Season 2 Episode 9 of the Quiet the Diet Podcast with Michelle Shapiro, RD and Kari Natwick, RD

Reduce Bloating with Functional Medicine

Sponsored by Raw Rev – 20% OFF with code MICHELLE20

In this episode, Michelle and Kari Natwick, gut health RD, dive into the all too common – but not normal – topic of BLOATING. Kari shares her own experiences with digestive discomfort and how isolating and scary it can feel. You’ll learn why it happens and how to banish bloating for good!

They share: 

• What bloating is & why it happens
• Methods to treat bloating without restrictive elimination diets!
• A recording to listen to when you’re in the middle of symptoms (*save for later!*)
• The truth about lemon water – does it actually work? 
• “Good” vs. “bad” gut bacteria
• Debunking the misconception of bloating as a normal occurrence

PLUS a discount on stool testing 

Links

20% OFF Raw Rev Bars (Code: MICHELLE20)

Kari’s resources: 

Beat the Bloat Guide
GI Map (Stool Test) discount in QTD Community (Sign up for free > Click “labs” > GI Map)
www.gutbrainrd.com

Work with Michelle and her free resources: 

Quiet the Diet
Podcast Page
Work 1-on-1 with a functional Registered Dietitian at Michelle Shapiro Nutrition LLC
8-Week Fitness & Nutrition Guide
Learn more about the practice

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Bloating

Michelle Shapiro RD 

Today’s episode is all about bloating. And I wanted to bring bloating into its own episode because I know how uniquely frightening it can be. For people who are experiencing weight loss resistance, for people who are experiencing other sorts of chronic illness, bloating is one of the most uncomfortable and frankly frightening symptoms.

So we want it to in this episode give you not only tangible solutions on how to kind of help with bloating in the long term or where to look from a root cause perspective, but also what to do in that exact moment that you’re feeling bloated and feeling scared about it. I have brought on the amazing Kari Natwick, who is an incredible functional dietitian, just one of the warmest, smartest dietitians I’ve ever known, or really practitioner of any kind for that matter.

And we are approaching bloating in a way that I hope is really productive for you and not the same kind of drink lemon water, do a low FODMAP diet conversation that you might have heard before. So we’re hoping to cover bloating in a way that feels really supportive and really acknowledges the fact that bloating can totally trigger us. I can’t wait for you to hear this episode. I can’t wait for you to meet Kari, and we’ll see you in there.

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Intro to Kari Natwick, Gut Health Dietitian

Michelle Shapiro RD 

Kari I’ve been calling Coach Kari because you are the type of person where just being around you can bring someone to tears from how warm you are, how empathetic you are. Your amazing coaching skills and you’re just, as a human, you are a coach in every area and aspects of your life and such a magical person. So I’m extremely excited to have you here today.

Kari Natwick, RD 

Thank you. And I think I will say, because you have called me Coach Kari, it kind of changed my own inner identity to it. It actually put me in contact with a part of me and a gift that I have it. I didn’t really realize before. So thank you for that.

Michelle Shapiro RD 

Kari I think the work that you do is so different than other functional Dietitians and we’ll talk about what your practice is and who you are and everything too. But I feel like you have a level of intuition and empathy in your practice that I don’t see often and is extremely special. So we also now share a couple of clients, which I’m really excited about.

Kari’s Experience as a WIC Dietitian

Kick us off with now that people know your coach, Kari coach Kari, kick us off with what led you to be a Functional Dietitian. Tell us about your journey a little bit and what your practice is like now?

Kari Natwick, RD  6:42 

Yeah, yeah. So I mean, I’ve been a Dietitian for a very long time. I’m ancient in the world of Dietitians, and especially ancient in the world of you know, Functional Dietitians. I started off my career started off working in WIC, wow, I don’t know, 20 years ago.

Michelle Shapiro RD  6:59 

Tell us for people who are listening and don’t know, what kind of roles do Dietitians play at WIC?

Kari Natwick, RD  7:06 

Well, the role that that I played, I would see high risk moms and babies and but what I what I really fell in love with when I was working with WIC was lactation. And so I actually became, not a high-level lactation consultant, but I had a certification in lactation. And I just loved watching this relationship that developed between mom and moms and babies. So that’s just what I love. And then I love working with children.

I loved really teaching moms how to feed their kids not just what to feed them but all about the feeding relationship that exists between a parent and a child and really helping moms and dads support autonomous eaters. And I think that led into the world of working with people around the space of mindfulness and intuitive eating and you know, just learning how to really trust themselves, we have to trust our children.

But in order to, to do that, we have to trust ourselves. So that’s kind of what I started with. And then I moved up to Alaska and I started working in the Indian health systems. And I started working with programs that really worked with Alaskan native tribes around traditional foods. So I’d be up in Alaskan villages, and they would have Moose camp where they would harvest a moose and we would teach people how to cook moose, how to how to preserve food, I helped with gardening projects that were in the communities.

And I would do a lot with just medical nutrition therapy. So a much more integrative way of looking at people’s relationship with food and their bodies in chronic illness, looking at traditional foods, and even historical trauma and what a huge role that plays in not only chronic disease, but also the way people think about food and the way that they think about supporting their own health and wellness.

Stress-Related Illness and Digestive Symptoms

So all of that was the biggest gift for me to be able to work in those spaces. And then I actually started working as the Director of Food Nutrition Services at a hospital. The most conventional job. And I really tried to transform that role, but it was so hard. I definitely fought my hardest and there were a lot of changes that were made within the rights that I had there. So that was probably the biggest, most stressful job that I’ve ever had. I started to experience more things with my health than I ever had before.

