Episode Summary
Why are you bloated all the time — and does bloating actually mean you are producing too much gas?
In this episode of Girls Gone Wellness, naturopathic doctor and gut-health educator Dr. Kim Bretz, ND joins Victoria and Jeanette for an in-depth conversation about chronic bloating, abdominal distension, irritable bowel syndrome (IBS), visceral hypersensitivity, the gut-brain connection, food intolerances, gluten sensitivity, SIBO and common gut-health myths.
One of the biggest misconceptions discussed in the episode is that bloating automatically means the body is producing excessive amounts of gas. Dr. Bretz explains the difference between bloating, which is the sensation of fullness, pressure or gas in the abdomen, and abdominal distension, which is a visible increase in abdominal size. She discusses research suggesting that many people with chronic bloating are not necessarily producing more gas than people without symptoms. Instead, they may be experiencing visceral hypersensitivity, where the nerves of the gastrointestinal tract become more sensitive to normal digestive sensations.
The episode explores disorders of gut-brain interaction, including conditions such as IBS and functional dyspepsia. Dr. Bretz explains how infections, stress, changes in the gut microbiota and other factors may alter communication between the gastrointestinal tract and the brain. This can cause normal digestive processes — including intestinal stretching and gas production — to feel uncomfortable or even painful.
Dr. Bretz also explains abdomino-phrenic dyssynergia, a mechanism that may contribute to visible abdominal distension. Rather than excessive gas alone causing the abdomen to expand, changes in the coordination of the diaphragm and abdominal wall may cause the abdomen to visibly protrude after eating.
Food is another major focus of the episode. Do chronic digestive symptoms mean you have a food intolerance? Should you eliminate gluten? Do elimination diets actually fix gut problems? Dr. Bretz discusses why overly restrictive diets may sometimes worsen digestive health by reducing dietary diversity, affecting the gut microbiota and increasing anxiety or hypervigilance around food.
The conversation also examines gluten sensitivity and non-celiac gluten intolerance, including research suggesting that components of wheat other than gluten — such as fructans, a type of FODMAP carbohydrate — may contribute to symptoms in some people. The episode also discusses the nocebo effect, in which expectations that a food will cause symptoms can influence the physical symptoms someone experiences.
Other major gut-health topics include intestinal permeability or “leaky gut,” low-FODMAP diets, probiotics, peppermint, gut-directed hypnotherapy, cognitive behavioural therapy for gastrointestinal symptoms, SIBO testing, food sensitivity tests and comprehensive stool testing such as GI-MAPs.
Dr. Bretz also challenges the idea that everyone with bloating needs to be tested or treated for small intestinal bacterial overgrowth (SIBO). She discusses limitations of commonly used breath tests and explains why bloating alone does not necessarily indicate bacterial overgrowth.
For anyone experiencing chronic bloating, abdominal distension, IBS symptoms, food-related anxiety or confusion about gut-health advice online, this episode offers a detailed look at what current research suggests may actually be happening — and why gut symptoms are often far more complex than simply identifying and eliminating the “wrong” food.
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What is the difference between bloating and abdominal distension?
Bloating is the sensation of fullness, pressure, gas or swelling in the abdomen, while abdominal distension is a visible increase in abdominal size. In this episode, Dr. Kim Bretz explains that someone can experience bloating without obvious distension, distension without severe discomfort, or both at the same time.
Does bloating mean you are producing too much gas?
Not necessarily. Dr. Bretz explains that many people with chronic bloating are not producing significantly more intestinal gas than people without symptoms. Instead, some may be more sensitive to normal gas and digestive sensations because of changes in how the gut nerves communicate with the brain.
What is visceral hypersensitivity?
Visceral hypersensitivity is an increased sensitivity to sensations coming from internal organs, particularly the gastrointestinal tract. Normal digestive processes such as intestinal stretching, movement or gas can feel unusually uncomfortable or painful in people with visceral hypersensitivity.
What causes visceral hypersensitivity?
The episode discusses several factors that may contribute, including gastrointestinal infections, stress, antibiotic use, changes in the gut microbiota and altered communication between the gut and brain. Visceral hypersensitivity is commonly discussed in connection with disorders of gut-brain interaction such as IBS.
What are disorders of gut-brain interaction?
Disorders of gut-brain interaction are gastrointestinal conditions involving changes in the communication between the digestive system and the nervous system. Conditions discussed in this episode include irritable bowel syndrome (IBS) and functional dyspepsia. These symptoms are real and physiological even when routine medical testing does not identify a structural abnormality.
What is abdomino-phrenic dyssynergia?
Abdomino-phrenic dyssynergia is an altered coordination between the diaphragm and abdominal wall that may contribute to visible abdominal distension. Dr. Bretz explains that instead of the diaphragm relaxing and the abdominal wall supporting the abdomen normally after eating, the opposite pattern may occur, causing the abdomen to protrude outward.
Can stress cause bloating?
Stress can influence digestive symptoms through the gut-brain connection, but this does not mean bloating is “all in your head.” The episode explains that stress can change nervous-system signalling, gastrointestinal motility, sensation and muscle responses, which may increase bloating, pain or abdominal distension.
If every food makes me bloated, is food really the problem?
Not always. Dr. Bretz explains that when someone feels symptoms after nearly every food — or even after water — it may point toward visceral hypersensitivity or altered gut-brain signalling rather than a long list of individual food intolerances. Continually removing foods may therefore not address the underlying problem.
Do elimination diets help with bloating and IBS?
They can sometimes be useful, but they are not appropriate for everyone. Dr. Bretz discusses why restrictive diets should ideally be targeted, temporary and individualized, particularly because long-term restriction may affect the gut microbiota, nutritional intake, quality of life and a person's relationship with food.
What is the low-FODMAP diet?
