Category: Wellbeing

“The fatigue doesn’t come overnight,” the founder of Open Heart Solution, a coaching practice that specializes in healing codependency, tells HealthyWay. “Instead, I lost vitality by inches over the course of several months.”
Gaines chalked her worsening symptoms up to getting older. Then she started getting headaches at the base of her skull. Trying to eat became a nauseating ordeal. This was not a natural decline, she realized.
“The fatigue was so bad, I couldn’t get out of bed for more than a few hours at a time,” she says. “Even though I was exhausted, I couldn’t sleep. Weight loss. Irritability came next. Then, sensitivity to light. For a month or two, all I could do was lie in bed, staring at the ceiling.”
At the time, Gaines was living with an acupuncturist. Her roommate tracked her symptoms and issued a confident diagnosis: adrenal fatigue. Gaines felt that she had found her problem. She was ready to address it. To her dismay, though, her doctors dismissed her concerns.
“Of course I talked to doctors, and they were like, ‘Adrenal fatigue is not a real thing,’” Gaines says. “And then we go to the functional medicine community and they say, ‘Yeah, medical doctors say it’s not a real thing because there’s no pill for it. There’s no code for it in insurance. There’s not a prescription for it…’ So adrenal fatigue will never be a diagnosis in the Western medical community.”
Healthcare, like everything else, is rife with cultural conflict. But what some call adrenal fatigue could become an ideological town square in which all patient-centered service providers—the scientists and the intuitionists alike—might find common ground. And even a mislabeled affliction can lead to lifestyle changes that are healthy for everyone.
That said, it’s important to understand the medical consensus on this cluster of symptoms, which ranges from apathy to light sensitivity. Regardless of your view of institutionalized medicine, this is what you should know before you go to your primary care physician—or your acupuncturist—about the very real difficulties that are often associated with adrenal fatigue.

What is adrenal fatigue?

As far as we can tell, the adrenal fatigue diagnosis debuted in 1998 when chiropractor James L. Wilson, DC, ND, PhD, coined the term. His definition of adrenal fatigue? “A collection of signs and symptoms, known as a syndrome, that results when the adrenal glands function below the necessary level.”
That definition comes from his website, where Wilson sells an array of herbal products, including an Adrenal Fatigue Quartet, which was listed at $183.44 at the time of this writing. Like many vitamin and supplement websites, Wilson’s site, AdrenalFatigue.org, is dotted with asterisks that point to the small print at the base of the page: “This statement has not been evaluated by the Food & Drug Administration. This product is not intended to diagnose, treat, cure or prevent any disease.”
The problem with Wilson’s definition of adrenal fatigue is that it can just as easily refer to an existing and scientifically verified diagnosis: adrenal insufficiency, which results from damage to the adrenal glands or the glands that send chemical signals to the adrenals. So how does the endocrine system work (or stop working) and why do people use different terms to identify issues that are seemingly the same?

The Endocrine System and Its Discontents

Broadly stated, the endocrine system is a self-regulating network of chemical-producing tissues and their targets within the human body. Target organs, including other endocrine glands, absorb these chemicals: aka hormones.
Suffice it to say that, just as certain neurotransmitters like serotonin and dopamine bind to receptors in your brain, certain hormones zero in on tissues and organs within your body. These hormones change the behavior of those tissues and organs, powering unconscious physical processes and experienced sensations alike. In the experiential act of being, your brain is just one part of the equation. Hormones and other organs also play significant roles, making it complex to say the least.
So let’s talk adrenal glands. These two small hormone-producing entities sit just atop your kidneys. They produce a number of hormones—from the stress hormone cortisol to aldosterone, epinephrine, and precursors to the sex steroids androgen and estrogen.
Don’t worry if you don’t know what those things are. We didn’t either, so we had to ask a doctor. Take just one of these substances—cortisol, for example.
“We need cortisol to live,” says Shirisha Avadhanula, MD, a senior fellow physician in the department of endocrinology, diabetes, and metabolism at Georgetown University Hospital. “We need it for normal human physiological functioning. This hormone, among many of its functions, orchestrates our body’s response to stress in such ways as regulating our blood pressure, for example. It coordinates our immune response and it also regulates our metabolism.”
Point being, adrenal insufficiency is a medically recognized condition in which damaged endocrine glands fail to produce enough hormones to maintain homeostasis, the delicate thermo-electrochemical balancing act by which our bodies and minds remain stable and healthy.
Adrenal fatigue, on the other hand, has grown from Wilson’s dubious hypothesis to a full-fledged cottage industry. We live stressful lives, say the believers. Our lives are so stressful that our adrenal glands essentially run out of cortisol.
According to endocrinologists, though, this argument doesn’t make physiological sense.
“Basically, the whole concept is that constant stress causes your adrenal glands to burn out and release—eventually—low levels of adrenal hormones, especially cortisol. That’s the whole concept behind adrenal fatigue,” Avadhanula says. “But, physiologically speaking, under periods of stress, your adrenal glands actually work harder, and they make more cortisol. Even under stressful conditions, our adrenal glands don’t fatigue out. They continue to maintain their role. They’re really not so easily subverted.”
But that in no way discounts the symptoms associated with the term, Avadhanula stresses. The doctors we spoke with focused on three main points they’d like to spread in the interest of public health.