I developed Hashimoto’s, started developing GI-related dysfunction, had constipation, bloating, felt terrible and had no energy. Plus I was a new mom at that time, so I had horrible adrenal fatigue. I was basically the kind of patient that I work with now. That’s who I used to be. There are very few answers within the space of conventional medicine. And so I found integrative and functional nutrition and medicine, and it’s just life changing.

Journey into Functional Nutrition

I’ve done some intensive trainings with the Integrative and Functional Nutrition Academy (IFNA), I’ve done a yearlong intensive with Aviva Romm MD. I’ve done some training with the Center for Mind Body Medicine (CMBM), and you know, just really have immersed myself in this. I love it as you do. This is transformational, it really changes people’s lives.

It’s really about getting to the root cause and integrating a human being as a whole. That’s the work that we do. And it ignites us, it lights me up. I know it lights you up. It’s what we love.

Michelle Shapiro RD  11:25 

Unquestionable, and I know Kari, when we first met, we were spilling each other’s deepest, darkest secrets and traumas to each other within one minute. You have all these different perspectives around nutrition, some of which I just learned, honestly. And under all of that you also really incorporate the soul of a person and the history of a person into every single thing that you do.

So WIC, Women, Infants and Children, is again, a very conventional path for a Dietitian versus you working with ancestral foods in Alaska. How did your brain grapple with the experience of different parents, different mothers, especially because that’s who you were working with, in these different places?

Helping Low-Income Mothers Cook Whole Foods

And how the societal aspect of what foods they had access to, and what knowledge they had access to, what a big shift, I feel that is such an opposite kind of experience, or in some ways could have been the same? Because there might be WIC in Alaska too. How did your brain grapple with that? And how did you feel during those experiences?

Kari Natwick, RD  12:46 

Well, I do have to say, the clinic that I worked at where the WIC office was housed was, again, within an Indian Health Services community. And it was probably one of the most unique places because we actually had a, I think it was a two or three acre organic garden, a two acre orchard.

And so one of the things that we would offer people that were part of the WIC program and the American Indian people that sought services there, was a twice-a-week farmers market so they could use their WIC vouchers there. I mean, it was the most ideal model of what other programs should look like, right? It’s farm-to-table so truly unique in that regard.

And then, when I would support moms around education with their babies, a lot of what we would do is focus on whole foods, using fruits and vegetables, teaching moms how to cook beans, how to cook dried beans. It’s one of the most inexpensive, nutrient dense foods that’s available.

And so I would teach moms how to use whole foods like that. And it was really fun. You know, it’s pulling a group of women together, in a community with their moms and their babies, everybody talking about food, talking about food traditions. I mean, it’s just beautiful. It was really so fun.

Michelle Shapiro RD  14:11 

It actually was much more similar an experience of you working within the community than I expected because locationally it was similar. And that’s actually a really beautiful experience. And I’m sure that these programs are so necessary and vital and to have the ability to work within a system that you felt was actually providing a supportive service.

I think it’s hugely advantageous, which I know a lot of Dietitians and other health care professionals do not feel much like when you were the Director of Clinical Services, and probably did not feel that way in Clinical Nutrition. Okay, I just wanted to dive into that because I found it fascinating.

So Kari, now you have your own functional nutrition private practice. You’ve taken all of your own personal and professional experience and you’ve brought it together. You end up working with clients who have Hashimoto’s, gut issues, other hormonal issues, matters of functional health basically, that’s kind of your target clientele.

Bloating Can Feel Disabling

We’re going to talk today about bloating. And the reason I wanted you, Kari Natwick, to be my bloating person is because the experience of being bloated is not only a physical experience, but it can also be so emotionally charged. I knew you would handle it with so much love.

Kari Natwick, RD  15:37 

Well, I’ve been there. I know exactly what bloating feels like. I mean, I see it on my clients. It is it’s disabling for people, for me, women in particular, right?

Michelle Shapiro RD  15:48 

Yeah, that is a powerful sentence saying bloating can be disabling for people. I mean, it could leave people unable to feel they can do their jobs, socialize, engage in life, in the experience of being bloated.

Can we go into just, on the very basic level, what is happening when you are bloated? We can talk about the root cause of what that is. What is it? Is it that there’s the wrong things in the wrong location, you’re storing too many things? What is being bloated?

What is Bloating?

Kari Natwick, RD  16:18 

What is being bloated? That’s a really good question. Because bloating is not simple to me. You know, it’s a really common experience that a lot of people who have GI-related dysfunction have, but there’s so many layers to it, right? When I talk to my patients about bloating, I first ask, where is your bloating? Is it above your belly button? Is it below your belly button?

Because that’s our first clue as to what is happening in the digestive tract. What might be happening in terms of digestive sufficiency and your nervous system? What might be happening microbially in the gut? So I always like to figure out first, where are you bloating?

The second question is, when are you bloating. Are you just perpetually bloated all the time? Well, that’s information. If you wake up in the morning and your stomach is flat, and you’re bloated by the end of the day, that’s information. When are you bloating? Is it after a meal? Or is it after you drink water first thing in the morning? It’s all information, right? So everything that I’m trying to figure out is giving me information and clues as to what the root cause of bloating is.

And then, and then if it’s lower abdominal, how bad is the bloating? Do you have pain associated with the bloating? Can you button your pants by the end of the day? Or do you just have to go lay down. I have so many patients who truly are unable to function. They just have to go lay down. They’re laying there in pain because their bloating is so bad.

Michelle Shapiro RD  18:13 

Let’s go in even further. This idea that we are bloated and it is just one thing needs to be myth-busted right off the bat. Everyone does not bloat the same. What bloating feels like could be different. Some people it feels more solid. And for some people it feels like there’s something pushing outwards. Some people it feels like oh, I just gained weight there and I’m not sure if it’s bloating or not.