A low-FODMAP diet temporarily reduces certain fermentable carbohydrates that gut bacteria can use to produce gas. The episode explains that the diet may reduce symptoms in some people with IBS, but symptom improvement does not necessarily mean those foods are inherently harmful or that they need to be avoided permanently.
Is gluten actually causing my bloating?
Possibly, but gluten may not always be the component responsible. Dr. Bretz discusses research in people without celiac disease or wheat allergy suggesting that fructans, fermentable carbohydrates found in wheat, may trigger symptoms more often than gluten itself in some individuals.
What is the nocebo effect with gluten?
The nocebo effect occurs when expecting a food to cause symptoms contributes to experiencing those symptoms. Dr. Bretz discusses research showing that some people who identify as gluten-sensitive experience more symptoms when they believe they are consuming gluten — even when they are not.
Is “leaky gut” real?
Increased intestinal permeability is a real physiological phenomenon, but Dr. Bretz explains that the popular concept of “leaky gut” is often oversimplified. Changes in intestinal permeability can occur in conditions such as celiac disease, inflammatory bowel disease and after gastrointestinal infections, but intestinal permeability itself is not necessarily a stand-alone disease.
Does gluten cause leaky gut in everyone?
No. The episode specifically challenges the claim that gluten damages the intestinal lining of everyone who eats it. Gluten can affect intestinal permeability in conditions such as celiac disease, but Dr. Bretz explains that this should not be generalized to the entire population.
What is SIBO?
SIBO stands for small intestinal bacterial overgrowth, meaning there is an abnormal amount or type of bacteria in the small intestine. Symptoms can include bloating and other gastrointestinal complaints, but those symptoms alone do not prove that someone has SIBO.
Does everyone with chronic bloating have SIBO?
No. Dr. Bretz strongly challenges the idea that chronic bloating automatically indicates SIBO. She explains that visceral hypersensitivity and disorders of gut-brain interaction are common alternative explanations for bloating and abdominal discomfort.
How accurate are SIBO breath tests?
The episode discusses important limitations of commonly used SIBO breath tests, including the possibility of false-positive and false-negative results. Dr. Bretz explains that test results need to be interpreted alongside symptoms, medical history and potential risk factors for bacterial overgrowth rather than in isolation.
Are food sensitivity tests accurate?
Dr. Bretz generally describes common food sensitivity testing as having limited clinical usefulness. The episode emphasizes that gastrointestinal symptoms after eating do not automatically indicate an immune-mediated food sensitivity and that unnecessary testing can sometimes lead to overly restrictive diets.
Does everyone need to take a probiotic?
No. Dr. Bretz explains that probiotics are not universally necessary and that probiotic research is often strain-specific. Certain probiotic strains may help particular symptoms, but taking any probiotic does not automatically improve every person's gut health.
Can peppermint help IBS, gas and bloating?
Peppermint is discussed as one herbal option that may help some gastrointestinal symptoms. Dr. Bretz explains that peppermint may have antispasmodic and analgesic effects, potentially helping reduce intestinal discomfort while other underlying factors are also addressed.
What is gut-directed hypnotherapy?
Gut-directed hypnotherapy is a therapy designed specifically to influence communication between the brain and gastrointestinal tract. Dr. Bretz discusses it as one potential treatment for disorders of gut-brain interaction, particularly when visceral hypersensitivity or heightened gastrointestinal symptom awareness is contributing to symptoms.
Can cognitive behavioural therapy help IBS and digestive symptoms?
Yes, gastrointestinal-specific cognitive behavioural therapy is discussed as one potential tool for disorders of gut-brain interaction. The goal is not to suggest symptoms are imaginary, but to help modify patterns of nervous-system activation, symptom-related anxiety and responses that may amplify gastrointestinal symptoms.
Are GI-MAP and comprehensive stool tests useful?
They may provide some clinically relevant information, but Dr. Bretz explains that stool microbiome testing has important limitations. A stool sample captures only part of the gastrointestinal microbiota, and current science cannot always translate every bacterial finding into a specific treatment or meaningful clinical outcome.
What is the biggest myth about chronic bloating?
One of the biggest myths challenged in the episode is that feeling bloated or visibly distended means you must be producing excessive amounts of gas. For many people, the issue may instead involve how the gut senses normal gas, how the brain processes those signals and how the diaphragm and abdominal muscles respond. goes here
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Girls Gone Wellness with Dr Kim Bretz
Edited website transcript
This transcript has been edited for clarity and readability while preserving the substance of the conversation.
Victoria
Welcome back to Girls Gone Wellness. Today we have a very special guest, Dr. Kim Bretz. Dr. Bretz is a naturopathic doctor, CCNM graduate, passionate speaker and consultant, and adjunct faculty member at the University of Waterloo School of Pharmacy. She works in the microbiota and gut-health field due to a potentially unhealthy love of our bacteria and discussing the Bristol Stool Chart. She has provided continuing education for healthcare professionals for over a decade and is the owner of the Gut Health Incubator, a company providing done-for-you gut-health resources for practitioners. She has spoken and consulted for numerous laboratory, supplement and pharmaceutical companies and served on the advisory board for Ferring Pharmaceuticals' natural healthcare products. She has also spoken at conferences internationally. She is a storyteller and a fan of teaching through a combination of clinical experience and evidence-based research. She is a member of the European Society of Neurogastroenterology and Motility and the American College of Gastroenterology. She has completed the Monash Low FODMAP Diet for IBS program and training in disordered eating in the GI patient, and she is a facilitator in gut-directed hypnotherapy through Nerva. Hello, Dr. Bretz. Thank you so much for being here today.
Dr. Kim Bretz
Thanks for having me. Apparently I love all things gut, after hearing all of that!
Jeanette
We are extremely grateful to have you here with us today. You're a true leader in our field, and there's really no one else we'd rather have this conversation with about gas, bloating and common gut-health myths. Can you tell us a little bit about how you decided to focus on gastrointestinal health?
