Gas

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(Almost) Everything You Need to Know About Gas

Out of the many gut-related issues patients have discussed with me over the years, problems with excess air and gas resulting in bloating, a sensation of fullness in your abdomen, are the most common by a long shot.

Just to make it really clear, EVERYONE produces gas — anywhere from 1-4 pints daily and passes it about 14 times a day — and it can build up in your gastrointestinal tract.

But how does this common issue go from an occasional embarrassment to a more serious health issue?

The GI tract

There’s a number of reasons why patients may have problems, and some may have more to do with the upper digestive tract and swallowing too much air, creating belching or bloating. In fact, this extra air may never reach the stomach or lower GI tract at all.

Much of it builds up in the esophagus, especially if patients are overdoing it on certain foods or they smoke, chew gum or drink and eat too fast.

Because most of these causes are obvious signs of the body reacting badly to a more stressful go-go-GO! lifestyle, we’ve got some simple solutions that could help.

More symptoms

Some signs that extra air and gas may be a real problem, however, are when patients begin experiencing symptoms of acid reflux (the backward flow of stomach acid to the esophagus), gastroesophageal reflux disease (GERD), a more severe form of acid reflux in which frequent heartburn is common, or an H. pylori infection in the stomach.

(Most people assume GERD and acid reflux are the same thing, but medical experts see them as slightly different health problems, according to the Mayo Clinic.)

And, for patients who have experienced a dramatic change in weight loss or gains, a hernia, any abdominal surgery or changes in the frequency or color of their stools (or see blood in them), you should visit your family physician for more guidance.

Minor challenges, easy solutions

Fortunately, the large majority of our symptoms will be minor inconveniences or embarrassing, at worst, in the moment. Here are some simple ways to treat bloating, belching or excess gas you may want to try first.

  1. Spend a little more time eating meals or drinking fluids. The more you rush, the more opportunities you have to swallow air that comes back in uncomfortable and embarrassing ways.
  2. Limit your intake of high-fiber foods (like broccoli, beans and onions) and fatty foods for a short time. After your symptoms lessen, try re-introducing those foods, and pay close attention to which ones give you trouble.
  3. Reduce your intake of carbonated drinks and foods that use sugar alcohol substitutes like sorbitol. Consuming fizzy drinks or chewing gum sweetened by sorbitol or xylitol just adds to your gas problems.
  4. Are you doing any exercise? Think about taking a short walk after your meals.
  5. Consider taking a probiotic. A healthy solution like EndoMune Advanced Probiotic — containing multiple species of beneficial bacteria — is a good way to restore the healthy balance of bacteria in your gut.

Taking a probiotic is important considering carbohydrates can be poorly absorbed by the gut, creating imbalances in your gut bacteria.

Also, multi-strain probiotics like EndoMune offer the extra benefit of treating constipation, another way food waste gets trapped in the colon and creates opportunities for excess gas to escape when you least expect it.

Probiotics can improve hypertension

Study after study shows that probiotics help treat gastrointestinal issues including IBS, diarrhea, gas and constipation. However, the benefits aren’t confined to digestive health.

Recent studies are also proving that probiotics can improve hypertension, more commonly known as high blood pressure. Primarily caused by environmental factors such as salt intake, minimal exercise, weight gain and high cholesterol due to bad diet, high blood pressure is a major risk factor for stroke, heart attacks and heart failure.

The International Journal of Molecular Science published a review on various studies conducted on how probiotics improved hypertension, particularly the effects on cholesterol and diabetes. Among their conclusions, researchers proved that probiotics could reduce the amount of cholesterol, thus decreasing the chance of high blood pressure. Additionally, probiotics provide a safe alternative treatment to drugs or hormone therapy, with milder or no known side effects.

Probiotics not only treat digestion problems, but they also help lower your risk for hypertension. Add a daily probiotic like EndoMune Advanced Probiotic to your diet to improve your chances for a healthier life.

Probiotics are Effective Treatment for Pediatric IBS

If you’re a parent, then you are probably familiar with the phrase, “My stomach hurts!”

This is often a self limited problem, but some children do experience recurrent abdominal pain which is often diagnosed as Irritable Bowel Syndrome (IBS).

A recently published study examined the benefits of probiotics for alleviating the symptoms of IBS in children(1). IBS is a common problem in pediatrics, and no safe and effective treatment has been available up until now(2).

Suspected Causes of IBS

The symptoms of abdominal bloating, gas, pain and change in stools are very common in both children and adults. Once appropriate tests have ruled out any underlying disorder like ulcers, colitis, or celiac disease, the diagnosis is often IBS.

