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If you’re one of the millions of people living with Hashimoto’s hypothyroidism, you’re likely no stranger to an uncomfortable and sometimes painful symptom: bloating.

In general, bloating is a relatively common gastrointestinal (GI) symptom, and almost everyone experiences it at some point. Bloating is often described as a feeling of fullness, tightness, or swelling in the stomach area. While there are many causes of bloating, we will focus on one cause: Hashimoto’s hypothyroidism.

Hashimoto’s thyroiditis is an autoimmune disease in which the immune system attacks the tissues of the thyroid gland. Over time, this causes chronic inflammation in the thyroid and leads to hypothyroidism. People with hypothyroidism have an underactive thyroid gland and reduced thyroid hormone production. Therefore, Hashimoto’s hypothyroidism is defined as a hypothyroid condition caused by Hashimoto’s.

Ahead, we’ll look at why people with Hashimoto’s hypothyroidism experience bloating and ways to manage it.

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Bloating occurs when your gastrointestinal (GI) tract fills with air or gas, causing feelings of fullness or tightness in your stomach. Other common gastrointestinal symptoms include mild to severe stomach pain or a stomach that appears swollen. You may even notice you are passing gas or burping more than usual. In some cases, bloating may also be accompanied by some weight gain. 

Bloating is usually related to a digestive issue, though hormones and underlying medical conditions also play a part. When food passes through your GI system, bacteria in your gut break it down. This process, called fermentation, produces gas, and as gas builds up in your GI tract, bloating can occur.

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There are 4 primary ways that Hashimoto’s hypothyroidism contributes to bloating:

1. Slower gut motility

Because thyroid hormones help regulate your gastric motility -- the speed at which food moves through the GI system -- it can take longer when your thyroid hormone levels are low. As a result, undigested food and gases can build up in your intestines, leading to bloating.

Further down your digestive tract, slower gut motility can also cause constipation. Constipation is a common GI symptom associated with hypothyroidism. The longer stool remains in the colon, the more time bacteria have to ferment the contents in your intestines, producing more gas. As a result, you may notice passing more gas or worsening of your bloating symptoms.

2. Small Intestinal Bacterial Overgrowth (SIBO)

As mentioned, people with Hashimoto’s often experience altered gastrointestinal motility, allowing bacterial overgrowth. In turn, this can lead to the development of SIBO, causing symptoms like

• Bloating
• Diarrhea
• Gas
• Unintentional weight loss
• Loss of appetite
• Stomach pains or cramps

According to a 2014 study, SIBO is relatively common in those with hypothyroidism. Nearly 50% of hypothyroidism patients report having SIBO at some point. Experts suspect SIBO may be a contributing factor to the chronic GI symptoms, such as bloating, seen in some individuals with Hashimoto’s or hypothyroidism.

The good news is that SIBO is treatable. Research shows that a course of antibiotics followed by probiotics is effective in the management of SIBO for the majority of individuals.

3. Food sensitivities

Consuming a food you have a sensitivity or intolerance to can lead to inflammation in your GI tract. This inflammation slows down the digestive process and disrupts the balance of gut bacteria. In turn, GI symptoms appear as gas builds up, resulting in GI discomfort.

Individuals with hypothyroidism are already at risk for slowed gut motility. Therefore, eating a food you are intolerant to can further aggravate GI symptoms, including bloating. Common food sensitivities or intolerances include ones to gluten and dairy.

4. Fluid retention

One of the common symptoms of hypothyroidism, including Hashimoto's hypothyroidism, is fluid retention (edema). This occurs because thyroid hormones play a role in regulating the balance of fluids in the body. When thyroid hormone levels are low, it can lead to increased capillary permeability and reduced kidney function, resulting in the accumulation of fluids in tissues. This fluid retention can contribute to bloating.

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Bloating usually goes away on its own, but it may take some time, depending on what is causing it. If something you ate is causing the bloating, it may ease up within a few hours. It may take longer to ease up or be a more chronic problem if it is related to slow GI motility, such as constipation.

Now, with a better understanding of factors contributing to bloating, let’s discuss ways to manage this uncomfortable symptom.

1. Make lifestyle modifications

Certain lifestyle factors can put you at greater risk for bloating. So, one of the first ways to manage bloating is to avoid or limit behaviors that promote it, such as:

• Eating too much
• Eating too quickly
• Chewing gum
• Drinking carbonated beverages
• Consuming foods with high levels of fructose or sorbitol
• Smoking
• Physical inactivity

2. Tailor your diet

Proper nutrition is also a crucial part of our lifestyle and is critical in curbing bloating. After all, people usually feel the most bloated after eating a meal, and often, what’s in your food causes the discomfort. For instance, consuming foods that produce gas -- like Brussels sprouts, cabbage, or beans -- can worsen bloat.

One of the best ways to identify food triggers is to try a temporary elimination diet. With an elimination diet, you eliminate foods and then reintroduce them slowly to determine your specific dietary triggers. This process can be incredibly beneficial for people with autoimmune conditions like Hashimoto’s.

Below are two types of elimination diets recommended for those with Hashimoto’s.

Autoimmune protocol, or AIP diet

The autoimmune protocol (AIP diet) is a rigorous elimination diet often followed by many with an autoimmune disorder.