Dr. Kim Bretz
It wasn't something I planned. Like a lot of naturopaths, I thought I was going to focus on women's health. I worked in a medical clinic with a gynecologist, who I still work with, and I loved seeing that variety of concerns. Then I ended up consulting with a pharmaceutical company. At first, I couldn't understand why a pharmaceutical company would want to work with a naturopath, but I learned that they also worked with natural healthcare products. They had strain-specific probiotics and, at that point, worked only with gastroenterologists. They wanted to expand because they viewed naturopathy as another field that worked heavily with the gut and microbiota. The science of the microbiota - all the bacteria and other microorganisms that live in and on us - was exploding. When I began learning how they interact with us and influence human health, it changed how I looked at health entirely. It set me on a different course that I have now been passionate about for well over a decade.
Jeanette
That's amazing I Can definitely agree with the whole microbiota thing I feel like once you learn about it. You can't unlearn it. So yeah.
Dr. Kim Bretz
Yeah, it is yeah it's a great area and when we think about having at least as many microbial cells that live inside of us as we have cells of our own human body and they play a huge part in how we function as human beings if we don't. Think about them. We're missing out on half of our health and it's such a great area to work in.
Victoria
No definitely I think also from both a patient perspective but also being naturopathic medical students. The conversation is so important because we all deal with gut related issues. So there's no shortage of people who need your help. But also for Jeanette and I. We haven't really got that far into gut health believe it or not in our education and we're stepping into our clinical year and we're like looking at each other like my goodness we really need some help here and it's great to have people like you in our fields.
Dr. Kim Bretz
Wow and I think about that and I actually was listening to a different podcast recently that was for gastroenterologists but they were talking about. The fact that there is so little education in most of the gastroenterology conditions. Because people are trained in hospital settings so you see severe inflammatory bowel disease that's gone horribly we see the appendix that has to come out but then the things within are what we used to call functional disorders and now disorders of gut-brain interaction that's 40% of the Canadian population will have. 1 or more of these diagnoses for Canadian women. We're looking at almost 48 percent of women will have one of these diagnoses but they're not treated in hospitals and they're not seen during medical education. So. It's a lack that's happening everywhere within. Unfortunately the medical care system in general, we're trained to deal with not letting people die. But then that quality of life can get lost really easily.
Victoria
Right? And I think on the opposite end of that spectrum. We have the medical field who's not really talking about it and then we've got the rest of us kind of googling. What can I do I'm bloated all the time and we're being told get rid of this food and we're being fed a lot of misinformation and we're kind of in this weird spot of like what do I do right.
Dr. Kim Bretz
Absolutely and I think this is a great time because we do have so much more information that is actually concrete and usable and backed up by studies but because so many people get lost in the Healthcare system especially before we had that information if we saw something kind of helped. Then we just went down that pathway and kept going down that pathway because there was nothing else that was being offered and now there's this mix of we're getting some more great information but the misinformation side of things is so incredibly high. And if people aren't getting the help that they need going through traditional routes. Of course they're going to look for other things and I think about it that if someone had a heart attack. You have that immediate sudden pain and symptoms that are going on and you get rushed in and it gets dealt with and then the pain goes away and even with. I see with patients who really want to improve their life three six nine months down the line or two years that focus isn't there in the same way because you don't feel your heart attack anymore but are patients who have bloating or diarrhea or abdominal pain and they can't find anything wrong with you and they're just saying. Good luck hope things get better. Try being less stressed but you're feeling acute symptoms every single day or you're feeling them multiple times a week and you're being told we can't really find anything wrong with you. Your head is saying no, there's a catastrophe happening right now. And you'll do anything to make it feel better.
Victoria
Totally yeah, let's jump right into that then because I think gas and gas and bloating are like probably correct me if I'm wrong, but probably 1 of the most common things you see because it impacts people's quality of life right? And like you said like it's. All the time and when you're feeling something all the time you're just desperate to fix it? So I think all of us are aware of what bloating is but can we get into why so many of us are bloated kind of what's the mechanism there and is bloating normal on some level.
Dr. Kim Bretz
First, bloating is the sensation of fullness, gas or air in the abdomen, while distension is a visible increase in abdominal size. We used to assume that bloating meant a person was producing more gas than average, but we had not actually measured it. When researchers began measuring gas production, they found that most people who experience bloating and distension are not producing more gas. There are exceptions, including severe constipation and some cases of small intestinal bacterial overgrowth, or SIBO, but SIBO is not as common as the internet makes it seem. Often, the larger issue is that a person is feeling normal gas production because the nerves in the gut have become more sensitive. Everyone produces gas as gut bacteria ferment food, particularly plant foods - somewhere from about half a litre to two or three litres each day - but most of us do not feel it. After an infection, antibiotics, a major stressor or even early-life trauma, the gut's nerve cells may begin to overrespond. I compare it with wearing glasses: you notice them when you first put them on, but your brain normally stops paying attention to that sensation. With chronic bloating, the nervous system may continue registering the normal stretch inside the intestines, which becomes very uncomfortable.
Victoria
Can I ask what causes that like how does somebody have hypersensitivity like that.
Dr. Kim Bretz
Some of the strongest research comes from post-infectious conditions such as post-infectious IBS and post-infectious dyspepsia. Changes in the gut microorganisms may alter nerve signalling between the gut and brain. When we talk about disorders of gut-brain interaction, we are not saying that someone should simply meditate for a few minutes or that the symptoms are 'in their head.' Something physiological has changed, although we do not yet understand every part of the mechanism. Brain imaging shows that people can respond differently to the same digestive stimulus. In balloon-distension studies, for example, people with IBS can experience intense pain at levels of rectal expansion that are not painful for people without a GI condition. The symptoms are real; the newer model simply explains them differently than we did in the past.
