Intestinal Gas

Gas production is part of the normal digestive process. However when it is produced in excess, when it smells, or when it is associated with bloating, discomfort, or pain, it can become problematic. Gas issues and bloating are some of the most common complaints in patients seeing a physician for digestive issues. The severity and frequency of the symptoms can vary tremendously amongst patients and ranges from mild discomfort to disabling pain. Anything that causes intestinal gas or is associated with constipation or diarrhea can lead to gas pains. These pains generally occur when gas builds up in your intestines and you’re not able to expel it. Most people pass gas at least 10 times a day.

For most patients, the signs and symptoms of gas and gas pain include:

• Voluntary or involuntary passing of gas, either as burping or as flatus (gas from the anus)
• Sharp, jabbing pains or cramps in the abdomen. These pains may occur anywhere in the abdomen and can change locations quickly and get better quickly
• A knotted feeling in the abdomen
• Bloating in the abdomen (swelling and tightness)

What causes gas?

Gas forms when bacteria in the colon ferment carbohydrates that are not digested in the small intestine. Healthy, high-fiber foods are often the worst offenders. Fiber has many health benefits, including keeping your digestive tract in good working order and regulating blood sugar and cholesterol levels. But too much fiber can lead to excessive gas. High-fiber foods that commonly cause gas are fruits, vegetables, whole grains, legumes such as beans and peas. The use of fiber supplements containing psyllium husk can cause gas.

Several other causes can lead to excess gas and include the following:

• Carbonated beverages: drinks such as soda and beer
• Swallowed air: air is swallowed every time you eat or drink, when you are nervous, eat too fast, chew gum, or drink with a straw

• Digestive disorders: excess gas may be the symptom of medical conditions such as colon inflammation [diverticulitis or inflammatory bowel disease, as in Crohn’s disease or ulcerative colitis], or bacterial overgrowth in the small intestine which can be induced by a variety of conditions including diabetes

• Food intolerance: if gas and bloating occur mainly after eating certain foods, then it may be related to food intolerance. Lactose intolerance (dairy products) occurs when the body is not capable of breaking down lactose (sugar) due a deficiency in the enzyme lactase. Intolerance can occur to other sugars such as fructose or to gluten (a protein found in wheat and some grains). Food intolerance can cause nausea, bloating, gas, diarrhea, abdominal cramps, and/or fatigue

• Artificial additives: a variety of food additives can cause abdominal bloating and diarrhea. Artificial sweeteners such as sorbitol, xylitol, and mannitol (commonly found in sugar-free gums, sweets, and food) can cause excessive gas and diarrhea

• Constipation: Constipation can cause bloating and gas pains

What can you do?

Diet

Dietary changes are the first step in treating gas and gas pains. The following general recommendations can be helpful in the majority of patients:

• Avoid foods that trigger excess gas production. Foods that cause gas problems include beans, onions, broccoli, Brussels sprouts, cabbage, cauliflower, artichokes, asparagus, pears, apples, peaches, prunes, sugar-free candies and chewing gum, whole-wheat bread, bran cereals or muffins, milk, cream, ice cream, ice milk, and beer, sodas and other carbonated beverages

• Temporarily avoid high-fiber foods and supplements. Decreasing the amount of fiber in the diet can help diminish gas production. After 1 month, you can gradually increase the fiber over several weeks. When you take fiber supplements, drink 1-2 glasses of water with it

• Decrease fried and fatty foods. Fat delays stomach emptying and can increase the sensation of fullness

• If intolerance to lactose, reduce dairy products. Try low-lactose dairy foods, such as yogurt instead of milk. Try products that help digest lactose, such as Lactaid or Dairy Ease. Consume a small amount of milk products or consume them with other foods

• Eat smaller portions. Eating smaller meal portions can help

• Eat slowly and chew your food thoroughly. If you have a hard time slowing down, put down your fork between each bite

• Avoid chewing gum, sucking on hard candies and drinking through a straw. These activities can cause you to swallow more air

• Don’t smoke. Smoking can increase the amount of air you swallow
• Physical activity may help move gas through the digestive tract

If the smell of gas is strong, limits foods high in sulfur-containing compounds — such as broccoli, Brussels sprouts or other cruciferous vegetables, beer, and foods high in protein.

Try over-the-counter remedies

A variety of over the counter remedies can be helpful. You can purchase them directly or ask the doctor for a prescription.

• It helps break up the bubbles in gas and is best taken after meals and at bedtime. Simethicone based products include Gas-X, Flatuna, Gelusil, Mylanta, Mylicon

• Activated charcoal.

  Charcoal tablets (CharcoCaps, Charcoal Plus) to be taken before and after a meal. Charcoal may stain the inside of the mouth

• Add Beano to beans and vegetables to help reduce the amount of gas they produce. For Beano to be effective, you need to take it as soon as you eat. It works best when there’s only a little gas in your intestines so that the enzymes in Beano can work best

• Lactase supplements.

  Supplements of the enzyme lactase (Lactaid, Dairy-Ease, Lactocontrol) help digest the lactose sugar. If you are lactose intolerant, you can try lactose-free dairy products or add a lactase supplement

When to see a doctor

Although most bloating and gas issues are not serious disorders, it is important to seek a consultation if any of the following symptoms are present:

• Chest pain
• Nausea or vomiting
• Heart burns and acid reflux
• Constant abdominal pain and cramps
• Bloody stools
• A change in stool color or frequency
• Weight loss
• Constipation or diarrhea
• Excessive gas that is not controlled with dietary changes

Before your appointment, make note of:

• Medical history: Previous or current conditions, prior operations, current medications, prior use of antibiotics, history of infectious diarrheal illness
• The nature, severity, and frequency of symptoms:

• • How long have you noticed the gas or gas pains?
  • Does your pain get better when you burp or pass gas?
  • Does eating certain foods trigger your symptoms?
  • Have you added any new foods or drinks to your diet recently?
  • Do you have nausea or vomiting with your gas pains?
  • Have you unintentionally lost weight?
  • Do you drink sodas or other carbonated beverages?
  • Do you chew gum, suck on candies or drink through a straw?

Keep a journal of what you eat and drink, how many times a day you pass gas, and any other symptoms you experience. Ideally you need to collect information over 1-2 month period. Go back and circle in red the “bad” days. Try to identify any association between food/drinks you had on those days and/or the previous days.

Any questions? Call Dr. Maher A. Abbas’ office nurse here!