Bloated Again? 5 Things Your Gut May Be Trying to Tell You

You cut out dairy. Then maybe gluten. You bought a probiotic because someone told you it would fix your gut. And you're still bloated.

In this episode, Dr. Sheri breaks down five things she wants every woman to understand about her gut, without a long lesson on digestive physiology and without another supplement to add to the cabinet.

She covers:

Bloating is a symptom, not a diagnosis. Why the pattern matters more than the fact that it happens at all, and the questions worth asking before you assume your microbiome is "bad."

Your bowel movements are giving you information. What the Bristol Stool Chart actually measures, and why going every day does not automatically mean everything is fine.

Your microbiome needs to be fed. Why fiber and plant variety matter more than the latest "gut healing" food, and how to add it without making bloating worse.

A probiotic is not a gut reset button. Why more strains and higher CFUs are not automatically better, and the three questions to ask before you keep taking one.

Testing should answer a clinical question. What stool testing can and cannot tell you, and why the biggest panel available is not always the most useful one.

At the end, Dr. Sheri walks through a simple seven-day gut check you can do at home. No expensive testing, no elimination diet, just paying attention to the patterns most of us never think to track.

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Transcript

Episode 19: Bloated Again? 5 Things Your Gut May Be Trying to Tell You
Healthspan on Her Terms with Dr. Sheri Erwin

[00:00] Dr. Sheri Erwin:
You're bloated again. So you try cutting out dairy. Then maybe you even try cutting out gluten. Then you bought some probiotics because someone told you that you needed them and that they would fix your gut. Maybe you've even Googled SIBO, leaky gut, candida, food sensitivities, and wondered if one of them explains why your stomach seems perfectly happy one day and looks like you're six months pregnant the next, and you're still bloated.

Here's the first thing I want you to know: bloating is a symptom. It is not a diagnosis, and it doesn't automatically mean your microbiome is bad, that you need an expensive stool test, or another supplement that will fix it. Your digestive system is actually giving us information. The trick is learning how to listen to it without blaming every symptom on your gut.

So today I'm going to give you five things I want every woman to understand about her gut, including what your bowel movements can tell you, why fiber matters more than most supplements, what probiotics can and can't do, and when bloating deserves a closer look. And at the end of this, I'm going to give you a simple seven-day gut check you can do at home. No expensive testing, no complicated elimination diet, just seven days of paying attention to a few things most of us never think to track. Because before you try to fix your gut, you need to understand what it's actually trying to tell you.

So let's get into this.

[01:48] Dr. Sheri Erwin:
Welcome back to Healthspan on Her Terms. I'm Dr. Sheri Erwin, Doctor of Nursing Practice, board-certified family nurse practitioner, certified integrative clinician, and founder of Root & Remedy Integrative Care. Today we're talking about your gut. And just like we did with iron in the last episode, I'm not going to give you a long lesson on digestive physiology. I'm giving you five things I want you to know about your own gut. And we're starting with something that may surprise you: not all bloating is abnormal.

Your abdomen is not supposed to look or feel exactly the same at 7 a.m. as it does at 7 p.m. You eat, you drink, food moves through your digestive tract. Your gut bacteria ferment certain carbohydrates and produce gas. Your intestines contain stool and fluid. So some change in how your abdomen feels throughout the day can be completely normal.

The question isn't simply, "Do I ever get bloated?" A much better question is, "What is the pattern?" This is where I want you to become a little bit of a detective. When does the bloating happen? Do you wake up bloated, or does it build through the day? Does it happen immediately after you eat, or several hours later? Is it associated with certain foods? Does it improve after you have a bowel movement? Are you also constipated? Do you feel like you can't completely empty your bowels? Is there abdominal pain? Has the pattern recently changed? Those details tell us much more than simply saying, "I'm bloated all the time."

And here's another important distinction: bloating and abdominal distension aren't exactly the same thing. Bloating is that sensation of fullness, pressure, and swelling. Distension is an actual, measurable increase in the size of the abdomen. You can experience one without necessarily having the other. And that matters because bloating isn't always caused by having too much gas. Sometimes it's related to constipation. Sometimes certain carbohydrates are being fermented in the gut. Sometimes it's related to how gas and intestinal contents are moving through the digestive tract. Hormonal changes can also influence digestion and bowel patterns. And sometimes the way the gut and the brain communicate can make normal digestive sensations feel more noticeable or uncomfortable.

