Although this question is not only related to people who have diabetes, I found it interesting. It is often asked and is well worth exploring. Feel free to write to us if you have a question or concern. We are looking forward to giving you an accurate answer.

Why am I so bloated? Can it be related to my diabetes?

Over 10 million people in the U.S. complain about bloating and stomach issues, which may be corrected by a few simple changes. Bloating is “air in the intestines”, which has several causes – including over-indulging in fatty and salty foods. Let’s explore some other possible reasons.

One of the most common oral medications prescribed for diabetes type 2 is Metformin, which targets the liver to produce less glucose. Metformin is cheap (free in Publix supermarkets which are located in Florida and the south), but can have the common side effects of bloating, stomach gas pains and diarrhea. Most physicians are fully aware of these problems and try to start on a low dose of medication which is gradually increased. This allows the body to acclimate without GI symptoms. If Metformin causes severe stomach issues, talk to your physician about Glumetza. Glumetza is a slow release variation given only once a day. Although it is more expensive, it may have fewer side effects. If you take Metformin, do not take it on an empty stomach. Either take a few bites of your meal prior to taking the pill or take it directly after eating your entire breakfast or dinner. The timing of the medication will reduce GI side effects. Research states that “berberine may have similar properties of Metformin without the GI side effects.” A small study published by the N.I.H. showed it did have a positive effect on lowering blood sugars and lipid levels. Berberine is a Chinese herb not regulated by the FDA, which can often lead to other complications. Always talk to your doctor before making any changes to your medications, or adding herbs to your current list of medications.

Other possible reasons for bloating, stomach gas pains and diarrhea are sugar-free foods or chewing gums which contain sugar alcohols. You should eat these products in moderation to prevent gastric discomfort. I recently taught a patient who thought since he only ate sugar-free cookies they could be eaten a dozen at a time. I reminded him that they were not calorie-free, and should never be eaten in large portions. He did comment about stomach issues after a few days of “eating too many sugar-free desserts.” Sugar-free chewing gum contains sugar alcohol as well, but just the act of chewing gum can promote swallowing air and increase bloating. See how products with sugar alcohol affect you personally.

Drinking diet soda is permissible when you have diabetes, but you should watch the amount if you are experiencing bloating. All sodas have carbonation. The carbon dioxide trapped in the fizzy bubbles can result in air build-up, gas and bloating. Drinking club soda (calorie-free with carbonation) or sparkling water can cause bloating and burping for some individuals. Try to drink flat bottled or tap water. Eating slowly and chewing your food carefully (10 – 20 chews per bite) also prevents gas build up. Try to increase eating water rich vegetables including celery, cucumbers, spinach, kale and lettuce. Water rich foods help to flush out waste, which reduces bloating. Watermelon and oranges are water rich fruits (remember, fruits are counted as carbohydrates, so watch your portion size). Pineapples contain bromelain – an enzyme which aids in better digestion and decreased bloating. Drinking peppermint, ginger or Chamomile tea can calm stomach muscles, relieve gas pain and pressure.

High fiber foods may cause bloating if added in large amounts too quickly. You should start slowly by incorporating high fiber foods and gradually increase them in your daily diet; eating about 25-30 grams of daily fiber will reduce constipation which is also associated with bloating. Include bran, berries, apples and oatmeal to increase fiber content. Drink plenty of water when eating high fiber. Yogurt contains good bacteria which may reduce bloating. Taking an over the counter pro-biotic may reduce bloating. Eating foods rich in potassium counter balances sodium which helps you retain less water and relieve bloating. Fruits and vegetables including bananas, strawberries, kiwis, asparagus and dandelion greens are very good at being natural diuretics and can reduce bloating.

Taking a 15 minute walk after eating your meals will also help relieve bloating. Exercise often helps control stomach issues including constipation (it helps lower blood sugars as well).

These suggestions do not replace medical advice. If you think you have a problem with water retention and bloating that is not easily rectified by these suggestions, please consult your health care provider. Usually bloating and GI distress can be eliminated with minor lifestyle changes. As usual, good nutrition and exercise tend to assist in many cases of bloating and GI distress. Sounds similar to caring for your type 2 diabetes! Good luck!


NOTE: Consult your doctor first to make sure my recommendations fit your special health needs.

Roberta Kleinman

Roberta Kleinman

Roberta Kleinman, RN, M. Ed., CDE, is a registered nurse and certified diabetes educator. She grew up in Long Island, NY. Her nursing training was done at the University of Vermont where she received a B.S. R.N. Robbie obtained her Master of Education degree, with a specialty in exercise physiology, from Georgia State University in Atlanta, Georgia.

She is a member of the American Diabetes Association as well as the South Florida Association of Diabetes Educators. She worked with the education department of NBMC to help educate the hospital's in-patient nurses about diabetes. She practices a healthy lifestyle and has worked as a personal fitness trainer in the past.

She was one of the initiators of the North Broward Diabetes Center (NBMC) which started in 1990 and was one of the first American Diabetes Association (ADA) certified programs in Broward County, Florida for nearly two decades. Robbie has educated patients to care for themselves and has counseled them on healthy eating, heart disease, high lipids, use of glucometers, insulin and many other aspects of diabetes care. The NBMC Diabetes Center received the Valor Award from the American Diabetes Center for excellent care to their patients. Robbie has volunteered over the years as leader of many diabetes support groups.
Roberta Kleinman

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