How to Fix Bloating And Flatulence

Bloating and flatulence are two nasty chronic conditions because they are visible, painful, audible, and stinky. The ‘audible and stinky’ factors aren’t compatible with acceptable norms in most societies and are a serious problem while in school, at work, on a date, or with family past the age of three. Fortunately, with the right know-how, both are fixable and preventable. This article shows how.

Your intestines generate up to 5.5 liters of gas daily, primarily carbon dioxide (CO₂), and all of it by design. About 3 liters are generated in the small intestine while neutralizing gastric acid, and up to 2.5 liters are generated by bacterial fermentation inside the large intestine. It sounds like a lot, doesn’t it?

Actually, it isn’t:

If you imagine opening three 2-liter soda bottles all at once, the gas that fizzes out is roughly five liters of CO₂.
At room temperature, five liters of CO₂ would fill a space about the size of a soccer ball.
The same amount of CO₂ liquified would weigh just 9.8 grams.
If you inhale normally, you breathe out about 25 ml of CO2. So, 5 liters of CO₂ is about 200 normal exhales, or about 17 minutes at 12 breaths per minute.

So, why, then, are bloating and flatulence so bothersome?

They become bothersome when the gas gets trapped inside the intestines and has no way out. Imagine blowing more gas into the ball than it can hold. Since it isn’t elastic, it will eventually explode.

Same thing with the intestines, except for the explosion bit. First, the intestines will expand and distend the abdomen (what we call “bloating”); second, the trapped gases will exit the body with a loud belch or a loud fart.

Until then, you’ll feel pain and cramps because the abdominal cavity has only so much space to accommodate expanded intestines. At one point, they’ll begin to pressure pain-sensitive organs inside the abdomen, and you’ll definitely feel pain.

Naturally, the next two questions are: but why do gases get trapped in the first place, and how do I untrap them?

Let’s delve into it…

Why is gas measured in liters?

Liters measure volume, not weight. That’s why a one-liter jar of water weighs about one kilogram, while the same jar filled with liquid mercury weighs about 13.6 kilograms.

Also, unlike water or mercury gases are compressible, so their weight doesn’t indicate how much space they’ll take up, which is what usually matters in medical or physiological contexts.

The mass of gas (in grams or kilograms) is tiny and varies with pressure and temperature. For example, 1 liter of CO₂ weighs about 1.96 grams at standard conditions. But if compressed or cooled, the same weight can occupy a much smaller volume.

At normal room temperature and atmospheric pressure, gases naturally expand to fill the space available. That makes volume the most meaningful and consistent way to describe how much gas you have, regardless of its weight or density.

What’s the difference between the pain in the gut and pain in the butt?

It’s close but not the same. Before we start untrapping the gases, that, in fact, may become a considerable source of “pain in the butt” from tensing anal muscles to prevent flatus when not alone.

But before we get this far down, I would like to address the technical issue of the abdominal pain from gas and bloating. Here are its primary causes:

Tension on the mesentery. The mesentery is a fold of connective tissue that attaches the intestines to the abdominal wall. The mesentery contains blood vessels, lymphatics, and nerves that supply the intestines. When intestines become distended with gas, they can stretch the mesentery and produce deep, dull, or cramping abdominal pain.
Compression of the parietal peritoneum. Parietal peritoneum is a richly innervated outer lining of the abdominal cavity. If gas-filled intestines press outward or if your doctor’s fingers press in, the peritoneum can trigger localized sharp or aching pain with or without gas.
Feedback from adjacent solid organs. Pressing on a distended abdomen may compress the liver, pancreas, uterus, bladder, ovaries, or kidneys, especially if those organs are already inflamed, congested, or displaced by bloated intestines.
Intestinal wall tension. While the abdominal wall itself isn’t highly sensitive to sharp stimuli, rapid distention from trapped gas activates stretch receptors and causes discomfort. This pain is diffuse and hard to localize.
Palpation of the lower abdomen. The uterus, ovaries, and bladder can all cause palpation pain in the lower abdomen, even without bowel bloating. Period, inflammation, fecal impaction, and fluid retention can increase this sensitivity.
Hypersensitivity. Some people react to normal amounts of gas or pressure with exaggerated pain. This is common in chronic IBS, IBD, and post-inflammatory states.

The more you understand where the pain is coming from, the easier it becomes to respond appropriately. Not all abdominal pain is caused by gas, and not all gas-related pain means you’re bloated.

Knowing these points is also important because they help you distinguish between benign discomfort, such as after overeating, a tight belt, or during a period, and symptoms that may point to more serious issues.

One abdomen, but multiple causes of bloating

Temporary abdominal bloating related to recent meals typically originates in the stomach and small intestine. When the stomach becomes overly full from large meals or slow gastric emptying, it can visibly expand and push the abdominal wall forward, creating a bloated appearance.

When this pattern becomes habitual, the stomach may remain permanently distended, a condition often referred to as a “beer belly.” While commonly associated with fat accumulation, much of the bulge actually come from the structural deformation and low tone of the upper abdominal cavity.

Consuming large volumes of food stretches the stomach wall beyond its comfortable capacity, leading to visible distention, pressure, bloating, and a sense of fullness that may last for hours. The digestive system slows down to manage the excess load, which increases fermentation, gas production inside the stomach, and reflux risk.

Gastroparesis is a stomach disorder that causes delayed gastric emptying even with moderate amounts of consumed food. As a result, food sits undigested in the stomach for prolonged periods, often causing distention, nausea, early satiety, and discomfort.

Most people assume that bloating is caused by gas in the large intestine, but that’s rarely the case. The large intestine wraps around the outer edge of the abdomen and is better at getting rid of gas with flatus (i.e., farts). Gas in the large intestine may cause sharp cramps or pressure, but not visible distention.

The most visible and uncomfortable form of bloating typically originates in the small intestine. Since the small intestine sits centrally in the abdominal cavity, any buildup of gas causes it to expand outward and upward, producing the classic distended “pregnant belly” appearance.