So before we jump to "my microbiome must be messed up," I want you to start somewhere much simpler. Look for the pattern.

Here's your first tool. The next time you're bloated, make a quick note of four things: When did it start? What had you eaten in the several hours before the bloating? When was your last bowel movement? And what made the bloating better or worse? That's it. You don't need an app, you don't need a complicated food diary, and you definitely don't need to start an elimination diet of ten different foods based on one uncomfortable afternoon. You're simply collecting clues.

[05:23] Dr. Sheri Erwin:
Now, there's a time when bloating shouldn't just be tracked at home. If it's new and persistent, progressively worsening, or accompanied by things like unexplained weight loss, blood in your stool, persistent vomiting, significant or worsening abdominal pain, or another concerning change, that's a reason to talk with your healthcare provider rather than assuming it's just a gut issue. And for women, especially as we move through midlife, new persistent abdominal bloating or an increase in abdominal size deserves attention, because gastrointestinal symptoms aren't the only conditions that can cause those changes.

So here's what I want you to remember from number one: don't diagnose the bloat, track the pattern. Because one of the biggest clues may actually be something most of us don't spend much time talking about. Your...

[06:20] Dr. Sheri Erwin:
...bowel movements. And yes, we're going there. I know it's uncomfortable, I know we don't like to talk about it, because number two is: your poop is giving you information.

Okay, so number two, you're going to have to talk about it. It's important to remember this is a major element of your body's elimination process. Because if you come into my office and tell me you're bloated, one of the first things I'm going to ask and want to know is what's happening with your bowel movements. And I'm not just going to ask, "Are you constipated?" because a lot of women will tell me no. Then I ask a few more questions and I find out they're having a bowel movement every three or four days, they're straining, they're passing hard little pellets, or they never really feel like they've completely emptied their bowels. That is constipation, and it can absolutely contribute to bloating.

So here's something useful I want you to know about. There's actually a tool healthcare providers use called the Bristol Stool Chart. It divides stool into seven types based on what it looks like. Type 1 is those separate, hard little pellets. Type 2 is hard and lumpy. Those tend to suggest constipation. Types 3 and 4 are generally softer, formed stools and are typically what we're aiming for. Then we move toward increasingly loose stools, Types 5, 6, and 7, with Type 7 being completely watery. You don't need to memorize all seven types. What I want you to start doing is looking before you flush.

Seriously, your bowel movements can give you useful information. Ask yourself: How often am I going? Is the stool hard, formed, loose, or watery? Am I straining? Do I have urgency? Do I feel completely empty afterward? Has any of this changed recently?

And here's a myth I want to clear up: you do not have to have a bowel movement every single day to have a healthy gut. Normal bowel frequency varies between people. What matters is the overall pattern, stool consistency, whether you're comfortable, and whether there's been any meaningful change from what's normal for you. On the other hand, going every day doesn't automatically mean everything is perfect either. You can have a daily bowel movement and still struggle with hard stools, straining, incomplete evacuation, or other symptoms. That's why the details matter.

And there's another reason I want women paying attention. Your bowel habits can change with travel, stress, hydration, movement, medications, supplements, changes in your diet, and hormonal shifts. So if something changes, don't immediately assume your microbiome has suddenly gone bad. Ask what else changed as well.

Here's your tool for number two. For the next week, pay attention to just three things: How often are you going? What does it look like? And how easy or difficult is it to pass? That's much more useful information to bring to your healthcare provider than simply saying, "My gut is a mess."

And of course, there are changes that shouldn't be ignored. Blood in your stool, black or tarry stool when it isn't explained by something like an iron medication, persistent diarrhea, significant abdominal pain, unexplained weight loss, or a new persistent change in your bowel habits deserve medical evaluation.

But for many women struggling with everyday bloating, one of the first places worth looking is much less glamorous than the latest microbiome supplement. It's whether your digestive system is moving things through effectively. And that brings us to number three.

[10:38] Dr. Sheri Erwin:
Because if we're talking about keeping your digestive system moving and supporting the microbes that live there, we need to talk about something that doesn't get nearly as much attention as probiotics. Fiber. And before you decide that means you should start eating enormous salads tomorrow, there's something important you need to know.