The 3 Things Endocrinologists Want You To Know About Adrenal Fatigue

The consensus of the Endocrine Society, the professional association of endocrinologists, is that adrenal fatigue as it’s defined by Wilson and many others does not exist. But when a patient can’t get out of bed for more than a few hours a day, clearly something has gone awry. Here’s what endocrinologists want you to know if you think you or a loved one are experiencing something that sounds like adrenal fatigue.
[sol title=”“Nobody’s disputing the symptoms.”” subheader=”A good doctor listens and investigates symptomatology.”]
“The first point I want to get across is: Nobody’s disputing the symptoms,” Avadhanula says. When a patient comes to her complaining of overwhelming tiredness, brain fog, and unexplained weight changes, she urges them to avoid the term adrenal fatigue because it’s not a legitimate diagnosis according to Endocrine Society consensus. But she knows that something is causing these symptoms.
“We need to listen to our patients, and we need to investigate their symptomatology,” Avadhanula says. As she makes these points, she speaks slowly and methodically, enunciating each syllable and clearly conveying her emphasis.
So that’s the first thing: If you fear that you have adrenal fatigue, no good doctor is going to discount your symptoms. On the contrary, they’ll look for the true cause to help you get back to health.
[sol title=”The term “adrenal fatigue” should be eradicated.” subheader=”The wrong label can prevent the right diagnosis.”]
“The second thing, of course, is that we encourage patients and other practitioners and other physicians to stop using this terminology,” Avadhanula says, referring to the term adrenal fatigue. “It can cloud an underlying diagnosis, and that’s when things become concerning.”
Joshua Miller, MD, MPH, is the medical director of diabetes care for Stony Brook Medicine and an assistant professor of endocrinology and metabolism in the school’s department of medicine. He’s certified in internal medicine and endocrinology, diabetes, and metabolism. And he shares Avadhanula’s concerns.
“It’s unfortunate, because you know full well there’s this information all over the internet, and if a patient has something, God forbid, more serious going on, but they themselves are convinced it’s adrenal fatigue, well, they’re going to miss getting that other issue addressed. And we have seen that happen before.”
[sol title=”The Dark Side to the Spread of Misinformation” subheader=”Someone’s profiting.”]
“As is the case in any industry, there are many health care practitioners out there, some of whom are physicians, some of whom are not, who will take advantage of patients who are convinced of their diagnosis of adrenal fatigue, and will try to sell them something,” Miller says. “And we’ve encountered this many times, my partners and I.”
Wilson, the inventor of the term adrenal fatigue, and many others who use it are in the business of selling herbal supplements, which can’t be a coincidence. And unregulated supplements may not address an underlying health issue that’s actually causing your symptoms. Miller describes the problematic scenario:

A patient will come and see me, and they’re taking a supplement that they bought from another doctor who they saw—and I use the term doctor loosely for some of these folks. And it’s a concoction of vitamins and herbs and this and that, that, one, probably costs hundreds of dollars, and two, is not helping, and three, has the potential to harm. So the first question, literally the first question I’ll ask patients when they come in with that story, is “Do you feel better taking the supplement than you did before you took it?” And most patients have never really asked themselves that question before. And when they do, many of them will sit back and say, “You know, Dr. Miller, I really don’t feel any different since starting this herb or starting this supplement.”