Jeanette
This is so interesting to me and my kind of blowing up right now because last summer I kind of went through something very similar I had like a Gi infection and I thought a part of it and I had this like. 10 out of 10 pain in my abdomen like I thought it was like shooting sharp pain. It was awful and then I didn't know what was going on I was like it got worse with stress I knew there was some sort of connection there like it's really interesting to know that we hear about this gut-brain connection all the time but it's. It's great to know that there actually is research behind that and people are just imagining it. It. It is real So you.
Dr. Kim Bretz
Right? Yeah, it's a legitimate this is happening but because we looked at pain in 1 way previously this the old model didn't fit into how we understand things like sensitization or visceral hypersensitivity which is specifically that point where. Not only are you just say feeling the gas or feeling the digestive process happening which again we're not supposed to feel digestion happening or for people with constipation that their bowels are full with stool and there's mixing and things moving around and they're you're feeling that. And we're not supposed to feel that but visceral hypersensitivity is now when your pain threshold is actually lowered. So Now you're feeling things way more acutely than you're supposed to and that's an area where it's so again, it's so scary for people when this is happening and Obviously. We have to figure out the difference between is there something acutely physiological going on. So That's where we're looking for our red flags in patients to make sure it's not Appendicitis. It's not an inflammatory bowel disease or something really more life threatening that could be happening. But then when we rule that stuff out and we're on this other side of this sensitization and visceral hypersensitivity and those things all cause physiologic changes but they're going to be at a lower level where it's not dangerous in the same way. That's where a lot of people are being told. Well. Good luck to you. You have IBS and there's nothing we can do and we don't understand it except we are at the point now where we have way more understanding and way more options. So yeah, but it's scary for people when you have pain and they're saying I can't find anything wrong with you?. It's horrifying to people. So yeah.
Victoria
Wow when you learn something new and you're like in your head diagnosing people and diagnosing yourself with something. That's what I'm doing right now that sounds like yeah that sounds like. Something that we actually probably see more common than we might think right.
Dr. Kim Bretz
It is very common. Food adds an important layer to the conversation. We have often used elimination diets or a low FODMAP diet for people with IBS. In the past, we assumed that if removing fermentable foods helped, the person must have been producing excessive gas. Studies comparing people with IBS on lower- and higher-FODMAP diets with people who do not have IBS suggest otherwise: the IBS group generally does not produce more gas; they feel it more acutely. Integrative and functional practitioners recognized early that food affects symptoms, but we sometimes assumed that the food itself was the underlying problem - an allergy or intolerance. A person may feel somewhat better after removing foods, then worsen during a stressful period and conclude that another food must also be removed. The diet becomes increasingly restrictive. That can reduce microbial diversity, change motility, increase visceral hypersensitivity and make eating socially isolating. Food can absolutely trigger symptoms, but if the food is not the root problem, we need a broader toolkit than continually removing foods.
Jeanette
That makes me think a lot because in school we are kind of still taught the elimination diet is kind of like the number 1 thing that we should be implementing and this really makes me think like it's not really getting to the quote unquote root cause the food may not be that root cause we need to work on the. Gut and the brain and all of that kind of stuff. So yeah, my brain is like going crazy right now.
Dr. Kim Bretz
Absolutely I know and it's so it's again, kind of like what you're saying with once you learn about the microbiota. You can't turn it off. It's funny because I am 100 years older than you all are and it seems like we're getting the same food interaction or understanding all of these years later and the science has changed and our understanding has changed and while I'm not encouraging that people are going to be eating. McDonald's and Doritos and Kraft Dinner all the time I think that being able to eat with families and have social interactions and not becoming more isolated in your world because you can't eat in any normal way I don't think that's health either and it can get reinforced. In our schooling. It can get reinforced in any health-based schooling. We actually know within the MDs and dieticians that there's a high level of disordered eating patterns. We don't have studies on naturopaths but I don't think it's any lower. But that's not helpful if we have that sort of bias when we. When we're leaving school so it's great that we're starting to talk about it more now.
Victoria
Yeah, we're gonna we're going to jump right into food very soon? But this conversation is also making me think of a friend of mine who was diagnosed with functional dyspepsia I believe and she was told by her doctor? Well. If a food is causing you pain just stop eating it and she said but I never know what food it's going to be like today. It's broccoli but tomorrow it's bananas and is it the food. No.
Dr. Kim Bretz
Functional dyspepsia falls under the umbrella of disorders of gut-brain interaction. There are 22 different adult conditions in this category, and the answer is not simply to remove any food that causes discomfort. Celiac disease is different: it is an autoimmune condition in which the person reacts to gluten, so gluten must be removed. But when a person cannot identify a consistent food trigger - or says that even water makes them bloat - that suggests a different mechanism. Water does not create intestinal gas, although someone may feel bloated or visibly distend after drinking it because of changes in sensation or the abdominal wall. When different foods cause symptoms on different days, that inconsistency is a clue that we may be dealing with visceral hypersensitivity or altered gut-brain communication rather than a true allergy. We need to screen for disordered eating, help people reintroduce foods where appropriate, and move beyond the old advice to simply stop eating anything that hurts.
Victoria
Wow! This is all so good to know I feel like our listeners are going to be just as mind blown as I am yeah, it sounds like it. Before we move on to food which we're going to do right away because I know that's probably everybody's question.
Dr. Kim Bretz
Yeah I Honestly this area is so fun.
Victoria
I Have a very important question that we added we were like we have to ask her even if our listeners don't care I care so I need to know this idea or this diagnosis of abdomino-phrenic dyssynergia are you able to touch on that before we move on.
