Banish Bloating

By: 

by Suzannah Olivier

Issue: 
Summer
Year of publication: 
2002

Many people, even if they are skinny, have a problem with bloating. Suzannah Olivier MSc, Dip.ION looks at the possible causes – whether digestive or as the result of a sluggish detox process – and pinpoints the best nutritional advice to combat this common condition.
Look up bloating in most medical textbooks and you will find it doesn’t exist. Various related conditions might satisfy your search for information – oedema, flatulence, colic – but not bloating. And yet 70% of women and 40% of men who seek help from nutritionists, note that bloating is a feature, or the core, of their health problems.
When bloating is acknowledged as a problem by the medical profession it is usually viewed as “idiopathic” – caused by unknown factors. Diuretics or indigestion remedies may be prescribed for a while, but these will only deal with the symptoms, and not address the underlying causes. In the meantime, a fortune is spent on these medications, both prescribed and over-the- counter.
Very few people like to bother their doctors with this problem in the first place – even though there now appears to be an epidemic of bloating. No symptom, even if it seems minor, should be ignored if it persists. Bloating on a regular basis can be indicative of underlying health issues and imbalances which, if left unchecked, can lead to more serious health problems in later years. The good news is that, because we are a complex web of interactions, it is impossible to positively affect one aspect of health without influencing other aspects. That is why someone who deals with their bloating and digestive problems, even minor ones, may find that other health issues, such as migraines, asthma, eczema and arthritis, resolve themselves.
If you experience bloating, you are probably receiving an early warning signal that all is not well. Hippocrates knew that digestive health was important when he wrote in around 400BC, “Death sits in the bowels, and bad digestion is the root of all evil”.
FOOD FACTS
The main components of food are proteins, fats, carbohydrates, vitamins and minerals. All of these nutrients are the essential parts of the jigsaw puzzle which allows functions to happen in every cell. If a part of the jigsaw puzzle is missing then the picture cannot be completed.
The most concentrated source of vitamins and minerals in the diet are fruits, vegetables, pulses, nuts, seeds, and cereals. Moderate amounts of dairy products, meat and fish, are also useful, although a well-balanced vegetarian diet is unlikely to be deficient in nutrients for most people. But a nutrient-rich diet is not always sufficient if there has been a history of poor diet or if illness has been experienced. Frequently, digestion has been impaired to such an extent that food is not being efficiently broken down to release the nutrients, or the lining of the digestive tract is not adequately absorbing them. This means the digestive health must be restored before a full return to health can be experienced.
If you are lucky, the bloating you are experiencing may be quite a simple issue which can be resolved by addressing one or two dietary factors. If the situation is more complex, perseverance may be needed to uncover the underlying cause.
“Death sits in the bowels, and bad digestion is the root of all evil” Hippocrates, c.400BC CAUSES
Protein problems
Some people find that protein foods are best not eaten with carbohydrate foods and that in separating them they can significantly reduce bloating problems. Protein can often interfere with the digestion of carbohydrate, or vice versa.
An excess of animal protein in particular has been linked to gas problems which plague some people with bloating. To put it bluntly, if the gas you expel smells unpleasant (animal proteins contain high levels of smelly sulphur) the chances are that you are eating too much animal protein or not digesting it properly.
Milk proteins can also cause problems in some people, and the most troublesome one is casein. Milk proteins can cause a straight-forward allergy reaction or can create a more subtle sensitivity. Either way, they irritate the gut lining, which can exacerbate inflammation, which in turn can increase bloating.
We’ve all heard the jests and jokes coined around beans and the digestive system. The gassy effects are created by bacteria in the large intestine, busily at work breaking down oligosaccharides – indigestible starches found more or less in all legumes. To help disperse some of the gas-producing compounds, always soak beans overnight and try adding some flavoursome digestion enhancer's such as bay leaves or a little ginger during the cooking process.
Saturated fats and inflammation
Excess animal fats in the diet encourage inflammation by increasing an inflammatory substance called PGE2. If this inflammation happens in the digestive tract, this can contribute to a sensation of bloating. On the other hand, the healthy fats, found in vegetables, nuts, seeds, their oils, and in oily fish, encourage two anti-inflammatory substances called PGE1 and PGE3 and these substances have the power to heal the gut tissue. Finally, hydrogenated fats (present in margarine, refined vegetable oils, fried food, biscuits, cakes) block the effects of the beneficial anti-inflammatory PGE1 and PGE3 and so contribute to bloating.