I think it feels really different for different people if it is fluid or stool or air, which is kind of three different things I would think of that could be contributing to that each have their own root cause. It’s hard to say what that bloating is for each person because bloating has those different layers. You can be bloated in any of those ways.

Why Do We Get Bloated?

Kari Natwick, RD  19:07 

I love the way that you distinguish that. So stool first of all, yes, if you’re not pooping, you’re gonna feel bloated, right? If you haven’t pooped for three days, that gonna give you that sensation of  fullness and bloating, especially in your lower abdomen. And then the air piece, that’s where it gets more interesting. So much of the air is really a sign of fermentation and gas that is being produced in the gut.

First, air in the gut can be because of digestive insufficiency. There are a lot of layers to digestive insufficiency. There’s a lot of reasons for digestive insufficiency. When you’re not digesting food properly, that food can sit in your gut. It can start to ferment. And the byproduct of fermentation is gas, and that can happen both in the stomach and in the lower GI tract. So that could be it.

But I think the biggest reason that we always have to be assessing for is what’s happening microbially in the gut. Is there dysbiosis? What is causing dysbiosis? Is there an infection in the gut? Because if you have dysbiotic bacteria in the small or large intestine, when you eat, especially if you eat refined carbohydrates, those microbes are going to eat it. And when they eat, they’re going to they start fermenting, they start producing gas. And that can also cause bloating.

Michelle Shapiro RD  20:41 

I need to hold you there, because I need people to understand this visual. Bad bugs are eating, and their farts are what is causing, yes, your bloating. So it’s extremely funny and worth acknowledging. Yeah, so we have to understand the bloating on a functional level. What is the physical form of your body? Right? Are you hunched over at all? Are your hips pushed forward? Is it a pelvic issue? A microbial issue? Is there an actual imbalance of bacteria? Is it maybe an acid balance issue or a mold issue?

If we think of our organs as being independent, but working together, and we think of the layers of our skin and our stomach and our organs being independent, but working together, it can happen in any of those places.

Does Lemon Water Help Bloating?

One thing I see on Instagram is that lemon water will help with your bloating. Actually, lemon water does help my clients’ bloating, but it’s a specific client.

Kari Natwick, RD  21:54 

Lemon water will likely help your bloating, but it probably won’t improve it all the way. It’s not going to truly address the root cause. And that’s really the way we need to be thinking about bloating. Not finding the band-aid approach.

When somebody makes some improvement with lemon water, the first question we’re going to ask is: What is that lemon water doing? It’s really helping to acidify the stomach. Low stomach acid is one of the main root causes of bloating for people.

Causes of Bloating

If your bloating is located above the belly button, where it feels like food is sitting in your stomach, or you really do get that gas and fermentation, I start thinking about things like H. Pylori as a potential root cause. H. Pylori can lower stomach acid. Chronic PPI use (proton pump inhibitors) can lower stomach acid. Lemon water, even apple cider vinegar or bitters, can be helpful for people who have low stomach acid.

But the other thing I think about too is, it’s also possible that somebody might have dysbiosis in their mouth. When we’re swallowing multiple times per day, or getting bloating after drinking water first thing in the morning, that’s often a sign of oral dysbiosis in the mouth, where they have bad bacteria growing and they swallow those bacteria. And then they start fermenting as soon as they land in the stomach. This can cause bloating upon waking that lingers all day long.

Where to Start When You Experience Bloating

Michelle Shapiro RD  24:35 

Let’s walk this back to the first thing you do when you experience bloating. Try to ask yourself questions:

• • When did this bloating start?

• • What is your experience of having this bloating?  

• • Is there anything that influences your bloating?

• • Is it above or below the belly button? Start to understand what organs are in those places to understand what we might need.

What Causes Dysbiosis?

A lot of what’s guiding our bloating is the fermentation from the bad bacteria. It’s basically what they’re eating, that seems to be a huge piece of it. And that’s not a simple fix, either, because we need to understand why they’re doing that. Why does the imbalance exist? And again, where are they coming from in the first place?

SIBO as a Cause of Bloating

Kari Natwick, RD  25:28  

If we kind of journey through our entire digestive tract, it starts with our mouth, right? So first thing to focus on is our oral hygiene: what might be growing in our mouth. Then, what’s growing in our stomach. And then into the small intestine. Because if you’re that person who wakes up in the morning with a flat stomach and your bloating gets progressively worse, almost painful, by the end of the day, the first thought that I have is whether or not they have small intestinal bacterial overgrowth, or SIBO. It’s just one of the most common reasons for people to experience bloating, with that type of presentation.

Parasites as a Cause of Bloating

But then, as we move into the large intestine, we start looking at just general dysbiosis,  bad bacteria that grow in the large intestine. Things like parasites are a very common cause of bloating. We just had a full moon last night and I’ve already had two of my patients reach out to me this morning and say, I didn’t get any sleep because I’m so bloated. It’s just gotten kind of worse in the last few days. Yes, because you have a parasite. And we’re working on it, we will get rid of it. It’s okay.

Michelle Shapiro RD  26:52 

Tell us about the parasites in the full moon.

Kari Natwick, RD  26:56 

I know this just seems like an old wives tale. It’s kind of folklore,  a woo woo thing. But there really is a correlation between full moons and an increased activity of parasites, which can wake people up in the middle of the night. Also, people tend to be more constipated and bloated around full moons. Sometimes those can just be signs for us. Again, it’s about what the root cause is for your digestive dysfunction.

