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Bacterial Overgrowth Or Coeliac? (Gas Issues)
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Hi mates

To cut to the chase, I have had on going flatulence issues for 3 months. It started with gas in the afternoons - roughly 2 hours after eating lunch, and would last for an hour or two. Progressively it got worse to where I would start feeling gas being formed in my stomach immediately after finishing lunch and within an hour I would start passing wind - every 5-10 minutes for hours. Having done my homework, I began taking probiotics two weeks ago and ever since the gas has changed from constant explusions to instead trapped wind/distention. A few hours after eating certain foods the gas bubbles will start forming and I can feel them moving around but I'll never get the urge to pass wind. If I go running or exercise the sensation disappears until I relax again at which time the distention returns. After many hours I will pass 4-5 huge 'toots' and it is gone. (Usually this is in the morning and I wake up feeling distended).

Now - the reason I suspected coeliacs is that I do not have any problem whatsoever with breakfast if I stick to eggs/salami and yogurt. Lunch, if I eat a caesar salad I am fine (but I also eat croutons and don't have an issue). But, if I eat, like yesterday, 2 mini white bagels with PB and J, I will get the gas bubbles forming roughly 3-4 hours later. Then the distention etc. Cereal is the worst for me and I do not drink milk and don't have any dairy besides yogurt.

I've been really trying to pinpoint foods that make it worse, and if I avoid carbs/sugar I am ok No symptoms at all. My only symptoms are the gas - BMs are normal and regular and I don't get bloating, "3 months pregnant". I've tried digestive enzymes and 20 billion cultured probiotic. Any ideas?

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To be honest, I am very skeptical of candida. It is posted everywhere online, but coming from a medical background, I have never heard of it as a legitimate diagnosis. And what is online are on health websites and not Mayo, Hopkins etc. How ironic it would be if it were the cause of my issues!

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I stopped eating gluten for a week and lost 2-3 pounds and it did help a bit with the gas/bloating. I still however had gas every night at 8pm - like clockwork. By gas I mean I felt the air moving around my intestines every once in a while. I didn't feel bloating but knew there was a lot of air in there. When I woke up within 30 minutes I passedwind a few times and deflated.

Could all this gas be caused why nervously swallowing air? I started to take align today and I am going to eat gluten again. I am at a loss.

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Wow, I've never heard of anyone swallowing air except my daughter! When she was about 2-3 years old she had a tic that made her swallow air. She had the most trumpetous loud farts all night long. Her belly was HUGE, too. One time she was in so much pain that I thought that the dr thought she must have broken a rib. She got X-rays and it showed that her stomach was distended because it was full of air. That's how I finally made the connection between the tics, the flatulance, and her being a very fussy eater. Fortunately that tic eventually went away and others took over.

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If it's all carbs and refined sugar that get you, it's probably bacterial imbalance and/or excess yeast in your gut. You might stop eating them entirely for a while and really focus on getting more bacteria into your diet with live sauerkraut, kefir, and good probiotics. Have a look at the GAPS diet. http://www.gapsdiet.com

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Wow, I've never heard of anyone swallowing air except my daughter!

Hah!! That was the very first diagnosis I was given when I complained about bloating - aerophagia, swallowing air. Made me feel like a fish :D So way off the mark in my case.

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To be honest, I am very skeptical of candida. It is posted everywhere online, but coming from a medical background, I have never heard of it as a legitimate diagnosis. And what is online are on health websites and not Mayo, Hopkins etc. How ironic it would be if it were the cause of my issues!

As was I...until my health turned around dramatically with probiotics, coconut oil, and a candida cleanse herbal preparation a few years back. I'm a believer now. Seriously, get the GAPS book. It will blow your mind. Besides, even the docs at Mayo & Hopkins know full well they'd better offer women diflucan along with antibiotics because otherwise we get yeast infections. The sad thing is that they don't make the jump that there could be yeast overgrowth in the GI tract as well.

Agreed there is a lot of nutty and even dangerous stuff on the Internet, but a so-called candida diet low in starch and refined sugars will do you no harm. Neither will cooking with coconut oil and plenty of onions and garlic. Probiotics are all over the medical literature now; the big question is which bacteria we should be eating. The easy answer, though hard to research, is traditional fermented foods that humans have been consuming for millenia.

