What foods can cause bloating in a general adult population?

Foods That Cause Bloating

The most common bloat-causing foods are those containing lactose (dairy products), fructose (fruits, honey, high-fructose corn syrup), artificial sweeteners (sorbitol, sugar alcohols), and fructans (wheat, onions, garlic), with lactose affecting 51% and fructose affecting 60% of bloating patients. 1

Primary Dietary Culprits

Carbohydrate-Based Foods

Lactose-containing foods are a leading cause of bloating due to lactase enzyme deficiency, creating osmotic effects in the colon from undigested sugars: 1, 2

• Milk and dairy products (especially if consuming >0.5 pint/280 ml milk daily) 1
• Cheese, yogurt, ice cream 1
• Cream-based products 1

Fructose-rich foods cause bloating in 60% of affected patients through malabsorption and subsequent fermentation: 1, 2

• Fruits high in fructose (apples, pears, watermelon) 1
• Honey 1
• High-fructose corn syrup in processed foods 1
• Fruit juices 1

Artificial sweeteners trigger bloating through incomplete absorption: 1, 2

• Sugar alcohols (sorbitol, mannitol, xylitol) 1
• Found in sugar-free gums, candies, and diet products 1

Fructan-containing foods cause symptoms through rapid fermentation in the proximal colon: 1

• Wheat products (bread, pasta, cereals) 1
• Onions and garlic 1
• Rye and barley 1

High-Fiber and Fermentable Foods

FODMAP foods (Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols) cause bloating through their small size, high osmotic activity, and rapid bacterial fermentation: 1

• Legumes (beans, lentils, chickpeas) 3
• Cruciferous vegetables (broccoli, cauliflower, cabbage) 1
• Non-digestible oligosaccharides (galactooligosaccharides, inulin) 1

High-fiber foods can paradoxically increase bloating, particularly when fiber intake is suddenly increased: 4

• The high-fiber DASH diet (32 g/day) increased bloating risk by 41% compared to low-fiber diets (11 g/day) 4
• This effect was greater in men than women 4

Sodium and Processed Foods

High sodium intake independently increases bloating risk by 27%, regardless of fiber content: 4

• Processed and packaged foods 4
• Restaurant meals 4
• Salty snacks 4

Mechanism-Based Understanding

The bloating from these foods occurs through three primary mechanisms: 3

1. Gas production from bacterial fermentation of undigested carbohydrates 3
2. Osmotic water mobilization into the intestine from poorly absorbed sugars 1
3. Abdominal distention from increased gas and fluid accumulation 1

Individuals with visceral hypersensitivity (such as those with IBS) experience symptoms at lower thresholds of bowel distention, making them particularly susceptible to these foods. 1

Diagnostic Approach

A 2-week dietary restriction trial is the simplest and most economically sound diagnostic method, with symptom resolution serving as a positive predictor of food intolerance. 1, 2

For patients who don't respond to dietary restriction: 1

• Hydrogen breath testing can identify lactose, fructose, or sucrose intolerance 1
• This testing is reserved for refractory cases 1

Critical Caveats

Not all individuals who malabsorb carbohydrates develop symptoms—those with normal visceral sensation may tolerate these foods without bloating. 1

Excessive dietary restriction can be harmful: 1

• Some patients adopt inappropriately restrictive diets based on perceived intolerances 1
• Exclusion diets require supervision by an enthusiastic dietitian 1
• Long-term benefit from exclusion diets occurs in approximately 50% of patients 1

The effect of high sodium on bloating can be mitigated by reducing salt intake, even when consuming high-fiber diets. 4