Between 5 to 20% of kids have IBS, and about one in five adults do, too. It’s not fun, but the good news is that IBS doesn’t lead to more serious problems. It is more about quality of life for the child and the family.

Since the cause is not really known, and the symptoms can vary, IBS can be hard to treat.

Over the years a variety of theories have been offered to explain IBS symptoms in children. These have included emotional stress, intestinal hypersensitivity, altered intestinal motility, dietary intolerances and genetics(3,4).

In the last several years there has been a shift in the paradigm, and now alterations in the intestinal bacteria are thought to be a major factor leading to IBS.

We are all familiar with the term “food poisoning” — a bout of infectious diarrhea due to the consumption of harmful bacteria in contaminated foods or drinks.

Researchers in the area of IBS noted that many of the people who developed symptoms of IBS had experienced a recent episode of food poisoning(5). It was theorized that the infection caused a disruption of the healthy intestinal bacteria resulting in ongoing intestinal inflammation and GI symptoms(6).

Recent studies have supported this association and identified post-infectious irritable bowel syndrome (PI-IBS) as a disorder due to a previous bout of  infectious gastroenteritis. Approximately 30% of individuals with IBS can date the onset of their symptoms following an episode of gastroenteritis(7).

Pediatric Medical Studies

In February of this year, a study(8) was published that documented for the first time that exposure to acute gastroenteritis in childhood is associated with an increased risk of IBS in early adulthood. There was an outbreak of infectious gastroenteritis due to drinking contaminated city water. Children were followed for 8 years after the exposure. The children who had a bout of gastroenteritis had a greater than fourfold increase in IBS compared with unexposed children.

This now brings us back to the new medical article that I mentioned at the beginning of this newsletter. The study(1) enrolled children 4 to 18 years of age who fulfilled the criteria for IBS. The children received a probiotic or a placebo. A daily record of their symptoms was maintained. At the end of the study, the results were reviewed.

The group receiving probiotics had a better than 50% improvement in their symptoms of abdominal pain, and bloating compared to the placebo group.  There was also an improvement in the passage of stools. Additionally, no adverse effects were noted in the group taking probiotics.

In 2008, a review article(2) on medications to ease the symptoms of IBS in children stated, “The lack of clear evidence of effectiveness for any of the recommended drugs suggests that there is little reason for their use outside of clinical trials.” The new study on childhood IBS, though, does show that probiotics are effective.

Take Home Message

If your child has IBS, probiotics may help to ease their symptoms. Fortunately, there have been no adverse effects associated with their use. Consider using EndoMune Jr for children less than 8 years of age and EndoMune Advanced for older children. It won’t hurt, and it certainly may help!

Eat healthy, exercise and live well!
Dr. Hoberman

(1) VSL#3 improves symptoms in children with irritable bowel syndrome: a multicenter, randomized, placebo-controlled, double-blind, crossover study.Guandalini S, Magazzù G, Chiaro A, La Balestra V, Di Nardo G, Gopalan S, Sibal A, Romano C, Canani RB, Lionetti P, Setty M.J Pediatr Gastroenterol Nutr. 2010 Jul;51(1):24-30.

(2) Pharmacological interventions for recurrent abdominal pain (RAP) and irritable bowel syndrome (IBS) in childhood.Huertas-Ceballos ALogan SBennett CMacarthur CCochrane Database Syst Rev. 2008 Jan 23;(1).

(3) Irritable bowel syndrome: epidemiology, diagnosis and treatment: an update for health-care practitioners.Grundmann O, Yoon SL.J Gastroenterol Hepatol. 2010 Apr;25(4):691-9. Epub 2010 Jan 13.

(4) Pathogenesis of IBS: role of inflammation, immunity and neuroimmune interactions.Ohman L, Simrén M.Nat Rev Gastroenterol Hepatol. 2010 Mar;7(3):163-73. Epub 2010 Jan 26. Review.

(5) The irritable colon syndrome. A study of the clinical features, predisposing causes, and prognosis in 130 cases.CHAUDHARY NA, TRUELOVE SC. Q J Med. 1962 Jul;31:307-22.

(6) Bacillary dysentery as a causative factor of irritable bowel syndrome and its pathogenesis . Wang LH , Fang XC , Pan GZ . Gut 2004 ; 53 : 1096 – 101.

(7) Postinfectious irritable bowel syndrome–a meta-analysis.Halvorson HASchlett CDRiddle MS.Am J Gastroenterol. 2006 Aug;101(8):1894-9; quiz 1942.