So what happens next? The endocrinologist will recommend that you stop taking the supplements.
“The problem is that these supplements are not regulated, nor are they approved by the FDA,” says Avadhanula. “We don’t really know what’s in them. There’s no way to know. The expert consensus is that you’d recommend the patient stop taking them.”

Adrenal Fatigue Symptoms According to the Internet

The Hormone Health Network, which is operated by Endocrine Society, lists the symptoms that have been associated with the term adrenal fatigue. They include:

• Severe tiredness and lethargy
• Sleep problems
• Difficulty getting out of bed in the morning
• Cravings for sugar or salt
• Over-reliance on caffeine

The trouble is that these symptoms are nonspecific; they can be caused by any number of factors. For many busy, stressed-out adults, they’re realities of daily life. One person’s adrenal fatigue could be another’s daily grind.
That’s not to say that you should simply accept a stressful lifestyle. Chronic stress is associated with a multitude of negative health effects, from musculoskeletal disorders to high cholesterol. Stress absolutely can produce the symptoms that some associate with adrenal fatigue. It’s just that the science doesn’t back up the adrenal-fatigue theory of how stress leads to poor health outcomes.
Still, many patients self-diagnose adrenal fatigue, which could be costing them the opportunity for a legitimate diagnosis and better treatment.

Evidence-Based Medical Disorders That Can Be Confused With Adrenal Fatigue

So if these symptoms aren’t caused by a burnt-out endocrine system, what is causing them? While the phenomena associated with adrenal fatigue are nonspecific and could be caused individually by many different conditions, there are a few illnesses that share symptomatology. Most notably, these include:

• Obstructive Sleep Apnea
• Depression
• Fibromyalgia
• Adrenal Insufficiency

“Per Endocrine Society consensus, adrenal fatigue is not a recognized medical entity,” says Avadhanula. “The reason I think patients have a lot of questions and come to me with queries about this diagnosis is that the symptomatology that adrenal fatigue describes consists of a lot of really nonspecific symptoms.”
Of course, these symptoms do “match up with stress,” says Avadhanula. Tiredness and confusion and caffeine addiction may not come from an illness, per se. They might just be the result of lives lived out of balance.

Self-Care for People Who Experience Symptoms Associated With Adrenal Fatigue

Gaines’ symptoms began to ease when she put herself on a wellness regimen of her own creation.
“I started really simply,” she says. “I started by getting up in the morning and making some tea, and going outside and drinking it for 10 minutes, with no sunglasses, and just looking, allowing the light to come into my eyes.”
That simple time carved out for herself—a quiet moment first thing in the morning—set Gaines on her path to a more balanced, peaceful lifestyle. But it was just the first step.
“I started walking around the park that was at the back of my house,” Gaines says. “I have the luxury of working at home, so sometimes I would take conference calls and do them while walking around the park.”
Gaines also began to take advantage of a major lifestyle change. She had moved from a tumultuous life in New York City to a slower pace in Texas. That made it easier for her to incorporate self-care behaviors like exercising in the great outdoors into her everyday routine.
“I live in a place where there’s plenty of sunlight, and plenty of places to walk, and plenty of places to breathe fresh air, and there’s plenty of places to put the phone away and just listen to the river running and not worrying about the text messages coming in,” she says. “If I didn’t have that, I don’t know where I would be right now.”
The thing is, the recommended lifestyle-based treatments for the symptomatology some call adrenal fatigue are commonly recommended treatments for chronic stress. You would be hard pressed to find a doctor who would caution you against practicing good sleep hygiene, exercising regularly, pursuing mindfulness, or spending time in nature. What they do have a problem with, however, are untested supplements and wellness programs that take advantage of suffering patients by charging hefty fees that insurance companies won’t cover.
“As in many parts of health care, people get taken advantage of,” Miller says. That’s a shame, when “some of the simplest interventions [for these symptoms] are exercise, good sleep hygiene, keeping screens out of the bedroom, eating a wholesome diet, not eating processed and fast foods, not drinking a lot of caffeine, avoiding a ton of alcohol, and not smoking. And you’ll feel better. You don’t have adrenal fatigue, you’re just living a healthier life.”
While the science behind the idea of adrenal fatigue doesn’t hold up, the lifestyle changes said to cure the condition will actually make most people feel better. In that sense, the shamans and the scientists are on the same page. Go outside. Listen to the real birds, not your Twitter notifications. Adrenal issue or no, managing stress is good for your overall health.
“You are born to be vital and alive,” says Gaines. “And there’s nothing in the world that should take you away from that.”
Say what you want about adrenal fatigue. Who can argue with that sentiment?

