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Celiac and bloating often accompany each other. In fact, bloating is a common symptom of celiac disease. In this post I will cover what bloating is, why it happens, and how to cope with it.
In order to understand the why behind celiac bloating, we must first understand celiac disease.
Celiac disease is an autoimmune disease that causes damage to the villi in the small intestine when gluten is consumed.
Villi are the hair-like projections in your small intestine responsible for nutrient absorption. When villi are damaged it can cause a wide array of symptoms like bloating, constipation, nutrient malabsorption, and more.
Essentially, celiac disease is a serious disease that impacts the functionality of your small intestine. Along with this comes over 300 reported symptoms.
So what is the treatment for celiac? A gluten-free lifestyle (notice I say lifestyle, and not diet). Or in other words, the treatment involves eating gluten-free for the rest of your life (or until a cure is found).
A gluten-free lifestyle should help reduce all symptoms as the small intestine heals, and you avoid gluten.
Side note: you can’t self-diagnose celiac disease. Meaning if you have a symptom, like bloating, that’s associated with celiac disease, that doesn’t mean you have celiac. You have to be tested for celiac disease (an intestinal biopsy is the gold standard) to know if you have it.
Now that we know what celiac disease is, let’s talk about bloating. Bloating is when your belly feels swollen and tight. Bloating can be a normal response to digestion or it can be a sign that something is wrong. As Beyond Celiac puts it,
Bloating can cause abnormal swelling of the abdomen. This results in the feeling of a full or tight abdomen and is often accompanied by discomfort and pain.
Bloating is caused by gas build-up, fermentation of foods in the digestive tract, fiber-rich meals, imbalanced microbiome, constipation, food sensitivities, gluten exposure, and more.
So how are celiac and bloating related? Bloating is one of the most common 300+ known symptoms of celiac disease. In fact, gluten can cause extreme bloating and gas in those with celiac disease
Bloating likely occurs because of the increased inflammation in the digestive tract when gluten is eaten. Meaning when someone with celiac eats gluten, the damage it causes to the small intestine results in bloating.
That being said, just because it is a known symptom, doesn’t mean that if you have bloating that it’s a sign you have celiac disease or that you’ve been exposed to gluten.
Bloating can be natural body response to digestion. However, it also can be a sign of underlying issues. If you’re concerned about your bloating, be sure to consult an appropriate health-care professional.
Bloating from gluten can occur from celiac disease or from non-celiac gluten sensitivity (also known as gluten intolerance). Remember, non-celiac gluten sensitivity and celiac disease are different. In the case of gluten intolerance, gluten may cause bloating due to someone’s inability to properly digest gluten.
This inability to digest gluten properly can cause gas build-up and bloat in the digestive system. Additionally, sometimes gluten intolerance is mistaken for fructan intolerance.
Fructans are a FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols). Basically, they are fermentable sugars found in gluten-containing grains, onions, garlic, and more. And these sugars can be known to trigger gas and GI distress in some people.
If you’ve ruled out celiac disease for your bloating and are considering gluten, you may want to talk to a dietitian to make sure it’s not Fructans either.
Bloating with celiac disease can be caused by gluten exposure and it can be caused by other things that are related and unrelated. This can make getting to the root cause of this pesky symptom tricky.
Bloating can be caused by gluten ingestion with celiac and it can also be caused by:
If you’re having trouble figuring out if your bloating is celiac or food related, a dietitian like myself can help you figure out what’s going on.
A common overlooked cause of bloating with celiac disease is your relationship to food. If your relationship with food is strained, then it could be causing if not worsening bloating.
For example, if you tend to be extremely stressed or anxious around food, you could be triggering or worsening bloating. This is because the stress response in your body can draw energy away from digestion and towards your limbs in anticipation of you needing to fight for your life. This distribution of energy away from your digestive system can slow digestion, causing food to sit in your digestive system for longer, fermenting and causing bloating.
Alternatively skipping meals frequently can cause bloating because if you’re not eating enough or routinely, your digestive system can slow to save energy. This slowing of your digestive system again, can cause food to sit in it for longer, causing gas build up and ultimately, bloating.
Furthermore, if you are in the binge-restrict cycle with celiac disease, and find yourself skipping meals or restricting foods only to overeat at the end of the day, you could be triggering bloating here too. This is because you can overload and overfill your digestive system, causing it to take longer to process foods and again, cause gas build up and bloating.
Lastly, eating too fast can also cause bloating. This can be for two reasons: one if you are eating too fast you may miss important fullness cues and thus, overeat and trigger bloating. Two, if you are eating too fast you could be swallowing more air then usual which can cause bloating as well.
Ultimately, addressing your relationship with food is important in reducing or eliminating bloating with celiac disease. This means making sure you’re eating enough, you’re reducing anxiety and stress around food, and you’re avoiding triggers for overeating.
Another cause for bloating with celiac disease is an improperly balanced gluten-free diet. If you’re not balancing a gluten-free diet for celiac disease appropriately, you could be worsening or triggering bloating.
This is because often a gluten-free diet is low in fiber, not getting enough fiber can cause constipation and bloating. To make sure you’re getting enough fiber on a gluten-free diet to prevent bloating, make sure you’re eating a balance go gluten-free whole grains, fruits, and vegetables.
On that same note, make sure you’re not eating too much fiber. Eating too much fiber can also cause an imbalance in a gluten-free diet and cause GI distress like bloating.
Lastly, make sure you’re drinking enough water for your fiber intake. As you increase fiber you need to increase water. This is because fiber pulls water into your digestive system so you need to be drinking enough of it to prevent bloating and constipation.
Additionally, a change in routine can cause bloating with celiac disease. Things like traveling or going to bed too late at night can disrupt digestion.