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I stopped eating gluten for a week and lost 2-3 pounds and it did help a bit with the gas/bloating. I still however had gas every night at 8pm - like clockwork. By gas I mean I felt the air moving around my intestines every once in a while. I didn't feel bloating but knew there was a lot of air in there. When I woke up within 30 minutes I passedwind a few times and deflated.

Could all this gas be caused why nervously swallowing air? I started to take align today and I am going to eat gluten again. I am at a loss.

I also have an issue with gas in the evening. It seemed to go away when I went dairy free.

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Curious. Have you had any gallbladder imaging studies or a gallbladder HIDA scan? I am not Celiac, but suspect my very ill teenager is. However, your post with "feel like I'm 3 months pregnant" caught my eye. I had my GB removed 2 months ago after 8 months of feeling like I was going to deliver a baby by 8 pm every night! Other GI symptoms too, but not like Celiac. My imaging studies were normal, but the HIDA scan was over the top positive. Might want to check this out. Good luck.

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I don't believe my gas is correlated - TO ANYTHING - now. It's frustrating. I can eat pancakes with lots of syrup in the morning and have no problems. Lunch I can eat an italian hoagie and be fine. But last night I ate steak and mashed potatoes and a few hours later I had gas. I actually just started align so I am not sure if I can blame the new gas on that.

For a while it was gas every afternoon. Then it turned into stomach gas that couldn't come out in the evenings. Now it's just completely random gas either in the afternoon, evening, or both. I've gone gluten free for a week and a half and noticed little improvement. I don't eat dairy so it can't be lactose intolerance. I've tried keeping a journal of what bothers me and it seems to point to carbs. However, some meals I eat tons of carbs and have no problems whereas others (or even the same meal) a different day causes gas.

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Out of curiosity - does anyone have lactose intolerance here? I am wondering if the lactose content of the bread, french toast/pancakes, cereal etc I have been eating is enough to cause me issues. The counter argument is that I can eat yogurt at 7am and not have gas until 9pm, but since it does vary I am wondering if the my lactose containing food fluctuation might be the culprit. It seems most people get diarrhea too but I haven't, cross fingers, had that just gas and sometimes bloating.

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Many people who are lactose intolerant can eat yogurt. The cultures added to the milk to make yogurt consume most of the lactose. Same goes with hard cheeses - there is very little lactose left once the enzymes and cultures have done their job. The test for lactose intolerance is to drink straight milk or eat ice cream or cream. If you challenge hard cheese (like an aged cheddar) and still have problems you should avoid all dairy and rechallenge in six months or so to find out if you are also casein intolerant or just lactose. (Lactose is the milk sugar, casein the milk protein; they are digested by different enzymes). :) The enzyme that digests lactose is made in the part of the small intestine that is damaged by gluten.

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Many people who are lactose intolerant can eat yogurt. The cultures added to the milk to make yogurt consume most of the lactose. Same goes with hard cheeses - there is very little lactose left once the enzymes and cultures have done their job. The test for lactose intolerance is to drink straight milk or eat ice cream or cream. If you challenge hard cheese (like an aged cheddar) and still have problems you should avoid all dairy and rechallenge in six months or so to find out if you are also casein intolerant or just lactose. (Lactose is the milk sugar, casein the milk protein; they are digested by different enzymes). :) The enzyme that digests lactose is made in the part of the small intestine that is damaged by gluten.

Do you know about breads/carbs etc that contain lactose? Do people generally have the same reactions to them as they would milk if that have Lactose intolerance? I am beginning to really suspect gluten now anyway, I had french toast this morning and now have had bad bubbling gas for a few hours (started 7 hours after eating). I had been gluten free for a week+ and feeling a bit better.

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During the time I was lactose intolerant I was able to eat baked goods that had some milk powder in them - it depended on how much; Mostly I would suspect the milk powder to be heavilyl casein oriented (:o not sure about that statement :D )

So you need to separate out gluten and lactose. Not eat both on the same day :) That willl give you a better idea. Get some almond milk and substitute that for cows milk, and eat bread. Then cut out all gluten (bread, cookies, pasta, etc. ) but eat some ice cream the next day. You may well, surprise, surprise, react to both if you have a gluten problem :o

I used to find the lactose symptoms pretty immediate; gluten symptoms could be delayed....