Your microbiome needs to be fed. And this is where I think the gut health conversation sometimes gets completely backwards. We spend a lot of time talking about what to remove. No gluten, no dairy, no sugar, no grains, a low FODMAP diet. And sometimes eliminating or temporarily reducing certain foods absolutely has a clinical purpose. But if you're constantly taking foods away without understanding why, you can eventually end up with a very restricted diet.

Meanwhile, we may be overlooking one of the simplest ways to support the microbes already living in your gut: feed them. And one of their favorite foods is fiber. Certain types of fiber make their way through the digestive tract, where they're fermented by gut bacteria. Those bacteria can then produce compounds called short-chain fatty acids, including butyrate. You don't need to remember the name butyrate. What I want you to remember is that these compounds help support the cells lining your colon and are involved in maintaining a healthy intestinal environment. So fiber isn't just about helping you poop, it's also food for your microbiome.

And this is where I want to bust another myth: you probably don't need one magical "gut-healing" food. What tends to matter more is the overall pattern of what you're eating: vegetables, fruit, beans, lentils, whole grains if you tolerate them, nuts, seeds, herbs, and spices. Different plant foods provide different fibers and other compounds that interact with your gut microbiome.

So rather than obsessing over whether blueberries or broccoli are the "best" food for your gut, I want you thinking about something much simpler: variety. Look at what you ate yesterday. How many different plant foods were there? Not servings, different plants. Maybe you had oatmeal with blueberries and walnuts for breakfast. At lunch, a salad with greens, tomatoes, cucumbers, chickpeas, and maybe some pumpkin seeds. A snack in the afternoon, an apple. Some roasted vegetables with dinner. Suddenly you've given your gut a much wider variety of plant material than if you ate the same two vegetables every day.

But here's the part that gets missed on social media: if you're currently eating very little fiber and you're already bloated, do not suddenly double or triple your fiber intake overnight. You may feel worse. More fermentation can mean more gas, particularly while your digestive system is adjusting. So start gradually. Add one thing. Maybe berries with your breakfast. Maybe add beans to your soup at lunch. Maybe you sprinkle chia seeds or ground flax into something like yogurt you're already eating. Maybe you swap one refined grain for a whole grain. And see how your body responds.

Also remember that fiber and fluid work together, and movement matters too. Sometimes one of the simplest things you can do for your digestion is go for a walk. Not because walking "detoxes" your gut, it doesn't. But movement can support normal gastrointestinal motility, and it happens to be pretty good for the rest of your body too.

So here's your tool for number three. For the next seven days, don't worry about hitting some perfect fiber number or an arbitrary number of different plants. Instead, ask yourself: "Can I add one more plant food today?" Just one. That's manageable. And over time, those small additions can create a much more diverse dietary pattern.

[15:04] Dr. Sheri Erwin:
Now, at this point you may be thinking, "Okay, but what about probiotics? Don't I need one of those?" Well, maybe you do, but probably not for the reason the bottle is telling you. Because number four is: a probiotic is not a gut reset button.

Walk into almost any pharmacy or supplement store and you'll see an entire wall of probiotics. 10 billion CFUs, 50 billion, 100 billion. 10 strains, 20 strains. Refrigerated, shelf-stable, women's formula, gut formula. And it's really easy to look at all of that and think, "Well, more bacteria and more strains must mean a better probiotic." Not necessarily.

Here's something I really want you to understand: probiotics are not all the same. Different probiotics contain different microorganisms, and different strains may have different effects. So asking, "Do probiotics work?" is a little like asking, "Do medications work?" Which medication? For what condition? At what dose? For whom? The same kind of thinking matters with probiotics. There is evidence supporting certain probiotic strains or combinations for specific situations, but that is very different from saying that everyone who is bloated needs to take a daily probiotic.

And here's another myth I want to bust: feeling more bloated after starting a probiotic doesn't necessarily mean it's "working." I sometimes hear people say, "My stomach felt terrible, but I was told that's just die-off happening." I don't want you automatically assuming that feeling worse means something beneficial is happening. Sometimes a supplement simply doesn't agree with you.