This type of bloating often worsens as the day progresses and subsides by morning, once the gas dissipates through absorption into the blood and via the lungs, or exits the body through the stomach via the mouth, or through the large intestine via the anus. I’ll explain how all this happens further down.

To summarize, If your abdomen feels tight, full, and visibly bloated after meals, it’s primarily the small intestine’s fault.

There are many more causes of bloating besides the stomach and intestines

This article will focus only on the bloating related to excessive gas, a predominant functional condition that can be corrected with diet changes.

The abdominal cavity is the home to 10 major organs, other than the small and large intestine, and any one of them is a potential troublemaker. These organs include the liver, stomach, pancreas, spleen, gallbladder, kidneys, adrenal glands, bladder, uterus and ovaries in women, and the prostate gland in men — and, from an anatomy point of view, the abdominal wall is also an organ.

I identified over fifty causes of abdominal bloating in eight groups: functional GI condition, diet-related, obstructive, reproductive, infectious, caused by adjacent organs, oncological, and medication-induced. Six of these groups are unrelated to intestinal gas.

Most medical doctors, outside of GI specialists and radiologists, aren’t trained in diagnosing all of these conditions. So if you notice any kind of bloating that has some permanence to it, spending five to ten minutes with a family physician who isn’t particularly curious or focused may not be enough to determine a correct diagnosis.

It isn’t difficult to distinguish gas-related bloating from other causes because gas in the small intestine is directly connected to previous eating, and gas in the large intestine manifests itself as flatus.

In most cases, the gases are present in the small and large intestines at the same time because excessive gas from the small intestine can migrate into the large intestine whenever the ileocecal valve opens up to let the chyme through.

The gases from the large intestine can also go back into the small intestine during the same process if there is more inside than it can handle. If in this case your small intestine is healthy, it will not bloat, because all of the gases will get absorbed back into the bloodstream, and leave the body through the lungs.

The excessive gas from the small intestine can also go back into the stomach and leave it belching whenever the esophageal sphincter opens up to let in the food or saliva that you may swallow in.

All of the above are the reasons why you can hold the gases while at work, and why the bloating dissipates by the time you wake up.

Now, with the full understanding of the dynamics between gas, bloating, and related organs, we can focus on how to untrap intestinal gas and prevent bloating.

Even if gases, cramps, or pain don’t bother you at all, getting rid of bloating will make you look a lot skinnier without losing an iota of weight.

Why does the gas get trapped?

As I wrote in the beginning, the small intestine produces about 3 liters of CO₂ daily. It forms when the acid from the stomach mixes with the bicarbonate from the pancreas to neutralize acidity. The chemical formula looks like this:

HCl + NaHCO₃ → NaCl + H₂O + CO₂↑

The formula shows hydrochloric acid (HCl) from the stomach, sodium bicarbonate (NaHCO₃) from the pancreas, and the results of the chemical reaction: water (H₂O), table salt (NaCl), and carbon dioxide gas (CO₂).

The salt will continue to move all the way down to the large intestine, and will be recovered (absorbed back into the blood) there. Most of the water and all CO₂ are supposed to get absorbed into the bloodstream while still in the small intestine, and it works as long as it is healthy.

Problems start when the mucosal lining of the small intestine becomes inflamed. In that case, gases, water, bile, and nutrients fail to get absorbed and instead accumulate inside. Because the small intestine is a long, coiled, and flexible tube — over 6 meters long (about 20 feet), it expands like a balloon and presses outward against the abdominal wall until you look visibly bloated, as if pregnant or as if you’d swallowed a watermelon.

This condition is called enteritis. The term 'enteritis' originated from the Greek word 'enteron,' meaning 'intestine,' combined with the suffix '-itis,' which denotes inflammation, similar to gastritis (stomach), colitis (large intestine), or nephritis (kidneys).

Here are 13 of the most common and often-overlooked causes of enteritis:

1. Indigestion-related enteritis

In many cases, enteritis begins in the stomach when protein-containing food fails to digest completely because of age, stress, low stomach acid, enzymatic deficiency, low-salt diets, gastroparesis, poor chewing, overeating, overhydration, alcohol, stress, intense exercise, medication side effects, antacids such as proton pump inhibitors (PPIs) or H2 blockers, and similar other factors.

The small intestine isn’t equipped to break down protein. It expects peptides, not undigested chunks of meat that will putrefy (rot, decompose) inside the small intestine. The putrefication (rotting) produces amines like cadaverine and putrescine, which are irritating and pro-inflammatory even in small amounts.

If left unaddressed, protein indigestion can easily evolve into chronic enteritis. In most cases, it won’t be diagnosed correctly because there’s no specific test for “undigested protein-induced enteritis.” The ensuing bloating, irregular stools, foul-smelling gas, and post-meal fatigue are often misattributed to food intolerances, allergies, SIBO, and leaky gut syndrome, none of which are true.

The effects of putrefication are especially pronounced 'the morning after' heavy drinking in the form of the hangover because alcohol blocks the digestion of plant and animal proteins in the stomach. The biggest offenders are boiled or fried egg whites, overcooked red meats, and dense proteins, such as shrimp.

Path to recovery
Start by addressing the root cause: impaired protein digestion in the stomach. If food feels like it lingers after meals, or you experience bloating, heaviness, or fatigue following protein-rich meals, gastric digestion likely isn’t going well.

First, reduce or eliminate factors that suppress stomach acid. These factors include systemic acid reducers such as proton pump inhibitors (PPIs) and H2 blockers, and low-sodium diets. Stomach acid production depends on adequate salt intake, so low salt diets can impair digestion just as effectively as medication.

Next, slow down and chew your food thoroughly. Swallowing half-chewed protein-containing foods overloads the system and leaves the stomach unable to keep up, especially if acid and enzyme production is already impaired.

To further support recovery, limit yourself to one protein-containing meal per day, ideally in the evening when digestion is the strongest. This reduces the strain on your stomach and ensures better breakdown of proteins before they enter the small intestine.

Also, avoid overhydration, especially after meals. Excessive water dilutes gastric acid, impairs digestion, and increases the likelihood of undigested food reaching the small bowel.