Michelle Shapiro RD  27:30 

So fascinating. The micro biotic particles and the other bugs that we have, they have their own vibes and their own personalities. And they’re doing things, which is really interesting. It’s just interesting, because you’re talking about how the parasites are getting hyped over the moon. And it’s because they have their own lifecycle. And we have trillions of bacteria existing within us, even just within our gut. We’re kind of made of bacteria. And it’s very interesting how we have to take into account not only how the bacteria are interacting with us, but how they interact on their own, and how they interacts with the world.

Kari Natwick, RD  28:21 

It’s so true. I mean, these bacteria, they just own us really, exactly right.

Michelle Shapiro RD  28:27 

I know, we’re so not the masters of the world, they are the masters of the world. I know it’s so true.

Parasites and Bacteria Can Cause Food Cravings

Kari Natwick, RD  28:33 

This is maybe a little bit tangential, but I’ve been reading some research lately on the gut-brain axis, and even looking at how the bacteria in our gut influence things like food cravings.

Michelle Shapiro RD  28:49 

Oh, my gosh, I know the parasites and food cravings is really fascinating.

Kari Natwick, RD  28:54 

These parasites and bacteria want food and they love carbohydrate. They love sugar, right? So if somebody has food cravings when they come to see us, it’s just another clue. The bacteria are really trying to signal food cravings, with perpetual thoughts about just wanting to eat sugar all the time. That is usually driven by bacteria. It’s just one of many things.

Probiotics Can Make Bloating Worse

Michelle Shapiro RD  29:29 

People are hearing this going: Yeah, yeah, yeah, I got it. Michelle and Kari, I’m so viciously uncomfortable with this bloating. I don’t really care that much about the root cause, I want to think about solutions. We will get there but I know what someone’s thinking of is “bacteria = bad.” Let me get a probiotic. Can we talk about the risks of probiotics, just taking them arbitrarily with people who are already bloated and why taking a probiotic can make someone more bloated.

Kari Natwick, RD  30:00 

I am so glad you brought that up actually. Because it’s the number one thing people reach for, right? They have gut issues, they have bloating, and there’s so much marketing around probiotics now that I think people think it’s just this magic pill that they take. But in fact, it just creates this battle in the gut. So if you have dysbiosis, or bad bacteria growing in your gut it’s like you have this army of bad bacteria. And then you start introducing this other army of the good guys, your good bacteria, and you start growing them. Now all you’re doing is just creating this giant war within your gut, right?

So as your bacteria are dying, they’re toxic, and their carcasses are toxic. They actually release toxins in our gut, which creates more inflammation in the gut, creating more bloating and more GI-related side effects. Which creates more brain fog, right? So when taking probiotics, oftentimes, you’re actually just fueling this battle that’s happening within your gut. And all of those things can create more symptoms for people.

 So I always just encourage people to slow down. We really have to work methodically and systematically to address what the underlying root causes of any GI related issue are.

Michelle Shapiro RD  31:55 

Yeah, that’s so important for people to hear, and also so frustrating for people to hear, and they’re gonna hate us for that. So I promise you, we will come back to that. And we totally understand the discomfort of bloating, and we also understand that, for any of our gut issues, it takes months to start functionally changing these things. So for any of them, it’s going to take a long time, there are absolutely things you can do symptom wise for all this.

Also, a lot of probiotics create more of that fermentation process too, especially if they’re prebiotics with probiotics. So those bacteria are feeding on the bad bacteria and the good bacteria. And what’s happening is it’s creating that process over again. So we love probiotics. We’re not saying probiotics are bad at all right? But there’s a specific time and place for them.

So just taking random supplements right off the bat, when you’re having that discomfort might not be the move. We’ll talk about what might be the move, I promise, I promise, I promise.

Bloating Can Feel Scary

I want to talk about the experience of feeling bloated. From personal experience and professional experience, it feels very frightening for people to feel bloated. Can we talk about  that experience and what is kind of going on inside of the body and the brain during bloating that kind of makes us so fearful?

Kari Natwick, RD  33:42 

Part of it is pain, right? You’re wondering: why is this happening? People feel so out of control with it. And there’s no immediate fix. There’s no pill that you can. My patients try and take gas-X when they feel bloated, with varying results, but there’s no immediate kind of quick fix for it.

What’s happening is this activation of your sympathetic nervous system. You really are in fight-or-flight, which when you’re feeling bloated is actually going to work against you. There’s fear, discomfort, and bad bacteria that are also signaling to your brain. They’re not supporting proper neurotransmitter production, serotonin, GABA, and you’re just kind of in this really negative feedback loop both with the microbes in your gut but with also with your nervous system.

Guided Support for Bloating

Michelle Shapiro RD  34:59 

Let’s together walk someone from the first second they notice they’re bloated, so they can always play this recording if they ever need it. I’ll be the listener. Oh, my God, I feel really, really bloated. I feel full up to my neck, I can’t eat anything, I’m in this constant cycle of feeling like I can’t eat, but then I get more bloated when I don’t eat. (This is because your body is releasing acid that you’re not getting rid of, because you’re not chewing or moving things through your gut. This is why intermittent fasting can cause a lot of bloating for people too.)

But let’s take someone in that moment of extreme fear and desperation. What’s the first thing you want someone to do? Talk right to the listener and say, here’s what you do right now.