So your skin is covered in itchy red welts, and you’re desperate for anything, ANYTHING to make it go away. Welcome to the world of allergies, where hives are an irritating side effect.
Although the name sounds like a place where bees live, hives can happen when you encounter just about anything you’re allergic to, not just stinging pests. And when those welts start to well up on your skin, you’re going to want to know how to get rid of hives from the comfort of your home—and how to do it fast!
So let’s do this, shall we?

How to Get Rid of Hives

Before you do anything to treat your hives, you need to know what you’re actually dealing with.
Are there red blotches that look like welts on your skin? Is it itchy? Try pressing on it. Does it blanch, or turn white when you press down, and then turn pink or red again when you let go?
If the answer to all three questions is yes, you’ve probably got urticaria, the medical term doctors use for hives. Unlike rashes, which tend to spread and don’t blanch when touched, hives tend to stick to one part of the body and blanch, says allergist Tania Elliott, MD, a spokesperson for the American College of Allergy, Asthma, and Immunology and chief medical officer at EHE. They can show up anywhere on the body, and the itch can be mild to severe, making you want to tear at your skin with sandpaper for some relief.
Now for the good news: Most people’s hives are acute, meaning they will go away within 24 hours. Fortunately, treating acute urticaria at home is fairly simple.
Elliott suggests hitting the pharmacy for a non-sedating or non-drowsy antihistamine. Brand name products like Claritin and Zyrtec or generic versions will all do the trick, taking the itch out of hives in about 20 minutes.
If you want to go the natural route, hit your kitchen. Grab a plastic baggie and fill it with ice cubes. Wrap the ice in a thin towel and place it up against the hives. Your body’s nerves will only be able to send one response to the brain, Elliott says, so your body will either process the cold or the itch. The cold from the ice will overwhelm and quell the itch, at least temporarily.
You can also apply some aloe vera to the affected area, according to esthetician Ildi Pekar. Not only is the aloe plant known for its skin-healing properties, it’s also naturally cooling, so it offers a similar sensation to ice without the need to hold a baggie full of ice cubes against your skin.
One important thing not to do? Don’t scratch furiously at your skin, no matter how much you are tempted. Deep scratching opens up the skin, which can lead to infection, taking a simple case of “treatable at home” hives into “it’s time to see the doctor now” territory.
Of course, if the hives aren’t your only symptom and you’ve got a fever and chills along with those red welts, don’t stick around the house. Call your doctor immediately. It may be nothing more than a simple virus that you’ll kick in 24 hours, but it’s better to be safe than sorry.
Elliott says, “If symptoms ever progress beyond the skin, such as difficulty breathing, swelling, feeling faint, or vomiting, that is a serious emergency and 911 needs to be called.”

What causes hives anyway?

