symptoms because it doesn’t address root causes. While there are a myriad of reasons for abdominal bloating and pain, it often starts with dysbiosis. This is the proliferation of bad bacteria in the gut causing changes in digestion, absorption, bowel frequency and function and its associated symptoms, and can adversely impact immune function.
Dysbiosis can be caused by taking a round of antibiotics, eating a high sugar/starch processed food diet, and hormonal changes triggering the undesirable proliferation of candida. Food additives, preservatives, MSG, and emulsifiers further insult the GI tract by loosening tight junctions resulting in leaky gut.
But there are other possible causes of your son-in-law’s discomfort:
Frequent or chronic use of PPIs (proton pump inhibitors) like Prilosec, Nexium, etc., creates a more alkaline environment in the GI tract, causing the conditions for opportunistic bacteria to proliferate. SIBO (Small Intestinal Bacterial Overgrowth) is a common cause of abdominal bloating and discomfort, and even nausea. A low FODMAP diet is often implemented temporarily while weeding and reseeding the gut with appropriate supplements, herbs, and probiotics to eradicate SIBO.
Food allergies and intolerances – it is best to avoid all allergenic foods to help diminish symptoms. If there are no suspected food allergies, try avoiding gluten and casein (the protein found in dairy—all animal milk) for a few weeks to see if symptoms subside.
We can’t underestimate the adverse impact of stress on physiological health—including the GI tract. Whether that stress is acute or chronic, consideration needs to be given to its impacts.
A qualified nutritionist can help guide you in finding root causes and relief of symptoms.
To your health!
Leyla Muedin, MS, RD, CDN
