On Dr. Joseph Salhab’s TikTok page, bloating is a hot topic. The gastroenterologist, who often broadcasts from the front seat of his car and goes by “The Stomach Doc,” likely reaches more people on the social media platform than he’ll ever see in his Florida practice: Just one of his posts about the five breakfast foods that won’t cause bloating has been viewed 13 million times. For scope, it’d be as if Dr. Salhab, whose practice cares for patients in the cities of Davenport and Lake Wales, saw the entire population of his hometowns 358 times.
When you type the word bloated into TikTok, you’re met with more than 80 million posts. Many of them feature legging-clad women in side profile showing their noticeably distended bellies, some even joking about appearing pregnant: “My favorite game: being bloated in public and getting to cosplay being pregnant” reads one post with over two million likes. Brands have been watching, too: There’s been a rise in techniques, products, and supplements all promising to be the golden ticket to deflation.
Lymphatic drainage (the massage technique believed to sculpt and reduce swelling on the body and face) has racked up millions of views and birthed a wave of experts with followings (and waitlists) thanks to high-profile clients and dramatic before-and-after photos. Influencers tout the benefits of quick-fix diet hacks like dandelion root capsules or three-times-daily drink blends (apple cider vinegar, lemon, and cayenne pepper or mint, lemon, and baking soda are often namechecked) to swiftly flatten bellies before a wedding or big event. Then there are the endless bloating supplements promising one-and-done solutions. “Have your carbs and debloat, too,” claims one of Hulu’s Mormon Wives about HUM’s Flatter Me gummies. “Bloating? Don’t know her,” says a fitness influencer promoting shakes by Flat Tummy Co., a company that both Kim and Khloe Kardashian have sung the praises of in the past. “Fastest way to eliminate belly bloat and feel your best,” intones a voice-over on an Instagram post for Viome’s gut health tests. Try Ryze adaptogenic mushroom coffee because “you could be filled with gas and toxic buildup,” suggests another post.
But ask any medical professional, and they’ll say that one-size-fits-all solutions aren’t the way to actually treat bloating. It’s a symptom that has many causes and is more multi-factorial than breezy social media posts suggest. Bloating is also, despite the alarm-raising way it’s spoken about online, bloating is often very normal. “People have really lost track of what’s normal versus abnormal, because gas and bloating are extremely normal,” says Brian E. Lacy, MD, a board-certified gastroenterologist at Mayo Clinic. A survey study of nearly 89,000 US adults found that 14% (that’s 1 in 7) had symptoms of gas, bloating, or distension within the past week. “Bloating is a sensation (and that’s a key point because it’s a sensory phenomenon) of gassiness, while distension is a physical manifestation that patients report as their abdomen looking swollen or pregnant, or like a balloon or basketball,” says Dr. Lacy, distinguishing the two. But bloating naturally happens. It’s only when it becomes chronic that it’s a problem. “When it’s every time somebody eats, or they wake up bloated daily, or they always feel six months pregnant with bloat by the end of a day, then that would be more concerning,” says Heather Finley, a registered dietitian with a doctorate in clinical nutrition whose practice is focused exclusively on gut issues.
Because bloating is a symptom that can arise from many sources, it is referred to as idiopathic (a word to describe a disease of unknown cause) and often treated empirically (when you begin treatment without a definitive diagnosis). One common cause Ali Rezaie, MD, director of the GI Motility program at Cedars-Sinai in Los Angeles, sees is small intestinal bacterial overgrowth (or SIBO), when there’s an imbalance of microorganisms in the gut. That bacterial overgrowth can be a result of surgery (like a C-section or bariatric procedure), autoimmune diseases like IBD or celiac, and medications that slow down the gut.
Dr. Rezaie mentions the class of GLP-1 drugs as a newer culprit. Constipation and food intolerances frequently lead to bloating, too. “Carbohydrate intolerance (lactose, sucrose, fructose), excess fiber, ingestion of legumes, cruciferous vegetables, and use of sugar-free products (especially those ending in -ol, like sorbitol or erythritol) are common reasons to develop gas, bloating, and distension,” says Lacy. Lactose intolerance is present in up to 35% of white adults and in greater numbers among Asians and African Americans. Then there is visceral hypersensitivity, which qualifies as an increased sensitivity to pain in certain areas of the body, including the stomach and intestines. “The GI tract has a lot of sensory nerves, and in a patient with IBS who has a sensitive GI tract, normal amounts of gas may be sensed abnormally as pain or discomfort,” says Dr. Lacy.