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I don't believe my gas is correlated - TO ANYTHING - now. It's frustrating. I can eat pancakes with lots of syrup in the morning and have no problems. Lunch I can eat an italian hoagie and be fine. But last night I ate steak and mashed potatoes and a few hours later I had gas. I actually just started align so I am not sure if I can blame the new gas on that.

For a while it was gas every afternoon. Then it turned into stomach gas that couldn't come out in the evenings. Now it's just completely random gas either in the afternoon, evening, or both. I've gone gluten free for a week and a half and noticed little improvement. I don't eat dairy so it can't be lactose intolerance. I've tried keeping a journal of what bothers me and it seems to point to carbs. However, some meals I eat tons of carbs and have no problems whereas others (or even the same meal) a different day causes gas.

The problem with gluten intolerance and most food allergies (which docs won't test for) is that they are DELAYED reaction allergies. Those are IgG or IgA antibody mediated allergies. Most allergists only test for those immediate reaction, anaphylactic IgE mediated allergies. Also there's a huge debate over whether to call IgG and/or IgA reactions 'allergies' or 'intolerance'. However both immediate reactions and delayed reactions from food antibodies are immune reactions. Intolerances (like lactose intolerance) are caused by inadequate enzyme production (like no lactase to digest lactose). So you actually could be reacting (after the steak and potato dinner) to the pancakes you ate for breakfast. Some people react more quickly. Others don't react until 24-36 hours later to the gluten or casein (milk protein) which they consumed in a meal.

Rather than guess, get tested for gluten intolerance. There are also blood tests for other delayed reaction allergens. Many naturopaths use blood tests for allergies. Most 'traditional docs' will test you for IgE or immediate reaction allergies. If you had an immediate reaction (anaphlactic) allergy, you would get more severe symptoms than gas. However, you could have several delayed reaction food allergies and not easily identify the exact foods which caused your reactions. You could be allergic to almost any food.

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The problem with gluten intolerance and most food allergies (which docs won't test for) is that they are DELAYED reaction allergies. Those are IgG or IgA antibody mediated allergies. Most allergists only test for those immediate reaction, anaphylactic IgE mediated allergies. Also there's a huge debate over whether to call IgG and/or IgA reactions 'allergies' or 'intolerance'. However both immediate reactions and delayed reactions from food antibodies are immune reactions. Intolerances (like lactose intolerance) are caused by inadequate enzyme production (like no lactase to digest lactose). So you actually could be reacting (after the steak and potato dinner) to the pancakes you ate for breakfast. Some people react more quickly. Others don't react until 24-36 hours later to the gluten or casein (milk protein) which they consumed in a meal.

Rather than guess, get tested for gluten intolerance. There are also blood tests for other delayed reaction allergens. Many naturopaths use blood tests for allergies. Most 'traditional docs' will test you for IgE or immediate reaction allergies. If you had an immediate reaction (anaphlactic) allergy, you would get more severe symptoms than gas. However, you could have several delayed reaction food allergies and not easily identify the exact foods which caused your reactions. You could be allergic to almost any food.

I certainly have delayed reactions. I don't think I've ever eaten a food and had an issue right away - it is always at least 1 hour after, but more recently 4-8 hours. I have another quick question. When a person is "glutened" do they have symptoms for a few hours or are they lasting? The reason why I ask, is that I have periods during the day where I am fine even if I ate a lot of dairy or wheat the day before. The gas from yesterday rarely travels into the next day. Yesterday I had the bloating/gas and woke up fine. I was fine for a few hours but like clockwork, in the afternoon, the gas came back. But I have had NO dairy or gluten today. I am curious if glutening issues only occur when there is food in the intestines.

