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I got the surprise of my life when people were complaining about a DR editorial. You mean the BYH column is not the...

Passing gas a fact of life

KathyKolasa

Kathy Kolasa

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Kathy Kolasa

Wednesday, August 29, 2018

Q: Will you please provide a public service and write a science-based column on flatulence? — P.C. and W.S., Greenville

A: I’m not sure what prompted this request from Dr. Paul Camnitz and Mr. Waighty Scales (and they did say I could use their names), but here we go. It doesn’t matter if you call it gas, flatus, breaking wind, or any other name, we all pass gas every day — between 1 and 4 total pints in about 10-14 episodes.

I guess I do have a responsibility to address this issue since we nutrition experts are making recommendations that include eating foods that might increase the volume of flatus you might produce. For example, we tell you to eat more fiber, but if you increase your intake too quickly (especially if you don’t increase your fluid intake) you will likely produce more gas. And if you consume some popular plant foods that are “gas formers,” you will increase the volume of gas you produce.

I feel like I need to warn you — just as they do before some news stories of a delicate nature — some people might find this column unsuitable for “polite company.”

I find men tend to treat the passing of gas differently than women. I had a male patient some years ago who returned with his wife for a followup visit after his doctor had prescribed a fat-blocking medication to help him lose weight. I had carefully instructed him on how to avoid both excess gas and explosive diarrhea that could accompany this medication if he didn’t control his fat intake. His wife declared that I also should have given him a T-shirt that read, “stand back … taking fat-blocker meds!” He, on the other hand, puffed out his chest and said he loved the side effects of the medication — it made him feel like the meds were working!

I have been in the company of young men who brag about their ability to pass gas on demand. I find women use more gentile terms, like “powder puff” and apologize for passing gas. The volume and odor of flatus can be a problem for some people. If the volume — caused by hydrogen, nitrogen and methane — is too great, it can also cause bloating and discomfort. And if there is strong odor — caused by sulfur gases — the person may be embarrassed or may disturb those nearby when expelling these gases.

I mentioned to Dr. Camnitz that bagels, especially those made the traditional way, can also be gas formers, but he said he didn’t want to hear that because he loved New York-style bagels. Some people have learned the hard way when they switched to “sugar free” products sweetened with sorbitol that eating too much sorbitol can cause painful bloating.

I have beautiful yellow sunchokes (also known as Jerusalem artichokes) blooming in my garden right now. I am told they once served as a valuable food source for Native Americans, but I just enjoy the blossoms. The roots are edible and a great source of the dietary fiber called inulin. Inulin is a popular prebiotic dietary fiber currently touted for gut health benefits. You will find it used as a dietary supplement or as an ingredient in protein bars, cereal bars, yogurt and other products. But get too much and you may be uncomfortable; sunchokes have the nickname “fartichokes.”

Flatus is created when bacteria that live in your large intestine cause incompletely digested carbohydrate foods to ferment. Most people know from experience that kidney, lima, navy, other dried beans and lentils are gas formers. Although there aren’t a lot of studies to guide advice, the vegetables known to bother many people also include cabbage, onions, carrots, celery, potatoes, sauerkraut and soy beans. Some people also are bothered by broccoli, brussels sprouts, carrots, cucumbers, green peppers, pimientos, cauliflower, radishes, rutabagas, corn, peas, scallions, kohlrabi, shallots, leeks and turnips.

Fruits that tend to be gas formers include apricots, prune juice and bananas. Some people are also bothered by raw apples, honeydew melon, avocados, raisins, cantaloupe and watermelon. It is fibers like pectin in fruit and bran, food gums and indigestible oligosaccharides (I love saying that, “o-le-go-sack-a-rides”) that are responsible for volume and odor. Milk and milk products — except those that have reduced lactose — can also contribute.

Camnitz and Scales asked for a scientific article, but, without much evidence over the years, I have given the following advice to patients who asked:

1.) Try eating at a slower rate, chew foods more thoroughly and do not gulp down foods or liquids (which causes you to swallow large quantities of air and leads to gastric distress and gas).

2) Try an enzyme gas blocker such as Beano before you eat (there is a bit of evidence that it can work).

3) Drink a cup of herbal tea before you eat, particularly one with some evidence of benefit which include anise, caraway, chamomile, coriander, fennel and peppermint.

4) When eating beans, soak dried ones before cooking or use canned.

I asked my colleague Gina Firnhaber, one of the outstanding librarians at Laupus Library, to search for evidence. She found that the experts suggest if the volume of flatus is truly problematic, use of an antibiotic that treats traveler’s diarrhea can help. So can taking an over-the-counter probiotic such as VSL#3 or a probiotic mixture of bifidobacterium. For odor, experts do not recommend eating activated charcoal (as suggested on some websites) but wearing activated charcoal underwear liners might help. Taking Pepto-Bismol may also help and is likely the least expensive approach.

If you have been encouraged by your doctor to move toward a plant-based diet or a cancer-prevention diet that includes cruciferous vegetables (the sulfur formers mentioned earlier), the benefits outweigh the risks. Just add them to your diet slowly to build a tolerance and then routinely include them in your diet.

Professor emeritus Kathy Kolasa, a registered dietitian nutritionist and Ph.D., is an Affiliate Professor in the Brody School of Medicine at ECU. Contact her at kolasaka@ecu.edu.

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