The swelling of the abdomen, retention of water and accompanying feeling of fullness occurs for wide and varied reasons -- hormones, unhealthy diets, and food allergies, to name a few.
It's an uncomfortable part of life. It could be caused by something simple -- such as lactose intolerance or air swallowing. But it could also be indicative of a more serious problem, such as diverticulosis or ovarian cysts.
Robynne Chutkan, a nationally renowned gastroenterologist, constantly has friends and acquaintances ask her about their inexplicable bloating. They pull her aside in yoga class, at her daughter's soccer games and in the supermarket to ask how to battle their bloat. At their doctor's office, many receive just a pat on the back and some lifestyle tips, or maybe an antacid prescription.
They were told it was stress, it was hormones, it won't kill you, it will go away.
"Doctor's are looking for cancer and sort of big, dangerous diagnoses," Chutkan said. "But bloating is a big deal, and it's always something that should be investigated. It's something that 99.9 percent of the time, we can do something about."
Chutkan is a regular guest on the Dr. Oz Show, and has made appearances on the Today Show, the Doctors and the Early Show. In 2004, she founded the Digestive Center for Women in the Washington, D.C., area where she and her husband, 1985 Beaufort High School graduate Eric Mann, reside. Her mother-in-law lives on Lady's Island, and Chutkan and her family visit frequently.
In her recent book "Gutbliss: A 10-Day Plan to Ban Bloat, Flush Toxins, and Dump Your Digestive Baggage," Chutkan gives a complete overview of the gastrointestinal tract -- of food's journey from start to finish -- and explains how better digestive health ultimately leads to a healthier, more comfortable, more energized life.
We talked to Chutkan about the bloat battle, eating healthy in the Lowcountry, and how to balance the good and the bad without depriving yourself of the comfort foods you love.
Question. How is bloating different from women and men?
Answer. Some of the causes of bloating are really unique to women. Women have longer colons, on average 10 centimeters longer. We have a wider pelvis. We have more pelvic organs -- we have a uterus, fallopian tubes, ovaries.
As a result, women have this very twisty, turny, what I like to call a "voluptuous colon," and men have a much straighter colon. For men, the stool has a much straighter shot out of the colon.
Some of the causes of bloating are equal opportunity employers. Things like food, gluten intolerance, air swallowing, gastroparesis. But there's anatomical differences.
Hormonally, estrogen and progesterone can bloat us. Estrogen can make us retain water. Men have a higher testosterone levels which means they have a tighter abdominal wall, so they have this kind of built-in Spanx situation.
Q. The Lowcountry diet isn't exactly the picture of health. How can we navigate Southern cuisine in a healthier way?
A. It's much less about what you're eating than what you're missing. So it's not the fried oysters that are going to kill you, it's the lack of the fruits and vegetables. The fried food can crowd out the healthy stuff, so make sure you're leaving room on your plate. By all means, have some fried oysters, but have some steamed okra with it and a big plate peaches afterwards for dessert.
Q. What tips do you have for eating barbecue and making that meal healthier?
A. There's literally a million ways you can sort of have your brisket and eat it too, but have less of it.
One of the things that people should be aware of is that a lot of grilled and charred and smoked meat increases the risk of stomach cancers because of nitrates in the food.
Second caution is if you're using a lot of barbecue sauce, it can have a ton of sugar in it. You might want to think about making your own sauce or cutting down on the amount of barbecue sauce you're having.
And of course, maybe go with the leaner meat. Something like pulled barbecue chicken is going to be better than brisket because chicken is naturally lower in fat.
If you're thinking of your typical barbecue plate, cut it in half and save it for lunch the next day. Then take that half of the plate and fill it with vegetables. You're going to feel so much better.
Q. So we shouldn't be cutting out foods we love, even if they aren't "health foods"?
A. So much of the time people get this all-or-nothing mentality. Today, I'm going to pig out, but tomorrow I'll be better.
But tomorrow sort of never comes.
And I think part of what promotes that sort of thinking is thinking of certain foods as good and others as bad.
I don't think that's healthy. You have to recognize the health benefits and the nutrient benefits of certain foods. You recognize brisket and pulled pork are not health foods, but it's okay to have some.
I try not to deprive myself of anything, but I think about how I can make my plate healthier. Whatever you're eating, if you can put a heaping mound of vegetables on it, you're so much better off.
Q. What are some good ways to incorporate vegetables into our diets?
A. I find so often that people do so much to the vegetables, and you really don't need to. You don't have a cook the vegetables to death.
Vegetables come with their own enzymes intact. Literally from the second you pick it, the enzyme activity starts to decrease. That's why local, fresh produce is so much better than something flown in from Cuba that's been sitting for a week.
The enzymes of the plants help you digest. When you cook vegetables, you also destroy a lot of the enzymes that come with them.
And the more you cook them, basically the more you errode the nutrient benefits of the vegetables. As much as you can, have stuff that's lightly steamed or raw. I get string beans, and I just wash and steam them. They have so much more flavor. I'll chop up tomatoes with a bit of balsamic vinaigrette and some black pepper, and that's all you need.
Q. What are your recommendations on caffeine?
A. A cup of coffee is fine, if you can keep it to a cup a day. If you have bad heartburn, you might want to get rid of it all together. Coffee is a stimulant for the gastrointestinal tract. If you are prone to diarrhea, you have to be careful with caffeine.
Q. What about soda?
A. I'm asked what is the worst thing you can put in your mouth: it's soda, and diet soda, without hesitation. If you did nothing else but got rid of soda, you'd be twice as healthy.
Diet soda is one of the worst things we can drink. Artificial sweeteners don't get absorbed in the small intestine, that's why they don't introduce calories. They end up traveling to the lower intestine and get fermented by bacteria and produce so much gas and bloating.
People think, "Oh this is great; it has zero calories." Totally not the case. It can still raise insulin levels and cause weight gain. Those artificial sweeteners not only cause gas and bloating, they're associated with migraines and all kinds of terrible problems. It seems really tempting because this doesn't have any calories, but we should be naturally suspicious of that.
Even if you're drinking regular soda, that's terrible too because of all the chemicals in it.
With the endoscopes that we use for colonoscopy and endoscopy, when they get clogged we use soda to unclog them because it's just like jet fuel. It just breaks through all the hair and dirt and whatever's clogging it. It's like Drano. That whole rusty nail thing is pretty close to the truth, so you don't want to be putting that in your gastrointestinal tract.
Q. What do you hope is the biggest takeaway from "Gutbliss" for readers?
A. I want people to realize that, as Hippocrates said, "All disease begins in the gut."
Your GI tract is your engine for your entire body. If your digestive engine is not working well, you're not going to feel well, you're not going to be healthy.
I want people to realize that good digestive health is within our reach for almost all of us. If you have access to fresh air to get some exercise, fresh vegetables to eat, water to drink ...it's not complicated.
You just have to create some healthy habits. It doesn't mean you can't have any fun either. You can have coffee and alcohol and some fried oysters, but you have to do the healthy things to. And the healthy things are nice.
I want to unravel the mysteries of the black box of the digestive tract for people so people understand how their gastrointestinal tract works and they understand what they need to do to keep it healthy.
And the goal is that you don't have to come see me. I hope to bump into you at the farmers market instead of my office.
Follow reporter Laura Oberle at twitter.com/IPBG_Laura.