Now that you’re feeling better, it’s time to get to the root of the problem.
The American College of Allergy, Asthma, and Immunology estimates some 20 percent of the population will deal with urticaria at some point in their lives. The main cause for all those hives typically comes down to just three things: food, medication, or illness.
Yes, illness. While most people think of hives as a reaction to an allergen, sometimes they’re just the body’s way of reacting to the flu or another sickness.
“It’s the immune system getting funky and going awry, and the allergy system goes along for the ride,” Elliott explains. In other words? You aren’t allergic to anything, but your body is reeling from infection. That’s why if you show up at your physician’s office with hives, doctors will typically ask if you’ve just gotten over an illness or opt to run tests for flu, strep throat, and the like.
If you haven’t been sick and don’t sense you’re coming down with an illness, an allergy to food or medication is another likely cause. While your body can react to other allergens, typically airborne environmental allergens don’t cause hives, Elliott says. “You’d really have to be rolling in it [for that to happen],” she says. Instead, most environmental allergies cause contact dermatitis with a rash that doesn’t blanch and tends to spread.
With true hives, on the other hand, typically you’re dealing with something ingested or something already going on internally, she notes. In cases of ingested allergens, the allergy cells in your body get aggravated and then release a chemical called histamine, which causes swelling, itching, and redness.
The reaction typically kicks in within 15 minutes, Elliott says, but doctors advise you to look to medicines or food you ingested within the past six hours, as there can be a delayed response.
Look for patterns. Have you taken a new medicine that you’ve never taken before? Did you eat a new food? Have you had itchy welts after eating one specific food? If it happens more than once, start writing things down. If you do end up scheduling an appointment to see a physician, you’ll want to take a food diary with you when you visit the doctor.
If your hives are acute—which is the case for most people who experience hives—they will go away within 24 hours, and it’s unlikely you will need to see your physician. They may come back again when you eat that one food item or take that one medication, but they’ll likely disappear once again within 24 hours, provided you don’t have contact with that allergen again.
Other people have what are called chronic hives, meaning they stick around for at least six weeks. But you don’t have to wait that long to get some help: It’s when the hives just won’t go away after a week or two that the medical community recommends you visit an allergist.
During your appointment, they’ll run blood tests and sometimes targeted food allergen tests (if you notice, for example, that the hives have occurred after eating a specific food) to see if they can pinpoint the problem. Typically adults can account for their eating habits better than kids, Elliott says, so it’s rare for doctors to have to run extensive food allergy testing on grown-ups.
While you’re there, the doctor will also look for other issues going on in the body. On rare occasions, hives can be a signal that you’re fighting an autoimmune disease or even a blood cancer, but that tends to come with additional symptoms. Again, Elliott is quick to point out that this is rare, but if you’ve got joint pain along with the hives, for example, or extreme fatigue, your doctor may start digging deeper to determine whether the hives are part of a larger problem or if they exist on their own.
Some people may also suffer from hives that can be traced back to temperature triggers, says allergist Ashok Gandhi, MD, of the Marion Area Physician Group in Marion, Ohio. For some folks, that means they experience hives in the winter when their body gets especially cold. For others, they may have a hive flare-up in sunlight.
But the majority of chronic hives sufferers are in Hilary H.’s boat. The hives sufferer tells HealthyWay she has lived for years with what’s known as “idiopathic hives,” meaning doctors can’t figure out why the itchy red welts crop up on her body.
“They began appearing about four years ago, and after a few months of having me try a combination of steroids and antihistamines to keep them under control, my immunologist declared them chronic,” Hilary tells HealthyWay. “When the immunology resident delivered the news that they were chronic, she prescribed antihistamines and told me, ‘You will be taking these…for the rest of your existence.’ That phrasing still cracks me up!”
Chronic hives remain a mystery for doctors, even the experts in the allergy field. “In a lot of chronic cases, even after all the testing, we still cannot find the reasons for hives,” Gandhi explains.
It’s frustrating for patients, but Elliott likes to tell her patients that hives are similar to conditions such as high blood pressure in that regard. She says most people simply accept that there are many factors that could be causing their high blood pressure…and the same goes for hives. It doesn’t mean they can’t be treated, nor does it mean you can’t live a normal life. It just means you don’t know why you have the condition. Half of chronic idiopathic (unexplained) hives cases will go away within a year, Elliott adds.

How to treat the discomfort of hives.