If what I described correlates with your experience, taking Gastrozymes Digestive Enzymes with meals may help. This supplement helps break down protein more efficiently, and prevents the risk of protein rotting, and the side effects its toxic byproducts.

We’ve been providing this supplement for my clients for almost 25 years, and many swear by it. It is also very helpful when overeating while dining out, during holidays, trips, cruises, and all other occasions that break your regular eating schedule and routine.

For more detailed lifestyle recommendations, see my essay 45 Timeless Recommendations for Bulletproofing Your Gut Against Wrong Food and Bad Habits.

2. Fiber-induced enteritis

Originally promoted to lower cholesterol by binding bile acids, high-dose insoluble fiber (such as wheat bran, cellulose, or psyllium husk) was shown in controlled studies to induce enteritis in otherwise healthy individuals consistently.

The acid-binding and gel-forming properties of fiber interfere with the normal emulsification of fats, disrupt bile flow, and impair fatty acid absorption. These mechanical and chemical factors lead to mucosal inflammation, which in turn produces symptoms commonly misattributed to “leaky gut,” such as bloating, excess gas, abdominal discomfort, irregular stools, and nutrient malabsorption.

I placed this condition in the first place because it is the subject of Fiber Menace, my much-ignored and maligned book by the promoters of fiber cult, one of the most absurd and deadly menaces waged against Americans.

Path to recovery:
Eliminate fiber added to foods, such as morning cereals and snack bars, and stop consuming foods high in fiber, such as bran, legumes, and whole grains. Discontinue fiber-based supplements marketed for constipation or cholesterol reduction, such as Metamucil, psyllium husk, and similar products.

If you’ve been on this type of diet for a long time, there is a near 100% chance that you’ll experience constipation once the bulk is removed, because the size and volume of your stools will drop substantially, and you will no longer experience the urge to move your bowels.

In this case, add the Hydro-CM supplement to your morning routine. It is the only way to normalize stools without relying on toxic or harmful laxatives. It’s also quite likely that you’re already taking some kind of OTC or prescription laxative that was never approved for long-term use, so discontinuing those will further improve your chances of recovery.

For more information, I recommend reading this chapter of Fiber Menace (free on the site):

3. FODMAPs-related enteritis

FODMAPs is an acronym for Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols. These are the names of short-chain carbohydrates that are poorly absorbed in the small intestine and often ferment in the colon, leading to gas, bloating, and discomfort. While not inherently harmful in small amounts, they can provoke symptoms in people with pre-existing sensitivity or an already present enteritis.

Fermentable Oligosaccharides include fructans and galactooligosaccharides (GOS), commonly found in foods like wheat, rye, onions, garlic, leeks, shallots, asparagus, and artichokes. These compounds are indigestible to most people but only problematic for those with compromised digestion.
Disaccharides primarily refer to lactose, the sugar in dairy products such as milk, yogurt, soft cheeses, cream, and ice cream. People with low levels of lactase, the enzyme that digests lactose, experience bloating and diarrhea after consuming lactose-containing foods.
Monosaccharides relate to excess fructose, too much fructose relative to glucose. High-fructose fruits like apples, pears, mangoes, and watermelon fall into this category, as do sweeteners like high-fructose corn syrup and honey.
Polyols include sorbitol, mannitol, xylitol, and maltitol—sugar alcohols found naturally in fruits like apples, cherries, plums, peaches, and watermelon, as well as in many sugar-free gums, candies, and diet products.

Even presumably healthy foods like apples or beans can trigger FODMAP-related symptoms if the small intestine is already inflamed or you develop an autoimmune reaction to any of those ingredients.

The FODMAP carbohydrates damage the small intestine through three interconnected mechanisms: by drawing water into the small intestine (osmotic effect), by blocking the absorption of nutrients, and by reaching down to the colon and increasing fermentation, overgrowth of pathogenic bacteria, and causing inflammation.

If you suspect sensitivity to any FODMAP carbohydrates, it’s best to avoid them, especially during episodes of enteritis when your gut is already compromised.

At present, an elimination diet followed by systematic reintroduction is the only reliable method to identify your sensitivities. The Low-FODMAP diet developed by Monash University is the gold standard for identifying and managing these sensitivities [link].

Laboratory tests for FODMAP intolerance are either unavailable or not clinically validated because it isn’t an allergy, so blood tests and skin-prick tests aren’t helpful.

Path to recovery:
Start by eliminating the most common offenders — onions, garlic, apples, pears, prunes, dairy, beans, and any product labeled "sugar-free" that contains sorbitol, mannitol, or xylitol.

Stick to a simplified diet for 7 to 14 days and monitor your symptoms. If they improve, gradually reintroduce one suspect food at a time in small amounts, leaving at least 48 hours between trials. This will help you pinpoint specific triggers without unnecessarily restricting your entire diet.

Do not rely on allergy tests, IgG panels, or skin-prick testing — FODMAP sensitivity is not an allergic reaction and can't be detected through blood work.

If you're not sure where to start, refer to the original Low-FODMAP diet guidelines developed by Monash University. They remain the most structured and clinically validated approach to identifying carbohydrate-related sensitivities. [link].

You can speed up recovery by adding an L-Glutamine formula to your daily routine. L-Glutamine is the primary fuel for enterocytes, or the cells that line your small intestine, and it helps repair mucosal damage caused by fermentation, restore normal absorption, and reduce sensitivity to fermentable carbohydrates.

4. Post-infectious enteritis

Following episodes of food poisoning, viral gastroenteritis, or traveler’s diarrhea, mucosal inflammation may persist even after the acute infection resolves. This post-infectious state can lead to prolonged bloating, urgency, loose stools, and fatigue, symptoms commonly folded into the “leaky gut” narrative despite being self-limiting or treatable with appropriate care.

Path to recovery:
Most cases of post-infectious enteritis resolve gradually as the mucosal lining heals, but symptoms like bloating, loose stools, and urgency can linger for weeks. During this time, it's important to reduce mechanical and chemical stress on the intestines. Eliminate high-fiber foods, fermented foods, and known irritants such as caffeine, alcohol, or artificial sweeteners. Stick to simple, well-cooked meals with minimal residue.

