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Is Bacteria Causing You to Feel Bloated or Have Excessive Flatulence?

Is Bacteria Causing You to Feel Bloated or Have Excessive Flatulence?
By: Rakesh Gupta, M.d


Why do we feel bloated?

It is a sensation we have when we feel our abdomen is bigger than what we are used to. It can either be due a simple thing like relaxing the abdominal wall, or because of excessive gas.
Do not confuse this with distension, which is a physical finding (not just a feeling) due to abdominal fat, fluid, excessive gas or tumor.

Why do we have flatulence or pass gas?

We either swallow air or the bacteria in our intestine produce gas. Discomfort is usually cause by the bacteria producing excessive gas. Bacteria act on undigested foods like starch and cellulose, which has passed the small intestine and form methane, hydrogen and carbon dioxide. CO2 immediately gets absorbed from the intestine and does not cause symptoms.

Some sugars are also not well absorbed like lactose (milk), fructose (candies and drinks), sorbitol (artificial sweetners) etc.
Starches commonly cause intestinal gas, examples are rice, wheat, corn and oats. Common offenders are wheat, oats and potatoes. Rice is easily digested and does not cause too much gas.
Whole wheat flour contains fiber and causes more gas than refined flour.
Kidney beans, cabbage and certain fruits also cause more gas because of poorly digested starches.
Most vegetables and fruits contain cellulose which is used by bacteria very slowly and does not produce that much gas.

All this swallowed air and gas produced by bacteria is propelled forward by intestinal peristalsis or rhythmic contractions of the gut, some of it is absorbed thru the intestinal lining into the blood stream and excreted in the breath, some of the gas is used up by 'good' bacteria present in the gut thus removing it and the rest is burped out or passed thru the anus.

What are the causes of too much gas?

1. Every person is unique and so are their bacteria in their intestines! Some bacteria produce more gas and some less.

2. Some people have poor digestion and more undigested food reaches the colon for the bacteria to act. Examples are celiac disease, lactose intolerance and pancreatic insufficiency.

3. Bacteria are usually confined to the colon but can sometimes spread to the small intestine. They act on a lot of undigested food in the small intestine and produce a lot of gas. This is called small bowel bacterial overgrowth, which is seen in intestinal obstruction due to surgical adhesion, scarring, narrowing of intestine, poor movement of the gut, severe constipation, paralysis of stomach or gastroparesis as in diabetics, poorly functioning muscles of the gut called chronic idiopathic pseudo-obstruction and irritable bowel syndrome.

What is the treatment for excessive gas?

1. If you are sensitive to milk and milk products, cut down or eliminate it, or use lactaid in the milk.
2. If certain sugars cause symptoms, then eliminate them. It could be certain fruits, juices or even vegetables. Keep a track of which foods cause most symptoms and even keep a diary for a week.
3. Avoid dietetic foods, sugar-free candies, gum, carbonated beverages and drinking with a straw.
4. Eat slowly and chew more, if you have dentures make sure they fit well.
5. Restrict beans, lentils, carrots, onions, brussels sprouts, cabbage, prunes, fruits like apples, pears and peaches and whole wheat products which are all gas causing foods.
6. Avoid wheat/gluten if celiac disease is diagnosed.
7. Medicines like Gas X, Mylicon, Phazyme, Mylanta gas, Beano, Charco tabs are useful in improving symptoms of gas.
8. If there is obstruction present, surgical intervention needs to be considered.
9. Prescription medicines like erythromycin and Reglan, Xifaxan can also have a role if your doctor thinks it to be appropriate.
10. Probiotics are now being recognized as playing an important role in symptoms of gas and irritable bowel syndrome with constipation and or diarrhea. Some of them are Align, Culturelle, Florastor, various yghurts like Activia and many many more.

Rakesh Gupta, M.D. Board Certified Gastroenterology http://www.guptagastro.com

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