What to do When You Feel Uncomfortable

1. 1. Stop and close your eyes. Just sit and be present. Notice the sensations in your body. Where are you feeling pain? Where are you feeling discomfort? Can you feel that in the absence of judgment? Can you just notice it?
   2. Put your hand on your belly really gently. I just want you to feel into your belly, and send love to your belly and send gratitude to your belly for all that it does for you, to your body for all that it does for you.
   3. Box Breathing. Breathe in through your nose for a count of 4. 1-2-3-4. And now just hold for 4. 1-2-3-4. Exhale out your mouth making a “shooshing” sound for 4. 1-2-3-4. Hold for 4. 1-2-3-4. Repeat that 10 times. What that does is it is creating a sense of safety in your body, which actually in that moment changes the microbial makeup and also activates your vagus nerve. Our vagus nerve is so important for the movement of food and passage through our digestive tract. It makes us feel relaxed, safe, and it promotes digestion. So we just slow down and send some love to our body. I know that sounds “woo”. But we really need to do it.
   4. Ask your body what it needs. Tap your heart and just ask: What do I need? What do I need? What do I need?

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When Bloating Triggers Negative Body Image  

Michelle Shapiro RD  38:14 

When we feel bloated, our brain is trying to grapple for solutions. IT creates so much of a sympathetic response and such a stress response. People feel something is horribly wrong. And there’s nothing I can do about it, it creates a very unique, uncomfortable spiral.

Also, people have so much trauma with their bodies related to weight too if they’re on some sort of a weight loss journey. And to feel like “I’m holding on to seven pounds of fluid (which is totally possible, by the way in my body.)” It can be easy to feel like all of your efforts for weight loss are gone, that you’re never going to look good in clothing and all those things.

1. 1. First, just let those thoughts exist with you and just allow them to come up, tapping into your body.
   2. Next, associate colors with the experience they’re having. So just picture a color of what it feels like. Then lean into that a little bit and see if you can try to change it with your mind a little bit. For example, if it feels red, let me make it a little blue, whatever that feels like. And try to, again, visualize and send energy to the area.

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Reduce Bloating by Calming the Nervous System

What’s not caught on Instagram, is that bloating is legitimately overwhelming experience for people from a couple different angles. And the most important thing you can first do is just bring down your sympathetic nervous system. Because that’s going to help you in the long term and the short term so much. And using that activity Kari gave (above). And these other tips, I think is the first step with bloating, which I know is not the answer of oh my god, you should have this exact herb or this exact supplement that people might want to hear.

But it is legitimately the most effective for getting through the experience, and also transforming what’s going on in your actual gut. So that’s unquestionably important. And also your vagus nerve, as we know. But in those times, when you’re feeling bloated, you’re not getting that parasympathetic activation. And again, your vagus nerve is not giving you the side of it that you really want the love from.

So I think it’s really important to create that communication because the vagus nerve also controls the pacing of food, leaving our gut or staying inside of our gut. And we know constipation and bloating are very interrelated. And I think that anything that’s going to make you feel like you’re bound up and feeling like you’re holding everything together, is just going to create more acid flowing in the wrong place, more bad bugs, and that feeling of not being able to move things through your digestive tract.

Kari Natwick, RD  41:33 

And I want to add tools for trying to really engage and activate the parasympathetic nervous system. There are certain poses, and movement in your body can also be helpful. One of the worst positions if you’re feeling bloated is just sitting, right? Because it creates more compression, especially because most people have pretty poor posture, and myself included, it creates more compression in our gut. One of my favorite positions for activation of the parasympathetic nervous system is just legs up on the wall.

Michelle Shapiro RD  42:16 

Blood flow is a huge part of this bloating piece too. The reason why some people have bloating is also because they have blood pooling in their abdomen, and it’s not moving to the appropriate places, it’s not moving to your heart being sent back. So walking can be really helpful for bloating for that reason to just to get the blood flowing. Bloating can be very stagnating. Gentle massage can help too.

How Trauma Impacts Bloating and the Gut

Talk to me about movement and the digestive tract. What’s gonna stop things from moving? Why do we hold onto things that we don’t want? Give us the physical reasons and the spiritual reasons.

Kari Natwick, RD  43:19 

There are a lot of energetics around things not moving through our digestive tract. About 99% of the people that I work with who have GI-related dysfunction have trauma. Trauma can actually blunt the vagus response, that connection and that communication between our gut and our brain. The gut-brain axis can be impacted. And when that happens, peristalsis and the Migrating Motor Complex (MMC) are affected.

The Migrating Motor Complex is a process that kicks in after your stomach is empty, about 3-4 hours after you haven’t eaten anything. The MMC is this cleansing wave that moves through the gut and creates this ripple effect, almost a broom that just sweeps up debris, bacteria, food particles, whatever is remaining from the day or from your last meal. And when you don’t have that vagal nerve activation, that cleansing wave isn’t occurring.

Without the MMC, you can just start growing a garbage can in your gut, right? So this debris starts to build up. Especially in SIBO, the bacteria love a dirty environment. Without the MMC, it’s just creating the most hospitable environment for some of these bad bugs, right. So, trauma, working on trauma, it’s almost mandatory if we’re working at healing the gut. We must also support our nervous systems. We must use a trauma-informed approach to healing. Adjunctive therapies, body work, Reiki, acupuncture, chiropractic work, can all be helpful.

So trauma, peristalsis, the MMC, these all play a role in bloating. When we’re feeling stressed out, in any particular moment, we’re feeling really activated. We’re engaged in that sympathetic nervous system. And that sympathetic nervous response, what’s happening in that moment is that our body is getting ready to run or to fight. When that happens, we’re actually shunting blood from our digestive tract into our larger muscle groups, into our brain into our heart, because we’re getting ready to run and fight and to survive, right.

So in fight-or-flight, or when our sympathetic nervous system is activated, our body stops focusing on digestion. So we stop producing as much stomach acid. We don’t have the signaling to our pancreas to produce pancreatic enzymes and to our gallbladder to produce bile. And so the whole digestive process of food breakdown, also comes to a halt.