(8) An Outbreak of Acute Bacterial Gastroenteritis Is Associated With an Increased Incidence of Irritable Bowel Syndrome in Children Marroon Thabane, Marko Simunovic, Noori Akhtar-Danesh, Amit X Garg, William F Clark, Stephen M Collins, Marina Salvadori, John K Marshall The American Journal of Gastroenterology 105, 933-939 (23 February 2010).

 

What Causes Gas – Is it a Normal Occurence?

All humans have gas in their gastrointestinal tract. The type of food, and beverages consumed and whether the individual smokes or chews gum will have a significant impact on the amount of gas produced and passed. Carbonated beverages will increase intestinal gas. Eating a healthy diet of fruits, vegetables and high fiber grains increases intestinal gas formation.

Dependent upon how it is measured, the gas in the intestinal tract varies from 3 to 6 ounces. The average adult produces 16 to 48 ounces of intestinal gas resulting in about 14 to 23 gas passages/day.

  • Complex Carbohydrates: The human intestinal tract can’t digest some of the complex carbohydrates in vegetables, fruits and whole grain products. These carbohydrates pass through the small intestines into the colon where they are fermented by gas producing bacteria. Hydrogen, carbon dioxide and methane are the main gases produced. Depending on the diet and the intestinal microflora, the amount of gas produced and expelled will vary from individual to individual. The strong odor sometimes associated with intestinal gas is due to the very small production of sulfide gases which is dependent on diet and intestinal bacteria.
  • Lactose is a sugar in dairy products which must be broken down to a simpler form to be absorbed by the intestines. Thirty to 50 million Americans develop lactose intolerance beginning after the age of 2. It is a common problem in the Asian, African American, American Indian, Hispanic, and Eastern European Jewish populations. Undigested lactose prevents fluid absorption and the sugar is fermented by the bacteria in the colon which results in increased intestinal gas and at times, diarrhea. The main form of therapy is to avoid lactose containing foods.
  • Fructose: Another dietary sugar that can cause excessive gas, bloating and loose stools is fructose. Fruits that are high in fructose include apples, apricots, pears, cherries, plums, prunes and peaches (as well as their juices). It is also a used as sweetener in soft drinks and other products. The small intestine has a limited ability to absorb dietary fructose. If it is exceeded, fructose will be fermented in the colon leading to excess gas formation.
  • Sorbitol is found naturally in fruits, including apples, pears, peaches, and prunes. It is also used as an artificial sweetener in many dietetic foods and sugar free candies and gums. Sorbitol is not well absorbed by the small intestines. Excess intake will also lead to bloating, gas, and diarrhea.

Studies have found that some individuals with symptoms of bloating and distention may be more sensitive to the amount of gas and fluid in the intestines. Some may have slow intestinal motility leading more fluid and gas in the intestines.

Having the right balance of bacteria in the intestines can be important to lessen the symptoms of bloating, distention and gas.

Probiotics, containing bacterial strains similar to those in Endomune have been studied and utilized to help lessen these symptoms. There have been positive results in many of the studies. There are no effective prescription medications to alleviate excess gas formation. One of the nice aspects of probiotics is the fact that they are safe and without significant side effects. Given the positive studies, taking Endomune may improve the digestion and absorption of the complex and simple carbohydrates.

How Probiotics Can Aid IBS Sufferers

I have spent a lot of time talking with physicians, pharmacists, and patients about the benefits of probiotics. The one topic that comes up most frequently is how probiotics can aid individuals who suffer with Irritable Bowel Syndrome (IBS).

IBS affects up to one in five Americans. Second only to the common cold as a leading cause of workplace absenteeism in the U.S., IBS costs the U.S. healthcare system up to an estimated $30 billion annually in direct and indirect costs.

Medical Presciptions for IBS

When I first went into gastroenterology, the understanding of IBS was very limited. It was generally thought that the symptoms of bloating, gas, diarrhea, and constipation were most likely related to stress. If the intestinal symptoms were manifestation of the stress, then controlling the stress would alleviate the problem. Commonly prescribed therapies included tranquilizers like Librium and phenobarbitol, and antidepressants like Elavil and Aventyl, which were then combined with other drugs – antispasmotics – that affected the nerves that go to the GI tract.  The typical drug armament included such medications as Librax, Bentyl, Levsin and Donnatal. They were relatively safe, but did have side effects of dry mouth and sedation.

Other longtime therapies have included fiber type products that increase stool bulk, like Metamucil and Fibercon.

More recently, drugs that interact with serotonin receptors in the GI tract have been developed. Serotonin is a neurotransmitter that is primarily found in the gastrointestinal tract and in the brain. Serotonin increases intestinal motility, probably by stimulation of 5-HT4 and 5-HT3 receptors. Two prescription medications that interact with the serotonin receptors were developed and approved by the FDA.

