I have said on many occasions that Bill Gates will borrow money from me when I solve the problem of gas and bloating. People will line up for blocks when this problem is solved. Having admitted what I cannot do, there are some valuable tools available to ease the problem and the anxiety that goes with the problem.
Intestinal gas is best explained by dividing the subject into upper intestinal gas and lower intestinal gas. Upper intestinal gas consists primarily of swallowed air. Air collection in the stomach is usually burped with small amounts of air being absorbed in the small intestine. Air swallowing can be intentional such as Billy trying to impress mom with the biggest burp. Some air is normally swallowed with eating but large amounts of air can be ingested by gulping solids or liquids. Gum chewing and smoking result in significant amounts of air swallowing. Carbonated liquids such as Coke and Sprite release carbon dioxide upon entering the stomach. Air swallowing can be a nervous habit unrecognized by the sufferer. I have had several patients who present to my office burping every 30 seconds. They can be observed to rapidly and unconsciously swallow air then release the air from the esophagus. Most of these persons are very distressed by what they perceive as uncontrollable burping. My nurse was very surprised when I made a patient aware of the repetitive air swallowing and instructed the patient to stop. The burping ceased immediately. It is my opinion that patients perceive some type of discomfort then repetitively swallow and release air in an attempt to relieve the discomfort. Anxiety can play a major role in air swallowing.
Intestinal gas is often blamed for bloating and swelling of the abdomen. A few will actually distend the abdomen with air by swallowing air. However, most bloating is not associated with excessive amounts of air in the gut. Bloating is more closely related to alterations in the normal muscular contractions of the gut . Increased sensitivity of the gut is also an important factor in bloating and abdominal discomfort. For example, introduction of air into the intestine or colon of a normal subject may cause no discomfort while introducing the same amount of air into the gut of a person with bloating may cause a great deal of discomfort. Most gastroenterologists observe this regularly at colonoscopy. Some people are acutely uncomfortable when air is introduced into the colon while others are unbothered.
Lower intestinal gas
Lower intestinal gas is produced normally by the fermentation of undigested complex sugars. Sulfur compounds, ammonia, and methane add an unpleasant odor to colonic gas. A rare disorder, malabsorbtion, results in large amounts of undigested fats or sugars entering the bacteria rich environment of the colon. Colon bacteria break down these items and create unpleasant odors and larger amounts of gas and loose stool. Complex sugars found in legumes, whole grain flour, and dried fruit are indigestible to humans but a rich source of food for bacteria.
Humans are commonly intolerant of certain kinds of sugars. Lactose is the 2 piece sugar found in all dairy products. (Glucose bonded to Galactose) Lactase is normally found in the upper small intestine. This enzyme breaks the bond between the two simple sugars. The small intestine readily absorbs the simple sugars (glucose and galactose) and the story ends. Some people do not have enough of the enzyme to do the job. Asians and African Americans tend to have very little lactase. Some people lose the enzyme with age. In the absence of this enzyme the two piece sugar enters the lower small intestine and the trouble starts. The intestine senses the abnormal content and water is drawn into the intestine causing the dreaded cramp. The large amount of water hits the colon and overwhelms the water absorbing capability. Large amounts of gas may be produced by colon bacteria digesting lactose and the person is anxiously trying to get to the bathroom before the flood is released. Fructose, xylose, sorbitol, and lactulose can cause the same symptoms. Lactose related symptoms are unpleasant and painful, but not dangerous.
Common sources of lactose
- Cheese especially the soft cheeses and white cheeses
- Cream cheese
- Ice cream
- Does it come from a cow or goat?
Common sources of fructose in large quantities
- High fructose corn syrup
- Soda and non diet drinks
- Manufactured sweets and candies
Other poorly absorbed sugars
- Xylitol, sorbitol and xylose may be found in gum, candies, and mints
Splenda (sucralose) deserves special mention because it tastes good and is a common sugar substitute for diabetics and weight watchers. Some people will experience excessive gas, increased stool frequency, and even diarrhea with urgency. If you are having these problems try eliminating this item from your diet. Remember to stop drinks that contain this sweetener!
What can be done to reduce gas and bloating?
- Eat small frequent meals
- Chew meats and vegetables carefully
- Eat more slowly
- Be aware of air swallowing if burping is frequent
- Cut off sources of artificial sweeteners
- Candy, cough drops, sweetened drinks, gum
- If it comes out of a cow or goat don’t eat it Yogurt is OK
- Reduce or eliminate beans of all varieties, onions, dried peas, cabbage, broccoli, dried fruit
- Avoid carbonated drinks
- Fiber cereals can increase intestinal gas but may be helpful with constipation
- I generally suggest water with a slice of lemon as the drink of choice
Experiment with the suggestions described above. Try adding some items back to the diet to determine your level of tolerance for these items. Nothing here is dangerous and everything is permissible but there may be unpleasant consequences.
This information is intended to reinforce but not replace what your physician has discussed with you.