Dr. Kim Bretz
I assume you mean abdomino-phrenic dyssynergia in relation to distension. Distension is not just the sensation of bloating; it is the visible change where your pants fit in the morning but not at the end of the day, or your abdomen looks several months pregnant. Normally, when we eat, the diaphragm relaxes and moves upward, creating more room in the abdomen, while the abdominal wall muscles contract toward the spine to help contain everything. In some people with significant GI symptoms, that coordination reverses: the diaphragm contracts and moves downward while the abdominal wall relaxes. Food, fluid and normally produced gas are then pushed into a more compressed space, so the abdomen protrudes. It can look and feel as though the person is producing excessive gas even when gas production is normal. The diaphragm may be responding to ongoing GI stress in much the same way that some people hold stress in their shoulders and neck. Worrying about food, bathrooms, clothing or being asked whether you are pregnant is stressful, and that can reinforce the physical response.
Victoria
I'm starting to think I'm not ready for clinic I did not know any of this is insane.
Dr. Kim Bretz
Okay, so they just did a really great study out of Britain looking at gastroenterologists who are just coming out of school and they're all feeling like they don't have training in this so I'm going to tell you. This is happening all over the place. But there's much more education that's happening now and it's so exciting. So yeah.
Victoria
Ok, good to hear. How do you address something like this with your patients.
Dr. Kim Bretz
It depends on the individual. We assess the symptoms and diagnosis, but we also look for catastrophizing, mental health conditions, disordered eating patterns such as avoidant restrictive food intake disorder, and GI-specific anxiety using tools such as the Visceral Sensitivity Index. Someone may not have generalized anxiety but can still have significant anxiety about gastrointestinal symptoms. We use a multidimensional clinical profile for disorders of gut-brain interaction, which gives us a roadmap for care. A low FODMAP diet or another targeted food intervention may still have a role, but it should be contained and individualized. We may consider herbs that reduce sensation, gut-directed hypnotherapy or GI-specific cognitive behavioural therapy. Constipation also matters because retained stool can mean retained gas. If someone has an eating disorder, removing more foods is not appropriate. The plan depends on the person in front of us.
Jeanette
I'm curious because you mentioned herbs there So in school. We're taught a lot about carminatives which are certain herbs that can fall into this category which so supposedly help with like cramping gasp bloating all of that. But. With this mechanism of like visceral hypersensitivity. These patients aren't producing more gas like would these herbs even be useful in and that case like is there any specific part like point when you would use these herbs I guess.
Dr. Kim Bretz
Yeah, So I think in some cases I do want to calm things down for people so that we can focus on some of the other things more easily so there can be a place. It's certainly something that I Love Peppermint. And it's one that we have a lot more research around not only around antispasmodic and if we're not feeling things quite as much that might be really helpful in that scenario but it has that little bit of an analgesic effect to it as Well. So if we can help with calming down the nerves a little bit and combine it with some other things. That could be that can be something that's really great. A lot of the things around Herbs. We don't quite understand what they're doing but I don't necessarily think it's wrong either in some cases to use some things to help with just decreasing. How much people are feeling things as long as we're looking at the other stuff because if the only thing that we have as a solution is to have you eat less foods so that you don't produce as much gas or you must take this herb that helps move the gas through more effectively and we haven't hit what the actual problem is. Then you either have to do that thing for the rest of your life or you're likely going to go back to your symptoms again and that's where people get really frustrated that it just becomes a game of whack-a-mole of okay this help for a while is not enough. Let's add in this other thing I'm going to try to get off of it. The symptoms come back like.
Jeanette
Right? So it seems like it's more so for the making them feel better and like for that analgesic effect and then part of a bigger plan I know me and Vick were talking beforehand that like when does you're giving someone an herb but like are they going to take it forever like is this something they have to rely on so that's also.
Dr. Kim Bretz
That's what tends to happen.
Jeanette
I Guess big part of a bigger conversation. But yeah.
Dr. Kim Bretz
Absolutely yeah I love herbs I really I think there's so much. That's great about them and it's funny because I work I teach at the pharmacy school at the University of Waterloo and our building is a glass building that has plants. All over it. Really colorful plant. Some people love it. Some people hate it. But it's actually based on the fact that so many pharmaceuticals come from a plant basis I think there's so much. That's great about them and I really love using herbs but in the same way that many of our patients come in. Rightly or wrongly never wanting to take a medication most of them don't want to take an herb for the rest of their life either. Even if that may feel more comfortable. So yeah.
Jeanette
Definitely that makes complete sense. So if you have a patient that's coming into you and they're saying that they've had chronic bloating everything makes them bloated you mentioned earlier water is making them bloated to what would be. What would be your first piece of advice or your first step with a patient like this.
Dr. Kim Bretz
Yeah, so once everything is bothering you that really is a sign that there's a miswiring miscommunication piece that's going on so I'm probably going to be as a bigger first thing that I would be looking at is that gut-brain connection side of things. Again, it doesn't mean that I probably would be adding in some herbs I'm probably looking at doing some things for the microbiota. We don't have as much information about probiotics as we want or as the industry likes to make it seem but we do have certain strains that we've seen. Can help out with decreasing bloating and gas a little bit so combining that in there but probably hypnotherapy cbt looking at avoidance response. Those are things that I'm going to be talking about pretty heavily. While we're doing some of the other stuff. But if you're responding to everything it usually means that the food is not actually the problem in that scenario. So there's no scenario like that where I'm going to be like well, it's probably soy then let's take out soy now. And that's what people want they want to know? Well what is the 1 food like if we figure out this 1 thing that it will make all the things better in my life that generally doesn't exist except for celiac is a but yeah.
Victoria
Right? Yeah, okay well on the on the subject of celiac I want to get into the conversation of removing foods of food intolerances. And of gluten because that's a big one that I think a lot of people associate their gut. Issues with. I think for many of us our first kind of idea we get when we are experiencing any gi distress is like what food or food group. Do I need to get rid of right and you've said that's always been the way that we've done things and that's the way that we've also been trained to do things.
Dr. Kim Bretz
Right? Yes.
