I don’t know if it’s the nature of my job, but it seems like every woman I speak with seems to struggle with bloating. Trust me—I get it. A full, distended abdomen is no fun. But what made the experience of bloat so painful for me in the past had less to do with the physical sensation of pressure in my tummy than it did with my body image struggles. When I felt bloated—or fullness of any sort—I thought I looked fat. Because of my terrible relationship with food and my body, this was a completely agonizing.

As I shared in this post, any sensation of tightness of pressure in my belly…if I thought the circumference of my waist had changed even a millimeter…I would totally flip out. The expansion of my stomach made me so uncomfortable that I actually would refuse to take full, deep breaths because I didn’t like the sensation of my belly pushing against my waistband. Instead, I’d suck in my stomach and take shallow, chest breaths. This dysfunctional pattern eventually led to neck pain and headaches. Sometimes, I am shocked when I sometimes think of the preventable symptoms I endured for the sake of my eating disorder.

For this reason, bloat was a particularly objectionable health experience for me. Any sort of gas was only made worse by my fear of looking puffy. If I didn’t have regular bowel habits that day, I felt depressed and anxious for the whole day because I felt like I’d gained weight. If I ate a large volume of food (which happened often, because I was frequently gorging myself on raw vegetables), I was miserable, even if I was still within the confines of my “calorie goal.” But the feeling of fullness horrified me, even if it was only from fiber and water (and air!)

Can you relate?

Many of the women I work with clinically complain of bloating. Since my specialty is functional medicine, the expectation of many new patients is that I will put them on a restricted diet such as an elimination diet, or diagnose them with a food allergy and forbid them from eating anything delicious. This is a huge misconception about the practice of functional medicine, and while nutrition and other lifestyle factors are certainly important considerations when evaluating a patient from a holistic perspective, food is by no means the whole picture. Furthermore, it’s also very infrequently the root cause of someone’s problem. (Sure, certain foods may flare up a condition like IBS or migraines, and diet modifications may help manage certain symptoms. But the food isn’t what causes those things. However, that’s a topic for another time.)

Truth be told, bloating isn’t all about the food. Cutting out dairy won’t necessarily cure chronic bloat. That only works if the reason you’re bloating is 100% due to a dairy allergy. The same is true about gluten, or corn, or anything else. In fact, starting up a new, highly restrictive diet regime can, and often does, make problems like bloating worse.

The are quite a few reasons for this, really, and that’s because bloating can be caused by so many different things. Believe it or not, occasional bloating is normal. It might not feel that way, because Instagram fitspo models rarely look bloated. But our stomachs naturally expand throughout the day. I used to think that eating made me bloated. Turns out, the physical volume change caused by putting food in my stomach made my tummy puff out a little. That wasn’t bloat. It was just volume. Bloating before my period? Also normal. Progesterone is the prominent hormone in the luteal phase of the menstrual cycle, and part of its job is to slow down digestive processes. When digestion slows down, food stays in the intestines longer, taking up space, and trapping gas. This bloating doesn’t always feel great, but it’s actually a sign that your body is behaving exactly like it should! Without the proper level of progesterone, we would suffer all kinds of fallout from hormonal imbalances.

Of course, not all bloating is normal. Sometimes it’s an important symptom of a deeper problem, and it certainly shouldn’t be ignored if it’s a chronic issue. However, in today’s post, I wanted to highlight a few of the lesser known causes of bloating—things that have nothing to do with the gut microbiome or food allergies/intolerances. (Hint: they can’t be cured with a probiotic supplement.)

Common Causes of Bloat

1. Stress

Our nervous system can be divided into two parts: the somatic nervous system (nerves that tell muscles to contract) and the autonomic nervous system. The autonomic nervous system is responsible for everything that happens in our bodies that we can’t consciously control—things like heart rate, sweating, temperature, and digestion. This autonomic system is further divided into two parts: the sympathetic (also known as “fight-or-flight”) and the parasympathetic (also known as “rest-and-digest.”) The key thing to know about the sympathetic and parasympathetic nervous system divisions is that they can’t both be activated at the same time. That means, if we are in a high stress state, or a fight-or-flight state, we are therefore not able to “rest and digest.” No digesting means bowel motility slows way down. Remember that conversation about progesterone slowing down the bowel? Stool and gas get trapped in the intestines, leading to bloat.