Lactose intolerance
While we think of dairy products as protein foods, they can cause great problems for people who are sensitive to milk sugar (lactose).
We produce a specific enzyme, lactase, which digests milk sugar. If lactose is not properly digested, then, as with any sugar, it can be fermented by the bacteria in the gut and produce uncomfortable bloating.
Babies are born with the ability to digest milk, as they are meant to be breast fed; however, in a significant number of people the production of lactase tails off from the age of around two or three. In addition to severe wind and bloating, other signs of lactose intolerance can include constipation, diarrhoea, excess mucus production, ulcerative colitis and irritable bowel syndrome (IBS).
Lactose intolerance varies in adults of different ethnic backgrounds, and the lactase enzyme is significantly absent in some racial groups. The percentage of people of Jewish, Mediterranean, African, Hispanic,
Asian and Native American descent who are lactose intolerant varies between 65-95%, whereas only 10-15% of those of Northern or Middle European descent are lactose intolerant.
Not all dairy products are rich sources of lactose and so some dairy foods are tolerated by lactose-intolerant adults, where others are not. For instance, the processing of milk into cheese will remove most of the sugars, leaving behind the protein and fat, and butter is almost 100% fat with little residual lactose. Yoghurt, home-made and fermented for 24 hours, is yet another exception as the bacteria which are used in the manufacturing process largely pre-digests the milk sugars. Skimmed milk will have a higher percentage of lactose, compared to full fat milk, and can cause greater problems for sensitive individuals. Goat and sheep milk are also sources of lactose.
Coeliac disease
The foods that we are most likely to be sensitive to are those to which we are well and truly addicted. And high up on the list of those foods are bread, pasta and other wheat-based products. Wheat-based foods are high in gluten, as are those made with oats, rye and barley.
Gluten is a sticky protein molecule which traps air in the bread-making process – a very useful characteristic, as it ensures loaves puff up nicely and are springy to the touch. Modern strains of wheat have been bred to contain even more gluten, and this seems to be contributing to the increase in gluten intolerance.
The orthodox view of gluten allergy is that it is only suffered by those with confirmed coeliac disease, where the gluten is responsible for “wearing down”, or atrophying the villi in the digestive tract. The villi are microscopic finger-like protrusions which line our digestive tracts and increase the area of absorption. They also secrete the digestive enzymes which break down carbohydrates. Because the villi are atrophied, the intestine is unable to perform its job of secreting these enzymes, and it is also unable to satisfactorily absorb the nutrients which have been successfully digested.
Coeliac disease is not, however, the whole story, and many people with gluten intolerance may have a number of the similar symptoms without the definitive damage to their villi that is suffered by true coeliacs. In some way the gluten is affecting their digestive tract sufficiently to impair digestion and to cause wide ranging digestive symptoms, including bloating, abdominal cramps, diarrhoea and gas.
It seems likely that one of the reasons why gluten grains are a problem for a significant number of people is that grains trigger an immune reaction which causes no immediate damage to the villi, but which ultimately causes inflammation and leads to increased gut permeability (see Gut permeability below).
Generally speaking, people with coeliac disease will need to avoid gluten grains for their entire lives, while people with gluten-grain intolerance may be able to reintroduce gluten grains after a period of time, though probably in reduced quantities and on a rotation basis.
Low stomach acidity
The stomach, when empty, is about the size of a clenched fist, but capable of expanding to accommodate 1.5 litres. The cells lining the stomach produce hydrochloric acid (HCI) which has a pH of around 2.0. The reason the stomach is such an acidic environment is that this is where protein digestion begins. Pouring acid on proteins is the first step in breaking them down.
HCI activates protein-digesting enzymes and also stimulates the pancreas to secrete fat and starch digesting enzymes, and the gall bladder to release bile for fat digestion. This feature makes it important for digestion of all types of food.
Symptoms of low stomach acidity can include excessive burping after a meal, indigestion, bad breath, bloating, flatulence and constipation or diarrhoea. The symptoms are likely to be more pronounced after eating a protein rich meal.
Gut permeability
The lining of our small intestine, when healthy, is designed to allow through only properly digested proteins, fats, and starches and the vitamins and minerals they contain. Absorption happens via a number of mechanisms through the cells themselves or at special junctions which, as the name implies, are closely fitted together and do not normally allow unwanted substances to pass between them.
Problems start when there is irritation or inflammation and the tight-junctions loosen up. This allows normally unabsorbable molecules to cross the barrier and to be taken into the blood stream. This condition has been nicknamed “leaky gut syndrome” and is associated with a number of conditions, including bloating, food allergies, asthma, bronchitis, eczema, psoriasis, Crohn’s disease and rheumatoid arthritis.
There are many factors which can contribute to disruption of the functioning of the gut lining, and in most people they probably have a cumulative effect. The factors that are most likely to contribute to altered gut permeability in adulthood are: constant stress, food allergies, alcohol, bacterial imbalance, medication such as aspirin, non-steroidal anti-inflammatory drugs (NSAIDs) and antibiotics, and some chemicals.
One of the key symptoms of food sensitivities and intolerances is bloating. This can be caused by inflammation of the lining of the digestive tract, or due to wind as the foods are not broken down properly 
Food allergies
The term allergy is strictly applied to substances which cause an instant immune reaction in an individual. These immune reactions can be quite severe, resulting in hay fever, asthma, hives, rashes, vomiting, swelling of the breathing passages and, in the most severe cases, death. This sort of immune response is easily measured with a blood test looking for a type of reaction called an IgE antibody. The most common food culprits are peanuts, sesame seeds, egg whites, dairy produce, soya, shellfish, citrus fruit and highly coloured fruit such as cherries.
