What's Really Causing Your Bloating
When you have chronic bloating, we test for these six root causes:
1. SIBO (Small Intestinal Bacterial Overgrowth)
Bacteria that belong in your colon have moved into your small intestine, where they ferment food and produce gas. This is one of the most common causes of chronic bloating that standard care misses.
Symptoms: Bloating after meals, especially carbohydrates. Feeling worse after eating, even "healthy" foods. Gas, abdominal pain, irregular bowel movements.
Tests needed: SIBO breath test
2. Gut Dysbiosis
Wrong balance of bacteria in your colon. Too much inflammatory bacteria, not enough beneficial bacteria. This creates inflammation, gas production, and digestive dysfunction.
Symptoms: Bloating, irregular bowel movements, food sensitivities, fatigue
Tests needed: Comprehensive stool testing (GI-MAP)
3. Food Sensitivities
Delayed immune reactions to foods cause inflammation and bloating. This isn't an allergy (immediate reaction). It's a sensitivity that can take hours or days to show up.
Symptoms: Bloating, fatigue, brain fog, skin issues, joint pain after eating certain foods
4. Low Stomach Acid
Can't break down food properly, so it ferments in your stomach and small intestine. Common in women over 40, especially with stress or nutrient deficiencies.
5. Estrogen Dominance
Too much estrogen relative to progesterone slows gut motility and causes fluid retention. This creates bloating that's worse before your period.
Symptoms: Bloating that worsens before period, heavy periods, PMS, mood swings
6. Cortisol Dysregulation
Stress hormones divert blood from digestion, slow gut motility, and increase intestinal permeability (leaky gut). This leads to SIBO, food sensitivities, and chronic bloating.
Most women with chronic bloating have 2-3 of these issues happening at once. That's why a single approach (like just probiotics) doesn't work. We need to test and address multiple root causes.
How Your Hormones Are Making Your Gut Worse
The gut-hormone connection goes both ways. Hormones affect gut function, and gut health affects hormones.
Estrogen Affects Gut Motility
High estrogen slows gut transit time. Food moves through your digestive tract more slowly. This creates constipation, bloating, and can contribute to SIBO.
Before your period, when estrogen is high relative to progesterone, bloating often worsens. Estrogen also causes fluid retention, which contributes to that "pregnant" feeling.
Gut Bacteria Regulate Estrogen
Your gut has an "estrobolome," bacteria that help regulate estrogen metabolism. When you have dysbiosis (wrong balance of bacteria), estrogen doesn't get metabolized properly. This can create estrogen dominance, which then affects gut function, creating a vicious cycle.
Cortisol Damages Gut Lining
Chronic stress increases cortisol, which damages the gut lining and increases intestinal permeability (leaky gut). This allows undigested food particles and bacteria to enter your bloodstream, triggering inflammation and immune reactions.
Thyroid Affects Digestion
Low thyroid function slows gut motility, which can lead to SIBO and chronic bloating. Thyroid dysfunction is a common underlying cause of digestive issues that many doctors miss.
During Perimenopause, Hormone Shifts Make Gut Issues Worse
As estrogen and progesterone fluctuate, gut function becomes more unstable. Many women with perimenopause symptoms also develop new gut issues or worsening of existing ones.
What Conventional Doctors Miss About Bloating
IBS Is a Description, Not a Diagnosis
"IBS" just means "irritable bowel." It describes symptoms, not causes. It doesn't explain WHY you're bloating. Without understanding the root cause, treatment is just guessing.
Most cases of "IBS" are actually SIBO, dysbiosis, food sensitivities, or hormone-driven gut dysfunction, all of which are testable and treatable.
Standard Tests Don't Look at Gut Function
Colonoscopy rules out disease (cancer, polyps, inflammation) but doesn't test bacteria, SIBO, or function. Standard stool tests only check for pathogens, not bacterial balance or gut health markers. This misses 90% of the causes of chronic bloating.
Hormones Are Never Considered
GI doctors don't test hormones. Gynecologists don't test gut. The connection is missed, so bloating gets treated in isolation without addressing hormone imbalances that are driving it.
Treatment = Symptom Management
Anti-spasmodics, fiber supplements, "low FODMAP forever." This manages symptoms without fixing root causes. Low FODMAP can help temporarily, but if you need to avoid FODMAPs forever, you haven't fixed the underlying problem.
The result: Women suffer with chronic bloating for years, told to "just avoid trigger foods" or "it's stress," when the real problem is testable and fixable. We test comprehensively to find what's actually causing your bloating.
How to Actually Fix Chronic Bloating
We don't guess. We test.
Comprehensive Testing Includes:
SIBO breath test
Comprehensive stool testing (GI-MAP)
Hormone testing (DUTCH)
Food sensitivity testing
Thyroid panel
Cortisol testing
Treatment Based on Results:
SIBO Treatment
If SIBO is present, we treat it with antibiotics or herbal antimicrobials. This usually takes 2-4 weeks, followed by gut restoration.
Gut Restoration Protocol
Restore beneficial bacteria, heal gut lining, reduce inflammation. This includes probiotics, prebiotics, gut-healing nutrients, and removing inflammatory foods.
Hormone Balancing
If estrogen dominance is contributing, we balance hormones with bioidentical progesterone, DIM, or other targeted interventions.
Food Sensitivity Removal
Temporarily remove inflammatory foods, then reintroduce systematically.
Digestive Support
If stomach acid is low, we support digestion with betaine HCl or digestive enzymes.
Stress Management
Essential for gut health. Cortisol management, stress reduction techniques, adaptogens if needed.
The Goal
The goal isn't just to reduce bloating temporarily. It's to fix the root causes so you can eat normally again.
This typically takes 3-6 months of comprehensive treatment, but most women see improvements within 4-6 weeks.
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