There are also hormonal factors that lead to bloating. Endometriosis, an inflammatory condition stoked by hormonal changes, is often characterized by a swelling known colloquially as “endo belly.” For Amy-Jane Davies, endo (and endometriomas, which are cysts on your ovaries) is the root cause of her perpetual bloating, something she felt massively self-conscious about when first diagnosed. But it was sharing her own story on social media that helped to quiet those feelings of ill ease.
“I soon came to realize that my endo isn’t going anywhere,” says Davies. “Neither is my underbelly so I learned to accept it for what it is and no longer hide it,” says Davies. Bloating is also always increased prior to and during your menstrual period, says Judy Nee, MD, a gastroenterologist at Boston’s Beth Israel. This is very common and not a warning sign of something dangerous, and is thought instead to be representative of the fluctuations in sex hormones (estrogen, FSH, LH) happening, says Lacy. Those hormonal shifts can have a ripple effect on gut motility and microbiome diversity during the menopause transition, too, when women often report more gas and bloating (often dubbed “meno belly”). Though, adds Dr. Nee, it’s a time that is often so disordered in terms of your bowels, diarrhea and constipation, and weight gain, that premenopausal women are regularly excluded from GI studies, which means we don’t know nearly enough.
What we do know is that bloating impacts women in far greater numbers than men, no matter what their life stage. Hormonal fluctuations are a big reason, but so is stress. Sandra Chiu, a Brooklyn-based TCM practitioner and acupuncturist, cites stress as a common factor among many of her bloating clients. “Stress really disrupts or impedes our gut’s ability to function well,” says Chiu. Finley echoes that, saying stress levels among her female clients who are juggling a lot are higher and can translate into gut motility issues that arise from eating too fast, not chewing their food enough, and skipping meals.
“Diet culture paints it as a badge of honor, like I was so busy I forgot to eat lunch,” says Finley. Restrictive diets can have a cumulative negative impact on the gut, and someone’s proclivity for bloating, too. “If somebody has been on a really restricted diet or cutting out a lot of fibrous foods for a long period of time, they have slowly shrunk the amount of beneficial bacteria in their gut, and it’s harder for them to actually digest,” says Finley. Bree Lenehan, an Australian influencer, finally got diagnosed with IBS after years of bloating and trying various diets and hacks to deal with it. “My doctor says my bloating and IBS were actually a result of years of dieting,” says Lenehan. “I possibly wouldn’t have even had this kind of severe bloating in the first place if I weren’t sold so many diet fads in my younger years.”
So, are we actually more bloated than in years past or just more hyper-aware of bloating thanks to our algorithms? Chiu thinks the social media influencer feedback loop is fueling the fire. “The more content you see on bloating, the more you may think you’re bloated too,” she says. But Missouri-based functional dietitian Rachel Muzzy was hearing about bloating so frequently from her clients that she pivoted her practice to center around it shortly after opening in early 2020; she goes by “bloat-free nutritionist” on social media. Camila Perez, founder of MOVA, a popular lymphatic drainage studio with locations in New York and Miami (and regulars like Penelope Cruz), says that in over twenty years in business, bloating is now the most common complaint. “I believe we are seeing more people experience bloating because our bodies haven’t adapted at the same rate as environmental, nutritional, and behavioral changes,” she says. And Dr. Rezaie reports that he’s witnessed a significant increase among patients in his medical practice, too. “Clinically, what I see is that the percentage of bloating and the severity of distension have dramatically increased,” says Dr. Rezaie. “It’s not just social media hype.”
