Upper gut digestive issues as the cause of shortness of breath are widespread and overlooked. Many people go to their doctors complaining of breathing issues and are told their lungs are healthy. Your lungs sound clear, your oxygen saturation is healthy, and your lungs appear normal on diagnostic scans, yet you still deal with occasional or constant shortness of breath, and it is worrisome. You eventually get diagnosed with anxiety and you are sent on your way with no diagnosis, comfort, or relief. Most doctors look at this condition as “perceived breathlessness” because there appears to be no direct cause of the troubled breathing. However, for most people with digestive problems the dyspnea (breathlessness) is real and has many direct reasons and solutions.
“Perceived Breathlessness” or True Dyspnea?
I suffered from asthma as a child, so I have suffered the differences between constrictive dyspnea (asthma) and upper gut digestive issues causing dyspnea. When I had asthma in my youth, my lung bronchi would become inflamed and constrict, causing wheezing, dyspnea, chest tightness, coughing, and low oxygen saturation. My allergy specialist could easily tell when I was having an asthmatic episode, there were clear cut presentable symptoms of the disease and I was given medication to treat it. I would take Albuterol (a short acting B2 adrenergic agonist) to dilate the smooth muscle in the airway so I could breathe better and wait until the episode passed. Later, in my early adulthood when I developed H. pylori upper gut dysbiosis I started having breathing issues again, but this time they were much different in presentation. I would have dyspnea, I felt like I could not take in a full breath sometimes and my breathing became more forceful and less autonomic. I visted many different doctors to see if they could determine what was happening. But since I did not have any other symptoms of asthma then dyspnea, my oxygen saturation was normal, and my diagnostic scans were clean, I was sent away with the diagnosis of “anxiety related perceived breathlessness”.
I wish I knew more about upper gut digestive issues eight years ago. I would have known that the issues I was having was not anxiety related but had a real cause. My cause was H. pylori caused upper gut dysbiosis that created much gas and stomach pressure that triggered my breathing issues. I later discovered a lesser known condition in the United States (it is well known in Germany) called Roemheld syndrome. Roemheld syndrome is also known as gastric-cardia syndrome and was discovered by Ludwig Roemheld in the 1930’s. The syndrome has many different triggers and most commonly is caused by upper gut dysbiosis. Mechanical triggers of the illness occur when pressure is placed on the fundus of the stomach or the esophagus. When the increased epigastric pressure occurs the diaphragm’s position is elevated and puts pressure on the heart, diaphragm, lungs, and vagus nerve. Hiatal hernia’s are known to be a significant mechanical trigger of Roemheld syndrome. Increased gas in the upper gut can also greatly expand the stomach or cause a sliding hiatal hernia, which will increase abdominal pressure triggering Roemheld syndrome. Displacing and restricting the diaphragm also interrupts the autonomic nervous system causing you to become aware of your labored breathing and trigger abdominal breathing. When excessive pressure is put on the diaphragm and the lungs, dyspnea may show up as the exact symptoms I had. I felt like I could not complete a full breath and felt increased chest and abdominal pressure.1 2
Reflux dyspnea manifests itself differently than Roemheld syndrome and causes symptoms that appear like asthma. Different types of stomach and duodenal contents can be refluxed into the upper esophagus causing dyspnea. Minute reflux particulates or rarely large amounts of emesis can be aspirated into the lungs. Aspirating reflux into the lungs can cause many different symptoms including lung inflammation, constriction, wheezing, coughing, lower oxygen saturation, and if severe enough aspiration pneumonia. These symptoms may appear to some physicians as asthma, but if you have symptoms of upper gut dysbiosis or structural issues including gastritis, reflux, abdominal hernia, hiatal hernia, abdominal pain, poor oral health, or constipation then reflux dyspnea might be the cause of your “asthmatic symptoms.”3 4 5 6
What to Do If You Are Having Trouble Breathing Due to Upper Gut Health Issues
Well if you breathing issues are caused by upper gut dysbiosis than improving your upper gut microbiome is probably the best way to improve your issues. There are a few people that have structural issues not caused by dysbiosis like people with abdominal hernia repair that might be limited in what they can do to improve their breathing. For people that are suffering from reflux or Roemheld dyspnea there are many different tips that you can do try to help improve your breathing issues:
- Reduce GERD (gastroesophageal reflux disease) or silent reflux occurrences.
- Chew your food slowly. Many of us forget about this critical tip to improve digestion significantly. The longer we masticate our food and mix it with saliva the easier it will be to digest. You should follow this advice firmly if you are eating carbs since one of the main components of saliva is amylase that helps us break down carbs. Finally, the slower we eat, the less chance we will overeat, since our stomach has time to fill up and signal to our brain that we are full.