Support recovery with hydration, rest, and possibly an L-Glutamine supplement to promote mucosal repair.

Avoid the typical supplements and interventions commonly recommended after gastrointestinal illness, including fiber powders, probiotics, prebiotics, fermented dairy, kombucha, and so on. These substances may seem helpful in theory, but often worsen symptoms in the presence of inflammation, impaired digestion, or disrupted motility. In this context, they’re more likely to cause harm than promote healing.

If this is a persistent situation — lasting more than a week — and you can’t improve it with a sparing, low-density diet, schedule a consultation. There may be other factors at play that require a more individualized approach.

For a broader context, refer to the related chapters in Fiber Menace or continue reading this guide.

5. Fortification-induced enteritis

The symptoms related to the consumption of wheat-based products, such as bread, pasta, and cereals, are real. But except for the <1% of people mentioned above, they have nothing to do with wheat or gluten.

I first encountered this paradox while trying to understand why the French and Italians seem blissfully unaware of the gluten controversy despite consuming untold quantities of bread, pizza, pasta, and pastries with reckless abandon and experiencing none of the symptoms commonly attributed to gluten.

To get to the root of this contradiction, I started asking friends of French and Italian backgrounds whether they experienced any issues eating wheat-based foods while visiting family in France or Italy. Every single one said no, even when bingeing on bread and pasta.

Some were just as bewildered as I was by this paradox because they actively avoided gluten-containing foods back home in the United States. As you can imagine, I wouldn’t be bringing up this subject if I hadn’t found the answer.

To the best of my knowledge, no one else has clearly connected gluten-related symptoms in the U.S. to the unique combination of agricultural chemicals, fortification agents, fiber additives, and industrial baking practices used in American wheat products.

While others have speculated about glyphosate or fermentation time, this is the first comprehensive explanation that ties these factors together as the true cause of so-called “gluten sensitivity” in individuals who do not react to wheat abroad. In one sentence, it all means that:

The vast majority of symptoms blamed on gluten sensitivity in the United States are actually caused by the widespread consumption of commercially produced wheat flour and rice, which are routinely fortified with iron, folic acid, and niacin under FDA enrichment standards.

This practice is not mandated or commonly used in countries like France or Italy, where unfortified wheat flour remains the norm.

Let's review the adverse reactions to each of these nutrients:

Iron-induced enteritis. Oral iron, especially in ferrous sulfate form, commonly found in fortified cereals, baked goods, and low-cost supplements, is poorly absorbed and highly irritating to the intestinal mucosa. In individuals without iron deficiency, the unabsorbed iron promotes oxidative stress and microbial shifts that may lead to inflammation, bloating, and bowel irregularity. This is particularly problematic in men, postmenopausal women, and children consuming iron-fortified foods daily.
Folic acid intolerance (MTHFR-related). Synthetic folic acid (vitamin B9), which is added to most wheat flour products in the U.S., can be a problem for people with certain genetic mutations, particularly MTHFR variants like C677T or A1298C. These individuals don’t process folic acid efficiently, so it can build up in their bodies and interfere with how their gut and immune systems function. Many people with these mutations report bloating, inflammation, and digestive distress, especially when exposed to high levels of fortified foods or B-vitamin supplements with folic acid.
Niacin-induced enteritis. High doses of niacin (vitamin B3), especially in fortified grain products or multivitamins, can cause mucosal vasodilation, irritation, and altered gut motility. While flushing is well known, gastrointestinal side effects are often overlooked. In some individuals, chronic niacin exposure may lead to nausea, diarrhea, and low-grade intestinal discomfort, particularly when combined with alcohol or otherwise inflammatory foods and supplements.

In recognition of these problems, our supplements are iron-free, provide folate in its coenzymated, bioactive form instead of synthetic folic acid, and limit niacin to 125% of the daily recommended value to avoid overload.

We also actively avoid fortified wheat, pasta, and rice for all the reasons outlined above. If you bake your own bread or make your own pasta and pizza, non-fortified wheat flour is available in many supermarkets under the King Arthur brand. Many specialty stores carry non-fortified paste varieties imported from Italy. Just make sure the label does not list added vitamins or iron.

In the United States and Canada, white rice is fortified by blending it with synthetic nutrient granules that contain iron, folic acid, and B vitamins. These granules are typically made from rice flour mixed with micronutrients and then coated to withstand washing and cooking. However, they are lighter than natural rice grains and often float to the surface when the rice is rinsed or soaked.

To reduce your exposure to these additives, rinse the rice thoroughly several times, soak it in water for 15 to 30 minutes, and skim off any floating particles before cooking. If the rice were fortified with spraying, you would not find any particles. Soaking and rinsing help remove a significant portion of the added or externally applied fortification. Alternatively, you can find imported, iron-free rice in most Asian grocery stores.

Path to recovery:
The most effective way to eliminate fortification-induced enteritis is to stop consuming commercially fortified grains and grain-based products. This includes nearly all mass-market breads, pastas, cereals, rice, and baked goods sold in the United States and Canada. Replace them with non-fortified alternatives, ideally those made from imported or artisan-milled flour that lists no added iron or synthetic vitamins.

If you bake at home, look for unfortified flour such as King Arthur’s “Organic Unbleached All-Purpose Flour.” For pasta and rice, specialty stores often carry imported, non-enriched varieties from Italy and Asia. Always check the ingredient list — if you see iron, folic acid, or niacin, skip it.

To support recovery, discontinue multivitamins or supplements that contain synthetic folic acid or ferrous sulfate unless medically necessary. If needed, switch to products that use bioactive folate (such as methylfolate) and iron-free formulations. These changes help reduce mucosal irritation and improve nutrient absorption.

Instead, use our Coenzymated Once Daily Multi formula, a high-potency, fully methylated B-complex that includes vitamin B-12 as methylcobalamin, Folate as Magnafolate®C 5-MTHF, and vitamin B-6 as pyridoxal-5-phosphate, along with flush-free niacin, thiamin, riboflavin, biotin, pantothenic acid, and key minerals like copper, zinc, and magnesium. It doesn’t contain iron, gluten, GMOs, or common allergens.

