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Opinion

Getting a grip on gas

YOUR DOSE OF MEDICINE - Charles C. Chante MD -
Flatulence, breaking wind, cut the cheese, squeaker, and fart: Whatever euphemism you use for passing gas, it is a normal occurrence and nothing to be embarrassed about. Everyone must pass gas, either from the anus or through the mouth as a burp. It is part of eating a healthful diet, particularly one high in fiber, and it’s also a part of having a healthy digestive system. In our intestines, gas is produced naturally as we digest food.

That terrible odor.Although it may be socially unacceptable in the United States, we must pass gas and we must do it frequently. We produce enough gas to fill half of a party balloon every day. One study found that women pass gas an average of seven times a day, and for men, the average is 12. The gas that we produce is actually a combination of many types of gasses, including carbon dioxide, hydrogen, methane and nitrogen. All of these are odorless. Unfortunately, among all of these inoffensive gasses lurk some with a foul odor, including hydrogen sulfide. Sometimes, you might feel that your flatulence is so stinky that you need to do something about the odor, but you really don’t want to discuss it with your doctor. Unfortunately, little research has gone into determining which over-the-counter medicines, if any, might either eliminate or alter the smell of flatulence. Some of the more common products that promise to decrease the amount of gas, such as those containing simethicone, have not been found effective for reducing odor. Other products contain activated charcoal or nutra flora, which is a type of carbohydrate that may encourage the growth of non-gas-producing bacteria in your gut. If none of the over-the-counter medications help to reduce the odor of your gas, you might ask your doctor about, a prescription medication commonly used to reduce gas odor is surgical patients who have lost part of their bowel. For the truly desperate, there is the Flatulence FilterTM, which is marketed for gaseous people and their families who are "suffering the consequences" of not having one. These activated charcoal-coated foam cushions were shown, according to one study, to eliminate 90 percent of the odor of flatulence from volunteers who sat on them. You might find that some of your favorite foods are at fault for the odor of you flatulence – particularly if you detect an unusual odor. Possible suspects may include garlic, onions, eggplant, mushrooms, certain herbs and spices. If you do eliminate these foods and the unusual odor persists, you may be suffering from a bleeding ulcer or a poorly functioning pancreas. These conditions should be discussed with a gastroenterologist.

Diet and gas. Changes in our diet can also reduce the amount of gas we produce and lessen bloating and pain. When bacteria living in our colon come into contact with undigested carbohydrates, gas is formed. Sugars, starches, glycogen and the plant fiber cellulose are the major groups of carbohydrates. Although cellulose has no nutritional value and cannot be digested, it does help to stimulate the intestines to move the food along, so eliminating it from your diet is not recommended. However, following are some carbohydrates-rich food substances that you may want to consider eliminating or reducing in your diet because they are known to produce gas.

Sorbitol is a sweetener found in many "sugar free" products. Studies have shown that relatively small amounts of this substance can produce large quantities of hydrogen gas. As is true with gas-producing foods in general, if your intestines have problems moving food along, you should avoid this product. You’ll find plenty of sorbitol in sugar-free gum. Mannitol, another sweetener for low-cal foods, is also a source of gas.

Fructose, a fruit sugar, is found in soft drinks, figs, dates, prunes, grapes and honey. It may pass undigested through the small intestine and into the colon, leading to the production of hydrogen gas. Fruits may also contain large quantities of pectin, a fiber that produces gas.

Glucose, the most important sugar for your metabolism, is usually not a major gas producer. It will enter the colon and become a source of gas only when it is part of a high-starch diet, which includes bread, noodles and potatoes.

Sucrose, which is obtained from sugar cane and sugar beets, and added to many foods, is broken down by the digestive system to become glucose and fructose. As a result, sucrose may also cause gas.

Beans produce a great deal of gas because they contain difficult-to-digest starches and complex sugars known as "oligosaccharides".

Cabbage, Brussels sprouts, broccoli and cauliflower are known as "gassy foods" because they also contain starches.

Refined flours were long thought to be easily digestible and relatively gas free. Now it is known that only rice flour fits into that category. White wheat and refined oat flour are known to increase the production of gas significantly. Whole oats, whole wheat and corn also increase gas production.

Intolerance to lactose, a sugar found in dairy products, is sometimes cited as a source of gas. Lactose intolerance occurs when your body fails to produce enough of the enzyme lactase, which is needed to break down and digest this sugar. Some of the symptoms of lactose intolerance include flatus, diarrhea, bloating, nausea and cramps.

The inability to digest lactose is best termed lactose malabsorption. When this malabsorption produces sufficient gas that you perceive symptoms, you are then said to suffer from lactose intolerance. Moderate amounts of milk, such as one cup, twice a day, do not produce symptoms, you are then said to suffer from lactose intolerance. For those with a low tolerance, drops and tablets containing lactose are available over-the-counter to assist with the digestion of dairy products and ease the discomfort of gas and other symptoms.