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Well, I suppose the obvious answer to your question is that when there is no food in the intestines they are not having to work, they can relax and work on the healing part. But they are still damaged, and when you ask a damaged intestine to do some hard work like digestion it is going to complain and create symptoms. It is all a part of the healing process, you know, Rome wasn't built in a day, blah blah, blah blah :P Symptoms last for varying times with diferent people. Some people swear they have symptoms for two weeks after a glutening; mine is normally a couple of days. What is normal for you is normal :)

Once you go gluten free and your body is no longer fighting the constant onslaught of gluten, the symptoms become more marked and usually more severe. If you are still eating a gluten diet then anything is possible. Pizza used to be my "comfort food" - never gave me any problems :rolleyes:

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PLEASE...if you even suspect bacterial overgrowth, go to a Gastroenterologist and beg for a stool sample to be sure. While you're at it, have him do a Celiac panel too. I was self treating for gluten intolerance, and turns out I had C Diff for 8 months! The only thing that kept it from becoming horrible were the probiotics I was taking. Being off gluten for so long, I feel amazingly better in many ways. But the doctor wants me to remain gluten free while healing. PS...I beat the C Diff with Flagyl, but still nervous about a recurrence. Keeping gluten free and will stay on probiotics, specifically Florastor and Culturell for the forseeable future. Good luck....but don't wait to see a doctor like I did!

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PLEASE...if you even suspect bacterial overgrowth, go to a Gastroenterologist and beg for a stool sample to be sure. While you're at it, have him do a Celiac panel too. I was self treating for gluten intolerance, and turns out I had C Diff for 8 months! The only thing that kept it from becoming horrible were the probiotics I was taking. Being off gluten for so long, I feel amazingly better in many ways. But the doctor wants me to remain gluten free while healing. PS...I beat the C Diff with Flagyl, but still nervous about a recurrence. Keeping gluten free and will stay on probiotics, specifically Florastor and Culturell for the forseeable future. Good luck....but don't wait to see a doctor like I did!

I did go to a GI doctor 3 weeks ago. My only symptom is gas and even then it's presentation is bizarre. The doctor did do a coeliac screen but I haven't heard back which I am assuming meant it was unremarkable. I did bring up bacterial overgrowth with him and he said my presentation is not at all consistent with what he has seen. I have had a coeliac biopsy before which came negative but he said it wouldn't hurt to do the blood test again. Judging that I have gone gluten free for a week and had 0 change and that I don't eat dairy my last guess would be anxiety, This. This right here. Is very frustrating.

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The doctor did do a coeliac screen but I haven't heard back which I am assuming meant it was unremarkable.

Never assume! Stuff gets lost or overlooked in doctors' offices. Besides, you should get copies of your tests for your own records - you never know when you will need them or whether they have been misread if you dont.

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Called up the doc - besides a slightly elevated calcium (which I have had for years) everything was normal. Coeliac came back negative as suspected. So after two blood tests and an endoscopy which say I am negative, I don't have any reason to question it.

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You can be negative on all testing and still have problems with gluten (and milk) if you have done any reading around the board. :)

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I did go to a GI doctor 3 weeks ago. My only symptom is gas and even then it's presentation is bizarre. The doctor did do a coeliac screen but I haven't heard back which I am assuming meant it was unremarkable. I did bring up bacterial overgrowth with him and he said my presentation is not at all consistent with what he has seen. I have had a coeliac biopsy before which came negative but he said it wouldn't hurt to do the blood test again. Judging that I have gone gluten free for a week and had 0 change and that I don't eat dairy my last guess would be anxiety, This. This right here. Is very frustrating.

Duh. I should have seen this sooner. I bet it's fructose malabsorption. It works sort of like lactose intolerance. You can't absorb fructose well so it builds up in your intestines. Bacteria break it down into hydrogen, or if you eat a LOT, you can end up with osmotic diarrhea.

Your eggs, salami, and yogurt breakfast you don't react to has virtually no fructose or fructans especially if it's plain or artificially sweetened yogurt. The bagel with PBJ that gets you has wheat, which has a fair amount of fructans, plus the jelly loads on sugar or even worse high-fructose corn syrup. The ceasar salad is mostly lettuce and low in fructose. A few croutons won't give you enough fructans to cause much trouble compared to the bagel. It's a bulk effect. The sugar you react to is a mix of fructose and glucose and people with fructose malabsorption often tolerate sugar very poorly. Does fruit typically give you digestive trouble? If you can't think of eating apples or pears that's another sure sign of it.

Since it takes time for the fructose to make it to your intestine, and more time for bacteria to work on it, reactions can be somewhat delayed. Frutose and fructans are common and in a lot of foods so it can also seem like you're reacting randomly to everything.

