Bloating, IBS, and Digestive Discomfort: A Dietitian's Approach

Bloating is one of the most common complaints in an Amman nutrition clinic, and one of the most poorly handled online — where it's typically met with a detox tea, a probiotic, or an instruction to eliminate half of all known foods.

Persistent digestive discomfort is worth taking seriously and is usually improvable. But the sequence matters, and most people start in the wrong place.

First: rule things out

Before any dietary strategy, some conditions need excluding, because treating them as IBS delays proper diagnosis:

• Coeliac disease — blood test first, and importantly, test before removing gluten, because eliminating it first invalidates the result
• H. pylori infection
• Inflammatory bowel disease — Crohn's or ulcerative colitis
• Lactose intolerance
• Thyroid dysfunction — affects gut motility
• Iron deficiency — sometimes a signal of gastrointestinal issues

Symptoms that require a doctor, not a diet: blood in stool, unintentional weight loss, persistent vomiting, difficulty swallowing, waking at night with pain, fever, or a family history of bowel cancer or IBD.

IBS is a diagnosis of exclusion. It should be arrived at, not assumed.

Common causes of bloating that aren't IBS

Many people who assume they have IBS actually have something simpler:

Eating quickly. Swallowed air, poor mechanical breakdown, and satiety signals arriving after the meal has ended. Slowing down resolves a surprising number of cases on its own.

Very large evening meals. The 10pm dinner pattern common in Amman is a frequent culprit.

Carbonated drinks.

A sudden fibre increase. Someone starts eating well, jumps from minimal fibre to lentils and salad at every meal, and the gut protests. Fibre should increase gradually over weeks, with water.

Constipation. Often unrecognised — bloating is frequently downstream of it.

Sugar alcohols. Sorbitol, mannitol, xylitol in sugar-free gum, sweets, and "diet" products. A common and easily missed cause.

Stress. The gut-brain connection is real and mechanically significant. Motility, sensitivity, and pain perception all change under stress.

Hormonal cycling. Bloating that tracks the menstrual cycle is normal, not IBS.

The sensible first steps

Before any elimination diet, try these for three to four weeks:

1. Slow down. Twenty minutes minimum per meal, seated, without a screen.
2. Regular meal timing. The gut responds well to rhythm. Erratic eating worsens IBS symptoms.
3. Move the largest meal earlier where your schedule allows.
4. Water. Especially if fibre has increased.
5. Walk after meals.
6. Reduce carbonated drinks and sugar-free products.
7. Keep a symptom and food diary — not to eliminate, but to identify patterns. Most people are wrong about their triggers until they track them.

A meaningful proportion of people improve substantially at this stage and never need anything more restrictive.

Low-FODMAP: what it actually is

FODMAPs are short-chain carbohydrates that ferment in the large intestine, drawing in water and producing gas. In people with sensitive guts, this causes pain and bloating. In everyone else, it's just normal digestion.

The low-FODMAP diet has strong evidence for IBS. It is also routinely misused.

It is a three-phase diagnostic process, not a permanent way of eating:

1. Elimination — 2 to 6 weeks only, removing high-FODMAP foods
2. Reintroduction — systematic, one group at a time, to identify your specific triggers and thresholds
3. Personalisation — a long-term diet that restricts only what genuinely affects you

Phase two is the point of the whole exercise, and it's the phase most people skip. Staying in elimination indefinitely restricts the diet unnecessarily, reduces fibre, and — importantly — starves the gut microbiome of the fermentable fibre it depends on. Long-term elimination can make things worse.

This is also why low-FODMAP should be done with a dietitian rather than from an app. Done alone, it commonly ends in a permanently narrow diet and no clear answers.

FODMAPs in Jordanian food

The relevant high-FODMAP items in a Levantine diet include:

• Onion and garlic — near-universal in Jordanian cooking, and one of the most common triggers. Garlic-infused olive oil retains flavour without the FODMAPs, since they aren't fat-soluble.
• Wheat in larger quantities — bread, burghul, freekeh
• Legumes — chickpeas, lentils, ful. Canned and well-rinsed versions are lower.
• Certain vegetables — cauliflower, mushrooms
• Some fruit — apples, pears, watermelon, and dried fruit
• Milk — though labneh and aged cheeses are usually well tolerated

Adapting this to a Jordanian kitchen without gutting the cuisine takes some skill, which is a good argument for doing it with guidance rather than a generic list built around Western food.

Work through this with a dietitian in Amman →

On probiotics

Probiotics can help some people with IBS, but strains are not interchangeable and evidence is strain-specific. Taking a random product from a pharmacy shelf for two weeks isn't a fair trial.

If you try one: choose a specific product, take it consistently for at least four weeks, and evaluate honestly. If nothing changes, stop — there's no benefit in continuing indefinitely out of hope.

Fermented foods — yoghurt, labneh, and pickled vegetables in moderation — are worth including regardless.

The stress dimension

This deserves to be stated plainly rather than tacked on: for many people with IBS, stress is a primary driver, not a secondary one. The gut and brain are connected by a dense nervous pathway, and psychological stress produces genuine, measurable changes in gut motility and pain sensitivity.

This does not mean the symptoms are imagined. It means the treatment plan is incomplete if it only addresses food. Sleep, stress management, and in some cases gut-directed psychological therapy have good evidence in IBS — sometimes better than dietary change alone.

Frequently asked questions

What causes bloating after every meal? Common causes include eating quickly, large late meals, carbonated drinks, a sudden fibre increase, constipation, sugar alcohols, and stress. IBS and food intolerances are also possible, but should be diagnosed rather than assumed.

Should I try a low-FODMAP diet? Only after other conditions have been excluded, simpler measures have been tried, and ideally with a dietitian — because the reintroduction phase is essential and most people skip it.

How long should the elimination phase last? Two to six weeks maximum. Longer restriction reduces fibre diversity and can worsen gut health.

Do I need to give up onion and garlic permanently? Usually not. Many people tolerate them at lower thresholds, and garlic-infused oil provides the flavour without the FODMAPs. The reintroduction phase establishes your personal tolerance.

Are probiotics worth taking for IBS? Sometimes. Effects are strain-specific. Trial one product consistently for at least four weeks and stop if there's no benefit.

When should I see a doctor rather than a dietitian? Immediately, if you have blood in stool, unintentional weight loss, persistent vomiting, difficulty swallowing, night-time pain, fever, or a family history of bowel cancer or IBD.

Rula Abu Ghazaleh is a clinical dietitian practising in Amman. Book a consultation →

This article is general nutrition information and is not a substitute for individual medical or dietetic advice.