More recently, a group of food related problems have been acknowledged as the cause of a wide variety of health problems. Because they do not trigger the classical IgE reaction which can readily be tested for, their relevance has been the subject of debate amongst more orthodox physicians. To compound the confusion, these reactions to foods have been grouped under the heading of allergies, when strictly speaking they should probably be grouped separately as sensitivities or intolerances.
The main difference between IgE allergies and food sensitivities is that the latter can cause symptoms to develop up to 72 hours after eating the food. This makes them difficult to diagnose.
One of the key symptoms of food sensitivities and intolerances is bloating. This can be caused by inflammation of the lining of the digestive tract, or due to wind as the foods are not broken down properly.
Bacterial Imbalance
Bacterial imbalance is usually the result of a number of conditions which, over time, leads to chronic overgrowth of “bad” bacteria at the expense of “good” bacteria. The most common lifestyle and dietary factors which influence this are: overuse of antibiotics; high levels of sugar, alcohol or refined carbohydrate; high levels of stress; low stomach HCI levels; slow transit time of food through the intestinal tract and pharmaceutical drugs.
Candidiasis
Candida albicans is normally present in the healthy body, but lies dormant and does not create a crisis. This opportunistic yeast thrives when there is a bacterial imbalance in the bowels and can proliferate, causing many problems. Candida albicans can produce around 80 powerful toxic by- products, resulting in allergic- type reactions which lead to a wide variety of possible symptoms, including abdominal bloating.
Toxic overload
A number of factors including inflammation, increased gut permeability, food allergies, sensitivities and intolerances, bowel bacteria imbalance, candida – either in isolation, or in combina tion – can lead to a build-up of toxins. They can overburden the body’s detoxification systems and lead to toxins having to be stored in body tissues, resulting in bloating on a grand scale, or aches and pains in joints.
Parasites
In our hygienic, sanitised and deodorised society it is unpleasant to think that we may be carrying parasites around. And yet wherever there is an opportunity in the natural world, some little beastie is ready to move in and make a home. It is not difficult to catch parasites of one sort or another – from restaurants where there is questionable hygiene, from overseas where water may not be well purified, even from our children, who have been exposed at school, or playgroups, or from our pets. For many people, parasites may do little harm and there are no discernible symptoms. If you find that your bloating symptoms are not alleviated by other measures, it is always wise to think about the possibility of a parasite infestation.
HEALING WITH E.A.S.E.
We’ve looked at the various symptoms which might be expressed under the collective term of “bloating”. We’ve also looked at what might be the food related or physical reasons for such bloating. Now for the really important part – how to banish bloating. We need to promote effective digestion, starting with the mouth and continuing along the whole length of the intestines, ensuring correct nutrient absorption and bacterial balance along the way until, finally, there is healthy elimination. The steps to take, in sequence, have been broken down into four steps with a programme called E.A.S.E. This programme owes much to the work of Dr Jeffrey Bland, a highly respected clinical nutritionist, in the state of Washington, USA. Here is a summary of the programme:
1. E - ELIMINATE THE CAUSE
The place to start when banishing bloating is to eliminate any foods from the diet which may be contributing to the problem. I have found that there are four regimes, or ways of eating, that are successful at eliminating bloating and related problems, and you will probably find that you prefer the sound of one option over the other. They are as follows:
The Avoidance and Reintroduction Plan
This involves identifying the foods, or drinks for that matter, which might be contributing to your bloating and helps about 50% of sufferers. The advantage of this approach is that you only tackle a small number of foods at the same time and, because there are so many substitutes for commonly disruptive foods, there is no need to feel deprived or to risk being on a too restricted diet. The disadvantage of this plan is that, because it does not take a blanket approach to foods, it is possible that some foods which are contributing to the problem may be missed out.
The best approach is to avoid all your suspect foods, strictly for 14 days. During the 14-day avoidance period, keep a list of any symptoms which improve, stay the same, or get worse. After the 14-day exclusion period, reintroduce the foods one at a time every third day. When the food is reintroduced make a note of any symptoms which return, within a couple of hours, or even within the next three days. Once you have tested the food, continue to avoid it, whether it has produced any symptoms or not, until you have tested all the other foods you are aiming to reintroduce.
When you have identified the foods which are related to your bloating, you will need to carry on avoiding them for a further two months. After this period you can reintroduce them into your diet to see if they have any effect. Some people will be able to tolerate the reintroduced foods, while others will find that there is a recurrence of problems. If you are able to tolerate the food, you will probably find that, if you abuse it, you will be back to square one. However, a rotation diet, where the food is eaten every fifth day, usually means that the food can be eaten without too much trouble.
Avoiding Foods Which Fight
This option is based on the food combining diet and helps about 25% of cases. The basic principle is that protein foods and starches are digested in different parts of the digestive tract and if they are eaten together they “fight” and impair digestion. This way of eating has some enthusiastic advocates, and it certainly does seem to work for a significant number of people. Possible benefits include a reduction, or elimination, of bloating problems such as water retention, stomach distension and wind. Three types of meals can be eaten:
 