Prednisone, a steroid, can keep hives at bay, Gandhi says, but it has drawbacks: Once you stop prednisone, the hives tend to come back. “Prednisone on a long-term basis also has a lot of side effects, so it’s not a real solution in terms of solving hives on a long-term basis,” he adds.
Doctors often turn to prescription-strength antihistamines to keep the redness and itchiness at bay. Medications such as Allegra or Zyrtec, which are available over the counter to be taken daily, are often increased to twice-a-day prescriptions to help get rid of hives. Zantac, an over-the-counter medication best known for treating acid reflux or heartburn, may also be added on for hives sufferers, as it’s been found to be effective for soothing urticaria.
If the hives don’t respond to the pill options, the next step is an injectable medication called Xolair, Gandhi says, which you receive at your allergist’s office. If you’ve heard your friends talking about their allergy shots, this is one of them. Because you have to return to the doctor’s office monthly, it can be inconvenient for patients, and it’s typically expensive, requiring prior authorization from insurance companies.
“It has its own set of side effects that one has to keep in mind,” Gandhi warns, “But it works pretty good for the hives which are not responding to any of the other [medications].”
Regardless of treatment, and regardless of the cause, doctors hope that the hives will eventually go away, and for most people they do, Elliott says. About half of chronic hives sufferers will see them simply disappear within a year. Others may see them go sometime within two years.
If they don’t disappear, and no other symptoms crop up that cause doctors to investigate further, a daily antihistamine regimen becomes a part of life. Even there, the news isn’t all bad.
Hilary has managed to get her hives under control with twice-daily Allegra, and she can go weeks without a hive popping up. Then again, it’s not all smooth sailing.
“Then suddenly something will set them off without warning, and I’ll add another antihistamine (Zyrtec or Pepcid),” she says. “Typically that gets them back under control within a day or so.”
“Usually any individual hive or patch of hives doesn’t last for more than 24 hours, although more might crop up that will also last 24 hours,” she adds. “ If they’re really itching or painful, I find that cooling my skin off can provide quick temporary relief. So I might run my hands under cold water or take a cool shower or hold an ice pack on them to take the edge off. That really helps!”

Never again!

If you can determine the trigger for your hives, you’re in luck. A specific food or medication can be avoided, which means you can avoid future flare-ups.
Sometimes your allergist may recommend a low histamine diet as well, Elliott says, as histamine is contained in a variety of foods.
“Ever get an itchy mouth from eating pineapple? That’s because it’s high in histamine content!” she notes. “Other foods to avoid [include] alcohol, aged cheese, processed meats, and dried fruit.”
All that said, sometimes hives show up only once, never to return again. Unless you’re seeing them repeatedly, the experts say you can often keep on living life the way you always have without fear of a recurrence.

If you’ve ever woken up with a stomach that feels like it’s housing an expanding balloon, you know all too well that bloating is no fun. That bloated feeling in your stomach can make you feel like crawling back in bed instead of heading out for the day.
But with recent warnings from British doctors that some women are confusing the symptoms of ovarian cancer with bloating during their menstrual cycle, a lot more of us are on edge about that full-belly feeling.
So when are you experiencing normal bloating, and when do you need to call the doctor? And if it’s just a bloated stomach, do you know how to get rid of bloating with fast home remedies that will have you getting on with life in 24 hours (or less)?
We talked to the experts to get you the answers you need.

What’s going on?

Bloating is uncomfortable, and it can send folks running for their doctors’ offices, but it’s not technically a disease. Instead, bloating is a symptom that can accompany various diseases and conditions. It can be a sign that you’ve eaten too much, had too much to drink, or even inhaled too much air.
If you were to describe what it means to feel bloated, words like bleeech and ugh would fit in nicely. But medical practitioners—not surprisingly—have a more clinical vocabulary when it comes to defining bloating.
“Bloating is a sensation of fullness in the upper abdomen,” says Alexandra Guillaume, MD, director of the Gastrointestinal Motility Center at Stony Brook Medicine and assistant professor in the Long Island, New York, university’s department of medicine.
That sounds simple enough, right? If the top of the belly feels extra full, you’re bloated.
But that’s where the simplicity ends and the confusion can begin.
That feeling of increased abdominal pressure is often accompanied by what’s called “abdominal distentions,” or a visible enlargement of the waistline. As anyone who has a pair of Thanksgiving pants knows, sometimes the two go together, sometimes they don’t. But it turns out you don’t need that distended-belly look to feel absolutely miserable…or to be bloated.
In one study published in the medical journal Gastroenterology, researchers measured abdominal girth in relation to pressure complaints, and just 48 percent of patients with bloating had measurable distention in their torsos. The other 52 percent were still bloated, but doctors couldn’t see the physical signs on the outside. And theirs wasn’t the only study to come to this conclusion.
What’s more, while some people experience bloating and gas at the same time, the two don’t have to go hand in hand.
“Bloating can be the result of having an increased or intolerable amount of gastric and/or intestinal gas, as some individuals experience the symptom of bloating with normal amounts of gas,” Guillaume says. Then again, bloating can be the result of anything from increased fluid in the abdomen to bowel wall inflammation to what Guillaume calls “malabsorbed food substrates” (parts of the food that haven’t broken down and been absorbed into the body yet).
In other words: You can be bloated without flatulence or burping, and you can have gas without being bloated.
So how do you know it’s really bloating and not, say, gas or weight gain that’s affecting your abdomen? And how do you know it’s not that virus that’s been going around your office?