Over-the-counter medications for reducing gas. If you eat a high-fiber diet or enjoy other gas-producing foods, you might want to try some of the over-the-counter medications that claim to reduce gas production. Products which contain an enzyme may reduce the occurrence of flatulence for some people. One medicine for reducing excess gas is simethicone. It causes the small gas bubbles in your gut to come together and form bigger bubbles. However, there is little evidence that simethicone is effective at reducing gas. Another widely used medication is activated charcoal. This substance is a world-class absorber of gas. The total amount of gas in the digestive system decreases significantly in people who take charcoal, which is readily available in tablet form.

Prescription medications for pain and bloating. Prescription medications known as prokinetic agents have been studied as a treatment for a host of symptoms directly or indirectly associated with gas, including irritable bowel syndrome (IBS) and the regurgitation of stomach acid, commonly referred to as bloating, it is because there is a problem with the way their intestines are digesting food. Part of the job of the intestines is to push liquid and food along to the anus. In some people, the intestines don’t do this as they should, and even a normal amount of gas can cause a lot of pain. Prokinetics stimulate the intestines to move food and liquid along more efficiently, resulting in a more rapid emptying of the gut. These drugs have proven valuable in reducing bloating. Your doctor might prescribe then for severe gas problems that don’t respond to diet changes or over-the-counter medications. In cases like this, your doctor may tell you that you have IBS, one of the most common – and least understood – disorders of the bowels.

The term IBS is used to describe certain symptoms such as cramps, gas, bloating and changes in bowel habits. The exact cause of these symptoms is not well understood, But perhaps the most important thing you should remember is, don’t worry. IBS does not lead to other chronic or life-threatening conditions. In the absence of any known disease, the doctor may diagnose you as having IBS if you have two or more of these symptoms:

Bloating of the stomach

Relief of stomach pain by producing stool

More frequent bowel movements when you are having pain

Looser bowel movement when you have pain

Most patient complaints of gas and abdominal discomfort are actually due to IBS. The majority of studies have found only average amounts of gas in people with IBS who complain about bloating, Prokinetic medicines have also proved useful in the treatment of dyspepsia, a term relating to indigestion and heartburn. Many of the symptoms of dyspepsia are also commonly associated with excess gas, including stomach pain, bloating, belching and flatulence.

When IBS is not the cause of bloating. Although IBS should be considered first when you suffer from pain and bloating, many other conditions of the stomach and small intestine may also cause these symptoms. Some of these conditions include obstruction of the intestine, cancer and infection from bacteria frequently associated with ulcers, called H. pylori. Other conditions to be considered include parasites, inflammatory diseases such as Crohn’s disease, and difficulty in digesting fats. Bloating can also result from general medical conditions that are completely unrelated to the intestines, including diabetes and thyroid disease, If you experience bloating accompanied by weight loss, vomiting, or diarrhea, you should consult a gastroenterologist.

From one end to the other. Perhaps flatulence is not our primary concern. Maybe, instead, it is belching. Most people discreetly belch to release air swallowed during a meal. However, excessive or loud belching may be done on purpose, as a result of a nervous habit, or may even signal the presence of an underlying disease.

For many of your noisy friends and relatives, their big belches start with a large gulp of air. While eating or drinking, small amount of air will naturally enter the stomach. However, the taking of large quantities of air into the stomach is a completely voluntary action and is used for the sole purpose of producing a belch. Interest in the subject is well reflected by the existence of almost 3,.000 Websites on belching as an art. It takes a lot of talent to release that burst of air form one’s gullet with just the right resonance, tone and volume. One of the great ironies about those who belch simply to relieve a feeling of fullness is that the air swallowed in preparation for the belch is the source of their discomfort in the first place. For others who claim no discomfort at all, belching may represent nothing more than a way of reducing stress or nervousness. The important first step toward a "cure" to this problem is to understand the generally harmless nature of the condition and so recognize that beyond trying to avoid swallowing air, treatment remains elusive. Most of the time, belching should be of little concern, however, it may occasionally clue you into the presence of other, potentially more serious, conditions such as peptic ulcer disease (stomach ulcers), GERD and hiatal hernia (the moving up of the stomach into the chest). Pregnancy, smoking, chewing gum and even poorly fitting dentures can also increase belching.

Living with gas. People’s discomfort over the subject of gas often discourages serious discussion and, subsequently, has left much to be learned. Enough is known, however, to provide help to those in need, whether it is through eliminating an offending food or by furthering your understanding of IBS. Perhaps with this difficult subject you can find some comfort from the Greek philosopher Hippocrates, who noted, "When you pass flatulence by chance, that is certainly acceptable. But, if it is passed deliberately, then we assume that the person is in pain, or maybe just a little coo-coo.

BLOATING

CROHN

FLATULENCE

GAS

IBS

ODOR

ONE

PROKINETIC

SYMPTOMS

UNITED STATES

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