Traveling for example can cause bloating because often your schedule changes meaning meal-timing and your sleep schedule likely changes. If this happens, it can impact your circadian rhythm, and thus digestion. This is because digestion is tied to the circadian rhythm.
Your circadian rhythm is you inner body clock. It helps influence when to wake up, go to sleep, when to eat (which is why you tend to be hungry around the same time every day), and more. When this get’s disrupted, it can impact digestion, causing bloating.
Additionally, you may be eating foods outside of your normal diet which could cause bloating. For example, if you typically eat a diet rich in gluten-free whole grains and other gluten-free fiber sources, and while traveling you are eating less of these foods, it can slow digestion causing bloating.
Lastly, another routine change that can impact bloating is your water intake. If you drink to little water than normal, it can cause constipation with celiac disease which can lead to bloating. If you drink too much fluid it can also cause bloating. Thus, making sure you are drinking enough water and keeping your routine, even when traveling, can save you from uncomfortable gas build-up.
Another potential cause for bloating with celiac disease are unaddressed food sensitivities and intolerances. There are a few food sensitivities to monitor if you have celiac disease, and what’s important to know is that often these sensitivities are temporary. Often resolving as you heal small intestinal damage from gluten.
One of the most common food sensitivities to pay attention to is lactose intolerance with celiac disease. This is because with celiac, the damage to the small intestine can impact the release of the digestive enzyme lactase. Lactase helps break down the sugar lactose in milk, and if you aren’t releasing enough due to intestinal damage, then it could cause a wide-array of symptoms like bloating.
If you are considering food sensitivities as a trigger for your bloating, I strongly encourage you to work with a celiac disease nutritionist who is trained to spot these things quickly. This will make sure you don’t unnecessarily restrict and maintain the highest quality of life possible.
Celiac bloating could also be caused be common gas triggering foods. These foods commonly include artificial sweeteners, beans, cruciferous vegetables, and more. Just like with food sensitivities, working with a registered dietitian can help you identify what exactly is triggering you.
Something else that often is overlooked when it comes to celiac disease and bloating is menstruation. If you menstruate then bloating can be a part of your cycle. Often with most bloating occurring just before or during your period.
While purely anecdotal, I have observed many menstruating people with celiac disease complain of more bloating than usual around their period. While I can’t explain, it is something I have observed. For other observations and research connected to Women’s Health and Celiac Disease, click here.
Lastly, other reasons for bloating with celiac disease include other co-occurring medical conditions. These medical conditions include, IBS, IBS, SIBO, and gastroparesis.
Irritable Bowel Syndrome (IBS) can be a cause of lingering bloating with celiac disease. IBS is digestive syndrome characterized by similar gastrointestinal symptoms as celiac disease, and is given after exclusionary tests have ruled out other causes of symptoms. It’s thought that there is a higher prevalence of IBS in the celiac population, but there is no conclusive evidence to prove this.
Another medical condition that may worsen or cause bloating with celiac disease are Irritable Bowel Disorders (IBD). These include Chron’s and Ulcerative Colitis, which both can cause bloating during flares.
Small intestinal bacterial overgrowth (SIBO) is another condition that can cause bloatng with celiac disease. Celiacs who are not improving after going gluten-free are thought to be at higher risk for SIBO. It’s thought to develop due to the damage to the small intestine. It is characterized by painful gas, bloating and diarrhea.
Lastly, gastroparesis could be a cause for celiac bloating. It’s a condition that impacts the movement of your digestive tract, typically slowing it down and thus causing food to build up gas as the move unusually slowly through your digestive system.
The good news is, if any of these things are the case for you, there are some interventions that could help the bloating from other medical conditions with celiac disease. If you’ve received any of these diagnoses with celiac, be sure to let your dietitian know so they can tailor your eating habits to help reduce associated bloating.
Whether bloating is caused by normal digestion or caused by a specific trigger that needs to be addressed, it can impact your body image with celiac disease. Often people struggle with managing a bloated belly, feeling like a failure, or feeling ugly when it happens.
When struggling with how bloating impacts your relationship to your body, neutralizing the conversation can be helpful. Remember, bloating is not good or bad, it’s just information. Consider the following:
Mantras like those listed above can help with negative self-talk in the moment. However, in the long term, exploring your values and beliefs around bloating can be helpful. What’s the story you’re telling yourself about bloating? Do you feel it makes you look less beautiful? Less worthy? Lazy? Then explore why this is the story you tell yourself and unpack the narrative. How does this tie back to your values? A GI Psychologist or Body Image Dietitian (Hi!) can be helpful with this if you’re struggling to do it on your own.
Bloating with celiac disease can be very uncomfortable, so naturally, people want to know how long it will last. If the bloating is from gluten, it can take anywhere from 2-3 days for gluten to leave your system, and the bloating usually matches that.
While not great news, that means you can expect to be bloating from gluten exposure with celiac for around 2-3 days. And currently, we have no proven medications or supplements that will prevent or shorten this time frame.
We do however, have treatments for non-celiac gluten sensitivity that target this completely different condition. For more on the difference between gluten intolerance and celiac disease, check out this post.
While we don’t have any proven treatments to shorten celiac-based reactions, what we do have are ways to soothe the bloating while you wait it out.
Unfortunately, the only way to get rid of bloating from gluten is to wait it out. Though there are some things you can do to soothe it. Below are tips on alleviating bloating:
Are you still struggling with bloating? Do you feel like you’re doing everything right to minimize the painful swelling of your belly but it just isn’t getting better? There are lot of reasons for this and I want to reassure you, you’re not alone.
I’ve helped many clients relieve lingering bloating after a celiac diagnosis. There’s a lot that can cause this so if you need help, consider working with a Celiac Dietitian to find relief.