• Wind
• Bloating
• Diet for wind
• Flatus

Belching

• This is a common symptom.
  • In one survey 17% of people stated that they had excess belching.


• This is not due to excess production of gas in the stomach but is due to swallowed air.
  • There is a small amount of air swallowed with every mouthful of food or fluid or with every swallow that unrelated to eating.
  • There are more swallows per day if;
    • There is discomfort in the mouth (such as ill-fitting dentures).
    • Chewing gum.
  • Excess air swallowing can be a “nervous” or stress response - analogous to the “gulp” when startled.
  • Excess air swallowing may relate to the conscious, or perhaps subconscious belief, that belching will relieve abdominal discomfort or bloating.


• Acid reflux is associated with belching.
  • Acid reflux causes increased saliva production.
    • The old-fashioned term is "waterbrash".
  • The saliva needs to be swallowed - therefore more swallows per day.
  • Treatment of reflux can often reduce the amount of belching by stopping this cycle of events.


• Other factors.
  • Rapid eating, gulping food.
  • Smoking.
  • Fizzy drinks and beer cause belching by release of carbon dioxide in the stomach.
    • The gas comes out of the drink with time.


• Belching may be associated with other symptoms of indigestion.


• Treatment can be difficult.
  • Acid lowering treatment should be tried first.
  • Stress needs to be addresses if possible.
    • Less hurried meals.
  • Some dietary changes.
    • Less fibre.
    • Avoid carbonated drinks.
  • Some success can be achieved with anti-anxiety medication.
    • I prefer Aropax which is an anti-depressant with activity against panic attacks and anxiety.

Bloating is common !!


Bloating can be very distressing!!

Abdominal Bloating

• This seemingly simple symptom is actually quite complicated and not well understood.


• The obvious suggestion is that there is too much “gas” in the abdomen.
  • This may be true but not to a great extent.
    • Some studies have suggested that there is a normal volume of gas.
  • If the gas volume is normal, or not greatly increased, what then accounts for the visible protrusion of the abdomen and the feeling of distension?


• There may be several factors that together explain the symptoms.
  • Abdominal protrusion (visible distension) is affected by posture and back shape  - the degree of curvature or lordosis of the back.
    • This can be illustrated by recognizing that women vary considerably in how visible a pregnancy is at a given stage.
  • Weight gain particularly around the middle.
    • This puts more pressure on posture and may weaken abdominal muscles allowing more protrusion.
  • There may be some delay in passage of wind through the bowel particularly in the small bowel.
    • This gives the sensation of “trapped wind” but the inability to pass anything because the delay is further upstream!
    • Fatty foods cause delay in transit of food and wind through the bowel as well as simply over-eating - lets face it – that’s happens sometimes.
  • Another feature of this symptoms is the characteristic variation over a day.
    • Typically the abdomen is flat and comfortable on awakening then gradually becomes more distended over the day.
    • There are some studies that show there is a daily cycle of variation in muscle tone in the abdominal walls and also in the wall of the bowel.
    • As there is relaxation of the bowel wall, then the air is allowed to take up a bigger space.


• Another clue is the association of irritable bowel syndrome and abdominal bloating.
  • Some of the bloating is an abnormal perception of a mild amount of distension.
  • The key feature of irritable bowel is an abnormal sensitivity to distension.
  • This can be proven in experimental studies with balloon distension of parts of the colon and small bowel.


• Some sensations in the abdomen are the result of internalisation of stress.
  • Hence common terms such as “butterflies in the stomach”, “gut reaction”, a “knotted stomach”.
  • Abdominal bloating is more common in people with panic attacks.
    • This may relate in part to hyperventilation and excessive air swallowing.


• An excessive amount of rumbling may be caused by;
  • Excess fermentation of food.
  • BUT it is more likely to be due to an over-active gut stimulated by the sympathetic nervous system.
  • This is the system that gives the “fright or fight reaction” - also makes your “hairs stand on their ends”.
    
• What can be done!
  • Treatment is difficult.
  • The underlying problem is not well understood therefore difficult to know what to suggest.
  • Reducing wind-forming foods can help (see below).
  • Treatment of constipation is important.
  • Treating acid reflux can help.
  • Understanding the role of air swallowing may help.
  • "Difficult stuff" - posture, strengthening abdominal muscles, weight loss.

Diet tips to reduce wind and bloating

• Fermentation of food causes about half of the wind in the gut therefore dietary changes can reduce bloating.
  • The other half is swallowed air - as discussed above.


