Managing Gas and Bloating: A Dietitian’s Evidence-Based Guide

Functional Bloating, more than just a nuisance

We’ve all had a bit of gas and bloating after a big meal — but when bloating becomes a daily problem, it’s more than just “a nuisance.” Functional bloating can affect sleep, confidence, and quality of life. In some cases, it may be a sign of mismanaged care that even has medico-legal consequences.

As a Consultant Dietitian, I see this every week in private practice — and occasionally in the courtroom, where bloating has been overlooked or dismissed in negligence cases.

Here’s what you need to know.

What Causes Gas and Bloating?

Bloating isn’t a diagnosis. It’s a symptom with multiple potential causes:

• Functional gut disorders: IBS, functional dyspepsia.

• FODMAP sensitivity: Fermentable carbs producing gas.

• Small intestinal bacterial overgrowth (SIBO).

• Gut-brain axis dysfunction: Stress, anxiety, poor sleep.

• Poor motility: Constipation, delayed gastric emptying.

In negligence contexts, missing or failing to investigate these causes can represent a breach of duty, especially if weight loss, malnutrition, or faltering growth results.

The Role of FODMAPs & Gut Microbiome

• FODMAP = Fermentable Oligo-, Di-, Mono-saccharides And Polyols.

• Excess fermentation → gas → distension.

• NICE-endorsed low-FODMAP diet (delivered by dietitians) can significantly improve symptoms.

• Microbiome diversity plays a role — antibiotics, diet, and stress shift balance.

When Bloating Is More Than “Just IBS”

Red flag symptoms that require urgent referral:

• Unexplained weight loss

• Anaemia

• Blood in stool

• Persistent vomiting

• Family history of GI cancers

Missed or delayed action here can lead to medico-legal claims if harm results.

Case Example

A young woman with persistent bloating was repeatedly told “it’s just IBS” without further workup. Two years later, she was diagnosed with coeliac disease. The delay contributed to severe anaemia and osteoporosis. In court, the missed dietetic and gastroenterology referrals were key issues.

Practical Strategies for Patients

• Food diary → patterns with meals, stress, sleep.

• Dietitian-led low-FODMAP trial (not DIY).

• Manage constipation → hydration, fibre balance, movement.

• Stress & sleep hygiene → gut-brain link is strong.

FAQs

Is bloating always diet-related? No — it can be linked to motility, microbiome, or systemic illness.

Can supplements help? Probiotics or digestive enzymes may help, but should be trialled under supervision.

Why is this relevant legally? Because mismanagement (failure to screen for coeliac, IBD, cancers) can lead to preventable harm.

Closing Thought

Bloating isn’t trivial. For patients, it’s life-limiting. For clinicians, it’s a signal to investigate properly. For solicitors, it can be the thread that unravels a negligence case.