Depending on your prior exposure, it may take several weeks to notice improvements. If symptoms persist, check for overlapping factors mentioned on this page, such as fiber intake, medication use, or latent constipation.

6. Enteritis caused by hot spices

Frequent consumption of pungent spices, such as chili, cayenne, black pepper, mustard seed, or certain curry blends, can contribute to chronic mucosal irritation, particularly in individuals with slow transit, latent constipation, or existing gut inflammation. Over time, spice-related inflammation may result in bloating, diarrhea, abdominal discomfort, and other symptoms associated with "leaky gut syndrome."

Path to recovery:
Exclude all pungent spices from your diet, including chili, cayenne, black pepper, mustard seed, and curry blends. At this stage, these ingredients are not just irritants — they often act as allergens, triggering inflammatory responses even in trace amounts.

Also, eliminate aromatics such as garlic, onion, shallots, leeks, and ginger. While not spicy in the traditional sense, these compounds can still provoke mucosal irritation and contribute to residual inflammation, especially in individuals with slow transit or existing damage to the small intestine.

In cases involving immune responses to spices or food-based antigens, antibodies such as IgG, IgA, or food-specific IgE can persist for extended periods. For example, tissue transglutaminase IgA (tTG-IgA) and deamidated gliadin peptide IgG (DGP-IgG) commonly elevated in celiac disease, may take 12 to 24 months to normalize after gluten is eliminated. Similarly, in non-celiac food sensitivities or spice-related immune reactions,

it may take up to two years for IgA or IgG antibodies to decline fully. Any reintroduction of the offending substance before that time risks reactivating the inflammatory response and setting back recovery. For this reason, reintroduction is not recommended until all other causes of enteritis are resolved and intestinal sensitivity is significantly reduced.

7. Celiac Disease (sensitivity to gluten)

Celiac disease is a chronic autoimmune disorder in which ingestion of gluten triggers an immune-mediated inflammatory response that damages the lining of the small intestine, leading to malabsorption and a wide range of gastrointestinal and systemic symptoms. Many of those symptoms are commonly attributed to "leaky gut syndrome."

Please note that, according to large-scale serologic screening studies (i.e., blood tests), the current best estimate of celiac disease prevalence ranges from 0.5% to 1% globally and 0.7% to 1.0% in the United States, nowhere near the number of people who believe they are gluten-sensitive.

Despite its minuscule impact, research indicates that about 18 million Americans, or roughly 6.3% of the population, consider themselves gluten-sensitive, and up to one-third of Americans report trying to reduce or avoid gluten for various health reasons, even if they do not identify as gluten-sensitive.

Allergy and sensitivity panels for gluten or wheat may produce false positives due to their high sensitivity but limited specificity. In individuals with pre-existing sensitivities, IgG or IgE antibodies to gluten-related proteins can persist for years after exposure. In many cases, it may take two to three years of strict avoidance for these antibody levels to decline significantly, making short-term re-testing unreliable and potentially misleading.

Path to recovery:
First, use the recommendations from the section above to determine whether you're dealing with true celiac disease rather than a reaction to the fortification agents, additives, or processing methods commonly found in American wheat products and rice.

If symptoms persist despite switching to unfortified, non-processed wheat, then proceed with a full elimination of all sources of gluten, including wheat, rye, barley, and anything derived from them. Strict, long-term adherence is essential for recovery in confirmed celiac cases.

This includes beer, unless it’s explicitly labeled gluten-free, because most traditional beers are made from barley or wheat and can trigger a reaction even in small amounts.

8. SIBO (Small Intestinal Bacterial Overgrowth)

Although SIBO is often presented as a standalone diagnosis, it’s usually a secondary complication of latent constipation — a condition thoroughly described in the Warning Signs of Latent Constipation article.

When the colon fails to evacuate fully, fecal matter can reflux back into the small intestine. This retrograde flow brings bacteria along with it, creating an environment in the small intestine that favors fermentation, gas accumulation, and nutrient malabsorption.

The result is a wide range of symptoms — bloating, pressure, cramping, food intolerance — frequently misattributed to unrelated causes. Treating SIBO with antibiotics may bring temporary relief, but it won’t resolve the underlying problem if the mechanical obstruction and fecal backup are still present.

Path to recovery:
Focus first on eliminating latent constipation, the root cause. Until the colon is consistently and fully evacuated, any attempt to treat bacterial overgrowth with antibiotics, herbal antimicrobials, or probiotics is likely to fail or lead to relapse.

Start by using Hydro-CM to bring latent constipation under control and restore full, consistent evacuation. Until downstream flow is normalized, any attempt to manage SIBO will be incomplete. Once the reflux into the small intestine stops, most cases of SIBO will improve without the need for antibiotics or other pharmaceutical interventions.

9. Crohn’s Disease

Crohn’s disease, localized to the terminal ileum (the last section of the small intestine), may cause intermittent symptoms that evade standard diagnostic criteria. In such cases, inflammation may be patchy and non-obstructive, leading to chronic discomfort, changes in bowel habits, and low-grade systemic effects that are frequently mistaken for “leaky gut syndrome.”

Path to recovery:
If you've been diagnosed with Crohn’s disease or suspect localized inflammation in the terminal ileum, start by reading my article on Leaky Gut Syndrome and implement the full set of recommendations outlined there. It covers the essential steps to reduce mucosal inflammation, support recovery, and avoid common dietary triggers that can worsen symptoms.

At the same time, I strongly recommend reviewing the article on Latent Constipation, since fecal reflux from the colon into the terminal ileum is one of the most overlooked but likely contributors to chronic inflammation in that region. Addressing this underlying mechanical issue is essential for lasting improvement, regardless of the formal diagnosis.

10. Infectious and chemical enteritis

Acute or chronic enteritis may result from viral, bacterial, parasitic, and chemical infections. These common conditions become clinically significant when their symptoms linger, recur, or are blamed for a leaky gut.