Let’s start with where it hurts.

“Most people feel this sensation between the belly button and up to the middle of the rib cage,” says Boston-based dietitian Kate Scarlata, author of The Complete Idiot’s Guide to Eating Well with IBS. Gas, on the other hand, tends to occur in the large intestine or lowest segment of the gastrointestinal (GI) tract.
Another defining feature of bloating? There are just a handful of typical causes:

Swallowed Air or Aerophagia (Excessive Swallowing of Air)

We need air to breathe, but there really is too much of a good thing, Guillaume says. Excess swallowing can occur when you’re sucking on hard candies, chewing gum, or experiencing anxiety, which may cause you to suck in large amounts of air.
“Carbonated beverages such as soda, seltzer, and beer can also generate excess gastric and intestinal air,” Guillaume warns, adding, “This is usually brief.”
The good news? All that extra air may cause bloating, but it’s typically easily expelled, so you can get rid of bloating fast.
“Air advancing from the stomach into the upper small bowel is usually promptly cleared,” Guillaume says. “Carbon dioxide and oxygen rapidly diffuse through the intestinal wall. Nitrogen gas is poorly absorbed, but is rapidly propelled towards the colon and expelled through the anus.”
In other words, you’ll probably burp and fart it out.

Food Intolerance and Carbohydrate Malabsorption

If you’ve ever felt like your dinner just didn’t agree with you, you might be right. Food doesn’t have to be spoiled or laced with a toxin to bother our systems. Nor does it have to be unhealthy.
Eating a lot of fiber or carbohydrates such as bran, cabbage, beans, broccoli, or similar foods can all cause discomfort in your abdomen.
Bloating after a meal can also be a sign of a food intolerance or disease, Guillaume warns.
If you experience bloating after consuming lactose, your body may be lacking the enzyme lactase, which is required to digest lactose, a sugar found in milk, certain cheeses, or ice cream. People with undiagnosed celiac disease may also bloat as their body struggles to absorb wheat, barley, and rye products.
Some foods, known as FODMAPs, are also common culprits when you’re feeling bloated. Carbohydrates found in everyday—and relatively healthy—foods like apples, pears, watermelon, wheat, cauliflower, onion, garlic, to name a few, FODMAPs are rapidly fermented by gut microbes and can also pull water into the gut, Scarlata says.
“The aftermath of excess water and/or fermentation of these carbs in the gut can contribute to the sensation of bloating in those with FODMAP sensitivities,” she warns.

Underlying Constipation

If you’re feeling “backed up,” that general feeling of pressure may, well, back up, spreading from the intestines north into the abdomen. Not surprisingly, this can be tied to foods as well, as excessive amounts of fiber can cause simultaneous constipation and bloating.

Small Intestinal Bacterial Overgrowth (SIBO)

This condition occurs when there’s an excess of normal bacteria in the small intestine. “These intestinal bacteria play a key role in bloating and flatulence through carbohydrate fermentation and gas production,” Guillaume says. “Patients with altered anatomy due to surgery, those with diabetes, or those with certain rheumatologic disease may be at an increased risk of bacterial overgrowth in the small intestine.”