  • Protein with vegetables
  • Starch with vegetables
  • Fruit meals

Protein foods: meat, poultry, fish, eggs, cheese, milk, soya, nuts, seeds and yoghurt.
Starchy foods: potato, bread, pasta, rice, oats, rye, barley and sweetcorn.
Neutral foods: can be combined with either proteins or starch based meals and include green leafy vegetables, avocado, red/yellow vegetables and root vegetables (but no potatoes), sprouted legumes, sprouted seeds, butter and oils, egg yolk and cream.
The Anti-Candida Programme
This is really just for people who have identified that they have a problem with candida. To eliminate an overgrowth of candida, it is most effective to combine a dietary programme together with anti- candida supplements. The whole point of an anti-candida diet is to starve the candida of the foods it thrives on.
Foods you can enjoy: meat, poultry, eggs, tofu, vegetables, beans, pulses, oils, fresh nuts, fresh seeds, brown rice and other whole grains (except wheat). Usually fruits which are not excessively sweet are allowed, such as green apples and green pears. If the candida is extremely bad then even these fruit may be best avoided.
Foods to be avoided: alcohol, sugar, foods containing yeast (e.g. bread, cheese, soya sauce), processed meats and other processed foods, wheat, all dried fruits, most fresh fruits which are very sweet, vinegar and mushrooms.
Natural anti-candida agents
It is important, when using strong antifungals, particularly in supplement form, that you follow the recommended doses. If you begin to feel worse, perhaps more tired, it is possible that this is caused by toxins being released from the candida as it dies off. If the die-off exceeds a sensible comfort zone, do not be a martyr, reduce the dose of your anti-fungals. Below is a table of the most popular natural anti-candida agents. As candida can cause a loss of nutrients because of malabsorption, it is important to take a daily multivitamin and mineral supplement which is of a sufficiently high dose to top up levels again. In particular, vitamin B6 and magnesium can be severely depleted.