Viral enteritis is typically caused by norovirus, rotavirus, or adenovirus. While symptoms often resolve within days, lingering inflammation can mimic post-infectious IBS, including bloating, diarrhea, and fatigue.
Bacterial enteritis, including infections by Salmonella, Campylobacter, Shigella, E. coli, or Clostridium difficile, can range from mild to severe.
Parasitic enteritis, most commonly caused by Giardia lamblia, Entamoeba histolytica, or Cryptosporidium, can persist for weeks and is frequently missed in routine stool tests.
Chemical or toxin-induced enteritis may result from alcohol, food preservatives, artificial sweeteners (such as sorbitol or sucralose), or contaminated water or food.

In all of these cases, the mucosal inflammation is real and has nothing to do with a leaky gut or SIBO.

Path to recovery:
The first step is to identify and eliminate the original trigger, whether it’s an active infection, chronic exposure to irritants, or a residual microbial imbalance.

If you're dealing with a known pathogen (e.g., Giardia, C. difficile), confirm its clearance through appropriate stool testing and medical follow-up if needed. For chemical or toxin-induced cases, stop all exposure to alcohol, artificial sweeteners (especially sorbitol and sucralose), preservatives, and any suspicious food or water sources.

Once the primary offender is removed, focus on reducing inflammation and supporting mucosal repair. Avoid raw vegetables, high-fiber foods, fermented products, probiotics, and anything that stimulates motility or fermentation. Stick to well-cooked, low-residue meals until symptoms improve.

Recovery may take weeks to months, depending on the duration and severity of the original cause. Don’t reintroduce stimulants, sweeteners, or high-density diet until baseline function is restored.

Supplemental support with L-Glutamine may help accelerate healing by fueling enterocyte regeneration. If lingering constipation is present — particularly after a bacterial or parasitic infection — add Hydro-CM to ensure complete evacuation and prevent fecal retention, which can prolong inflammation.

11. Medication-induced enteritis

A wide range of prescription and over-the-counter medications can cause direct mucosal inflammation, impaired motility, and enteritis of various intensities. These side effects are frequently misinterpreted as “sensitivity,” “dysbiosis,” or “leaky gut,” when in fact, they are well-described and pharmacologically driven outcomes.

If a medication lists bloating, gas, abdominal discomfort, or diarrhea among its primary side effects, it may be causing or contributing to enteritis.

NSAIDs (non-steroidal anti-inflammatory drugs): Chronic use of ibuprofen, aspirin, naproxen, and similar agents erodes the mucosal lining of the small intestine and may cause bleeding, inflammation, and impaired absorption without overt symptoms.
Proton Pump Inhibitors (PPIs): Chronic use alters pH gradients throughout the GI tract, impairs nutrient absorption, and contributes to inflammation.
Metformin: Frequently prescribed for type 2 diabetes and PCOS, metformin is associated with bloating, gas, and diarrhea in a large subset of patients, reflecting a combination of malabsorption, microbial shifts, and chemical irritation.
GLP-1 receptor agonists (e.g., semaglutide, liraglutide): These drugs delay gastric emptying and suppress peristalsis, leading to fecal retention and small intestinal bacterial overgrowth (SIBO), often presenting as gas, distention, nausea, or erratic bowel habits.
Antibiotics: Broad-spectrum antibiotics disrupt the intestinal microbiome, often resulting in inflammation secondary to overgrowth of opportunistic pathogens (e.g., C. difficile, Candida), impaired barrier function, or direct mucosal toxicity.
Systemic medications that impair motility: Opioids, tricyclic antidepressants, anticholinergics, and certain antihypertensives (e.g., calcium channel blockers) slow intestinal transit. Prolonged stasis promotes fermentation, gas pressure, fecal reflux, and, ultimately, inflammation, especially in patients predisposed to constipation.
Bisphosphonates (i.g, Fosamax, Zometa, Aclasta, Reclast, and similar others to treat osteoporosis): If not taken correctly, these can cause significant mucosal irritation or ulceration in the upper GI tract, with inflammatory consequences for the colon.
Chemotherapy and immunosuppressants: Drugs like methotrexate, 5-FU, and azathioprine directly impair intestinal cell renewal and mucosal barrier integrity, resulting in inflammation, diarrhea, and malabsorption.

Path to recovery:
Bloating, gas, abdominal discomfort, or diarrhea are not rare reactions. In many cases, these outcomes are well-known pharmacological effects, not mysterious food sensitivities or microbiome imbalances.

If you're experiencing symptoms consistent with enteritis and take any medication known to affect the gut, like the ones listed above, review the drug’s side effect profile carefully.

Do not stop or adjust any prescribed medication without medical supervision. Identify whether one or more of your medications may be impairing motility, damaging the mucosa, or disrupting absorption, and discuss alternatives, dose adjustments, or mitigation strategies with your prescribing physician.

Some medication-induced effects may improve within weeks; others require longer-term management strategies tailored to the specific drug involved. The key is to recognize the source and not confuse side effects with separate diagnoses.

Support your recovery by minimizing all additional irritants such as fiber, alcohol, sweeteners, and fermented foods, and by maintaining full, regular evacuation. If constipation or slow transit is present, use Hydro-CM to prevent fecal retention and reduce backpressure on the small intestine.

Where appropriate, supplement with L-Glutamine to promote mucosal repair and bioactive B-vitamins in the Once Daily formula to support metabolic clearance of drug byproducts.

12. Enteritis induced by non-prescription (OTC) laxatives

Chronic use of laxatives can lead to significant mucosal irritation, altered motility, and long-term functional impairment of the intestines. These effects are rarely acknowledged in clinical settings and are frequently mislabeled as IBS, “gut sensitivity,” or “leaky gut.”