• Most gas is produced by fermentation of poorly absorbed carbohydrates. See additional information in links below.


• Some suggestions for dietary changes to reduce wind.
  • Switch from bread and pasta to rice as much as possible.
    • The diet for reduction of wind is similar to a gluten-free diet.
    • Except that corn can cause increased wind but is OK as part of the gluten-free diet.
    • There does not need to be strict exclusion of wheat - just a change in "emphasis" from bread to rice.
    • Gluten-free breads may still cause problems because of the use of substitutes like cornflour.
    • Use rice crackers for snacks.
  • Reduce dairy products: see section on Lactose Intolerance.
    • Yoghurt is OK.
    • Small amount of hard cheese..
    • Avoid milk drinks and ice-cream.
  • Reduce some fresh fruits. See section on Fructose Intolerance.
    • Reduction in fresh fruit and using mainly canned fruit or stewed fruit helps.
    • Avoid citrus juices, apples.
    • Bananas and berryfruit are OK.
    • Lactose and fructose are used as "fillers" in commercial foods such as museli bars etc.
    • Fructose is present in large amounts in carbonated drinks e.g Coke - avoid!!!
    • Definitely avoid diet carbonated drinks.
  • Avoid wind-forming vegetables.
    • Cabbage family - incl. broccoli, cauliflower.
    • Beans - "baked beans", lentils, chick peas.
    • OK vegetables are sliced green beans, lettuce, spinach, root vegetables (carrot, pumpkin, beetroot).
  • Avoid Sorbitol and xylitol.
    • Present in sugar free chewing gum. Chewing gum also increases wind because of increased number of swallows in a day (more swallowed air).
    • Present in "diet sweets" and some artificial sweeteners.
  • Avoid excess amounts of seeds and nuts.


• Drug treatment: in general not very helpful.
  • Simethicone (found in antacids such as Mylanta Plus) has limited efficacy.
  • Reduction of stomach acid by Losec or Somac is worth a trial of treatment.
  • Activated charcoal tablets may help.
  • Digestive enzymes (from health food shops) are not likely to work.
  • Beano is a product available in USA - it reduces gas from lentils, beans - but not gas from fibre or lactose - not available in NZ.

Flatulence

• It is normal to pass wind!
  • This is a wide variation of normal.
    • Range from 400 to 2500 mls of flatus per day.
  • Most people "break wind" on average 15-20 times per day.
    • There is a wide range - up to 40 times per day is normal.


• Swallowed air, if not belched up, is rapidly has to pass all the way through to the anus.
  • There is nowhere else to go!
  • For example - a laparoscopic fundoplication operation for reflux can dramatically increase flatus because of a reduction in belching.
    • In this case all swallowed air has to come out via the bottom end!

Smelly Wind

• Smelly wind may be the result of having bacteria that produce sulphur type compounds (hydrogen disulphide, indoles, skatoles).
  • It is easy to be too self-conscious.
  • You may actually have an incorrect perception that there is a problem.
  • It is not your fault – it is an effect of the type of bacteria in your colon.


• There is little known about how to change the bacteria in the colon – it does seem to unique to an individual and relatively fixed.
  • The balance is important – some bacteria can destroy the gas (hydrogen) that other bacteria produce.
  • Antibiotics may temporarily alter the balance of bacteria and produce more bad-smelling wind.
    • Perhaps metronidazole could be useful because of a more selective effect – but the effect will be temporary (an not recommended).
  • Probiotics such as lactobacilli or acidophilus could be useful but there is no scientific evidence.


• Constipation or incomplete emptying of the rectum can be a problem.
  • It is important that treatment of constipation should not aggravate wind (avoid fibre and lactulose).
  • Lactulose increases wind although there are some reports that odour is reduced.
  • The longer the time that faeces are in the colon then this is more fermentation taking place.


• Dietary changes to reduce sulphur gases could include;
  • Elimination of broccoli, beer and white wine ( also asparagus, eggs).
  • Also avoid garlic, onions and herbs of the fennel family.
  • Some of these foods can cause bad breath because of the absorption into the bloodstream of some substances like hydrogen disulphide.
  • There is suggestion that some foods like yoghurt and cranberry juice can reduce odour.
    
• Other treatments.
  • Charcoal may reduce wind but not odour.
  • Bismuth compounds – in particular Pepto-Bismol – have been stated to help – these products are not available in NZ.