NUTRIENT
HERB DOSAGE

Caprylic acid 400 mg 
Three times a day between meals

Garlic 
Best taken raw on salads

Biotin 200 µg 
Three times a day

Pau d’arco 
One cup of tea twice a day

Grapefruit seed extract 75-150 mg 
Three times a day

Pseudowintera colorata 
One capsule a day


The Stone Age Diet

This is a much more radical approach that involves eating in a way that our hunter-gatherer ancestors would have done, avoiding all modern-day food processing innovations. The Stone Age Diet is favoured by many doctors and clinicians working as allergists, since it is a relatively pure diet which resolves many health problems. Difficult cases which are not helped by other dietary regimes may benefit from following this diet.
The diet allows you to eat meat and game, fish, honey and seeds, but these should not form more than 30% of the diet. The bulk of the diet (70%) should be made up of green leafy vegetables, salad leaves, root vegetables, and fruits (other than citrus). Buckwheat, quinoa, sago and tapioca are also allowed, as are very small quantities of oils.
The Stone Age Diet does not permit most grains/cereals, dairy products, peanuts, sugar, alcohol, coffee, tea, chocolate or any other modern food innovations.
2. A - AID DIGESTION
In the Eliminate the Cause section you have addressed by far the most difficult aspect of bringing your bloating under control. The remainder of the programme is no less important.
Here we look at giving your digestive tract a chance to do its job efficiently by examining when and how you eat, the possibility of using digestive enzymes if they are deficient, and other digestive aids.
How do you eat?
It is worth reflecting for a few moments on how you go about this daily ritual, and assessing whether some changes would be desirable.
First and foremost it is important to relax when eating. Nervous tension at meal times limits the digestion and means that while you may be eating healthily, you may not be getting the best out of your food, nutritionally speaking. Chewing your food well is vital. Chewing stimulates gastric and pancreatic juices to allow these juices to do their job properly.
You may be bloating because you are eating large portions, and the distended feeling in your stomach may be the result of your digestive capacity being unable to cope with the size of the meals. You may find you are better off eating five or six small meals a day rather than eating three large “square” meals.

DIGESTIVE SUPPLEMENTS
Hydrochloric acid (HCl)
If you think that you have low stomach acid, HCI supplements are readily available to help increase levels. If you take it and get a burning sensation, stop immediately. Betaine hydrochloride with pepsin provides a natural source of HCI. Take one or two 100 mg capsules with each meal, to see if it makes a difference to your digestion. Use them for at least six months, while making positive changes to your diet. After that time, you should be able to reduce, and eventually stop, your use of them.
Digestive enzymes
Digestive enzymes can be taken just before, during or just after a meal. Do not rely on them long term; the point of using them is to help create better nutrient absorption and simultaneously improve the diet to the point when you can be weaned off them. There are many different types of digestive enzyme compounds and it is usually best to go for a good broad-spectrum supplement which contains amylase, protease and lipase.
Helpful herbals
There are some herbal preparations, many of which make delicious teas, which can aid digestion. These include dandelion, fennel, liquorice, peppermint, ginger, aloe vera, milk thistle, slippery elm, meadowsweet and marshmallow.
3. S - SOLVE THE DAMAGE

A digestive system which has been under the continued assault from foods which do not agree with it, toxic by-products of bacterial overgrowth, or possibly candida, will probably have sustained some damage to its basic fabric. Much can be done to encourage healing of the digestive tract, and, if this is done successfully, there is less chance that the problems will recur at a later date. During the time that you are working on healing the gut wall it is necessary to continue avoiding foods which you have identified as triggers for reactions you have experienced in the past.
Repairing the damage to the digestive tract means healing any possible excess gut permeability, re-establishing healthy villi lining in the gut wall, and eliminating inflammation along the length of the digestive tract.
Some supplements have been shown to speed up the healing of the gut wall considerably. It is a good idea to base any supplement programme on a good quality multi vitamin and mineral. Once you have done this, the supplements below can help to heal the gut wall.
Purging Parasites
If all else fails with elminating bloating - think parasites. It is wise to have them checked for before embarking on a programme to eradicate them, but not always necessary. Remember parasites are no always easy to detect with tests and that throughout history people have conducted regular purges of parasites. You will find it difficult to heal your gut wall once-and-for-all if there are parasites present.
Anti-parasitic plant preparations have been used for many centuries. People can, however, have individual reactions to herbs and some can suffer side effects. In view of this, it maybe best to consult a herbalist about anti-parasitic herbs. Natural anti-parasitic options are available from several nutritional and herbal supplement companies, and these supplements will contain some, or all, of the ingredients in the following list. You will need to take them for between two to six months. Herbal anti-parasite preparations include: wormood, goldenseal, black or green walnut, berberis and grapefruit seed extract.
There are some foods which have anti-parasitic properties and which can be helpful to include at every opportunity: onion, garlic, pumpkin seeds, raw cabbage, fresh pineapple and papaya and the herbs thyme, sage, cloves and turmeric.