And probiotics aren't the only way to interact with your gut microbiome. Remember what we just talked about: your dietary pattern matters, fiber matters, plant diversity matters, fermented foods may be another option for some people, sleep matters, movement matters, your medications matter, your overall health matters. Your microbiome lives within the context of your entire life. You can't necessarily compensate for everything else by swallowing a capsule every morning.

So here's your tool for number four. If you're considering a probiotic, ask: "Why am I taking this? What problem am I actually trying to solve?" Then ask, "Is there evidence for this particular product or strain for that problem?" And finally, "Is it actually helping me?" Because taking the same probiotic for years simply because you've been told probiotics are "good for your gut" isn't necessarily a strategy. And if you're already taking one, I'm not telling you to throw it away, I'm asking you to understand why it's part of your routine.

That's a question I want you asking about supplements in general: What am I taking this for? What evidence supports it? And how will I know whether it's helping? Those three questions can save you a lot of money and a very crowded supplement cabinet.

[18:23] Dr. Sheri Erwin:
Now let's get to number five, because there's another place women spend a lot of money trying to understand their gut: testing. You've probably seen comprehensive stool tests online that promise to tell you everything about which bacteria live in your gut, whether you have inflammation, parasites, yeast, digestive problems, or something called "dysbiosis." Some gastrointestinal testing can absolutely be useful. But here's what I want you to know before you spend hundreds of dollars: more testing doesn't automatically give us better answers.

And this one may surprise you coming from an integrative clinician, because I absolutely use advanced testing when I think it's going to help me answer a clinical question. But that's the key: before you spend hundreds of dollars on a test, you should know what you're hoping to learn from it. If you're bloated, ordering the biggest stool panel available just because it measures hundreds of things doesn't necessarily tell us why you're bloated. And finding something on a test doesn't automatically mean we've found the cause of your symptoms.

Your gut microbiome is incredibly complex. There are trillions of microorganisms living in and on your body, and we're still learning what many of them do, how they interact with one another, and what a "healthy" microbiome even looks like across different people. So when a commercial microbiome test tells you that one organism is "too high" or another is "too low," I don't want you assuming that you've found the explanation for every symptom you're experiencing. That's not where the science is.

Now, does that mean stool testing is useless? Absolutely not. There are situations where stool testing can be very helpful. There are established tests we use to look for things like infection, intestinal inflammation, or blood in the stool. There are breath tests that may be appropriate when conditions such as small intestinal bacterial overgrowth, or SIBO, are being considered. Testing for celiac disease may be appropriate in certain situations. Sometimes endoscopy or colonoscopy is what actually needs to happen. And there may be situations where additional specialty testing provides useful information. But the test should follow the clinical question, not the other way around.

Here's a myth I especially want to bust: you don't need an expensive stool test just because you're bloated. Sometimes the most useful first steps are much less exciting. What's happening with your bowel movements? Are you constipated? Did your symptoms begin after an illness? Did they begin after taking an antibiotic? Are there particular foods that consistently trigger your symptoms? Are you getting enough fiber? Are you eating enough? What medications and supplements are you taking? Are there symptoms that point toward something that needs a medical evaluation? That's clinical reasoning. Those are things you should be asking yourself, even if you're not a clinician. Or maybe you are a clinician, and a patient too.

We start with your story. Then we decide whether testing can help answer the questions your story creates. Not every test that can be ordered needs to be ordered.

And I also want you to be cautious about another phrase that's everywhere online: "gut dysbiosis." Dysbiosis generally refers to an imbalance or alteration in the microbial community. It's a real area of scientific research. But seeing the word "dysbiosis" on a report doesn't automatically give you a diagnosis, explain your symptoms, or tell you exactly which supplement you need. The microbiome is much more complicated than good bacteria versus bad bacteria.

So here's your tool for number five. Before you spend money on any gut test, ask: "What are we hoping this test will tell us?" Then ask, "How will this result change what happens next in my care?" Those are two questions I use in medicine all the time. Because if we don't know what we're looking for, and we don't know what we're going to do differently based on the result, we need to think carefully about whether that test is actually useful right now.

And that brings us back to where we started today. You're bloated, you want to know why. Before you start eliminating foods, buying supplements, and ordering every gut test available, start by listening. Because now I'm going to give you a simple way to do exactly...