Victoria
And I really do want to get into that conversation and kind of debunk some of these common myths that we see so how many people roughly like in your opinion what you've seen in clinical experience how many people with gut symptoms like bloating and gas and what we see.
Dr. Kim Bretz
I struggle with what we mean by a 'true food intolerance,' so I cannot give a reliable number. Gluten and wheat are useful examples because wheat contains many components, not only gluten. When someone feels unwell after eating a gluten-containing grain, we often assume gluten is responsible because we understand its role in celiac disease. But studies have taken people without celiac disease or wheat allergy who identify as gluten-intolerant and compared bars containing gluten, fructans or neither. Fructans - fermentable carbohydrates in wheat that gut bacteria use to produce gas - caused the most symptoms. The placebo bar caused the next most symptoms, and the gluten-containing bar caused the fewest. This illustrates that people can experience real symptoms without correctly identifying which component is responsible. If fructans are contributing to symptoms through fermentation and visceral sensitivity, that is not the same thing as a gluten intolerance.
Jeanette
It's interesting and like I wonder a lot where this whole gluten thing comes from like is it just because it's very rampant on social media. Yeah I don't know like.
Dr. Kim Bretz
Is it from us as you say it's us. Yeah.
Jeanette
Yeah, it makes me wonder because everyone seems to have like gluten sensitivity and there's this huge like Nocebo effect with gluten specifically. So it's just it's very interesting. Yeah.
Dr. Kim Bretz
Yeah, and that's the other study that I really like it just came out fairly recently I would say within the last four or five months where again they had a very similar group of people so they did not have celiac disease. They did not have a wheat allergy. But were self-declared gluten intolerant and they were put into one of four groups. So the first group or the first two groups they were told that they were going to be eating food that contained gluten half of the group actually got food with gluten in it and half of the group did not get food with gluten in it. And then the other two groups were told that they were going to be eating food that did not have gluten in it half of those people did not get gluten and half of the people did get gluten. The people who responded the highest with symptoms were the people who were told that they were going to be eating gluten. And that included the people who did not eat the gluten. The people who responded the least were the people who were told that they were not eating gluten even if they did eat the gluten and that's where when we have a belief that something can cause us a problem we can have symptoms. Again, This is happening for legitimate reasons. But it's not a food intolerance in that scenario. That's a Nocebo effect now I know I know.
Victoria
Wow I Feel like when you have like confirmation bias for yourself where you're like no, no, that's not me though I'm experiencing that right now.
Dr. Kim Bretz
Huh Yes, and I will say I speak at conferences all the time and like when I talk about the bloating and the sensitization I'm like people are like okay but I see their hands raising and they're what like. But what about the fact that I can see my abdomen puffing out like you are wrong right? Now it is different for me. But it's hard like we can't assume that every one of our patients never has a nocebo effect or never has doesn't understand where the food problems can come in or that there's no sensitization like we can't only have the magical. Rainbow unicorns and sometimes when we're treating everyone that way and it's only taking bucket loads of supplements and taking out more and more foods and living these really restrictive small lives that are really scary. We can actually be making things worse. And that when we have this idea of do no harm I think there's a really huge risk because we think that taking away food can do no harm and that is something that I strongly disagree with whether it's the fact that we actually see it can change. Our microbiota and our physiology and do these things that we sort of understand in a tangible science way. But also how much it means that you can't eat pizza with your kids. You can't go on the field trip with other people. Your soccer team is doing this thing and you can't eat what everyone else is eating. You can't figure out how to go on vacation anymore or go on a road trip like these things harm people and we have to be more cognizant of that.
Victoria
Absolutely I know for me I have my kind of passion and I always have in Thyroid health and gluten is a huge conversation when it comes to thyroid and Hashimoto's specifically and I've talked about it. Quite a bit on my own personal thyroid health page that I have on Instagram and I'm often met with a little bit of anger about this topic because people are saying no, no, you're wrong I don't care what the research says I took this out of my diet and look how good my life is and I think that. Argument is that even if you don't have celiac Even if you don't have this quote unquote sensitivity that gluten is this inflammatory food and a big thing I hear is it contributes to leaky gut syndrome and I definitely need to ask you about leaky gut I Need you to tell us is leaky gut.
Dr. Kim Bretz
Yeah, so leaky gut conversations in most areas are things that make me want to stab my eye with a pen.
Victoria
Real and if it is it as common as we think it is.
Dr. Kim Bretz
Because it's taking something that is a really complex. Interaction that's happening the body and making it feel like it's something that we really understand super well in many conditions. And it almost trivializes it which is something that really makes me Crazy. So leaky gut or an intestinal permeability issue is sort of a better way of looking at it is a real thing. We absolutely see and specifically for me thinking about gut conditions. We know this happens in celiac Disease We know it and happens in inflammatory bowel disease. We can see it for periods of time in individuals who have post-infectious IBS. This is a thing that happens. So if we're thinking about the lining of the inside of our digestive tract so that tube that we have. It's lined all with cells and those cells are held together with. Tight Junctions and it's way more complicated than that but we'll just talk about our tight Junctions We just think about them like specialized zippers. That are in between all the cells and it allows for hopefully mainly only good things to go in and we keep the bad things not going into our body and that's the way it's supposed to work. But there's always changes in permeability that are happening so you do a long hard Workout. You have a higher stress that's going on you drank more alcohol. The permeability changes. We can see the permeability change when people are eating gluten who have celiac disease but when they stop eating it. The leaky gut goes away. So it's something that we kind of talk about it like it's a disease in itself and we don't see that and even within what we understand most of it is based on biomarkers because actually studying. The tight junctions in a live human being with a condition is not something that is very easy to do so most of what is done is either looking at biomarkers that we haven't really been able to link up very well with what is actually happening in human beings Gut. Or they're preclinical trials where we're looking at animals and models because we don't have anything better to look at in actual human beings with the conditions that we live with in the lifestyles that we live within with the food that we eat and all of those sorts of things. So. It's absolutely a thing. But is it The thing that is a disease that's the problem. Not really, it's a response to some of the other things that are happening.