Using Mindfulness to Calm the Nervous System

I love incorporating the aspect of mindfulness for patients to help with this. So before you’re about to sit down and eat a meal, or even a snack, just bringing mindfulness into that moment. And inventorying, your state. What state are you engaging? Are you in your sympathetic nervous system? Or are you engaged in your parasympathetic nervous system, which is the rest, digest and heal part of our nervous system.

If you feel activated, this is a perfect opportunity, again, to use breath, work to have legs up the wall, even just laying on the ground sometimes, which may not always be practical, but can feel really grounding, right. Sometimes just having our bodies being held by the ground is something that can kind of shift our state, so to speak.

When we do that, then when we eat, our body is primed to break down food. When we break down food, and especially with adequate, you know, acidification of the stomach, that is going to help with the passage of food through our digestive tract.

Reduce Bloating with Movement

Michelle Shapiro RD  48:33 

So this entire topic that we’re bringing up first, we really talked about the gut bugs as being really important when it comes to bloating. The next kind of piece that we brought in is stagnation, momentum, movement, blood flow. Again, Bloating is this state digestion feeling turned off, stagnant, or stopped. So things that introduce flow and movement are going to help.

Even acupuncture now we have a lot of research on, but 10 years ago, we didn’t know why it works. And now we know it’s because of that blood flow return. There is this huge energetic component to it too. But a lot of it is bringing awareness and physicality to movement. I think that’s so important. And that doesn’t mean go lift a bunch of weights when you’re feeling bloated, it just means gently positioning and moving and manipulating in a way that creates flow.

Reduce Bloating by Adding Heat to the Gut

The third component of bloating that I want us to talk about is that heat component. When you feel you don’t have enough stomach acid, just bringing heat to the gut with that lemon water or ginger tea. Anything bitter, astringent can help. Not if you feel you’re on fire because acid reflux can feel you’re already burning so much, you don’t want to add too much heat. But I think bringing some heat to the gut can also, again, promote that blood flow and that energetic flow at the same time.

Can we talk about heat a little bit in our conversation, too?

Kari Natwick, RD  50:14 

There are so many considerations for who and when to bring heat, right. It’s also really important note that if you have a history of things like ulcers, gastritis, active reflux, chronic NSAID use, esophagitis, you probably really want to be careful with the use of heat. But, all the things that you mentioned are really great considerations for promoting acidification of the stomach, or bringing heat.

With very judicious use, and with somebody who’s a very qualified professional, I may use things like betaine HCl with my patients. In combination with things like Pepsin, usually other digestive enzymes too to go along with that. And honestly, this is just in my patient population. So this is really people who have severe GI-related dysfunction, it’s kind of a necessary intervention.

Michelle Shapiro RD  51:26 

In the practice of functional medicine, we see a lot of functional medicine providers recommending betaine HCl right off the bat when they suspect low stomach acid. However, it’s got to be the right person at the right time. But for that person, it could be life changing. And that’s, that’s the absolute truth.

The bloating tips we’ve given you so far today are applicable to everyone, you always need to be mindful of your nervous system, you always need to be mindful of your posture, you always want to create movement, but you don’t always want to add heat. But you do always want to create and initiate flow and bring that back to your body.

There’s a practice in Ayurveda called abbiamo, which is an oil massage. I find that can be really helpful for people too. And any kind of massaging of that area that you can tolerate.

If you’re a person who feels chronically bloated, this will pass. I know, it feels like right now it is forever. And it’s the worst thing that’s ever happened to you. And I totally get it. We totally understand that you feel that way. But this is not going to be forever. This is just right now, and I hate that you feel this way. But it will pass.

Impact of Bloating on Body Image

I need to talk about this thing that I’m seeing on social media all the time. Many people post pictures of themselves super bloated and then say this is normal. This is how I feel towards the end of the day, this is how bodies work. What do you feel about that? Is that true? Is everyone super bloated? How do you know when it’s an actual problem for you?

Kari Natwick, RD  53:49 

This is where I think we have to look at bloating in the bigger context of what else is happening in somebody’s health picture. Rarely will you meet a person who the only thing that they’re dealing with is bloating. Right?

Michelle Shapiro RD  54:05 

Totally. So it’s what they notice the most because it’s so uncomfortable. And it’s visual.

Kari Natwick, RD  54:13 

That is a piece that I think is so important that I rarely hear talked about is the impact of body image and even Body Dysmorphia around bloating. If you’re somebody who already was dealing with Body Dysmorphia or body image issues, this is going to be very triggering without question, right?

It’s important to really promote awareness around the thoughts that you are having, rather than letting the train just run off the tracks. It’s easy to spinal thinking “I’ve gained seven pounds. And I’m retaining all this fluid look at my stomach and none of my pants fit.” First thing we have to do is slow down. Because this isn’t actually an emergency. This is just information.

Michelle Shapiro RD  55:17 

This is not an emergency, this is information. Bloating is a trigger. And we have to intervene in the reaction to that trigger. So what we often want to do when we feel uncomfortable is get rid of the trigger or get rid of this horrible feeling. What is causing a lot of the discomfort around bloating is, of course, the physicality. But there is also pain in the reaction. There’s also further distress in the reaction. So catch yourself in that cycle.

You can verbally say stop, you can accept and acknowledge when it comes up. But realizing that bloating is not usually indicative of a hugely dangerous situation. Of course, always talk to your doctor and dietitian if you’re having any symptoms. If you’re listening, this is not medical or nutrition advice. But bloating feels very, very, very scary. It’s a big bark with no bite kind of symptom.

