Paging Dr. Frischer: Flatulence

I had fun with my girls when they were young! We would make a game of using the scientific term for socially awkward bodily functions. Soon, all of their friends were doing it as well. Along those lines, let’s address…flatulence. 

Gas is always present in the GI tract - in the stomach and throughout the intestines. It builds as a normal part of the digestive process. On average, we pass gas 10 to 25 times per day, between one and three pints in total. It’s often released with a sound and/or odor. You may hear it referred to as flatulence, passing gas, farting, or breaking wind.

Flatulence is made up of five odorless gasses; nitrogen, hydrogen, carbon dioxide, methane, and oxygen. The familiar odor is from trace gasses and sulfur-containing compounds. The proportion of each of these gasses depends on the unique balance of gut bacteria. Gas can be quite uncomfortable. When the pain is on the left side, it can be confused with symptoms of heart disease. When it is to the right of the colon, it might be confused with gallstones, or appendicitis. 

A food may not be fully digested in the small intestine, often due to the lack of an enzyme. It then enters the large intestine, where bacteria break it down further and gas is produced. What are the most common foods that may lead to excessive gas?

High lactose foods, including milk, ice cream, and cheese. A deficiency of the digestive enzyme lactase is very common, and results in lactose intolerance. 

■ Beans, which contain the complex natural sugar raffinose – as do cabbage, asparagus, broccoli, and Brussels sprouts.

■Potatoes, corn, noodles, and wheat are high in starches that can produce gas. (Rice is also a starch, but does not cause gas.)

■Onions, artichokes, pears, and wheat contain fructose. It is also added as a sweetener to some soft drinks and fruit drinks.

■Stone fruits like apples, peaches, apricots, cherries and pears, and dried fruits such as prunes, raisins and figs contain the sugar sorbitol. Sorbitol is also added as a sweetener to sugar-free gum, candy, and other weight-loss products. 

■  Beans, peas, oat bran, and most fruits contain soluble fiber. Bacteria in the large intestine break down soluble fiber, and this produces gas. (Insoluble fiber, on the other hand, cannot be broken down by intestinal bacteria, and produces little gas.)

Some activities may lead to an increase in gas, like swallowing air by eating or drinking in a hurry, chewing gum, consuming various tobacco products, sucking on hard candy, drinking carbonated beverages, and hyperventilating. 

Some medical conditions can be responsible for excessive gas production. Malabsorption syndrome occurs when the body isn’t able to properly digest some foods. Small bowel intestinal bacterial overgrowth is a result of an increase in the number or types of bacteria. In fact, any condition that slows the speed of food passing through the colon will allow more opportunities for bacteria to create fermentation, and therefore, gas. 

What can be done about it?

Keep a food diary, and use trial and error to help identify those foods that may lead to excessive gas. Stop eating a suspicious food, and watch for any improvement. Increase water intake. Increasing your dietary fiber will help if constipation is the cause of the gas. I have seen the following gentle remedies suggested (and they won’t hurt): yogurt, ginger, raw honey, peppermint, cinnamon, pineapple, flaxseed, fennel, and juices made from kale, spinach, cucumber, and other greens. 

If making changes in the diet doesn’t help, try an over-the-counter product. Lactase supplements provide the enzyme to digest lactose. Beano contains an enzyme that digests the sugar in beans and many vegetables. Mylanta, Maalox, and Gas-X bind to gas bubbles in the stomach. Activated charcoal tablets may provide relief from gas in the intestines. Probiotics can help by correcting the balance of bacteria in the gut. 

Certain prescription medications may be effective; for example, Reglan can reduce gas by increasing bowel activity, and antibiotics would be used in the case of bacterial overgrowth syndrome or parasitic infections. 

The key is to figure out what will work best for you. If you need help, see your doctor. Don’t hesitate to get medical attention if gas is accompanied by pain, severe cramps, diarrhea, constipation, blood in the stool, fever, nausea, or vomiting. 

Dr. Alan Frischer is former chief of staff and former chief of medicine at Downey Regional Medical Center. Write to him in care of this newspaper at 8301 E. Florence Ave., Suite 100, Downey, CA 90240.