Cutting out food groups won’t cure your stress. In fact, it’ll probably add to it. I realize that the media likes to make a big deal about “miracle diets” that can “banish bloat forever” and other sensationalized claims. But those diet plans rarely work, and they require enormous amounts of time, effort, and money to follow perfectly. Allocating resources to something like dieting is a major source of stress for many people.

2. Too much exercise

Exercise really is a form of stress. A little stress can be good for us, and that’s part of the reason we receive health benefits from regularly engaging in moderate exercise. But too much of a good thing becomes a bad thing, and that’s true of exercise too. Excessive exercise leads to elevated cortisol, and this chronic stress response creates all kinds of hormonal problems for us via the HPATG axis. Too much exercise also often leads to mild dehydration, which makes stools difficult to pass, trapping gas and causing a backup. Oh, and bloat…

If you’re concerned that you might be exercising too much, check out this post: How Much Exercise Do We Really Need?

3. Disordered eating

One of the most common physical complications of disordered eating is bowel disturbances. Yo-yo dieting messes with our digestion is quite a few ways. First of all, an energy deficit leads to a self-preservation response in the body where it slows down the digestive process, keeping food in the intestines longer with the hope of absorbing more nutrients before expelling the stool. This slowed digestion has the same effect as slowed digestion from any of the other causes…bloating.

Irregular eating patterns, especially those characterized by skipping meals or going too long between meals/snacks, leads to blood sugar dips. This triggers a stress-mediated “starvation response” in which the body shuts down non-essential functions in an effort to preserve energy. If there’s no food coming in, the digestive process is therefore “non-essential.” So, it’s among the first to get crossed off the list of bodily processes. Less digestion = back up of stool = trapped wind = bloat.

Disordered eating patterns characterized by overeating, binge eating, vomiting, or use of laxative actually damages the nerves involved in the digestive process. The gastrocolic reflex refers to the nervous-system-mediated urge to defecate after the stomach is filled. When eating patterns are erratic, or vomiting/laxative use is common, those nerves become damaged and the reflex is eliminated. This means food goes in with a lesser likelihood of it being let out in a timely manner. Once again, food gets backed up and leads to bloating.

4. Maybe you’re not actually bloated

I’m not trying to invalidate your lived experience here, I promise. You know your body better than anyone else does, and you have a right to be heard when you’re experiencing something with your health that doesn’t feel right. But I do want to highlight this topic a little because it’s common. If this is your experience, you’re not alone, and there’s a way out.

I’ll circle back to myself. I mentioned earlier that there were many instances throughout my disordered eating journey that I struggled with bloat. My bloat experiences ran the whole gamut of the causes I just explained…stress, over exercising, under eating, making myself throw up, using laxatives, blood sugar fluctuations, PMS…

But there were also many, many years that I thought (hoped?) I was bloated because of a food allergy or intolerance, or I believed that the bloat was from eating “bad” food when in reality it wasn’t. I cut out dairy, and my symptoms would improve for maybe a day, and then they’d come back. Even though dairy *clearly* wasn’t the issue, I’d stay away from dairy and then cut out gluten. Then dairy, gluten, and corn. Then dairy, gluten, corn, and FODMAP foods. It didn’t help, and my diet would just get more and more restrictive until I’d end up binge eating, feeling really bloated, and further convincing myself that food was the problem.

But the food wasn’t the problem. Binge eating the food was the problem. Or avoiding the food, or throwing up the food, or all the other disordered things I did with food, like drinking excessive amounts of diet soda. (I was literally drinking myself into gassiness and bloat.) But sometimes, I wasn’t actually bloated at all, I was just so intolerant of the sensation of food or fullness in my stomach that I was desperate for an explanation. I craved a reason for my discomfort, and I was totally in denial about my eating disorder.

It took me a long time to be okay with feeling full. I thought that feeling hungry and empty was good because it was basically the only time of day that I had a flat stomach…even when I was significantly underweight. But I finally realized that in order to live my life, I need to give myself permission to eat, and that means giving my stomach permission to change size. After all, if I needed my body to stay the same size in order to feel okay, then I was putting my hope and trust in the wrong thing.

Bodies change.