Doctors believe there are a host of reasons for that uptick. There is the fact that autoimmune diseases (which can lead to bacterial overgrowth) are on the rise. The same goes for food poisoning. “Whenever you get food poisoning, you have an increased chance of having long-standing GI symptoms, including bloating,” says Dr. Rezaie. The CDC estimates that 48 million people get sick yearly. Then there’s the increase in IBS, which affects close to 15% of the US population, with 80 million Americans experiencing a GI event weekly. Lacy points also to higher usage of antibiotics (which can alter the gut microbiome) and the evolution in our diets—the average American ingests almost 40 pounds of high fructose corn syrup yearly, and bread is now often fast-rising, which means less time to break down complex sugars, both of which cause bloating. Bloating is simply more commonly reported nowadays, too. “Increased awareness feeds into increased reporting,” says Lacy. “And no different than with eating disorders or menopause, things nobody used to discuss, people now feel more comfortable talking about bloating.”
And companies feel more comfortable marketing products touted as one-and-done solutions to them; with more bloating has come more opportunism. “Everyone is searching for the one probiotic or supplement or lifestyle modification that will make the change, and I haven’t found it,” says Dr. Nee. That’s because bloating is extremely variable; it’s a symptom, so treating it requires seeking out the underlying causes and targeting specific biomarkers, says Rezaie.
Gastroenterologists will use a battery of tests to rule out issues like SIBO, and Muzzy often relies on stool testing to help give her a snapshot of what’s happening in clients’ guts. Finley will have many clients cut out excess amounts of cruciferous vegetables, beans, raw foods (too much salad is a frequent bloating culprit), and work on meal hygiene (chewing well, taking 20 minutes to eat, not eating while distracted). Both Finley and Lacy recommend adopting a low-FODMAP diet to treat symptoms of the gut like bloating, but emphasize that the six-week elimination diet is a temporary tool. “It’s not meant to be a lifestyle,” adds Finley.
Debloating supplements, of which there are now many, are not tested for bloating specifically. “Their primary endpoint is whether it improves abdominal pain, and then also happens to improve bloating,” says Dr. Nee. A number of probiotic brands like Lemme, VSL #3, and Seed have conducted randomized clinical trials to support the efficacy of the microbiota strains in their products to address bloating, and the results were supportive. But the placebo effect with probiotics studies is also high—so it’s often hard to tell what is working. “It’s not a bad thing, but patients do tend to improve by taking anything, and that just means it’s tougher to tout one probiotic or strain,” says Dr. Nee. Not to mention, adds Lacy, that there is no certainty on the right dosing or combination. Because bloating is so multi-factorial, finding relief with diet modifications or a supplement requires trial and error. Dr. Nee suggests trying something like a probiotic for two to three months and then assessing how much better you feel; if there hasn’t been a significant improvement, switch it out. The problem with many of the products being pushed by influencers and touted by marketing campaigns as magic in a bottle is that there are no quick fixes here. “The evangelism almost always outpaces the evidence,” says Ara Katz, cofounder of Seed.
Many turn to Dr. Google and social media because they are frustrated. “People are bothered by these symptoms and are willing to try all types of interventions, often without much data, to improve them,” says Lacy. Hailey Karcic, a college student studying occupational therapy, first shared a video of her bloated belly in 2022 because she didn’t know what was going on; she’s since tried a number of diet modifications (like cutting out dairy and gluten) and supplements and even had a colonoscopy to try to get to the root of her bloating but it remains a mystery. “There are times when I feel disgusting and I don’t even like looking at myself in the mirror or trying to fit into my clothes,” says Karcic. “I just feel defeated.”
While social media is filled with flimsy, quick fixes and hacks for bloating, not to mention impossible (often filtered) beauty ideals for women (and men, too) to live up to, it’s also become a safe haven for commiserating about how needless these insecurities are. Lenehan started using her platform as a space to openly chronicle her body’s fluctuations, which she sees as just another part of keeping things real with her audience (she has 1 million followers on Instagram and 450,000 on TikTok). The reaction has been mostly positive and has shown her how many people are experiencing the same thing. “I caused myself long-term gut health problems to reach a beauty standard that didn’t exist because no matter how lean you become, your body is still going to expand, fluctuate, roll, wobble, and squish,” she says. “The beauty and health industries know they can make big bucks selling ‘solutions’ for our insecurities.”
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