Victoria
Wow. Okay, so it sounds like we're overdiagnosing in our fields with a condition that we yeah.
Dr. Kim Bretz
It might be a little bit of it might be a little bit of overdiagnosing but again I think it would be easier if there were better ways to help people because if people weren't stuck and feeling like they had no other options. I Don't think people would be going down this pathway. We don't see people who break their arm going down really in some cases crazy pathways to fix it because we have a great fix that exists and then you do that thing that fixes it. But for so many of our patients. Who have got things or autoimmune conditions are another great example like Thyroid disease which most of our average Thyroid disease is going to be an autoimmune condition when there's not these great answers that tell us exactly what to do or if there haven't been for a very long period of time. People try to just do it themselves and extrapolate on the preclinical trials and then they just do it because they're desperate for anything and it can be really hard to walk back from those sort of places where you felt heard and it. It felt like something made sense and this whole area of misinformation is so hard right now because we there's been so many people who have been left behind within the healthcare system the Healthcare care system is great at keeping people alive and dealing with emergencies but dealing with things like the average thyroid condition or almost. All gastrointestinal conditions. There's not a lot of help that has been offered So of course people are going to look for anything and then once you get an idea in your head. We all know it's very hard to walk it back.
Jeanette
Seems like for every health condition. There is nuance right? It's not just black and white. There's not 1 pill to fix if there if it was that easy. We'd be out of a job. So unfortunately it doesn't go that way.
Dr. Kim Bretz
Yeah, but I think I think it's really yeah I do think though, it's really hopeful and I think especially for me with looking at sort of these gut conditions and how many people are affected but how we have so much more information and we're seeing. Better ways to get people feeling better and actually getting to some of those issues that are causing more of the imbalance in the first place that we've got more of that now and hopefully we can get louder voices so that. Options for people are not just to live in a small little box of having to be perfect all the time with this insane regime and insane diet and all of those sorts of things. So I think it's actually really exciting. What's happening right now and I think there's a lot more. Place for hope within what is going on.
Jeanette
Definitely exciting with all the new research coming out with the microbiome and this visceral hypersensitivity and all of this. So definitely exciting about that. I know you touched briefly about SIBO and of course SIBO could be its own and its own. But when we're talking about bloating and gas here I have to ask you just briefly about it. So could you just quickly explain First of all like what SIBO is how common is it and is it a major contributor to chronic bloating and gas that we've talked about today.
Dr. Kim Bretz
SIBO stands for small intestinal bacterial overgrowth. It means there are too many bacteria, and likely the wrong kinds of bacteria, in the small intestine. It went from being a condition that was rarely discussed to an explanation applied to almost anyone with gut symptoms, and the evidence does not support that. Breath testing can produce substantial false-positive and false-negative results, with some estimates suggesting that up to half of tests may be wrong. Lactulose breath testing is especially problematic. In some studies comparing people with IBS to people without GI symptoms, positive breath-test rates were nearly equal between the two groups. We also used to assume that bloating meant excess gas production, so it seemed logical to connect bloating with SIBO. Now we know that many people with bloating do not produce excess gas. Symptoms should therefore be considered alongside a plausible reason for SIBO, such as abdominal surgery or a condition that slows movement through the small intestine. We should not start with an inaccurate test result and then reverse-engineer a cause. Claims about the migrating motor complex and prokinetics are also frequently repeated far beyond the available research. When I reviewed hundreds of papers for a five-hour practitioner lecture, I found very little direct evidence connecting those claims to SIBO.
Jeanette
So interesting I think this is like the perfect example of people will take something and they'll run with it and it becomes almost common knowledge. But then when you look into the research and it's not there and you're like how did we get here.
Dr. Kim Bretz
Right? Well and I have to say this and I do so much presenting that was a presentation that gave me the most stress because I've talked little bits about SIBO before in presentations and it is the thing where people are like no, you're wrong and I legitimately. Was contacting up to date I was contacting the people from the North American consensus the european because I was like I don't get this. This doesn't make sense that this research doesn't make sense what you're saying isn't making sense and this is everything in the research is like controversial. This is misunderstood. This is like all these things are coming out but that's not what we're talking about often within our sort of naturopathic or integrated medicine sphere of what's being looked at and that certainly not was what being talked about on social media or on. YouTube videos or whatever it is. It's not being talked about and I think people are being misled.
Victoria
Wow I think it's also such a disservice to patients because I'm thinking about what we've learned about SIBO in school and first of all, it's pretty expensive. We've learned about yeah we've learned about these at home breath tests.
Dr. Kim Bretz
It's very expensive. Yeah, but.
Victoria
And all of these supplements to treat our patients with bloat with bloating and suspected SIBO with and I think like okay, but if they have visceral hypersensitivity what a waste of money time like.
Dr. Kim Bretz
Absolutely and that's where if we're doing better assessments if we're looking at some of the things better. We shouldn't be getting people into situations where they're paying hundreds of dollars for testing and hundreds of dollars for treatments. That I will see practitioners legitimately saying well this is really hard to treat and this is why you're going to have to go through treatment over and over and over again and like maybe it's the wrong diagnosis like maybe it's just wrong or maybe you fix them? Maybe you did. Legitimately fix them but in the process of fixing them Now you've used antibiotics that you've used a lot of restrictive eating what if they now have a disorder of gut-brain interaction and you keep treating it like it's a physical entity solely. And that's where I think if we don't really understand what's going on again. We can be harming patients and that's something that I don't think we're always good at looking at that.