- Poor gastric emptying and an elevated stomach pH can lead to greater gas production in the upper gut. If you are suffering from poor gastric emptying and gas, consider taking digestive enzymes or digestive bitters to try to facilitate proper digestion. If you are dealing with elevated stomach pH consider ingesting one teaspoon of apple cider vinegar mixed in with your vegetables (as long as you do not have histamine intolerance) or betaine HCL (if your meal is going to have fat and protein and as long as you are not suffering from silent reflux or have an ulcer) to help support your body. Salt your food as well; chloride is important for proper stomach acid production and taste (as long as you are not Th-17 dominant).
- Proper bile production is important for people suffering from poor upper gut digestion.
- Drink little liquid with meals, I recommend no more than eight ounces. Waterlogging your stomach can put excessive pressure on the LES and slow down digestion. If you are consuming water or tea, it should be room temperature to improve digestion. You want to fill your stomach up with nutritious food during meals, not liquid.
- If you are suffering from severe gas causing breathlessness take some activated charcoal a few hours after your meal. The activated charcoal should absorb the gas, improving breathing.
- If you are constipated, improve your motility to reduce pressure on the upper gut. One of the simplest ways to improve constipation is by using a Squatty Potty.
- If you are suffering from a hiatal hernia, visit a chiropractor and have them manipulate your stomach back into correct anatomical position. If they can do it safely, have them teach you how to perform this manipulation at home.7
- Reduce inflammation in your airways by supplementing with producing vitamin D, magnesium, vitamin C, and ingesting omega 3 fatty acids. Supplementation of vitamin C and magnesium might help with intestinal motility and improve constipation.8 9 10 11
- Improve the functionality of your lungs use a lung trainer to improve breathing. Slow deep breathing might activate your vagus nerve which can help with dyspnea.
- http://www.dpmartinjunghöfer.de/pdf/Breath%20Training%20for%20Roemheld%20Syndrome.pdf ↩
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3339066/ ↩
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2714564/ ↩
- https://www.sciencedirect.com/science/article/pii/S0954611106002332 ↩
- https://www.ncbi.nlm.nih.gov/pubmed/3721948 ↩
- https://pmj.bmj.com/content/79/929/183 ↩
- https://drcarolyndean.com/2012/06/healing-hiatal-hernia-with-massage/ ↩
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3026181/ ↩
- https://www.ncbi.nlm.nih.gov/pubmed/8509592 ↩
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2706673/ ↩
- https://www.sciencedirect.com/science/article/pii/S1323893014000100 ↩
I have a small hiatal hernia and barrett’s esophagus. The GI doc said i have to be on a ppi for life. I now have dysbiosis and shortness of breath that is slightly relieved by burping. The air hunger is mainly when standing. I definitely don’t want to have to take antibiotics because I have had bad reactions in the past. I do take enzymes. Any advice on threading this needle?
I have had the breathlessness described in the above article for 4 years. All tests come back negative. I have asthma and the doctors keep treating me for either asthma or anxiety. I have tried bitters and activated charcoal. Neither worked. I had Sibo and leaky gut. Was treated by a functional medicine doctor. All follow up tests showed no sibo or leaky gut but still have the forced breathing symptom. I barely sleep as it gets much worse when I lay down. I don’t know where to turn. Please let me know if there is something additional that can be done. Thank you!
Hi Martha, have you had a full iron panel run recently? I found that I had extremely low Ferritin causing the air hunger feeling. Optimal Ferritin for women is 80-100; mine was 8! I had a series of three iron infusions and it helped a lot. I’m still struggling with stomach symptoms but no more air hunger. Also, low ferritin can be caused by things like SIBO. Best of luck. I hope this information helps.
I have very similar symptoms like yours. Did your symptoms Improved ?
Did you have bad stomach pain durring this? Or was it mild
I had horrible silent reflux and occasionally gastritis.
Increased breath is why I take 1/8 level cup of Red Star nutritional yeast from BulkFoods.com before lunch and 1.5 grams of plankton mornings from Phytoplanktonsource.com, because RNA increases lung volume. If I don’t take the nutritional yeast, then I won’t be breathing as deeply into the afternoon. Plankton also has RNA and I noticed my muscles responding to my lungs’ intake of air when I first started taking plankton in 2011.
So crazy to read this article now. I got pregnant last summer with my third child. I already knew I had definite gut issues and was working with a functional MD. Well I immediately had this feeling of breathlessness after I fell pregnant. I asked al my doctors and even walked into the ER twice. I kinda read something and thought maybe it is just reflux coming up into my lungs. I ended up using Urban Apothecary bitter for like every meal. Baby was born and it’s gone away. I still definitely have issues but I’m currently working with a doctor from Chris K’s group. Hopefully I find answers soon. Thank you for the great articles-I totally think I have upper gut issues instead of just “SIBO” and I was blown away by how obvious it is.