GI doctors in the US have barely heard of fructose malabsorption, which is why the possibility has never been mentioned to you. To figure out if it's the problem you could ask for a fructose challenge and hydrogen breath test. You could also try a low-FODMAP diet for a while - it almost seems like you're there on your own.

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I actually had looked into that - however my symptoms aren't consistent. For instance today, I had eggs/salami for breaksfast, salad for lunch, and chicken salad 3 hours later for a snack. Without fail, 5pm rolls around and I start getting the stomach noises (gurgling, like a back fart). I noticed this morning before my test (I'm in medical school, so I promise to help you all out when I finish), that I got the sensation of the gas starting but as soon as the test started and I got my mind off of it, it went away. Same thing at the barber, I felt a little gurgle, but as soon as we made conversation and I got my mind off of it, it went away.

It would be great if it was just a food intolerance, but there should be some variation or consistency. This all started when I had afternoon classes and I stressed about breaking wind, tooting, letting one out, contributing to the atmosphere, whatever they are calling it these days.

And as a post script, I have a history of anxiety - I gave myself functional dyspepsia/hypochlorhydria for 9 months when I convinced myself I had ALS. Took Reglan and some Betaine HCl to get me normal. I'm not ruling out any pathological processes but nothing makes sense. I have a GI visit Monday, which he already alluded to wanting to put me on Xifaxin, so I'll update then.

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    • I'll give my PCP a call tomorrow and see what they can offer. My only worry is the expense as anymore tests will put me behind in being able to afford to see the GI. I have high deductible insurance but get money put into my HSA. I'm still trying to pay off the CT scan though. Which is why I'm trying to pick and choose which poses the greatest risk for me right now and what can wait. (Though I would prefer not to wait on any of it.)

      I really do hope its only IBS. Though I always worry IBS is more or less a doctors way of saying "I have no clue" at that point. :C

      Again, I'll be sure to give my PCP a call tomorrow then and see what the options are. I can feel a lot better trying the blood work first. however, once that is done, do I still need to be on a gluten diet before the endoscopy? Also, is it ok if I still mildly reduce the gluten. As in, can I avoid a whole wheat pasta dinner, but still be eating the peanut butter crackers? That sort of thing. Again I guess that is more of a doctor related question. I just wasn't sure if in order to raise your chance, you have to mass consume gluten or not. (Its already in just about everything to begin with.)
       
    • Excellent point, GFinDC!!! I just assumed that Steph had the endoscopy and not just the antibodies tests.    
    • She (your PCP)  can order a celiac blood panel.  It might not be a complete panel, but it's a start.  Any medical doctor can order one.  A GI is needed for the endoscopy (ulcers, Celiac disease, h.pylori, etc.), HIDA scan (gallbladder)  or colonoscopy (IBS).   Since you just saw her, email/call/write a letter and ask her to order (lab) the celiac panel.  You could go to the lab before or after work.  Pretty easy!  
    • I just now saw the second reply and I see what you mean. Again, the issue is that I may have to go with the gluten until close to the end of the year.

      However, an idea did just come to mind, and that is, can my primary care doctor do such a test? I had normal blood work done, but they didn't really say anything about testing for celiacs. I can get an appointment with my primary care doctor much sooner than a GI.

      When I was talking to my PCP last, I asked her what I should expect as far as testing goes or what she may have been concerned about. Her reply was about a HIDA scan for the gallbladder but also any test needed in case of IBS or Celiacs. Just the way she threw that in there like an after thought and left me hanging kinda had me worried.
    • I am not a doctor that's for sure.  So, I can't even answer your questions.  If you know you have pre-diabetes, you probably are working with a doctor.  Can you email them and ask for a celiac blood panel?   You can work on the weight loss and diabetes -- that you can handle yourself now and take action.  I have diabetes and my glucose readings are fairly normal now without medication and I'm thin.  Being overweight does not cause diabetes.  It's either autoimmune (type 1) or you become insulin resistant (type 2).  You can cut out all sugar and  processed stuff ASAP to help take action and start walking 10,000 steps (helps with the insulin resistance).    But the prediabetes is not going to kill you in the next year.  Whatever's in your gut is more likely going to get you much sooner.  But heck, I'm not a doctor and I don't even know you!    
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