Nutrient
What it does
Dosage

Vitamin A
Necessary for the healing of mucous membranes
7500 i.u. a day

Vitamin C
Build collagen and is therefore very important for repairing mucous membranes. (Supplementing a non-acidic form, such as magnesium ascorbate, means that is unlikely to disturb the digestive tract.)
2000-5000mg a day

Zinc
Vital for all tissue building and repair, as well as for the production of enzymes and HCI.
20-30 mg a day

Essential Fatty Acids
Instrumental in healing the gut wall.
Evening primrose oil to provide 200 mg of GLA a day or 1 gram of fish oils to provide 200 mg DHA and 150 mg EPA a day

L-Glutamine
This amino acid is used directly by the digestive tract for repairing tissue.
5-15 grams a day between meals

Butryic Acid
This short chain fatty acid (SCFA) is normally produced by health bacteria in the intestines, and is used as an energy source by the surrounding cells lining the gut wall.
750 mg three times a day

N-Acetyl Glucosamine (NAG)
Needed for the formation of porteoglycans, which glue together the gastro-intestinal  cells, along with collagen.
500 mg twice a day

Gamma Oryzanol
This is an oil found in brown rice. It is very useful for repairing the mucous membrane of the digestive tract.
100 mg three times a day

 
4. RE - ESTABLISH A FRIENDLY ENVIRONMENT
The final step is to create the right environment for continued digestive health, and this means making sure that the bacterial occupants promote health and prevent the symptom of bloating returning to trouble you.
Supplementing bacteria
The most significant beneficial bowel bacteria are the Bifidobacteria, Lactobacillus acidophilus and Lactobacillus bulgaricus and the best product include all three of them. Make sure that the bacteria you buy have at least one billion viable organisms per dose, are within sell-by date and have been kept refrigerated. Taking beneficial bacteria for two to four months at the end of your E.A.S.E. programme will significantly improve the chances of remission.
Fab fibre
A diet high in fibre is conducive to encouraging the correct conditions in the bowels for the growth of beneficial bacteria. The exception to this is if the fibre of a type that causes a sensitivity reaction, as does wheat fibre in a number of people, and oat fibre in a few. Good sources of fibre include brown rice, buckwheat, corn on the cob, butter beans, haricot beans, lentils, linseeds, sunflower seeds, walnuts, carrots, cauliflower, broccoli, apples, bananas, pears, dried figs and prunes.
Other foods that promote good bacteria include cabbage, Jerusalem artichokes, onions and live yoghurt.
WHAT NOW?
Now you are home and dry! You have banished bloating, and are feeling energetic and health. What now? The temptation for some people will be to go back to their old eating patterns. This may not happen overnight, but it is easy, when not following a specific regime, to slide slowly and almost imperceptibly back into familiar habits.
The trick is not to recreate the vicious cycle by again over-doing foods which are likely to induce bloating by damaging the digestive tract wall, or lead to an imbalance in bowel bacteria and an increase in mucus. This means eating food to which you are sensitive only on a minimal basis - maybe a couple of times a week.
The main foods to avoid or limit, which undermine most people with health problems, are refined and sugary foods, excess alcohol, gluten grains, dairy products and caffeine-containing foods. Keep to a rotation plan for these, while maintaining a high level of fibre, fruit and vegetables in the diet, and you shouldn't find that you do not re-establish bloating once it has been banished.
Note: If you have a problem with bloating it is recommended that you consult a nutritional therapist who will help you identify the cause. A nutritional therapist can then work out an appropriate eating and supplement plan tailored to your individual case and requirements.
 
This article has been extracted from Banish Bloating by Suzannah Oliver. For further information visit her website at www.healthandnutrition.co.uk.
 

Keywords: 
HEALTH CONDITIONS, bloating
The Institute for Optimum Nutrition is an independent educational charity.
Registered company number 2724405, registered charity number 1013084