Victoria
Absolutely I think this is a really good lesson for any students that are listening any naturopathic doctors that are listening because it's so easy to just like what Jeanette said take what we learn and run with it and not enough of us are questioning the things that we've been taught. And like you said earlier I think some of the things we've been taught are probably the exact same PowerPoint slides that you were taught and the people before you were taught and it's really important that we start questioning it and we start also looking for newer research because there is so much newer research available to us. Why aren't we using it.
Dr. Kim Bretz
Well and I'm paid to look at the research so much and I can't keep up with it. There's so much. And this is an area where I think we've gotten complacent because we often can get people to feel better in a pretty short period of time based on some of the things that we did. But it doesn't last a lot of the time or it requires people to be super restrictive and living in worlds that are super stressful and again I don't think that's healthy either. So there's we can be doing better and that's really exciting to me.
Victoria
Yeah, it is. It's empowering. It's empowering for us to in the position that we're in starting clinic. Okay, so we can talk with SIBO Honestly, all day we really could we might have to have you back for another episode. But I do want to do a little rapid fire myth busting.
Dr. Kim Bretz
Yeah, so. Yes, exactly? Yeah.
Victoria
We've covered some of this but I'm going to just say a statement I want you to say myth or truth or it depends. And just give us kind of a quick. Yeah, we'll give it a try and see what happens. Ok so the first one.
Dr. Kim Bretz
I feel like the answer is going to be nuance. A lot of the time but we'll give it a try. Yeah.
Victoria
Food sensitivity testing is accurate and clinically useful. Fair. Next statement: most people are intolerant to gluten because of how it is processed, and gluten causes leaky gut.
Dr. Kim Bretz
There is nuance for people with autoimmune conditions, but generally that is a myth. I love looking at the Blue Zones, where people tend to live longer and in better health. People in those regions eat pork, wheat, dairy, beans and legumes - foods that break many of the rules promoted here. Processing matters, of course, and eating large amounts of refined flour and ultra-processed food can be problematic in many ways. But gluten is not damaging everyone.
Victoria
In general, everyone can benefit from taking a probiotic. And patients should consider an elimination diet to address GI distress.
Dr. Kim Bretz
You can take a probiotic if you want to, and I am not terribly concerned about that, but not everyone needs one. As for elimination diets for every patient with GI distress: no, that is a myth.
Victoria
My last statement is that GI-MAPs and other comprehensive stool tests are accurate and clinically useful.
Dr. Kim Bretz
I think GI-MAPs and other comprehensive stool tests can provide some clinically relevant information, but we are not yet able to translate every finding into a meaningful treatment. A stool sample measures only a specific subset of the microbiota and tells us much less about organisms living closer to the intestinal lining. There may be some value, but this testing is not necessary for everyone.
Jeanette
Yeah, those tests are also I think they run for like $500 or something like that. So probably not the first step.
Dr. Kim Bretz
In some cases, testing may show that several beneficial bacteria are low, but many people in North America have reduced microbial diversity and richness. Markers such as fecal calprotectin, fecal fat and elastase can be useful in the right patient. However, if one beneficial bacterium appears low, we cannot assume that taking a probiotic will correct it. If another bacterium appears high, we do not have a perfectly targeted treatment that removes only that organism without affecting the rest of the microbiota. We are not there scientifically. We need informed-consent conversations about what the test can and cannot tell us, and practitioners ordering the testing need to understand those limitations.
Jeanette
We end all of our episodes by asking our guests one final question: what is one myth you commonly hear in the gut-health space or on social media that you want to clarify once and for all?
Dr. Kim Bretz
We have been talking about myths throughout this episode, but I would return to the idea that feeling bloated or experiencing visible distension means you must be producing too much gas. For the vast majority of patients, bloating and distension do not mean excess gas production. Once we understand that, we also need to reconsider treatments that focus only on removing gas-producing foods, killing microorganisms or ordering SIBO tests. All of those interventions carry risks, and I think we can do better.
Victoria
Dr. Bretz, we are so grateful to have had you on today. I do not want to sound like a fangirl, but we are huge fans of yours. You are iconic in our field, and I think this will be a fantastic episode for our listeners and for our colleagues who are also entering clinic very shortly. Where can our listeners follow you, book with you or learn more about your work?
Dr. Kim Bretz
Absolutely. I mainly see patients virtually, and information about booking with me is available at drkimbretznd.com. My Instagram handle is also @DrKimBretzND. I work with a group of practitioners who want to advance their knowledge of GI health, and we have a free public summit happening in June 2024. For practitioners, we also have a full-day intensive on disorders of gut-brain interaction. I am putting together a public education program as well, so people can enter their appointments better informed and less vulnerable to misinformation on social media. We are trying to reach people in several different ways and get this message out.
Jeanette
That is amazing, and it is so needed. We will include all of your information in the show notes so listeners can find it easily. Thank you again for coming on. We appreciate it so much.
Dr. Kim Bretz
You're welcome. Thanks for having me.
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Dr. Kim Bretz, ND is a naturopathic doctor, menopause-certified practitioner, international speaker and faculty member at the University of Waterloo School of Pharmacy. For more than 20 years, she has worked at the intersection of gut health, hormonal transitions and evidence-based integrative care.
Dr. Bretz helps patients and healthcare professionals better understand concerns such as chronic bloating, irritable bowel syndrome (IBS), disorders of gut-brain interaction, food-related anxiety, menopause and lifestyle medicine. Her approach emphasizes clarity over unnecessary restriction, practical strategies over perfection and evidence without overwhelm.
Her professional training includes the Monash Low FODMAP program, eating-disorder education, gut-directed hypnotherapy through Nerva and menopause certification through The Menopause Society. She is also a member of the European Society of Neurogastroenterology and Motility and the American College of Gastroenterology.
Through patient care, practitioner education, consulting and speaking, Dr. Bretz helps people move beyond confusing wellness rules and return to fuller, less restricted lives.