Bloating and bad breath in teenager - supplements, probiotics?

April 3, 2023 11:53 AM

Sixteen-year-old niece has long-standing problems with stomach cramps (not period pain), feeling bloated and with bad breath (excellent teeth and hygienist care). As a child they were treated with strong antibiotics and we were warned at the time that this might have an effect on their gut functioning. We are wondering whether a gut issue could explain both the bloating and breath issues. Wondering about supplements or probiotics - advice appreciated.

We realise the cramps and bloating may be related to stress, and niece receives support for this. We have consulted their GP. Niece has kept a food diary, with no clear results.

posted by anonymous to Health & Fitness (12 answers total)

This does sound like a gut issue. There are lots of things it could be. Definitely push for more testing. GPs, in my experience, don't do much to figure out root causes especially for mystery illnesses related to gut health. I regret not pushing harder for testing and diagnosis until I was really sick.

I went to the doctor with stomach issues in my early teens and was given midol (eyeroll). I didn't get diagnosed as celiac for another 15 years. Lots of discomfort and health issues could have been avoided had someone advocated for me when I was young.

So, I don't know what the root cause is for what your neice is experiencing but it's worth pushing for diagnosis.
posted by CleverClover at 12:38 PM on April 3, 2023 [4 favorites]

I hate to say this, but, have you tried eliminating lactose? This is exactly how lactose intolerance presented in my kids when it started. It took a long time to figure it out because avoiding lactose for a day or two wasn't enough to resolve the symptoms. Similarly, symptoms didn't always occur right away when lactose was consumed. So we kept thinking, 'nahh, must be something else...'. But once we really committed and stopped all lactose, within two weeks symptoms were gone permanently.
posted by Ausamor at 12:49 PM on April 3, 2023 [2 favorites]

I was also going to say lactose intolerance. That sounds a lot like what I used to deal with (for some reason I can handle lactose now). If that’s what she has, she can try lactaid pills. They worked really well for me.
posted by imalaowai at 1:20 PM on April 3, 2023

Lactose intolerance is a possibility, for which she can get a diagnosis. It's worth getting tested.

When you mention the antibiotic treatment, a disrupted gut microbiome could be an issue. For that, she needs to change her diet, maybe even her entire lifestyle (get a dog!). It isn't terrible, because you can still eat everything that isn't processed food, but the proportions might be different -- less meat and more vegs. Look at the Zoe YouTube channel for information and maybe try their counseling.
posted by mumimor at 1:49 PM on April 3, 2023

Has a strict elimination diet been attempted? This seems extreme and important enough to try this.
posted by amtho at 2:15 PM on April 3, 2023

Does she have tonsils and have they been checked for crypts?
posted by Ardnamurchan at 2:26 PM on April 3, 2023 [4 favorites]

This could be SIBO, an overgrowth of bacteria in the wrong part of the intestine, which produce extra gas when processing food. It can be diagnosed via a breath test after a day of restricted diet.
posted by space snail at 2:29 PM on April 3, 2023 [2 favorites]

First off, if you're able to consult a qualified dietician, I would do that.

I'd recommend looking into the FODMAP diet:
https://www.monashfodmap.com/ibs-central/diets/

FODMAP sensitivity can definitely cause bloating, pain and bad breath. I have a family member who had these and other symptoms after a gut illness and a course of very strong antibiotics. She went on the FODMAP diet which ultimately worked for her.

I'm assuming if it was just lactose intolerance your niece's food diary would have picked it up. With FODMAP issues, keeping a food diary won't necessarily give a clear answer because the compounds that cause the problems occur across multiple foods.

You asked about probiotics and supplements. I am a fan of Partially Hydrolised Guar Gum (PHGG) because it's a prebiotic fiber that is very easy to digest. Prebiotics are very beneficial but some can make gut issues worsse. PHGG is very safe (Amazon).

It might be worth trying a probiotic but I feel they are pretty hit and miss, the evidence is not great, and some can make issues worse. I would look for a high quality one without too many strains in it, and monitor to make sure it's not making her feel worse. The strains I would look for are: Lactobacillus rhamnosus, Lactobacillus plantarum, Bifidobacterium animalis, Bifidobacterium breve and Bifidobacterium longum. They are all considered safe and there is at least some evidence they help with IBS.
posted by riddley at 7:00 PM on April 3, 2023

Endometriosis can present as abdominal pain, bloating, and digestive problems. It affects 10- 15% of adolescent and reproductive-aged women, and up to 70% of those with persistent abdominal pain. Unfortunately, because of a combination of institutional sexism and lack of easy, reliable testing, it often takes 6 to 7 years to be diagnosed, which can lead to serious health problems, including damage to the internal organs, loss of fertility, and the mental health struggles one might expect with chronic pain. (Also, female patients presenting with abdominal pain are often given estrogens (birth control) as a first line treatment, which can make the endo worse.)
posted by radiogreentea at 6:23 AM on April 4, 2023 [3 favorites]

IANAD and this is not medical advice, but antibiotics can cause an imbalance in gut bacteria, which is sometimes called gut dysbiosis when it's extreme.

You can search out naturopaths who can assess the symptoms and make suggestions for probiotics and supplements to support the gut. Be wary though if they want to do a ton of pricy tests right away, there's a lot of variability in people's qualifications and experience.
posted by lafemma at 6:26 AM on April 4, 2023

IANYRD, but seconding that she consider getting tested for SIBO. If that's ruled out, work with a dietitian/dietician* if possible in conjunction with her GP.

Also seconding riddley that a low FODMAP approach may be indicated, but that would be best undergone with guidance from a specialist (usually a dietitian/dietician) to ensure she would be getting enough of everything nutritionally depending on what would be eliminated.

In any case, I'd encourage further assessments as mentioned upthread. As an example, celiac, FODMAP sensitivity, and lactose intolerance all present similarly at some points, but the treatment would be different.

*differential spelling for US vs UK
posted by OhHaieThere at 3:45 AM on April 5, 2023

Stomach pain, bloating and bad breath could all be symptoms of too much acid in her system. Is her tongue also white/yellow a lot of the time? Does she also have disturbed sleep and/or post-nasal drip or a stuffy nose? It could be LPR or "silent reflux". This could be tested by trying some antacids or talking to her GP about a short course of a H2 blocker like Pepcid.
posted by fight or flight at 12:02 PM on April 5, 2023