And we can have that weight relationship with it. Because when digestion is altered, it can feel really scary. If people are phobic of throwing up, it can feel really scary because you start getting nauseous around it. It’s realizing that it might just be a level three or four discomfort. And that a lot of the discomfort around bloating is actually coming from the reaction to it. I think that’s really important for people to realize. What do you think about that?

Bloating is Temporary

Kari Natwick, RD  57:10 

I totally agree. I mean, I really love that you said that. Because again, it’s going back to what we were saying earlier, it really is that activation of the sympathetic nervous system where your body feels like it is now in danger, right? And initiating that level and type of response in your body is only going to make things worse.

This really is the time that we have to promote safety for ourselves. And remember that this too shall pass. Bloating is not a perpetual state of being. It’s a very dynamic state. For most people, it’s really everchanging. And arguably, always worse by the end of the day, right? Especially after dinner.

When you’re inventorying your own reaction, create separation between the trigger in your response, rather than reacting to it. The other thing that you have to inventory within yourself is where your nervous system is, what you’re telling yourself about this. Start to focus on the things that you do have control over in that moment.

Beathing and movement can help. Stagnancy can make bloating feel worse. Stretching can make bloating feel better, kind of getting back into your body, getting some movement going on in your gut. All of that can just be something that’s very actionable and within somebody’s control.

Michelle Shapiro RD  59:09 

Bloating is literally fluid or gas. It’s fluid and stool what it is in your body. Even if you think about how heavy a cup of water is, around  five cups of water, can you imagine if you miss going to the bathroom a couple of times how heavy that can be inside of you?

Kari Natwick, RD  59:35 

This is not to discount or diminish anybody’s experience of bloating whatsoever. But so many women do believe and kind of get freaked out that  bloating equates to weight gain and  everything’s out of control and I haven’t done anything different and I haven’t eat anything differently and my body is just betraying me right now.

Michelle Shapiro RD  1:00:04 

If your bloating feels like a betrayal, I get that. It can feel mysterious. But it’s not! There are a lot of different reasons why you can be bloated, but there’s not infinite reasons that are totally mysterious. There’s a finite amount of reasons that you can be bloated. And we discussed a lot of them today.

Again, it can make you feel like your body’s trying to make you feel and look bad. But it’s just trying to communicate a single symptom and a sign. This is not your body trying to get back at you.

Kari Natwick, RD  1:01:20 

You have to remember there are so many things you can do. And once you start working with a practitioner, the first thing we do is to start supporting your nervous system, start supporting digestive sufficiency in your gut, movement through your body.

Functional Lab Testing for Gut Health

And then we have to address what’s happening with the bad bacteria, right? You have to get rid of those bad bacteria. It depends on what the microbial landscape of your gut is. Is it a parasite? A pathogen? Is it SIBO? There’s a lot of different interventions that you can use, and testing!

So we have to know if you have SIBO or if it’s just general dysbiosis. There’s even testing that we can do to look at things like enzyme production. I don’t ever test for stomach acid. But just because there’s plenty of clues that we can look at that would tell us whether or not someone has low stomach acid. I use functional stool testing in my practice, or I’ll test somebody for SIBO. Once we get all the information we can create the roadmap.

Michelle Shapiro RD  1:03:22 

As a part of my online community, formerly called Wellness Map, and now as the Quiet the Diet community, we have developed a system for people where they don’t even have to be working with either of us to get a stool test. They can literally go into my online community and get one from Kari at an amazingly discounted rate, and she will analyze it for them. This service has been so amazing for my clients, so amazing for my non-clients, just people in the community who are coming to you.

Because these lab tests can be so cost-prohibitive, and I’m not saying they’re cheap, even through this process. But generally if you’re walking into a functional medicine doctor’s office, it could be 1000s of dollars when you walk in the front door. So I purposely made the shortcut for people. It’s under “lab packages” and you will see the options for lab testing.

8 Steps to Reduce Bloating Using Functional Medicine

Let’s recap.

1. 1. It likely feels scarier than it is. So the first thing is bloating’s bark is a lot worse than its bite. In the moment that you feel bloated, rewind back to the part of this episode where Kari goes through that exercise of what you can do in the moment.
   2. Bloating is temporary. Bloating is temporary and not very dangerous. And I’m not telling you to not seek medical care, please seek medical care if you need it. But in most cases with bloating, if it’s just bloating, and you’re not showing other symptoms, and it’s something that’s frequent for you, it’s likely not dangerous. If you think something deeper may be going on under the surface, seek help from a GI doctor and/or one of our Registered Dietitians. 
   3. Calm your nervous system. Bloating can be created and further perpetuated by a sympathetic nervous system response. Turning that nervous system around is going to be your absolute first best bet. Lean into those very parasympathetic activities like laying on the ground with your legs up against a wall.
   4. Initiate movement. If you need, do things that initiate a little bit of movement to stop the stagnation that’s happening and create flow within the body. Things like gentle movement, listening to music, and taking a warm bath with Epsom salt are good ways to introduce flow. Keep your nervous system in mind the entire time.
   5. Bring heat to the gut. When it comes to actual heat remedies that can help with bloating, ginger tea is always really supportive. Anything that’s calming like chamomile tea can help a lot of people too.
   6. Promote optimal digestion. When it comes to the actual fluid or food piece of it, chewing really slowly is critical for digestion. Also, not going too long without eating but, at the same time, not eating too frequently. You want enough time for that migrating motor complex to kick in (about 2-4 hours, depending on the person). But if we go too long without eating (over 5-6 hours), like in intermittent fasting, you can have a buildup of acid that is not removed from the eating process. So you can kind of play with your meal timing.
   7. Keep it simple. Eating uncomplicated foods, really slowly, and trying not to mix too many different foods at once can be helpful. So just chewing really slowly, not having too many different types of foods might help people in those moments.
   8. When you’re eating, just eat! Alot of people multitask while they’re eating. They sit and eat in front of their computer. They’re on their phones or they’re reading something. It’s so hard for people to really just stop and kind of be with themselves even for 10 minutes, and to just stop and eat. That change in and of itself for some people is an absolute game changer in the realm of bloating, because now you’re chewing your food better. You’re engaging the cephalic phase of digestion. You’re breaking down food better. You’re supporting motility through the gut. You’re feeling relaxed. Just being relaxed and present while you’re eating and having good posture can improve digestion and reduce bloating.