You eat only easy-to-digest foods for the first several weeks while eliminating typical food triggers like gluten and grains, dairy, nuts, and eggs. Processed and refined sugars, oils, and caffeine are also off-limits.

After the elimination phase, you intentionally reintroduce one food group at a time to determine which foods best support your body. During this initial elimination phase and with the reintroduction of each food group, you want to allow your body enough time to reset after reintroducing a new food group. Giving yourself enough time will enable you to notice a difference in how you feel physically and mentally.

Low-FODMAP diet

FODMAP is an acronym for a class of carbohydrates called fermentable short-chain carbohydrates, which are difficult for most people to digest. As a result, a diet high in FODMAPs can cause bloating and other GI symptoms.

In a low-FODMAP diet, you remove foods known for triggering uncomfortable digestive symptoms, including grains, beans, lactose-containing dairy products, and fructose-containing foods like figs and mangoes.

About 50 to 82% of those with irritable bowel syndrome (IBS), a health condition associated with stomach pain and bloating, who follow a low FODMAP diet reported a reduction in bloating. Because of this, many believe following a low FODMAP diet is one of the most effective treatments for bloating.

3. Medication management

Most individuals with hypothyroidism take thyroid hormone replacement medication to replace missing thyroid hormones and manage symptoms of an underactive thyroid gland. Since low thyroid hormone levels can slow down your gastric motility and contribute to bloat, it is essential that you take an optimal dosage of your thyroid medication as prescribed.

You may notice bloating improves or worsens when you take your thyroid medication. If you feel that your thyroid hormone medication is making your bloating worse, talk with your provider to explore your other options.

You can also manage symptoms of bloating with over-the-counter (OTC) medications, depending on the underlying cause. Laxatives, such as bisacodyl (Dulcolax) or docusate (Colace), help to relieve constipation. Simethicone can help reduce gas.

4. Explore supplements and natural remedies

Several supplements may help relieve bloating and improve digestion for individuals with Hashimoto’s hypothyroidism.

Digestive Enzymes: Hashimoto’s hypothyroidism can lead to a decrease in stomach acid and digestive enzymes, which can contribute to bloating. Taking a digestive enzyme supplement can help improve the breakdown and absorption of nutrients, reducing bloating and promoting better digestion.

Probiotics: Probiotics are beneficial bacteria that can support a healthy gut microbiome. They help maintain a balance of good bacteria in the digestive system, which can improve digestion and reduce bloating. Look for a probiotic supplement with strains specifically beneficial for gut health, such as Lactobacillus and Bifidobacterium.

Betaine HCl: As mentioned earlier, individuals with Hashimoto’s hypothyroidism often have low stomach acid. Betaine HCl is a digestive enzyme supplement that can increase stomach acid production, aiding in the digestion of proteins and reducing bloating. However, it’s important to consult with a healthcare professional before starting this supplement, as it may not be suitable for everyone.

Ginger: Ginger has long been used for its anti-inflammatory and digestive properties. It can help soothe the digestive system, relieve bloating, and improve overall digestion. You can take ginger in supplement form or consume it as a tea or fresh root.

Turmeric: Turmeric is another powerful anti-inflammatory herb that can help relieve bloating and support digestion. It can reduce inflammation in the gut, improve the digestive system’s function, and alleviate bloating symptoms. Consider adding turmeric to your meals or taking a curcumin supplement, which is the main active compound in turmeric.

Marshmallow Root: Marshmallow root is known for its soothing properties on the digestive system. It can alleviate inflammation, promote gastric mucosa healing, and reduce bloating. Marshmallow root is often available in supplement form or as a tea.

While there isn’t much scientific evidence regarding natural remedies for bloating, many people also share that peppermint, ginger, cloves, and chamomile help soothe their guts. Some people also add apple cider vinegar to their beverages or take activated charcoal supplements before and after meals to improve digestion.

Remember, before starting any new supplement, it’s important to consult with a healthcare professional, especially if you have any underlying health conditions or are taking medications. They can guide you on the appropriate dosage and possible interactions.

5. Try alternative medicine therapies

Acupuncture is an alternative medicine method that may help relieve digestive discomfort. Acupuncture can affect the internal organs by stimulating the somatic nervous system. More studies are needed to understand acupuncture’s benefits fully. However, some evidence shows that it may help with digestive symptoms.

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Excessive burping, passing gas, and bloating often resolve on their own or with simple lifestyle or diet modifications.

However, if your symptoms are persistent or you continually rely on OTC medications to reduce bloating, it is time to see your provider, especially if you also notice:

• Diarrhea
• Persistent or severe abdominal pain
• Bloody stools
• Changes in the frequency or color of stools
• Unintended weight loss
• Chest discomfort
• Loss of appetite or feeling full quickly

These signs and symptoms could signal an underlying digestive condition. You’ll need to partner with a professional to determine the best treatment to support your specific health needs.

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Given the connection between thyroid hormone levels and bloating, people with Hashimoto’s hypothyroidism need to monitor thyroid function regularly.  You can do this easily from the comfort of your home using Paloma’s at-home testing kit while working closely with your healthcare provider to ensure you are on the correct thyroid replacement medication dosage. And remember, if you feel your bloating worsens with thyroid medications, tell your provider.

If you want to learn how to implement an elimination diet to identify triggers, schedule an appointment with one of Paloma’s certified nutritionists. Their expertise and guidance can help you seamlessly integrate these dietary changes into your life.