[23:20] Dr. Sheri Erwin:
...that: your seven-day gut check.

For the next seven days, don't try to fix your gut. Just observe it. We're so quick to react to symptoms. We're bloated, so we eliminate a food. We're constipated, so we buy a supplement. We have gas, so we start a probiotic. But sometimes we haven't spent enough time figuring out what the pattern actually is.

So for seven days, I want you to pay attention to five things.

Number one: what are you eating? I'm not asking you to count calories or track every gram of food. Just notice the overall pattern. Are you eating a variety of plant foods? Are you getting sources of fiber throughout the day? Are there particular meals or foods that consistently seem to be followed by symptoms? Don't eliminate anything yet. Just notice.

Number two: when does the bloating happen? Are you waking up bloated? Does it start after breakfast? Does it gradually build throughout the day? Does it happen immediately after eating, or several hours later? Does it improve after you have a bowel movement? Write that down.

Number three: what's happening in the bathroom? How often are you having a bowel movement? What does it look like? Are you straining? Do you feel like you've completely emptied your bowels? Are your stools consistently hard, loose, or somewhere in between? Remember, look before you flush. I know that doesn't sound great, but it is so informative.

Number four: pay attention to what else is happening. How did you sleep? Did you have an unusually stressful day? Did you move your body? Are you approaching your period? Did you start a new medication or supplement? Did you eat differently because you were traveling or eating out? Your gut doesn't operate independently from the rest of you.

And finally, number five: what makes things better? Maybe you walked after dinner and that simply seemed to help. Maybe your bloating improved after a bowel movement. Maybe you noticed you're much more comfortable on days when you eat differently. Or maybe you don't find any obvious pattern at all. That's useful information too.

At the end of the seven days, look back. You're not looking for perfection, you're looking for repetition. What keeps showing up? And if you're talking with your healthcare provider about digestive symptoms, bring those observations with you. Instead of "I'm bloated all the time," you may be able to say, "I've tracked this for a week. I usually feel fine when I wake up, but the bloating starts several hours after lunch and gets worse on days I haven't had a bowel movement." That is much more useful information. Or, "I've noticed this isn't occasional anymore. I'm waking up bloated, it's happening every day, and this is new for me." That's useful information too.

This is what I mean when I tell you that symptoms are clues. We're not ignoring them. We're also not letting one symptom convince us that we already know the diagnosis. We're getting curious.

[26:45] Dr. Sheri Erwin:
So your five big takeaways today are: Bloating is a symptom, it is not a diagnosis. Your bowel movements are giving you information, I know, icky, who wants to look at your bowel movements, but they're informative. Your microbiome needs to be fed, not just supplemented. A probiotic isn't a gut reset button. And testing should answer a clinical question.

You don't need to become an expert on your microbiome. You don't need to diagnose yourself with SIBO. And you don't need a cabinet full of gut supplements. Start by understanding your own patterns, because the better you understand what's happening in your body, the better questions you can ask about what it might need.

Before we finish, I want to leave you with one thought. Taking care of your gut isn't about achieving a "perfect microbiome," and it certainly isn't about never being bloated again. It's about supporting a digestive system that allows you to nourish your body, absorb the nutrients you need, maintain regular bowel function, and enjoy food without constantly wondering what you need to eliminate next. That's part of healthspan too, because the goal isn't just to live longer, it's to spend those years with the energy, strength, and health to actually enjoy them.

So this week, try the seven-day gut check. Don't change everything. Don't buy anything. Just pay attention. You may be surprised by what you notice when you stop trying to fix every symptom and start looking for the pattern.

And if something doesn't feel right, especially if your symptoms are new, persistent, worsening, or accompanied by any of the warning signs we talked about today, please bring that information to your healthcare provider.

If this episode made you think of a woman who's always saying, "I don't know why I'm so bloated," send it to her. And if you're enjoying Healthspan on Her Terms, follow the show and leave a review. It helps more women find these conversations.

You can find me and learn more about Root & Remedy Integrative Care at RootRemedyIC.com. Thank you for spending part of your day with me.

Until next time, remember: your body isn't working against you, it's communicating with you. And every symptom is an opportunity to better understand the remarkable woman you're becoming.

Take care, and I'll see you next week.