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How We Eat Impacts Bloating More than What We Eat

Michelle Shapiro RD  1:09:49 

I’m laughing that we went this whole conversation without talking about food. I’m actually glad we didn’t. I’m not doing it and I’m going to tell listeners why. I want you to use your own body as a basis for understanding your bloating before you start cutting random foods out, before you start going on any of these diets. A low FODMAP diet, let me tell you, it definitely in the short term can reduce bloating for people. It’s not even a question. But, you guys already found that information out online.

At this point, if you’ve been bloated for a long time, you’ve used Google and you’ve already come upon lemon water and the low FODMAP diet. The tips that we’re giving are different. First and foremost, the most important thing is tapping into your body, and facilitating the overall process of digestion and understanding your own body. And then you can start to see if a certain food is affecting you.

It’s also important to understand that those foods are going to change over time. So it’s not if you eat onions one time, onions are forever your problem, and you can never have that food again. You will likely be able to eat that food again down the line. So I don’t get too hung up on those elimination diets when they’re not supposed to be long term.

Secondly, I don’t care about what a piece of paper says about what food someone should eat. I only care about your body is telling us. So yes, it took one hour and eight minutes for Kari and I to talk about food on a nutrition podcast.

Kari Natwick, RD  1:11:13 

It’s actually really important that we talked about all the other causes of bloating and things that can contribute to bloating first, because mostly it is not food. And if it is food, it’s because you’re not able to break down those foods because you’re not producing enough stomach acid, you’re not producing enough digestive enzymes, and/or you have dysbiosis in your gut.

Elimination Diets are Not a Long-term Solution

When you eat something that is a fermentable carbohydrate, you’re just feeding those dysbiotic bacteria. So you can’t just eliminate your way to healing. You have to consider the bigger picture of everything. Food is actually just kind of last. And I love what you said about people really tuning into their body that their body has that wisdom. Our bodies really know what feels good and what doesn’t.

Yes, some people get great relief from going on a low FODMAP diet. But I don’t think that anyone needs to go full-fledged low FODMAP. I think there’s a lot of modifications to that diet that make it much easier to implement with the same results. And that’s sometimes where I’ll start in my practice.

Michelle Shapiro RD  1:12:33 

The reason that it’s working is because you’re not introducing those fermentable particles that Kari was talking about with the bad bacteria. Food is not a root cause unless it’s a true food allergy. Listen to me, if you have celiac disease, and you’re eating gluten, straight up, that is your problem. That is the issue. Now I can also say that the root cause may be that you might have some sort of immunological or gut issue that’s causing the food allergy. But otherwise, food is not a root cause!

Even the phrase “food is medicine,” I’m a little wary on because food has healing properties in that it can initiate the process of healing, but it’s not fixing the problem. So it’s not the first place I look funny enough.

Kari Natwick, RD  1:13:40 

Unfortunately, many patients come to us having been on a low FODMAP diet for years, and they’re now saying it doesn’t work anymore. So then they start looking at more things to cut out, and they’re just cutting, cutting, cutting their way along. And again, you can’t cut your way to healing! This is actually creating more dysbiosis in the gut because you’re no longer feeding beneficial bacteria.

You are putting yourself in the position of developing vitamin and nutrient deficiencies and mineral imbalances. Just the psychological impact of that, it creates so much fear around food. And then we develop the belief that the body is betraying you in the process. It really debilitates people, and it’s just because there’s thinking about it wrong, they’re asking the wrong questions, and they’re going about healing in the wrong way.

Michelle Shapiro RD  1:14:55 

On top of that, as we cut more foods out and eat less and less, our digestive system actually slows down. And now we lose the motility and movement component that is necessary to clear this bacteria from the gut in the first place! And we need diversity of foods for that good bacteria as well.

Your first 30 days on a low FODMAP diet can feel great, because you’re not pissing your gut off during that time. But you still have to explore the root cause at the end of the day.

Kari Natwick, RD  1:15:33 

Doing the low-FODMAP diet for just those first 30 days can actually be great for creating a window of opportunity to eradicate dysbiosis, support digestion, heal your gut lining, regulate the nervous system, etc. You can reduce the inflammation and stop feeding those bacteria, which is really the magic of the low FODMAP diet. In the short-term, it just opens up that opportunity. But you can’t just do one thing. We have to use that time to focus on all of these interventions.

Michelle Shapiro RD  1:16:03 

The low-FODMAP diet kind of buys you time. Feeling chronically bloated can deplete your reservoir of resiliency to even focus on all of these things. So reducing symptoms for even a couple of days can buy you enough time to then explore things further.

All the other food and nutrition strategies are so dependent on the person. That relief for one person could be having chia seeds, relief for another could be having no fiber, or going on a carnivore diet or something. The type of dysfunction you have is going to depend on that. So anyone who gives you broad sweeping recommendations around food when it comes to bloating, that’s not our vibe.