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 up to 80% of patients with carbohydrate malabsorption 1, 2, 3

• Fructose intolerance affects approximately 60% of patients with digestive disorders and dietary restriction leads to complete symptom resolution in 50% at one year 1, 2, 3

• Avoid prolonged restrictive diets beyond 4-6 weeks without benefit, as they can cause microbiome disruption and malnutrition 1, 3

Second-Line: Central Neuromodulators

• Tricyclic antidepressants (amitriptyline) or SNRIs (duloxetine, venlafaxine) reduce visceral hypersensitivity and improve bloating by modulating the gut-brain axis 1, 2, 3

• These medications work best when bloating occurs during or after meals by reducing the abnormal viscerosomatic reflex that triggers distention 1, 3

Third-Line: Targeted Pharmacotherapy

• Secretagogues (linaclotide, plecanatide, lubiprostone) are superior to placebo for bloating associated with constipation 1, 2, 3

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

Behavioral Interventions

• Anorectal biofeedback therapy achieves 54% responder rate for bloating when evacuation disorder is identified 1, 3

• Diaphragmatic breathing techniques provide immediate relief by correcting paradoxical diaphragmatic contraction 2, 3

• Cognitive behavioral therapy and gut-directed hypnotherapy have robust evidence for improving bloating symptoms 2, 3

Critical Pitfalls to Avoid

• Do not use probiotics for bloating—current AGA guidelines explicitly recommend against them due to insufficient evidence and potential adverse effects including brain fogginess and lactic acidosis 1, 3

• Do not use peppermint oil as it showed no improvement in bloating in recent placebo-controlled trials 1, 3

• Screen for eating disorders before implementing restrictive diets, as dietary restrictions can worsen avoidant/restrictive food intake disorder 1, 3

Diagnostic Workup When Symptoms Persist

• Breath testing for hydrogen, methane, and CO2 identifies carbohydrate malabsorption or SIBO 2, 3

• Serologic testing rules out celiac disease 3

• Anorectal physiology testing evaluates for pelvic floor dyssynergia in patients with concurrent constipation 2, 3