Month: August 2016

Gas and Bloating

Bloating can have many causes.   Most commonly it is due to poorly absorbed carbohydrates.  When these reach the colon, bacteria digest them and cause hydrogen as a byproduct.  There are many different carbohydrates and also many different digestive enzymes to break them down.  A specific deficiency of one enzyme will cause bloating due to maldigestion of the associated carbohydrate.  For example up to 25% of the population is unable to break down lactose, the carbohydrate in milk (also in sour cream, yogurt, ice cream, cheese, cottage cheese, pizza [with cheese], pasta [with cheese] etc.

In order to successfully find the cause of bloating, you will have to sequentially try and eliminate several different carbohydrates to see if they are the culprit.  Just because you can ‘get away with’ eating a particular carbohydrate (eg yogurt), doesn’t rule out maldigestion (ie lactose intolerance).

My suggested approach starts with the most likely causes and moves to the least likely.

  1. Stop all smoking, pop, and carbonated beverages for 4 weeks.  If you eat quickly and are done your meal before others, SLOW DOWN.
  2. Avoid ALL milk and milk products for 4 weeks.  This includes milk, milk in your tea/coffee, yogurt, cheese (including pizza/pasta etc with cheese), sour cream, cottage cheese, ice cream etc.  If this helps you can use lactaid treated milk and/or use lactaid drops or pills (these digest the lactose for you).
  3. Avoid all fruits, fruit juices, and jams for 4 weeks (tests for fructose intolerance).  If this helps you will have to continue to avoid these products as you likely have Fructose intolerance. See here and here for a list of foods to avoid.  You can also use the Monash university FODMAPS app (for iPhone & Android – see here) – go to their food guide and use the ‘filter settings’ at the top right of the screen to select ‘fructose’ and ‘sorbitol’ by moving the bar to the right (red).  You can then use their extensive database of foods to see what is safe to eat.  Further resources are also available: here, & here.
  4. Avoid all wheat, wheat products, barley, rye and oats for 8 weeks.  We now realise that there is a disorder of wheat sensitivity (different from celiac disease) which results in bloating.  If you are scheduled to have an upper endoscopy, only start avoiding wheat AFTER your scope.
  5. The Australians have done some excellent research on what products tend to cause gas/bloating and have labelled them as ‘F-O-D-M-A-P-S’.  Here is a brief video introduction with more information here.  Books on this subject in the Hamilton Public Library are listed here.  An excellent app for smartphones (iPhone & Android) is also available.  Note that FODMAPS are not bad things – they actually feed your gut bacteria.  So if you respond to a low FODMAPS diet, you should then add high FODMAP foods back one at a time (I’d suggest you wait about a week after adding each back) in the diet in small amounts to identify foods that could be “triggers” to your symptoms.  Thus you only end up having to avoid foods which trigger your symptoms and you keep your gut bacteria happy.  When adding back foods, make sure you start with small quantities.  I recently had a chance to meet Dr Gibson & chat with him.  One point he made is that their understanding of which foods to avoid (ie which are the bad FODMAPS) has evolved in the last few years.  So for this reason I would strongly suggest only using his book/apps since other lists you find on the internet could well be out of date and therefore inaccurate.
  6. Although drugs are rarely helpful in this disorder, there are a few over the counter things you can try (I’d suggest you try each 4 or 5 times and continue them if they are helpful): Beano, peppermint (eg real peppermint tea), simethicone (eg Phazyme, Gas-X, Mylanta Gas).
  7. Finally, here is a list of foods which MIGHT help.