Common laxative categories and their mechanisms of injury include:

Bulk-forming agents (e.g., psyllium, methylcellulose): Add mechanical load and viscosity to intestinal contents, which can irritate the mucosa, especially in patients with slow transit or latent constipation.
Lubricants (e.g., mineral oil): Coat the mucosa and interfere with water exchange and absorption, potentially impairing mucosal integrity and promoting dependency.
Stimulant laxatives (e.g., senna, bisacodyl): Trigger peristalsis through chemical irritation, which, over time, can lead to enteric nerve desensitization and inflammation.
Stool softeners (e.g., docusate sodium): Alter the surface tension of stool and water balance in the colon; chronic use may affect mucosal tone and contribute to functional enteritis.
Osmotic laxatives (e.g., polyethylene glycol 3350 [Miralax]): Marketed as “gentle” and non-absorbable, PEGs are widely prescribed despite mounting evidence that they can cross intestinal and blood-brain barriers, accumulate systemically, and contribute to neurological symptoms in sensitive individuals.
Chronic use of PEGs has been linked to behavioral changes, anxiety, memory loss, and possibly long-term neurotoxicity. In the gut, PEGs disrupt fluid gradients, promote overhydration, and contribute to mucosal inflammation and microbial imbalance, especially in children and older adults. I describe their side effects in-depth here: Is MiraLAX the next Vioxx?

In many patients, long-term laxative use results in excessive flatulence, bloating, mucosal inflammation, and incontinence. These side effects may persist even after discontinuation and are often misinterpreted as “leaky gut syndrome.”

Path to recovery:
Discontinue all OTC laxatives, regardless of type or branding. Whether stimulant, osmotic, or fiber-based, these products are not designed for long-term use and often become the very cause of the symptoms they claim to relieve. Their continued use impairs mucosal integrity, desensitizes the bowel’s natural signaling, and leads to chronic inflammation.

Replace them with Hydro-CM, formulated specifically to restore complete, regular evacuation without irritating or overstimulating the intestines. Unlike laxatives, Hydro-CM works by improving stool hydration and motility without disrupting electrolyte balance, nerve function, or mucosal stability. It helps normalize bowel movements gently, making it suitable for long-term use while giving the gut lining time to recover.

13. Prescription laxative-induced enteritis

Prescription laxatives are widely used to manage chronic constipation, IBS-C (constipation-predominant irritable bowel syndrome), and opioid-induced bowel dysfunction. While typically marketed as gentler or more targeted than over-the-counter laxatives, these drugs still carry a significant risk of mucosal irritation, fluid imbalance, and inflammation, particularly with long-term use.

Medications in this category often cause bloating, gas, abdominal pain, and loose stools, symptoms consistent with low-grade enteritis. These effects are frequently misdiagnosed as “leaky gut” or misattributed to food intolerance.

These are the most common prescription laxatives:

Linaclotide (Linzess): Activates guanylate cyclase-C receptors to increase cGMP, chloride secretion, and intestinal transit. It can lead to excess fluid in the small intestine, mucosal stress, and bacterial overgrowth.
Plecanatide (Trulance): A similar mechanism to linaclotide promotes water secretion and accelerated movement through the small bowel. It may aggravate borderline inflammation or motility-related reflux.
Lubiprostone (Amitiza): Activates chloride channels (ClC-2) to increase fluid secretion in the intestinal lumen. It may cause distention, cramping, and loose stools with repeated use.
Naloxegol (Movantik): μ-opioid receptor antagonist used for opioid-induced constipation. It can rapidly reverse opioid-related slowing of transit, causing rebound motility and irritative symptoms.
Naldemedine (Symproic): Similar to naloxegol in function and side effects. Diarrhea, abdominal pain, and nausea are common.
Methylnaltrexone (Relistor): Parenteral opioid antagonist for severe constipation. It can trigger cramping and diarrhea by abruptly restoring peristalsis.
Prucalopride (Motegrity): A selective 5-HT4 receptor agonist that stimulates colonic peristalsis. Often causes gas, bloating, and abdominal discomfort due to rapid propulsion and incomplete absorption.

Path to recovery:
None of the above medications addresses the core causes of chronic constipation. They rely on pharmaceutical stimulation to trigger bowel movements, but each comes with its own set of side effects, including fluid shifts, mucosal stress, motility disruption, and microbial imbalance, all of which may cause or contribute to enteritis.

The most prudent approach is to study the constipation-related materials on my site and follow the same recovery steps outlined in the previous section for OTC laxatives. After that, discontinue pharmaceutical agents gradually (with medical oversight if needed), and switch to Hydro-CM to restore full, regular evacuation without irritating the gut lining. This approach gives the intestines a chance to recover from long-term chemical stimulation, reestablish natural bowel movements, and is suitable for long-term use.

As you can see from this long list of 12 types of enteritis, there are plenty of readily preventable, identifiable, and avoidable factors behind it that are often ignored or written off as the 'leaky gut,' except in all cases, the real leak goes into the sewer.

What About “Leaky Gut”?

If you've been searching for answers about bloating, gas, diarrhea, or general gut discomfort, you've probably come across the term "leaky gut." It's become a catch-all explanation for nearly every unexplained digestive symptom, and it shows up everywhere from YouTube videos to wellness blogs to expensive supplement marketing.

While the term itself lacks anatomical precision and isn’t recognized as a formal diagnosis, the symptoms people associate with it — inflammation, poor absorption, food sensitivities, fatigue, skin issues — are real. But they’re not caused by your gut “leaking” like a faucet. They’re the result of mucosal injury, immune overactivation, and often the wrong treatments applied over and over again.

I’ve written a dedicated article that explains exactly what most people are actually dealing with when they think they have leaky gut, and why the usual protocols often make things worse. If you're serious about resolving this pattern, start there: How to Check If You Have a Leaky Gut?

Takeaways

Below is a summary of key takeaways from the article. It's not meant to be a checklist or a protocol. It's a distillation of common mistakes, overlooked causes, and corrective strategies. Some are obvious, others rarely acknowledged. Together, they map out what actually matters when it comes to fixing persistent bloating and gas.

