“Doctor, I Suffer From Too Much Gas!”

How many times have I heard this complaint in my 38 years of practicing gastroenterology? If I had a cure for gas and bloating, I’d be on my way to Stockholm to collect my Nobel Prize. Fortunately, we’ve come a long way in understanding digestive physiology and why certain people have excessive gas and bloating. The answers, however, are complex and have multiple, potential causes. Most people with this complaint have trouble digesting certain carbohydrates (FODMAPs). One also needs to rule out other common disorders, such as celiac disease, which is a food allergy to wheat, barley, and rye. Other considerations include: irritable bowel syndrome, bacterial overgrowth, and pancreatic insufficiency.

Today, let me tell you about FODMAPS and Celiac Disease, and how they can cause symptoms and disease. I will tell you about IBS, Bacterial Overgrowth and Pancreatic Insufficiency, another time.

Fermentable, Oligo-Di-Monosaccharaides and Polyols (FODMAPS) are carbohydrates (sugars) found in certain foods. When these foods are not digested, they wind up in the colon where they are fermented by colonic bacteria causing gas and bloating, and sometimes diarrhea. Common foods in high FODMAP diets, include: Fruits, high fructose corn syrup, milk containing dairy products, wheat, beans, soybeans, and artificial sweeteners, such as sorbitol. These foods, when decreased or eliminated from the diet, will often improve symptoms of gas and bloating. I often use a low FODMAP diet in conjunction with other strategies in patients with Irritable Bowel Syndrome and Inflammatory Bowel Diseases (Ulcerative Colitis and Crohn’s Disease). Too learn more about foods which are low in FODMAPS, I refer you to the Stanford University Nutritional Service.

I also want to tell you about Celiac Disease which, unlike malabsorption of FODMAPS, can be associated with serious disease and malabsorption of important minerals and vitamins. This disease is underdiagnosed in this country and present in about 1 in 100 Americans. It may be asymptomatic, often runs in families, and may be present with weight loss, diarrhea, anemia, bone disease, abdominal pain, and gas and bloating. The disease is secondary to an allergy to foods that contain gluten (wheat, barley, and rye), which causes an immunological destruction of the lining of the small intestine. The end result of this inflammation of the small intestine is a malabsorption of nutrients. In children, failure to diagnose Celiac Disease or not following a gluten free diet, once diagnosed, can be associated with growth retardation and, in adults, cancers. Treatment for Celiac Disease is to follow a strict, gluten free diet. If one does, in most cases, the intestine will repair itself and the malabsorption of nutrients will correct itself over time. For more information on Celiac Disease, I refer you to the American Celiac Disease Alliance website.

Gas and Bloating remain a difficult management problem for gastroenterologists. Over the next few months, I will continue to explain other management strategies. For now, remember Diet potentially plays a major role in controlling these symptoms.

So long for now.