Gas Is a Blast – For Some

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February 20, 2014

How serious a problem is intestinal gas? Serrin’s mind started wandering after she read an article titled “Flatulent Cows Start Fire at German Dairy Farm.” Ninety cows producing methane gas plus a static charge resulted in one cow being burnt and damage to the barn. It led to wondering whether humans might pose a similar fire risk. Human flatus is composed of a number of gases which include methane and hydrogen, both flammable. There are those, generally teenage or college age boys, who may inadvertently burn their “arses” by holding a lighter near their bum as they fart. Most people, however, are quite embarrassed by either the sound or odor of gas passing and will often seek medical help to try to correct it.

Gas is either produced by gut bacteria, typically colonic, or is swallowed (i.e. from sipping hot beverages and ingesting air or from drinking carbonated beverages). On average, we pass gas 8-20 times day, more often in the morning when gravity and the nocturnal fermentation process exerts its effect. This may have embarrassing implications when one is attending a morning workout session. Flatus comes from the word flare, meaning to blow; the narrow anal sphincters are responsible for the sound that the gas makes as it passes through. The foods we include in our diet are primarily responsible for the creation of flatus – how much and when.  Unfortunately many of the foodstuffs that are healthy do result in gas formation. These include the usual suspects- cabbage, beans, broccoli, apples, pears, dried fruit, lactose but can also be sugar free chewing gum, sodas, protein bars (often rich in whey, artificial sweeteners, dried fruits, etc). Gas is natural and wasn’t such a problem when we lived on farms, but has now become a social nuisance.

Evaluation involves making sure that there isn’t another cause of excess gas production besides the food we eat. If there is significant pain or weight loss, more extensive work-up is indicated. Lactose intolerance is the most common cause of excess gas production. Another possibility is celiac disease. A simple blood test can screen for celiac, which is a true gluten allergy, but there is no test for gluten intolerance – i.e. gluten causes side effects but not an allergic reaction) other than eliminating wheat, rye and barley products for a few weeks and seeing if the symptoms change. Bloating and a change in bowel habits, possibly with pain or weight loss, may necessitate an evaluation for gynecologic issues, especially a concern for ovarian cancer (which can be screened for with a pelvic/transvaginal sonogram and a gynecologic exam).

It can take some trial and error to find out what treatment works best for any specific patient. A two week trial off milk products (milk, yogurt, cheese, ice cream, butter) may be helpful. There are patient information handouts which describe the worst dietary culprits (see above) and patients are encouraged to moderate their intake of gas-producing foods and drinks. Recently the FODMAPS (fermentable oligosaccharide, disaccharide, monosaccharide and polyols) diet has come into vogue as a diet aimed at reducing IBS symptoms such as bloating with pain, stool urgency/diarrhea. Typically, once a patient has been screened for celiac disease and, if female, ovarian pathology, the next step would be to avoid lactose, wheat, sodas, and gum, prior to the more extensive food elimination contained in the FODMAP diet.

If this does not lead to success, then one can try making fruit or vegetable substitutions- blueberries instead of apples, spinach instead of cabbage, etc. The book “IBS, Free at Last” by Patsy Catsos has some helpful suggestions, as does the book “Breaking the Vicious Cycle”. There are reports that some spices may diminish the production of flatus such as cumin, turmeric, coriander. Digestive enzymes taken with the meal or a probiotic containing lactobacillus and/or bifidobacterium can help. Simethicone containing products such as Gas-X or Mylicon may help correct burping but not colonic gas. Similarly, activated charcoal though used for intestinal gas, is not helpful. Pepto Bismol may help reduce odor by binding hydrogen sulfate but will result in black stools.

In the end, it’s reassuring to know that you’re not alone—it’s just that no one wants to talk about it!

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