What are the Ayurvedic treatments for bloating?

Ayurvedic Treatment for Bloating

The evidence-based medical literature does not support Ayurvedic treatments for bloating, and current American Gastroenterological Association guidelines recommend dietary modification, central neuromodulators, and biofeedback therapy as first-line evidence-based interventions instead. 1, 2

Why Ayurvedic Approaches Lack Evidence

The 2023 AGA guidelines specifically evaluated herbal remedies for bloating and found insufficient evidence to support their use 1. While peppermint oil (the most studied herbal remedy in the United States) showed no improvement in bloating symptoms in a recent placebo-controlled trial, Ayurvedic treatments have not been rigorously studied in controlled trials for bloating 1.

Evidence-Based Alternatives You Should Consider Instead

First-Line: Dietary Interventions

• Start with a low-FODMAP diet trial (4-6 weeks restriction phase, then reintroduction, then personalization) under guidance of a trained gastroenterology dietitian, as this improves bloating in over 80% of patients with carbohydrate malabsorption 1, 3

• Identify and restrict specific triggers through breath testing for fructose, lactose, and other carbohydrate intolerances, which affect 60-65% of patients with digestive disorders 2, 3

• Avoid artificial sweeteners (sorbitol, sugar alcohols) and limit fructans rather than gluten, as recent studies show fructans are the actual culprits in non-celiac gluten sensitivity 1, 3

Second-Line: Pharmacological Interventions

• Central neuromodulators (tricyclic antidepressants like amitriptyline or SNRIs like duloxetine/venlafaxine) reduce visceral hypersensitivity and improve bloating by modulating the gut-brain axis 1, 2

• Secretagogues (lubiprostone, linaclotide, plecanatide) are superior to placebo for bloating associated with constipation according to meta-analysis of 13 trials 1, 2

• Rifaximin (non-absorbable antibiotic) is effective when small intestinal bacterial overgrowth is confirmed by breath testing 2, 3

Third-Line: Behavioral Therapies

• Anorectal biofeedback therapy achieves 54% responder rate for bloating when evacuation disorder is identified, with long-lasting improvements 1, 3

• Diaphragmatic breathing techniques provide immediate relief by correcting paradoxical diaphragm contraction and reducing vagal tone 2, 3

• Cognitive behavioral therapy and gut-directed hypnotherapy have robust evidence for improving bloating symptoms, particularly when psychological factors amplify sensations 2, 3

Critical Pitfalls to Avoid

• Do not use probiotics for bloating—current AGA guidelines explicitly recommend against them due to insufficient evidence, and they may paradoxically cause brain fogginess, worsening bloating, and lactic acidosis 1, 3

• Do not continue elimination diets beyond 4-6 weeks without benefit, as prolonged restriction can cause malnutrition and negative impacts on gut microbiome 1, 3

• Screen for eating disorders before implementing restrictive diets, as bloating management can trigger or worsen avoidant/restrictive food intake disorder 1, 3

Algorithmic Approach

1. Begin with dietary modification: Low-FODMAP diet trial for 4-6 weeks with trained dietitian 1, 3

2. If diet fails: Consider breath testing to identify specific carbohydrate malabsorption 2, 3

3. If bloating persists: Add central neuromodulators (amitriptyline or duloxetine) to reduce visceral hypersensitivity 1, 2

4. If constipation present: Add secretagogues (linaclotide, plecanatide) 1, 2

5. If evacuation disorder suspected: Refer for anorectal biofeedback therapy 1, 3

6. Throughout treatment: Incorporate diaphragmatic breathing and consider CBT/hypnotherapy for refractory cases 2, 3