Bloating and gas are not single-issue problems. They're the outcome of multiple overlapping biomechanical, chemical, and nutritional disruptors, most of them self-inflicted. To attain full recovery, all of those causes must be addressed.
Not all bloating is diet-related. Stomach distension from overeating or delayed gastric emptying (gastroparesis) can contribute to a chronically bloated look. Abdominal fat distribution, posture, diaphragm tension, and even ascites can also mimic or compound the effect.
The digestive tract doesn't operate in isolation. What starts in the stomach often ends up affecting the small intestine, and what goes wrong in the colon can reverberate back upstream. That's why a one-size-fits-all approach almost never works.
Persistent bloating usually reflects enteritis. Inflammation of the small intestine can result from protein putrefaction, laxatives, medications, infections, hot spices, or undiagnosed conditions like Crohn's disease, celiac disease, or fecal reflux. Most of these are self-inflicted or preventable.
Protein indigestion is a common driver. When protein isn't properly broken down in the stomach, it ferments in the small intestine, producing gases and toxic amines that inflame the mucosa.
Low stomach acid is a major factor. It can result from age, stress, low-salt diets, PPIs, overhydration, poor chewing, or nighttime eating. Without enough acid, protein digestion fails.
Fecal reflux causes chronic irritation. Incomplete bowel movements lead to stool and gas backing up into the small intestine, where they don't belong. This triggers SIBO and enteritis.
Laxatives are not a solution. Most over-the-counter and prescription laxatives eventually damage the intestinal lining and make bloating worse. Even so-called gentle agents like PEG and psyllium contribute to gas, distention, and inflammation.
Fermented foods, fiber, and probiotics can worsen the problem. These add microbial load or mechanical irritation to already inflamed tissues. Most people feel better once they stop using them.
Post-infectious and drug-induced enteritis are often missed. Viral or bacterial infections, alcohol, Metformin, NSAIDs, GLP-1 drugs, and many common medications can cause long-lasting low-grade enteritis that gets blamed on "sensitivity" or "leaky gut."
One high-protein meal per day is safer than spreading it out. This improves digestion and reduces the chance of undigested protein fermenting in the small intestine.
For lasting results, normalize digestion and stool transit first. That means correcting dietary mistakes, improving stomach function, and resolving latent constipation. Without this, no supplement or therapy will work long-term.
Read more: You can find specific recommendations in my article "45 Timeless Recommendations for Bulletproofing Your Gut Against Wrong Food and Bad Habits."
Age amplifies digestive vulnerabilities. With aging, stomach acid production declines, motility slows, enzyme output drops, and chewing efficiency often worsens. These changes make older adults more susceptible to bloating, indigestion, and small intestinal inflammation even without changes in diet.
SIBO is not an isolated condition but a secondary outcome of incomplete bowel emptying. Gas buildup, bloating, and reflux into the small intestine are typically caused by latent constipation, not by "bad bacteria" alone. Antibiotics or antimicrobial herbs will not resolve SIBO unless the root motility issue is addressed first.
Leaky Gut Syndrome is not a diagnosis but a lay label for various forms of low-grade enteritis. Inflammation, not permeability, is the primary issue. Most cases attributed to "leaky gut" stem from chronic irritation caused by diet, supplements, medications, or motility disorders and resolve only when those triggers are eliminated.
Avoid all kinds of probiotics, prebiotics, fermented dairy (yogurt, kefir), and kombucha when dealing with enteritis. All of them turn your small and large intestine into a proverbial compost pile, worsen enteritis, generate prodigious amounts of gas, and block recovery.
Avoid smoothies when dealing with bloating or enteritis. Most smoothies are high in fiber, sugars, and FODMAPs, served cold, consumed quickly, and poorly broken down due to a lack of chewing. This combination overwhelms gastric processing, dilutes stomach acid, triggers fermentation in the small intestine, and promotes gas buildup, inflammation, and prolonged bloating.
Professional-grade supplements are critical for recovery from chronic enteritis, especially after 40. The intestinal inflammation blocks not only gases, but also all of the essential vitamins, minerals, and microelements that you are supposed to get from foods. Skipping this aspect of recovery is a primary cause of its continuous failure. I recommend our Once Daily Multi supplement or similar conezymated formulations.
Hydro-CM can help reverse chronic bloating caused by latent constipation. By improving stool hydration and facilitating complete evacuation, Hydro-CM reduces fecal retention that contributes to gas buildup and small intestinal reflux.
L-Glutamine supports mucosal recovery in cases of low-grade enteritis. This amino acid serves as a preferred fuel for intestinal epithelial cells and helps restore barrier integrity in inflamed or irritated segments of the small intestine.
Digestive enzymes can reduce bloating by improving protein breakdown, particularly in older adults, people with dentures, or those on high-protein diets. Most consumer-grade enzymes are marginally effective. I recommend our Gastrozymes supplement because it has withstood the test of time.
Effect on appearance. Reducing bloating and gas will make you appear a few sizes slimmer without losing an iota of weight. That's one of the least appreciated, but most apparent benefits of keeping both problems under control.
Withholding flatulence. A tendency to tense the anal and pelvic floor muscles to hold flatus when you are not alone is another poorly known side effect of excessive gas. Over time, this habit disrupts the normal relaxation of the pelvic floor and anal sphincter muscles, and makes bowel movements painful and incomplete. It is also one of the top causes of straining, latent or chronic constipation, laxative dependence, irritable bowel syndrome, enlarged hemorrhoids, anal fissures, and diverticular disease. Pelvic floor tension is also behind urination problems in men of any age, including difficulty starting, dribbling, and incomplete bladder emptying.

When push comes to shove, most cases of bloating and gas are caused by countless overlapping and self-inflicted problems that no single article can cover. Fortunately, most of these problems are reversible if you know where to look. Explore my related materials on nutrition and colorectal health (the bulk of this site and the list below). Each topic connects to the others and contributes to your recovery.

Author's note

If you’ve ever looked five months pregnant after a bowl of chilli or felt like you swallowed a watermelon whole, you’re not alone. That’s what led me to write this page.

I’ve seen way too many people misdiagnosed with everything from fake leaky gut to mysterious food allergies, when the real culprit was chronic low-grade enteritis triggered by everyday things like fiber, fortification, or medications.

This guide will help you get out of stretchy pants and back to normal. It did its job.

Please share this post with your family and friends to support my work!

Thank you!

Konstantin Monastyrsky