Bloating (Intestinal gas) is a very common problem in the general population and is a frequent reason why people seek medical attention. BloatingPassage of intestinal gas is viewed differently depending your age and gender.

Kids make lots of jokes and take pride in telling someone to “pull my finger.” Boys grow up to be men who believe passing flatus is not rude or embarrassing and like to use phrases like “whoever smelt it dealt it” or “whoever denied it supplied it.”

Females would like to deny that intestinal gas exists and will try to hold it to avoid any embarrassment. This practice can certainly lead to increased intestinal symptoms of bloating, distention, and discomfort.

One of the most common symptoms leading individuals to seek gastrointestinal evaluation is “gas.” They are convinced that excess gas is the cause of their abdominal bloating and distention. In addition, they believe that the need to belch and expel flatus is also due to an excess production of gas.

There have been many studies evaluating the above mentioned symptoms and results are rather surprising.

BELCHING

Belching is due to swallowing excess air. It is not due to increased intestinal or gastric production.

We all swallow some air when we eat or drink especially carbonated beverages. But people who complain of needing to belch frequently usually have developed an air-swallowing habit. This usually occurs for one of two reasons:

  • Sometimes people swallow excess air to ease symptoms due to heartburn or ulcers. Easing these symptoms with acid suppressive medications may lessen the desire to swallow air.
  • The other reason for chronic belching is due to an unconscious way of dealing with stress or anxiety. For these individuals, making them aware of their excess air swallowing can sometimes be helpful.

BLOATING AND DISTENTION

When people experience the discomfort of abdominal bloating and distention, they believe it is due to excess gas production in the intestines.

Studies have determined that people who have symptoms of bloating have no more intestinal gas than normal people1. The cause of the symptoms has been attributed to “visceral hypersensitivity.”

Visceral hypersensitivity is a term used to describe the heightened level of intestinal discomfort that individuals experience due to normal intestinal activity.

Research studies have found that when air is instilled into the intestines of individuals with visceral hypersensitivity, they experience symptoms of bloating and distention while the normal group notices no discomfort.2

Visceral hypersensitivity has been thought to be part of the syndrome of Irritable Bowel Syndrome(IBS). Historically, this syndrome has been attributed to psychological disorders. However, recent observations have noted that up to 30% of individuals who experience an episode of infectious diarrhea develop post infectious IBS symptoms3. One of the most prominent symptoms of IBS is bloating.

The current thinking is that an intestinal infection disrupts the healthy intestinal bacterial flora resulting in an immune response that leads to chronic low-grade inflammation. The inflammation then causes visceral hypersensitivity.

Recent studies using probiotics to re-establish the normal intestinal bacterial flora have been successful in down regulating the inflammation and easing the symptoms of bloating.4,5

FLATULENCE

Here are some interesting facts you can share with your friends, about flatulence:

  • Passage of gas or flatus is normal. Generally, healthy people pass 8-25 ounces daily. Frequency is 10-20 passages/day.

 

  • Gas is produced by intestinal bacteria primarily located in the colon.

 

  • The amount gas produced is determined by three factors:
  1. The amount and type of carbohydrates consumed
  2. The amount and types of intestinal bacteria present
  3. The ability of the small intestines to digest and absorb the carbohydrates

 

  • Two common causes of excess flatulence are:
  1. poor digestion of the sugar lactose in dairy products;
  2. limited absorption of fructose which is a sugar found in soft drinks and certain fruits like apples and bananas.

 

  • Some vegetables have starches that are only partially absorbed. The nonabsorbed starches pass into the colon and contribute to excess flatus production. Beans, brussel sprouts, carrots, onions and celery are the major offenders.

 

  • The carbohydrates in bread and pasta can be a problem for some people. Recently, there has been a lot written about “gluten sensitivity.” Avoiding the grains of wheat, barley, and rye can help some people lessen the production of excess flatus.

 

  • Colonic bacteria normally generate intestinal gas through fermentation of the carbohydrates that escaped absorption in the small intestines. An imbalance in the gut bacterial flora may result in excessive gas formation. Some bacterial groups are more prone to gas production than others. Hence, improving the bacterial balance with a probiotic may improve gas-related symptoms.8

Take Home Message

If you are experiencing symptoms of bloating, distention, or increased flatus, consider taking a high quality probiotic like EndoMune.

In addition, you may want to modify your diet by avoiding foods that contribute to flatulence. It is always wise to check with your doctor if your symptoms persist.

Eat healthy, exercise and live well!!!

Best Wishes,

Dr. Hoberman

Foods that may cause gas include:*

  • Beans
  • Vegetables, such as broccoli, cabbage, brussels sprouts, onions, artichokes, and asparagus
  • Fruits, such as pears, apples, bananas and peaches
  • Whole grains, such as whole wheat and bran
  • Soft drinks and fruit drinks
  • Milk and milk products, such as cheese and ice cream, and packaged foods prepared with lactose, such as bread, cereal, and salad dressing
  • Foods containing sorbitol, such as dietetic foods and sugar-free candies and gums

*National Digestive Diseases Information Clearinghouse
Gas in the Digestive Tract

http://digestive.niddk.nih.gov/ddiseases/pubs/gas/

1) An understanding of excessive intestinal gas.
Suarez FL, Levitt MD.Curr Gastroenterol Rep. 2000 Oct;2(5):413-9. Review.

2) J Gastroenterol Hepatol. 2011 Apr;26 Suppl 3:119-21. doi: 10.1111/j.1440-1746.2011.06640.x.Visceral hypersensitivity in irritable bowel syndrome.
Kanazawa M, Hongo M, Fukudo S

3) Incidence of post-infectious irritable bowel syndrome and functional intestinal disorders following a water-borne viral gastroenteritis outbreak.Zanini B, Ricci C, Bandera F, Caselani F, Magni A, Laronga AM, Lanzini A; San Felice del Benaco Study Investigators.Am J Gastroenterol. 2012 Jun;107(6):891-9. doi: 10.1038/ajg.2012.102. Epub 2012 Apr 24.

4) The putative role of the intestinal microbiota in the irritable bowel syndrome.
Collins SM, Denou E, Verdu EF, Bercik P.Dig Liver Dis. 2009 Dec;41(12):850-3

5) Probiotic bacteria Lactobacillus acidophilus NCFM and Bifidobacterium lactis Bi-07 versus placebo for the symptoms of bloating in patients with functional bowel disorders: a double-blind study.
Ringel-Kulka T, Palsson OS, Maier D, Carroll I, Galanko JA, Leyer G, Ringel Y.
J Clin Gastroenterol. 2011 Jul;45(6):518-25.

6) Non-Celiac Wheat Sensitivity Diagnosed by Double-Blind Placebo-Controlled Challenge: Exploring a New Clinical Entity.Carroccio A, Mansueto P, Iacono G, Soresi M, D’Alcamo A, Cavataio F, Brusca I, Florena AM, Ambrosiano G, Seidita A, Pirrone G, Rini GB.Am J Gastroenterol. 2012 Jul 24. doi: 10.1038/ajg.2012.236.

7) Review article: the treatment of functional abdominal bloating and distension.Schmulson M, Chang L.Aliment Pharmacol Ther. 2011 May;33(10):1071-86. doi: 10.1111/j.1365-2036.2011.04637.x. Epub 2011 Mar 29. Review.