Zelnorm, approved by the FDA in 2002, eases constipation by stimulating the 5HT4 serotonin receptor.  It was withdrawn from the market in 2007 due to serious adverse effects on the blood supply to the intestines.

Lotronex was approved by the FDA in 2000 for women with severe diarrhea-predominant irritable bowel syndrome. Lotronex blocks the 5HT3 serotonin receptor. It is called a 5HT3 antagonist. Clinical studies showed only a 15-20% improvement in diarrhea symptoms in patients taking Lotronex versus placebo.  There have been serious adverse effects associated with this medication. Overall, Lotronex has very limited use in treating IBS patients.

A major concern with prescribing prescription medications is adverse drug interactions. Most medications are metabolized and eliminated by the liver. In the liver there are enzymes that can modify and eliminate drugs. The blood level of a specific medication can be increased or decreased by a second drug’s effect on the liver enzymes. The second medication can induce or inhibit the enzyme system resulting in elevated or reduced blood levels of the first drug. Changing the blood level of a medication can cause significant adverse drug reactions.

What About Probiotics for IBS Sufferers?

Here is the good news with regard to probiotics:

  1. Probiotics are safe and not associated with any severe adverse effects in healthy individuals.
  2. There are no drug interactions with other medications.
  3. Studies have shown that probiotics can alleviate symptoms of IBS.

Two recent reports(1, 2) reviewed the available studies using probiotics to treat symptoms of IBS. Both reports concluded that probiotics appear to be efficacious in IBS but the magnitude of the benefit and the most effective species and strains are uncertain. This means that probiotics show statistical significance in reducing IBS symptoms compared to patients taking a placebo. The problem is determining what types of probiotic bacteria and what dosage of probiotics work best.

There are a number of studies that indicate that the dosage of a multispecies/strain probiotic should be at least 5-10 billon organisms per day.

The mechanisms by which probiotics lessen IBS symptoms are being actively investigated(3).  For example, studies have shown that the bacterial flora in patients with IBS is different than in individuals without IBS symptoms. The bacteria in IBS patients can produce increased gases like methane which causes constipation and bloating(4). By altering the bacteria population with probiotics, it is possible to lessen methane production and ease symptoms of constipation.

I can go on about how probiotics improve intestinal function, but I am afraid I will start to bore you.

The point I am trying to make is that probiotics can help people with IBS symptoms, and they are very safe. If you have symptoms, then consider a trial of a probiotic. Obviously, if you have new onset symptoms, it is best to consult your physician first.

The problem is trying to choose the right probiotic product. It’s important to consider:

  1. Dosage per serving size – how many billon organisms/serving?
  2. Number and type of different probiotic bacteria – how many Lactobacillus, Bifidobacteria strains in each serving?
  3. What is the shelf life at room temperature?
  4. Does the product also contain fructooligosaccharides (FOS) – prebiotics*?
  5. Is the packaging in dark, glass bottles, helping to lessen exposure to oxygen and sun light?

Take Home Message

If you have symptoms of IBS, consider taking an excellent probiotic like EndoMune Advanced. Each capsule contains 10 different bacteria strains.  A serving size of two capsules contains 16 billon organisms and 50mg of FOS.

For children, consider EndoMune Junior. Each serving size of ¼ Tsp contains four bacterial strains, a total of 10 billon organisms, and 50mg of FOS.

Eat healthy and live well!
Lawrence J Hoberman MD

*FOS are prebiotics. Prebiotics are starches in foods like those found in the fiber of fruits, beans and the bran in whole grain breads and cereals. They are called resistant starches because our intestines can’t break them down. These starches enter the colon and are used as nourishment by the good bacteria, Lactobacillus and Bifidobacteria. These bacteria ferment these starches and produce short chain fatty acids that nourish the colon cells and enhance its healthy function.

(1) The efficacy of probiotics in the therapy of irritable bowel syndrome: a systematic review.Moayyedi P, Ford AC, Talley NJ, Cremonini F, Foxx-Orenstein A, Brandt L, Quigley E.Gut. 2008 Dec 17.

(2) Meta-analysis of probiotics for the treatment of irritable bowel syndrome. McFarland LV, Dublin S.World J Gastroenterol. 2008 May 7;14(17):2650-61.

(3) The role of probiotics in management of irritable bowel syndrome. Borowiec AM, Fedorak RN.Curr Gastroenterol Rep. 2007 Oct;9(5):393-400.

(4) Methane and the Gastrointestinal Tract.Sahakian AB, Jee SR, Pimentel M. Dig Dis Sci. 2009 Oct 15.

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