Hormones

No, you’re not imagining that puffy feeling in the lead-up to your period. “Feeling bloated is a real concern in the week prior to actually menstruating,” says Latasha Murphy, MD, an OB-GYN at the gynecology center at Mercy Medical Center in Baltimore. The reason? Your hormones fluctuate. “The progesterone drops and the estrogen levels rise,” Murphy explains. “This can lead to sluggish bowel motility and water retention that leads to the bloating sensation.”
Although those are the most typical causes, Guillaume says if you’re trying to figure out if you’re feeling uncomfortable because you’re coming down with that virus that’s been floating around your office or just feeling bloated, it may be both! Because bloating is a symptom and not a disease, it can be a precursor to worse symptoms ahead.
“An acute infectious enteritis may be associated with severe bloating and distention in the early stages, even before diarrhea occurs,” Guillaume warns.
That said, if you’re feeling abdominal pain that’s accompanied by fever, vomiting, diarrhea, weight loss, joint pains, or an abnormal rash, it’s wise to call your doctor. Those symptoms can be a sign of trouble.

Fight the bloat.

Let’s face it: No matter what’s causing it, you want to get rid of that bloated-belly sensation as soon as possible.
How to do it—and how fast it can be done—comes down to the cause. That bloating from slurping down a soda too fast during your super short lunch break can disappear on its own in less than an hour.
If a virus is causing the bloat, you might just have to wait it out, as viral conditions typically have to run their course.
If the problem is your impending period, it’s time to get up and move, and change up what you’re eating and drinking. Exercise will promote bowel motility, Murphy says, which can help you feel less backed up, and drinking a lot of water can help, too.
Abdominal massage can help move the gas into the lower GI tract so that it is easier to pass, Scarlata advises, and there are medicines that can help get things moving, too.
“The herbal supplement Iberogast can help the intestinal move more efficiently, lessening bloating,” Scarlata notes, “Some find simethicone supplements helpful. Simethicone reduces the surface tension of gas bubbles, making the gas bubbles smaller and easier to move through the GI tract for elimination.”
If you’ve been eating any gas-inducing foods (beans, cabbage, and the like), cutting back can help you fight the bloat. But sometimes figuring out just what is making it happen can require a bit of trial and error…and hyper vigilance.
“Maintain a food journal for at least one month and list what you experience after eating a variety of foods and food groups,” Guillaume suggests. “Also, be cognizant of your bowel habits and pattern and how this affects your perception of bloating or visible abdominal distention.”

When to Call the Doctor

If you’re feeling bloated after one meal or days before you’re expecting your period, there’s likely no cause for concern. Occasional bloating happens.
It’s when you feel bloated for days on end or there are other symptoms—such as fever, diarrhea, vomiting, feeling a constant need to urinate or defecate—that you need to call your doctor.
Among the diseases that may be causing bloating along with these symptoms are celiac disease, ovarian cancer, and irritable bowel syndrome.
Although those sound scary, frequent bloating is not always a sign of serious disease. It could simply be an indicator that you have a food intolerance. Treating it could be as simple as cutting a single food out of your diet, which is why it’s important to keep a food journal and bring it with you to your doctor’s office.
“Measures to reduce bloating should be determined and implemented depending on the cause of bloating,” Scarlata notes. “It really is not a one-size-fits all approach. [You need to] work with a healthcare provider to better gauge the reason for the bloating to develop a more tailored approach to treatment.”

Bye Bye, Bloating

Let’s face it: Life is a lot easier if we just avoid bloating altogether. While that’s not always possible (see also: disease causes), there are some preventative measures that work for a number of cases.
If you regularly suffer from menstrual bloating, increasing your water intake and cutting gassy foods from your diet in the days leading up to your period can help, Murphy says, along with kicking your exercise routine into high gear.
If you don’t have a diagnosed food intolerance but know that eating a hot dog smothered in onions is going to make you gassy (and bloated), you can avoid the food entirely. Or you can indulge your cravings while trying to stave off the bloat with a dose of an over-the-counter remedy such as simethicone (aka Gas-X) or alpha-d-galactosidase, the generic of Beano.
If you’re looking to go in the opposite direction by upping the healthy quotient on your foods, dive into fibrous eats with a dose of caution. It’s good to increase bran foods and beans, but do so slowly, lest your new health kick make you feel like Violet Beauregarde from Willy Wonka.
Probiotics work for some folks as well, but Guillaume warns that the data in medical literature is mixed, and there’s no consistent evidence that shows that probiotics are effective at relieving bloating, distention, or flatulence.
One piece of advice that doctors routinely give patients when advising on general health applies when it comes to bloating, too: Exercise regularly and maintain a healthy weight.