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

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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.

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