Most of your gas and bloating problems may be self-inflicted. By Dr. James Rosser
The COVID 19 pandemic has impacted all of our lives in many ways. It should be no surprise that our digestive system has not been spared. Since the appearance of this surge, I have seen an increase in complaints of bloating, diarrhea and constipation. These symptoms are so challenging to treat because the source of the problem is so diverse and difficult to nail down. I feel as if I have to become a gastrointestinal Sherlock Holmes to discover the cause and subsequently a way to help my patients. I cannot embark on this journey alone. My patient must be my trusted assistant Dr. Watson to help me solve your gastrointestinal mystery. This is the first of a three-part series on bloating, diarrhea, and constipation. I shall cover the definition, causes and treatment of each one of these perpetrators and hopefully solve your gastrointestinal mysteries.
Bloating is when your belly feels swollen after eating. Bloating can often cause pain, discomfort and a "stuffed" feeling. It can also make your stomach look bigger. One in 10 Americans say they suffer from bloating regularly, even when they haven't eaten a large meal. In some cases, bloating can become severe enough that it causes distention, or a perceptible swelling of the abdomen. Bloating has been intimately associated with gas. They go hand in hand. Most do not realize that half of the gas in the intestines is caused by swallowing. The other half is caused by what you eat and what bacteria produce. This is an important distinction to keep in mind because most of your gas and bloating problems may be self-inflicted.
- Overeating in general
- Eating too fast
- Eating rich fatty food
- Chewing gum
- Drinking through a straw
- Guzzling carbonated beverages
- Anxiety and nervousness (increase swallowing of air)
- Bean and lentils have indigestible sugars (oligosaccharides)
- Vegetables-Brussel sprouts, broccoli, kale, cabbage cauliflower, carrots, prunes
- Fruits-apples, apricots, oranges, peaches, pears, watermelon (fructose, sorbitol, fiber)
- Low-sugar or sugar-free foods and treats (contain Sorbitol difficult to digest)
- Fructose a natural sugar that is difficult to digest
- Milk and milk products (decrease lactase/lactose intolerance)
- Whole grains/high fiber foods
Frequently, the criminals that cause gas, and bloating can be found at the crime scene called your refrigerator. Many foods can be the culprit for gas and bloating. Oligosaccharides are a type of sugar in beans and lentils that make it all the way to the large intestine undigested. Bacteria in the large intestine finally break down these sugars. Doing so causes fermentation and the production of gas that can be released as flatulence. Vegetables like cabbage are cruciferous vegetables, which contain raffinose — a sugar that remains undigested until bacteria in your gut ferment it, which produces gas and, in turn, makes you feel bloated. Fruits for the most part are very healthy but you can go overboard with the amount you eat and the type of fruit you eat. Many fruits also have soluble fiber, which is a type of fiber that dissolves in water. Sorbitol and soluble fiber must both also pass through the large intestines, where bacteria break them down to create hydrogen, carbon dioxide, and methane gas.
In the quest to maintain a healthy weight, many resort to low-sugar and sugar-free foods. However, similar to fruit, these foods frequently contain fructose. Fructose is used to sweeten foods like jellies, soft drinks, gelatin, ice cream, candy, and certain diet foods. Fructose also absorbs moisture so it helps keep baked goods from becoming stale. In addition, fruits and fruit juices with high levels of fructose may cause gas, bloating, and abdominal cramping. Fructose is usually absorbed in the small intestine, but for those with fructose intolerance, some travel to the colon, where bacteria ferment the fructose. This causes the release of hydrogen and methane gases to cause the aforementioned symptoms.
People with lactose intolerance are unable to fully digest the sugar (lactose) in milk. As a result, they have gas and bloating after eating or drinking dairy products. You can have low levels of lactase and still be able to digest milk products. But if your levels are too low you become lactose intolerant, leading to symptoms each time you eat or drink dairy.
The first place I start when I have to take care of patients with this problem is to go through a bloat checklist (See self-inflicted list above). This not only is the place to start to address why a patient has this issue but it is the foundation of beginning treatment. Your day-to-day behavior may be the root cause and you must first address these items. Decreasing your amount of food consumption and slowing down how fast you eat can go a long way in decreasing swallowed air. To help, use a stopwatch to pace yourself and set it for 15 minutes and eventually work up to 20-25 minutes. Stop chewing gum and drinking from a straw. Slowly wean yourself from drinking carbonated beverages. And finally, have a professional evaluate you for your level of nervousness and anxiety. During the pandemic, this has become a dominant initiating factor for gas and bloating.
I am a big proponent of natural remedies being used alongside traditional medicines to address a patient's symptoms. One of my big standbys is a mixture of warm chamomile tea with ginger to taste and honey for sweetener. Green tea has been also known for easing gastrointestinal distress. Another option is lemon water. It provides hydration and it has been known to soothe the digestive system. Celery can also help to flush out the system and make your stomach flatter. Probiotic yogurt helps to establish and maintain the proper level of good gut bacteria. It increases the ability of the intestines to digest bloat-causing agents.
Finally, if all else has failed, you may have to use over-the-counter medicines. The key is to address either breaking up the gas or increase digestion efficiency of the offending agents. Simethicone reduces the surface tension of the formed gas bubbles, which prevents bubble formation. It also helps to combine lots of small bubbles into larger bubbles, which can be expelled more easily. Alpha-galactosidase is another means to prevent bloating and gas. This is an enzyme derived from Aspergillus niger, and it has the ability to break down complex oligosaccharide (complex sugars) linkages found in gas-producing foods that humans cannot digest. You are then able to absorb the simpler single-component sugar residues and relieve gas and bloating. Some common medications that contain simethicone include Alka-Seltzer and Maalox. If the bloating is from beans or vegetables, Gas-X is a popular choice that contains alpha-galactosidase. Finally, Beano has both of these ingredients.
By Dr. James Rosser